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Diagnosis
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
In 1981, medical experts from across the world contributed to the creation of a WHO publication titled “The Treatment and Management of Severe Protein-Energy Malnutrition”.9 Its purpose was to provide guidelines for the treatment of severe protein-energy malnutrition in children. In this document, protein-energy malnutrition was classified as marasmus, kwashiorkor, or a mixed form, marasmic kwashiorkor.9 The leading diagnostic signs for marasmus were described as those of starvation: an “old man’s face”, an emaciated body that is “only skin and bones”, accompanied by “irritability and fretfulness”.9 Kwashiorkor was described as edema and apathy, often accompanied by discoloration of the hair and, especially if the edema is severe, by “flaky paint” dermatosis.9 The WHO publication also classified protein-energy malnutrition in children by the presence of edema and the degree of underweight as defined by the National Center for Health Statistics (NCHS) classification “weight for length” reference values.9 This definition became the basis for the diagnosis of malnutrition in children and is listed in the International Classification of Diseases (ICD), also published by the WHO.
Cardiac Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Megan Horsley, Jeffrey Anderson
Protein-energy malnutrition in hospitalized children is associated with increased physiological instability and increased resource utilization potentially affecting outcomes. Protocols for initiating and advancing EN during the preoperative and postoperative periods are advantageous. When determining energy needs for the critically ill infant, indirect calorimetry (IC) is the gold standard. Energy needs are heterogeneous and predictive equations are often inaccurate. Obtaining IC is challenging in small infants due to the specific criteria and limited resources available. If IC is unavailable, literature recommends initially aiming for basal energy expenditure using the WHO tables during the first 3–5 days, then multiplying basal energy expenditure by stress or injury factors after postoperative days 5–7. Alternate predictive equations to consider are the Dietary Reference Intakes (DRI) from 2002 and REE tables by Page and colleagues. Table 14.2 summarizes postoperative nutrition guidelines for patients with CHD.
Answers
Published in Samar Razaq, Difficult Cases in Primary Care, 2021
Protein-energy malnutrition encompasses a number of conditions of which kwashiorkor and marasmus are the best described. Marasmus is essentially caused by a low-calorific diet in which the child has access to very little of what is otherwise a nutritionally complete diet. The child is usually ravenous (unlike the child with kwashiorkor who is listless, irritable and has a depressed appetite). Biochemical abnormalities are less common in marasmus in comparison to kwashiorkor. The child is thin with reduced weight and loss of fat and muscle tissue. Provision of ample calories results in the child regaining weight and the prognosis is generally good when identified and treated in infancy. Kwashiorkor is caused by a deficiency in protein intake that occurs as breast milk is eliminated from the diet. Low protein content of the weaned foods leads to a decrease in total energy intake and nutritional deficiencies. Concurrent increase in risk of enteric infections from various bacteria worsens the nutritional deficiencies and increases the risk of death. Although more common in the developing world, protein-energy malnutrition is seen in the industrialised world in the context of neglect and fad diets.
Relationship Between Appetite-Related Peptides and Frailty in Older Adults
Published in Endocrine Research, 2023
Burcu Candemir, İbrahim İleri, Mehmet Muhittin Yalçın, Aydın Tuncer Sel, Berna Göker, Özlem Gülbahar, İlhan Yetkin
Preserving body composition and weight depends on the relationship between anabolic and catabolic mechanisms. The balance between the orexigenic and anorexigenic hormones has been suggested to be essential to maintain this relationship and to avoid frailty.5 However, in general, a decrease in energy intake is higher than a decrease in energy expenditure, hence leading to weight loss in many older adults. Over time, this leads to protein-energy malnutrition, sarcopenia, and weakness.6 Some studies have suggested that the decrease in some orexigenic peptides, such as ghrelin, is associated with loss of muscle strength and functional capacity during the aging process.6,7 Moreover, the results of a cross-sectional study has suggested thatthe decrease in ghrelin concentration might not be a part of the physiological aging process, but is related to unhealthy aging.8 Low ghrelin levels in older adults has been demonstrated to be associated with poor nutritional status and lower functional capacity, however, a certain relationship between ghrelin levels and frailty has not been established yet.7
In-patient outcomes of patients with diabetic ketoacidosis and concurrent protein energy malnutrition: A national database study from 2016 to 2017
Published in Postgraduate Medicine, 2021
Asim Kichloo, Hafeez Shaka, Zain El-Amir, Farah Wani, Jagmeet Singh, Genaro Romario Velazquez, Ehizogie Edigin, Dushyant Dahiya
Protein-energy malnutrition (PEM) is a nutritional deficiency that is a consequence of inadequate protein or energy, meaning caloric intake [4]. This can result in either kwashiorkor, a disease mainly affecting children characterized by edema and/or ascites and is a consequence of severely restricted protein intake, or marasmus, which is marked by bodily tissue wasting particularly in the subcutaneous fat and muscles, and is a consequence of severely restricted energy intake [4]. Marasmus and kwashiorkor can be present simultaneously resulting in marasmic kwashiorkor, and can mask malnutrition because of an edematous presentation [4]. Protein wasting, also referred to as protein-energy wasting, can occur in patients with DM, specifically if they have end-stage renal disease or are on maintenance dialysis [5]. Although literature describes the concurrence of PEM in patients with DM, there is a paucity of objective clinical data on the differences in clinical outcomes in patients hospitalized with DKA with and without PEM.
Dietary intake of HIV-seropositive clients attending Longisa County Hospital Comprehensive Care Clinic, Bomet County, Kenya
Published in South African Journal of Clinical Nutrition, 2020
Kenneth Kipngeno Tonui, Eunice Njogu, Agatha Christine Onyango
According to the WHO,1 HIV-seropositive adults require approximately 50% to 100% more proteins than non-HIV-infected adults. Irregular consumption of legumes, meats, eggs and fish by the HIV-seropositive respondents in the current study meant that the protein needs were rarely met. As such, the respondents were more predisposed to protein energy malnutrition. The most frequently consumed source of protein was milk. While it is true that milk is a high biological value protein (animal-based protein), there is always the need to complement plant and animal proteins to enhance the nutritional status of an individual. The most probable reason for reduced consumption of proteins by the respondents is the reduced production of such foods in the study area. The commonly consumed staple food crop in the study location (Bomet County) is maize,8 which is milled into flour and consumed as porridge. In addition, beans are grown in this area. On another note, irregular consumption of certain protein types such as fish by the respondents is a result of cultural norms, whereby fish is not considered as a food by the Kalenjin and Maasai cultures whose members are the major residents in the areas surrounding the study setting.9,10