History
See the list below:
-
Clinical signs and symptoms of protein-energy malnutrition (PEM) include the following:
Poor weight gain
Slowing of linear growth
Behavioral changes - Irritability, apathy, decreased social responsiveness, anxiety, and attention deficits
-
Clinical signs and symptoms of micronutrient deficiencies: Some of the clinical signs and symptoms of specific micronutrient deficiencies may closely resemble those observed in PEM. Deficiencies of micronutrients, including vitamins, minerals, and trace elements have been well described. The most common and clinically significant deficiencies include the following:
Iron - Fatigue, anemia, decreased cognitive function, headache, glossitis, and nail changes
Iodine - Goiter, developmental delay, and mental retardation
Vitamin D - Poor growth, rickets, and hypocalcemia
Vitamin A - Night blindness, xerophthalmia, poor growth, and hair changes
Folate - Glossitis, anemia (megaloblastic), and neural tube defects (in fetuses of women without folate supplementation)
Zinc - Anemia, dwarfism, hepatosplenomegaly, hyperpigmentation and hypogonadism, acrodermatitis enteropathica, diminished immune response, poor wound healing
Physical
Physical findings that are associated with PEM include the following: [2]
-
Decreased subcutaneous tissue: Areas that are most affected are the legs, arms, buttocks, and face.
-
Edema: Areas that are most affected are the distal extremities and anasarca (generalized edema). See the image below.
This infant presented with symptoms indicative of a dietary protein deficiency, including edema and ridging of the toenails. Image courtesy of the Centers for Disease Control and Prevention.
-
Oral changes
Cheilosis
Angular stomatitis
Papillar atrophy
-
Abdominal findings
Abdominal distension secondary to poor abdominal musculature
Hepatomegaly secondary to fatty infiltration
-
Skin changes
Dry peeling skin with raw exposed areas
Hyperpigmented plaques over areas of trauma
-
Nail changes: Nails become fissured or ridged.
-
Hair changes: Hair is thin, sparse, brittle, easily pulled out, and turns a dull brown or reddish color.
Causes
See the list below:
-
Inadequate food intake is the most common cause of malnutrition worldwide. In developing countries, inadequate food intake is secondary to insufficient or inappropriate food supplies or early cessation of breastfeeding. In some areas, cultural and religious food customs may play a role. Inadequate sanitation further endangers children by increasing the risk of infectious diseases that increase nutritional losses and alters metabolic demands.
-
In developed countries, inadequate food intake is a less common cause of malnutrition. Instead, diseases and, in particular, chronic illnesses play an important role in the etiology of malnutrition. Children with chronic illness are at risk for nutritional problems for several reasons, including the following:
Children with chronic illnesses frequently have anorexia, which leads to inadequate food intake.
Increased inflammatory burden and increased metabolic demands can increase caloric need.
Any chronic illness that involves the liver or small bowel affects nutrition adversely by impairing digestive and absorptive functions.
-
Chronic illnesses that commonly are associated with nutritional deficiencies include the following:
Chronic renal failure
Childhood malignancies
Congenital heart disease
Neuromuscular diseases
Chronic inflammatory bowel diseases
-
In addition, the following conditions place children at significant risk for the development of nutritional deficiencies:
Prematurity
Developmental delay
In utero toxin exposure (ie, fetal alcohol exposure)
-
Children with multiple food allergies present a special nutritional challenge because of severe dietary restrictions. Patients with active allergic symptoms may have increased calorie and protein needs.
-
Guidelines on fruit juice intake for children by the American Academy of Pediatrics recommend that in the evaluation of children with malnutrition, the pediatrician should determine the amount of juice being consumed as excessive juice consumption may be associated with malnutrition (overnutrition and undernutrition). [13]
-
Hormonal adaptation to the stress of malnutrition: The evolution of marasmus.
-
A classic example of a weight chart for a severely malnourished child.
-
This infant presented with symptoms indicative of a dietary protein deficiency, including edema and ridging of the toenails. Image courtesy of the Centers for Disease Control and Prevention.
-
This infant presented with symptoms indicative of Kwashiorkor, a dietary protein deficiency. Note the angular stomatitis indicative of an accompanying Vitamin B deficiency as well. Image courtesy of the Centers for Disease Control and Prevention.
