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Abstract
Introduction: PEM is a clinical problem caused by inadequate intake of one or more nutritional elements, and remains as one of the most important health problems in developing countries. Recent studies said that there is correlation between Serum leptin levels of infants with marasmus, kwashiorkor, marasmic-KWO. Leptin appears to be an important signal in the process of metabolic adaptation to prolonged nutritional deprivation.
The Aim of the work: is to evaluate the levels of serum leptin concentrations in children with PEM and correlation with growth parameters and also to study the relationship between changing nutritional anthropometric measures and serum leptin concentration after treatment and catch up growth in these children.
Subjects and Methods: The study was conducted on 40 infants diagnosed to have PEM, their ages ranged between 2-24 months, with a mean age of (10.7 ± 7.1) month they were 25 males and 15 females .They were classified into three groups according to the new classification suggested by Gernaat and Voorhoeve, (2000) : 21 marasmic infants, 9 kwashiorkor infants and 10 marasmic kwashiorkor. They were recruited from the inpatient department and the nutrition clinic of paediatric hospital, faculty of medicine, Zagazig university. The study also included 10 age and sex matched apparently well nourished infants serving as controls, They were 6 males and 4 females, their ages ranged between 2.5 and 18 months with a mean age of 8.85 ±4.94. All studied cases; before and after treatment and controls were subjected to full history taking, thorough clinical examination and laboratory investigations.
The results of the study can be summarized in the following:
1- The mean age of PEM infants was statistically significant higher in oedematous group (kwashiorkor and marasmic kwashiorkor) compared to non-oedematous one (marasmic infants).
2- The mean values of total serum proteins and serum albumin was Statistically significant lower in oedematous group compared to non-oedematous one.
3- The weight, length, weight %, height %, BMI, Z score, TSF and head circumference were significantly lower in Protein energy malnourished infants compared to controls
4- The serum leptin concentration levels were significantly lower in malnourished infants compared to controls.
5- A significant higher values of all anthropometric measurements after 2 months of nutritional therapy versus before treatment.
6- A significant higher values of serum leptin level, total proteins ,serum albumin and HB concentration in patients after 2 months of nutritional therapy versus before treatment.
7- The serum leptin level is not affected by either age or sex.
8- The serum leptin levels in infants with marasmus, kwashiorkor and marasmic-kwashiorkor were not significantly different when comparing with each other.
9- A positive significant correlation between BMI and serum leptin levels in all infants (malnourished patients and controls).
10- A positive correlation between serum leptin levels, Z score and percentage weight for height (W/H %) in all groups.
11-A statistically significant higher anthropometric measurements and serum leptin levels in group of catch up growth versus group of non catch up growth after treatment.
12 - No significant correlation between serum leptin concentrations and triceps SFT in the malnourished group before the initiation of nutritional therapy but during the catch-up growth period (2 months after treatment) a positive correlation was developed between serum leptin concentrations and triceps SFT and serum leptin concentration in infants who showed catch - up growth (catch-up group) was reached to the same level in healthy controls.
On the other side, In spite of significant increase in midarm circumference and occipitofrontal circumference (HC), minimal non significant increase in weight, height and Z Score and no change in triceps skin fold thickness in infants who did not have catch-up growth (non catch-up group) there was no increase in leptin concentrations. Conclusion: Therefore, we propose that an increase in leptin concentration develops in relation to fat mass if the fat mass reaches a critical point, leptin at that point might be the triggering factor to achieve catch-up growth in infants with PEM through its regulatory effects on the process of growth.