PEM

1. NUTRITIONAL DISEASE
Dr.T.Arivazhagan
Post graduate
Dept.Of.Pathology

2. PROTEIN ENERGY
MALNUTRITION

3. • Malnutrition also referred as PEM
• Inadequate intake of proteins & calories
• Deficiencies in the digestion & absorption
• Resulting loss of fat, muscle tissue,
weight loss,lethargy,generalized weakness

4. Appropriate diet
•Should provide sufficient energy
•Amino acids & fatty acids used for
synthesis of proteins
•Vitamins & minerals function as co
enzyme

5. •One or all of the
these components
are missing
Primary
•Malabsorption,
•Impaired
utilization
secondary

6. Etiology
• Poverty
• Infections
• Acute & chronic illness
• Chronic alcoholism – Thiamine deficiency
• Ignorance & failure of diet supplementation
• Self imposed dietary restriction

7. PEM
•Serious , often lethal disease
•Children's
•High death rate children's
<5years of age

8. Malnutrition determined by
• Body mass index
• Weight in kilograms / Height in meters squared
• Normal 18.5 to 25kg/m²
• BMI < 16kg/m² - malnourished

9. Other parameters…..
•Evaluation of fat stores -
Thickness of skin fold
•Muscle mass – Mid arm
circumference
•Serum proteins

10. Types
• Marasmus
• Kwashiorkor
Functional aspect:
• Somatic compartment - Proteins in the skeletal muscle
• Visceral compartment – Proteins in the visceral organs

11. Marasmus
• Weight falls to 60% of normal for sex,height,age
• Growth retardation
• Loss of muscle
• Depletion of somatic compartment
• Visceral compartment normal
• So serum albumin levels normal or slightly reduced
• Extremities are emaciated
• Anemia

15. Reduced leptin level
Stimulate the HPA
Produce high level of cortisol
lipolysis

16. kwashiorkor
• Occurs when protein deprivation is more then deficit of total calories
• Severe depletion of visceral compartment
• Resultant hypoalbuminemia
• Generalized or dependent edema
• Weight loss is masked by edema
• Skin lesion – hyperpigmentation, desquamation,
hypopigmentation
• Flaky paint appearance
• Hair changes – loss of hair or alternating pale or dark colour hair
• Fatty liver
• Defects in immunity – secondary infections

18. Morphology
• Main anatomic changes
• Growth failure
• Peripheral edema – kwashiorkor
• Liver enlarged – kwashiorkor
• Loss of fat , muscle – Marasmus
• Small bowel – Mucosal atrophy, loss of villi & microvilli
• Bone marrow – Hypoplastic nature
• Brain – Reduced number of neuron
• Thymic or lymphoid atrophy

19. Cachexia
• PEM is common complication in AIDS & advanced cancer
• Cachexia occurs in GIT , pancreatic, lung cancer patient
• Exact pathogenesis not known
• Mediators released from the tumor cells contributes its
development
• Proteolysis inducing factor
• Lipid mobilizing factor

20. TNF &
CYTOKINES
PIF
TUMOUR
NF - ҡB
NUCLEUS –
TRANSCRPITION
FACTOR
MUSCLE
SPECIFIC
UBIQUITIN
LIGASES
MYOSIN
HEAVY
CHAIN
PROTEASOME
LOSS OF
MYOFIBRILS &
MUSCLE MASS