Protein energy malnutrition pathophysiology

Jump to navigation Jump to search

Protein energy malnutrition Microchapters

Home

Patient Information

Kwashiorkor
Marasmus

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Protein energy malnutrition from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Protein energy malnutrition pathophysiology On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Protein energy malnutrition pathophysiology

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Protein energy malnutrition pathophysiology

CDC on Protein energy malnutrition pathophysiology

Protein energy malnutrition pathophysiology in the news

Blogs on Protein energy malnutrition pathophysiology

Kwashiorkor

Risk calculators and risk factors for Protein energy malnutrition pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2], Syed Hassan A. Kazmi BSc, MD [3]

Overview

Protein-energy malnutrition represents a shift of the body from fed to fasting/starvation state. Starvation leads to a decreased basal plasma insulin concentration and in decrease of glucose-stimulated insulin secretion. Prolonged fasting results in a deficiency in amino acids used for gluconeogenesis. It is thought that kwashiorkor is produced by a deficiency in the adequate consumption of protein-rich foods during the weaning process. However, the associated edema is not fully understood. Several theories have been put forward to explain this finding. Marasmus on the other hand is thought to be due to the total caloric deficiency leading to wastingin a child. Marasmus always results from a negative energy balance.

Pathophysiology

Several studies have shown that a deficiency in the consumption of protein, carbohydrates and fat is responsible for the development of protein-energy malnutrition. However, other studies have proposed that chronic infections such as helminthic infections are mainly responsible for the development of protein-energy malnutrition.[1] The underlying mechanisms include the following:

The pathologic changes involved in protein-energy malnutrition include:[2]

Pathogenesis

Hormonal and molecular mechanisms (fed to starvation state)

Insulin and glucagon in starvation

Eventual decreased gluconeogenesis in protein-energy malnutrition

  • Prolonged fasting results in a deficiency in amino acids used for gluconeogenesis.
  • Glucagon concentrations have been found to be lower in children with kwashiorkor compared with marasmus but similar to normal controls.[6]

Malnutrition, Leptin, and Immunity

Pathogenesis of marasmus

Pathogenesis of edema in kwashiorkor

Several theories have been postulated to explain the mechanism of edema seen in children with kwashiorkor. Some of them include:

1. Protein deficiency / hypoalbuminemia

It was initially believed that a deficiency in the consumption of protein was responsible for the development of kwashiorkor in children.

Multiple evidences have now shown that inadequate intake of dietary protein is not the primary trigger for edematous malnutrition.

2. Oxidant stress

3. Microbiome

Genetics

Protein-energy malnutrition is frequently reported in Cri du chat syndrome(CDS), a genetic disease that causes developmental delay and global growth retardation.

Associated conditions

Some of the conditions that are associated with kwashiorkor include:

Gross pathology

Post mortem examination of the liver shows the presence of fatty infiltration and necrosis which disappears with adequate treatment.[18]

Microscopic pathology

Both in kwashiorkor and marasmus hair analysis is therefore advocated as a useful diagnostic procedure for both conditions. In both cases, there is a decrease in the amount of melanin present in the scalp hair.

Kwashiorkor

Marasmus

References

  1. Cederholm T, Jägrén C, Hellström K (1995). "Outcome of protein-energy malnutrition in elderly medical patients". Am J Med. 98 (1): 67–74. doi:10.1016/S0002-9343(99)80082-5. PMID 7825621.
  2. Lerner AB (1971). "On the etiology of vitiligo and gray hair". Am J Med. 51 (2): 141–7. PMID 5095523.
  3. Saudek CD, Boulter PR, Arky RA (1973). "The natriuretic effect of glucagon and its role in starvation". J. Clin. Endocrinol. Metab. 36 (4): 761–5. doi:10.1210/jcem-36-4-761. PMID 4686383.
  4. Hedeskov CJ, Capito K (1974). "The effect of starvation on insulin secretion and glucose metabolism in mouse pancreatic islets". Biochem. J. 140 (3): 423–33. PMC 1168019. PMID 4155624.
  5. "Wiley: Metabolism at a Glance, 3rd Edition - J. G. Salway".
  6. "Pediatric Research - Mechanisms Behind Decreased Endogenous Glucose Production in Malnourished Children".
  7. Scrimshaw NS, SanGiovanni JP (1997). "Synergism of nutrition, infection, and immunity: an overview". Am. J. Clin. Nutr. 66 (2): 464S–477S. PMID 9250134.
  8. Monk JM, Makinen K, Shrum B, Woodward B (2006). "Blood corticosterone concentration reaches critical illness levels early during acute malnutrition in the weanling mouse". Exp. Biol. Med. (Maywood). 231 (3): 264–8. PMID 16514171.
  9. Auphan N, Didonato JA, Helmberg A, Rosette C, Karin M (1997). "Immunoregulatory genes and immunosuppression by glucocorticoids". Arch. Toxicol. Suppl. 19: 87–95. PMID 9079197.
  10. Coulthard MG (2015). "Oedema in kwashiorkor is caused by hypoalbuminaemia". Paediatr Int Child Health. 35 (2): 83–9. doi:10.1179/2046905514Y.0000000154. PMC 4462841. PMID 25223408.
  11. Golden MH (1998). "Oedematous malnutrition". Br Med Bull. 54 (2): 433–44. PMID 9830208.
  12. Manary MJ, Heikens GT, Golden M (2009). "Kwashiorkor: more hypothesis testing is needed to understand the aetiology of oedema". Malawi Med J. 21 (3): 106–7. PMC 3717490. PMID 20345018.
  13. Golden MH (2015). "Nutritional and other types of oedema, albumin, complex carbohydrates and the interstitium - a response to Malcolm Coulthard's hypothesis: Oedema in kwashiorkor is caused by hypo-albuminaemia". Paediatr Int Child Health. 35 (2): 90–109. doi:10.1179/2046905515Y.0000000010. PMID 25844980.
  14. Ciliberto H, Ciliberto M, Briend A, Ashorn P, Bier D, Manary M (2005). "Antioxidant supplementation for the prevention of kwashiorkor in Malawian children: randomised, double blind, placebo controlled trial". BMJ. 330 (7500): 1109. doi:10.1136/bmj.38427.404259.8F. PMC 557886. PMID 15851401.
  15. Smith MI, Yatsunenko T, Manary MJ, Trehan I, Mkakosya R, Cheng J; et al. (2013). "Gut microbiomes of Malawian twin pairs discordant for kwashiorkor". Science. 339 (6119): 548–54. doi:10.1126/science.1229000. PMC 3667500. PMID 23363771.
  16. Prentice AM, Nabwera H, Kwambana B, Antonio M, Moore SE (2013). "Microbes and the malnourished child". Sci Transl Med. 5 (180): 180fs11. doi:10.1126/scitranslmed.3006212. PMID 23576812.
  17. Kau AL, Planer JD, Liu J, Rao S, Yatsunenko T, Trehan I; et al. (2015). "Functional characterization of IgA-targeted bacterial taxa from undernourished Malawian children that produce diet-dependent enteropathy". Sci Transl Med. 7 (276): 276ra24. doi:10.1126/scitranslmed.aaa4877. PMC 4423598. PMID 25717097.
  18. Lefranc, Violaine; de Luca, Arnaud; Hankard, Régis (2016). "Protein-energy malnutrition is frequent and precocious in children with cri du chat syndrome". American Journal of Medical Genetics Part A. 170 (5): 1358–1362. doi:10.1002/ajmg.a.37597. ISSN 1552-4825.

Template:WH Template:WS