Protein-energy malnutrition (PEM) is a pathological condition arising from a lack of proteins and calories, most common in infants and young children. It manifests as marasmus, due to calorie deficiency, or kwashiorkor, due to protein deficiency. PEM is a global problem causing childhood mortality and morbidity. Causes include inadequate food intake, infections, and poor hygiene. Treatment involves stabilizing the patient, rebuilding tissues, and preparing for follow-up rehabilitation. Preventive measures encompass promoting breastfeeding, improving family diets, and early diagnosis and treatment of infections.
2.
The World Health Organization (WHO) defines
malnutrition as "the cellular imbalance between the supply
of nutrients and energy and the body's demand for them to
ensure growth, maintenance, and specific functions.”
WHO defines PEM as range of pathological conditions
arising from coincidental lack in varying proportions of
proteins and calories, occuring most frequently in infants,
young children
Protein-energy malnutrition - weight loss of greater than
10% of normal body weight
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3. Marasmus
• Greek word marasmos, which
means withering or wasting.
• Chronic state of insufficient
calorie intake
• characterized by emaciation
kwashiorkar
• the Ga language of Ghana and
means "the sickness of the
weaning."
• Insufficient protein intake
• characteristic is edema
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A global problem
First national nutritional disorder
Childhood mortality and morbidity
Physical impairment
Retardation of mental growth
‘Protein gap’ replaced by ‘food gap’
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5. CAUSES
Worldwide, the most common cause of is inadequate food
intake
ineffective weaning
poor hygiene, economic factors, and cultural factors
Gastrointestinal infections
malnutrition
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9. MARASMUS
insufficient energy intake to match the
body's requirements
Duration : months to years
Emaciation
loss of subcutaneous fat
muscle wasting
an adaptive response to starvation
skin is xerotic, wrinkled, and loose
Monkey facies
fine, brittle hair; alopecia; impaired growth; and fissuring of the
nails
Good appetite
Listless
Temperature - subnormal
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Hypoalbuminemia
-Impaired synthesis of B-lipoprotein
produces a fatty liver
- Atrophy of pancreas,salivary gland
and intestine
hair-pull analysis
Flaky paint dermatosis
Pavement dermatosis
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13. elderly persons
indicative sign of malnutrition is delayed healing
decubitus ulcers
increased likelihood of calciphylaxis, a small vessel
vasculopathy involving mural calcification with intimal
proliferation, fibrosis, and thrombosis. As a result,
ischemia and necrosis of skin occurs. Other tissues
affected include subcutaneous fat, visceral organs, and
skeletal muscle
Noma
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Laboratory Studies
The WHO recommends the following laboratory tests:
Blood glucose
Examination of blood smears
Hemoglobin
Urine examination and culture
Stool examination by microscopy for ova and parasites
Serum albumin
HIV test
Electrolytes
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16.
Cellular reactions to protein deficiency
Decrease
cellular RNA
Decreased protein
catabolism
Decreased DNA
synthesis
Decreased formation
of new cells
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CNS –delayed mental development
Immunologically competent cells – deficient immune response
Decreased myeloid, monocytes – susceptibility to infection
Decreased erythrocytes – anemia
Endochondral bone growth - growth retardation
Hair follicle – atrophy
Stomach and small intestine - malabsorption
17.
Cellular reactions to protein calorie deficiency
Decrease
cellular RNA
Fall in tissue and
cellular proteins and
enzymes
Anatomical changes –
Fatty liver
Atrophy of pancreas, salivary
glands
Decreased protein
catabolism
Delayed
mental
development
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Decreased DNA
synthesis
19. KWASHIORKAR
transferrin (<150 mg/dl)
Iron binding capacity < 200 mcg/dl
hypoglycemia
lymphopenia
growth hormone levels are high
insulin secretion and insulin like growth factor levels are
decreased.
percentage of body water and extracellular water is increased
potassium and magnesium depleted
iron deficiency anemia
lactase, amylase, lipase - reduced
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20. MARASMUS
Urinary excretion of hydroxyproline diminished, reflecting
impaired growth and wound healing
Increased urinary 3-methylhistidine is a reflection of muscle
breakdown
Creatinine – height index –low (< 60%)
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21. PREVENTIVE MEASURES
From WHO expert committee on nutrition
Health Promotion
1.Measures directed to pregnant and lactating women
2.Promotion of breast feeding
3.Meal given at frequent intervals
4.Improve family diet
5.Promotion of correct feeding practices
6.Family planning and spacing of births
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22.
Specific Protection
1.Immunization
2.Food fortification
3.Diet must contain protein and energy rich foods – milk, egg,
fresh fruit
Early Diagnosis and treatment
1.Early diagnosis of any lag of growth
2. Early diagnosis and treatment of infections and diarrhea
3.Rehydration
4.deworming
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23. treatment
PH A SE
ST A B IL ISA T IO N
D ay 1-2
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
H yp oglycaem ia
H yp oth erm ia
D eh ydration
E lectrolytes
In fection
M icronutrients
C autious feedin g
Rebuild tissues
Sen sory stim ulation
Prepare for follow-up
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Day 2-7+
n o iron
R E H AB IL IT A T IO N
W eek 2-6
with iron
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