PROTEIN ENERGY MALNUTRITION IN ADULTS & DIFFERENTIATION BETWEEN KWASHIORKOR AND MARASMUS

PROTEIN ENERGY MALNUTRITION IN ADULTS & DIFFERENTIATION BETWEEN KWASHIORKOR AND MARASMUS

• Protein Energy Malnutrition (PEM) is a pathological condition arising due to prolonged deficiency of proteins and calories in the diet.

• Though more prevalent in children, it also affects adults, especially in cases of chronic illness, poverty, famine, eating disorders, and poor absorption.

DEFINITION

• According to Modern Medicine: PEM refers to a spectrum of pathological conditions arising due to simultaneous deficiency of dietary protein and energy, frequently accompanied by infections.

• According to Ayurveda: It can be correlated with Karshya (emaciation), Balakshaya (loss of strength), and Agnimandya (weak digestive fire), often classified under Apatarpana Janya Vyadhi (diseases due to undernutrition).

ETIOLOGY (NIDANA)
MODERN VIEW

• Inadequate intake of protein and calories

• Malabsorption syndromes

• Chronic infections (e.g., TB, HIV)

• Anorexia nervosa

• Elderly with chewing/swallowing difficulty

• Alcoholism

• Famine, poverty, mental illness

AYURVEDIC VIEW

• Mithya Ahara-Vihara – improper dietary and lifestyle habits

• Agnimandya – diminished digestive capacity

• Dhatukshaya – depletion of body tissues

• Nidana like Shoka (grief), Krodha (anger), Ativyayama (excessive physical exertion)

• Reference:
  "अतियोगात् तपस्याश्च वायुर्दोषो विशेषतः।
  शरीरं क्षपयेद्वेगो बलमूढीकरोति च॥"
  — Charaka Samhita, Sutrasthana 28/21

PATHOGENESIS (SAMPRAPTI)
MODERN PATHOGENESIS

• Prolonged deficiency leads to catabolism of fat and muscle tissue.

• Loss of visceral protein stores causes hypoalbuminemia.

• Immunodeficiency and delayed wound healing occur.

• Leads to systemic derangements like edema, anemia, and organ dysfunction.

AYURVEDIC PATHOGENESIS

• Deranged Agni → Impaired digestion → Improper Ahara Rasa

• Poor formation of Rasa dhatu → Sequential Dhatukshaya

• Leads to Karshya, Daurbalya, Shosha and Ojakshaya

• Reference:
  "सन्ततं ह्यल्पभोजित्वात् क्लेशात् चापि तथा मलात्।
  रसादीनां क्षयं प्राप्तं, शरीरं लघुतां नयेत्॥"
  — Ashtanga Hridaya, Sutrasthana 11/18

CLINICAL FEATURES (LAKSHANA)
GENERAL FEATURES IN ADULTS

• Weight loss

• Muscle wasting

• Weakness and fatigue

• Edema (in Kwashiorkor)

• Poor wound healing

• Skin and hair changes

• Immunodeficiency and recurrent infections

• Gastrointestinal disturbances

AYURVEDIC CORRELATION

• Karshya – emaciation

• Balakshaya – reduced strength

• Alpagni – low digestive capacity

• Shithilata – flaccidity

• Daurbalya, Shrama, Shwasa, Atisara

TYPES OF PEM IN ADULTS

• Marasmus – energy deficiency

• Kwashiorkor – protein deficiency with relative calorie sufficiency

• Marasmic-Kwashiorkor – combined form

DIFFERENCE BETWEEN KWASHIORKOR AND MARASMUS

DIAGNOSTIC APPROACH

• Anthropometric measures: BMI, MUAC, skinfold thickness

• Blood tests: serum albumin, total protein, electrolytes

• Clinical examination: edema, skin, muscle wasting

• Dietary assessment

COMPLICATIONS

• Hypoglycemia

• Hypothermia

• Infections (e.g., pneumonia, TB)

• Electrolyte imbalance

• Organ failure (liver, kidney)

• Death if untreated

MANAGEMENT
MODERN MANAGEMENT

• Correction of dehydration and electrolyte imbalance

• Gradual nutritional rehabilitation

• High-protein, energy-rich diet

• Supplementation of vitamins and minerals

• Treatment of infections

• Psychosocial support

• Referral in case of complications

AYURVEDIC MANAGEMENT

• Brimhana chikitsa – nourishing therapy

• Use of Balya, Rasayana, Agnideepana herbs

• Yavagu, Mamsarasa, Ksheer, Ghrita based diet

• Rasayana drugs like Ashwagandha, Shatavari, Pippali Rasayana

• Panchakarma: Mridu Snehapana and Basti in chronic cases

• Reference:
  "बल्यं स्नेहकरं स्वादु स्निग्धं स्थैर्यकरं गुरु।
  चिरस्थायी रसाद्यं च लघ्वन्नं मृदुपाचनम्॥"
  — Charaka Samhita, Chikitsa Sthana 15/95

PROGNOSIS (SAPARYAYA)

• Favorable if early diagnosed and managed.

• Poor prognosis with complications like infections, electrolyte imbalance, or organ failure.

• In Ayurveda, chronic Dhatukshaya may lead to Kashayata (cachexia) and poor prognosis if Ojas is depleted.

PREVENTION

• Balanced diet with adequate calories and protein

• Nutritional education and public health programs

• Early diagnosis and prompt intervention

• Ayurveda recommends seasonal Rasayana therapy and dietary discipline:
  "रसादिभिः सदा तुष्टः संवर्धयति देहम्॥"
  — Ashtanga Hridaya, Sutrasthana 3/28