Pathophysiology Of Malnutrition 

Malnutrition

Patients with malnutrition are also classified as having ankylosis. Malnutrition is often used to indicate a child's improper nutrition, and it can have serious consequences for the child's health and development if left untreated.

Classification Of Malnutrition

Two major categories can be used to classify the word malnutrition.
• Undernutrition: This term is used interchangeably with protein-energy malnutrition (PEM), which is a severe lack of calories and proteins. The iceberg phenomenon is demonstrated by PEM (Protein-energy malnutrition).
• Overnutrition: Generally speaking, this term refers to obesity.
 A particular dietary deficit. While the World Health Organization employs the word "undernutrition," the Indian Council of Medical Research (ICMR) uses the terms "undernutrition" and "protein energy malnutrition" interchangeably.. The iceberg phenomena is also shown by PEM.

Also Read: Rapid Acquisition Of Key Concepts - Nutrition And Nutritional Disorders

Etiology Of Malnutrition

There are two types of protein-energy malnutrition, or PEM.
• Primary PEM: No additional serious illness is discovered, but there are dietary and nutritional deficits pertaining to fats, carbs, and proteins.
• Secondary PEM: In this case, the insufficiency results from a decreased usage of proteins and carbs in a variety of illness conditions, or from any secondary reason. Malabsorption occurs in conditions such as long-standing or undiscovered cystic fibrosis and celiac disease.

Adverse Effects Of PEM On Various Systems

Protein-energy malnutrition (PEM) can have a devastating impact on numerous vital organs in the body, including the central nervous system (CNS). Acquired or secondary malnutrition due to PEM can lead to microcephaly and decreased brain growth, resulting in anomalies in auditory potentials and VEP (visually evoked potentials).

Furthermore, it can cause brain atrophy, which can result in comparatively poor IQ in later life. The dendritic arborization of neurons is affected, leading to cognitive impairments.

 The Gastrointestinal Tract, Or GIT

  The oral inspection of the patient revealed flattened papillae and a smooth tongue, indicating a decrease in the number of taste buds and a loss of flavor sensation. Endoscopy showed shiny, atrophic mucosa in the jejunum and ileum, which is a sign of reduced absorption of vital nutrients.

Lower levels of brush border enzymes such as lactases and disaccharidases were detected leading to secondary lactose malabsorption. The patient also exhibited prolapse of the rectal area, which can cause discomfort and difficulty with bowel movements.

Additionally, the liver and pancreas were affected, resulting in fatty liver and impaired digestion. Overall, this patient's condition is indicative of a vicious cycle of malnutrition that requires prompt attention to address the underlying causes and prevent further complications.

The endocrine system plays a crucial role in regulating various physiological processes in the body, including metabolism, growth and development, and response to stress. In cases of malnutrition such as kwashiorkor and marasmus, the endocrine system is affected in different ways. In kwashiorkor, thyroid levels are normal to low, indicating a hypothyroid state, while cortisol and growth hormone levels are increased in response to the body's stress response. This rise in cortisol and growth hormone can occur when there is catabolic activity in the body.

In contrast, marasmus is characterized by low serum insulin levels, indicating decreased beta cell function in the pancreas. Additionally, there is a drop in insulinotropic variables, which can further exacerbate the hypoglycemic state.

 Overall, the endocrine system plays a crucial role in maintaining homeostasis and responding to stressful conditions, and abnormalities in endocrine function can have significant consequences for overall health and well-being.

Malnutrition has far-reaching effects on various bodily systems, including the cardiovascular and renal systems. In individuals who are malnourished in protein and energy, there is observable atrophy of cardiac muscle. This leads to a decrease in cardiac output, resulting in bradycardia and congestive heart failure. Furthermore, the renal system suffers significant decline, leading to decreased renal plasma flow and glomerular filtration rate.

Additionally, tubular malfunction results in phosphaturia and aminoaciduria. Notably, when hypokalaemia is present, the body tends to retain potassium, which leads to an increase in acidic urine production through the activation of potassium hydrogen ATPase. This increases the exchange of urinary potassium with hydrogen ions and enhances the hydrogen ion secretion. In conclusion, malnutrition has significant consequences for various bodily systems, including the cardiovascular and renal systems. It is essential to address malnutrition promptly to prevent or minimize these adverse effects on overall health.

Metabolic Dysfunction in PEM (Protein-Energy Malnutrition)  

Increases in total body water in all forms of malnutrition involving protein and calories. Two contradictory observations in cases of severe PEM. There is a direct relationship between TBW and the degree of weight loss. Therefore, TBW has increased higher in Marasmus than in Kwashiorkor.  A malnourished child is thirsty despite higher TBW. This is because these kids have a broken thirst system.

Potassium: A 25% decrease in the overall potassium concentration.  Muscles experience the greatest loss, followed by the brain. In many individuals, hypokalaemia coexists with acute renal failure and either pyelonephritis or diarrhea.

Sodium: The body has an increased total sodium content due to the correlation between sodium and water retention, which raises the amount when sodium retention occurs. More prevalent in Kwashiorkor compared to Marasmus. As sodium levels rise, certain types of edema may exhibit dilutional hyponatremia.

Magnesium: A decrease in the overall amount of magnesium. There's also a correlation with neurological symptoms including convulsions, twitches, and tremors.

Phosphorus: Protein-energy malnutrition is characterized by low phosphorus levels. It is discovered that the levels of phosphate, both organic and inorganic, are low.

Calcium: Protein-energy malnutrition is associated with normal to low calcium levels.

Iron and Copper: Patients with protein-energy malnutrition have low copper levels.

Chromium: In PEM, low chromium levels are linked to glucose intolerance, which in turn causes stunted growth.

Zinc: Patients with protein-energy malnutrition are more likely to have anemia, hepatomegaly, short stature, and hypogonadism if their zinc levels are low.

 Additionally, diarrhea is a propensity.  Sugar Hypoglycemia can occur as a result of reduced tissue level metabolism, decreased lactose intolerance in a patient, decreased glucose absorption in the stomach, and decreased glycogen reserve in the liver. In response to hypoglycemia, growth hormone, cortisol, and glucagon levels rise and insulin levels fall.

Proteins and amino acids:  Hypoalbuminemia, which is frequent in Kwashiorkor, is caused by a decrease in total protein concentration.

Alpha and gamma globulin levels fluctuate, whereas beta globulin levels decline.  The essential amino acids valine, isoleucine, leucine, and tyrosine are all found in low concentrations in Kwashiorkor. As a compensatory mechanism, increasing protein-energy malnutrition was caused by amino acid recycling.

 Lipids: Steatorrhea-like stool is caused by decreased absorption of gut lipids and increased stool losses.

Levels of conjugated bile acids fall while those of free bile acids rise. Hepatic steatosis, or kwashiorkor, frequently results in fatty liver. Fatty acids that are essential in causing liver dysfunction.

Q. Why Do Fatty Liver In Kwashiorkor?

A. Fatty liver in kwashiorkor typically results from a variety of variables that surround and initiate the condition. The factors involved are:  Boost the movement of fat from tissue to the liver.  Promote the liver's natural synthesis of lipids.

A reduction in the beta lipoproteins and LDL that are important in the transfer of fat beyond the liver. • A shortage in essential fatty acids, which also contributes to fatty liver.

Repeated Infections In Protein-Energy Malnutrition

Patients with protein-energy deficiency often develop recurrent infections due to compromised cell-mediated immunity. This results in a decline in neutrophil killing, bactericidal capacity, and immunoglobulins (such as secretory IgA).

As a consequence, the body's two distinctly damaged systems lead to separate infections. For instance, patients may experience skin infections caused by streptococcus or staphylococcus bacteria, as well as respiratory and gastrointestinal system infections. These infections can manifest themselves through a variety of symptoms, including fever, fatigue, and muscle weakness.

Also Read: Infections of the Upper Airway- Common Cold and Sinusitis

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