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__NOTOC__ | __NOTOC__ | ||
{{ | {{Protein energy malnutrition}} | ||
{{CMG}}; {{AE}} {{DAMI}} | {{CMG}}; {{AE}} {{DAMI}} | ||
==Overview== | ==Overview== | ||
If left untreated, all children with protein energy malnutrition will progress to develop a failure to thrive, poorly developed immune system which causes overwhelming bacteremia and sepsis which is | If left untreated, all children with protein energy malnutrition will progress to develop a [[failure to thrive]], [[Immune system|poorly developed immune system]] which causes overwhelming [[bacteremia]] and [[sepsis]] which is the cause of death in most malnourished individuals. | ||
==Natural history, Complications, Prognosis== | ==Natural history, Complications, and Prognosis== | ||
===Natural history=== | ===Natural history=== | ||
The symptoms of protein energy malnutrition usually develop between the first and fifth year of life, and start with symptoms such as lethargy, irritability, failure to thrive, decreased muscle mass, diarrhea, and recurrent infections due to decreased immunity. | The symptoms of protein energy malnutrition usually develop between the first and fifth year of life, and start with [[symptoms]] such as [[lethargy]], [[irritability]], [[failure to thrive]], [[Atrophy|decreased muscle mass]], [[diarrhea]], and [[Infections|recurrent infections]] due to [[Immunity|decreased immunity]]. Without treatment patients with protein energy malnutrition which comprises of [[kwashiorkor]] and [[marasmus]] present with changes in their facial appearance with children with [[kwashiorkor]] having [[Moon face|moon faces]] while those with [[marasmus]] develop monkey-like face due to loss of [[subcutaneous fat]] pad in the cheeks. There is [[generalized edema]], [[hepatomegaly]], [[Skin changes|changes in skin]], [[Hair|hair color]] and texture, [[Infections|recurrent infections]] like [[diarrhea]] with [[kwashiorkor]] which will eventually lead to overwhelming [[shock]] and [[sepsis]] and death.<ref name="pmid27237815">{{cite journal |vauthors=Bourke CD, Berkley JA, Prendergast AJ |title=Immune Dysfunction as a Cause and Consequence of Malnutrition |journal=Trends Immunol. |volume= |issue= |pages= |year=2016 |pmid=27237815 |pmc=4889773 |doi=10.1016/j.it.2016.04.003 |url=}}</ref><ref name="pmid25153531">{{cite journal |vauthors=Rytter MJ, Kolte L, Briend A, Friis H, Christensen VB |title=The immune system in children with malnutrition--a systematic review |journal=PLoS ONE |volume=9 |issue=8 |pages=e105017 |year=2014 |pmid=25153531 |pmc=4143239 |doi=10.1371/journal.pone.0105017 |url=}}</ref><ref name="pmid12514318">{{cite journal |vauthors=Scrimshaw NS |title=Historical concepts of interactions, synergism and antagonism between nutrition and infection |journal=J. Nutr. |volume=133 |issue=1 |pages=316S–321S |year=2003 |pmid=12514318 |doi= |url=}}</ref> | ||
===Complications=== | ===Complications=== | ||
Complications that can develop as a result of protein energy malnutrition are:<ref name="pmid12700964">{{cite journal |vauthors=Bagga A, Tripathi P, Jatana V, Hari P, Kapil A, Srivastava RN, Bhan MK |title=Bacteriuria and urinary tract infections in malnourished children |journal=Pediatr. Nephrol. |volume=18 |issue=4 |pages=366–70 |year=2003 |pmid=12700964 |doi=10.1007/s00467-003-1118-0 |url=}}</ref><ref name="pmid25475887">{{cite journal |vauthors=Jones KD, Berkley JA |title=Severe acute malnutrition and infection |journal=Paediatr Int Child Health |volume=34 Suppl 1 |issue= |pages=S1–S29 |year=2014 |pmid=25475887 |pmc=4266374 |doi=10.1179/2046904714Z.000000000218 |url=}}</ref><ref name="pmid26084628">{{cite journal |vauthors=Ahmed M, Moremi N, Mirambo MM, Hokororo A, Mushi MF, Seni J, Kamugisha E, Mshana SE |title=Multi-resistant gram negative enteric bacteria causing urinary tract infection among malnourished underfives admitted at a tertiary hospital, northwestern, Tanzania |journal=Ital J Pediatr |volume=41 |issue= |pages=44 |year=2015 |pmid=26084628 |pmc=4472394 |doi=10.1186/s13052-015-0151-5 |url=}}</ref><ref name="pmid1471885">{{cite journal |vauthors=Doherty JF, Adam EJ, Griffin GE, Golden MH |title=Ultrasonographic assessment of the extent of hepatic steatosis in severe malnutrition |journal=Arch. Dis. Child. |volume=67 |issue=11 |pages=1348–52 |year=1992 |pmid=1471885 |pmc=1793750 |doi= |url=}}</ref><ref name="pmid26553908">{{cite journal |vauthors=Silverman JA, Chimalizeni Y, Hawes SE, Wolf ER, Batra M, Khofi H, Molyneux EM |title=The effects of malnutrition on cardiac function in African children |journal=Arch. Dis. Child. |volume=101 |issue=2 |pages=166–71 |year=2016 |pmid=26553908 |doi=10.1136/archdischild-2015-309188 |url=}}</ref> | Complications that can develop as a result of protein energy malnutrition are:<ref name="pmid12700964">{{cite journal |vauthors=Bagga A, Tripathi P, Jatana V, Hari P, Kapil A, Srivastava RN, Bhan MK |title=Bacteriuria and urinary tract infections in malnourished children |journal=Pediatr. Nephrol. |volume=18 |issue=4 |pages=366–70 |year=2003 |pmid=12700964 |doi=10.1007/s00467-003-1118-0 |url=}}</ref><ref name="pmid25475887">{{cite journal |vauthors=Jones KD, Berkley JA |title=Severe acute malnutrition and infection |journal=Paediatr Int Child Health |volume=34 Suppl 1 |issue= |pages=S1–S29 |year=2014 |pmid=25475887 |pmc=4266374 |doi=10.1179/2046904714Z.000000000218 |url=}}</ref><ref name="pmid26084628">{{cite journal |vauthors=Ahmed M, Moremi N, Mirambo MM, Hokororo A, Mushi MF, Seni J, Kamugisha E, Mshana SE |title=Multi-resistant gram negative enteric bacteria causing urinary tract infection among malnourished underfives admitted at a tertiary hospital, northwestern, Tanzania |journal=Ital J Pediatr |volume=41 |issue= |pages=44 |year=2015 |pmid=26084628 |pmc=4472394 |doi=10.1186/s13052-015-0151-5 |url=}}</ref><ref name="pmid1471885">{{cite journal |vauthors=Doherty JF, Adam EJ, Griffin GE, Golden MH |title=Ultrasonographic assessment of the extent of hepatic steatosis in severe malnutrition |journal=Arch. Dis. Child. |volume=67 |issue=11 |pages=1348–52 |year=1992 |pmid=1471885 |pmc=1793750 |doi= |url=}}</ref><ref name="pmid26553908">{{cite journal |vauthors=Silverman JA, Chimalizeni Y, Hawes SE, Wolf ER, Batra M, Khofi H, Molyneux EM |title=The effects of malnutrition on cardiac function in African children |journal=Arch. Dis. Child. |volume=101 |issue=2 |pages=166–71 |year=2016 |pmid=26553908 |doi=10.1136/archdischild-2015-309188 |url=}}</ref> | ||
*Congestive heart failure | *[[Congestive heart failure]] | ||
*Fatty liver disease | *[[Fatty liver differential diagnosis|Fatty liver disease]] | ||
* | *[[Renal insufficiency]] | ||
*Bacteremia and sepsis | *[[Bacteremia]] and [[sepsis]] | ||
*Immune dysfunction | *[[Immune dysfunction]] | ||
*Disorders of endocrine system | *[[Endocrine system|Disorders of endocrine system]] | ||
*Permanent mental and physical retardation | *Permanent mental and [[Growth retardation|physical retardation]] | ||
*Shock | *[[Shock]] | ||
*Coma | *[[Coma]] | ||
===Prognosis=== | ===Prognosis=== | ||
The prognosis | The presence of severe of [[hypoproteinemia]], [[hypoalbuminemia]], [[electrolyte imbalance]] or an underlying [[HIV AIDS|HIV infection]] is associated with poorer [[prognosis]] among patients with protein energy malnutrition.<ref name="pmid25937927">{{cite journal |vauthors=Munthali T, Jacobs C, Sitali L, Dambe R, Michelo C |title=Mortality and morbidity patterns in under-five children with severe acute malnutrition (SAM) in Zambia: a five-year retrospective review of hospital-based records (2009-2013) |journal=Arch Public Health |volume=73 |issue=1 |pages=23 |year=2015 |pmid=25937927 |pmc=4416273 |doi=10.1186/s13690-015-0072-1 |url=}}</ref> | ||
==References== | ==References== | ||
Latest revision as of 19:51, 20 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]
Overview
If left untreated, all children with protein energy malnutrition will progress to develop a failure to thrive, poorly developed immune system which causes overwhelming bacteremia and sepsis which is the cause of death in most malnourished individuals.
Natural history, Complications, and Prognosis
Natural history
The symptoms of protein energy malnutrition usually develop between the first and fifth year of life, and start with symptoms such as lethargy, irritability, failure to thrive, decreased muscle mass, diarrhea, and recurrent infections due to decreased immunity. Without treatment patients with protein energy malnutrition which comprises of kwashiorkor and marasmus present with changes in their facial appearance with children with kwashiorkor having moon faces while those with marasmus develop monkey-like face due to loss of subcutaneous fat pad in the cheeks. There is generalized edema, hepatomegaly, changes in skin, hair color and texture, recurrent infections like diarrhea with kwashiorkor which will eventually lead to overwhelming shock and sepsis and death.[1][2][3]
Complications
Complications that can develop as a result of protein energy malnutrition are:[4][5][6][7][8]
- Congestive heart failure
- Fatty liver disease
- Renal insufficiency
- Bacteremia and sepsis
- Immune dysfunction
- Disorders of endocrine system
- Permanent mental and physical retardation
- Shock
- Coma
Prognosis
The presence of severe of hypoproteinemia, hypoalbuminemia, electrolyte imbalance or an underlying HIV infection is associated with poorer prognosis among patients with protein energy malnutrition.[9]
References
- ↑ Bourke CD, Berkley JA, Prendergast AJ (2016). "Immune Dysfunction as a Cause and Consequence of Malnutrition". Trends Immunol. doi:10.1016/j.it.2016.04.003. PMC 4889773. PMID 27237815.
- ↑ Rytter MJ, Kolte L, Briend A, Friis H, Christensen VB (2014). "The immune system in children with malnutrition--a systematic review". PLoS ONE. 9 (8): e105017. doi:10.1371/journal.pone.0105017. PMC 4143239. PMID 25153531.
- ↑ Scrimshaw NS (2003). "Historical concepts of interactions, synergism and antagonism between nutrition and infection". J. Nutr. 133 (1): 316S–321S. PMID 12514318.
- ↑ Bagga A, Tripathi P, Jatana V, Hari P, Kapil A, Srivastava RN, Bhan MK (2003). "Bacteriuria and urinary tract infections in malnourished children". Pediatr. Nephrol. 18 (4): 366–70. doi:10.1007/s00467-003-1118-0. PMID 12700964.
- ↑ Jones KD, Berkley JA (2014). "Severe acute malnutrition and infection". Paediatr Int Child Health. 34 Suppl 1: S1–S29. doi:10.1179/2046904714Z.000000000218. PMC 4266374. PMID 25475887.
- ↑ Ahmed M, Moremi N, Mirambo MM, Hokororo A, Mushi MF, Seni J, Kamugisha E, Mshana SE (2015). "Multi-resistant gram negative enteric bacteria causing urinary tract infection among malnourished underfives admitted at a tertiary hospital, northwestern, Tanzania". Ital J Pediatr. 41: 44. doi:10.1186/s13052-015-0151-5. PMC 4472394. PMID 26084628.
- ↑ Doherty JF, Adam EJ, Griffin GE, Golden MH (1992). "Ultrasonographic assessment of the extent of hepatic steatosis in severe malnutrition". Arch. Dis. Child. 67 (11): 1348–52. PMC 1793750. PMID 1471885.
- ↑ Silverman JA, Chimalizeni Y, Hawes SE, Wolf ER, Batra M, Khofi H, Molyneux EM (2016). "The effects of malnutrition on cardiac function in African children". Arch. Dis. Child. 101 (2): 166–71. doi:10.1136/archdischild-2015-309188. PMID 26553908.
- ↑ Munthali T, Jacobs C, Sitali L, Dambe R, Michelo C (2015). "Mortality and morbidity patterns in under-five children with severe acute malnutrition (SAM) in Zambia: a five-year retrospective review of hospital-based records (2009-2013)". Arch Public Health. 73 (1): 23. doi:10.1186/s13690-015-0072-1. PMC 4416273. PMID 25937927.