Protein-Energy Malnutrition (Protein-Energy Undernutrition,PEM,PEU,)

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Protein-Energy Malnutrition
Body Parts: Whole Body
Medical Subjects: Children's Health Elderly Health
Overview

What Is Protein-Energy Malnutrition?

What is the Protein-Energy Malnutrition?

Protein-Energy Malnutrition (PEM) is a state caused by the human body unable to obtain enough protein and energy. Common in children and the elderly. Not getting enough healthy food is a common cause.

However, with the improvement of living conditions, more and more common diseases in the body cause poor nutrition absorption, such as digestive absorption disorders caused by anatomical or functional abnormalities of the digestive system, long-term fever, a variety of acute and chronic infectious diseases and chronic consumptive diseases (such as cancer), which can lead to increased catabolism, reduced food intake and metabolic disorders, premature birth, multiple births, intrauterine malnutrition and other congenital deficiencies can also cause post-natal malnutrition.

Can Protein-Energy Malnutrition Be Cured?

Protein-Energy Malnutrition can be cured by gradually supplementing the nutrients needed by the human body. However, if there is a malignant disease or the underlying disease is not controlled, protein energy malnutrition may be difficult to improve.

Does Protein-Energy Malnutrition have sequela?

For children, chronic malnutrition may improve after treatment, but developmental delays may not always catch up completely.

Protein energy malnutrition in infancy, not only will affect the body development, also can cause damage to the development of the brain. It is easy to fall behind in cognitive function.

Is Protein-Energy Malnutrition common?

It is common in areas with poor economic conditions, mainly due to the lack of access to healthy food and the low content of protein in the food.

Cause

What Is The Cause Of Protein-Energy Malnutrition?

What are the causes of the Protein-Energy Malnutrition? Who are more susceptible to this disease?

There is not enough protein in the food, or not enough energy. The popular saying is not enough to eat. Or simply eat satisfied, but there is no meat, eggs, milk and other high-quality sources of protein in the food.

With the improvement of living conditions, nowadays more and more common diseases in the body cause poor nutrition absorption, such as digestive absorption disorders caused by anatomical or functional abnormalities of the digestive system, long-term fever, a variety of acute and chronic infectious diseases and chronic consumptive diseases (such as cancer), which can lead to increased catabolism, reduced food intake and metabolic disorders, premature birth, multiple births, intrauterine malnutrition and other congenital deficiencies can also cause post-natal malnutrition.

Therefore, apart from the fact that energy malnutrition in protein is more common among the people suffering from the above-mentioned diseases, children, the elderly, pregnant women, anorexia and picky eaters and partitioners in families with poor financial conditions can also suffer from Protein-Energy Malnutrition.

What other conditions could Protein-Energy Malnutrition cause?

Patients with Protein-Energy Malnutrition may develop complications such as trace element deficiency, vitamin A deficiency, vitamin D deficiency, iron deficiency anemia, hypoproteinemia, and hypoglycemia, which can be life-threatening in severe cases. At the same time due to malnutrition, easy to appear each organ infection. Such people have low immune function and are more vulnerable to various infections. Which in turn can further exacerbate malnutrition. Specific performance is as follows:

  • Vitamin A deficiency can be manifested as decreased vision, blurred vision at night and dry eyes.
  • Vitamin D deficiency can lead to abnormal bone growth and development, manifested as short height, square head, ribs a grain of a bump.
  • Anemia can be manifested as pale complexion, white lips, pale nails, easy to fatigue.
  • Hypoproteinemia is manifested as skin edema, ascites, firm skin and decreased elasticity.
Symptom

What Are The Symptoms Of Protein-Energy Malnutrition?

What are the clinical manifestations of protein-energy malnutrition?

Worldwide, severe PEM is the leading cause of death in children under 5 years of age. Severe PEM can cause one of two classic syndromes, namely, malnutrition wasting (wasting syndrome) and malignant malnutrition, or a combination of both.

PEM can be divided into different clinical subtypes according to the presence of edema. Traditionally, a PEM without edema is referred to as dystrophic wasting, and a PEM with edema is referred to as malignant malnutrition:

Malnutrition wasting: Malnutrition wasting (that is, PEM without edema) is characterized by muscle atrophy and body fat storage consumption. This is the most common form of PEM and is caused by insufficient intake of all nutrients and in particular insufficient dietary energy source (total calories). Typically, malnourished, emaciated children may have severe constipation and, once refeeded, are very hungry. Physical examination findings include:

  • Age, weight and height are below normal range.
  • His head was obviously large and his eyes were glassy.
  • Emaciated and weak in appearance, irritable and agitated in emotion.
  • Bradycardia, hypotension, and hypothermia.
  • The skin become thin and dry.
  • Atrophied arms, thighs and buttocks and extra skin wrinkles due to loss of subcutaneous fat.
  • Thin and thin hair, easy to tear off.

Malignant malnutrition: Malignant malnutrition (that is, PEM with edema) is characterized by marked muscle atrophy with normal or increased body fat, and by the presence of peripheral edema (systemic edema). Edema is a defining feature in determining the diagnosis. Protein and insufficient energy intake may contribute to the clinical features of malignant malnutrition, but its pathogenesis has not been fully elucidated. Anorexia is almost universal. Physical examination findings include:

  • Abnormal or near normal weight.
  • Systemic edema (severe generalized edema).
  • Pitting edema of the lower extremities, presacral region, genitalia, and periorbital.
  • Apathy, lethargy.
  • The cheeks are round and prominent.
  • Pursed mouth.
  • The skin is dry, atrophic and easily exfoliated with fused areas of hyperkeratosis and hyperpigmentation.
  • Hair dry, lusterless, pigmentation reduced, easy to tear off or fall off.
  • Hepatomegaly (caused by fatty liver infiltration).
  • Abdominal distension with dilated loops but no ascites.
  • Hypothermia.

Mixed malnutrition: Mixed malnutrition (edematous malnutrition) may occur in children with insufficient intake of various nutrients and can be caused by common infectious diseases in childhood. Children with this condition often have anorexia, dermatitis, and sometimes neurological abnormalities (depression and emotional blandness) and hepatic steatosis.

Among them, the morbidity and mortality of complications are relatively high when patients change from malnutrition wasting to mixed malnutrition.

Detect

How To Check For Protein-Energy Malnutrition?

What check does protein-energy malnutrition need to do to ability diagnose?

Review the patient's diet (it is best for the patient to keep a detailed diet diary), and arrange routine blood tests, biochemistry, abdominal color Dopplar ultrasound, thyroid function, stool tests, etc. as appropriate.

What effect does physical examination have on patients with protein energy malnutrition?

  • Review the patient's diet: Evaluate whether the food meets the body's needs for adequate energy and protein.
  • Complete set of routine blood test and biochemical test: Judge the liver and kidney function of the body, assess the presence of anemia, hypoproteinemia, electrolyte disorder and metabolic acidosis/alkalosis, and judge the anemia, electrolyte condition and dehydration type.
  • Abdominal color Dopplar ultrasound: to look for ascites and tumor mass, and understand whether there is any special lesion of abdominal organs.
  • Determination of thyroid function and growth hormone: to judge whether there is any abnormality in the endocrine system.
  • Stool test: to judge whether there are parasites, chronic gastrointestinal bleeding and other conditions.
Prevention

How To Prevent Protein-Energy Malnutrition?

Protein-Energy Malnutrition can be prevented and different measures should be taken at different times.

  • Breastfeeding is preferred in infancy. Nursing mothers need protein and calcium supplements. Breastfeeding at least to one year old, conditional to two years of age.
  • When the breast milk is insufficient, supplement the infant formula instead of rice porridge and pure milk. Children under one year of age should not eat pure milk. Children within 6 months should be fed exclusively with milk and do not need additional water, sugar water, etc. During the supplementary feeding period, attention should be paid to supplementing foods rich in iron, including lean meat and liver. Rice paste containing iron is better than rice porridge.
  • Science is appropriate to add complementary food. The varieties of complementary foods should also be rich and varied.
  • Children under 2 years of age require a daily vitamin D 400 IU (or 10 ug). Children over two years of age also need vitamin D if there is less outdoor activity.
  • Children were given regular physical examinations and body weights, height and developmental status were measured regularly.
  • Adults with eating disorders, or consumptive disease, or cancer should seek timely guidance from a dietician. Evaluate the status and take appropriate nutritional measures to avoid malnutrition.
Treatment

How To Treat Protein-energy Malnutrition?

What clinic does Protein-Energy Malnutrition belong to?

Adults suggest to nutrition, digestive internal medicine. In addition to the Nutrition department, children can also visit a Pediatric or Child Health department.

How to Treat Protein-Energy Malnutrition?

The status is evaluated first. WHO has established the classification criteria for moderate or severe child malnutrition. The criteria referred to factors such as the degree of emaciation and growth retardation and the presence of edema. Children's height/weight and age/height were expressed as Z- scores. Emaciation and growth retardation are defined as follows (these diagnoses may be simultaneous):

Emaciation (suggestive of acute malnutrition):

  • Moderate emaciation: Z- score for weight/height was less than -2 to -3.
  • Severe emaciation: Z- score of weight/height was less than -3.

Growth retardation (suggestive of chronic malnutrition):

  • Moderate growth retardation: Z- score for height or length was less than -2 to -3.
  • Severe growth retardation: Z- score for height or length was less than -3.

Malnutrition:

  • Moderate malnutrition: moderate emaciation or growth retardation.
  • Severe malnutrition: severe wasting, severe growth retardation, or edematous malnutrition.

WHO recommends these definitions of severe emaciation or bilateral edema as hospitalization criteria for severe acute malnutrition.

Secondly, gradually supplementing nutrition. When the body is in a state of chronic malnutrition, do not put all the nutrients for one step. But should gradually increase the supply of nutrition, improve food collocation.

If the digestion and absorption dysfunction, can consider enteral nutrition supply or parenteral nutrition, and supplement of trace elements and vitamins.

Secondly, gradually supplementing nutrition. When the body is in a state of chronic malnutrition, do not put all the nutrients for one step. But should gradually increase the supply of nutrition, improve food collocation.

If the digestion and absorption dysfunction, can consider enteral nutrition supply or parenteral nutrition, and supplement of trace elements and vitamins.

What do patients with protein energy malnutrition need to pay attention to during hospitalization?

Eat regularly as recommended by your doctor. Pay attention to the appropriate variety of food. Various nutrients are balanced.

Do I need to review my treatment after discharge?

Need follow-up and, in the case of children, periodic review and assessment of developmental status. If there is motor function and cognitive decline, special training and rehabilitation treatment should be conducted under the guidance of the doctor.

Will the Protein-Energy Malnutrition relapse after treatment?

If it is an obstacle to nutrient absorption caused by disease, there may be a chance of recurrence if the cause is not removed or bad eating habits are not corrected. (For example, people who are vegetarian have no diseases but prefer to eat. If such people don't get rid of the habit of eating, they may suffer from repeated malnutrition.)

Life

What Should Patients With Protein-energy Malnutrition Pay Attention To In Life?

What should patients with protein energy malnutrition pay attention to in their diet?

Watch the amount and mix of food, and add high-quality protein (including meat, eggs, milk, fish, soy products) and fat. And eat enough vegetables and fruits. Be rich in food varieties. Take vitamin d if you have less outdoor activity.

If it is a treatment plan, diet should be carried out under the guidance of a dietician. The adjustment speed of calorie, protein and fat will vary from person to person and should not be too fast to avoid causing indigestion.

What do patients with protein energy malnutrition pay attention to in their lives?

Infants and young children should undergo periodic physical examinations to assess height, weight, head circumference and developmental status. If you find growth retardation or developmental delay, look for the reason in time.

Regular physical examinations are also needed to assess nutritional status in the elderly and chronically ill. Early detection of signs of malnutrition, timely correction.

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