Macronutrient Status in Children Aged 1-6 years in and
Indian Journal of Public Health Research & Development, April-June 2018, Vol.9, No. 2 175 It causes poor learning ability and is also harmful to
the immune system, making malnourished children more prone to diseases such as measles, diarrhea, respiratory infection, tuberculosis, and malaria, than normal children4.The rate of malnutrition tends to be higher in the city among vegetarian and village children5. Our aim is to study serum lipid and protein status resulted from malnutrition in Pondicherry town and in and around Pondicherry village school children aged 1-6 years.
Measuring Malnutrition: Anthropometric information can be used to determine an individual’s nutritional status compared with a reference mean. The basic information and measurements that constitute anthropometric measurements in children are: age, sex, length, height, weight, oedema. These measurements are the key building blocks of anthropometrics and are essential for measuring and classifying nutritional status in children under 5 years.
MeThOdOlOgy
Study subjects All children aged 1-6 years (N = 358; 183 boys, 175 girls) from Pondicherry government and in and around Pondicherry government school stdents were studied. All subjects’s were taken a patients information concern and taken Institutional Ethical committee clearance (IEC). All the students’ 3ml blood samples were collected and done the assays lipid profile and Total Protein and Albumin.
Statistical Analysis: Descriptive statistics, analysis of variance were used to analyses the data.
ReSulTS
Tables 1 showed mean and standard deviation of all the study biochemical parameters for boys and girls, respectively.
None of the study children had serum total protein below 5 g% (Table 2).
About 4.8% of boys and 3.9% of gilrs had serum total protein at or below 6.1 g% (Table 2). None of the study children had low albumin or <3.5 g% (Table 2).
The percentage of children had serum globulin below and above cut-off levels were shown in Table 2.
Most children had serum total cholesterol (TC) lower than 170 mg% (Table 3). Only 7% of children had serum TC >=200 mg%. According to age group 1-3 years, only 15.6% of boys had serum TC >182 mg%
(Table 3). According to age group 4-6 years, only 6% of girls had serum TC >189 mg% (Table 3).
About 59% of children had serum triglycerides above or equal 100 mg% (Table 3) and 45.2% of boys and 50.6% of girls had serum high density lipoprotein cholesterol (HDL-C) below 35 mg% (Table 3). Only 1.3% of boys and 2.6% of girls had serum low density lipoprotein cholesterol (LDL-C) >=130 mg% (Table 3).
None of the study children had LDL/TC ratio >4. On average, only 9.6% of children had LDL/HDL ratio >4.
dISCuSSION
Access to medical care has been found to have a positive effect on child health outcomes though there is some debate in the literature as to the mechanism through which the access-health link is mediated. It is not surprisingly that in the future, these children will face several kinds of problems such as health conditions, illnesses and malnutrition6.
In the present study, few percent of the study children had serum total protein at or below 6.1 g%
which indicated low serum total protein. Also, none of them had low serum albumin (<3.5 g%). These findings corresponded to the incidence of mild and moderate under nutrition (not the severe form of malnutrition such as marasmus and kwashiorkor) found in these children.
Rural area of pondicherry children ate enough portions from the meat and cereal groups, but had inadequate intakes of milk, fruits and vegetables. Therefore, although total protein intakes exceeded the RDA’s, the quality of protein in the diets of rural children can be improved by increased milk intakes. It is possible that not enough essential amino acids are taken in for protein synthesis and growth. Additionally, in low energy diets as seen in the rural children, dietary proteins could be used as an energy source and not for protein synthesis.
The percentages of children who had low or high serum total cholesterol and other lipid profiles varied.
However, most children had serum total cholesterol
176 Indian Journal of Public Health Research & Development, April-June 2018, Vol.9, No. 2 level lower than 170 mg% and serum LDL-C level less
than 130 mg% which were in normal levels. Cholesterol minus HDL Cholesterol) could be more representative of all atherogenic, apolipoprotein (apo) B containing lipoproteins –LDL,VLDL, IDL and Lipoprotein(a).
Although apolipoprotein B can be assessed directly, measurement of Non-HDL Cholesterol is more practical, reliable, inexpensive and can be considered as a surrogate marker for apolipoprotein B in routine clinical practice7-8. Hence Non-HDL cholesterol can be included in Lipid Profile. The normal Non-HDL Cholesterol level is < 130mg/dl. However, some children had mild hypercholesterolemia (1-3 years: >186 mg%; 4-6 years
>192 mg%). On average, only 15% of children had LDL/HDL ratio >4 which indicated high risk of future coronary heart diseases in these children if the ratio still persisted through adult life. When the concentration of albumin falls, an increased proportion of free fatty acids and other amphipathic lipids normally bound to albumin may be bound instead to VLDL8. This would have at least two effects on lipoprotein metabolism.
First these compounds may affect the interaction of triglyceride rich lipoproteins with lipoprotein lipase.
And second, the concentration of unbound free fatty acids may increase. These unbound free fatty acids may inhibit lipoprotein lipase, thus further reducing the rate of VLDL triglyceride clearance7-8.
Although some of the micronutrient deficiencies can be addressed by fortification programmes, it is suggested that the question of iron fortification should be examined in depth by an expert committee by government.
Fortification of weaning foods is an option to consider.
The limited information on the nutritional status of children’s in pondicherry, not normally regarded as a high priority target group, indicates that their nutritional status is far from optimal9-10. It is essential that to ensure maximum benefit from development programmes, the nutritional status of many adults should also be improved by the government.
Research has consistently demonstrated a strong correlation between women’s education and children’s morbidity and mortality outcomes11-14. Results suggest that children of more educated mothers have better health outcomes; however, as with access to care, the exact mechanism through which maternal education is translated into improved child health is not clear.
CONCluSION
The children aged 1-6 years were from very poor family in the villages. It would appear that the priority recommendations for improving nutrition in and around pondicherry villages and to increase protein and energy consumption such as fat ,oil and Protein diet. Very little is known about the impact of the rapid urbanization on nutritional status and its determinants in people living in and around Pondicherry city.. The biochemical information on nutritional status is limited to a few nutrients in selected groups. Much more information on, for example zinc, calcium, Iron, iodine status is needed.
Clearly, all these areas require urgent research to support intervention programmes.
Table No.1. Mean ± Sd of the study biochemical parameters
S. No. Parameter Boys (Mean ± SD) Girls (Mean ± SD)
1. Total protein (g%) 6.9 ± 0.61 6.9 ± 0.42
2. Albumin (g%) 4.4 ± 0.23 4.5 ± 0.24
3. Globulin (g%) 2.4 ± 0.48 2.4 ± 0.34
4. Total Cholesterol (mg%) 133.0 ± 28.0 137.0 ± 22.86
5. Triglycerides (mg%) 121.0 ± 45.98 118.2 ± 48.04
6. HDL-C (mg%) 37.0 ± 9.74 37.1 ± 9.67
7. HDL-C (mg%) 74.2 ± 23.82 78.8 ± 24.38
8. LDL/TC (ratio) 0.53 ± 0.10 0.56 ± 0.09
9. LDL/HDL (ratio) 0.27 ± 0.85 2.43 ± 1.07
Indian Journal of Public Health Research & Development, April-June 2018, Vol.9, No. 2 177 Table No. 2: Percentage of children had serum total
protein, albumin and globulin below and above cut-off levels
Parameter Boys (%) Girls (%)
Total protein (g%)
n 75 69
≤5.0 0 0
≤6.1 4.8 3.9
6.2-7.9 89.6 93.8
>7.9 6.5 3.4
Serum albumin (g%)
n 75 69
<4.0 0 0
4.0-5.0 98.8 97.7
>5.0 1.2 2.3
Serum globulin (g%)
n 75 69
<=2.2 33.1 20.7
2.3-2.8 51.4 71.6
>=2.9 15.4 7.6
Table No. 3: Percentage of children had serum total cholesterol (TC), high density lipoprotein cholesterol (HDL-c), low density lipoprotein cholesterol (LDL-c) and triglycerides (TG) levels below and above cutoff
levels
Parameter Boys (%) Girls(%)
Serum TC (mg%)
Children aged 1-6 years
n 179 173
<170 87.0 82.6
>=170 16.0 17.3
Children aged 1-3 years
n 145 140
<45 0 0
45-182 89.3 100.0
>182 15.6 0
Children aged 4-6 years
n 134 133
<109 21.2 27.6
109-189 78.7 70.2
>189 15.6 2.0
Serum ldl-C (mg%)
n 179 170
<=110 10.0 11.2
<130 98.6 97.3
>=130 1.3 2.6
Contd…
Serum hdl-C (mg/dL)
n 181 173
<35 45.2 50.6
35-60 49.3 44.8
>60 5.4 4.5
Serum Tg (mg%)
n 181 173
<100 41.8 41.5
>=100 59.2 59.5
>=150 26.3 24.1
>=200 9.6 14.0S
Conflict of Interest: Nil
Source of Funding: Self/Diagnostic kits are provided by institution as on complimentary basis for research.
ethical Clearance: No. IEC/C-P/021/2016
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