Malnutrition remains a leading cause of childhood morbidity and mortality in low- and middle-income countries, with India carrying one of the highest burdens globally. Despite sustained public health efforts, recent estimates from the National Family Health Survey (NFHS-5) indicate that 36% of Indian children under five years are stunted, 32% are underweight, and 19% suffer from wasting, reflecting persistent nutritional deficiencies at a national level.¹ Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) not only impair physical growth but also increase vulnerability to infections, electrolyte imbalances, and metabolic disturbances.

Traditional diagnostic tools for malnutrition—such as weight-for-height, MUAC, and visible wasting—are essential but often insufficient for predicting prognosis. A growing body of evidence highlights that biochemical parameters such as serum sodium, potassium, calcium, random blood sugar (RBS), and albumin levels play a pivotal role in determining disease severity, guiding treatment, and assessing short-term outcomes.^2,3 Electrolyte derangements, particularly hyponatremia and hypokalemia, are common in SAM and can lead to life-threatening complications including seizures, arrhythmias, and coma if left uncorrected.⁴ Moreover, hypoalbuminemia is increasingly recognized as an early indicator of poor prognosis and higher mortality among malnourished children.⁵

Clinico-demographic determinants—such as age, gender, socioeconomic class, maternal literacy, breastfeeding duration, and feeding practices—strongly influence the nutritional trajectory of a child. Studies have demonstrated that children from lower socioeconomic backgrounds and those who are inadequately breastfed are disproportionately affected by SAM and its complications.⁶

This study evaluated the clinico-demographic profile and biochemical abnormalities in malnourished children and correlated them with clinical features and short-term outcomes to inform early intervention and care strategies.

MATERIALS AND METHODS

Study Design and Setting: This cross-sectional observational study was conducted in the Department of Pediatrics, Government Medical College, Haldwani, in collaboration with Dr. Susheela Tiwari Government Hospital. All children diagnosed with malnutrition and admitted to the pediatric ward or Pediatric Intensive Care Unit (PICU) were evaluated.

Study Period: The study was carried out over 18 months, from April 2022 to October 2023.

Study Population: Children aged >6 months to ≤5 years admitted with a diagnosis of Moderate Acute Malnutrition (MAM) or Severe Acute Malnutrition (SAM) were included. Diagnosis was made using WHO anthropometric criteria.

Inclusion Criteria

• Children aged 6 months to 5 years
• Diagnosed with MAM or SAM as per WHO criteria
• Informed consent obtained from parents or guardians

Exclusion Criteria

• Children aged <6 months or >5 years
• Children with known kidney disease or on diuretic therapy
• Those not meeting WHO diagnostic criteria
• Parental refusal to participate

Sample Size: The sample size was determined to be 110 children.

Diagnostic Criteria

• SAM: weight-for-height/length < −3 SD, or MUAC <115 mm, or bilateral pitting edema, or visible wasting.
• MAM: weight-for-height/length < −2 SD without edema.

Biochemical Investigations: Venous blood samples were collected to evaluate serum sodium, potassium, calcium, random blood sugar (RBS), and serum albumin levels. These markers were then correlated with clinical severity and short-term outcomes such as recovery, referral, or mortality.

Data Collection: Demographic and clinical data were collected through a structured case record form. Parameters recorded included age, gender, socioeconomic status, literacy level, immunization status, feeding practices, and medical history. Nutritional intake was assessed using the 24-hour dietary recall method.

RESULTS

Table 1: Age and SES Distribution

SAM was significantly more prevalent in 6–12-month-olds and lower SES (p=0.001), while MAM was more common in 1–3-year-olds and middle SES (Table 1).

The study population showed male predominance, with 57.3% males and 42.7% females (See Figure 1).

Figure 1: Gender Distribution

Table 2: Feeding & Immunization

Shorter breastfeeding (<6 months), fewer meals (<3/day), and partial immunization were significantly associated with SAM and infections (p<0.05) (Table 2).

Clinical features were more prevalent in SAM than MAM, with higher rates of pedal edema, hypothermia, hepatomegaly, skin and hair changes, while MAM had more cases without clinical signs. Among children with MUAC <11.5 cm, 89.6% were classified as WHZ < -3SD, indicating severe malnutrition, while 23.3% fell in the WHZ -2 to -3SD range, suggesting overlapping classification (See Figure 2 & 3).

Figure 2: Clinical Features

Figure 3: MUAC vs. WHZ Classification

Table 3: Biochemical Parameters

SAM showed more abnormalities in hemoglobin, liver enzymes, electrolytes, and calcium than MAM, reflecting greater metabolic disturbances (Table 3)

Table 4: Blood Sugar, Albumin & Outcomes

SAM had lower RBS and albumin (p=0.001), with low albumin (<2.5 g/dL) linked to higher mortality and poorer recovery (Table 4).

Table 5: Diarrhea & Electrolytes

Diarrhea was significantly associated with electrolyte imbalances—hyponatremia, hypokalemia, and combined deficits (p<0.01) (Table 5).

Co-morbid infections like gastrointestinal infection, pneumonia, UTI, and sepsis were significantly more common in SAM children compared to MAM, who had a higher rate of no infection (60.5%) (See Figure 4).

Figure 4: Co-morbid Infections

DISCUSSION

The present study showed a male predominance in malnourished children (57.3%), similar to findings by Khan S⁷ and Pandurangi R⁸, possibly reflecting gender bias in care-seeking. Children aged 1–3 years constituted the highest burden in both SAM and MAM groups, aligning with Haldar P⁹, who linked early childhood with heightened nutritional vulnerability due to improper weaning. Most SAM cases belonged to lower socioeconomic strata (77.6%), reaffirming poverty as a critical determinant, as supported by Cossa-Moiane¹⁰ and Thakur S¹¹.

Shorter breastfeeding duration (<6 months) was more frequent among SAM children (61.2%) compared to MAM. Meal frequency <3 times/day was reported in 89.6% of SAM children, reinforcing previous findings by Khan S⁷ and Chowdhury NR¹² that inadequate caloric intake contributes to malnutrition severity. Immunization status was significantly associated with infection risk; only 44.9% of infected children were fully immunized, similar to the studies by Mahajan A¹³.

Clinical signs like hepatomegaly (61.2%), skin/hair changes (55.2%, 49.3%), and pedal edema (43.3%) were prominent in SAM. The correlation between MUAC <11.5 cm and WHZ <-3SD further validated the concordance of anthropometric markers, consistent with Sharma IK et al¹⁴.

Laboratory findings revealed higher anemia in SAM (80.6%) than MAM (48.8%). SGOT and SGPT were elevated in 70–75% of SAM cases, reflecting hepatic stress. Electrolyte imbalances such as hyponatremia (70.1%), hypokalemia (59.7%), and hypocalcemia (70.1%) were significantly more common in SAM.

Co-morbid infections were markedly more prevalent in SAM (71.6%) than MAM (39.5%), particularly pneumonia (47.8% vs 27.9%) and UTI (22.4% vs 11.6%), reflecting findings from Chowdhury NR et al.¹². Blood sugar levels were significantly lower in SAM (54.3 ± 12.7 mg/dL), while albumin levels were also reduced (2.4 ± 0.6 g/dL), similar to Chowdhury NR et al¹². Mortality was notably higher in SAM (11.9%), and lower albumin levels (<2.5 g/dL) correlated strongly with poorer recovery and higher death rates.

Electrolyte disturbances were significantly more common in children with diarrhea (87.9%), especially hyponatremia (72.4%) and hypokalemia (67.2%), confirming the impact of diarrheal losses, as reported by Owais MJ et al¹⁵. Conversely, 46.2% of non-diarrheal children had normal electrolyte levels—an observation unique to this study.

The limitations of the study include its single-center setting, small sample size, and recall bias due to caregiver-reported data, which may affect generalizability.

The strengths of the study include detailed clinical and biochemical assessment with direct SAM–MAM comparison, offering valuable insights into hospital-based malnutrition patterns.

CONCLUSION

Severe acute malnutrition in children is significantly associated with younger age, low socioeconomic status, inadequate breastfeeding, and poor meal frequency. Biochemical abnormalities like hypoalbuminemia, hypoglycaemia  and electrolyte imbalances were strongly linked to adverse clinical outcomes. Prompt nutritional support, infection control, and early correction of metabolic disturbances are vital for improving recovery and reducing mortality in malnourished children.

Conflict of Interest: None.

Funding: None.

Ethical Approval: Obtained.

Consent: Written consent secured.

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