Nagaraj S. Javali1, Shashikala P2, Nasima Banu3, Ramya R4
INTRODUCTION: Protein energy malnutrition is one of the leading causes of childhood mortality and morbidity in developing countries. (1) It is a global health problem which starts in womb and ends in tomb. Protein energy malnutrition is a disease of multi-deprivation and poverty affecting nearly 150 million children under the age of 5 years in the world. Out of the 120 million children in India, 75 million are estimated to suffer from visible protein energy malnutrition. (2) Three countries, India, Bangladesh, Pakistan account for half of world’s underweight children despite having just 29 percent of the developing world’s under five population.(3) It is not only an important cause of childhood morbidity and mortality but leads to permanent impairment of physical and possibly of mental growth. Magnesium is essential for bioenergetic reactions controlling fuel oxidation, membrane transport and signal transmission contributing to the action of more than 300 enzymes.(4) It is important for membrane stabilization and nerve conduction. Adenosine triphosphate and Guanosine triphosphate (GTP) need associated magnesium when they are used by ATPases, cyclases and kinases. However hypomagnesaemia may produce hypokalaemia that only corrects with magnesium therapy(5) Magnesium deficiency may cause grave disturbances including neurologic signs such as twitching, tremors and convulsions(6) Magnesium decreases calcium uptake by the cells, inhibits smooth muscle contractility, inhibits histamine and acetyl choline release and depresses excitability of smooth muscle fibres. Thus it has bronchodilator and anti-inflammatory properties.(2) Magnesium modulates vasomotor tone, blood pressure and peripheral blood flow. Magnesium deficiency is known to trigger vasoconstriction and enhances vascular endothelial injury. (1,7) On the other hand ET-1(endothelin -1) is a potent vasoconstrictor peptide. Results of a previous study showed that the mean serum endothelin-1 levels in a group with low magnesium levels were significantly higher than that of group with normal magnesium levels in malnourished children(p<0.05).(8) An article cites evidence in support of a hypothesis that a fall in magnesium levels triggers a temporal sequence of events involving vasoconstriction, hemodynamic alterations and vascular endothelial injury to produce pro-inflammatory, pro- oxidant and pro-fibrogenic effects resulting in initial perivascular myocardial damage and replacement fibrosis.(7) Dietary magnesium deficiency is more prevalent than generally suspected and can cause cardiovascular lesions leading to diseases in all stages of life. Magnesium deficiency leads to cardiac arrhythmias that are refractory unless magnesium is added to regimen.(9) Rich sources of magnesium include legumes, nuts, bananas and whole grains.(4) So knowing the patho-physiology of magnesium deficiency in human body it is very clear the damage that occurs in a malnourished child who is already in a oxidative stress. As a result this study will help us to know the poor outcome of protein energy malnutrition child with hypomagnesaemia (serum magnesium level <1.5mg/dl).
