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This article can be downloaded from www.ijpbs.netB - 834

Int J Pharm Bio Sci 2013 July; 4(3): (B) 834 - 839

Research Article BioChemistry

International Journal of Pharma and Bio Sciences

SERUM FT3, FT4,TSH AND PROTEINS IN CHILDREN WITH PROTEIN

ENERGY MALNUTRITION.

SHAHEEN B*1, ISMAIL M HAJI2, SUMA M B3,

AKILA P3 AND SARFARAJ S2.

1Department of Biochemistry, Institute of Medical Sciences and Research , Mayani , Maharastra ,

India. 2Department of Critical Care Medicine, St. Johns Medical College, Bangalore, India.3Department of Biochemistry, JSS University, Mysore, India.

ABSTRACT

Protein-energy malnutrition (PEM) is one of the important causes of under 5morbidity and mortality in our country. The aim of this study was to assess thethyroid hormone levels and to correlate the levels with serum protein levels in thePEM patients with that of healthy controls. Serum thyroid hormones and serumproteins were measured in 30 protein energy malnourished children of differentgrades (I-IV).Serum levels of free triiodo thyronine( FT3),Free thyroxine( FT4) andthyroid stimulating hormone (TSH) were measured by chemiluminometric assay,serum total proteins by biuret method and serum albumin by BCG Dye method. Theresults were compared with 30 healthy, age and sex matched controls. There was asignificant decrease in serum FT3, FT4 and TSH and serum total proteins in PEM

patients, when compared to the control group. There was a significant positivecorrelation between serum thyroid hormones and serum albumin levels in PEMcases.

KEYWORDS: Protein energy malnutrition, tri-iodo thyronine , thyroxine, total proteins, albumin.

SHAHEEN BDepartment of Biochemistry, Institute of Medical Sciences

and Research , Mayani , Maharastra , India.

*Corresponding author
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INTRODUCTION

Protein Energy Malnutrition (PEM) is widelyrecognised major health problem in thedeveloping countries of the world. It is the mostprevalent form of malnutrition among children.PEM is an important cause of childhood

morbidity and mortality, leading to permanentimpairment of physical and possibly mentalgrowth of those who survive. The child may bemarasmic or kwashiorkor1,2. Prevention of PEMis becoming an important issue world wide.Determining the prevalence of PEM in anycountry is important for planning the care ofpatients affected by it. UNICEF reports that Indiahas unfortunate distinction of having 75 millionmalnourished children below 5 years of age. Soplanning for the prevention and strategies for thetreatment of PEM are becoming key issue for all

countries, including India3

.PEM is a range ofpathological condition arising from coincidentlack of protein and calories and usuallyassociated with infections and deficiency ofmicronutrients 4. PEM affects every organsystem. As PEM progresses, organ dysfunctiondevelops. Multiple system affection and severalmetabolic derangements are expected. Hepaticsynthesis of serum proteins decreases anddepressed levels of

circulating proteins are observed. Thyroidhormones play an important role in the

regulation of lipid and carbohydratemetabolism and necessary for normal growthand maturation. Absence of thyroid hormones

I A P Classification9.This is based on weight for age values.

causes mental and physical slowing, mentalretardation and dwarfism 5.Studies haveshown that in PEM, there are marked changesin secretion and metabolism of thyroidhormones and in the structure of thyroid

gland. This results in reduction of activity ofthe gland and hence decrease in T3 and T4 6 .Though few studies have been done on statusof thyroid hormones, the studies on freethyroid hormones levels (FT3/ FT4) inchildrens are not many 7,8. With this view theaims and objectives of this study was toestimate the concentration of serum thyroidhormone levels and proteins in PEM patientsand healthy controls and to find out if there isany correlation between serum thyroidhormones and serum proteins levels in PEM

cases.

MATERIALS AND METHODS

This prospective study was carried out on 30children with age range of 12-48 months. Anequal number of age and sex matched healthysubjects formed the control group. Thepresent study was conducted on diagnosedpatients of PEM admitted in paediatric ward ofJ.S.S.Medical College and Hospital,

Mysore.Diagnosis of PEM was diagnosed byanthropometric measurements and physicalexamination.

Table 1I A P classification of malnutrition.

Grade of malnutrition Weight for age of the standard (median) (%)

Norm

alGrade

I

Grade

> 80

71-80 (mild malnutrition)61-70 (moderate malnutrition)

51-60 (severe malnutrition)

< 50 (very severe malnutrition)

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Exclusion criteria: Patients with chronicinfectious diseases like nephrotic syndrome,chronic glomerulonephritis and acute renalfailure in which there is an excessive loss ofproteins and patients with lead poisoning,thalassemia and with congenital anomalies

were excluded from the study. A semistructured questionnaire (Performa) was used toobtain information from the subjects usinginterview method.Sample collection, separationand preservation: Aseptically 5ml of venousblood was collected with due consent from the
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parents of patients and controls .As soon as theblood was collected from the patients, it wascarried to the laboratory in an ice-container. Theblood was allowed to clot and serum wasseparated by centrifugation at 5000 rpm for 5minutes. It was used to estimate

various parameters.Analytical procedure:Serum FT3, FT4 and TSH were estimated bychemiluminometric assay, using ADVIAcentaur CP, Siemens. Serum total proteins bybiuret method and serum albumin by BCGDye method. All the parameters wereestimated in Rx Daytona autoanalyzer usingkits provided by Randox. The quality controlwas done for all the tests performed.

STATISTICAL ANALYSIS:SPSS for windows Version-16 (2007) wasemployed for statistical analysis. The

Independent- Samples t test procedure wasused to compare the mean for two groups ofcases. The One-Way ANOVA was used forone-way analysis of variance for a quantitativedependent variable by a single factor

(independent) variable. The correlationbetween the parameters was worked outusing Pearsons correlation. p value < 0.05was considered to be statistically significant.The study protocol was approved by theinstitutional ethical committee before thecommencement of the study. Informedconsent was obtained from theparents/caregivers of participants.

RESULT

In the present study the mean age of PEMpatients was 2.861.02 years where as incontrols, it was 2.720.96 years. Sixty five %of PEM cases and sixty five % in controlswere males. Table 2 shows weight and heightdistribution in all the groups. In PEM cases,the mean weight was 9.60 1.64 (kgs) and the

height was 101.30 2.95 (cms). In the controlgroup, the mean weight was 13.70 2.47 (kgs)and mean height was 102.86 3.03 (cms). Thedifference was statistically insignificant.

Table 2Showing the mean SD of weight and height distribution in cases and controls.

Subjects Weight (kgs) Height (cms)

Controls 13.70 2.47 102.86 3.03( n = 3 0 )

Cases 9.60 1.64 101.30 2.95( n = 3 0 )SD = Standard Deviation


Table 3 shows mean serum concentration ofFT3, FT4 and TSH were significantly decreasedin patients when compared to control group.The mean FT3 value in PEM cases was 1.53 0.27 pg/ml and in controls was 2.25 0.48pg/ml (p

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Table 3Showing the mean SD of FT3, FT4, TSH, total proteins and albumin, with their significant

differences between cases and healthy controls.

Cases(n = 30)

Controls(n = 30)

t value p value

FT3 1.53 0.27 2.25 0.48 -6.91

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DISCUSSION

Protein energy malnutrition (PEM) continuesto be a major public health problem throughout the developing world. Malnutritionincreases ones susceptibility to and severityof infections, and is the major component of

illness and death from diseases. The risk ofdeath is directly correlated with the degree ofmalnutrition 10. UNICEF reports that India hasunfortunate distinction of having 75 millionmalnourished children below 5 years of age1.The National Child nutritional surveyconducted in 2000 demonstrated that amongthe children of 6 to 71 months of age, almost49% were found stunted and nearly 12%wasted and 52% were underweight11.Thepresent study has been undertaken to assessthe thyroid hormone levels and to correlate

the levels with serum protein levels in thestudy group .In the present study (table 3) itwas observed that mean serum concentrationof FT3, FT4 and TSH were significantlydecreased in patients with PEM whencompared to control group. The mean FT3value in PEM cases was 1.53 0.27 pg/ml andin controls was 2.25 0.48 pg/ml (p

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levels.

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