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Protein energy malnutrition affects every organ system The most obvious results are loss of body weight, adipose stores, and skeletal muscle mass Weight losses of 5 10% are usually tolerated without loss of physiologic function; losses of 35 40% of body weight usually result in death Loss of protein from skeletal muscle and internal organs is usually proportionate to weight loss Protein mass is lost from the liver, gastrointestinal tract, kidneys, and heart As protein energy malnutrition progresses, organ dysfunction develops Hepatic synthesis of serum proteins decreases, and depressed levels of circulating proteins are observed Cardiac output and contractility are decreased, and the electrocardiogram (ECG) may show decreased voltage and a rightward axis shift Autopsies of patients who die with severe undernutrition show myofibrillar atrophy and interstitial edema of the heart Respiratory function is affected primarily by weakness and atrophy of the muscles of respiration Vital capacity and tidal volume are depressed, and mucociliary clearance is abnormal The gastrointestinal tract is affected by mucosal atrophy and loss of villi of small intestine, resulting in malabsorption Intestinal disaccharidase deficiency and mild pancreatic insufficiency also occur Changes in immunologic function are among the most important changes seen in protein calorie undernutrition T lymphocyte number and function are depressed Changes in B cell function are more variable Impaired complement activity, granulocyte function, and anatomic barriers to infection are noted, and wound healing is poor
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Protein energy malnutrition occurs as a result of a relative or absolute deficiency of energy and protein It may be primary, due to inadequate food intake, or secondary, as a result of other illness For most developing nations, primary protein energy malnutrition remains among the most significant health problems Protein energy malnutrition has been described as two distinct syndromes Kwashiorkor, caused by a deficiency of protein in the presence of adequate energy, is typically seen in weaning infants at the birth of a sibling in areas where foods containing protein are insufficiently abundant Marasmus, caused by combined protein and energy deficiency, is most commonly seen where adequate quantities of food are not available In industrialized societies, protein energy malnutrition is most often secondary to other diseases Kwashiorkor-like secondary protein energy malnutrition occurs primarily in association with hypermetabolic acute illnesses such as trauma, burns, and sepsis Marasmus-like secondary protein energy malnutrition typically results from chronic diseases such as chronic obstructive pulmonary disease (COPD), congestive heart failure, cancer, or AIDS These syndromes have been estimated to be present in at least 20%
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lead to malabsorption and diarrhea due to abnormalities in the gastrointestinal tract Refeeding edema is a benign condition to be differentiated from congestive heart failure Changes in renal sodium reabsorption and poor skin and blood vessel integrity result in the development of dependent edema without other signs of heart disease Treatment includes reassurance, elevation of the dependent area, and modest sodium restriction Diuretics are usually ineffective, may aggravate electrolyte deficiencies, and should not be used The prevention and early detection of protein energy malnutrition in hospitalized patients require awareness of its risk factors and early symptoms and signs Patients at risk require formal assessment of nutritional status and close observation of dietary intake, body weight, and nutritional requirements during the hospital stay
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Cooper BA et al Protein malnutrition and hypoalbuminemia as predictors of vascular events and mortality in ESRD Am J Kidney Dis 2004;43:61 [PMID: 14712428] Delano MJ et al The origins of cachexia in acute and chronic inflammatory diseases Nutr Clin Pract 2006 Feb;21(1):68 81 [PMID: 16439772] Faintuch J et al Severe protein-calorie malnutrition after bariatric procedures Obes Surg 2004 Feb;14(2):175 81 [PMID: 15018745] Franfenfield D Energy expenditure and protein requirements after traumatic injury Nutr Clin Pract 2006 Oct;21(5):430 7 [PMID: 16998142] Furman EF Undernutrition in older adults across the continuum of care: nutritional assessment, barriers, and interventions J Gerontol Nurs 2006 Jan;32(1):22 7 [PMID: 16475461] Wanke C Pathogenesis and consequences of HIV-associated wasting J Acquir Immune Defic Syndr 2004 Dec 1;37 Suppl 5:S277 9 [PMID: 15722870]
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