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Revision as of 18:57, 7 August 2017
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Protein energy malnutrition Microchapters |
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Patient Information |
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Differentiating Protein energy malnutrition from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Protein energy malnutrition overview On the Web |
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American Roentgen Ray Society Images of Protein energy malnutrition overview |
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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 edema. 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
Common risk factors in the development of protein energy malnutrition may be classified as maternal and environmental.
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
The history of protein energy malnutrition includes a failure to thrive in children under 1 year of age especially after they have just been weaned of breast milk. Some common signs and symptoms include failure to thrive, fatigue, irritability, changes in skin and hair pigment, decreased muscle mass, diarrhea, increased and more severe infections due to damaged immune system, edema and hepatomegaly.
Physical Examination
Laboratory Findings
X ray
There are no chest X ray findings associated with protein energy malnutrition.
CT
There are no CT findings associated with protein energy malnutrition.
MRI
There are no MRI findings associated with protein energy malnutrition. However, a MRI may be helpful in the diagnosis of complications of protein energy malnutrition which include cerebral atrophy and ventricular dilatation.