Protein energy malnutrition effect

The development, maintenance, and optimal functioning of the immune system are dependent on balanced and adequate nutrition. However, either a deficiency or an excess of a number of nutrients can have adverse effects. The nutrients with the most pronounced effects in humans include amount and type of dietary fatty acids (FAs), protein energy malnutrition, vitamins A, B6, B12, C, and E, and minerals including zinc, copper, selenium, and iron. Multiple rather than single nutrient deficiencies... 

Measurements of the levels of semm proteins such as albumin, transthyretin (also known as prealbumin), transferrin and retinol-binding protein are used as biochemical parameters in the assessment of protein energy malnutrition (Table 17-1). An ideal protein marker should have rapid turnover and present in sufficiently high concentrations in semm to be measured accurately. Transthyretin has these properties it is a sensitive indicator of protein deficiency and is effective in assessing improvement with refeeding. 

Ascariasis has a worldwide distribution affecting nearly 1000-1300 million people with nearly 20,000 patients dying every year [1,2,26], In addition to the protein-energy malnutrition caused in children, ascariasis is also associated with a series of pathogenic effects. The main clinical manifestations of the disease during migra-... 

Nutrients have a profound effect upon the production and actions of cytokines. Protein-energy malnutrition, dietary (n-3 polyunsaturated fatty acids, and vitamin E suppress the production of specific cytokines. The synthesis of acute-phase proteins and glutathione is dependent on the adequacy of dietary sulfur-containing amino acids. The consequences of the modulatory effects of previous and concurrent nutrient intake on cytokine biology are the depletion of resources and damage to the host, which ranges from mild and temporary to severe, chronic, or lethal. 

Total iron binding capacity (TIBC) of a serum specimen is an indirect measure of transferrin concentration, although in some laboratories transferrin can be measured directly. Normally transferrin is around 30% saturated with iron. When this falls to less than 15%. iron deficiency is likely and. some degree of clinical effect can be expected. A high percent saturation is the most sensitive marker for iron overload. Like serum iron, transferrin is decreased as part of the acute phase response. Protein-energy malnutrition also decreases transferrin synthesis by the liver and hence its serum concentration. 

Nnakwe, N. (1996). The effect and causes of protein-energy malnutrition in Nigerian children. Nutr. Res. 15, 785-794. 

In some instances, such as when rats may possess different tissue metabolism and cortical function compared with humans, the rat model may be inappropriately extrapolated to humans. For example, the newborn human has relatively more cortical activity than the rat, so nutrient effects on cortical structures may be underestimated in the rat model. In contrast, the rat has a large and metabolically active hippocampus at birth relative to the human. Thus nutrient perturbations, such as iron deficiency, protein-energy malnutrition, or hypoglycemia, which profoundly affect the rat s hippocampus, may overestimate the effect in humans. 

The effects of protein-energy malnutrition (PEM), and its treatment, on the plasma retinol transport system have been investigated in a large number of studies during the past decade. Patients with PEM have decreased plasma concentrations of RBP, TTR, and vitamin A. Two major factors can contribute to these low plasma concentrations. First, patients with PEM manifest a defective hepatic production of RBP because of a lack of substrate (calories, amino acids from dietary protein) needed for RBP synthesis. Thus, PEM per se is associated with impaired production of RBP and TTR and defective vitamin A mobilization from the liver. Second, however, PEM is often accompanied by inadequate... 

A more serious effect of protein—energy malnutrition is impairment of cell proliferation in the intestinal mucosa (section 4.1). The villi are shorter than usual, and in severe cases the intestinal mucosa is almost flat. This results in a considerable reduction in the surface area of the intestinal mucosa, and hence a reduction in the absorption of such nutrients as are available from the diet. As a result, diarrhoea is a common feature of protein—energy malnutrition. Thus, not only does the undernourished person have an inadequate intake of food, but the absorption of what is available is impaired, so making the problem worse. 

HOST DEFENSE MECHANISMS IN PROTEIN ENERGY MALNUTRITION TABLE III Major Known Effects of Complement in Host Defense Complement Component Role in Host Defense ... 

This review has focused on effects of protein energy malnutrition on immune responses in the human host. These studies document major impairment of the T-cell and complement systems in severe PEM, and less profound, but probably significant, effects upon B-cells and immunoglobulins, particularly SIgA. While mild-moderate malnutrition also alters the T-cell system and may predispose to... 

Dewan, P., Kaur, I., Chattopadhya, D.A., et al. (2007) A pilot study on the effects of curd (dahi) and leaf protein concentrate in children with protein energy malnutrition (PEM). Indian J Med Res 126,199-203. 

Nunez, I.N., Maldonado Galdeano, C.M., Carmuega, E., et al. (2012) Effect of a probiotic fermented milk on the thymus in BALB/c mice under non-severe protein-energy malnutrition. British J Nutr 110, 500-508. 

The fact that normal humans have a requirement for biotin has been clearly documented in two situations prolonged consumption of raw egg white and parenteral nutrition without biotin supplementation in patients with short bowel syndrome and other causes of malabsorption. Based on lymphocyte carboxylase activities and plasma biotin levels, some children with severe protein-energy malnutrition are biotin deficient. Investigators have speculated that the effects of biotin deficiency may be responsible for part of the clinical syndrome of protein-energy malnutrition. 

The evidence presented supports the contention that severe global malnutrition in early life is deleterious to cognitive development. Such a premise is not particularly relevant in developed countries, where marked protein-energy starvation is rare. Are there demonstrable effects of selective nutrient lack or of milder degrees of malnutrition ... 

In contrast to experimental malnutrition in animals, in which single nutrient deficiencies can be produced almost at will, human malnutrition is nearly always a mixture of abberations of different dietary constituents. Human PEM is in fact a mosaic of alterations in not only protein and energy nutriture, but in vitamin, mineral, and trace element balance as well. The problem is made even more complex by the impact of distinctive dietary intake patterns around the world, by the almost certain influence of genetics on cell function and response to stress of various kinds, and by the effect... 

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