Malnutrition protein-caloric

The economic losses incurred by helminth infections have been assessed in several ways. In ascariasis the loss is due to the carbohydrate depletion by Ascaris worms in the patients. It has been estimated that a patient with 20 adult worms of Ascaris lumbricoides may lose 2.8 g of carbohydrate daily [8] which amounts to 2800 kg of carbohydrate per 1 million cases per day. Thus the world-wide loss of carbohydrate for 1100 million patients carrying ascariasis would be nearly 3080 tonnes per day, Stephenson and coworkers [9] have shown that ascariasis is not only associated with poor growth and protein-caloric malnutrition in pre-school children, but also reduces absorption of macronutrients and vitamin A. The authors also showed that economic loss due to ascariasis in Kenya in 1976 was about US 5 million which could have been saved by the use of an anthelmintic costing about US 1 million only. 

Recent studies on bile salts in duodenojejunal samples from subjects suffering from tropical sprue have shown a significantly lowered glycine/ taurine ratio compared to ratios in control or protein-caloric malnutrition subjects (37). 

Hypocupremia and hypoceruloplasminemia of marked degree are found regularly in patients with kwashiorkor, a form of protein malnutrition with normal caloric intake and complicated by multiple vitamin deficiencies (E4, G9, L2, R8). Macdonald and Warren (M3) found that the copper content of the liver (on a fat-free dry weight basis) is significantly reduced... 

Low copper and ceruloplasmin levels have been reported in marasmus of infants (protein and caloric malnutrition) from Chile (M28) and India (G9). 

Patients with severe sepsis are susceptible to progressive malnutrition secondary to the hypermetabolism associated with severe illness and injury. Hence early enteral nutrition is recommended in patients with severe sepsis and septic shock to meet the increased energy and protein requirements. Protein requirements are increased to 1.5 to 2.5 g/kg per day, and increased amounts of branched-chain amino acids may be beneficial in septic patients. Nonprotein caloric requirements range from 25 to 40 kcal/kg per day, and overfeeding of carbohydrates should be avoided to reduce the ventilatory requirements of the patient. The use of increased amounts of lipid to meet nonprotein caloric needs while reducing carbohydrate administration may be useful in this setting. 

A general guideline for the estimate of calorie requirements of burned children is 60 calories per kg per day plus an additional 30 calories for each 100 cm of burned area. Burned children are often anorexic, have delayed gastric emptying, and develop diarrhea with duodenal tube feeding. Severe malnutrition is therefore a frequent complication (Blocker et al., 1955 Levenson et al., 1945 Sutherland and Batchelor, 1968) of patients with burn injury and is associated with protein breakdown,delayed wound healing and infection which further increase caloric demands. 

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