The effect of severe protein - energy malnutrition of the values of plasma albumin, calcium , inorganic phosphate, alkaline phosphatase, and bone age in suda nese children under fi e years of age .


Research type: Research Paper

Authors: Ibrahim, Manal Abdel Mutaal .

Abstract: A hospital-based study was carried out in children with severe protein-energy malnutrition (PEM) and anthropometrically normal controls below five years of age admitted to Soba University Hospital and Ahmed Gasim Fadi Specialized Hospital. For Children during during the period July 1996 to November 1996. The aim of the study was to estimate the plasma values of albumin, calcium, inorganic phosphate and alkaline phosphatase and to find any correlation between them and the radiological bone age in the groups studied. 85 children were included in the study. Demographic and clinical data were obtained from each child. Anthropometric measurements and a thorough physical examination were done for each child. According to the Wellcome classification, 18 35.3 percent had marasmus, 23.5 percent marasmic-kwashiorkor, 11.8 percent kwashiorkor and 29.4 percent were anthropometrically normal. Plasma was analysed for total protein, albumin, calcium, inorganic phosphate, alkaline phosphatase, creatinine and urea. Aibumin, calcium and inorganic phosphate were analysed using an automatic analyzer (MERCK MEGA.E.Merck.64271 Darmastadt, Germany) while the other biochemical parameters were analysed manually. Creatinine and urea were estimated to exclude children with renal failure. Mean plasma albumin values values varried significantly between the different groups studies (p equal 0.000). All the maluourished groups showed significantly low values compared to the control group, the kwashiorkor group showing the lowest values. Mean plasma calcium and inorganic phosphate did not differ significantly between the different froups studied (P equal 0.508 and 0.1514 respectively). Mean plasma alkaline phosphatase showed significant difference between the groups studied (P equal 0.010). It was significantly low in the marasmus (P less than 0.001) and kwashiorkor (P less than 0.05) groups compared to the control group. All the groups studied showed variable percentages of children with retarded ossification status of the bones. These percentages were higher in the malnourished groups compared to the control group (37.5 percent in the control group, 45.8 percent in the marasmic group, 50 percent in the marasmic-kwashiorkor group and 42.9 percent in the kwashiorkor group). The percentages showed no significant difference between the different groups studied. The retarded ossification status was associated with low plasma values of albumin and calcium in the marasmic and control groups. This suggests that depressed bone formation could be due to lack of proteins and calcium, both of which are necessary for calcification and ossification. 70 percent of the marasmic - kwashiorkor, 40 percent of the marasmic and 30 percent of the kwashiorkor children studied were found to be stunted (height - for - age less than -2 Z score based on NCHS standard). 20 percent of the normal controls were stunted suggesting that bone formation could be altered in those considered anthropometrically normal. An apparent relationship was observed between stunting and retarded ossification status in all the groups studied. Further work is suggested to study calcium metabalism in PEM in detail and to include markers of bone formation and resorption to clarify the effect of PEM on the bones of growing children, since this study depended only on insensitive gross radiological observations .