Despite efforts to improve nutrition around the world, around 1 billion people still suffer from protein-calorie malnutrition, or PCM. As the name suggests, people with PCM don’t get enough calories or protein. A number of disorders can cause PCM, from lack of food to gastric bypass surgery. Protein-calorie malnutrition is also called protein-energy undernutrition, or PEU. The two disorders most commonly associated with PCM in children are marasmus, sometimes called the “dry” form of the disorder, and kwashiorkor, known as the “wet” form.
Lack of calorie and protein intake is the primary cause of PCM, but many secondary causes can also cause the disorder. Cancer, alcoholism, cardiac diseases, AIDS infection and kidney disease can all cause cachexia, loss of appetite and muscle wasting. Disorders that cause the body to use up a higher number of calories than usual, such as severe burns or other trauma, can also cause PCM. Gastrointestinal diseases that affect absorption may lead to PCM as well.
Symptoms of PCM include muscle wasting, lack of subcutaneous fat, slow heart beat, difficulty maintaining body temperature, poor wound healing and low energy levels. Hair becomes dry, brittle and sparse, while skin turns dry, cool to the touch and rough. Diarrhea commonly occurs. In patients with kwashiorkor, fluid accumulates in the abdomen and other tissues. Blood pressure and respiratory rate may also slow, and the person becomes susceptible to infection as the immune system fails. If the disease progresses, organs such as the heart, liver and kidneys fail. Death will occur if the disease continues to progress without intervention.
Increasing calorie intake will normally increase protein intake to normal levels. Liquid diets may be better tolerated at first than solid foods. Giving yogurt may lessen diarrhea caused by lactose intolerance. Use of a feeding tube or total parenteral nutrition given via intravenous infusion may be necessary in severe cases. Children may need intravenous hydration for 24 hours before starting feedings to prevent worsening diarrhea. Care must be taken not to overhydrate, which can place an extra burden on the heart. Electrolyte abnormalities can also occur, leading to heartbeat irregularities and muscle weakness.
Between 5 and 40 percent of children with PCM will die, according to the Merck Manuals Online Medical Library. Children with kwashiorkor recover faster than children with marasmus, the same source reports. Permanent mental retardation or cognitive problems may remain. Elderly patients may have difficulty recovering from surgery or infections.