พญ.

สิตานัน เวทย์วฒ
ั นชัย
PROTEIN-ENERGY MALNUTRITION
Marasmus 
 Marasmus is characterized by the wasting of muscle
mass and the depletion of body fat stores. It is the
most common form of PEM and is caused by
inadequate intake of all nutrients, but especially
dietary energy sources (total calories).
Physical examination findings include:
 Diminished weight and height for age
 Emaciated and weak appearance
 Bradycardia, hypotension, and hypothermia
 Thin, dry skin
 Redundant skin folds caused by loss of subcutaneous fat
 Thin, sparse hair that is easily plucked.
Kwashiorkor 
 Kwashiorkor is characterized by marked muscle atrophy with normal
or increased body fat. It is caused by inadequate protein intake in the
presence of fair to good energy intake. Anorexia is almost universal.
 Physical examination findings include:
 Normal or nearly normal weight and height for age
 Anasarca Rounded prominence of the cheeks ("moon-face")
 Pursed appearance of the mouth
 Pitting edema in the lower extremities and periorbitally
 Dry, atrophic, peeling skin with confluent areas of hyperkeratosis and
hyperpigmentation
 Dry, dull, hypopigmented hair that falls out or is easily plucked
 Hepatomegaly (from fatty liver infiltrates)
 Distended abdomen with dilated intestinal loops.
Mixed marasmus-kwashiorkhor
 Mixed marasmus-kwashiorkhor may occur in a child
who has inadequate dietary intake of all nutrients and
subsequently develops a common infectious illness of
childhood. In this setting, the undernourished child
develops hypoalbuminemia and edema because the
acute loss of nutrients associated with an
inflammatory response is superimposed on the
chronic wasting of body fat and muscle nutrient
stores.
Severity of malnutrition
Grade of Weight for Age Height for Age Weight for
malnutrition (Wasting) (stunting) Height

Normal > 90 > 95 > 90

Mild 75-90 90-95 81-90

Moderate 60-74 85-89 70-80

Severe < 60 < 85 < 70

FAT-SOLUBLE VITAMIN DEFICIENCIES 

Function Deficiency syndrome

A Vision, epithelial differentiation Xerophthalmia
D Prohormone for calcium Rickets, osteomalacia
regulation
E Antioxidant
K Clotting factors, bone proteins Hemorrhagic disease
WATER SOLUBLE VITAMIN
DEFICIENCIES
Function Deficiency
syndrome
B1, thiamine Thiamine pyrophosphate Beriberi
B2, riboflavin Flavine adenine dinucleotide
Niacin, nicotinic Nicotinamide adenine dinucleotide Pellagra
acid
B6, pyroxidine, Transaminase cofactor Anemia
pyridoxal
B12, cobalamin One carbon transfer Pernicious anemia
Folate One carbon transfer Megaloblastic anemia
C ascorbate Antioxidant, collagen synthesis Scurvy
MINERAL AND TRACE ELEMENT
DEFICIENCIES
Calcium, phosphate, and magnesium
Iron 
Zinc
Copper
Selenium
Iodine