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Letters to the Editor Indian Pediatrics 2000;37: 912-913 |
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Status of Micronutrients in Malnutrition Before and After Rehabilitation |
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Micronutrient deficiency in children with malnutrition is one of the important causes of growth retardation and morbidity(1,2). Most of the available studies focus on micronutrient deficiency in the acute stages(3,4). Data on the status of micronutrients after rehabilitation are scarce and are centered on the outcome after zinc supplementation(5,6). The serum levels of 4 micronutrients, namely calcium, magnesium, zinc and copper and protein and albumin were assessed on 60 under-fives with varying grades of malnutrition before and after rehabilitation and were compared with appropriate controls. Standardized techniques were utilized for anthropometric and biochemical evaluation. Atomic absorption spectrophotometry was done in the Division of Cellular and Molecular Cardiology, Sree Chitra Thirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum. Children with congenital anomlies, genetic disorders and those already on vitamin and mineral supple-ments were excluded. The subjects were enrolled after controlling the acute infections from the Nutrition Follow up Clinic of a teaching hospital. They were rehabilitated using a comprehensive package that included nutrition and health education (NHE), medical care and food supplementation. They were not given any vitamin or mineral supplements during rehabilitation. They were followed up for 3 months. There were 3 drop outs and no deaths. The data was analyzed using paired t-test. Sixty-eight per cent of them were above the age of one year and the male to female ratio was 45:55. Majority of them were consuming cow’s milk and rice in their daily diet and diet was deficient in legumes, vegetables, fruits and meat group predisposing them to micronutrient deficiency. Twnety eight per cent of them had severe PEM (weight <60%) and 18% had severe stunting (height <85%). At the end of 3 months of rehabilitation, there was significant improvement in weight (initial-62.2%, final-88.6%), height. (initial–93.1%, final-94.6%) and serum protein (initial4.6, final–5.7 g/dl) and albumin (initial–2.9, final–3.9 g/dl) levels. Serum calcium levels were normal (initial–9.6, final–9.8 and control-10.9 g/dl). Serum magnesium levels were slightly low (initial–1.7, final–1.9 and control–2.1 mg/dl). Serum zinc levels were very low and remained low even after rehabilitation (initial–48.9, final–78.4 and control-140.4 mcg/dl). Serum copper also showed the same trend (initial-38.9, final-69.5 and control-120.6 mcg/dl). Thus, dietary supplementation alone appears to be inadequate to replenish the already depleted stores in children with protein energy malnutrition. They may need micronutrient supplementation especially trace elements.
The financial support rendered by the SAT Endowment scheme is gratefully acknowledged. K.E. Elizabeth,
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