Protein Energy Malnutrition (Dr. Low)

1. Organ failure 2. Infections or secondary malabsorption

How do children with Marasmus die? How do children with Kwashiorkor die?

1. More severe than Marasmus 2. Apathy/listlessness/ loss of appetite 3. Visceral protein loss = edema 4. Skeletal muscle and fat are preserved 5. Fatty liver 6. Vitamin Deficiencies 7. Immune Deficiency/infections 8. Hypermetabolism of infection and anorexia due to increased epinephrine levels

What are clinical manifestations of Kwashiorker Protein Energy Deficiency?

1. Emaciated/loss of somatic muscle mass 2. No edema 3. Visceral muscle spared 4. Anemia 5. Vitamin deficiencies (esp. folate, Vit. C, and folate) 6. Immune Deficiency/infections 7. Hypermetabolism of infection and anorexia due to increased epinephrine levels

What are clinical manifestations of Marasmus Protein-Energy Malnutrition?

1. Albumin 2. Immunoglobulins 3. Lipid transport 4. Transferrin 5. Hemoglobin

What are examples of visceral protein?

1. Extended restriction of energy intake. 2. Selective restriction/imbalance of essential amino acids 3. Selective restriction of essential vitamins or nutrients 4. Underlying issues (illness, infection, stress)

What are the causes of Protein-Energy Malnutrition?

Immune system impaired, due to lack of immune proteins, tissue repair. This leads to infection-induced inflammatory cytokines (interleukines, TNF-alpha, pyrogens, fever) AND lost T-cell function, reduced immunoglobins and reduced interferons. Also: 1. Increased protein breakdown 2. Gluconeogenesis 3. Insulin resistance

What happens in Protein-Energy Malnutrition when cortisol levels rise?

Low insulin and high Cortisol results in mobilization of adipose triglyceride reserves.

What hormones play the largest role in calorie malnutrition (Marasmus)?

Bronchopneumonia, due to wasting of breathing muscles and loss of immune function

What is a primary cause of death among seriously ill patients?

Skeletal muscle

What is an example of somatic protein?

1. Normal insulin (plenty of carbs in diet) 2. Edema: decreased synthesis of blood proteins. 3. Anemia: decreased synthesis of hemoglobin 4. Fatty liver: decreased synthesis of fat transport molecules, which means decreased fat mobilization.

What is the hormone profile in Kwashiorkor? What are three outcomes of reduced proteins as building blocks?

Marasmus

What protein energy malnutrition disorder affects somatic protein?

Kwashiorker

What protein energy malnutrition disorder affects visceral protein?

Kwashiorker: growth failure, hypalbuminemia, fatty liver, preservation of adipose and muscle, EDEMA

What protein energy malnutrition disorder results from inadequate protein?

Marasmus: stunted growth, loss of adipose and muscle, NO edema

What protein energy malnutrition disorder results from lack of sufficient caloric intake?

Cortisol

Which hormone plays a large role in Protein-Energy Malnutrition?

There are fewer blood proteins, which means there is less osmotic pressure in the blood. This means that more fluid escapes from the capillaries and is not recaptured.

Why is there edema in Kwashiorkor?