Serum concentrations of sex hormone binding globulin are elevated in kwashiorkor and anorexia nervosa but not in marasmus.
BACKGROUND
Customary blood protein markers for malnutrition are of limited value in the diagnosis of protein-energy malnutrition or anorexia nervosa in children and in the follow-up to refeeding in such children.


OBJECTIVE
For these diseases, we compared the diagnostic value of sex hormone binding globulin (SHBG) with that of albumin, transferrin, transthyretin, and retinal binding protein and determined the relations between concentrations of insulin, insulin-like growth factor I, and SHBG.


METHODS
SHBG was assayed in children with protein-energy malnutrition (29 children with kwashiorkor and 28 with marasmus), in 29 anorectic girls (before and after refeeding), and in age- and sex-matched control subjects.


RESULTS
Mean (+/-SE) serum SHBG concentrations were higher in the children with kwashiorkor (0.18 +/- 0.07 micromol/L) than in the children with marasmus (0.11 +/- 0.05 micromol/L, P < 0.0001) or the control subjects (0.11 +/- 0.03 micromol/L, P < 0.0005). In the children with anorexia nervosa before weight gain, serum SHBG concentrations were significantly higher (0.10 +/- 0.04 micromol/L) than in the age-matched control subjects (0.06 +/- 0.03 micromol/L, P < 0.001) and decreased significantly after 30 d of refeeding (0.04 +/- 0.01 micromol/L, P < 0.0001). This decrease was negatively correlated with insulin-like growth factor I but not with insulin. Mean serum SHBG concentrations were influenced neither by inflammation, as indicated when C-reactive protein was used as a marker (0.27 +/- 0.27, 0.34 +/- 0.42, and <0.04 micromol/L in the children with marasmus, kwashiorkor, and anorexia nervosa, respectively), nor by glomerular filtration, as indicated when cystatin-C was used as a marker (68.46 +/- 23.08, 66.90 +/- 43.08, and 49.23 +/- 7.69 micromol/L, respectively).


CONCLUSIONS
The high SHBG concentration observed in anorexia nervosa and kwashiorkor seems to be of multifactorial origin. For these 2 diseases, SHBG is a reliable marker of nutritional status, is unrelated to either C-reactive protein or cystatin-C, and may be helpful in distinguishing kwashiorkor from marasmus and as a follow-up marker after refeeding.
Pascal
Nathalie
N
Laboratoire de Pathologie Cellulaire et Moléculaire en Nutrition, EMI INSERM 0014 et URM IFREMER 20, Faculté de Médecine, Vandoeuvre, France.
Amouzou
Emile Kou Santa
EK
Sanni
Ambeliou
A
Namour
Farès
F
Abdelmouttaleb
Idrissia
I
Vidailhet
Michel
M
Guéant
Jean-Louis
JL
D000293:Adolescent; D000856:Anorexia Nervosa / Q000097:blood* / Q000628:therapy; D015415:Biomarkers / Q000097:blood*; D002352:Carrier Proteins / Q000097:blood; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007328:Insulin / Q000097:blood / Q000502:physiology; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D007732:Kwashiorkor / Q000097:blood*; D008297:Male; D011228:Prealbumin / Q000032:analysis; D011502:Protein-Energy Malnutrition / Q000097:blood*; D012709:Serum Albumin / Q000032:analysis; D012738:Sex Hormone-Binding Globulin / Q000032:analysis*; D014168:Transferrin / Q000032:analysis; D015430:Weight Gain
C020932:11-cis-retinal-binding protein; D015415:Biomarkers; D002352:Carrier Proteins; D007328:Insulin; D011228:Prealbumin; D012709:Serum Albumin; D012738:Sex Hormone-Binding Globulin; D014168:Transferrin; D007334:Insulin-Like Growth Factor I