Protein-energy Malnutrition In Children Research Articles

Frequency and distribution of co-morbidities in protein energy malnutrition children admitted in nutrition unit DHQ Hospital, District D.I. Khan, Pakistan.

Objective: To determine frequency and distribution of co-morbidities by type, age groups and gender in PEM children. Study Design: Cross-sectional study. Setting: Department of Pediatric (Nutrition Unit) and Community Medicine, GMC. Period: 15-8-2022, to 30-12-2022. Material & Methods: Data for diagnosed PEM cases was retrieved from Nutrition Unit DHQ Hospital DI Khan for which non-probability consecutive sampling technique was used. Research variable was type of comorbidities while demographics variables were age groups and gender. Association of gender and age groups with the presence or absence of co-morbidities in PEM children were found using Chi Square test. Results: Out of 400 participants, most frequent co-morbidity was gastroenteritis (GE) in 157(39.3%) patients in which females were 87(55.41%) and males 70(44.58%). 101(64.33%) were in 1–5-year age group and 56(35.66%) in under 1 year. Second to GE was pneumonia with 84(21%) patients in which females were 45(53.57%) and males 39(46.42%). Pneumonia in 1-5 year affected 61(72.61%) and 23(27.38%) patients were less than 1 year. Anemia affected 74(18.5%) patients in which females were 45(60.81%) and males 29(39.18%). 58(78.37%) patients were in 1-5 years and 16(21.62%) in less than 1 year. Other co-morbidities were seen in small number of patients. Difference in age groups were statistically significant at p-value of 0.005006 (<0.05) while there was no association of gender with comorbidities at p-value of 0.459344 (>0.05). Conclusion: Most common comorbidities were GE, pneumonia and anemia and their prevalence was higher in females and 1–5-year age group.

Early childhood malnutrition impairs adult resting brain function using near-infrared spectroscopy.

Early childhood malnutrition affects 200+ million children under 5 years of age worldwide and is associated with persistent cognitive, behavioral and psychiatric impairments in adulthood. However, very few studies have investigated the long-term effects of childhood protein-energy malnutrition (PEM) on brain function using a functional hemodynamic brain imaging technique. This study aims to investigate functional brain network alterations using near infrared spectroscopy (NIRS) in adults, aged 45-51 years, from the Barbados Nutrition Study (BNS) who suffered from a single episode of malnutrition restricted to their first year of life (n = 26) and controls (n = 29). A total of 55 individuals from the BNS cohort underwent NIRS recording at rest. Using functional connectivity and permutation analysis, we found patterns of increased Pearson's correlation with a specific vulnerability of the frontal cortex in the PEM group (ps < 0.05). Using a graph theoretical approach, mixed ANCOVAs showed increased segregation (ps = 0.0303 and 0.0441) and decreased integration (p = 0.0498) in previously malnourished participants compared to healthy controls. These results can be interpreted as a compensatory mechanism to preserve cognitive functions, that could also be related to premature or pathological brain aging. To our knowledge, this study is the first NIRS neuroimaging study revealing brain function alterations in middle adulthood following early childhood malnutrition limited to the first year of life.

Analysis and prediction of protein-energy malnutrition in children aged 8-10 years.

To identify independent risk factors for protein-energy malnutrition (PEM) in children aged 8-10 years and to develop and validate a nomogram model for estimating PEM risk. In this retrospective study, a cohort of 1,412 children from The Fifth Affiliated Hospital of Guangzhou Medical University, spanning January 2022 to December 2023, was identified. Participants were randomly classified into a training set (n=988) and a validation set (n=424). Patients in the training set were divided into normal (n=667) and PEM (n=321) groups. Data collection involved demographic, sociological, physical, and biochemical assessments. Independent risk factors for PEM were identified using univariate and multivariate logistic regression. A nomogram risk model was constructed from significant predictors, and its performance was assessed using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). An independent dataset further validated the nomogram model. Among the 1,412 children, 497 (35.2%) had PEM, which included stunting (11.83%), underweight (11.61%), and wasting (11.76%). Multivariate analysis identified six independent risk factors for PEM: gestational age (OR (95% CI)=5.830 (3.604-9.431), P<0.001), household income (OR (95% CI)=0.383 (0.281-0.523), P<0.001), sleep duration (OR (95% CI)=1.800 (1.319-2.457), P<0.001), mood disorders (OR (95% CI)=6.924 (4.437-10.805), P<0.001), and physical activity time (OR (95% CI)=3.210 (2.342-4.400), P<0.001). The nomogram model demonstrated good predictive performance (AUC=0.803 (0.773-0.832)) and was validated well on an independent dataset (AUC=0.783 (0.739-0.828)). The study identified key independent risk factors for PEM in children and established a robust nomogram model for clinical risk assessment. The model's high predictive accuracy and clinical applicability suggest it may be a valuable tool for the early identification and intervention strategies for PEM in clinical practice.

Effect of essential mineral status in growth shunt and metabolic abnormalities of protein energy malnutrition children

Effect of essential mineral status in growth shunt and metabolic abnormalities of protein energy malnutrition children

A study of plasma proteins (serum total protein, serum albumin), and thyroid function in children with protein-energy malnutrition

Background: The study's objective was to evaluate and compare total serum protein, serum albumin, and thyroid hormones in children with PEM (protein-energy malnutrition) and healthy controls. Methods: In this cross-sectional study, 100 children with PEM served as cases, while an equal number of age and gender-matched healthy children served as controls. 4 ml of venous blood were taken (3 ml in a plain vial and 1 ml in an EDTA vial) and immediately submitted for further investigation. SPSS software (version 25) was used to analyze the data. A p value of ≤0.05 was considered statistically significant. Results: PEM children have lower serum total protein, albumin level, total T3 (TT3), and total T4 (TT4) levels compared to healthy controls (p&lt;0.0001). Mean TSH levels in cases and controls were nearly similar. There was no significant difference between serum TSH concentrations in PEM children and the controls. Grade I PEM had the highest mean total protein, serum albumin, T3, and T4 levels, followed by grades II, III, and IV. When mean total protein, serum albumin, T3, and T4 levels of each grade of PEM were compared to controls, mean total protein, serum albumin, T3, and T4 levels were substantially lower in each grade of PEM (p&lt;0.0001). Conclusions: PEM children have low serum total protein and albumin levels. This is probably due to decreased oral intake of proteins and reduced biosynthesis. Serum TT3 and TT4 levels are lower in children with PEM than in healthy controls, which is most likely due to reduction in circulating plasma proteins.

Efficacy of Ayurveda Interventions in Protein Energy Malnutrition in Children: A Systematic Review and Meta-Analysis

According to United Nations International Children's Emergency Fund (UNICEF), in India, around 46 percent of all children below the age of three are too small, and 35.7% are underweight and come under MAM (Moderate Acute Malnutrition). Protein Energy Malnutrition (PEM) can be correlated with Karshya, Balashosha, Phakka, Parigarbhika, Sushka Revati, and Apatarpanjanya Vyadhi based on similar clinical features. Multiple evidencebased clinical studies are conducted in this sector, but no comparative conclusion of results or systemic review is accomplished. The study aims to evaluate and compare Ayurveda interventions' efficacy in managing children's protein energy malnutrition and to assess the effect of Ayurveda Interventions on weight gain and serum protein values in children suffering from PEM. This systemic review was conducted according to the guidelines of the Cochrane Handbook of Systemic review of interventions and is reported following the Preferred Reporting Guideline for Systemic review and meta-analysis guidelines (PRISMA). All study groups showed significant p values within the group and insignificant p values in the fixed random effect model. Though the p-value is insignificant between the groups, one group among the four shows better results in the fixed effect model. In the primary outcome of weight, group 3, i.e., the category of drugs having Bruhana and Pachana combination, shows better results than other groups in the fixed effect model. In the outcome of serum protein values, BMI, and Head circumference, group 4, i.e., drugs with only Bruhana properties, show better results than other groups. Based on this review, few policies or treatment protocols can be hypothesized for managing PEM at the national level. The Ayurveda intervention combinations have worked better because they work on multiple aetiological factors and biological variations in PEM in Children.

Nutritional therapy for protein-energy malnutrition in children with sepsis

This review presents meta-analyses on nutrition in patients with critical illness using ASPEN/SCCM (2017), SSC (2012, 2021), ESPNIC (2020), and SSC (2020) pediatric sepsis guidelines. The ESPNIC (2020) guideline, based on new evidence, complements most of the existing ASPEN (2017) guidelines for critical pediatrics. Childrens SSC (2020) did not find direct evidence and sufficient data to develop strong nutritional recommendations for children with sepsis/SS. Many issues remain unresolved, requiring systematic analysis. In the literature search, only a few randomized clinical trials have focused on the assessment and correction of protein-energy malnutrition in pediatric intensive care. Over the past decade, small and large pediatric studies have recommended nutritional therapy. However, given the heterogeneity of children admitted to intensive care units in terms of age, pathology, disease severity, presence of comorbidities, and nutritional status, it is unrealistic to expect that one nutrition strategy applies to all patients requiring intensive care. Therefore, most clinicians emphasize the need for an individualized approach to nutrition support in children, taking into account the pathology, severity, initial nutritional status, and riskbenefit ratio of different nutritional therapies. An extensive search of the literature on the problem did not reveal strong nutritional recommendations for children with sepsis/SS, which dictates the need for future research on the topic and correction of protein-energy malnutrition in children with sepsis/SS.

Under Five Girls Found More Prone to Protein Energy Malnutrition Compared to Boys: A Squatter Settlement Study from Karachi

Background: Protein-energy malnutrition (PEM), is an imbalance between protein and energy intake and the body’s requirement for optimal growth. In Pakistan, almost 40% of children, less than 5 years, have stunted growth, while 17.7% suffer from muscle wasting. This study aimed to explore the frequency of the different types of protein energy malnutrition in children under 5 years residing in Sikandarabad and evaluate the risk factors leading to this condition. Methods: This cross-sectional observational study, recruited 220 children less than 5 years of age. Previous health record was investigated. Physical examination was done and anthropometric measurements of each child were plotted on WHO/CDC Growth Standard Charts to classify the degree of protein energy malnutrition. Binary and multivariate logistic regression was computed to see a significant association with the outcome. Results: The prevalence of PEM was 136(61.5%). Overall girls were underweight (9±3.8 kg) and stunted (77.2±16.1) compared to boys. Delayed weaning was a significant risk factor for PEM (p=0.044). The majority of children belonged to Low socio-economic status 65(47.8%), with more than 2 siblings. However, 40(29.4%) of those below 5 years were malnourished. A positive association (OR:1.37,1.21) was found between PEM and acute illnesses (56.6%), worm infestation (14%) and measles outbreaks (5.9%). Conclusion: Young girls (9±3.8 kg) were found severely undernourished compared to boys. This is probably because of bias attitude toward gender preference in the distribution of quality food (p=0.14). Keywords: Protein Energy Malnutrition; Underweight; Stunting; Wasting; Overweight.

Nutritional status and its effect on dental health among children

Nutritional status has a significant role in oral health and disease. Protein deficiency is the key deficiency in intermediate malnutrition. Malnutrition can disrupt homeostasis, resulting in disease progression of the oral cavity, decreased resistance to microbial biofilm, and decreased tissue healing capacity. This paper examines the association between malnutrition, protein-energy malnutrition, and dental health. Malnutrition is a risk factor for several dental diseases, such as dental caries and periodontal diseases. Studies have suggested that enamel hypoplasia, salivary gland hypofunction, and compositional changes in the saliva may be the mechanisms through which malnutrition is associated with caries. The exfoliation and eruption of teeth are impacted by malnutrition, or protein energy malnutrition (PEM), starting in the early years and continuing throughout infancy. The risk of hypoplasia was higher in malnourished children. The development of hypocalcemia as a result of diarrhoea in chronic undernutrition may explain the link between PEM and poor enamel formation. Deficiencies of vitamins A, C, and D are found to be associated with hypoplasia. Protein-deficit malnutrition and low vitamin D levels, as well as obesity, are risk factors for dental caries in children. Early childhood malnutrition affects salivary gland hypofunction and compositional changes in the saliva, and these might be the mechanisms through which malnutrition is associated with caries. Early childhood protein-energy malnutrition (ECPEM) is associated with poor periodontal status and causes cancrum oris, necrotizing gingivitis, and other periodontal disease conditions, as well as symptoms that mimic periodontal conditions.

Effects of Cricket Addition on the Chemical, Functional, and Sensory Properties of Complementary Formulation from Millet Flour

The effect of cricket addition on the proximate composition, mineral compositions, functional and sensory properties of complementary food formulated from millet was studied. The result of the chemical composition showed significantly increase in the protein and fat level of the formulated complementary food (9.28±0.16 - 20.20±0.07) % and (3.65±002 - 8.12±0.08) %, respectively. However, a significant decrease in the carbohydrate level (75.61±0.03 - 60.44±0.31) g/100g was observed. Evaluation of functional properties showed that cricket addition did not affect the bulk density but increased the water absorption (2.46±0.05), Emulsion (38.02±0.40%), foam (6.00±0.00), gelation (20.00±0.00%) capacities and pH (6.20±0.02). The mineral contents including Fe, Ca, Na, and K of the food ranged from 7.54±0.10 - 10.25±0.05 mL/100g, 30.35±0.15 - 34.98±0.10 mL/100g, 9.35±0.29 - 14.47±0.06 mL/100g and 30.92±0.03 - 56.40±010 mL/100g respectively increasing with increased addition of cricket flour The formulated samples were rated higher for taste, colour, flavour, texture and the overall acceptability than the control. In general sample 513 containing 75:25 cricket: millet flour showed more improvement than other formulated samples and most acceptable in terms of taste, flavour mouth feel and overall acceptability. Adding cricket flour to millet flour as complementary food would help in addressing protein energy malnutrition in children.

Efficacy of Ayurveda Interventions Specifically on Weight Gain in the Management of Protein Energy Malnutrition in Children: A Systematic Review Protocol

Background: In India, Protein Energy Malnutrition (PEM)remains a significant and challenging public health issue despite implementing different nutritional policies over the period. It is also accompanying with aggravated risk of all-cause morbidity, as well as fatality Ayurveda mentions about various nutritional disorders such as karshya, balashosha, phakka, yakshma which are having similar symptomatology and treatment approach as that of the PEM. Several clinical studies have been conducted and some are under trial but systematic review is still pending to explore an effective treatment modality to combat PEM in Children.&#x0D; Aim: A systematic review to evaluate the efficacy of Ayurveda Interventions specifically on weight gain in the Management of Protein Energy Malnutrition in Children.&#x0D; Materials and Methods: A systematic review which will evaluate published clinical work of Ayurveda treatment modalities specifically for weight gain in the management of PEM in children that will involve “The randomized controlled trials (RCTs), multiple-arms clinical trials, quasi-experimental trials, observational studies (case series and case reports) through databases like PubMed, COCHRANE, AYUSH Research Portal, DHARA; Google Scholar; etc. and Ayurveda compendia to fetch complete available literature.”&#x0D; Observations and Discussion: The work of selection of the studies, data extraction, and synthesis will be taken up. Established guidelines for study selection, quality assessment, and narrative synthesis will be followed. Risk of bias assessment will be performed. A protocol will be designed that will ensure transparency for the completed review. Results of the study will be elaborately synthesized. The data will be presented in percentage, count and frequency; and if we find the data to be sufficiently homogeneous then meta-analysis will be carried out.&#x0D; Conclusion: The results obtained from this systematic review will be useful in identifying the evidence-based efficacy of Ayurveda interventions on weight gain in the Management of PEM. It will also provide substratum for future research studies for generating good-quality evidence that can be helpful to design new health policy to combat PEM effectively.

Особенности преподавания темы «Белково-энергетическая недостаточность у детей» англоязычным студентам

В статье отражены проблемы, возникающие в процессе преподавания темы «Белково-энергетическая недостаточность у детей» англоязычным студентам. Освещены отличия протоколов разных стран, в частности приведен сравнительный анализ терминологических понятий «гипотрофия», «белково-энергетическая недостаточность» и under nutrition, stunting, acute, сhronic malnutrition, wasting, kwashiorkor, указаны антропометрические показатели для оценки тяжести дефицита питания (дополнительно используется Mid-Upper Arm Circumference), приведены антропометрические критерии диагностики степени тяжести белково-энергетической недостаточности и группы риска по ее развитию. Описаны вопросы ведения пациентов с тяжелым и умеренным нарушением питания согласно зарубежным документам, представлена дифференциальная таблица выбора типа лечения ребенка с тяжелым нарушением питания, освещены принципы, фазы и стадии лечения, особенности ведения пациентов с использованием продуктов, готовых к употреблению (ready to use therapeutic food). Анализ протоколов Украины, Всемирной организации здравоохранения, Индии, Кении позволил адаптировать методику преподавания указанной темы англоязычным студентам.

Nutritional Evaluation of Unripe Plantain, Moringa Seed and Defatted Sesame Seed Cookies

Cookies are widely consumed all over the world and can bring important nutrients, especially to children. Composite ours consisting of plantain, moringa seed and sesame seeds were used to produce cookies in this study. Response surface methodology was employed in setting up the cookie's formulation. The samples with the best protein and fibre contents were sample F (71.34% plantain, 6.66% moringa and 22.00% sesame seed, with 14.08% protein and 3.02% fibre) and sample I (68.00% plantain, 10.00% moringa and 22.00% sesame seed, with 14.35% protein and 2.29% fibre). Cookies from 100% wheat flour were prepared as control. The protein, fat, ash and crude fibre contents of formulated cookies were significantly (p≤0.05) higher than control, whereas carbohydrate content was lower. There was no significant difference between the formulated cookies and the control in terms of overall acceptability, aroma and crunchiness. The formulated cookies showed higher biological value, net protein utilization, true digestibility, protein efficiency ratio, net protein ratio and protein retention efficiency than control, resulting in a significant increase in rat growth and development. The composite cookies containing unripe plantain, moringa seed and defatted sesame, at the blending ratio obtained in this study showed better nutritional quality than control cookies. These composite cookies, therefore, would be suitable for mitigating protein energy malnutrition in children.

Effect of process and variety on physico-chemical and rheological properties of two corn flour varieties (Atp and Kassaï)

Corn is the world's most widely used cereal in the production of supplementary foods. This use involves several processing steps such as fermentation, roasting and dehulling. These processes are either applied alone or in combination, and are accompanied by the modification of the nutritional, functional and rheological characteristics of the flour obtained. This led us to investigate about the influence of the process and the variety on the physico-chemical and rheological properties of the flours. White and yellow corn flours used were process using three processes. Unroasted flours were obtained after dehulling and fermentation, roasted flours after fermentation and roasting and unfermented flours after soaking and grinding. The proximate chemical composition, physical, rheological properties and PCA (Principal Component Analysis) were evaluated. The results showed that treatment and variety significantly affected these properties with roasted flours who had the best contents of digestible carbohydrates, minerals and ash while unroasted flours had the highest of protein and lipid contents. The white variety had the highest levels of carbohydrates and proteins, while the yellow variety had the highest of lipid and minerals contents. The evaluation of the rheological properties shows that the pasting temperature is between 74.50 and 77.77 °C, between 490 and 1053.55 cP for the Holding viscosity and between 431.50 and 2348 cP for the peak viscosity. The rheological properties always showed that the roasted flours had the lowest pasting temperatures, retrogradation, final viscosity and peak temperatures while unfermented flours had the highest values. Principal component analysis (PCA) showed that unroasted flours are characterized by the carbohydrates, starch, amylose, amylopectin and lipids content, roasted by minerals, anti-nutrient and protein contents and the unfermented flours by rheological properties. All this shows that the combination of the process and use of these corn flours varieties could be used to prepare the infant meal and thus fight against protein energy malnutrition in children. • Variety influence physico-chemical and rheological properties of different flours. • The different process has influenced physico-chemical and rheological properties. • Yellow flour variety exhibits the best rheological properties. • Unroasted flour (process I) has present the highest proteins and lipids content.

Serum albumin and total protein level as plausible marker for diagnosis of protein energy malnutrition in children under age 5 years

Background: The circulating concentration of transport protein, traditionally albumin, has been used to define protein deficiency. However, few studies have been conducted to see if there is any correlation between serum total protein and albumin levels in children with PEM. Hence the study was planned to estimate serum total protein, serum albumin levels in children with PEM and healthy controls.Methods: All the children were divided in two groups. Case Group A consist of 250 children with protein energy malnutrition and control Group B consist of healthy 250 children. Venous blood of amount 3 ml was collected with full aseptic precautions. The blood was collected in the EDTA vacutainer and test tube. Serum total protein was estimated by Biuret method, serum albumin was estimated by Bromocresol green dye method (BCG dye).Results: When the mean serum levels of albumin levels and the total protein levels were measured in the controls as well as case groups, there was decrease in levels in case group as compared to control group. This difference of decrease when evaluated statistically it was found to be statistically significant. When the albumin/globulin ratio was calculated in both the groups, it was found to be statistically lower in case group as compared to control group. PEM children have low serum total protein and albumin levels as compared to healthy controls (p&lt;0.001), this is probably due to decreased intake of proteins and reduced biosynthesis. PEM children have lower hemoglobin levels as compared to healthy controls; this is probably due to deficiency of iron and other micronutrients, which is often found in a child with malnutrition.Conclusions: Early diagnosis and prompt management of PEM and its complications can prevent development of permanent physical and mental retardation.

Review on some cereal and legume based composite biscuits

The major determinants of malnutrition in Africa are low availability of nutritious foods and inadequate consumption of protein-rich diets. Consumption of nutritious snacks could help to reduce protein-energy malnutrition in children and adults. Biscuits are a ready-to-eat, convenient and cheap snack that is consumed by all age group in many countries. It can be produced from cereal and legume flour blends. A proximate composition such as protein, ash, crude fiber, and fat content of some cereal-legume based biscuit increased with increase in the percentage substitution of legumes flour. Carbohydrate content of biscuits decreased as legume substitution increased. The Ash (total mineral) content of some cereal and legume-based composite biscuits increased as the level of legume flour incorporation increased. The increased in some nutrient composition of the biscuit in cereal and legume blends could be due to the significant quantity of nutrients in legumes. Anti-nutritional factors (ANF) such as tannin and phytic acid affect digestibility and nutrient bioavailability for absorption. Substitution of malted cereal flour with legume flour resulted decreased in the level of both tannin and phytate in the composite biscuits and vice versa. Lower tannin and phytate content observed could be due to degradation of tannin and phytate during malting. Sensory attributes such as color, texture, aroma, taste, and overall acceptability of some cereal and legume-based biscuits were highly rated (in acceptable ranges).

Proximate, Anti - Nutrients and Sensorial Acceptability of Some Cereal and Legume Based Composite Biscuits: Review

The major determinants of malnutrition in Africa are low availability of nutritious foods and inadequate consumption of protein-rich diets. Consumption of nutritious snacks could help to reduce protein-energy malnutrition in children and adults. Biscuits are a ready-to-eat, convenient and cheap snack that is consumed by all age group in many countries. It can be produced from cereal and legume flour blends. A proximate composition such as protein, ash, crude fiber, and fat content of some cereal-legume based biscuit increased with increase in the percentage substitution of legumes flour. Carbohydrate content of biscuits decreased as legume substitution increased. The Ash (total mineral) content of some cereal and legume-based biscuits increased as the level of legume flour incorporation increased. The increased in some nutrient composition of the biscuit in cereal and legume blends could be due to the significant quantity of nutrients in legumes. Anti - nutritional factors (ANF) such as tannin and phytic acid affect digestibility and nutrient bioavailability for absorption. Substitution of malted cereal flour with legume flour resulted decreased in the level of both tannin and phytate in the composite biscuits and vice versa. Lower tannin and phytate content observed could be due to degradation of tannin and phytate during malting. Sensory attributes such as color, texture, aroma, taste, and overall acceptability of some cereal and legume-based biscuits were highly rated (in acceptable ranges). Keywords: Nutrient composition, Cereal, Anti-nutritional factors, Biscuits, Legume, Sensory acceptability, composite flour DOI: 10.7176/FSQM/98-03 Publication date: June 30 th 2020

Association of vitamin A deficiency with early childhood stunting in Uganda: A population-based cross-sectional study.

BackgroundDespite the high prevalence of childhood protein-energy malnutrition and vitamin A deficiency in sub-Saharan Africa, their association has not been explored in this region. A better understanding of the epidemiologic link could help define effective preventive strategies. We aimed to explore the association of vitamin A deficiency (VAD) with stunting, wasting, and underweight among preschool children in Uganda.MethodWe analyzed a population-based, cross-sectional data of 4,765 children aged 6–59 months who participated in 2016 Demographic and Health Surveys conducted in Uganda. We utilized generalized linear mixed-effects models with logit link function, adjusting for potential confounders to estimate associations between VAD and stunting, wasting, and underweight.ResultsThe prevalence of VAD was 8.9% (95% CI: 8.1% to 9.6%, n = 424). Twenty-seven percent were stunted (95% CI: 26.1% to 28.6, n = 1302), 4% wasted (95% CI: 3.6% to 4.7%, n = 196), and 17% underweight (95% CI: 16.0% to 18.2%, n = 813). After adjusting for household factors (e.g., wealth index, education and working status of parents, owning land for agriculture, livestock, herds, or farm animals), vitamin A supplementation, and community factors (e.g., population density, crop growing season lengths, place of residence), children with VAD had 43% higher odds of stunted growth than those without VAD (adjusted odds ratio, 1.43 (95% CI: 1.08 to 1.89, p = 0.01). No association was observed between VAD and wasting or underweight.ConclusionVitamin A deficiency was associated with higher odds of stunting, and the association was independent of the individual, household, and community-level variables.

Estimation of serum albumin and serum total protein levels in children with protein energy malnutrition

Background and Aim: Protein energy malnutrition (PEM) continues to be a major public health problem throughout the developing world. PEM is associated with reduced synthesis of plasma proteins. The present study has been conducted to study the effect of PEM on plasma protein levels.Materials & Methods: The study included children of age group 1-5 years. Two hundred fifty children with PEM were included as cases and 250 healthy children were enrolled as controls. Details were collected in predesigned proforma. Serum total protein by biuret method, serum albumin by bromocresol green dye method and hemoglobin was estimated using auto analyzer. The parameters were compared among cases and controls.Results: Mean hemoglobin, serum total protein, serum albumin levels and A/ G ratio were significantly low in PEM children (cases) as compared to controls. Conclusion: PEM children have low serum total protein and albumin levels as compared to healthy controls. This is probably due to decreased intake of proteins and reduced biosynthesis. PEM children have lower hemoglobin levels as compared to healthy controls; this is probably due to deficiency of iron and other micronutrients, which is often found in a child with malnutrition.

A study on prevalence of symptomatic not confirmed pulmonary tuberculosis under 5 to 15 years of age in protein energy malnutrition children in a tertiary care centre

Background: Tuberculosis (TB) and malnutrition are important causes of morbidity and mortality in children, in developing countries. Tuberculosis can be a cause of malnutrition in children and also a common cause of pneumonia in such malnourished children. In the present study ,our aim is to know the prevalence and early clinical diagnosis of symptomatic not confirmed TB, in recent challenging environment, in protein energy malnutrition children, this information would certainly help clinicians in early detection, diagnosis and management of PTB (Pulmonary Tuberculosis) in such populations ,to reduce morbidity and mortality.Methods: We prospectively investigated protein energy malnutrition children, with clinical features of tuberculosis, between 5 to 15 years of age , admitted during 18 months of study period. Clinical and demographic data of studied children were collected. Anthropometric (Height and Weight) measurement and physical examination were made. PEM (Protein energy malnutrition) children were classified according to Indian academy of pediatric classification. History of BCG vaccination and exposure to contact were inquired. Chest radiography was done for all children in our study.Results: A total of 150 protein energy malnutrition children, between 5 to 15 years, admitted over 18 months period were studied. Majority of children were female as compared to male and under 5 to 10 years of age. Out of these, symptomatic not confirmed pulmonary TB 93 (62%) and Extra pulmonary TB 18 (12%) and Non TB cases were 39 (26%). According to Grade of PEM, symptomatic not confirmed pulmonary TB cases under grade III were 45 (48.5%) and 35 (37.6%) were under grade II .Conclusions: Pulmonary tuberculosis may be a common cause of pneumonia in malnourished children and the cause of death in these population. So Its frequency and early clinical detection ,even without microbiological confirmation and supportive evidence and treatment guideline should be made by more further study. So that, it will help clinicians to treat these population to reduce morbidity and mortality.