Assessment of Acute Malnutrition Using Transthyretin Levels in Blood of Children Under Five Years of Age in Tikur Anbessa Specialized Hospital and Yekatit 12 Hospital, Addis Ababa
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Date
2015-03
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Addis Ababa University
Abstract
Background: - Malnutrition is one of the leading causes of morbidity and mortality in children
under the age of five years in developing countries, including in Ethiopia. The most important
forms of malnutrition in Ethiopia is protein energy malnutrition, but there is no reliable laboratory
method present to assess acute malnutrition. Transthyretin level of immunochromatography
method is one of the newly introduced method for the identification of children with acute
malnutrition recently admitted to Hospital and used as valuable laboratory measurements in the
identification of patients requiring malnutrition assessment and nutritional support.
Objective: - To evaluate acute malnutrition status in children of age less than five years, who
attend in Tikur Anbessa Specialized Hospital and Yekatit 12 hospital; by using anthropometric
methods, and by measuring albumin and transthyretin level in blood serum samples.
Methods: - Hospital based cross sectional study design was applied from August 2014 to
December 2014. 51 malnourished and 51 non- malnourished children were recruited for this
study. Anthropometric measurements (weight, height, length, MUAC) were performed and serum
transthyretin and albumin levels were measured as biochemical parameters in these hospitalized
patients.
Results: - The mean age of the cases and controls were 1.14 year and 1.48 year, respectively.
Comparison of mean between control and study group shows 14.32 cm and 10.45 cm for MUAC,
4.24 g/dl and 3.86 g/dl for albumin and 303.08mg/l and 132.89 mg/l for transthyretin for control
group and study group respectively. All above mean values shows significant difference between
controls and study groups with p value < 0.0005. Prevalence of malnutrition assessed by weight
for height were categorized as 21.6% for moderate malnutrition and 78.4% for severe
malnutrition. Using MUAC it could be predicted that 23.5% were moderately malnourished and
76.5% were severely malnourished. But using transthyretin tests, the prevalence of 82.4% for
moderate malnutrition and 13.7% for severe malnutrition were obtained. Multivariate analysis
revealed positive correlation between albumin and transthyretin level (r = 0.307, P=0 .03), but
there was no significant correlation between anthropometrics measurement with biochemical
measurements. The sensitivity and specificity of transthyretin using MUAC as reference standard
were 91.60 %, and 15.38% (0.0318 Kappa agreement). The sensitivity of transthyretin using
weight for height (wasting) as reference standard was 100 %, and specificity was 17.5 %. (0.16
Kappa agreement). Transthyretin validation by using MUAC as reference material was found to
be a sensitivity of 81.82 % and specificity of 47.5 % with cut off of transthyretin 120 mg/l.
Conclusions: - Transthyretin is a better acute malnutrition marker in the serial nutritional
assessment and it is a cost effective, feasible, reliable tool for malnutrition screening, particularly
for the purpose of settings where it is difficult to perform a more detailed and comprehensive
nutritional assessment.
Key words: - Transthyretin, Albumin, Anthropometric parameters, Acute Malnutrition
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Keywords
Transthyretin; Albumin; Anthropometric parameters; Acute Malnutrition