Moderate Protein-energy Malnutrition Research Articles

Malnutrition-related polyunsaturated fatty acid changes in plasma lipid fractions of cirrhotic patients

Cirrhotic patients have both impaired liver function and nutritional derangement. In fact, the prevalence of protein-energy malnutrition (PEM) is very high in these patients. The aim of the present study was to elucidate whether the nutritional status in cirrhosis could be an additional factor that would affect levels of plasma lipids. Plasma lipid phosphorus, cholesterol, and triglycerides (TG), and fatty acid profiles in plasma and plasma fractions were determined in 50 healthy subjects and 92 patients with liver cirrhosis. The cirrhotic patients were prospectively included in three groups according to the result of nutritional assessment: group 1 (n = 38), acceptable nutritional status (including well-nourished and mildly malnourished patients); group 2 (n = 29), moderate PEM; and group 3 (n = 25), severe PEM. The main findings of this study were that the decrease in plasma cholesterol and linoleic,dihomo- γ-linolenic, and arachidonic acid levels of cirrhotic patients was related to the degree of PEM. Cholesteryl esters (CE) appeared to be the most sensitive indicator of lipid changes in cirrhosis. We consider that the role of malnutrition in the changes observed for polyunsaturated fatty acid (PUFA) profiles in plasma lipids of cirrhotic patients may be of major importance, since severe malnourished subjects exhibited the lowest levels of those compounds. Dietary supplementation of both essential fatty acids (EFA) and long-chain PUFA in adequate amounts to the cirrhotic patient might be of importance in the management of the disease.

Thymulin (Zn-FTS) activity in protein-energy malnutrition: new evidence for interaction between malnutrition and infection on thymic function

The combined effects of protein-energy malnutrition (PEM) and infection on thymic function evaluated by specific plasma thymulin activity were studied in Senegalese children: 29 hospitalized in Dakar for severe malnutrition and various diseases; 9 infected without sign of severe PEM, living in Dakar; 13 apparently healthy, uninfected, living in Dakar; and 7 apparently healthy, uninfected, living in Paris. Most of the free-living children in Dakar suffered from mild to moderate PEM. The specific thymulin activity (total plasma activity minus the activity recorded after adsorption of the plasma with a monoclonal antithymulin antibody) was almost undetectable in the infected children and was normal only in the children living in Paris. Such activity might be decreased by moderate and severe PEM and severe malnutrition may not be the only underlying cause of depressed level of thymulin in malnourished children from the Third World. Concurrent infections are important factors.

Moderate and severe protein energy malnutrition in childhood: effects on jejunal mucosal morphology and disaccharidase activities.

The enzymatic activities of maltase, sucrase, and lactase were determined in jejunal biopsies obtained from 24 children with gastrointestinal symptoms and different degrees of protein energy malnutrition (PEM) to see if these differences were related to the extent of malnutrition or concomitant small intestinal mucosal injury. Even in patients with moderate PEM, lactase activities were significantly lower than control values. The decrease in lactase activity seemed to depend on the severity of malnutrition. In contrast, maltase and sucrase activities were decreased only in second and third degrees of PEM, while no significant changes were observed in first degree and marasmic kwashiorkor. Histologically, all children with PEM had grade I to II mucosal injury which did not correlate with the degree of malnutrition. These results indicate that PEM affects each of the disaccharidases of the jejunal mucosa differently, with lactase being most sensitive to PEM and reflecting most closely the degree of PEM. In contrast, morphological changes showed no correlation with the degree of PEM.

Moderate and Severe Protein Energy Malnutrition in Childhood

Summary:The enzymatic activities of maltase, sucrase, and lactase were determined in jejunal biopsies obtained from 24 children with gastrointestinal symptoms and different degrees of protein energy malnutrition (PEM) to see if these differences were related to the extent of malnutrition or concomitant small intestinal mucosal injury. Even in patients with moderate PEM, lactase activities were significantly lower than control values. The decrease in lactase activity seemed to depend on the severity of malnutrition. In contrast, maltase and sucrase activities were decreased only in second and third degrees of PEM, while no significant changes were observed in first degree and marasmic kwashiorkor. Histologically, all children with PEM had grade I to II mucosal injury which did not correlate with the degree of malnutrition. These results indicate that PEM affects each of the disaccharidases of the jejunal mucosa differently, with lactase being most sensitive to PEM and reflecting most closely the degree of PEM. In contrast, morphological changes showed no correlation with the degree of PEM.

Infantile malnutrition in the tropics.

One of the major factors in the development of severe protein-energy malnutrition (PEM) is infection, such as diarrhea, upper respiratory infection, and malaria. Social and environmental factors include family size, access to land and occupation of parents, and exposure of rural populations to urban centers. Breast milk has been shown to play a role in the prevention of infections; however, the mother must be well-nourished to provide the optimum product. Traditional foods available to rural children in most developing countries are difficult to digest and low in energy and protein and inadequate nutritional education prevents the inclusion of good protein sources in children's diets. Severe PEM, called marasmus and kwashiorkor is indicated by wasting of muscles, absence of subcutaneous fat, wrinkled skin, thin and sparse hair, and weakness. The basic treatment for severe PEM is dietary. Treatment of kwashiorkor and marasmus is divided into 3 stages: 1) attending to acute problems, 2) restoring nutritional balance, and 3) ensuring nutritional rehabilitation. Care must be taken to ensure a minimum daily intake of 3-4 gm of protein and 120-150 Kcal of energy/kg of body weight. There must be, in addition, replacement of vitamin A, zinc, potassium, magnesium, and iron. An initial regimen which has been advocated is based on dry skim milk, sugar, and vegetable oil, divided into 6-12 feedings/day, which prevents vomiting. It is not necessary to remove lactose from the diet, and other animal protein sources such as meat and meat extracts are also well accepted. Soy and vegetable protein have been used successfully. In treating mild and moderate PEM it is important to ensure the intake of these food supplements by the child and to avoid a major substitution effect in the household diet. It is crucial for the physicians, nutritionists, public health workers, and educators to convince parents about the safety of using foods that are fed only to adults and older children. In addition nutritional and health education must not be restricted to the rehabilitation of the child but the prevention of nutritonal deterioration of the entire family and sometimes to the entire community.

Detection of moderate protein-energy malnutrition in pre-school children

Several biochemical and anthropometric tests were used to define the states of mild or moderate protein-energy malnutrition among 810 children aged under five years in the forest region of Southern Cameroon. The results show that the percentage and the identity of children classified as undernourished may be different according to the anthropometric test employed. The mean values of most of the biochemical variables assayed decrease in the groups affected with moderate weight and arm deficiencies. A system is proposed for the evaluation of the nutritional status based on the simultaneous use of four anthropometric tests. Some biochemical parameters may be useful for establishing a diagnosis.