BIOCHEMICAL TEST

(PROTEIN-ENERGY
MALNUTRITION)

SUBMITTED BY -:
Shradha Duggal
BSc. Dietetics 6th semester
38/17
PROTEIN-ENERGY MALNUTRITION is a form of malnutrition defined as
range of pathological conditions arising from co-incident lack of dietary protein in and /or
energy (calories) in varying proportions .

2) This condition has mild , moderate , and severe degrees .

3) It affects mainly children as they have less protein intake with consequences ranging
from physical to cognitive growth and susceptibility to infection .

4) It is of 3 types -:

(a) KWASHIORKAR -: It is due to severely inadequate amount of protein in the diet .

SIGNS AND SYMPTOMS – edema (swelling of the ankles and feet) , distended
abdomen , an enlarged liver with infiltrates , thinning of hair , skin depigmentation and
dermatitis .
(b) MARASMUS -: It is due to reduced calorie intake. Body weight is reduced to less than
62% of the normal (expected) body weight for the age.

SIGNS AND SYMPTOMS - It is represented by a shrunken , wasted appearance , loss

of muscle mass and subcutaneous fat mass . Some other symptoms are unusual body
temperature , anemia , dehydration, abdominal manifestations , dry skin , brittle hair .

(c) MARASMIC KWASHIORKAR -: It is due to the presence of both protein as well as

energy insufficiency . It is the most severe form of malnutrition .

SIGNS AND SYMPTOMS - It shows signs and symptoms of both as present in

marasmus and kwashiorkor .

CAUSES OF PEM ARE -:

Poverty , neglected maternal care and attention , unsanitary conditions , infectious
disease
Biochemical tests are precise and measure individual nutrient concentration in
body fluids (serum retinol , serum iron) or detection of abnormal amount of metabolites
in urine (urinary iodine) frequently after loading dose or measurement of enzymes in
which the vitamin is a known co-factor (riboflavin deficiency) to help establish
malnutrition in its preclinical stages .

In the development of any deficiency disease , biochemical changes can be expected to

occur prior to clinical manifestation .

Therefore , biochemical tests which can be conducted on easily accessible body fluids
such as blood and urine , can help to diagnose disease at the sub clinical stage .

These tests confirm clinical diagnosis if symptoms are non-specific .

 TEST FOR PROTEIN – ENERGY
MALNUTRITION

Though several biochemical tests based on reduction in serum proteins (total proteins ,
albumin, transferrin , retinol- binding protein, thyroxine-binding prealbumin, somatomedin-
C) , alterations in nitrogenous constituents (non-essential/essential amino acids ratio,
hydroxyproline index, creatinine height index, urea creatinine ratio) have been described for
evaluation of protein nutrition status . They do not provide early indication of protein
malnutrition and do not offer any advantage over the anthropometric measurements .

In nutrition surveys , as well as in clinical practice, serum albumin measurement is the

method of choice. While serum albumin and transferrin reflect long-term changes in protein
nutrition status, serum retinol-binding protein and thyroxine-binding pre-albumin show
more rapid changes and can be used for monitoring protein status during convalescence.
Serum total proteins tend to be elevated when there is superimposed infection due to rise in
the alpha globulin fraction.
TENTATIVE GUIDELINES FOR INTERPRETATION OF SERUM
ALBUMIN AS AN INDEX OF PROTEIN ENERGY MALNUTRITION
SERUM ALBUMIN (g/100 ml)
Deficient low Acceptable
(high risk)
Medium risk Low risk
0 - 11 months <2.5 >2.5
1 - 5 years <2.8 <3 >3
6 – 17 years <2.8 2.8 – 3.4 >3.5
Adults <2.8 2.8 – 3.4 >3.5
Pregnant <3 3 – 3.9 >4
(first trimester)
Pregnant <3 3 – 3.4 >3.4
( second & third
trimester)
THANK YOU