ABSTRACT
This study was done to estimate the value of determination of serum concentrations of albumin, prealbumin, insulin-like growth factor-I [IGF-I] and procollagen 111 peptide [PIIINP] as early predictors of protein energy malnutrition [PEM] in children as well as to demonstrate the effect of nutritional rehabilitation therapy on these parameters. This work was carried out on 60 infants and children suffering from PEM. Their age ranged from 6 months to 3 years. They were classified into four groups according to Welcome classification of PEM; group I included 15 underweight infants and children, group I/ included 15 infants and children with marasmus, group III included 15 infants and children with kwashiorkor and group IV included 15 infants and children with marasmus-kwashiorkor. Another 30 normal healthy infants and children of matching age and sex served as a control group. All patients and control groups were subjected to a careful history taking, thorough clinical examination, anthropometric measurements including; weight, length, head circumference, mid-upper arm circumference [MUAC] and skin fold thickness [SFT] as well as laboratory investigations including complete blood picture, serum albumin, serum prealbumin, serum IGF-I, and serum PIIINP. All these laboratory investigations were repeated after 6 weeks of nutritional rehabilitation therapy in the form of a diet providing 4 gm proteins/kg/day and 150 cal./kg/day
Before nutritional rehabilitation: weight, MUAC and SFT were significantly decreased in comparing all the studied PEM groups and control one with a significant decrease in length and head circumference only in marasmus and marasmus-kwashiorkor groups. Albumin, prealbumin, IGF-I and PlllNP were significantly low in all the studied PEM groups compared to control one with more significant decrease in kwashiorkor group. Correlation study using weight for age percentage of median [WAM] as a fixed parameter showed a highly significant correlation with IGF-I more than with PlllNP and prealbumin
After nutritional rehabilitation: weight, MUAC and SFT were significantly increased in PEM groups as compared to that before nutritional rehabilitation. Albumin, prealbumin, IGF-I and PlllNP were significantly increased in PEM groups as compared with their values before nutritional rehabilitation. Correlation study using WAM as a fixed parameter showed a highly significant correlation with PlllNP more than with IGF-I and prealbumin
Conclusion: IGF-I is an early sensitive predictor of malnutrition status before nutritional rehabilitation therapy as compared to albumin, prealbumin and PIIINP. On the other-hand, PlllNP can be used as a sensitive prognostic marker that evaluates the short-term response to nutritional rehabilitation in malnourished children more than other nutritional parameters