Beyond Anthropometry: A Biochemical Profiling and the Burden of Hidden Hunger Among Under-Five Children in Sokoto State, Nigeria

Abstract: While anthropometric indicators like stunting and wasting provide visible evidence of malnutrition, they often fail to capture the underlying physiological dysregulation caused by micronutrient deficiencies, or "hidden hunger." This study aimed to comprehensively assess the biochemical nutritional status, including protein-energy markers, micronutrient deficiencies, inflammation, and patterns of multiple concurrent deficiencies among children under five years in Sokoto State, Nigeria. A community-based cross-sectional study was conducted among 150 mother-child pairs attending Primary Health Centres in Sokoto State. Venous blood samples were collected and analyzed for a panel of biomarkers: Prealbumin, C-Reactive Protein (CRP), Serum Retinol (Vitamin A), Hemoglobin, Serum Albumin, and Serum Zinc. Descriptive statistics were used to summarize biomarker levels, and prevalence of deficiency was determined using standard clinical cut-offs (WHO, IZiNCG). The burden of multiple concurrent deficiencies was assessed by counting the number of deficiencies present in each child. The biochemical profile revealed a profound and multifaceted nutritional crisis. Protein-energy malnutrition was confirmed by critically low mean Prealbumin (6.8 ± 2.1 mg/dL) and Serum Albumin (3.1 ± 0.5 g/dL) levels, with 94.6% and 64.0% of children deficient, respectively. A rampant burden of "hidden hunger" was evidenced by a 91.3% prevalence of Vitamin A deficiency (28.0% severe) and a 73.3% prevalence of Zinc deficiency (34.7% severe). Furthermore, 78.0% of children had elevated C-Reactive Protein (CRP >3 mg/L), indicating widespread systemic inflammation, while 78.7% were anemic (Hemoglobin <11 g/dL), including 8.0% with severe anemia. Critically, 98.7% of children suffered from at least one deficiency, and 78.7% suffered from three or more concurrent deficiencies. Only 1.3% of children were deficient in none of the biomarkers assessed. The findings reveal a syndemic of protein-energy malnutrition, critical micronutrient deficiencies, and chronic inflammation that underpins the high rates of anthropometric failure in this population. The near-universal prevalence of multiple concurrent deficiencies constitutes a state of comprehensive metabolic failure, systematically compromising immune function, growth, and cognitive development. Public health strategies must urgently move beyond single-nutrient interventions to integrated, multi-micronutrient and multi-sectoral approaches that address dietary diversity, infection control, and the structural determinants of poverty. Keywords: Nutritional Biomarkers, Hidden Hunger, Vitamin A Deficiency, Zinc Deficiency, Anemia, Inflammation, C-Reactive Protein, Multiple Deficiencies, Under-Five Children, Sokoto State. Title: BEYOND ANTHROPOMETRY: A BIOCHEMICAL PROFILING AND THE BURDEN OF HIDDEN HUNGER AMONG UNDER-FIVE CHILDREN IN SOKOTO STATE, NIGERIA Author: Ibrahim Ashafura Musa, Kabir MY International Journal of Novel Research in Healthcare and Nursing ISSN 2394-7330 Vol. 13, Issue 1, January 2026 - April 2026 Page No: 78-92 Novelty Journals Website: www.noveltyjournals.com Published Date: 30-March-2026 DOI: https://doi.org/10.5281/zenodo.19335236 Paper Download Link (Source) https://www.noveltyjournals.com/upload/paper/BEYOND%20ANTHROPOMETRY%20A%20BIOCHEMICAL-30032026-3.pdf