Severe Protein-energy Malnutrition Research Articles

Nutrition: Basis for Healthy Children and Mothers in Bangladesh

Recent data from the World Health Organization showed that about 60% of all deaths, occurring among children aged less than five years (under-five children) in developing countries, could be attributed to malnutrition. It has been estimated that nearly 50.6 million under-five children are malnourished, and almost 90% of these children are from developing countries. Bangladesh is one of the countries with the highest rate of malnutrition. The recent baseline survey by the National Nutrition Programme (NNP) showed high rates of stunting, underweight, and wasting. However, data from the nutrition surveillance at the ICDDR,B hospital showed that the proportion of children with stunting, underweight, and wasting has actually reduced during 1984-2005. Inappropriate infant and young child-feeding practices (breastfeeding and complementary feeding) have been identified as a major cause of malnutrition. In Bangladesh, although the median duration of breastfeeding is about 30 months, the rate of exclusive breastfeeding until the first six months of life is low, and practice of appropriate complementary feeding is not satisfactory. Different surveys done by the Bangladesh Demographic and Health Survey, United Nations Children's Fund (UNICEF), and Bangladesh Breastfeeding Foundation (BBF) showed a rate of exclusive breastfeeding to be around 32-52%, which have actually remained same or declined over time. The NNP baseline survey using a strict definition of exclusive breastfeeding showed a rate of exclusive breastfeeding (12.8%) until six months of age. Another study from the Abhoynagar field site of ICDDR,B reported the prevalence of exclusive breastfeeding to be 15% only. Considerable efforts have been made to improve the rates of exclusive breastfeeding. Nationally, initiation of breastfeeding within one hour of birth, feeding colostrum, and exclusive breastfeeding have been promoted through the Baby-Friendly Hospital Initiative (BFHI) implemented and supported by BBF and UNICEF respectively. Since most (87-91%) deliveries take place in home, the BFHI has a limited impact on the breastfeeding practices. Results of a few studies done at ICDDR,B and elsewhere in developing countries showed that the breastfeeding peer-counselling method could substantially increase the rates of exclusive breastfeeding. Results of a study in urban Dhaka showed that the rate of exclusive breastfeeding was 70% among mothers who were counselled compared to only 6% who were not counselled. Results of another study in rural Bangladesh showed that peer-counselling given either individually or in a group improved the rate of exclusive breastfeeding from 89% to 81% compared to those mothers who received regular health messages only. This implies that scaling up peer-counselling methods and incorporation of breastfeeding counselling in the existing maternal and child heath programme is needed to achieve the Millennium Development Goal of improving child survival. The recent data showed that the prevalence of starting complementary food among infants aged 6-9 months had increased substantially with 76% in the current dataset. However, the adequacy, frequency, and energy density of the complementary food are in question. Remarkable advances have been made in the hospital management of severely-malnourished children. The protocolized management of severe protein-energy malnutrition at the Dhaka hospital of ICDDR,B has reduced the rate of hospital mortality by 50%. A recent study at ICDDR,B has also documented that home-based management of severe protein-energy malnutrition without follow-up was comparable with a hospital-based protocolized management. Although the community nutrition centres of the NNP have been providing food supplementation and performing growth monitoring of children with protein-energy malnutrition, the referral system and management of complicated severely-malnourished children are still not in place.

Children with protein energy malnutrition: management and out-come in a tertiary hospital in Nigeria.

Background: Protein energy malnutrition (PEM) is a common condition in our environment, and still associated with high morbidity and mortality. Objective: The aim of the study was to evaluate the outcome and management of children with PEM in Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Methods: The records of all malnourished children admitted into the Paediatric unit of Aminu Kano Teaching Hospital (AKTH) were retrieved over five year period (January 2002 – December 2006). Demographic data, predisposing factors, clinical types of PEM, outcome of management and time of discharge or death were also extracted from the case notes. Results: There were 169 children with PEM. The male to female ratio was 1:3:1. The prevalence rate was 5.4%. Marasmus was the commonest type of PEM (39.1%). Poverty, poor weaning practices and communicable diseases such as measles (26.6%), HIV (22.6%) and tuberculosis (10.7%) were the common associated factors. Ninety eight (58%) of the patients were discharged after full recovery. The case fatality rate was 29%. Conclusion: The mortality rate of severe PEM is still high. There is the need for close monitoring of all cases throughout admission. It is also advocated that special wards for this group of patients should be carved out in Paediatric units. Sahel Medical Journal Vol. 10 (3) 2007: pp. 84-88

Pericardial effusions in children with severe protein energy malnutrition resolve with therapeutic feeding: a prospective cohort study

Background: Malnutrition underlies 50% of paediatric morbidity and mortality in sub-Saharan Africa. It is important to look for the underlying causes of the malnutrition, and some clinicians have assumed that...

Serum Retinol Concentrations in Hospitalized Severe Protein-energy Malnourished Children

Vitamin A deficiency (VAD) is a major nutritional problem in many developing countries. Vitamin A status has been reported to be adversely affected in protein-energy malnutrition (PEM). To assess and compare serum retinol concentrations in hospitalized children with severe PEM and normal ones. A prospective series of 34 malnourished and 29 normal control children, <60 months old, hospitalized at IMIP, Recife-PE were recruited for the study between August 2004 and May 2005. Serum retinol level was assayed by high performance liquid chromatography and concentrations adjusted for presence of inflammation as evidenced by levels of C-reactive protein. Blood retinol level was compared according to nutritional status (severe PEM versus normal), gender, age, maternal schooling, family income, breastfeeding practice, residence and perceived morbidity. The prevalence of low serum retinol (<0.70 micromol l(-1)) was 41.2% in children with severe PEM and 24.1% in normal children. Serum retinol concentrations were lower in children whose mothers had low schooling (p = 0.025) and families with low per capita income (p = 0.049), regardless of their nutritional status. Serum retinol concentrations had similar distribution between children with severe PEM and normal, when adjusted for gender (p > 0.05), age (p > 0.05), maternal schooling (p > 0.05), family income (p > 0.05), breastfeeding practice (p > 0.05) and residence (p > 0.05). However, malnourished children with diarrhoea showed lower serum retinol concentrations (p = 0.021) compared to those without diarrhoea. VAD was prevalent in hospitalized children with severe PEM and also among normal ones although in lesser magnitude. Intervention for prevention and control of deficiency of vitamin A are recommended in settings where diarrhea is endemic and there are unfavorable socio-economical conditions.

Ghrelin response in malnourished African children undergoing nutritional rehabilitation

Recovery from severe protein energy malnutrition (PEM) requires a strong anabolic drive. We investigated the response of ghrelin, an orexigenic hormone, in malnourished Gambian children undergoing nutritional rehabilitation. Pre‐ and post‐prandial serum ghrelin levels were measured in undernourished cases (children 1–3y, Weight‐for‐Height Z score, WHZ &lt;−2SD) at days 0, 10 and 30 after starting nutritional rehabilitation, and in controls (children seen at MRC Keneba clinic during the same period, matched for age and sex with WHZ &gt;−2,) at day 0. H. pylori (HP) status was assessed using 13C‐Urea Breath Test. Post‐prandial day 0 ghrelin levels were significantly different from the pre‐prandial day 0 (baseline) levels in cases and controls (see Figure). Although not statistically significant, the baseline serum ghrelin was higher in malnourished children (2437pg/ml vs. 1978pg/ml, P=0.2), and fell towards control levels with nutritional rehabilitation. Baseline ghrelin was related to age (cases: r = −0.6, P=0.009; controls: r = −0.6, P=0.005), but not to baseline WHZ, Weight‐for‐Age and Height‐for‐Age Z scores, insulin, hGH or CRP levels. Eradication of HP in 3 subjects led to a fall in ghrelin levels from 3027 pg/ml at day 0 to 947pg/ml at day 30 (P=0.001). The data suggest that normal ghrelin response remains intact in malnourished African children and may be stimulated by HP infection. This study was sponsored by MRC Keneba, The Gambia

Enteral Feeding

Enteral Feeding

Effect of the nutritional recovery on serum concentration and intracellular expression in T lymphocytes of Interleukin‐2 in severely malnourished children

With the purpose to demonstrate the effect of intensive nutritional support on the cellular and serum concentration of IL‐2 in children with severe protein energy malnutrition a clinical assay was carried out in a tertiary care hospital with 10 severely malnourished children &lt; 48 months of age who received formula without lactose via enteral feeding for two weeks and ad libitum for an additional two weeks were included. Cellular and serum concentrations of IL‐2 and the subpopulation of CD4+ and CD8+ were obtained. A control group (n = 13) was included. A paired student t test for initial‐final determinations and the Mann‐Whitney Test for comparison with control group were used, and null hypothesis was rejected with a p value &lt; 0.05. There was a noteworthy increase in the comparison between the initial vs. final percentage of the cellular expression of IL‐2 (p &lt; 0.001) and in the serum concentration of IL‐2 (p = 0.001). However, at the end of the study the serum concentration of IL‐2 was still lower than in the control group (p = 0.013). Four weeks of nutritional recovery significantly restored the production of IL‐2, although, the total restoration may take longer and probably related with the severity of the PEM. Funded by CONACYT.

Normalized Protein Catabolic Rate Versus Serum Albumin as a Nutrition Status Marker in Pediatric Patients Receiving Hemodialysis

Protein-energy malnutrition occurs commonly in patients receiving hemodialysis (HD). Although serum albumin (sAlb) is recommended to monitor nutrition status in patients receiving HD, many processes unrelated to nutrition status can affect albumin concentrations. We previously showed normalized protein catabolic rate (nPCR) to be superior to sAlb to reflect improvement in nutrition status in pediatric patients receiving maintenance HD after treatment with intradialytic parenteral nutrition for severe protein-energy malnutrition. We now compare nPCR and sAlb as nutrition status markers for pediatric patients on HD irrespective of current nutrition status. Forty-four patients comprising 840 months of HD provision were assessed. nPCR was higher for younger patients. Mean nPCR values were significantly lower for adolescent patients with persistent weight loss of at least 2% for at least 3 consecutive months versus patients without persistent weight loss (1.03 +/- 0.29 g/kg/d vs. 1.15 +/- 0.27 g/kg/d, P < .002), and the odds for developing persistent weight loss were four times greater for adolescent patients with nPCR less than 1 g/kg/d. No association between nPCR and weight loss was observed for younger patients. Mean sAlb levels were greater than 4 g/dL for all patient age groups and did not demonstrate a clinically significant difference between patients with or without weight loss. We suggest that nPCR may be useful for monthly nutrition status in adolescent patients receiving maintenance HD and that adolescents with nPCR less than 1 g/kg/d may be at increased risk for subsequent weight loss.

T-helper 1 versus T-helper 2 lymphocyte immunodysregulation is the central factor in genesis of Burkitt lymphoma: hypothesis.

BackgroundThe HIV epidemic has challenged our previous understanding of endemic Burkitt's lymphoma. Despite the strong association of Burkitt's lymphoma and HIV infection in the Developed world, and against previous postulations that the cancer is due to immunosupression among African children, the HIV epidemic in the Malaria belt has not been associated with a corresponding increase in incidence of childhood Burkitt's lymphoma. Even outside the context of HIV infection, there is substantial evidence for a strong but skewed immune response towards a TH2 response in genesis of Burkitt lymphoma.Presentation of the hypothesisRather than a global and/or profound immunosupression, the final common pathway in genesis of Burkitt's lymphoma is the dysregulation of the immune response towards a TH2 response dominated by B-lymphocytes, and the concomitant suppression of the TH1 cell-mediated immune surveillance, driven by various viral/parasitic/bacterial infections.Testing the hypothesisCase control studies comparing TH2 and TH1 immune responses in Burkitt lymphoma of different etiological types (sporadic, HIV-related, endemic and post-transplant) to demonstrate significant dominance of TH2 immune response in presence of poor CMI response as a common factor. Immunological profiling to evaluate differences between immune states that are associated (such as recurrent Malaria infection) and those that are not associated (such as severe protein-energy malnutrition) with Burkitt lymphoma. Prospective cohorts profiling chronology of immunological events leading to Burkitt lymphoma in children with EBV infection.Implications of the hypothesisThe dysregulation of the immune response may be the missing link in our understanding of Burkitt lymphomagenesis. This will provide possibilities for determination of risk and for control of development of malignancy in individuals/populations exposed to the relevant infections.

Malnutrition improvement for infants under 18 months old of Dai minority in Luxi, China

Child malnutrition and thiamine deficiency remain a matter of public concern in Dai children under 5 years old in Southwest areas of China. The aim of the present study was to understand the status and correlates of malnutrition and thiamine deficiency in Dai children under 18 months old in Yunnan, China, and to explore an effective intervention for improving their nutritional status and decreasing the prevalence of malnutrition and thiamine deficiency in Dai children. Well-trained investigators completed a baseline evaluation survey, including questionnaire survey by maternal interviews, child physical measurements, lab examination of thiamine, and group discussions in a cross-sectional study. An intervention plan was constructed by a group consisting of the city governor, government officers, maternal and child health workers, community leaders, and villagers etc. A comprehensive community-based intervention was carried out for 352 children born after July 2001 and their mothers or caregivers in half of the baseline survey villages by the end of 2003. The intervention included participatory intervention, community nutrition education, child growth monitoring and distributing thiamine to new mothers just before or after delivery. The baseline evaluation survey in 2000 indicated that the prevalence of moderate and severe protein-energy malnutrition was 19.5% for underweight, 16.4% for stunting, and 6.7% for wasting, respectively. With increasing age, the prevalence increased, peaking at 12-15 months. The prevalence of underweight in girls was higher than in boys. A total of 10.5% of children suffered from thiamine deficiency, and 5.7% of the children were insufficient in thiamine supply. Low Kaup target (<25%) was significantly associated with lack of guidance by doctors, lack of nutrition knowledge, lack of knowledge of causes of malnutrition and local culture food taboos. The status of child nutrition has been improved significantly since the intervention measure implementation. The change of prevalence of underweight children aged 6-17 months prior to and after the intervention was significant: 20.5% before and 13.7% after the intervention in infants aged 6-11 months, and 39.0% before and 26.4% after the intervention in young children aged 12-17 months. Prevalence of girls was higher than that of boys. Some women began to eat vegetables and pork from the market, which were forbidden by the culture food taboos. There is no case report of child thiamine deficiency in project villages. The prevalence of moderate and severe protein-energy malnutrition is high in Dai infants and young children. However, based on the local situation, participatory community-based comprehensive nutrition intervention effectively reduces the prevalence of child malnutrition and thiamine deficiency. It is highlighted that population nutritional intervention can produce better results with participation at a community level.

THE MYELINATION PROCESS IN SEVERELY MALNOURISHED CHILDREN: MRI FINDINGS

This study reports cranial magnetic resonance imaging (MRI) findings in children with severe protein energy malnutrition (PEM) performed to determine malnutrition related myelination delay. A total of 20 children aged 2 months to 24 months were included in this study. Eleven (55%) of the children had severe wasting, five (25%) children had edematous malnutrition, and four (20%) children had severe stunting. The MRI findings of two (10%) children, both with severe stunting, indicated myelination delay according to and van der Knaap and Valk criteria 2005. Seventeen (85%) children also had MRI findings of cerebral atrophy. Conclusions indicate that the brain myelination process in the first two years of life of severely malnourished infants, as assessed by MRI, does not show significant delay caused by the nutritional impact on the myelination process.

Copper Deficient Anemia in Severe Protein-Energy Malnutrition due to Child Abuse

Copper Deficient Anemia in Severe Protein-Energy Malnutrition due to Child Abuse

Hypoglycaemia in a Nigerian Paediatric Emergency Ward

Hypoglycaemia is a common problem in paediatric emergency admissions. It has not received enough attention in Nigeria. It has been shown to complicate many childhood illnesses. This study aimed to determine the prevalence of hypoglycaemia in paediatric emergency admissions, describe clinical factors that commonly predispose to it and investigate its effect on outcome of management. Three-hundred and ninety-two consecutively admitted patients were studied. Two milliliters of blood was obtained from each patient for plasma glucose determination. Hypoglycaemia was defined as plasma glucose <2.5 mmol/l (<45 mg/dl). Out of these 392, twenty-five (25) of them were hypoglycaemic giving a prevalence of hypoglycaemia to be 6.4 per cent in our emergency ward. Hypoglycaemia was found to be associated commonly with severe malaria, septicaemia, pneumonia, and protein energy malnutrition. Interval of last meal and unconsciousness were the only two significant associated factors to hypoglycaemia. However, the likelihood of hypoglycaemia is increased with night admissions and prolonged duration of illness before admissions. Presence of hypoglycaemia at admission was also found to be significantly associated with death and dying within 24 hours of admission. The prevalence of hypoglycaemia was found to be 6.4 per cent. It was found to complicate many childhood illnesses and it is associated with a higher mortality. It should be suspected in all very ill children, particularly when they are unconscious and have not eaten for over 12 hours.

Stratégie de prise en charge nutritionnelle de l'enfant et de l'adolescent (Nutrition orale, entérale, parentérale)

Children are especially threatened by malnutrition, because of the high protein-energy cost of growth. Any nutritional deficiency is the source of protein energy malnutrition, which compounds the problems of underlying disease. The protein-energy cost of catch-up growth is particularly high, and should lead to a rigorous adjustment of nutritional supply to prevent metabolic disorders associated with refeeding syndrome (directly related to the homeostatic change secondary to severe protein energy malnutrition). If the gastrointestinal tract can be used for refeeding, it should be used (oral or enteral nutrition). When the gastrointestinal tract is unable to meet the protein and energy requirements, parenteral nutrition is required. Catch-up growth may be achieved by using appropriate nutritional support.

Conséquences de la dénutrition chez l'enfant et l'adolescent. Mortalité, morbidité, conséquences médicoéconomiques

In the developed countries, the sick children are at risk of protein-energy malnutrition (PEM). Marasmus is the most common form of severe PEM in such children. Its major characteristics are low muscle and fat masses with the presence of marked facial, axillary and inguinal skinfolds. Furthermore the marastic children are irritable and depressed. When the PEM is moderate, which is more frequent, the affected children present a failure to thrive. Severe and moderate PEM have multiple functional consequences on different systems and organs with an impact on mortality, morbidity and costs. In this paper, the functional consequences on the immune system, digestive tract, liver, lung, heart, kidney, skin, bone and brain are passed in review. To end, some comments are done about the particularities of PEM in mental anorexia and obesity.

Assessment of Some Biochemical Parameters for Early Detection of Protein Energy Malnutrition

Protein energy malnutrition (PEM) is a common health problem in developing countries. The mild form of PEM results in growth retardation while severe forms result in the syndromes of marasmus and kwashiorkor. Mild PEM was described as a condition in which specific or , non specific clinical signs , as well as non specific laboratory indices are present without any of the classical manifestations of nutritional deficiency. Objective of this work was to assess serum transferrin and fibronectin as a biochemical markers for early detection of PEM. We studied 42 children: 30 patients had PEM (15 cases were mild to moderate PEM and 15 cases were severe PEM) with their age ranged between 4-36 months and the remaining 12 children were age and sex matched healthy children as controls. All studied children were subjected to: full history taking, thorough clinical examination including anthropometric measurements [weight, hight,body mass,index (BMI), and mid arm circumference (MAC)] as well as estimation of serum albumin, serum transferrin, fibronectin, Hb and urine analysis. Results revealed significant reduction in all anthropometric measurements in both mild to moderate and severe PEM patients as compared to control group . Serum albumin was significantly lowered in severe PEM as compared to control and still within normal level in mild to moderate PEM patients. Serum transferrin and fibronectin were significantly lowered in mild to moderate PEM as compared to controls and more reduction in severe form of PEM as compared to controls . Serum fibronectin and transferrin correlated positively with BMI (P <0.05) and serum albumin (P <0.001) in both mild to moderate and severe PEM . In conclusion serum fibronectin and transferrin are markedly reduced in patients with mild to moderate PEM and correlated positively with BMI and serum albumin. This represents an evidence for the role of serum fibronectin and transferrin as biochemical markers for early detection of PEM.

Assessment of Some Biochemical Parameters for Early Detection of Protein Energy Malnutrition

Protein energy malnutrition (PEM) is a common health problem in developing countries. The mild form of PEM results in growth retardation while severe forms result in the syndromes of marasmus and kwashiorkor. Mild PEM was described as a condition in which specific or , non specific clinical signs , as well as non specific laboratory indices are present without any of the classical manifestations of nutritional deficiency. Objective of this work was to assess serum transferrin and fibronectin as a biochemical markers for early detection of PEM. We studied 42 children: 30 patients had PEM (15 cases were mild to moderate PEM and 15 cases were severe PEM) with their age ranged between 4-36 months and the remaining 12 children were age and sex matched healthy children as controls. All studied children were subjected to: full history taking, thorough clinical examination including anthropometric measurements [weight, hight,body mass,index (BMI), and mid arm circumference (MAC)] as well as estimation of serum albumin, serum transferrin, fibronectin, Hb and urine analysis. Results revealed significant reduction in all anthropometric measurements in both mild to moderate and severe PEM patients as compared to control group . Serum albumin was significantly lowered in severe PEM as compared to control and still within normal level in mild to moderate PEM patients. Serum transferrin and fibronectin were significantly lowered in mild to moderate PEM as compared to controls and more reduction in severe form of PEM as compared to controls . Serum fibronectin and transferrin correlated positively with BMI (P <0.05) and serum albumin (P <0.001) in both mild to moderate and severe PEM . In conclusion serum fibronectin and transferrin are markedly reduced in patients with mild to moderate PEM and correlated positively with BMI and serum albumin. This represents an evidence for the role of serum fibronectin and transferrin as biochemical markers for early detection of PEM.

Impact of nucleotides and nutritional support on growth and body composition of severely malnourished infants

The adequate nutritional support of severe protein energy malnutrition (PEM) in infants represents a great challenge. An accepted approach has not been established by most health professionals attending malnourished infants. The objective of this study was to determine if an improvement in the growth rate and body composition of infants with PEM occurred after receiving a starting infant formula with nucleotides. Twenty-five malnourished infants from 3 to 18 months of age participated in the study. All were fed through a nasogastric tube with infant formula (3.35 kJ/mL) for 2 weeks and ad libitum for another 2 weeks. Direct and indirect anthropometric indicators were determined. The subjects were divided into 2 groups; group 1 (n = 11) was fed a formula with added nucleotides, and group 2 (n = 9), with no nucleotides. A paired t test was used to determine the differences between the initial and final measurements for each group, and nonpaired t test was used to compare the groups. Indicators of growth and fat incorporation showed significant differences within each group ( P < .001). The comparison of the rate of anthropometric changes showed no significant difference between the groups. Skin fold thickness and fat percentage were higher but not significant in group 2. An infant formula with an intake of 837 kJ/kg per day and protein of 4 g/kg per day in infants with PEM had a favorable impact on growth, fat incorporation, and body composition indicators regardless of the addition of nucleotides.

Relation between liver fat content and the rate of VLDL apolipoprotein B-100 synthesis in children with protein-energy malnutrition1–3

Fatty infiltration of the liver is associated with an increased morbidity and mortality in children with severe protein-energy malnutrition (PEM), but its pathogenesis remains unclear. Although impaired synthesis of VLDL apolipoprotein B-100 (VLDL-apo B-100) is generally accepted as the pathogenetic mechanism, the rate of it synthesis has not been measured in children with PEM. The objective of the study was to ascertain the relation between the degree of hepatic steatosis and the rate of VLDL-apo B-100 synthesis in children with PEM. The fractional and absolute rates of VLDL-apo B-100 synthesis were measured with a prime-constant intravenous infusion of [2H3]leucine in 13 severely malnourished children (8 boys and 5 girls) aged 7-18 mo. Hepatic fat content was estimated by computerized tomography scanning by using the ratio of liver to spleen (L:S) attenuation. The ratio is inversely related to hepatic fat content such that the lower the L:S, the greater the amount of fat in the liver. There were significant inverse relations between L:S attenuation and VLDL-apo B-100 concentration (P < 0.02), the absolute rate of VLDL-apo B-100 synthesis (P < 0.02), and plasma triacylglycerol (P < 0.02) and serum cholesterol (P < 0.05) concentrations. These results suggest that children with PEM synthesize VLDL-apo B-100 at a faster rate as the degree of hepatic fat infiltration increases. Thus, fatty infiltration of the liver in PEM is not due to a reduction in the synthesis of VLDL-apo B-100.

Auditory brainstem potentials in children with protein energy malnutrition

In this study, auditory brainstem potentials (ABPs) were studied in children with protein energy malnutrition (PEM) to determine the effects of PEM on the developing brain in children. A total of 31 children, aged 3-36 months with moderate/severe PEM and 25 healthy children, aged 3-48 months were included in the study. Nutritional status of the children was assessed by the Gomez classification. Recordings of ABPs were performed by using Nihon Kohden Neuropack 2 device. Of 31 children, 22 (71%) had severe malnutrition, 9 (29%) had moderate malnutrition. Additionally, 8 (26%) and 9 (29%) children had iron deficiency anemia and hypoalbuminemi, respectively. There were significant differences in the mean latencies of the waves I-V on the right and left ears and in the mean interpeak latencies (IPLs) of the waves III-V and I-V on the right ear between the study and control groups (P<0.05). The mean IPLs of I-V on the left side were found to be longer in the moderate PEM group than those of severe PEM group (P<0.05). There was not any difference between the groups of PEM with low serum albumin and PEM with normal serum albumin. While the mean IPLs of I-III on the right side were found longer in the cases of PEM without iron deficiency anemia, the mean latency of wave I on the left side, and the mean IPLs of III-V on the right side were longer in the children with PEM plus iron deficiency anemia (P<0.05). Our findings showed that children with moderate/severe PEM had ABPs abnormalities in different degrees, which reflect defects in myelination of auditory brainstem pathways in children with moderate/severe PEM. However, we found contradictory results between abnormalities in ABPs and degree of malnutrition and iron deficiency anemia. We think that more extensive studies should be performed to determine whether or not there was a relationship between these parameters.