Thyroid Hormone Status in Severely Malnourished Children between 6 Months to 5 Years Admitted to Nutritional Rehabilitation Centre of a Tertiary Care Hospital
DOI:
https://doi.org/10.6000/1929-4247.2023.12.04.4Keywords:
Severe Acute Malnutrition, Kwashiorkor, Marasmus, Thyroid-Stimulating Hormone, Free Triiodothyronine (fT3), Free Tetraiodothyronine (fT4)Abstract
Introduction: Severe malnutrition poses a significant risk to the thyroid gland's function and hormonal balance, which can lead to numerous physiological and developmental complications. Understanding the relationship between severe malnutrition and thyroid hormone status is crucial for the effective management of these children.
Aim and Objective: To investigate the prevalence and patterns of thyroid hormone abnormalities in severely malnourished patients with subgroup analysis in Marasmus, Kwashiorkor, and edematous malnourished patients.
Methodology: We conducted a cross-sectional study involving 116 children diagnosed with severe acute malnutrition (SAM). The study protocol was approved by the Institution Ethics Committee. Well-informed written consent in the local language was taken from parents. SAM was diagnosed and managed according to WHO criteria (1). Comprehensive laboratory investigations were conducted to assess serum levels of thyroid-stimulating hormone (TSH), free thyroxine (T4), and triiodothyronine (T3). Statistical analysis was performed to examine the associations between these variables and SAM.
Results: Most of the 116 subjects included in the study were male (53.4%) and had a lower socioeconomic status (43.9%). The age distribution of the children aged below 5 years revealed that 46.5% were between 12 and 36 months old. In the present study, Marasmus was 55.2%, Kwashiorkor was 12.1%, and edematous malnutrition was 32.7%. Among 116 participants, 94.8% were discharged, while 5.2% were expired during treatment. The mean levels of fT3, fT4, and TSH were 1.88±1.06 pg/ml, 0.99±0.84 ng/dl, and 3.22±0.87 µIU/ml, respectively. Most SAM patients had low fT3, fT4, and TSH levels relative to the normal range.
Conclusion: Monitoring of thyroid hormone status in SAM patients is mandatory for this vulnerable population.
References
World Health Organization. Updates on the management of severe acute malnutrition in infants and children 2013. Website: who.int> severe acute malnutrition. [Accessed on Sep 16, 2023].
Müller O, Krawinkel M. Malnutrition and health in developing countries. CMAJ 2005; 173(3): 279-86. https://doi.org/10.1503/cmaj.050342 DOI: https://doi.org/10.1503/cmaj.050342
Ambey R, Gupta R. Committing to child survival: A promise renewed-Progress. Report 2013. Australasian Medical Journal (Online) 2014; 7(2): 136.
Ulahannan SK, Wilson A, Chhetri D, Soman B, Prashanth NS. Alarming level of severe acute malnutrition in Indian districts. BMJ Glob Health 2022; 7(4): e007798. https://doi.org/10.1136/bmjgh-2021-007798 DOI: https://doi.org/10.1136/bmjgh-2021-007798
Sahu SK, Kumar SG, Bhat BV, Premarajan KC, Sarkar S, Roy G, Joseph N. Malnutrition among under-five children in India and strategies for control. J Nat Sci Biol Med 2015; 6(1): 18-23. https://doi.org/10.4103/0976-9668.149072 DOI: https://doi.org/10.4103/0976-9668.149072
Chandrashekaraiah S, Ratageri VH, Kamath L. Thyroid status in children with severe acute malnutrition. Karnataka Pediatric Journal 2022; 36(4): 165-8. https://doi.org/10.25259/KPJ_13_2021 DOI: https://doi.org/10.25259/KPJ_13_2021
Surewad GV, Ambatipudi K, Rao AV, Rao KN. Interrelation of free thyroid hormone levels and serum proteins in malnourished children at rural tertiary care hospital in Andhra Pradesh. Journal of Advanced Medical and Dental Sciences Research 2020; 8(11): 64-8.
WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children. A Joint Statement by the World Health Organization and the United Nations Children's Fund 2009. [Last accessed on 2016 Sep 15].http://www.who.int/nutrition/publications/severemalnutrition/9789241598163/en/index.html
Ingenbleek Y. Thyroid dysfunction in protein-calorie malnutrition. Nutrition reviews (USA) 1986; 48(8); 253-64. https://doi.org/10.1111/j.1753-4887.1986.tb07649.x DOI: https://doi.org/10.1111/j.1753-4887.1986.tb07649.x
Bunker S, Pandey J. Educational case: understanding Kwashiorkor and Marasmus: disease mechanisms and pathologic consequences. Academic Pathology 2021; 8: 23742895211037027. https://doi.org/10.1177/23742895211037027 DOI: https://doi.org/10.1177/23742895211037027
Iwaku K, Noh JY, Minagawa A, Kosuga Y, Suzuki M, Sekiya K, Matsumoto M, Ohye H, Kunii Y, Yoshihara A, Watanabe N. Determination of pediatric reference levels of FT3, FT4, and TSH measured with ECLusys kits. Endocrine Journal 2013; 60(6): 799-804. https://doi.org/10.1507/endocrj.EJ12-0390 DOI: https://doi.org/10.1507/endocrj.EJ12-0390
Banerjee B, Mandal ON. An intervention study in malnutrition among infants in a tribal community of West Bengal. Indian Journal of Community Medicine 2005; 30(1): 27-29.
Mallik S, Mitra SP, Roy A, Basu SS, Saha A, Munsi AK. Malnutrition-A missed opportunity to treat at tertiary care. Indian Journal of Community Medicine 2006; 31(3): 196.
Shukla Y, Tiwari R, Kasar PK, Tomar SP. Risk factors for severe malnutrition in under five children admitted to nutritional rehabilitation centre: a case-control study from Central India. Int J Community Med Public Health 2016; 3(1): 121-7. https://doi.org/10.18203/2394-6040.ijcmph20151484 DOI: https://doi.org/10.18203/2394-6040.ijcmph20151484
MK M, Khan SA, Saldanha P. Clinical study of anemia in rural school children of Mangalore, Karnataka, India. International Journal of Contemporary Pediatrics 2019; 6(2): 416-421. https://doi.org/10.18203/2349-3291.ijcp20190051 DOI: https://doi.org/10.18203/2349-3291.ijcp20190051
Ncogo P, Romay-Barja M, Benito A, Aparicio P, Nseng G, Berzosa P, Santana-Morales MA, Riloha M, Valladares B, Herrador Z. Prevalence of anemia and associated factors in children living in urban and rural settings from Bata District, Equatorial Guinea, 2013. PloS One 2017; 12(5): e0176613. https://doi.org/10.1371/journal.pone.0176613 DOI: https://doi.org/10.1371/journal.pone.0176613
Shukla P, Pandey SK, Singh J, Bajaj N, Tripathi G, Dwivedi S. Clinico-Etiopathogenesis of Vitamin B12, Folic Acid and Iron Deficiency in Severe Acute Malnutrition Children: A Tertiary Care Hospital Experience from Central India. Indian Journal of Clinical Biochemistry 2023; 1-5. https://doi.org/10.1007/s12291-022-01100-5 DOI: https://doi.org/10.1007/s12291-022-01100-5
Badi MA, Ba-Saddik IA. Severe acute malnutrition among hospitalized children, Aden, Yemen. Open Journal of Epidemiology 2016; 6(2): 121-7. https://doi.org/10.4236/ojepi.2016.62012 DOI: https://doi.org/10.4236/ojepi.2016.62012
Madhusudan SR, Devi MK, Ahuja S, Nagaraj N. Clinical profile of anemia among 6–60-month children living in South Karnataka–A cross-sectional study. Indian Journal of Child Health 2018; 24: 133-6. https://doi.org/10.32677/IJCH.2018.v05.i02.015 DOI: https://doi.org/10.32677/IJCH.2018.v05.i02.015
Mehta S. Thyroid hormone status in children with severe acute malnutrition. EJPMR 2017; 4(4): 592-4.
Abrol P, Verma A, Hooda HS. Thyroid hormone status in protein-energy malnutrition in Indian children. Indian Journal of Clinical Biochemistry 2001; 16: 221-3. https://doi.org/10.1007/BF02864867 DOI: https://doi.org/10.1007/BF02864867
Orbak Z, Akin Y, Varoglu E, Tan H. Serum thyroid hormone and thyroid gland weight measurements in protein-energy malnutrition. Journal of Pediatric Endocrinology and Metabolism 1998; 11(6): 719-24. https://doi.org/10.1515/JPEM.1998.11.6.719 DOI: https://doi.org/10.1515/JPEM.1998.11.6.719
Turkay S, Kus S, Gokalp A, Baskin E, Onal A. Effects of protein-energy malnutrition on circulating thyroid hormones. Indian Pediatrics 1995; 32: 193-197.
Sircar PK, IP B, VC O. Endocrine and protein energy malnutrition. Indian Pediatr 1982; 19(10): 833-7.
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