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Pem
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- 3. • Malnutrition alsoreferred 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 providesufficient energy •Amino acids & fatty acids used for synthesis of proteins •Vitamins & minerals function as co enzyme
- 5. •One or allof 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 , oftenlethal 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 offat stores - Thickness of skin fold •Muscle mass – Mid arm circumference •Serum proteins
- 10. Types • Marasmus • Kwashiorkor Functionalaspect: • Somatic compartment - Proteins in the skeletal muscle • Visceral compartment – Proteins in the visceral organs
- 11. Marasmus • Weight fallsto 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 Stimulatethe HPA Produce high level of cortisol lipolysis
- 16. kwashiorkor • Occurs whenprotein 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 anatomicchanges • 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 iscommon 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