Protein Energy Malnutrition Flashcards
What are the two main types of malnutrition?
Over-nutrition (overweight and obesity) and under-nutrition (e.g., Protein Energy Malnutrition).
What is Protein Energy Malnutrition (PEM)?
A general term for clinical syndromes of undernutrition due to inadequate food intake, absorption, or excess catabolism. It includes conditions like kwashiorkor and marasmus.
What are the primary and secondary causes of PEM?
Primary: Inadequate food supply (common in children).
Secondary: Anorexia, hypermetabolism (e.g., burns, TB), malabsorption (common in adults).
How does kwashiorkor differ from marasmus in terms of adaptation?
Marasmus: Adaptive response (body uses fat stores before muscles).
Kwashiorkor: Maladaptive response (body prioritizes protein conservation over fat).
What are the key features of kwashiorkor?
Oedema (hypoalbuminemia).
Muscle wasting, growth retardation.
Moon face, hair/skin changes.
Often linked to abrupt weaning and infections.
What are the key features of marasmus?
Severe wasting of muscle and subcutaneous fat.
No oedema.
Child appears older (“old man’s face”).
Due to chronic starvation (protein + calorie deficiency).
What are common causes of PEM in Sub-Saharan Africa?
Poverty, low-protein diet, political instability.
Infections (worms, measles, TB), poor sanitation.
Inadequate breastfeeding, crop destruction.
What are the consequences of PEM?
Impaired immune response (sepsis risk).
Poor wound healing, circulatory disturbances (hypoalbuminemia).
Skeletal muscle dysfunction (respiratory failure risk).
How is PEM treated?
Correct water/electrolyte imbalance.
Treat infections/worms.
Dietary support + vitamins/minerals.
Continue breastfeeding, small frequent feeds.
What lab findings distinguish kwashiorkor from marasmus?
Kwashiorkor: Serum albumin <28g/L, low TIBC.
Marasmus: Normal/slightly reduced albumin, no oedema
Why is kwashiorkor mortality risk higher than marasmus?
Due to severe metabolic disruptions (e.g., hypoalbuminemia, infections) and rapid onset.
What are methods to assess nutritional status?
Anthropometry (weight-for-height, height-for-age).
Clinical signs (e.g., oedema, hair changes).
Laboratory tests (albumin, micronutrient levels).
What is the epidemiological significance of PEM?
PEM contributes to >50% of deaths in children under 5 (5 million/year), mostly in developing countries.
What are the two ends of the malnutrition spectrum?
Obesity (over-nutrition) and under-nutrition (e.g., PEM, micronutrient deficiencies).
What non-dietary factors contribute to kwashiorkor?
Infections (e.g., measles, TB), food toxins (aflatoxins), psycho-social/cultural factors (e.g., abrupt weaning).
What are the three forms of under-nutrition in children?
Wasting (low weight-for-height).
Stunting (low height-for-age).
Underweight (low weight-for-age).
: Why does kwashiorkor cause edema?
Hypoalbuminemia (low serum albumin) reduces oncotic pressure, leading to fluid leakage into tissues.
What is the “sickness of weaning”?
Kwashiorkor, named from the Ga language (Ghana), often occurs when a child is weaned abruptly to a low-protein diet.
How does marasmus differ from kwashiorkor in time course?
Marasmus: Develops over months/years (chronic starvation).
Kwashiorkor: Can develop in weeks (acute-on-chronic imbalance).
What anthropometric measurement distinguishes marasmus?
Triceps skinfold <3mm (indicates severe fat/muscle depletion).
Why are infections a major risk in PEM?
Impaired immune response (e.g., reduced lymphocyte function, antibody production) increases sepsis susceptibility.
What is a key diagnostic lab value for kwashiorkor?
Serum albumin <28g/L (vs. near-normal in marasmus).
What are common conditioning factors for PEM?
Diarrhea, intestinal parasites, recurrent infections (e.g., measles, HIV), and poor sanitation.
What is the role of aflatoxins in kwashiorkor?
They may precipitate liver damage, worsening hypoalbuminemia and edema (one proposed theory).
