Protein energy malnutrition overview: Difference between revisions

Jump to navigation Jump to search
Line 32: Line 32:
There is insufficient evidence to recommend routine screening for protein energy malnutrition.
There is insufficient evidence to recommend routine screening for protein energy malnutrition.


==Natural History, Complications and Progonosis==
==Natural History, Complications and Prognosis==
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 responsible for the cause of death.


==Diagnosis==
==Diagnosis==

Revision as of 15:57, 7 August 2017

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 overview On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Protein energy malnutrition overview

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 overview

CDC on Protein energy malnutrition overview

Protein energy malnutrition overview in the news

Blogs on Protein energy malnutrition overview

Kwashiorkor

Risk calculators and risk factors for Protein energy malnutrition overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]

Overview

Protein energy malnutrition is defined by measurements that fall below 2 standard deviations under the normal weight for age (underweight), height for age (stunting) and weight for height (wasting). Protein energy malnutrition is a nutritional deficiency resulting from either inadequate energy (caloric) or protein intake and manifesting in either marasmus or kwashiokor. Marasmus is characterized by wasting of body tissues, particularly muscles and subcutaneous fat, and is usually a result of severe restrictions in energy intake. Kwashiorkor affects mainly children, is characterized by edema (particularly ascites), and is usually the result of severe restrictions in protein intake. However, both types can be present simultaneously (marasmic kwashiokor) and mask malnutrition due to the presence of oedema. 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.

Historical Perspective

The first clinical description of protein energy malnutrition was made in 1865 in Spanish which led to little dissemination of the information. In 1932, kwashiorkor was first described by Dr Cicely Williams, working with African children on the Gold Coast. The word kwashiorkor came from the Ga language of Accra, Ghana meaning the disease of the deposed baby when the next one is born. The term marasmus is derived from the Greek word marasmos, which means withering or wasting.

Classification

Protein energy malnutrition may be classified according to the Gomez classification based on weight for age, or the Water low classification based on stunting and wasting or the Welcome classification based on the presence or absence of edema.

Pathophysiology

Different pathophysiologic mechanisms are involved in the development of protein energy malnutrition as it comprises of two main diseases, kwashiorkor and marasmus. 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 understand. Several theories have been put forward to explain this finding. Marasmus on the other hand is due to the total caloric deficiency leading to wasting in a child. Marasmus always results from a negative energy balance.

Causes

Protein energy malnutrition may be caused by reduced breast feeding, poor weaning practices, limited availability of food and very little child care in cases of extreme poverty. This classically affects several poor people in regions of poor social and economic background. Other environmental causes such as infections, drought and earthquakes leading to decreased availability of food have also been identified.

Differentiating Kwashiorkor from other Diseases

Protein energy malnutrition must be differentiated from other diseases that cause edema, wasting, failure to thrive, recurrent infections, skin and hair changes. It is important to also differentiate kwashiorkor from marasmus as the two diseases belong to the protein energy malnutrition.

Epidemiology and Demographics

The prevalence of protein energy malnutrition in children under 5 is estimated to be 150 million cases annually. In Nigeria, the prevalence is as high as 41,600 per 100,000 children. Protein energy malnutrition is majorly a diseases of the developing countries. There is no racial or sexual predisposition.

Risk Factors

Screening

There is insufficient evidence to recommend routine screening for protein energy malnutrition.

Natural History, Complications and Prognosis

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 responsible for the cause of death.

Diagnosis

History and Symptoms

Symptoms of kwashiorkor

Symptoms of kwashiorkor include a swollen abdomen known as a pot belly, as well as reddish discoloration of the hair and depigmented skin. The swollen abdomen is generally attributed to two causes: First, the observation of ascites due to increased capillary permeability from the increased production of cysteinyl leukotrienes (LTC4 and LTE4) as a result of generalized intracellular deficiency of glutathione. It is also thought to be attributed to the effect of malnutrition on reducing plasma proteins (discussed below), resulting in a reduced oncotic pressure and therefore increased osmotic flux through the capillary wall. A second cause may be due to a grossly enlarged liver due to fatty liver. This fatty change occurs because of the lack of apolipoproteins which transport lipids from the liver to tissues throughout the body. Victims of kwashiorkor fail to produce antibodies following vaccination against diseases including diphtheria and typhoid.[3] Generally, the disease can be treated by adding food energy and protein to the diet; however, mortality can be as high as 60% and it can have a long-term impact on a child's physical growth and, in severe cases, affect mental development.

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

References

Template:WH Template:WS