Serum albumin and transferrin in protein energy malnutrition. Their use in the assessment of marginal undernutrition and the prognosis of severe undernutrition

Abstract

Deficits in weight and length for age, and serum albumin and transferrin concentrations were determined for children who were either marginally undernourished (25 children) or suffering from either marasmus (32 children) or kwashiorkor (26 children) defined according to the Wellcome Classification. The measurements were also made in 8 children with kwashiorkor after the loss of oedema, and in 16 children who were recovering from either marasmus or kwashiorkor. Them mean concentration of serum albumin was similar for children from the 'undernourished' group and from the group with marasmus, but was significantly reduced in those with kwashiorkor. The concentration of serum transferrin was significantly reduced in both the group of children with marasmus and those with kwashiorkor. The serum transferrin concentration was significantly lower in children with kwashiorkor when compared with the level in those with marasmus. 17 children (7 with kwashiorkor and 10 with marasmus) died. These children were neither lighter nor shorter than the severely malnourished children who survived. The concentration of serum albumin was not lower in the children who died than in those who survived. In contrast to the results for serum albumin concentrations, the children who died had significantly lower levels of serum transferrin than those who survived. There was a significant linear relationship between serum transferrin concentrations and the deficits in length for age (P < 0.05) and weight for length (P < 0.001) in the marginally undernourished children. The deficit in weight for length was also linearly related to he serum transferrin concentrations (P < 0.001) in children recovering from severe malnutrition. It is suggested that the measurement of serum transferrin concentrations provides an index of severity in severely malnourished children, and should prove useful in field assessments of nutritional status.