Introduction: It is the most widespread nutritional problem
in developing countries; predominantly affecting children. The prevalence rate varies from 20-50% in
different areas depending on socioeconomic status and level of education and
awareness.
Spectrum of
the condition: At one end
of the spectrum of malnutrition is marasmus, which results from a continued
severe deficiency of both dietary energy and proteins (primary calorie
inadequacy and secondary protein deficiency).
At the other end of the spectrum is kwashiorkor, where isolated
deficiency of proteins along with adequate calorie intake is seen. A classification by WHO is based on body
weight as a percentage of standard body weight.
Manifestations: The hallmarks of kwashiorkor are
hypoalbuminemia, which stands for lower than recommended plasma proteins
specifically Albumin. Albumin values
less than 2 g/dl is a biochemical marker in cases of kwashiorkor. There is also poor wound healing and
edema. In marasmus, this may not be so
low. However, IgG increases due to
associated infections. Fatty liver is
seen in some cases of kwashiorkor, but not in marasmus. Fatty liver is due to decreased lipoprotein
synthesis. Glucose tolerance is often
normal, but hypoglycemia may be seen in marasmic children. Hypokalemia and dehydration may be seen when
there is diarrhea. Hypomagnesemia is a
usual finding.
Treatment of
Protein Energy Malnutrition: Optimal response is
observed with diets providing 150-200 kcal/kg body weight and 3-4 g of
protein/kg body weight. A mixture of three parts of vegetable proteins (Bengal
gram or peanuts) and one part of milk protein is found to be very
effective. It is monitored by
disappearance of edema, rise in serum albumin level and gain in weight.
Sequelae of
Protein Calorie Malnutrition: Severe
malnutrition in early life can lead to permanent and irreversible physical and
functional deficits. Severe persistent
malnutrition may have deleterious effects on the intellectual capacity in later
life. There may not be any sequelae
where the moderate and mild forms are corrected in time. Since the children of today are the force of
tomorrow, a nationwide effort is to be made to eradicate childhood
malnutrition.
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