Management Of Protein-energy Malnutrition Research Articles

Comparative analysis of different therapeutic approaches in the management of protein-energy malnutrition: Case reports from a clinical setting.

Severe protein-energy malnutrition (PEM) presents a significant clinical challenge, often compounded by comorbidities such as type 2 diabetes. This case report aims to elucidate the intricacies of managing severe PEM in conjunction with type 2 diabetes, emphasizing the importance of personalized interventions and multidisciplinary collaboration in achieving optimal outcomes. By addressing the unique challenges this complex clinical scenario poses, this report contributes valuable insights to the medical literature and guides clinicians in effectively managing similar cases. The patient, pseudonymously identified as Emma Thompson, underwent a comprehensive diagnostic evaluation to assess her symptoms' severity and underlying causes. This included a thorough physical examination, laboratory testing, imaging studies, and collaboration with specialists to formulate a tailored treatment plan. Interventions were meticulously administered, with dosages, strengths, and durations adjusted based on ongoing assessments and patient response. Implementing multidisciplinary therapeutic interventions significantly improved the patient's nutritional status, glycemic control, and overall well-being. Objective measures such as BMI, serum albumin levels, and physical functioning showed marked improvement throughout treatment. Patient-reported outcomes indicated enhanced quality of life, reduced fatigue, and increased energy levels, underscoring the comprehensive success of the integrated therapeutic approach. This case report highlights the efficacy of a holistic, patient-centered approach in managing severe PEM and comorbid type 2 diabetes. Optimal outcomes were achieved by addressing the complex interplay of medical conditions through tailored interventions and multidisciplinary collaboration. The lessons from this case underscore the importance of individualized care, ongoing assessment, and long-term follow-up in enhancing patient well-being and guiding future clinical practice.

A Pre - Experimental Study to Assess the Effectiveness of Community based Education Program on Knowledge Regarding Prevention and Management of Protein Energy Malnutrition among the Mothers of Under Five Children in Selected Rural Areas

A Pre - Experimental Study to Assess the Effectiveness of Community based Education Program on Knowledge Regarding Prevention and Management of Protein Energy Malnutrition among the Mothers of Under Five Children in Selected Rural Areas

Influence of different conventional processing methods on the resistant starch content and diastatic power of Bambara groundnut (Vigna subterranean) starch

The edible seeds in the pods of legumes have been used in the management of protein-energy malnutrition after undergoing food processing operations to promote their utilization. However, starch were obtained from the raw seeds when subjected to operations like drying, germination, soaking, boiling, and milling. Therefore, this study investigated the effect of conventional processing methods such as drying, boiling, and germinating on the starch qualities of Bambara groundnut for value addition in the food system and healthy therapy. The seeds were divided into four batches (native, boiled, germinated and dried) while starch was isolated from each using alkaline methods and the products were compared in terms of starch yield, color, amylose content, resistant starch, and diastatic power. The starch yield was 38, 32 and 28% for the germinated, dried and boiled samples, respectively when compared to the native sample (44%). The higher lightness (whiteness) obtained for the native starch (84.57) over the processed starches was due to its low pigmentation level. Meanwhile, the amylose contents of native and processed starches were in the range of 26.48 to 27.49%. The resistant starch ranged from 17.56 to 18.03%, with cooking (boiling) process significantly increasing the resistant starch contents, which may be attributed to the effect of retrogradation on the boiled starch after cooling. Contrarily, the diastatic power was very high in the germinated starch sample (9.34 oL) when compared with other samples due to the malting or germination process of the seeds before starch extraction. However, the information generated from this study could be useful for indigenous promotion and effective utilization of Bambara groundnuts both domestically and industrially as a functional and nutraceutical food.

Efficacy of Ayurveda Interventions Specifically on Weight Gain in the Management of Protein Energy Malnutrition in Children: A Systematic Review Protocol

Background: In India, Protein Energy Malnutrition (PEM)remains a significant and challenging public health issue despite implementing different nutritional policies over the period. It is also accompanying with aggravated risk of all-cause morbidity, as well as fatality Ayurveda mentions about various nutritional disorders such as karshya, balashosha, phakka, yakshma which are having similar symptomatology and treatment approach as that of the PEM. Several clinical studies have been conducted and some are under trial but systematic review is still pending to explore an effective treatment modality to combat PEM in Children.
 Aim: A systematic review to evaluate the efficacy of Ayurveda Interventions specifically on weight gain in the Management of Protein Energy Malnutrition in Children.
 Materials and Methods: A systematic review which will evaluate published clinical work of Ayurveda treatment modalities specifically for weight gain in the management of PEM in children that will involve “The randomized controlled trials (RCTs), multiple-arms clinical trials, quasi-experimental trials, observational studies (case series and case reports) through databases like PubMed, COCHRANE, AYUSH Research Portal, DHARA; Google Scholar; etc. and Ayurveda compendia to fetch complete available literature.”
 Observations and Discussion: The work of selection of the studies, data extraction, and synthesis will be taken up. Established guidelines for study selection, quality assessment, and narrative synthesis will be followed. Risk of bias assessment will be performed. A protocol will be designed that will ensure transparency for the completed review. Results of the study will be elaborately synthesized. The data will be presented in percentage, count and frequency; and if we find the data to be sufficiently homogeneous then meta-analysis will be carried out.
 Conclusion: The results obtained from this systematic review will be useful in identifying the evidence-based efficacy of Ayurveda interventions on weight gain in the Management of PEM. It will also provide substratum for future research studies for generating good-quality evidence that can be helpful to design new health policy to combat PEM effectively.

Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein-Energy Malnutrition.

Protein-energy malnutrition (PEM) diminishes amino acid and energy availability, impairing the body's healing capability after injury, such as in myocardial damage following acute myocardial infarction (AMI). We sought to investigate the influence of PEM on clinical outcomes of AMI. We identified records with a primary discharge diagnosis of AMI from the Nationwide Inpatient Sample (2012-2014), stratified by concomitant PEM. We matched PEM to no-PEM (1:1) using a greedy algorithm-based propensity methodology and estimated the impact of PEM on health outcomes (SAS 9.4). Of the 332,644 hospitalizations for AMI, 11,675 had concomitant PEM accounting for roughly $US 1.5 billion and over 119,792 hospital days. PEM was associated with older age (74.43- vs. 66.90-years; P<0.0001), female sex (49.19% vs. 38.44%; P<0.0001), black race (12.78% vs. 10.46%; P<0.0001), and higher comorbidity burden (Deyo > 3: 32.77% vs. 16.69%; P<0.0001). After propensity matching, PEM was associated with higher mortality (Adjusted odds ratio [AOR]: 1.59 [1.46-1.73]), cardiogenic shock (AOR: 2.26 [2.08-2.44]), discharge to secondary facilities (AOR: 2.21 [2.10-2.33]), charges ($135,500 [$131,956-139,139] vs. $81,084 [$79,241-82,970]), cardiac artery bypass surgery (AOR:1.81 [1.66-1.97]), intra-aortic balloon pump placement (AOR: 1.83 [1.65-2.04]) and longer length of stay (10.15- vs. 5.52-days). PEM is a predisposing factor for devastating clinical outcomes among AMI hospitalizations. Higher prevention, identification and management of PEM among high-risk individuals (older age, female sex, and black race) residing in the community are needed.

Evaluation of Protein Nutritional Quality of Four Soybean Varieties Grown in Western Kenya

Protein nutrition is important for human health because its deficiency leads to major public health problems such as Protein Energy Malnutrition. Soybean an excellent and cheap source of high quality protein has been introduced into the Western Kenya and other developing countries for improved health and food security, but end use qualities may reduce its utilization. The main objective of this study was to evaluate the protein nutritional quality of four soybean varieties grown in Western Kenya. Protein quality was determined using male weanling albino rats for the indices of net protein retention, food efficiency, apparent and true protein digestibilities and faecal weight. Soybean amino acid efficiency was evaluated using Protein digestibility corrected amino acid score (PDCAAS). Soybean diet SB 132 had the highest protein nutritional quality with the best protein retention of 6.29 g, Apparent Protein digestibility of 89.13%, True Protein Digestibility of 96.48%, weight gain of 5.50 g and a Net Protein Retention Ratio of 4.70. All the four soybean varieties had high amino acid profiles with a Protein digestibility Corrected Amino Acid Score of 1.0. Soybean variety SB 132 is the most superior in digestibility and the study recommends its promotion as a food crop in Western Kenya and other developing countries for the management of Protein Energy Malnutrition and for food security.

Efficacy assessment of supplementary food product in management of PEM among children of 3–6 years

The prevalence of protein energy malnutrition (PEM) is assessed about 70% among children under 5. The main reason behind is inadequacy of diet. The present study emphasizes on the management of malnutrition among children. For the purpose a supplementary product ladoo rich in energy and protein was prepared. It was fulfilling 1/3 of day's requirement of energy and protein. Effect of product in management of malnutrition was assessed by assessing changes in anthropometric measurement, dietary intake and presence of clinical signs of PEM among malnourished children after intervention. A pre-post test design was used to assess the effect of supplementary food. To select the 10 normal and 30 malnourished children a preliminary survey was conducted on one hundred five children (3–6 years) of village Bhesana, Jhadol block of Udaipur district (Rajasthan). Due to supplement the weight of children under the entire category increased significantly (p<0.05). The increment observed was 1.07, 1.15 and 0.8 kg for grade I, II and III children, respectively. Dietary intake of all the children under study was poor than the recommended daily allowances. The significant (p<0.05, 0.01) improvement in daily intake was observed due to the supplement contributing about 1/3rd of days requirement. No change was found in clinical examination after intervention of 60 days. The study concluded that the food based approach is effective in management of malnutrition.

Missed opportunities in the diagnosis and management of protein energy malnutrition among children under 5 years in Wakiso district, Uganda.

Protein energy malnutrition (PEM) is one of the leading causes of death among children below 5 years in Uganda. It develops after acute childhood illnesses despite children having received treatment from health facilities. This study assessed knowledge and practices of health workers in the diagnosis and management of PEM, which was used to establish missed opportunities to prevent severe acute malnutrition (SAM) in its management. This was a cross sectional descriptive study that used questionnaires and observation of health workers at Health Center IV (HCIV) in Wakiso district, Uganda. The clinical nutrition diagnosis of the children was then obtained. There were 44 health workers that assessed 225 children. Most of the health workers 32 (72.7%) had education in PEM management and over 60% of them knew the forms of PEM, clinical signs of kwashiorkor and marasmus and the factors that predispose to PEM. Health workers did not weigh 56 (24.9%) of the children, 193 (86%) children had no height taken and only 32 (14.2%) had mid upper arm circumference measured. The weight for height of 223 (99.2%) and weight for age of 109 (93%) children was not calculated. Only 38 (16.89%) were examined for edema and 40 (17.78%) for muscle wasting. Health workers diagnosed only 21 (9%) children with malnutrition, while researchers found 94 (31.9%) with malnutrition. Children who missed opportunity to have malnutrition diagnosed at the health facility were 73 (32.9%). The knowledge of health workers on PEM is adequate, but their practice is inadequate. There is missed opportunity to diagnose and manage PEM among children who present with acute illnesses at the health centers, hence missed opportunity to prevent SAM.

Practical dietary management of protein energy malnutrition in young children with cow’s milk protein allergy

Cow's milk protein allergy (CMPA) affects between 1.9 and 4.9% of infants and young children. This food allergy requires the complete elimination of cow's milk and its derivatives, impacting on nutritional status. The risk of having protein energy malnutrition (PEM) in children with CMPA has been well documented. In 2007, the World Health Organisation published guidelines on the dietary management of PEM, which has impacted on the recommendations and composition on specialist feeds for many chronic diseases, but not on CMPA. The main change in management of the child with PEM is the protein energy ratio and energy requirements. The ideal protein energy ratio lies between 8.9 and 11.5%, which would ensure a deposition of about 70% lean and 30% fat mass. In addition, for optimal catch-up growth between 5 and 10 g/kg/day, energy requirements should be between 105 and 126 kcal/kg/day. Although most current hypoallergenic formulas fall well within the recommendation for protein, there is a problem in achieving energy requirements. As a result, modular additions are often made, disturbing the protein energy ratio or feeds are concentrated, which impacts on osmolality. We therefore aimed to review current guidelines on PEM and how these can be applied in the management of the malnourished child with CMPA.

Nutrition counseling impacts serum albumin levels

Objective To determine the difference in the rate of change of serum albumin levels between protein-energy malnourished patients who receive intensive dietary counseling and patients who receive a special oral liquid nutritional supplement (Nepro; Ross Products, Division Abbott Laboratories, Columbus, OH). Design Participants with serum albumin values ≤3.5 g/dL (bromocresol green) or 3.2 g/dL (bromocresol purple) and a Mini Nutrition Assessment (MNA) Malnutrition score ≤23.5 were randomized to the supplement group (Nepro) or the nonsupplement group with intensive dietary counseling. Patients Forty-one hemodialysis patients 18 years and older who had been on dialysis for at least 6 months. Intervention Participants were randomly assigned to supplement (26) or nonsupplement (14) groups. Main outcome measures Albumin levels. Statistical analyses performed Analysis of variance and χ 2 tests, linear regression. Results After adjustment for demographic and clinical characteristics, the rate of change in serum albumin level was significantly greater among patients randomized to dietary counseling alone than among those who received oral supplements. These preliminary results suggest that intensive nutritional counseling may be of greater benefit than nutritional supplements alone in the management of protein-energy malnutrition in patients on hemodialysis. These preliminary findings should be confirmed by a larger full-scale trial.

Involuntary weight loss in elderly individuals: assessment and treatment.

The loss of body weight and fat late in life is associated with premature death and increased risk of disability, even after excluding elderly subjects who have a preexisting disease. Although it is important to recognize that periods of substantially positive or negative energy balance and body weight fluctuation occur as a normal part of life, weight losses greater than 5% over 6 months should be investigated. We can divide the major causes of weight loss in the elderly into 4 categories: social, psychiatric, due to medical conditions, and age-related. The clinical evaluation should include a careful history and physical examination. If these fail to provide clues to the weight loss, simple diagnostic tests are indicated. A period of watchful waiting is preferable to blind pursuit of additional diagnostic testing that may yield few useful data, if the results of these initial tests are normal. The first step in managing patients with weight loss is to identify and treat any specific causative or contributing conditions and to provide nutritional support when indicated. Non-orexigenic drugs have found an established place in the management of protein-energy malnutrition. Early attention to nutrition and prevention of weight loss during periods of acute stress, particularly during hospitalization, may be extremely important, as efforts directed at re-feeding are often unsuccessful. Narrative review.

MANAGEMENT OF NUTRITIONAL PROBLEMS IN SUBACUTE CARE

Poor nutritional status is one of the major factors associated with functional decline and mortality in older persons. Older persons are at increased risk for malnutrition because of the physiologic anorexia of aging. During a stay in a subacute care facility, attention to nutrition is a major component of the rehabilitative process. The pathophysiology of malnutrition, diagnostic techniques available to diagnose malnutrition, causes and management of protein energy malnutrition, specific nutritional problems caused by vitamin and trace element deficiency, and nutritional management of specific diseases (e.g., hip fracture and diabetes mellitus) are reviewed.

Management of protein-energy malnutrition in Nigeria: an evaluation of the regimen at the Kersey Nutrition Rehabilitation Centre, Nigeria

An evaluation of the performance of the Kersey Nutrition Rehabilitation Centre in Nigeria was undertaken with particular focus on mortality, rate of weight gain, and the management strategy. During 1987–1991 the total number of admissions for protein-energy malnutrition (PEM) was 803. The age group most commonly represented were those aged 12–29 months. Kwashiorkor cases formed the largest proportion of admissions (66%). Marasmic cases consistently predominated among children aged < 18 months. Average mortality was 22% during the 5 years. Mortality among oedematous patients was 25% compareed with 15% among marasmic cases. The rate of weight gain averaged 7 g/kg/d for marasmic and marasmic-kwashiorkor cases and 6 g/kg/d for kwashiorkor cases. Specific recommendations are made to improve case-management, focusing particularly on the prevention of deaths in the first few days after admission.

Prevalence of Xerophthalmia and Efficacy of Vitamin A Prophylaxis in Preventing Xerophthalmia Co-existing with Malnutrition in Rural Indian Children

Data of 4302 children, 0-6 years old were analysed to study the prevalence of vitamin A deficiency and the efficacy of vitamin A prophylaxis in preventing xerophthalmia co-existing with malnutrition. Manifestation of ocular signs of vitamin A deficiency were seen in 10 per cent children. The prevalence of xerophthalmia was higher in the normal and mild to moderately malnourished children, and lowest in the severely malnourished ones. The ability of vitamin A prophylaxis to curb xerophthalmia was greatest at the extreme ends of the nutritional grade spectrum. These findings have important implications for the existing national Vitamin A Prophylaxis Programme, and suggest that: (a) normal and mild to moderately malnourished children less than 6 years old, should be preferably considered for vitamin A mega dosing; (b) in the management of protein energy malnutrition, vitamin A status of the children should be monitored; and (c) the coverage should be improved as most children are in the mild and moderate degrees of malnutrition.

Protein Energy Malnutrition

This chapter discusses severe form of malnutrition in children. Protein-energy malnutrition (PEM) is the term most frequently used to embrace the severe forms of malnutrition seen in childhood and the nutritionally determined growth failure that precedes clinical syndromes. It is easy to recognize gross abnormality in the severe forms of PEM. It is much more difficult to decide the boundary between mild malnutrition and normal light weight or short stature. The effects of infection in children from malnourishing environments exacerbate the effects of the poor nutrition as infection leads to anorexia, pyrexia with increased metabolic rate, toxicity affecting metabolic reactions, and often tissue loss because of diarrhea. Nutrition deteriorates in these children during infection and is insufficient in between the episodes of infection to allow complete catch-up growth. Increased susceptibility to infection resulting from poor nutrition leads to further deterioration in nutritional status. The management of protein energy malnutrition depends largely on the severity of the illness and the facilities available for investigation and treatment. Unfortunately, severe PEM is commonly found in areas where investigative and therapeutic facilities are very limited, and management may be dependent on feeding the children locally available foods prepared so as to provide optimum nutritional benefit.

Nutrition support and malnutrition in Nigeria.

In 1983, a nutritional support team was formed at the University of Ife-Ife, Nigeria, that used high calorie enteral mixtures successfully for dietary management of protein energy malnutrition (PEM) in children. PEM has several causes. Poverty is often cited, but the incidence of mild to severe PEM in children under 5 is higher in the Ivory Coast, Nigeria, Egypt and Sudan with per capita gross national product (GNP) above $400 than in Sierra Leone, India, Uganda, and Kenya with GNP below this amount. The consumption of legumes and oil seeds ward off kwashiorkor and marasmus, but in countries with traditional food practices they are not consumed in adequate amounts. Beans, groundnuts, melon seeds, and soya beans are cheap and produced in African and Asian countries. In Nigeria the traditional weaning food is a thin gruel made from maize, sorghum, or millet. Milk, groundnut paste, or sugar is not added. Legumes and other oil seeds are forbidden for children because of deep-rooted cultural practices that favor tubers. Longer duration of breast feeding protects infants from kwashiorkor or marasmus, but the recent drastic change in the pattern with early introduction of artificial feeding has resulted in early appearance of kwashiorkor or gastroenteritis. Low literacy of mothers is another factor, and it inversely correlated with infant mortality. The increase in the level of female literacy and maternal education in less developed countries is a major requirement from governments if they are to combat harmful food taboos. Since Williams associated maize diets with kwashiorkor in 1933, research has show energy deficiency more perilous than protein insufficiency in the treatment and prevention of PEM in these countries.