Alterations in Thyroid Hormone Levels in Children with Protein-Energy Malnutrition

Prabita D Oinam; Paras S Takhelmayum; Diana D Wahengbam; Marcony Moirangthem; Amuba S Maisnam

doi:10.55489/njmr.150220251051

Authors

Prabita D Oinam Department of Biochemistry, Shija Academy of Health Sciences, Imphal, Manipur, India https://orcid.org/0009-0000-1431-1975
Paras S Takhelmayum Department of Biochemistry, Shija Academy of Health Sciences, Imphal, Manipur, India https://orcid.org/0000-0001-9222-3305
Diana D Wahengbam Department of Biochemistry, Shija Academy of Health Sciences, Imphal, Manipur, India https://orcid.org/0000-0002-2616-5458
Marcony Moirangthem Department of Biochemistry, Shija Academy of Health Sciences, Imphal, Manipur, India
Amuba S Maisnam Department of Biochemistry, Shija Academy of Health Sciences, Imphal, Manipur, India

DOI:

https://doi.org/10.55489/njmr.150220251051

Keywords:

Protein energy malnutrition, Thyroid hormones, Marasmus, Kwashiorkor

Abstract

Background: Nutritional deficiencies are among the most significant public health challenges in India and other developing nations. Among those nutritional diseases, the Protein Energy Malnutrition (PEM) is the most prevalent one, affecting a large population especially children under five and is a major cause of morbidity and mortality. Aims and Objectives: To estimate serum total thyroxine (TT4), total tri-iodothyronine (TT3), thyroid stimulating hormones (TSH) in normal controls and children with PEM. To find out relationship between thyroid hormones and different grades of PEM.

Methodology: Fifty children below 12 years of age suffering from different grades of protein energy malnutrition admitted in Pediatric ward, RIMS, Imphal, were selected as cases. Fifty healthy children, closely matched for age and gender, formed the control group. The study was carried out over a 24-month period, beginning in September 2016 and concluding in August 2018. Total thyroxine (TT4) and total trio-iodothyronine (TT3) were estimated by ELISA.

Results: Serum thyroid hormones (TT3, TT4 and TSH) were significantly decreased in PEM when compared with controls. Among the different grades of PEM, total tri-iodothyronine (TT3) level was significantly low in Marasmic kwashiorkor children (0.61±0.14) whereas undernutrition group has the lowest value of Total Thyroxine (5.31±0.65) and TSH (1.60±0.81).

Conclusion: A decrease in circulating thyroid hormone levels was linked to the severity of PEM. All the PEM cases should undergo a screening for thyroid hormone status which is essential for proper growth and health of the children.

References

Vinod V Bagilkar, Bharatesh B Savadatti. A descriptive study on Malnutrition. Asian J. Nursing Edu. and Research. 2015;5(1):72-77. DOI: https://doi.org/10.5958/2349-2996.2015.00016.6 DOI: https://doi.org/10.5958/2349-2996.2015.00016.6

Caulfield LE, de Onis M, Blössner M, et al. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutrition. 2004;80(1):193-8. DOI: https://doi.org/10.1093/ajcn/80.1.193 PMid:15213048 DOI: https://doi.org/10.1093/ajcn/80.1.193

Ramachandran P, Gopalan HS. Undernutrition & risk of infections in preschool children. Indian Journal of Medical Research. 2009;130(5):579-83.

Saunders J, Smith T. Malnutrition: causes and consequences. Clin Med (Lond). 2010 Dec;10(6):624-627. DOI: https://doi.org/10.7861/clinmedicine.10-6-624 PMid:21413492 PMCid:PMC4951875 DOI: https://doi.org/10.7861/clinmedicine.10-6-624

Collins S, Dent N, Binns P, et al. Management of severe acute malnutrition in children. Lancet. 2006;368(9551):1992-2000. DOI: https://doi.org/10.1016/S0140-6736(06)69443-9 PMid:17141707 DOI: https://doi.org/10.1016/S0140-6736(06)69443-9

De Onis M, Blossner M. WHO global database on child growth and malnutrition. World Health Organization; 1997.

Sandeep M, Krishnamurthy B. Thyroid hormone status in children with protein energy malnutrition. Int J Contemp Pediatr. 2016 Feb;3(1):193-199. DOI: https://doi.org/10.18203/2349-3291.ijcp20160158 DOI: https://doi.org/10.18203/2349-3291.ijcp20160158

Satapathy A, Satapathy A, Rout DS, et al. Prevalence of Protein Energy Malnutrition among Under-five children in Odisha: A Review. The Journal of Phytopharmacology. 2021; 10(4):272-276. DOI: https://doi.org/10.31254/phyto.2021.10410 DOI: https://doi.org/10.31254/phyto.2021.10410

Barrett KE, Barman SM, Boitano S, et al. The thyroid gland. In: Ganong's review of Medical Physiology. 23rd ed. New York: McGraw-Hill; 2010:301-14.

Valinjkar SK, Sutay NR, Prachi, et al. Thyroid Status and Serum Protein Levels in Severe and Moderate Acute Malnourished Children. Journal of Medical Science and Clinical Research. 2016;4(1):9059-9067.

Chatterjee R, Sethi AS, Verma M, et al. Study of plasma proteins (serum total protein, serum albumin), and thyroid function in children with protein-energy malnutrition. Int J Contemp Pediatr. 2023;10:1572-6. DOI: https://doi.org/10.18203/2349-3291.ijcp20232886 DOI: https://doi.org/10.18203/2349-3291.ijcp20232886

Venkatesha KR, Naik RR. Prevalence of protein energy malnutrition among children: a cross-sectional study. Int J Contemp Pediatr. 2019;6:329-32. DOI: https://doi.org/10.18203/2349-3291.ijcp20190679 DOI: https://doi.org/10.18203/2349-3291.ijcp20190679

Abrol P, Verma A, Hooda HS. Thyroid hormone status in protein energy malnutrition in Indian children. Indian J Clin Biochem. 2001;16(2):221-3. DOI: https://doi.org/10.1007/BF02864867 PMid:23105324 PMCid:PMC3453633 DOI: https://doi.org/10.1007/BF02864867

Kumar S, Nadkarni J, Dwivedi R. Thyroid hormone status in malnourished children. Indian Pediatr. 2009;46(3):263-4.

Gupta S, Chaurasiya OS. Evaluation of thyroid functions in severely malnourished children. International Journal of Research and Review. 2019;6(6):199-202.

Lazarus M, Kashyap AK, Borkar R, et al. Study of thyroid profile in malnourished children (6 months - 5 years) admitted in the nutritional rehabilitation centre and paediatric ward NSCB Medical College Jabalpur, India. Int J Contemp Pediatr. 2018;5:1072-7. DOI: https://doi.org/10.18203/2349-3291.ijcp20181545 DOI: https://doi.org/10.18203/2349-3291.ijcp20181545

Sah SP, Arora M, Kumar S, et al. Effect of PEM on thyroid status, serum total protein and A/G ratio in pre-school going children. Int J Res Med Sci. 2017;5:4486-9. DOI: https://doi.org/10.18203/2320-6012.ijrms20174582 DOI: https://doi.org/10.18203/2320-6012.ijrms20174582

Adegbusi H, Sule MS. Anthropometric and biochemical assessment among under five children in Kusada local government area, Katsina state, Nigeria. Bajopas. 2011;4(2):137-40. DOI: https://doi.org/10.4314/bajopas.v4i2.27 DOI: https://doi.org/10.4314/bajopas.v4i2.27

Mishra SK, Bastola SP, Jha B. Biochemical nutritional indicators in children with protein energy malnutrition attending Kanti Children Hospital, Kathmandu, Nepal. Kathmandu Univ Med J. 2009;7(26):129-34. DOI: https://doi.org/10.3126/kumj.v7i2.2705 PMid:20071845 DOI: https://doi.org/10.3126/kumj.v7i2.2705

Chandrashekaraiah S, Ratageri VH, Kamat L. Thyroid status in children with severe acute malnutrition. Karnataka Paediatr J. 2021;36:165-8. DOI: https://doi.org/10.25259/KPJ_13_2021 DOI: https://doi.org/10.25259/KPJ_13_2021