Malnutrition

Malnutrition is a pathological state caused by nutrient deficiency, malnutrition advances stages are refered to as cachexia,cachexia highest level is marasmus. Karence is an isolated deficiency of one of the necessary nutritional factors (vitamins, trace elements, essential fatty acids). The causes of malnutrition are conditions associated with decreased intake, increased nutrient losses or increased metabolic requirements.

According to the extent of the disease

 * acute,
 * subacute,
 * chronic.

According to the cause of the disease

 * Primary (exogenous)

They are caused by insufficient or excessive supply of nutrients. Some of the primary malnutrition affects millions of people.
 * Secondary (endogenous)

They arise due to disorders of nutrient absorption, disorders of nutrient utilization (enzyme defects) or nutrient interactions with drugs. Environmental factors (xenobiotics, smoking) can also contribute to malnutrition. Then there are diseases leading to malnutrition.

According to the missing food ingredients

 * General malnutrition

They arise from a lack of energy in the food intake (protein energy malnutrition).
 * Specific malnutrition

They arise from a deficiency or excess of individual nutrients.

Marasmus
Marasmus is a simple starvation caused by an insufficient supply of energy and protein. Accompanied by proportional reduction of fat and fat-free mass, edema does not develop, cachectic appearance at normal albumin concentration and preserved immunotherapy is clinically evident, nutritional support is able to restore anabolism, an example is mental anorexia.

Kwashiorkor
Kwashiorkor is a stress-induced, cytokine -induced (TNF-α, IL-1, IL-6) malnutrition. The body is not able to use carbohydrates and lipids as an energy substrate. In combination with reduced protein intake, they must use visceral. plasma and muscle proteins. The fat supple does not decrease, swellings are present. Clinically, there is poor wound healing, pressure ulcers, more frequent infections. An example might be MODS, sepsis. Nutritional support is only able to slow down this type of malnutrition.

Protein-energy malnutrition
It is a combination of marasmu and kwashiorkor.

General symptoms

 * Loss of subcutaneous fat will cause loss of round contours.
 * The skin rests loosely over the deeper tissue, best visible over the triceps and interosseous muscles.
 * Loss of muscle above the quadriceps and deltoid. bony appearance of the shoulders.
 * Hypoproteinemia, swelling perimalleolarly, in the sacral region, or ascites.
 * Changes in mental state, self-sufficiency disorder.
 * Changes in mucous membranes, skin and adnexa (alopecia, brittle nails).

Symptoms of marasmus

 * Starved appearance, weight loss, fat stores and muscle mass.
 * Normal visceral proteins.

Symptoms of kwashiorkor

 * Normal appearance and weight, preserved fat stores.
 * Swelling, pressure ulcers, reduced wound healing, more common infectious complications.
 * Decreased visceral proteins and lymphocytes, increased CRP.

Assessment of nutritional status
Physical examination including anthropometric measurements:
 * Anamnesis:
 * weight changes over the last 1-6 months;
 * changes in food intake;
 * presence of gastrointestinal manifestations (anorexia nervosa, nausea and vomiting, diarrhoea);
 * physical ability.
 * subcutaneous fat condition, muscle, swelling, ascites;
 * weight, height, BMI (bellow 18,5 it is malnutrition);
 * determination of adipose tissue and lean body mass, thickness of skin lashes with a caliper, dynamometry, hand grip strength.
 * Laboratory findings:
 * visceral proteins (albumin, transferrin, prealbumin) are reduced;
 * lymphocytes are decreased;
 * serum cholinesterase activity;
 * under stress albumin is also negative for acute phase proteins;
 * increased capillary permeability (capillary leak syndrome);
 * after rehydration treatment:
 * albumin – half 21 days – standard 35–50,
 * transferrin – 9 days,
 * prealbumin – 2 days,
 * lymphocytes – 1500–4000.

Related articles

 * Biochemical evaluation of nutrition
 * Evaluation of nutritional status
 * Obesity
 * Carbohydrates in the diet
 * Fats in the diet
 * Proteins in the diet
 * Diseases from excess or deficiency of nutrients
 * Nutrition recommendations
 * Eating disorders