Flashcards in Protein Energy Malnutrition Deck (16):
What is protein energy malnutrition?
- Not enough calories -- energy requirements trump all
- multi-nutritional deficiency complex; energy deficiency most outstanding
- If negative energy balance, obligatory negative N balance
Broad categories of PEM
Marasmus - severe wasting due to energy deficiency; slower onset and better adaptation
Kwashiorkor - edematous PEM, generally w/o wasting; protein deficiency, rapid onset, "mal-adaptation"
Starvation - pure caloric deficiency (conserve lean body mass & increase fat metabolism)
Cachexia - associated with inflammatory or neoplastic conditions (not reversed by feeding; anorexia)
Sarcopenia - subnormal amount of skeletal muscle w/o weight loss
45% deaths related to malnutrition
Causes of PEM
- Social and economic factors: poverty, ignorance, restricted diets
- Biologic factors: maternal under-nutrition, low birth weight infants
- Environmental factors: overcrowding, infectious burden, agricultural patterns
What is the most common PEM for infants?
What is the most common PEM for older infants?
Kwashiorkor (12-24 mos)
What is the most common PEM for elderly?
Cachexia and sarcopenia
Underweight, Stunting, Wasting
Underweight: low weight-for-age (
Mild underweight/wasting is commonly referred to as _____
failure to thrive
Response to starvation
Switch from glucose to ketone bodies and fatty acids
Since marasmus is normal response to starvation, where do the tissues get their energy?
Muscle = TG/FA; decreased protein degradation
Brain = Ketones
Liver = decreased gluconeogenesis; urea production decreases and excretion of urea decreases
Result: utilization of fat stores, minimize muscle wasting --> Reduced BMR
Normal physiologic responses to starvation
- decreased physical activity
- dec BMR (Hypothermia, hypotension, bradycardia)
- Endocrine: dec insulin, dec thyroid, inc. epi and corticosteroid
- GI atrophy
- Myocardial atrophy, dec CO
Loss of functional reserve and physiologic responsiveness to stress
Etiology of kwashiorkor
- protein deficiency with adequate energy
- + infectious stress, cytokine release, + micro-nutrient deficiency, oxidative damage
** hypoalubinemia and edema **
- increased insulin, decreased lipolysis
- increased FA synthesis --> fatty, enelarged liver
What does kwashiorkor look like?
- flaky paint rash (pellagroid)
- flag sign - dry brittle depigmented hair
Principles of Tx for severe PEM
- resolve life-threatening conditions
- restore nutritional status w/o abruptly disrupting homeostasis
- ensure nutritional rehabilitation (macro and micro nutrients)
Kwashiorkor has higher mortality