الفهرس 
Protein Energy MalnutritionOnly 14 pages are availabe for public view
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Abstract
This case-control, cross sectional study aimed to assess the serum resistin level in infants or children with PEM, before and after rehabilitation to examine the possibilities of its use as a diagnostic and prognostic tool and whether or not it correlates to severity of PEM .
In this work, 15 PEM patients (group 1) were studied before nutritional rehabilitation (group1a) and after nutritional rehabilitation (group1b)and divided according to Gernaat and Voorhaeve classification into two subgroups:
1- Non-edematous PEM group: which included 8 (marasmic) infants 2- Edematous PEM group: which included 7 (KWO and marasmic KWO) infants. 15 normal healthy infants comprised Group 2 as controls.
All studied patients and controls were subjected to: complete history taking with special emphasis on nutritional history, thorough clinical examination including weight, height, head circumference, mid arm circumference, edema, signs of dehydration, hair and skin changes, abdominal examination and chest examination, rehabilitation and discharge were done according to WHO, (1999), Laboratory investigations for (fasting serum glucose level, fasting serum insulin fasting serum resistin, total serum protein levels, serum albumin and total leucocytic counts, hemoglobin levels, and red blood cells counts), calculations of weight %, height %, body mass index (BMI), Z score and Calculation of HOMA values and statistical methods: using Mean, Median, T Test, Mann-Whitney Test, Chi-Square Test and Pearson Correlation Coefficient (r).
In the present study, although, the mean values of fasting resistin were higher in control subjects compared to the PEM patients and their subgroups before rehabilitation , yet no statistical significant difference was found. Moreover, resistin levels in PEM patients and their subgroups after rehabilitation were higher than in controls, but also no statistical significance was found, Furthermore, significant correlation was found between fasting serum resistin and fasting serum insulin levels in all PEM patients before nutritional rehabilitation and controls.
In the present study, The mean values of fasting glucose were significantly higher in control subjects compared to the PEM patients and their subgroups before rehabilitation, moreover, glucose levels in PEM patients and their subgroups after rehabilitation were significantly higher than in controls and pre-interventional values, but still they were within the normal reference range in both groups.
As regards fasting serum insulin levels , the results of this study showed decrease in all PEM patients and their subgroups before nutritional rehabilitation relative to controls in spite of significantly lower fasting glucose due to increase insulin sensitivity in PEM patients,
HOMA index values paralleled serum insulin levels, being markedly decreased among all PEM patients and their subgroups before nutritional rehabilitation compared to control group. with no statistical significant difference between the two subgroups. HOMA was significantly higher in all PEM patients and their subgroups after nutritional rehabilitation compared to pre-interventional values, with significant correlation between fasting serum resistin and HOMA in all PEM patients before nutritional rehabilitation and edematous group after rehabilitation. Furthermore, significant correlation was found between fasting serum resistin and fasting serum insulin levels in all PEM patients before nutritional rehabilitation and controls.
To sum up, the studied anthropometric measurements (weight %, and Z Score for weight, skull circumference %, mid arm circumference (MAC) and body mass index (BMI)) were significantly lower in patients compared to the controls and showed significant degree of nutritional improvement after institution of the program of rehabilitation but still without restoration of the normal nutritional status since the follow up assessment were after approximately 3 months.
As regards the laboratory data, our study revealed that the initial total leucocytic count (TLC) showed no statistical significant difference among all PEM infants and their subgroups as compared to controls, with no inter-group differences. Following nutritional rehabilitation, both TLC count and PLT count values remained statistically insignificant among all PEM infants and their subgroups as compared to pre-interventional values, controls and with each other.
Initial hemoglobin (Hb) levels were significantly lower among all PEM infants and their subgroups as compared to controls with no inter-group differences. Following nutritional rehabilitation, Hb levels significantly increased among all PEM infants and their subgroups as compared to pre-interventional values, yet were still significantly lower than controls with no inter-group differences. The current study revealed that initial serum albumin values were significantly lower among all PEM infants and their subgroups as compared to controls. In addition, edematous infants showed significantly lower values as compared to non edematous ones. Following nutritional rehabilitation, serum albumin value significantly increased among all PEM infants and their subgroups as compared to pre-interventional values.
Concerning total serum proteins before nutritional rehabilitation, no significant differences were detected among all PEM infants and non-edematous ones as compared to controls, However they were significantly lower among edematous ones as compared to controls and non edematous ones Following nutritional rehabilitation, total serum proteins values were statistically higher among all PEM infants and non-edematous ones in comparison to controls, but still they were within normal reference range, however there were no statistically significant difference among edematous infants as compared to controls, Also, there was significant increase in total serum protein after nutritional rehabilitation among all PEM infants and their subgroups as compared to pre-interventional values.
The comparison of the laboratory data before and after nutritional rehabilitation showed that in edematous and non-edematous patients significant improvement in RBCs count, hemoglobin, total protein and serum albumin levels was evident.
Our results revealed that age and sex were not significantly different among all PEM infants and their subgroups as compared to controls as well as each other.