Nutritional disease refers to protein energy malnutrition (PEM), which results from inadequate intake of proteins and calories. PEM causes deficiencies in digestion and absorption, resulting in loss of fat, muscle tissue, weight loss and general weakness. PEM is a serious and often lethal condition, especially in children under 5 years old. It has various etiologies including poverty, infections, illness, alcoholism and dietary restrictions. PEM is diagnosed using measurements like body mass index, mid-arm circumference and serum protein levels. The two main types are marasmus, characterized by weight loss and muscle depletion, and kwashiorkor, distinguished by edema and hypoalbuminemia.

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

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

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