Vitamin protein-energy malnutrition

Vitamin A deficiency in preschool children is now rare in Thailand due to public health programs that have been implemented since the early 1970s. In rare instances, it still can be found in remote areas of northern Thailand (Was-antwisut, 2002). From 1995 to 1999, there were 39 cases of malnutrition with vitamin A deficiency reported. (It should be noted that vitamin A deficiency is usually associated with other nutritional deficiencies, especially protein-energy malnutrition.) Two of these cases are presented in this chapter. 

The fourth section deals with various aspects Digestion, Absorption, and Nutritional Biochemistry. The chapter Obesity considers current problems with respect to the ever-increasing incidence of imbalance between energy intake and utilization. Key problems of undemutrition are discussed in the chapters Protein-Energy Malnutrition and Vitamin A Deficiency in Children. The chapters Lactose Intolerance, Pancreatic Insufficiency, and Abetalipoproteinemia focus on the biochemical processes underlying food digestion and absorption. Calcium Deficiency Rickets, Vitamin B12 Deficiency, and Hemochromatosis provide discussions of absorption and utilization of vitamin D, vitamin B12, and iron, respectively. 

Protein-energy malnutrition results in functional vitamin A deficiency, with very low circulating levels of the vitamin and development of clinical signs of xerophthalmia (Section 2.4). The condition is unresponsive to the administration of vitamin A and often occurs despite adequate liver reserves of retinol. The problem is one of impaired synthesis of RBP in the liver and hence a... 

Functional vitamin A deficiency may occur despite adequate liver reserves of retinol, as a result of impaired synthesis of RBP in protein-energy malnutrition, and possibly also in zinc deficiency (Smith et al., 1973 Solomons and Russell, 1980 Rahman et al., 2002). 

The leading cause of death in children in developing countries is protein-energy malnutrition. This type of malnutrition is the result of inadequate intake of calories from proteins, vitamins, and minerals. Children who are already undernourished can suffer from protein-energy... 

At special risk of vitamin A toxicity are those whose liver function is compromised by drugs, viral hepatitis, or protein-energy malnutrition (12). Elderly people may also be at increased risk for similar reasons but also from different causes. In addition to protein deficiency, alcohol intake and co-existing liver and renal disease may be present (86). 

Fat malabsorption, particularly caused by celiac disease or chronic pancreatitis, and protein-energy malnutrition predispose to vitamin A deficiency. Liver disease diminishes RBP synthesis, and ethanol abuse leads both to hepatic injury and to a competition with retinol for alcohol dehydrogenase, which is necessary for the oxidation of retinol to retinal and retinoic acid. Vitamin A deficiency may lead to anemia, though the precise mechanism is not known. ... 

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... 

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. 

Among humans, zinc supplementation of children with protein-energy malnutrition (PEM) was reported not to alter the response in vitamin A and RBP levels immediately following admission to a hospital, but was necessary to sustain higher plasma levels throughout the recovery period. Studies in children with cystic fibrosis and in normal adult humans with moderately depressed or adequate serum zinc levels failed to demonstrate a plasma retinol response to zinc supplementation (Palin et aL, 1979 Garry and Visconti, 1980). 

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... 

Retinol is nearly always present in the food in the form of esters which are hydrolysed in the lumen of the intestine. The retinol released is quite readily absorbed into the mucosal cells where it is re-esterified, chiefly with palmitic acid. The retinyl esters are then transported via the lymphatic system into the portal circulation from which they are removed and stored in the liver. Release of the vitamin from the liver depends on the production by the liver of a special retinolbinding protein (RBP). Production of the retinol-binding protein may be disturbed in diseases of the liver or kidneys or in protein/energy malnutrition. In such circumstances retinol cannot be mobilized from the stores and a secondary deficiency may result. Thus it can be seen that the level of retinol in the general circulation is normally highly regulated and is more or less independent of the body s reserves. 

The terms protein—energy malnutrition and protein—energy deficiency are widely used to mean a general lack of food, as opposed to specific deficiencies of vitamins or minerals... 

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. 

Dietary deficiency diseases are those whose major features are due to the lack of one or more nutrients. They are often characterized by specific signs of abnormalities, such as discoloration of the hair or skin, bleeding gums, swollen glands, etc. one of the major causes of such diseases is the consumption of a diet which does not contain sufficient amounts and varieties of foods. For example, young children fed mainly cereals in the form of watery gruels may develop either protein-energy malnutrition, and/or blindness, due to vitamin A deficiency. 

A mixture of corn flour, cottonseed flour, torula yeast, minerals, and vitamins developed by the Institute of Nutrition of Central America and Panama (INCAP) with the aid of funds from Central American governments, the Kellogg Foundation, the Rockefeller Foundation, and several other foundations. It has a protein content of about 25%. Incaparina can be used as a cereal for weanling infants and young children. It was test marketed in Nicaragua, El Salvador, Guatemala, and Colombia for the treatment and prevention of protein-energy malnutrition. 

COMMON TYPES OF MALNUTRITION. About one billion cases of malnutrition around the world result mainly from lack of sufficient food. However, hundreds of millions of people suffer from mild to severe nutritional deficiency diseases such as anemia, beriberi, blindness due to vitamin A deficiency (xerophthalmia), goiter, marasmus, pellagra, protein-energy malnutrition, rickets (children) or osteomalacia (adults), and scurvy. 

Compared to Irish potatoes, tannia tubers furnish about twice as many calories, the same amount of protein, and less than half as much vitamin C. The protein to calorie ratio (1.6 g per 100 kcal) of the tubers is barely high enough to meet the protein requirements of adults. So, children fed a tannia-rich diet are likely to develop protein-energy malnutrition unless they are given supplemental protein foods in their diets. Finally, tannia tubers are deficient in many vitamins and minerals. 

Reddy V (1981) Fat-soluble vitamin deficiencies in children in relation to protein energy malnutrition and environmental stress. Prog Clin Biol Res 77 109-117... 

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