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Protein energy malnutrition
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.
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Protein energy malnutrition
- 1. PROTEIN ENERGY MALNUTRITION Dr.RittuChandel Second year resident Grant Government Medical College 02 -01-2013 1 Rittu Chandel
- 2. The World HealthOrganization (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 2 Rittu Chandel
- 3. Marasmus • Greek wordmarasmos, 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 3 Rittu Chandel
- 4. A global problem Firstnational nutritional disorder Childhood mortality and morbidity Physical impairment Retardation of mental growth ‘Protein gap’ replaced by ‘food gap’ 4 Rittu Chandel
- 5. CAUSES Worldwide, the mostcommon cause of is inadequate food intake ineffective weaning poor hygiene, economic factors, and cultural factors Gastrointestinal infections malnutrition 5 infection Rittu Chandel
- 6. Early detection First indicator– underweight for age Method – maintenance of growth charts 6 Rittu Chandel
- 7. CAUSES by decreased absorptionor abnormal metabolism Burns cystic fibrosis chronic renal failure childhood malignancies congenital heart disease neuromuscular diseases psychiatric diseases, such as anorexia nervosa 7 Rittu Chandel
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- 9. MARASMUS insufficient energy intaketo 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 9 Rittu Chandel
- 10. KWASHIORKAR adequate carbohydrate consumption decreasedprotein intake Duration : weeks edema, moon facies a swollen abdomen (potbelly) Poor appetite Irritable, moaning cry 10 Rittu Chandel
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- 12. Hypoalbuminemia -Impaired synthesis ofB-lipoprotein produces a fatty liver - Atrophy of pancreas,salivary gland and intestine hair-pull analysis Flaky paint dermatosis Pavement dermatosis 12 Rittu Chandel
- 13. elderly persons indicative signof 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 13 Rittu Chandel
- 14. Marasmic Kwashiorkar Initially marasmic-------thenoedema develops 14 Rittu Chandel
- 15. Laboratory Studies The WHOrecommends 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 15 Rittu Chandel
- 16. Cellular reactions toprotein deficiency Decrease cellular RNA Decreased protein catabolism Decreased DNA synthesis Decreased formation of new cells 16 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 toprotein 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 Rittu Chandel Decreased DNA synthesis
- 18. Kwashiorkar Proteins - decreases hypoalbuminemia(< 2.8 g/dl) Hypoglobulinemia • Amino acids essential amino acids ( branched ones) – decreases Non essential - tyrosine, arginine, citrulline, ᵧ- amino butyric acid - decreases Ratio – branched essential amino acids glycine, glutamic acid, serine Incomplete metabolism of histidine, phenylalanine, tryptophan 18 Rittu Chandel
- 19. KWASHIORKAR transferrin (<150 mg/dl) Ironbinding 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 19 Rittu Chandel
- 20. MARASMUS Urinary excretion ofhydroxyproline diminished, reflecting impaired growth and wound healing Increased urinary 3-methylhistidine is a reflection of muscle breakdown Creatinine – height index –low (< 60%) 20 Rittu Chandel
- 21. PREVENTIVE MEASURES From WHOexpert 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 21 Rittu Chandel
- 22. Specific Protection 1.Immunization 2.Food fortification 3.Dietmust 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 22 Rittu Chandel
- 23. treatment PH A SE STA 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 23 Day 2-7+ n o iron R E H AB IL IT A T IO N W eek 2-6 with iron Rittu Chandel
- 24. Bibliography Harrisons internal Medicine17th edition Nelsons Pediatrics IAP pediatrics Parks Preventive Social and Medicine Talwar THANK YOU 24 Rittu Chandel