What Is Protein-Calorie Malnutrition?

Protein energy malnutrition (PEM) is a malnutrition caused by inadequate food supply or disease factors. It is clinically manifested as marasmus and kwashiorkor.

Protein-calorie dystrophy

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Protein energy malnutrition (PEM) is caused by insufficient food supply or disease factors.

Wasting is the result of a chronic lack of calories, protein, and other nutrients in the diet, or a patient's difficulty in digesting, absorbing, and using food. This type is dominated by energy deficiency and protein deficiency, which is manifested by progressive weight loss, subcutaneous fat reduction, edema, and dysfunction of various organs. Malignant malnutrition is manifested by a lack of protein in the diet, while the supply of thermal energy is sufficient, mainly manifested by malnutrition edema. But most patients are somewhere in between, and mild chronic protein-caloric dystrophy is often overlooked. It affects children's growth and development, immune function, and is prone to disease and difficult to recover. Severe protein-calorie dystrophy can directly cause death; mild chronic protein-calorie dystrophy is often ignored, but it has an impact on children's growth and development and patient recovery, so protein-calorie dystrophy is An important issue in clinical nutrition.

The heart is a metabolically active organ that can use a variety of substances, such as sugar, lactic acid, pyruvate, fatty acids, phospholipids, and amino acids, as energy sources. Nutritional cardiomyopathy (nutritional cardiomyopathy) refers to a group of diseases that cause cardiac dysfunction due to abnormal energy metabolism of myocardial cells due to malnutrition or excessive nutrition, and pathological changes in cell structure. Insufficient or excessive removal of nutrients in time may prevent or reverse these changes. Common causes of nutritional cardiomyopathy clinically include: protein-energy malnutrition (PEM), vitamin B1 deficiency, excessive alcohol, selenium deficiency, and obesity. At present, selenium deficiency is believed to be related to Keshan disease. Alcoholic cardiomyopathy caused by excessive alcohol is also introduced. Obesity is associated with hypertension, hyperlipidemia, and insulin resistance. It is one of the risk factors for coronary heart disease and has been included in "metabolic and invasive cardiomyopathy". The focus here is on cardiac changes caused by protein-calorie dystrophy and vitamin B1 deficiency.

Protein-calorie dystrophy

protein-energy malnutrition

energy-protein malnutrition; protein-energy malnutrition; protein-energy malnutrition; protein-energy malnutrition

classification

Department of Metabolism> Nutrition Deficiency

classification

Cardiovascular Medicine> Cardiomyopathy

Protein-calorie malnutrition occurs in all parts of the world, and it is more common in underdeveloped countries. Especially during natural disasters and wars, the incidence is higher when food and food supplies are insufficient. It is a serious problem that affects children's health and causes death. Disease one. The disease can occur in people of all ages, but it is more common in infants and young children. Secondary malnutrition is mostly induced by the disease. Malnutrition in economically developed countries such as Europe and the United States, as well as in older children and adults, is mostly secondary. According to statistics, the incidence of inpatients can reach 28% to 80%.

Protein-calorie dystrophy can be caused by severe protein deficiency and / or severe energy intake. There are several reasons: insufficient intake: food shortage or imbalance caused by famine, war or economic backwardness. Patients with mental disorders, anorexia nervosa, and upper gastrointestinal obstruction cannot eat as normal. Indigestion and malabsorption: stubborn and long-term vomiting, diarrhea, and digestive and malabsorption disorders associated with other diseases. The body needs to increase and the supply is insufficient: It is more common in infants and young children, pregnant and lactating women. In addition, wasting diseases such as hyperthyroidism, tumors, tuberculosis, and diabetes all increase the consumption of various nutrients in the body, and protein-calorie malnutrition can occur if the supplement is insufficient.

The occurrence of protein-calorie dystrophy is a complex pathophysiological process. When the supply of protein and energy in food is inadequate, the body begins to reduce the nutrient requirements of tissues and organs through physiological regulation, which can allow the body to survive in the internal environment with low nutrition levels. Failure of the mechanism can lead to death. Protein-calorie malnutrition can cause deficiency of other nutrients, such as vitamin B1, vitamin B6, folic acid, iron, magnesium, etc., often accompanied by hypokalemia, hypomagnesemia, hypophosphatemia. These factors can all contribute to aggravating malnutrition and damage to organs.

Patients with protein-calorie malnutrition suffer from mental fatigue, sluggish movements, low metabolic rate, relatively light heart load, and clinically no symptoms of heart failure. Large livers, pleural effusions, and peripheral depression edema are mostly caused by malnutrition, so for a long time, people have not been aware of the cardiac changes caused by protein-calorie dystrophy. It was not until 1958 that Gomez reported that patients with kwashiorkor had an enlarged heart, decreased cardiac output, and caused refractory heart failure. In 1962, Smythe reported that the heart weight of patients with kwashiorkor was significantly reduced compared with normal people. In 1971, post-mortem examination of 93 cases of protein-calorie malnutrition in Piza confirmed that 56 cases had severe heart damage, and the damage was enough to cause symptoms of heart failure. Pulmonary congestion and central hepatic lobular congestion confirmed that the patient had heart failure before birth. It shows that protein-calorie dystrophy can cause nutritional cardiomyopathy and cause fatal heart failure.

The clinical manifestations of protein-calorie dystrophy vary depending on factors such as individual differences, severity, and onset time. Clinical symptoms include non-weight gain and loss, subcutaneous fat reduction and disappearance, and varying degrees of dysfunction in various organ systems throughout the body. Clinically, there are 3 types of marasmus, kwashiorkor and marasmickwashiorkor. According to the degree of nutritional deficiency, it can be divided into light, medium and severe degrees; according to the disease process, it can be divided into acute, subacute and chronic.

Electrocardiogram showed sinus bradycardia and QRS wave low voltage, ST-T abnormality, and obvious U wave.

Two-dimensional echocardiography shows that the heart is shrinking, and a few can see that the heart cavity is enlarged and the cardiac output is decreased.

Chest X-ray examination: the heart shrinks, a few patients have a slightly enlarged heart, and osteoporosis of the chest wall and spine.

According to the patient's history of severe protein and / or energy malnutrition, specific skin and hair changes, weight loss, weak pulse, reduced blood pressure, hypothermia, low body weight, with or without edema, clinical manifestations should be highly suspected of nutrition Cardiomyopathy. However, such patients often do not have symptoms of heart failure such as jugular venous distension and hepatic dysfunction; the changes of electrocardiogram and two-dimensional echocardiography are non-specific, which is not helpful for diagnosis. Endocardial myocardial biopsy can help confirm myocardial pathological changes.

Children with edema due to a significant lack of protein should be distinguished from heart, kidney edema, tuberculous peritonitis, ascites due to liver cirrhosis, and allergic edema.

The principle of treatment of this disease is to supplement nutrition and correct the imbalance of water and electrolyte balance. Nutritional treatment should be carried out slowly, starting with 0.8 g / kg of protein per day and gradually increasing to 1.5 to 2.0 g / kg per day, of which 1/3 should be animal protein. If the patient can take food, oral administration is encouraged. Eat small meals and eat easily digestible semi-liquid. The amount of sodium should be controlled. If the patient cannot take it orally, nutritional therapy is given via a gastric tube or intravenously. Anemia patients should be given a small number of blood transfusions. At the same time, supplemented with an assimilating agent, such as 25mg of nandrolone phenpropionate, intramuscular injection, once or twice a week. The drug has a mild natrium effect and should not be used prematurely.

Protein-energy deficiency patients often die not from hunger, but from water and electrolyte disorders, so it is extremely important to correct water and electrolyte disorders in a timely manner. It is difficult to judge the loss of water by conventional methods. Care should be taken to observe the dryness of lips and tongue, lower blood pressure, coldness at the extremities, and decreased urine output. The fluid supplement should ensure that the patient has sufficient urine output. Children should urinate at least 200ml every 24 hours, and adults should urinate at least 500ml.

The treatment of protein-calorie dystrophy is divided into two phases: first aid and recovery.

If protein-calorie malnutrition can be diagnosed and treated in time, nutritional cardiomyopathy can often be reversed. The cause must be analyzed and both the symptoms and the symptoms can be treated with good results. The prognosis depends on the age, duration and extent of malnutrition, in particular the age of onset is the most important. The younger the age, the greater the long-term impact, and the abstract thinking ability is more vulnerable.

Often died of severe complications or death from respiratory paralysis due to sudden spontaneous hypoglycemia.

The prevention of protein-calorie dystrophy is very important. Since this disease mostly occurs in children, strengthening child health care is the key. We should vigorously promote the new method of childcare, publicize correct feeding methods, and provide nutrition guidance. The specific measures are as follows.

Phospholipid, Folic Acid, Vitamin A, Bailing, Glutamate, Taurine, Methionine, Urea, Nandrolone Phenylpropionate

Insulin, folic acid, vitamin A, serum transferrin, amino acid determination, glycine, serine, glutamic acid, hydroxyproline, proline