What Is Protein Malnutrition?

Protein malnutrition, also known as Kwashiorkor disease, is a malnutrition syndrome of abnormal skin and hair caused by a severe lack of protein. It is a type of protein-energy malnutrition-related disease spectrum. The disease is most common in infants and preschool children from 6 months to 5 years of age, and often has a series of lesions such as growth retardation, mental retardation, and hypoproteinemia.

Basic Information

nickname

Kwasioko disease

Visiting department

dermatology

Multiple groups

Infants and preschoolers from 6 months to 5 years

Common causes

Protein deficiency

Common symptoms

Skin and mucosa manifestations, whole body manifestations

Causes of protein malnutrition

Insufficient protein in the diet can cause protein malnutrition. For example, in some countries, cassava and plantain with a protein content of only 1% is the main food, and protein intake can be seriously insufficient; protein digestion, absorption and synthesis disorders can cause protein deficiency, such as the gastrointestinal , Pancreatic, liver diseases; lack of aromatic amino acids can also cause disease, such as patients with phenylketonuria who do not eat food containing phenylalanine or blindly refuse to eat protein-containing food may lead to protein malnutrition.

Clinical manifestations of protein malnutrition

1. Children with fair skin and mucous membranes have specific skin lesions, erythema appears in the friction and pressure parts, the pressure subsides, and then there are small reddish-brown, purple spots, the surface is shiny, and there is a waxy feel when touching. The border is clear, higher than the surrounding skin, and it does not fade. Later, you can see that the skin is dry, there are cracks on brown or black spots, cleft palate and skin ulcers can appear, and more pigmentation is left over the forehead, buttocks, tail, and back of the foot.
Mild patients are seen in young people, and often occur in the front of the tibia, lateral thigh, back and other places along the skin tangent tortoise cracks, said inlaid skin or cracked skin, with superficial desquamation. Severe patients can see large areas of skin erosion, manifested as bleeding points, bullae, ulcers and necrosis, and the skin is vulnerable to injury.
Mucosal damage can be seen in cheilitis similar to vitamin B2 deficiency, as well as dry eyes, cheilitis, stomatitis, oral ulcers, atrophy of the tongue and nipples, and it can also affect the anus and vagina.
The fingernails of the patient became thinner and softer, and there was separation of old and new nails when there was normal new nail growth. Hair is dry, non-glossy, curly hair becomes soft and straight, and there are obvious dandruff, called fine-crack hair, hair growth period is reduced, resting period is increased, and hair loss occurs due to lying on the temporal pillow. Hair bleaching appears as black hair becomes brown or light red, brown hair becomes light yellow or even light gray or white, mixed with black and white spots.
2. Children with systemic performance have difficulty feeding, skeletal and mental retardation, low muscle tone, muscle relaxation, cold or excited expression, no smile, weight loss, muscle atrophy, disappearance of subcutaneous fat, weight loss, and low protein edema , Often with diarrhea and abdominal distension.

Protein malnutrition check

1. Physical examination patients may have characteristic skin and mucosal damage, edema, dry and dull hair, mental abnormalities, weight loss and abdominal distension.
2. Serological examination: Serum albumin and total protein decrease, hemoglobin content decreases, blood cholesterol and serum enzymes decrease, and potassium and magnesium deficiency are common.
3. In the early stage of histopathological examination, skin changes may have incomplete keratinization. Pale keratinocytes are distributed in the upper part of the epidermis, the spinal cell layer is thinned, and the basal cells are irregular and vacuolated. The ultrastructure shows that the mitochondria are shorter than normal.

Protein Malnutrition Diagnosis

According to the history of malnutrition, combined with the age of onset of the patient, physical examination revealed characteristic changes such as edema, dermatitis, changes in hair pigmentation, growth and development disorders, mental abnormalities, weight loss, and abdominal distension. Laboratory serological examinations showed a decrease in protein, which can be diagnosed.

Differential diagnosis of protein malnutrition

1. Nicotinic acid deficiency Nicotinic acid deficiency is more common in adults. Dermatitis can occur first, followed by gastrointestinal and psychiatric symptoms. The skin lesions are more common in exposed areas, and clear-eyed erythematous rashes can appear after sunlight exposure. The border is clear and the red thickening skin lesions may have dry desquamation, while the hair and nails are normal. Laboratory tests showed decreased blood niacin levels.
2. Skin lesions of enteric acral dermatitis are clustered small vesicles or pustules around the mouth of the cavity and the extremities of the extremities. They can be fused into bullae and quickly dry and crusted. Psoriasis-like scales appear. Appeared in batches, symmetrically distributed, and 90% of patients had gastrointestinal symptoms.

Protein malnutrition treatment

Correct primary diseases, provide adequate nutrition, increase animal protein, plant protein and fresh vegetables. Symptomatic treatment of water and electrolyte disorders, skin damage, etc.

Prognosis of protein malnutrition

The prognosis of protein malnutrition depends on the age, duration and extent of onset. The prognosis of mild patients is good after treatment. The younger the age of onset, the greater the long-term effects, especially the cognitive and abstract thinking abilities are prone to defects. If the child's growth and development are extensively impaired, his mental and physical retardation can be permanent.

Protein malnutrition prevention

The diet provides standard food with sufficient animal protein and calories, supplemented with minerals, vitamins and trace elements, especially for children, pregnant women, and lactating women, they should eat sufficient animal protein, plant protein and fresh vegetables.