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Protein Energy Malnutrition
One would think that in this modern age there would be little worry over diets that are deficient in any major ways by lack of access to nutrients as opposed to intentional omission. Unfortunately this is not the case. Most of us in developed Western countries find ready access to most key food groups. However there are many in the world and even in the United States that do not have this same access. In this paper we will explore the diseases of Marasmus and Kwashiorkor and the associated causes, effects and treatments.
PEM/PCM Defined
Malnutrition as a whole can be defined and is defined by the World Health Organization (WHO) as "an imbalance between the supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions. When addressing this from the specific viewpoint of a protein deficiency we come to a collective group of nutritional disorders and diseases called protein-energy malnutrition (PEM). This group is composed of two disorders that include marasmus and kwashiorkor (Hendrick Health Systems, 00).
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Marasmus comes from a Greek word marasmus that means wasting or withering. Marasmus is caused by too little consumption of protein and calories and is seen visibly as severe emaciation. Kwashiorkor is a word taken from the native language of Ghana and means the sickness of the weaning. Kwashiorkor is somewhat different from marasmus in that the affected person usually had sufficient calorie intake but is lacking severely in proteins and edema is normally present in kwashiorkor but is absent in marasmus (Hendrick Health Systems, 00).
Effects of PEM
PEM affects many bodily systems and almost every organ. Marasmus and the lack of caloric intake results in the body depleting its own fat and energy reserves and ultimately results in severe emaciation in the effected person. There is extreme weakness when the effects of marasmus become advanced. The body breaks down and uses its own tissues as a calorie source. This results in people loosing all their body fat and muscle strength. They also will become quite skeletal in physical appearance that is the most noticed in the hands and the muscles in front of and above each ear (Hendrick Health Systems, 00).
Children that develop marasmus are small for their age and they suffer from frequent infections with their weakened immune system. There is also a loss of appetite, diarrhea, dry and baggy skin, dull thinning hair, mental retardation, and low body temperatures just to name a few.
Kwashiorkor is a similar condition in the PEM group where affected people will develop extremely think arms and legs but will have a distended abdomen due to fluid build up, liver enlargement, anemia and diarrhea are common. The body's immune system is also quite weakened with Kwashiorkor resulting in frequent infections. In children behavioral development is slow, mental retardation occurs frequently and while they may grow to a normal height children affected by kwashiorkor are abnormally thin.
At Risk Populations
PEM is not a disorder that is prevalent in the United States among the majority of the population. However it is common in children from extremely poor families and the elderly who live in nursing facilities. In one survey by the WHO that focused on low income areas of the United States, -5% of children between the ages of two and six were below the 15th percentile in weight. The survey also identified that 11% of children in the same low income areas were in only the 5th percentile for height (WHO, 00).
When viewing these statistics from a global standpoint in 000 WHO estimated that there were over 181. million malnourished children in developing countries and that malnutrition was the leading cause of death for children under 10 in those areas. WHO also estimates that 14.6 million children under the age of 5 are far below normal rages in height and weight. These numbers are even more startling when you consider that over 50% of the children in South Central Asia and Eastern Africa have severe growth retardation due to PEM. This figure is over 5 times the amount per capita in western countries (WHO, 00).
PEM also occurs in approximately 50% of all surgical patients and 48% of all other hospital patients. PEM also occurs as a secondary condition frequently in patients who are suffering from cancer or AIDS. This increased risk for hospital patients or people suffering from other illnesses is due to difficulty chewing, swallowing, and digesting food (WHO, 00).
Pain, nausea, and the lack of appetite are the commonest reason that these patients do not take in enough of the proper nutrients. The loss of vital nutrients is also greatly increased in these same individuals due to bleeding, diarrhea, abnormally high sugar levels, kidney disease, and other malabsorption disorders. Infections, surgery, malignant and benign tumors, trauma, burns and even some medications increase the amount of nutrients required for proper body function (WHO, 00).
How Can Diet Prevent Or Manage The Disease
Protein is a key component in a healthy diet. Actually the root of the word protein comes from Greek and means "of first importance". Protein makes up over 0% of an adult's body mass and composes the majority of muscles, organs, bones, cartilage, enzymes, skin and some hormones (USDA, 00).
The human body is constantly breaking down proteins and having to be replaced. The exception to this is the amino acids. This process is referred to as protein turnover. This process begins at conception and lasts throughout the entire life cycle. Without proteins in our diet growth and all other bodily functions would eventually cease to operate (USDA, 00).
The human body cannot manufacture proteins and all the amino acids needed like plants life is able to. The human body can only manufacture thirteen but they are sometimes referred to as nonessential. They are essential to the body's daily functions but are not essential as a dietary item. There are nine essential amino acids though that are a required part of our diets. They can come from plant proteins or from animals that eat plants and other animals (USDA, 00).
As we eat proteins our digestive system breaks them down into each of the amino acids and those are then circulated throughout the body. Each cell then takes the available amino acids and assembles them into the proteins it needs to perform its function. However, if there are not enough of a given building block then the cells cannot create the proteins that it needs to function and system failure may occur. This is why it is crucial for a healthy diet to contain all the proper proteins (USDA, 00).
This balance is what is so difficult for the poor to obtain especially in developing nations where food is often in short supply to begin with. Short term solutions include providing food directly to the effect individuals but long term solutions are needed. These may include public health and education programs. This can be helpful because the higher the education people have the better choices they are able to make about their lifestyles, diets and those of their children.
For hospital patients screening and monitoring of dietary intake and weight loss should be a priority. Patients should be screened upon admission for illness or other factors that could make them susceptible to PEM. Those that are at risk should be provided with an even higher and more diligent monitoring of their diets and caloric intake.
Cure And Recovery
Treatment for PEM basically consists of providing adequate nutrition that will help restore normal balance and body weight. This treatment should be coupled with any other necessary treatments for other medical conditions, especially those which may have contributed to the malnutrition. In many cases feeding through alternate methods such as a feeding tube is necessary for patients who are unable to physically or unwilling to eat protein rich foods (Hendrick Health Systems, 00).
Initial treatment for severe cases begins with returning the body's fluid and electrolyte balance to normal, and treating any infections with antibiotics that will not have an adverse effect on the absorption of proteins. Continuing treatment and the addition of essential nutrients to the diet is done slowly so the body is not overwhelmed by the sudden dietary changes and stressing of the immune system (Hendrick Health Systems, 00).
Patients can often lose up to 10% of their overall body weight with no long term effects. However, patients with severe PEM that loose more than 40% almost always loose their lives. The death in those cases is generally due to heart failure, as is often seen in people afflicted by Anorexia (Hendrick Health Systems, 00).
Recovery times are different between marasmus and kwashiorkor. Marasmus often takes longer and some, especially children never completely recover. There are not any hard facts on the long term effects of malnutrition during childhood. Some children can completely recover and have no ill effects, while others have many lifelong disorders including the inability to properly absorb nutrients or mental retardation (Hendrick Health Systems, 00).
Conclusion
While PEM is not a disorder that impacts a large segment of the population within developed western nations it is a worldwide issue. The lack of access to proper nutrition either due to geographic, political or economic issues is a growing concern for many. The establishment of effective monitoring for hospital and nursing home patients, education and food programs may potentially have a positive effect on those people who are at risk of PEM. The establishment of long term food programs to provide essential nutrition to the children of the developing world is by far and away the most critical.
References
Hendrick Health Systems. (00). Online. http//www.ehendrick.org/healthy/00110.htm Retrieved from the World Wide Web May 16, 00.
USDA. (00). Online http//www.usda.gov/ Retrieved from the World Wide Web May 16, 00.
World Health Organization (00). Online http//www.who.org Retrieved from the World Wide Web May 16, 00.
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