4B BB0107 Integrated Topic III: Protein energy malnutrition

(Dr Despo Papachristodoulou)

Explain the importance of macronutrients (fat, carbohydrate

and protein) in the diet and indicate the health implications
of insufficient or excessive intake of these dietary
components in adulthood and childhood
A human needed to consume food from four food groups to maintain
a balanced and healthy diets. These four food groups are:

Dietary Lipids or Fats

The average UK diet contains 88g fat a day, with 40% of total
energy intake coming from fats.
Fat comes in the diet as TAG (Triacylglycerols) and cholesterol in
small amounts.
Unsaturated fatty acids are much healthier than Saturated fatty
acids.
Dietary fat is essential, as the body requires fatty acids and lipids as
precursors for eicosanoids, which include prostoglandins that
needed for hormone synthesis. Lipids are also essential as they are
major constituents of membrane phospholipids.

Cardiovascular Disease
Humans are at risk from cardiovascular disease through genetics,
smoking, high blood pressure, high serum cholesterol and a
sedentary life cycle.
Increase in saturated fatty acids leads to increase in LDL and total
cholesterol, increasing risk of Cardiovascular Disease, but an
increase in polyunsaturated fatty acids in the diet can reduce blood
cholesterol levels and reduce risk.
Fatty acids, such as Linoleic Acid (Omega-6) and Linolenic Acid
(Omega 3) are healthy fatty acids found in fish that provide
protection from cardiovascular disease.

Cancer
Studies show that if Cancer A was dominant in Country A and
Cancer B was dominant in Country B, an immigrant from Country A
to Cancer B is more likely to suffer from Cancer A. This has been
linked to a high dietary fat content, as breast, colon, pancreas and
prostate cancer are all related to a high fat diet.

Carbohydrates
Carbohydrates are much greater consumed in poor populations,
mainly due to the consumption of rice.
Carbohydrates come in the forms of starch, fibre and sugars, mainly
originating from plants, except lactose.
• Monosaccharides
Glucose and Fructose are found in small amounts in fruit.
Inositol (used for IP3) is found in fibre, but has a negative effect on
absorption of iron and calcium.
Sorbital is commercially prepared for diabetics, as it does not
increase blood glucose concentration.
• Disaccharides
Sucrose is the most common disaccharide and the UK consumption
is 105g/day.
Lactose is a disaccharide found in milk and many non-Europeans
cannot tolerate it.
• Polysaccharides
Polysaccharides, to which Starch is the most common, are
crystalline and insoluble.

Protein
Protein is found at between 10-15% of total energy of diet in both
developed and developing countries. The UK recommendations are
0.75g for every kg body weight, and no more than 1.5g/kg body
weight. The protein requirements decrease from 2.4g/kg/day from
childbirth to 0.75g/kg/day in adulthood.
Proteins of animal origin are more effective in supporting growth of
animals, and high quality proteins have higher utilization/less waste
as the amino acid pattern is nearer to body protein.
Proteins are needed in the diet as the provide the essential amino
acids needed for synthesizing new proteins such as thyroid
hormones, neurotransmitters, and haem.
Excessive intake of proteins can lead to bone demineralization or
deterioration of renal function with renal disease sufferers.

The body in starvation preserves muscle stores by using

carbohydrate and fat as energy. However, in the stress of illness
associated with weight loss, protein is used as an energy source
instead, and muscle breakdown occurs, giving rise to impaired
immunity and increased susceptibility to illness.
Unintended weight loss is an important marker for physical and
mental disease and is taken seriously. There is a significant increase
in morbidity when more than 10% weight loss occurs, and death is
inevitable when 40% weight loss occurs.
However, a previous fit young person can survive 60 days without
food.

Describe the aetiology, world distribution and clinical

presentation of protein-energy deficiency states
Malnutrition has many causes:
• Starvation due to lack of food is the most common cause of
malnutrition, with 5million children dieing every year and
300milllion children generating growth retardation due to it.
The problem is access to food, not lack of food.
• War and Political upheaval are aggravating factors.
 • Illnesses such as Cancer and Aids, as well as stress and injury
are also causes.

Explain the terms ‘stunting of growth’, ‘marasmus’ and

‘kwashiorkor’ and their relationship to the spectrum of
protein-energy deficiency states
Stunting of growth relates to a person having the normal weight for
height, but being of a low height for their age.
However, a low Body Mass Index indicates Protein-Energy
Malnutrition (PEM).
Protein Energy Malnutrition is found in three forms:
• Marasmus
Marasmus is caused by failure to take in sufficient calories.
Marasmus can affect people of any age of vulnerable groups. Main
groups are elderly people and slimmers, as well as people suffering
from cancer, aids and eating disorders.
Symptoms of Marasmus include impaired absorption, immune
response, diarrhea, and extreme emaciation (loss of vital body fat
reserves, muscles and organ proteins).
• Kwashiorkor
As infection often produces Kwashiorkor, it is likely caused by the
body being not able to cope with added oxidative stress of infection
due to general food and antioxidant deficiency.
Symptoms of Kwashiorkor include severe oedema (swelling of
organs due to increased tissue fluid), liver enlargement, dermatitis
(inflammation of skin) and changes in hair colour and texture.
• Marasmic Kwashiorkor
Marasmic Kwashiorkor is a mixture of both conditions. Sometimes a
family may have both conditions and a child can switch from one to
the other.

Outline means of treatment and their limitations.

Treatments for Protein Energy Malnutrition include the Fluid and
Electrolyte balance being restored by consumption of the Oral Dehydration solution.
Dextrose Solution and dilute milk are consumed after and then normal food when
tolerated.
Success of treatment depends on duration and severity.