Phys. Journal No. 3, December 2008.pmd


Article

Introduction

Serum Total Protein and Albumin Levels in Different Grades of
Protein Energy Malnutrition

Chowdhury MSI 1, Akhter N 2, Haque M 3, Aziz R 4, Nahar N 5

The present study has been designed to estimate serum total protein and albumin  levels in different
grades of protein energy malnutrition  and this will be helpful in early diagnosis, management and
rehabilitation of PEM. The serum total protein and albumin levels  were studied on 20 healthy children
and 30 children suffering from protein energy malnutrition of  different grades.

Serum total protein and albumin levels of different grades of protein energy malnutrition were
significantly  lowered than that of control.  Lowering being  maximum in grade III PEM. This lowering
of  total protein and albumin occur in any form of PEM and related to  severity of  the disease.

Key Words: Serum, Protein, Malnutrition

J Bangladesh Soc Physiol.2008 Dec;(3):58-60.
For author affiliations, see end of text.

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and thus help in reducing problem created by
PEM5.

Methods
The study was carried out in a total number of
50 children of 06 months to 05 years of age of
both  sexes and out of them twenty of apparently
healthy children with no systemic disorder and
in terms of median Harvard standard Weight/
Height  ratio more than 80% were taken as
control group. Thirty children suffering from
various grades of PEM of  same age and both
sexes were selected as  experimental group and
excludes hepatobiliary  and other disease by
history and physical examination  30 children
with PEM of both sexes in the age group of 6
month to 5 years were selected for the study the
attendant parents of the patients was put through
a questioners to collect data  related to the study
and verbal consent were taken from them for

alnutrition is one of the common
public health problem and observe a
leading cause of mortality in

Bangladesh.  Children under 06 years are victims
of different grades of malnutrition1. Children with
PEM have greater deficient of Total Protein and
in severe cases the total protein may be reduced
to around 50%2. The reductions of total serum
protein and albumin were more marked in
kwashiorkor than in marasmus.

Physical findings generally help in the diagnosis
of advanced   malnutrition but is not frequently
positive in children in mild and moderated degree
of malnutrition.  Early diagnosis of these cases
is very useful, as they are amenable to early
rehabilitation, have better prognosis.3, 4

The assay of total protein and albumin will
prove very useful in the diagnosis of PEM
before clinical manifestations are established

M

58 J Bangladesh Soc Physiol. 2008 Dec;(3):58-60



participation his/her child in the study.
Experimental groups were collected from
BSMMU, child nutrition unit of Dhaka Shisu
Hospital and Dhaka Medical College Hospital,
Dhaka.

Grade – I, II and III PEM cases were selected
according to classification set by Gomez, shown
in Table- I.

Table – I
Gomez classification of PEM

Degree of PEM % of desired
body wt. for

age & sex
Normal 90%-100%
Grade –I. Mild Malnutrition 75% - 89%
Grade – II. Moderate Malnutrition 60%-74%
Grade –III, Severe Malnutrition <60%

Another classification of PEM based on Height
for age and weight for height called water low
classification is shown in Table – II.

Table – II
Waterlow classification of PEM

Degree of Stunting (%) Wasting (%)
PEM Height for age  weight for height
Normal 90% 90%
Mild 87.5-95% 80-90%
Moderate 80-87.5% 70-80%
Severe <80% <70%

Blood was drawn with all aseptic precaution and
serum total protein was determined by
colorimetric Biuret method.  Albumin was
determined by colorimetric Bromcresolgreen
method. Statistical analysis of the result was done
by unpaired student “t”test.

Results
Serum total protein and albumin levels in grade
I, grade – II and grade III. PEM are significantly
lowered (P<0.001) than that of control (Table –
III). Serum total protein and albumin levels in
grade III, PEM are significantly lowered
(P<0.001) than that of grade II and grade I, PEM.
When comparison was done between grade II
PEM and grade I PEM, it was found that serum
total protein and albumin levels in grade II PEM
was significantly lower that of grade I PEM.

Table – III
Mean (±SE) serum total protein and albumin levels in control and different grades of PEM.

Parameters Control Grade-I PEM Grade-II PEM Grade-III PEM
n=20  n=10  n=10  n=10

Total protein (gm/dl) 7.02±0.14 5.15±0.26*** 4.6±0.09*** 4.0±0.08***
Albumin(gm/dl) 4.46±0.06 3.38±0.13*** 3.12±0.12*** 2.6±0.11***

*** P<0.001= Highly significant

Discussion
In this study serum total protein and albumin
values in all grades of PEM are significantly
lowered than control. Lowering of these serum
total protein and albumin values in PEM could
be explained on the basis of generalized

p r o t e i n  d e f i c i e n c y  l e a d i n g  t o  i m p a i r e d
synthesis. These results are in agreement to that
of other workers. 2, 4, 5, 6, 7 In the final stage of
wasting low plasma albumin concentration can
appear because of feature of adaptation of
protein deficient diet5.

Protein Energy Malnutrition Article

J Bangladesh Soc Physiol. 2008 Dec;(3):58-60 59



In the development of mararasmus, there occur
deficiencies of energy in the diet reselling in the
change of normal pattern4.

It is also observed that reduction in serum
albumin and total protein in PEM was due to
reduced synthesis of protein because of
inadequate intake of dietary protein9.

Conclusion
It may conclude that serum total protein and
albumin were significantly lowered in protein
energy malnutrition and this varies according to
its severity. The result may help physician to
diagnose PEM and could help to detect its
severity.

Author Affiliations
1. * Md Serajul Islam Chowdhury, Assistant Professor of

Biochemistry, Chittagong Medical College, Chittagong,
Bangladesh

2. Nayeema Akhter, Professor of Physiology, Chittagong
Medical College, Chittagong, Bangladesh

3. Mahmudul Haque, Professor of biochemistry,
Chittagong Medical College, Chittagong, Bangladesh

4. Rehana Aziz , Assistant Professor  of Biochemistry,
Chittagong Medical College, Chittagong, Bangladesh

5. Nazibun Nahar, Lecturer of Biochemistry, Chittagong
Medical College, Chittagong, Bangladesh

* For correspondence

References
1. Bangladesh bureaus of statistics. Report of the child

nutrition status survey, 1995-96. Dhaka. Bangladesh
Bureau of Statistics, 1996-:22-39.

2. Montogomery RD. Muscle morphology in infantile protein
energy malnutrition. J Clin Path 1962;15:511-21.

3. Bengoa JM. Recent trends in the public health  aspects
of protein calorie malnutrition  WHO Chron
1979;24:552-61.

4. Coward WA & Lunn PG. The Biochemistry and
physiology of kwashiorkor and marasmus. Br Med
Bulletin 1981;37(1):19-24.

5. Coward BWA, Whitehead RG & Lunn PG. Reasons why
hypoalbuninaemia mayor may not appear in protein
energy malnutrition. Br J Nutr 1977;38:115-26.

6. Coward BWA, Whitehead RG & Coward DG.
Quantitative changes in serum  protein fractions during
the development of kwashiorkor and in recovery. Br J
Nutr 1972;28: 433-41.

7. Kumer V, Chandrasckharan R, Belavalgidad M.I.
Blood biochemical tests in the diagnosis of
malnutrition. Indian  pediatrics 1975;12(10):955-60.

8. Bhattacharya AK. Studies on Kwashiorkor and
Marasmus in Calcutta (1957-74): Pathological,
Biochemical and metabolic studies. Indian J Pediatrics
1975;12:1115-21.

9. Osifo Boa & Bloodekujo. Serum aspartate and alanine
aminotransferase activities in protein energ y
malnutrition. Enzymes 1982;28:300-4.

Article Protein Energy Malnutrition

60 J Bangladesh Soc Physiol. 2008 Dec;(3):58-60