Pem etiopathogenesis

PROETIN ENERGY MALNUTRITION ETIOPATHOGENESIS

1. Cristi Francis

2. Inadequate intake of protein and energy either because the dietary intakes of these 2 nutrients are less than required for normal growth are greater than can be by what would otherwise be adequate intake [Nelson 18E] Range of pathological conditions arising from coincident lack in varying proportions of protein and calories occurring mostly in infants and young children commonly associated with infections (WHO 2014)

3. Different combinations of many aetiological factors can lead to PEM in children.They are: Social & Economic factors Biological factors Environmental factors Role of Free Radicals & Aflatoxin Age of the Host

4. Amongst the Social,Economic ,Biological & Environmental Factors the common causes are : Lack of breastfeeding and giving diluted formula Improper complementary feeding Ignorance Illiteracy Lack of health education Poverty Infection Familial Disharmony

5. Role of Free Radicals & Aflatoxins : Two new theories have been postulated recently to explain the pathogenesis of kwashiorkor.These include Free Radical Damage & Aflatoxin Piosoning.These may damage liver cells giving rise to kwashiorkor .

6. Age Of Host Frequent in Infants & young children whose rapid growth increases nutritional requirement.

7. The causes of PEM can either be direct or indirect. Direct causes The direct factors, which are commonly referred to as immediate factors include: (i) Inadequate food intake ( ii) Diseases

8. (i) Inadequate food intake Inadequate food intake is the result of limited access to food in terms of quality and quantity. (ii) Diseases Diseases notably malaria and measles lead to loss of appetite, increased rate of metabolism due to fevers thereby increasing the body’s nutrient demands. Diarrhoea reduces the absorption of food nutrients, whereas vomiting decreases food intake. Intestinal parasites compete for nutrients with the body e.g. hookworm competes for iron.

9. Indirect causes of PEM include : ( i) Food insecurity and limited access to foodstuffs (ii) Poor water / sanitation and inadequate health services (iii) Inadequate maternal and childcare practice

10. Pathophysiological changes associated with nutritional and energy deficits can be described as ( 1) body composition changes, ( 2) metabolic changes, and ( 3) anatomic changes.