NUTRITIONAL AND DIGESTIVE DISORDERS (PEM)

NUTRITIONAL AND DIGESTIVE DISORDERS (PEM):

Digestive diseases are among the leading causes of doctor visit, hospitalization and disability in the United States each year. The main function of the digestive system is to absorb nutrients from the food that we eat. The body will use vitamins, proteins, fats and calories in order to carry out various tasks around the body. A digestive problem is a change or abnormality in the natural functioning of this process.

About 40% of the United Kingdom population is suffering from atleast one symptom of a digestive problem at one time. It covers a variety of conditions, symptoms and diseases that affect the digestive system from IBS and indigestion to ulcerative colitis and Crohn’s disease.

It is estimated that some form of digestive disorders affects more than 100 million people in America. For some people digestive disorders are a source of irritation and discomfort that may cause them to drastically limit their lifestyles and frequently will work.

 

PEM (Protein Energy Malnutrition):

·         PEM is also known as Protein Calorie Malnutrition.

·         It develops in children where consumption of protein and energy (measured in calories) is insufficient to satisfy their nutritional needs while pure protein deficiency can occur when a person’s diet provides energy but lacks an adequate amount of protein. In most cases deficiency will exist in both total calorie and protein intake.

·         PEM may also occur in children with illness that leave them unable to absorb vital nutrients to convert them to the energy essential for healthy tissue formation and organ function.

          

Types of PEM:

There are following types of PEM found in organisms:

1)      Primary PEM:

This results from a diet that lacks sufficient sources of protein. Secondary PEM is more common in the U.S, where it usually occurs as a complication of AIDS, cancer, chronic kidney failure, inflammatory bowel disease and other illness that impair the body’s ability to absorb or use nutrients or to compensate for nutrient losses. PEM can develop gradually in a child who has a chronic illness or experiences chronic semi starvation. It may appear suddenly in a patient who has an acute illness.

2)      Kwashiorkor or Wet protein energy malnutrition:

It is a form of PEM characterized primarily by protein deficiency. This condition is usually appears at about the age of 12 months when breast feeding is discontinued, but it can develop anytime during child’s formative years. It causes fluid retention (edema), dry, peeling skin and hair discoloration. Kwashiorkor like secondary PEM usually develops in children who have been severly burned, suffered trauma or had sepsis (massive tissue destroying infection) or another life threatening illness. This condition onset is so sudden that body fat and muscle mass of normal weight may not change. Some patient even gain weight because of fluid retention.

 

Causes and Symptoms:

·         Children suffering from Kwashiorkor often have extremely thin arms and legs, but liver enlargements and ascites can distend the abdomen and disguise weight loss.

·         Hair may turn red or yellow.

·         Anaemia, Diarrhoea and fluid and electrolyte disorders are common.

·         The body’s immune system often weakened, behavioural development is slow and mental retardation may occur.

·         Children may grow to normal height but are abnormally thin.

Prevention and Control:

By including food rich in protein into the diet, the disease can be cured. Wheat, gram, peanut, soyabean and jaggery are recommended.  

3)      Marasmus:

It is a PEM disorder which is caused by total calorie/ energy depletion rather than primarily protein calorie/energy depletion. It is due to protein deficiency. In developing countries like India it is common in infants below one year of age. The casual factor may be due to early replacement of another’s milk by others food of low protein and calorific value. This may happen if the mother has a second pregnancy when the older infant is too young. In marasmus body breaks down its own tissues.  Marasmus is characterized by stunted growth and wasting of muscle and tissues. Marasmus usually develop between the age of 6 months and 1 year in children who have been weaned from breast milk or who suffer from weakening conditions such as chronic diarrhoea.

Causes and Symptoms:

·         Profound weakness accompanies severe marasmus. Since the body breaks down its own tissues to use for energy.

·         Children with this condition lose all their body fat and muscles strength and acquire a skeletal appearance in the hands and in the temporal muscle in front of and above each ear.

·         Children with marasmus are small for their age. Since their immune systems are weakened, thus suffer from frequent infection.

·         Other symptoms include loss of appetite, diarrhoea, skin is dry and buggy, sparse hair i.e. dull reddish or brown yellow, mental retardation, behaviour retardation, low body temperature(hypothermia) and slow pulse and breathing rates.

·         Ribs become prominent and limbs become very thin as the fat layer beneath the skin disappears.

·         Retarded physical and mental growth.

·         Severe diarrhoea and other digestive disorders.

          

Diagnosis:

Some physical examinations are:

·         Eating habits and sudden change in weight.

·         Body fat composition and muscle strength.

·         Gastrointestinal symptoms.

·         Presence of underlying illness.

·         Delay in development and loss of acquired milestones in children.

·         Nutritional status of patient can be quantify by: composing height and weight to standardize norm, calculating body mass index (BMI), measuring skinfold thickness or circumferences of upper arm.

Prevention and Control:

A protein rich diet such as a combination of wheat, gram, peanut, soyabean and jaggery or a diet with animal protein like mutton, chicken and fish will help the patient return back to health.

Treatment:

Treatment is designed to provide adequate nutrition, restore normal body composition and cure the condition that causes the deficiency. Tube feeding or intravenous feeding is used to supply nutrients to patients who cannot eat protein rich foods. In patients with severe PEM, the stage of treatment consists of correcting fluid and electrolyte imbalances.  Infections can be treated with antibiotics that do not affect the protein synthesis and addressing related medical problems. The second phase involves replenishing essential nutrients slowly to prevent taxing the patient’s weakened systems with more food than it can handle physical therapy may benefit patients whose muscles have deteriorated significantly.

Prognosis:

Most children can lose some of their body without side effects, but losing more than 40% is usually fatal. Death usually results from heart failure, an electrolyte imbalance or low body temperature. Patients have poor prognosis with certain symptoms like semi-consciousness, persistent diarrhoea, jaundice and low blood sodium levels.

Prevention:

Breast feeding a baby for atleast 6 months is the best way to prevent childhood malnutrition. Consulting to doctor before putting child on any kind of diet such as vegetarian or low carbohydrate diet can help assure that the child gets the full supply of nutrients that the children used. The nutritional status of patient at   higher risk should be more thoroughly assessed and periodically re-evaluated during extended hospital stays.

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