Protein-energy malnutrition In developed countries
Starvation uncomplicated by disease is relatively uncommon in developed countries, although some degree of undernourishment is seen in very poor areas. Most nutritional problems occurring in the population at large are due to eating wrong combinations of foodstuffs, such as an excess of refined carbohydrate or a diet low in fresh vegetables. Undernourishment associated with disease is common in hospitals and nursing homes. Surgical complications, with sepsis, are a common cause. Many patients are admitted to hospital undernourished, and a variety of chronic conditions predispose to this state.
The majority of the weight loss, leading to malnutrition, is due to poor intake secondary to the anorexia associated with the underlying condition . Disease may also contribute by causing malabsorption and increased catabolism, which is mediated by complex changes in cytokines, hormones, side-effects of drugs, and immobility. The elderly are particularly at risk of malnutrition because they often suffer from diseases and psychosocial problems such as social isolation or bereavement.
Treatment of Protein-energy malnutrition In developed countries
When malnutrition is obvious and the underlying disease cannot be corrected at once, some form of nutritional support is necessary. Nutrition should be given enterally if the gastrointestinal tract is functioning adequately. This can most easily be done by encouraging the patient to eat more often and by giving a high-calorie supplement. If this is not possible, a liquefied diet may be given intragastrically via a fine-bore tube or by a percutaneous endoscopic gastrostomy (PEG). If both of these measures fail, parenteral nutrition is given.
Protein-energy malnutrition In
In many areas of the world, people are on the verge of malnutrition. In addition, if events such as drought, war or changes in political climate occur, millions suffer from starvation. Although the basic condition of PEM is the same in all parts of the world from whatever cause, malnutrition resulting from long periods of near-total starvation produces unique clinical appearances in children virtually never seen in the West.
The term 'protein-energy malnutrition' covers the spectrum of clinical conditions seen in adults and children. The World Health Organization (WHO) classification of chronic undernutrition in children is based on standard deviation scores. Thus, children with a standard deviation score of less than -2 (2 standard deviation scores below the median - corresponding to 2.3 centile) can be regarded as being at high risk of undernutrition. The following terminology is used:
- low weight-for-age: underweight
- low height-for-age: shortness (stunting when pathological)
- low weight for height: thinness (wasted when pathological).
Treatment of Protein-energy malnutrition In developing countries
Treatment must involve the provision of protein and energy supplements and the control of infection.
Prevention of protein-energy malnutrition - GOBIF (a WHO priority programme)
Growth monitoring: The WHO has a simple growth chart that the mother keeps, Oral rehydration, particularly for diarrhoea, Breast-feeding supplemented by food after 6 months, Immunization: against measles, tetanus, pertussis, diphtheria, polio and tuberculosis.
Prevention of PEM depends not only on adequate nutrients being available but also on education of both governments and individuals in the importance of good nutrition and immunization. Short-term programmes are useful for acute shortages of food, but long-term programmes involving improved agriculture are equally important. Bad feeding practices and infections are more prevalent than actual shortage of food in many areas of the world. However, good surveillance is necessary to avoid periods of famine.
Food supplements (and additional vitamins) should be given to 'at-risk' groups by adding high-energy food (e.g. milk powder, meat concentrates) to the diet. Pregnancy and lactation are times of high energy requirement and supplements have been shown to be beneficial.