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A review of some metabolic changes in protein-energy malnutrition.Niger
Postgrad Med J. 2007 Jun;14(2):155-62.
Protein-energy
malnutrition (PEM) is a major public health problem in the tropical
and subtropical regions of the world and often arises during protein
and / or energy deficit due to nutritional inadequacy, infections and
poor socio-economic and environmental conditions. It is the most
common nutritional disorder affecting children in developing countries
and the third most common disease of childhood in such countries. PEM
has a lasting effect on immune functions, growth and development of
children, learning ability, social adjustment, work efficiency and
productivity of labour. It seems that many deaths from PEM occur as a
result of outdated clinical practices and that improving these
practices reduces the rate of morbidity and mortality. This paper
reviews various metabolic changes in protein-energy malnutrition (PEM).
It gives an overview of the theoretical basis for the understanding of
the biochemical derangements in PEM. It aims at stimulating the
paediatricians and clinical chemists to read more on the recent
advances in this broad subject with the view to improving the
understanding of the current laboratory investigation of PEM. This
review demonstrates that the metabolic changes in PEM include water
and electrolytes imbalance, amino acids and proteins deficiencies,
carbohydrates and energy deficiencies, hypolipidaemias,
hypolipoproteinaemias, hormonal imbalance, deficiency of anti-oxidant
vitamins and enzymes, depression of cell-mediated immune complexes and
decrease in amino acids and trace elements in skin and hair. The
review therefore suggests that assessment of these conditions in PEM
patients could improve the management of this group of patients and
hence reduce the rate of morbidity and mortality from PEM.
Risk
factors for protein-energy malnutrition in children under 5 years:
study from Luangprabang province, Laos.Pediatr
Int. 2007 Apr;49(2):260-5.
BACKGROUND:
Laos is one of the poorest countries in which chronic malnutrition is
highest. The aim of the present study was to determine the prevalence
of and to identify risk factors associated with protein-energy
malnutrition (PEM) in children under 5 years of age in Luangprabang
province, Laos. METHODS: This cross-sectional study was undertaken
from March to May 2004. Anthropometric measurements of 798 children
were done and data were transformed into height-for-age,
weight-for-age and weight-for-height ratios. Mothers were also
interviewed with a semi-structured questionnaire. Anthropometric data
were entered into Nutstat in Epi-Info 2000 and transferred to SPSS for
analysis. RESULTS: There was a high prevalence of stunting,
underweight and wasting, that is, 54.6%, 35%, and 6% respectively. It
was also noted that children aged 12-23 months and Khmu ethnic
children had a higher prevalence of stunting (65% and 66%) and
underweight (45% and 40%), respectively. However, it was also found
that boys were more prone to be stunted and underweight. Furthermore,
restricted intake of meats, vegetables during illness, and low
maternal education were main risk factors for child malnutrition in
the study area. CONCLUSION: Socioeconomic-demographic factors, low
maternal education, poor nutrition knowledge for mother and feeding
practices for sick children are affecting children's health regarding
stunting and underweight. It is recommended that an improvement in
societal infrastructure, better maternal education and nutrition are
needed to address the child malnutrition issue.
Association of
resident, facility, and geographic characteristics with chronic
undernutrition in a nationally represented sample of older residents
in U.S. nursing homes.J
Nutr Health Aging. 2007
Mar-Apr;11(2):179-84.
BACKGROUND:
Undernutrition (also known as protein-calorie malnutrition or
energy-deficiency) is associated with exacerbation of health
conditions, increased frailty, and decline in physical, cognitive, and
affective function. This is a critical problem for older adults who
reside in nursing homes and have many limitations that contribute to
reduced food intake. OBJECTIVE: To determine the relationship of
chronic undernutrition [body mass index (BMI) < 18.5 kg/m2] to
resident, facility, and geographical characteristics in a national
sample of nursing home residents aged 60 y or older in the U.S.
DESIGN: A cross-sectional, secondary analysis of a 10% nationally
representative random sample of annual assessments of nursing home
residents in the U.S. (n = 128,514), using the Minimum Data Set (MDS).
Data included measured weight and height, resident characteristics,
facility characteristics, and geographic location. RESULTS: More than
12% (n = 15,566) were chronically undernourished (energy-deficient),
with more than 27% of those being severely undernourished (BMI < 16).
Independent correlates of chronic undernutrition (multivariate
analysis) included resident characteristics (ADL, having chewing or
swallowing problems, or leaving at least 25% of the meal uneaten),
facility characteristics (% Medicare and for-profit status), and
geographic characteristics (living in nursing home in urban or large
towns). CONCLUSION: This study found a high percentage of chronic
undernutrition in this nationally representative sample of U.S.
nursing home residents. Furthermore, resident, facility, and
geographic characteristics were associated with chronic undernutrition.
Strategies need to be developed and documented that ensure nutritional
health to residents with a variety of health problems.
Nutritional status of Kamar tribal children in Chhattisgarh.Indian
J Pediatr. 2007 Apr;74(4):381-4.
OBJECTIVE:
Assessment of the nutritional status among 309 Kamar children (161
boys and 148 girls) aged 4-12 years. METHODS: In this cross-sectional
study, 24-hours dietary recall method was used to assess dietary
intakes of children. Height and weight were recorded and children were
classified by WHO criterion (Z-score) using nutritional indices i.e.
weight for age, height for age and weight for height. NCHS data were
used as reference. Mean energy and protein intake per day were
measured and compared with Recommended Dietary Allowances (RDA) of
Indian standards. RESULTS: More than 90 percent of children (both boys
and girls) in the age group of 4-6 years suffered by underweight (<-2
SD weight for age), which was comparatively lower in 7-9 and 10-12
years age group children. 84.51 percent of boys suffered by stunting
(<-2 SD height for age), which was much higher than girls (47.54%) in
4-6 years age group. Similarly, 80 percent of 4-6 years age group
children were affected by wasting (<-2 SD weight for height). The
consumption of energy and protein were also much lower among Kamar
children than the RDA of India throughout the ages. CONCLUSION:
Undernutrition in the form of underweight, stunting and wasting and
low consumption of dietary intake (energy and protein) was found to be
widely prevalent among Kamar tribal children. Therefore, an urgent
dietary intervention programme is necessary. Further studies are
required to investigate into problem and to supplement the key
nutrients which are required to ensure a good nutritional status in
children.
A
prospective assessment of food and nutrient intake in a population of
Malawian children at risk for kwashiorkor.J
Pediatr Gastroenterol Nutr. 2007
Apr;44(4):487-93.
OBJECTIVE: To determine what foods, nutrients, and dietary patterns
are associated with development of kwashiorkor in populations of
vulnerable 1- to 3-year-old Malawian children. PATIENTS AND METHODS:
This was a prospective observational study conducted in 8 rural
villages. Upon enrollment, demographic, anthropometric, and dietary
intake data were collected. Children were studied every 2 weeks for 10
weeks to determine whether they developed kwashiorkor. Dietary intake
was assessed on enrollment using a food frequency questionnaire, which
included all possible foods in the child's diet. Food frequency data
were used to estimate energy, protein, vitamins C and A, niacin,
thiamin, zinc, and iron intake using food composition and serving size
data. Dietary diversity was assessed with a 7-point score. Regression
modeling was used to determine whether the consumption of any food or
nutrient was associated with the development of kwashiorkor. RESULTS:
A total of 43 (2.6%) of the 1651 healthy children ages 1 to 3 years
enrolled developed kwashiorkor. Children who developed kwashiorkor
were younger and had more nutritional wasting than those who did not.
Thirty children (70%) who developed kwashiorkor were breast-fed. In
the combined regression model no foods or nutrients were found to be
associated with the development of kwashiorkor. There were no
differences in the dietary diversity between children who developed
kwashiorkor and those who did not. CONCLUSIONS: No association between
the development of kwashiorkor and the consumption of any food or
nutrient was found.
Diarrheal
disease as a cause of malnutrition.Am
J Trop Med Hyg. 1992 Jul;47(1 Pt
2):16-27.
Although long
associated with infectious diseases, malnutrition is recognized as a
major effect of specific infections, especially those of the
gastrointestinal tract. Synergistic exacerbation of infections and
nutritional deficiency commonly begin with weaning, where the impact
of repeated infections and possible monocyte mediator release may have
an even greater effect on malnutrition of young children than that of
deficient diets in many areas. Reviewed here are the detailed host
alterations seen with specific enteric infections that lead to
malnutrition. These include mucosal dysfunction, systemic metabolic
responses, impaired intake, digestion and absorption, nutrient losses,
altered immune responses, and ultimately, impaired growth,
development, and nutrition. The tremendous health impact of diarrhea
on both morbidity and mortality in many developing areas must be
recognized and controlled along with correction of food shortages in
order to improve the nutrition, growth, and survival of impoverished
children.
Skin in
protein energy malnutrition.Arch
Dermatol. 1987 Dec;123(12):1674-1676a.
Protein energy
malnutrition (PEM), the most widespread nutritional deficiency
disorder of mankind, is a group of related disorders, with a more
complex and still incompletely understood etiologic basis than its
name suggests. Dermatologic and other clinical manifestations are more
florid and characteristic in kwashiorkor than in marasmus. The complex
of clinical syndromes that constitute PEM is best considered when
using a three-dimensional model to illustrate its varying degrees (ie,
mild, moderate, or severe) and the spectrumlike nature of the forms of
the severe degree (ie, kwashiorkor, marasmic-kwashiorkor, or marasmus).
Protein energy malnutrition is not confined to children in the Third
World and is the most common form of undernutrition in hospitalized
patients in Western countries. Marasmus is by far the most prevalent
form. Much of the nutritional support given in hospitals is not based
on an assessment of nutritional status, and little attention is paid
to the different forms PEM might take. Even those who do consider this
last point confuse hypoalbuminemia in patients acutely stressed or
infected with kwashiorkor. Recent evidence suggests that the skin
changes of kwashiorkor may be caused by zinc deficiency. Almost
nothing is known about the histopathology of the skin per se in PEM
but studies of the hair bulb have shown important differences among
patients with kwashiorkor, marasmus, and normal skin.
Height,
weight, and head circumference in survivors of marasmus and
kwashiorkor.Am
J Clin Nutr. 1979 Aug;32(8):1719-27.
The physical
growth of 44 survivors of marasmus and 43 survivors of kwashiorker 7
1/2 years after their hospitalization and cure from malnutrition has
been evaluated. The collected data on height, weight, and head
circumference of these 87 previously malnourished children have been
compared with data on height, weight, and head circumference of 559
children of the same age and sex from the same environment who have
never been malnourished. The statistical analysis of the data indicate
the following conclusions. 1) The survivors of marasmus are shorter
and lighter and have a smaller head circumference than controls. The
observed difference is statistically significant. 2) The survivors of
kwashiorkor have the same physical stature as controls. 3) The
survivors of marasmus are shorter and lighter and have a smaller head
circumference than survivors of kwashiorkor. 4) The survivors of
marasmus who were hospitalized for treatment of malnutrition when
younger than 1 year have the same physical stature as the survivors of
marasmus who were hospitalized for treatment of malnutrition when
older than 1 year.
Simplified
methods for detection of proteino-caloric malnutrition in child
(author's transl).Med
Trop (Mars). 1981 Jul-Aug;41(4):385-91.
This paper
emphasized proteino-caloric malnutrition (P.C.M.) frequency in the
Third-World (in developing countries (i.c. kwashiorkor, marasmus,
kwashiorkor associated with marasmus. It is consequently necessary to
define some methods of detection able to cope with the conditions
prevailing in this part of the world. The conventional classifications
and methods of detection appear too sophisticated. These methods
mostly rely on body-weight for each age group. But even this
apparently simple control is often impossible: lack of scales,
ignorance of educated assistants of the true age of the children. The
author presents a simple and clinical method, requiring no medical
appliance. It appreciates autophagy, main sign of malnutrition by
estimating the brachial perimeter, the tricipital cutaneous fold, the
volume of fatty and muscular masses in the buttocks and in the face,
and by detecting the kwashiorkor oedema. After this first screening, a
more accurate classification can be established in nutritional
rehabilitation centers. This method has two requisites even if
available means are poor: necessity of mass surveys and constant
efforts to reach the young patients.
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