Protein-energy malnutrition is due to a relative or absolute deficiency of energy and protein. It may be a primary deficiency due to inadequate nutritional intake or it can be secondary to another illness. For most developing countries, primary protein-energy malnutrition is a major health concern, especially among children.
Two Types
The two specific syndromes that fall under the categorization of protein-energy malnutrition are kwashiorkor and marasmus. Kwashiorkor is a result of deficiency of protein in the presence of adequate energy and is most commonly seen in weaning infants at the birth of a sibling in areas where foods containing protein are scarce. Marasmus is due to combined protein and energy deficiency, and is most common in places where food is scarce
Epidemiology
By estimates made by the United Nations, 852 million people, including 170 million children worldwide, suffer from protein-energy malnutrition. This condition results in 5 million deaths per year.
Symptoms And Signs
Kkwashiorkor and marasmus, besides differing in their etiologies, also differ in the physical manifestations associated with each. The defining characteristic of kwashiorkor is edema, due to a decreased concentration of plasma proteins. Also, there is enlargement of the liver as a result of accumulation of fat which causes these children to have a deceptively large abdominal girth. These children are also irritable and apathetic, have diarrhea, muscle wasting and photophobia. Skin manifestations include hypopigmentation of the face and pale patches on the body. The hair may become hypopigmented and easily pluckable. Children with marasmus are severely emaciated and have stunted growth. They have dry, thin, loose, wrinkled skin due to loss of subcutaneous fat.
Treatment
Initial management of protein-energy malnutrition should be aimed at correcting dehydration, electrolyte abnormalities, and infections. The second phase of treatment is aimed at repletion of protein, energy and micronutrients. Treatment is started with moderate quantities of protein and calories calculated based on the patient's actual body weight. Simultaneous administration of vitamins and minerals is essential, especially thiamine and oral phosphate.
References
- "Current Diagnosis and Treatment"; Robert B. Baron, M.D., M.S.; 2011
- "Fitzpatrick's Dermatology in General Medicine"; Melinda Jen, M.D., Kara N. Shah, M.D., Ph.D., FAAP, Albert C. Yan, M.D.; 2008
- "Protein Energy Malnutrition"; Pediatric Clinics of North America; Zubin Grover, M.D., MBBS, LooiC. Ee, MBBS, FRACP; 2009
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