PEM- Protein energy malnutrition

Outline things that may cause such malnutrition

- Poor intake (in terms of both quality and quantity) - Increased metabolism - Increased losses - Defective utilisation

Give 5 examples of those who are at risk of developing PEM

- Those with Cancer - Ulcerative Colitis - The elderly - Medication - Arthritis - Acute and Chronic pain - Respiratory disease - Depression and grief

Effects of PEM on women's reproductive organs

--> amenorrhea (absence of a period) and infertility

What is a full nutritional assessment?

a comprehensive process of identifying and evaluating the nutritional status of an individual using appropriate quantifiable methods

What is a Nutritional screening

a simple and rapid process of identifying clinical characteristics known to be associated with malnutrition

At what BMI are 90% of women infertile

<18

Define PEM

A type of malnutrition in which there is a deficiency of protein or calories

Outline how long the stores of Lipids, Carbohydrates and proteins last for

Carbohydrates (mainly liver glycogen)--> 6-12 hours Lipids--> 20-25 days Protein (mainly muscle)--> 10-12 days

What is the main cause of death in those with PEM and why?

Cardiac arrythmia Cardiac arrest Due to tissue wasting and also electrolyte imbalance

Outline what happens when the carbohydrate stores have been used

Ketogenesis will occur, this is a process whereby ketones are manufactured from fatty acids within the liver. This may lead to ketoacidosis, whereby ketogenesis is extreme and uncontrolled, leading to a build up of keto-acids and a lowered pH of the blood.

Give the 2 types of PEM

Kwashiorkor Marasmus

List the consequences of PEM in terms of the gut epithelium

Lesser rate of mitosis--> Malabsorption due to a lesser surface area over which absorption can take place Muscle atrophy --> May lead to the leakage of gut bacteria into the blood--> septicaemia Impaired secretion of enzymes from the pancreas--> maldigestion Impaired secretion of stomach acid--> maldigestion and impaired infection barrier

What is the 3rd and most severe type of PEM

Marasmic-Kwashiorkor

List the consequences of PEM in terms of brain function

Over the course of starvation, the brain will become adapted to the use of ketones as a source of energy, after 4 days, the brain will obtain 70% of its energy from ketone bodies. Semi comatose hypoglycaemia Starvation will also lead to an impaired production of neurotransmitters. This can lead to the individuals mood being affected, becoming irritative, lethargic etc

List the consequences of PEM in terms of the immune system

PEM leads to suppression of cell-mediated immunity --> leaving the body vulnerable to opportunistic infections

List the consequences of PEM in terms of the Renal System

Poor concentration--> polyurea Poor acid secretion--> acidosis

List the consequences of PEM in terms of respiratory function

Reduced oxygenation

Outline what causes the metabolic consequences of PEM

The liver glycogen stores are used within hours, thus, glucose must be obtained from other sources - Glycerol from body far - Amino acids from muscle protein May explain why starvation leads to an emancipated appearance.

Briefly outline Marasmus

This is a severe form of malnutrition- that of calories/energy. This results in the sufferer becoming emancipated (loss of muscle mass and subcutaneous tissue, resulting in body weight reducing). It can be distinguished from Kwashiorkor insofar as it is deficiency of all forms of energy as opposed to just proteins.

Briefly outline Kwashiorkor

This is malnutrition of proteins. It is often characterised by the swollen belly that it causes. This is the result of a build up of fluid, that occurs due to the lack of proteins in the blood, thus lessening the concentration gradient.

List the consequences of PEM in terms of cardiac function

Will lead to a reduced cardiac output--> decreased tissue perforation

What are the effects of PEM on the men reproductive organs

• Delays puberty • Decreased sex drive and performance • Decreased sex hormones • Zn deficiency decreased sperm count • Heavy metals (cadmium/lead) injure testes