Protein energy malnutrition infection

The signs and symptoms of protein-energy malnutrition (PEM) depend on various factors, including the duration of the nutritional inadequacy, age at onset, and frequency/types of concomitant infections. Figure 24-1 shows children diagnosed with kwashiorkor and marasmus and outlines some of the diagnostic features discussed in this section (Scrimshaw and Behar, 1961). 

Interpretation of plasma concentrations of retinol is confounded by the fact that both RBP and transthyretin are negative acute phase proteins, and their synthesis falls, and hence the plasma concentration of retinol fall, in response to infection. Similarly, both protein-energy malnutrition and zinc deficiency result in a low plasma concentration, despite possibly adequate liver reserves as a result of impaired synthesis of RBP. 

Protein energy malnutrition occurs with high frequency (30%-50%) in hospitalized patients as well as in populations in chronic care facilities as either an acute or a chronic problem. These individuals suffer from inadequate nutrition due to a disease or depression, and are susceptible to infections due to impaired immune function. Surgical patients with protein energy malnutrition exhibit delayed wound healing with increased length of... 

Signs of vitamin A deficiency also occur in protein-energy malnutrition (section 8.2), regardless of whether or not the intake of vitamin A is adequate. This is due to impairment of the synthesis of RBP. Hence, functional vitamin A deficiency can occur secondary to protein-energy malnutrition. In this case, there is severely impaired immunity to infection, as a result of both the functional vitamin A deficiency and also the impairment of immune responses associated with undernutrition. 

Treatment and Prevention of Protein-Energy Malnutrition Emergency Care of Severely III Patients Treatment of Protein Depletion in Hospital Patients (With Trauma, Infection, Burns, or After Surgery) Correction of Mild to Moderate Protein-Energy Malnutrition Prevention of Protein-Energy Malnutrition Recent Developments in the Treatment and Prevention of Protein-Energy Malnutrition... 

Malnutrition lowers immunity, and infections are more common transferrin (the body s iron-carrying protein) and antibody response to some antigens are defective in protein-energy malnutrition . A vicious circle results ... 

Taylor, A.K., Cao, W., Vora, K.P., et al. (2013) Protein energy malnutrition decreases immunity and increases susceptibility to influenza infection in mice. J Infect Dis 207, 501-510. 

Mixedmarasmus/kwashiorkor is a form of severe protein-calorie malnutrition that develops in chronically ill, starved patients during periods of hypermetabolic stress. There is reduced visceral protein synthesis superimposed on wasting of somatic protein and energy (adipose tissue) stores. Immunocompetence is lowered, increasing the incidence of infection, and wound healing is compromised. 

The issues of starvation and malnutrition are raised again in Chapter 8, where foods rich in energy but poor in protein are discussed. Malnutrition is discussed under Sodium, Potassium, and Water in Chapter 10, w here the problem of infant diarrhea is outlined. This problem often occurs with weaning in underdeveloped countries, when pathogenic bacteria and parasites are inadvertently introduced into the infant s diet. The problem is compounded when basic supplies, such as firewood for boiling drinking water, are missing. Malnutrition and infection are also discussed under Vitamin A in Chapter. ... 

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