Protein energy malnutrition pathophysiology
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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
Severa acute malnutrition affects many organs of the body. Several theories have been put forward to explain the various form in which the organs are affected. Some of the major organ systems affected include cardiovascular system,[1] liver,[2] genitourinary system,[3] gastrointestinal tract, immune system,[4] endocrine system, metabolism and circulation,[5] cellular function skin and glands.
Pathophysiology
Pathogenesis
There are 3 major theories that have been proposed to describe the mechanism of edema in the kwashiorkor patient.
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.
- Albumin concentrations were also noted to increase steadily within two weeks after refeeding.
- Presence of features similar to congenital nephrotic syndrome, in which the primary pathology is renal loss of albumin.[6]
Multiple evidences have now shown that inadequate intake of dietary protein is not the primary trigger for edematous malnutrition.
- Some patients have edematous malnutrition without hypoalbuminemia
- Others develop edematous malnutrition (kwashiorkor) despite adequate proportion of protein in the diet (eg, in exclusively breastfed infants)
- Others recover from edematous malnutrition with supportive care even without enhancing the protein content of the diet.[7][8][9]
Genetics
Associated conditions
Gross pathology
Microscopic pathology
References
- ↑ Silverman JA, Chimalizeni Y, Hawes SE, Wolf ER, Batra M, Khofi H; et al. (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.
- ↑ 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.
- ↑ Bagga A, Tripathi P, Jatana V, Hari P, Kapil A, Srivastava RN; et al. (2003). "Bacteriuria and urinary tract infections in malnourished children". Pediatr Nephrol. 18 (4): 366–70. doi:10.1007/s00467-003-1118-0. PMID 12700964.
- ↑ Sauerwein RW, Mulder JA, Mulder L, Lowe B, Peshu N, Demacker PN; et al. (1997). "Inflammatory mediators in children with protein-energy malnutrition". Am J Clin Nutr. 65 (5): 1534–9. PMID 9129488.
- ↑ Spoelstra MN, Mari A, Mendel M, Senga E, van Rheenen P, van Dijk TH; et al. (2012). "Kwashiorkor and marasmus are both associated with impaired glucose clearance related to pancreatic β-cell dysfunction". Metabolism. 61 (9): 1224–30. doi:10.1016/j.metabol.2012.01.019. PMID 22386944.
- ↑ 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.
- ↑ Golden MH (1998). "Oedematous malnutrition". Br Med Bull. 54 (2): 433–44. PMID 9830208.
- ↑ 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.
- ↑ 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.