1.

Laboratory Examinations

Other than scoring systems, laboratory examinations are often done to diagnose
malnutrition either in children or in adults and other age groups, with serum protein tests
playing the main role to do so. Based on a 2016 review by Bharadawaj et al, there are
numerous markers that can be drew from blood to determine the nutritional status of
patients.1

Albumin, prealbumin, transferrin, and retinol-binding protein are serum proteins that are
already used by physicians on a frequent basis to know the nutritional status of a patient.
However, the evidence of their specificity in determining malnutrition is arguable. Albumin
has a lot of other modifying factors such as diseases and traumas, so that it is better to be used
to define inflammation status of the patient. A study showed that there is no correlation
between transferrin, an iron transporter, and fat free mass, proving that this protein can’t be
relied on. Prealbumin and retinol-binding protein rises and decreases rapidly, showing short-
term effects of nutritional modifications. Therefore, they can be used to detect early
malnutrition, with prealbumin as the more sensitive serum marker. Other serum marker, C-
reactive protein and total lymphocyte count are also proven as poor markers to determine
nutritional status.1

While having other serum markers as poor indicators, transthyretin showed a good result
in a 2017 cross-sectional study to distinguish malnourished and the normal ones in children
under five years old. This serum protein can only be producted with essential amino acid
tryptophan at high concentration, so that low level of transthyretin reflects impairment in
hepatic synthesis of plasma protein. Despite having a rapid turnover, the study still showed a
good result in malnutritioned children in Ethiopia taken at a time. Transthyretin could be used
to complement physical examinations in diagnosing malnutrition in children below five years
old.2
1. Bharadwaj S, Ginoya S, Tandon P, et al. Malnutrition : laboratory markers vs
nutritional assessment. 2016;4(December 2015):272-280. doi:10.1093/gastro/gow013

2. Tsegaye B, Mekasha A, Genet S. Serum Transthyretin Level as a Plausible Marker for

Diagnosis of Child Acute Malnutrition. 2017;2017. doi:10.1155/2017/9196538