Int J Clin Pediatr

International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access

Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc

Journal website https://www.theijcp.org

Original Article

Volume 10, Number 2-3, September 2021, pages 35-42

Serum Phosphate Profile of Children With Severe Acute Malnutrition Treated With Locally Prepared Therapeutic Feeds: A Prospective Observational Study

**Table 1.** Socio-Demographic and Clinical Profile of Children Enrolled in the Study
Variables	N (%)
Age group
6 - 23 months	102 (85.0)
24 - 59 months	18 (15.0)
Sex
Male	55 (45.8)
Female	65 (54.2)
Clinical profile on admission
Not growing well (parental perception)	19 (15.8)
Diarrhea/vomiting	56 (46.7)
Cough/difficulty in breathing	28 (23.4)
Fever	7 (5.8)
Other comorbid conditions
Anemia	85 (70.8)
Rickets	38 (31.7)
Celiac disease	4 (3.3)
Hypothyroidism	1 (0.8)

Table 1. Socio-Demographic and Clinical Profile of Children Enrolled in the Study

Variables

N (%)

Age group

6 - 23 months

102 (85.0)

24 - 59 months

18 (15.0)

Sex

Male

55 (45.8)

Female

65 (54.2)

Clinical profile on admission

Not growing well (parental perception)

19 (15.8)

Diarrhea/vomiting

56 (46.7)

Cough/difficulty in breathing

28 (23.4)

Fever

7 (5.8)

Other comorbid conditions

Anemia

85 (70.8)

Rickets

38 (31.7)

Celiac disease

4 (3.3)

Hypothyroidism

1 (0.8)

**Table 2.** Anthropometric Parameters/Indices on Admission and at Discharge
Variables	On admission, mean (SD)	At discharge, mean (SD)	t-statistics/Chi-square statistics, P-value
WAZ: weight-for-age z-score; HAZ: height-for-age z-score; WHZ: weight-for-height z-score; MUAC: mid-upper arm circumference; SD: standard deviation.
Weight (g)	6,146.17 (1,409.83)	6,395.42 (1,413.51)	t-statistics = 9.30, P < 0.001
WAZ	-4.18 (1.16)	-3.74 (1.02)	t-statistics = 10.69, P < 0.001
HAZ	-2.91 (1.38)	-2.82 (1.30)	t-statistics = 4.00, P < 0.001
WHZ	-3.96 (1.10)	-3.48 (1.00)	t-statistics = 10.92, P < 0.001
MUAC (mm)	108.02 (9.43)	110.75 (8.29)	t-statistics = 7.63, P < 0.001
WHZ < -3	103 (85.80)	82 (68.30)	Chi-square statistics = 10.35, P = 0.001
MUAC < 115 mm	92 (76.70)	83 (69.20)	Chi-square statistics = 1.70, P = 0.19
Bilateral pitting edema	24 (20.0)	0 (0.00)	Chi-square statistics = 26.56, P < 0.001

Table 2. Anthropometric Parameters/Indices on Admission and at Discharge

Variables

On admission, mean (SD)

At discharge, mean (SD)

t-statistics/Chi-square statistics, P-value

WAZ: weight-for-age z-score; HAZ: height-for-age z-score; WHZ: weight-for-height z-score; MUAC: mid-upper arm circumference; SD: standard deviation.

Weight (g)

6,146.17 (1,409.83)

6,395.42 (1,413.51)

t-statistics = 9.30, P < 0.001

WAZ

-4.18 (1.16)

-3.74 (1.02)

t-statistics = 10.69, P < 0.001

HAZ

-2.91 (1.38)

-2.82 (1.30)

t-statistics = 4.00, P < 0.001

WHZ

-3.96 (1.10)

-3.48 (1.00)

t-statistics = 10.92, P < 0.001

MUAC (mm)

108.02 (9.43)

110.75 (8.29)

t-statistics = 7.63, P < 0.001

WHZ < -3

103 (85.80)

82 (68.30)

Chi-square statistics = 10.35, P = 0.001

MUAC < 115 mm

92 (76.70)

83 (69.20)

Chi-square statistics = 1.70, P = 0.19

Bilateral pitting edema

24 (20.0)

0 (0.00)

Chi-square statistics = 26.56, P < 0.001

**Table 3.** Changes in Serum Phosphate Profile From Admission to Discharge
Phosphate profile	Admission, N (%)	Transition, N (%)	Discharge, N (%)
Normophosphatemia	86 (71.7)	86 (71.7)	97 (80.8)
Hypophosphatemia	30 (25.0)	28 (23.3)	10 (8.3)
Hyperphosphatemia	4 (3.3)	6 (5.0)	13 (10.8)
Total	120 (100.0)	120 (100.0)	120 (100.0)

Table 3. Changes in Serum Phosphate Profile From Admission to Discharge

Phosphate profile

Admission, N (%)

Transition, N (%)

Discharge, N (%)

Normophosphatemia

86 (71.7)

97 (80.8)

Hypophosphatemia

30 (25.0)

28 (23.3)

10 (8.3)

Hyperphosphatemia

4 (3.3)

6 (5.0)

13 (10.8)

Total

120 (100.0)

**Table 4.** Comparison of Serum Phosphate Levels on Admission, Transition and Discharge in Subjects With Different Clinical Characteristics Present on Admission
Mean serum phosphate	Clinical characteristics on admission	Status	Mean (SD), mg/dL	P value*
*Unpaired t-test. SD: standard deviation.
Admission	Diarrhea	Yes	4.32 (1.07)	0.569
		No	4.43 (1.06)
Transition		Yes	4.51 (1.34)	0.772
		No	4.44 (0.98)
Discharge		Yes	5.19 (1.10)	0.569
		No	5.07 (1.09)
Admission	Dehydration	Yes	4.42 (1.06)	0.693
		No	4.34 (1.08)
Transition		Yes	4.45 (1.30)	0.891
		No	4.48 (1.08)
Discharge		Yes	5.2 (1.22)	0.578
		No	5.09 (1.02)
Admission	Edema	Yes	4.31 (1.11)	0.713
		No	4.39 (1.06)
Transition		Yes	4.21 (1.16)	0.211
		No	4.54 (1.16)
Discharge		Yes	4.79 (1.13)	0.089
		No	5.22 (1.08)

Table 4. Comparison of Serum Phosphate Levels on Admission, Transition and Discharge in Subjects With Different Clinical Characteristics Present on Admission

Mean serum phosphate

Clinical characteristics on admission

Status

Mean (SD), mg/dL

P value*

*Unpaired t-test. SD: standard deviation.

Admission

Diarrhea

Yes

4.32 (1.07)

0.569

4.43 (1.06)

Transition

Yes

4.51 (1.34)

0.772

4.44 (0.98)

Discharge

Yes

5.19 (1.10)

0.569

5.07 (1.09)

Admission

Dehydration

Yes

4.42 (1.06)

0.693

4.34 (1.08)

Transition

Yes

4.45 (1.30)

0.891

4.48 (1.08)

Discharge

Yes

5.2 (1.22)

0.578

5.09 (1.02)

Admission

Edema

Yes

4.31 (1.11)

0.713

4.39 (1.06)

Transition

Yes

4.21 (1.16)

0.211

4.54 (1.16)

Discharge

Yes

4.79 (1.13)

0.089

5.22 (1.08)

**Table 5.** Comparison of Serum Phosphate Profile on Admission, Transition and Discharge Between Children With Edema and Without Edema on Admission
	Edema on admission	Hypophosphatemia	Normophosphatemia	Hyperphosphatemia	P value*
*Chi-square test.
Admission	Yes	8 (33.33%)	16 (66.67%)	0 (0%)	0.379
	No	22 (22.90%)	70 (72.70%)	4 (4.2%)
Transition	Yes	11 (45.82%)	12 (50%)	1 (4.2%)	0.014
	No	17 (17.7%)	74 (77%)	5 (5.30%)
Discharge	Yes	5 (20.8%)	16 (66.67%)	3 (13%)	0.040
	No	5 (5.2%)	81 (84.40%)	13 (13.4%)

Table 5. Comparison of Serum Phosphate Profile on Admission, Transition and Discharge Between Children With Edema and Without Edema on Admission

Edema on admission

Hypophosphatemia

Normophosphatemia

Hyperphosphatemia

P value*

*Chi-square test.

Admission

Yes

8 (33.33%)

16 (66.67%)

0 (0%)

0.379

22 (22.90%)

70 (72.70%)

4 (4.2%)

Transition

Yes

11 (45.82%)

12 (50%)

1 (4.2%)

0.014

17 (17.7%)

74 (77%)

5 (5.30%)

Discharge

Yes

5 (20.8%)

16 (66.67%)

3 (13%)

0.040

5 (5.2%)

81 (84.40%)

13 (13.4%)

**Table 6.** Predictors of Hypophosphatemia Among Children on Admission
	Odds ratio	95% CI
*P < 0.01, P < 0.05, *P < 0.10. WAZ: weight-for-age z-score; PTH: parathyroid hormone; CI: confidence interval.
Age group (0 - 23 months = 0 and 24 - 59 months = 1)	22.05***	4.12 - 118.02
Gender (male = 1, female = 0)	0.22**	0.06 - 0.90
Weight for age z-score (WAZ) on admission	1.77*	0.98 - 3.20
Exclusive breastfeeding (yes = 1, no = 0)	2.11	0.52 - 8.58
Dehydration (yes = 1, no = 0)	1.09	0.26 - 4.50
Bilateral pitting edema (yes = 1, no = 0)	0.44	0.07 - 2.64
Micronutrient deficiency (yes = 1, no = 0)	3.06	0.72 - 12.99
Potassium profile (hypo = 1, normal = 0)	6.67**	1.18 - 37.88
Sodium profile (hypo = 1, normal = 0)	3.60*	0.85 - 15.21
Calcium profile (hypo = 1, normal = 0)	0.36	0.10 - 1.34
Vitamin D (deficient = 1, normal = 0)	0.71	0.22 - 2.28
PTH profile (hypo = 1, normal = 0)	0.15	0.02 - 1.42
Anemia (yes = 1, no = 0)	4.19*	0.86 - 20.40
Constant	0.62

Table 6. Predictors of Hypophosphatemia Among Children on Admission

Odds ratio

95% CI

***P < 0.01, **P < 0.05, *P < 0.10. WAZ: weight-for-age z-score; PTH: parathyroid hormone; CI: confidence interval.

Age group (0 - 23 months = 0 and 24 - 59 months = 1)

22.05***

4.12 - 118.02

Gender (male = 1, female = 0)

0.22**

0.06 - 0.90

Weight for age z-score (WAZ) on admission

1.77*

0.98 - 3.20

Exclusive breastfeeding (yes = 1, no = 0)

2.11

0.52 - 8.58

Dehydration (yes = 1, no = 0)

1.09

0.26 - 4.50

Bilateral pitting edema (yes = 1, no = 0)

0.44

0.07 - 2.64

Micronutrient deficiency (yes = 1, no = 0)

3.06

0.72 - 12.99

Potassium profile (hypo = 1, normal = 0)

6.67**

1.18 - 37.88

Sodium profile (hypo = 1, normal = 0)

3.60*

0.85 - 15.21

Calcium profile (hypo = 1, normal = 0)

0.36

0.10 - 1.34

Vitamin D (deficient = 1, normal = 0)

0.71

0.22 - 2.28

PTH profile (hypo = 1, normal = 0)

0.15

0.02 - 1.42

Anemia (yes = 1, no = 0)

4.19*

0.86 - 20.40

Constant

0.62