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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Addis Ababa University


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



Transthyretin; Albumin; Anthropometric parameters; Acute Malnutrition