International Journal of Pharma and Bio Sciences
 
 
    ISSN 0975-6299
www.ijpbs.net


REVIEW ARTICLE
Int J Pharm Bio Sci Volume 15 Issue 1, January - March, Pages:39-53

The Effects of Protein-Energy Malnutrition On Children Under Five Years of Age

Muhammad Zubair, Meenakshi Mishra, Umesh Kumar and Pankaj Kishor Mishra
DOI: http://dx.doi.org/10.22376/Ijpbs.2024.15.1.b39-53
Abstract:

Nutritive status is one of the essential pointers for crucial signs of health. Malnutrition is a public health problem ofsignificant significance in growing countries. Malnutrition affects about one in five children and is associated with a higher risk ofinflammation and other diseases. This review identifies several protein-energy malnutrition (PEM) types and presents ourperspective on PEM. This review outlines the diseases caused by PEM and the variables influenced by PEM. Additionally, itdescribes how children are fed in India. The term "severe acute malnutrition" has replaced the term PEM, which was once usedto describe children with severe wasting and kwashiorkor (nutritional edema). The determinants of PEM can be broadly dividedinto four groups: biological, environmental, behavioural, and healthcare service-related factors. This article reviews malnutritionhealth status in developing countries, its classifications, determinants, epidemiology and impact, biochemical disturbances in thebody, laboratory investigation, diseases, effects on the brain, and influence of climate change.

Keywords: Protein-Energy Malnutrition, nonage, chronic obstructive pulmonary disease, Paediatric, Severe Acute Malnutrition.
Full HTML:
  1. Katsilambros N, Dimosthenopoulos C, Kontogianni MD, Manglara E, Poulia K. Clinical nutrition in practice.2nded. Wiley-Blackwe;2011.
  2. Iorember FM.Malnutrition in chronic kidney disease. Front Pediatr. 2018;6(161):161. doi: 10.3389/fped.2018.00161, PMID 29974043.
  3. Akner G, Cederholm T.Treatment of protein-energy malnutrition in chronic nonmalignant disorders. AmJClinNutr. 2001;74(1):6-24. doi: 10.1093/ajcn/74.1.6, PMID 11451713.
  4. Mazzoni BP, Lessa BV, Zamberlan P.Metabolic and Nutritional Repercussions of Liver Disease on Children: how to Minimize them?RevPaulPediatr. 2021;40(40):e2020149. doi: 10.1590/1984-0462/2022/40/2020149, PMID 34076201.
  5. Black MM, Walker SP, Fernald LCH, Andersen CT, DiGirolamo AM, Lu Cet al.Early childhood development coming of age: science through the life course. Lancet. 2017;389(10064):77-90. doi: 10.1016/S0140-6736(16)31389-7, PMID 27717614.
  6. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis Met al.Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427-51. doi: 10.1016/S0140-6736(13)60937-X, PMID 23746772.
  7. Prado EL, Dewey KG.Nutrition and brain development in early life. NutrRev. 2014;72(4):267-84. doi: 10.1111/nure.12102, PMID 24684384.
  8. Stevens GA, Bennett JE, Hennocq Q, Lu Y, De-Regil LM, Rogers Let al.Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013. a pooled analysis of population-based surveys.Lancet Glob Health. 2015;3(9):e528-36. doi: 10.1016/S2214-109X(15)00039-X, PMID 26275329.
  9. Lamberti LM, Walker CL, Chan KY, Jian WY, Black RE.Oral zinc supplementation for the treatment of acute diarrhea in children: a systematic review and meta-analysis. Nutrients. 2013;5(11):4715-40. doi: 10.3390/nu5114715, PMID 24284615.
  10. Zimmermann MB.Iodine deficiency and excess in children: worldwide status in 2013. EndocrPract. 2013;19(5):839-46. doi: 10.4158/EP13180.RA, PMID 23757630.
  11. Stammers AL, Lowe NM, Medina MW, Patel S, Dykes F, Pérez-Rodrigo Cet al.The relationship between zinc intake and growth in children aged 1-8 years: a systematic review and meta-analysis. Eur JClinNutr. 2015;69(2):147-53. doi: 10.1038/ejcn.2014.204, PMID 25335444.
  12. Ashorn P, Alho L, Ashorn U, Cheung YB, Dewey KG, Gondwe Aet al. Supplementation of maternal diets during pregnancy and for 6 months postpartum and infant diets thereafter with small-quantitylipid-basednutrientsupplementsdoesnotpromotechildgrowth by 18 months of age in rural Malawi: A randomized controlled trial. JNutr. 2015;145(6):1345-53. doi: 10.3945/jn.114.207225, PMID 25926413.
  13. Semba RD. The rise and fall of protein malnutrition in global health. AnnNutrMetab. 2016;69(2):79-88. doi: 10.1159/000449175, PMID 27576545.
  14. Murray RD, Kerr KW, Brunton C, Williams JA, DeWitt T, Wulf KL.A first step towards eliminating malnutrition: a proposal for universal nutrition screening in pediatric practice. NutrDietSuppl.2021;Volume(13):17-24. doi: 10.2147/NDS.S287981.
  15. Shim JO, Kim S, Choe BH, Seo JH, Yang HR.Effect of nutritional supplement formula on catch-up growth in young children with nonorganic faltering growth: a prospective multicenter study. NutrResPract. 2020;14(3):230-41. doi: 10.4162/nrp.2020.14.3.230, PMID 32528630.
  16. Khanna D, Yalawar M, Saibaba PV, Bhatnagar S, Ghosh A, Jog Pet al.Oral nutritionalsupplementationimprovesgrowth in children at malnutritionrisk and with pickyeatingbehaviors. Nutrients. 2021;13(10):3590. doi: 10.3390/nu13103590, PMID 34684591.
  17. Arthur SS, Nyide B, Soura AB, Kahn K, Weston M, Sankoh O.Tackling malnutrition: a systematic review of 15-year research evidence from In-depth health and demographic surveillance systems. Glob Health Action. 2015;8:28298. doi: 10.3402/gha.v8.28298, PMID 26519130.
  18. Ibrahim MK, Zambruni M, Melby CL, Melby PC.Impact of childhoodmalnutrition on hostdefense and infection. ClinMicrobiolRev. 2017;30(4):919-71. doi: 10.1128/CMR.00119-16, PMID 28768707.
  19. Titi-Lartey OA, Gupta V.Marasmus. StatPearls. 2022.
  20. Kulkarni B, Mamidi RS.Nutrition rehabilitation of children with severe acute malnutrition. Revisiting studies undertaken by the National Institute of Nutrition.Indian J MedRes. 2019;150(2):139-52. doi: 10.4103/ijmr.IJMR_1905_18, PMID 31670269.
  21. Coulthard MG.Oedema in Kwashiorkor is caused by hypoalbuminemia. PaediatrInt Child Health. 2015;35(2):83-9. doi: 10.1179/2046905514Y.0000000154, PMID 25223408.
  22. Nduhukire T, Atwine D, Rachel L, Byonanebye JE.Predictors of in-hospital mortality among under-five children with severe acute malnutrition in South-Western Uganda. PLoS One. 2020;15(6):e0234343-e234358. doi: 10.1371/journal.pone.0234343, PMID 32589637.
  23. Batool R, Butt MS, Sultan MT, Saeed F, Naz R.Protein-energy malnutrition, a risk factor for various ailments. CritRev Food SciNutr. 2015;55(2):242-53. doi: 10.1080/10408398.2011.651543, PMID 24915388.
  24. Girma T, Kæstel P, Mølgaard C, Michaelsen KF, Hother AL, Friis H.Predictors of oedema among children hospitalized with severe acute malnutrition in Jimma University Hospital, Ethiopia: a cross-sectional study. BMC Pediatr. 2013;13:204. doi: 10.1186/1471-2431-13-204, PMID 24314329.
  25. National Family Healthsurvey 4 – Indiafactsheet. Mumbai: International Institute for Population Sciences, Ministry of Health and Family Welfare, Government of India;2015-2016.
  26. Islam MM, Alam M, Tariquzaman M, Kabir MA, Pervin R, Begum Met al. Predictors of the number of under-five malnourished children in Bangladesh: application of the generalized Poisson regression model. BMC Public Health. 2013;13:11. doi: 10.1186/1471-2458-13-11, PMID 23297699.
  27. Asfaw M, Wondaferash M, Taha M, Dube L. Prevalence of undernutrition and associated factors among children aged between six to fifty-nine months in BuleHora district, South Ethiopia. BMC Public Health. 2015;15:41. doi: 10.1186/s12889-015-1370-9, PMID 25636688.
  28. Abuya BA, Ciera J, Kimani-Murage E.Effect of mother’s education on child’s nutritional status in the slums of Nairobi.BMC Pediatr. 2012;12(1):80. doi: 10.1186/1471-2431-12-80, PMID 22721431.
  29. Zhang X, Zhang L, Pu Y, Sun M, Zhao Y, Zhang Det al.Global, regional, and nationalburden of protein-energymalnutrition: A systematicanalysis for the globalburden of diseasestudy. Nutrients. 2022;14(13):2592. doi: 10.3390/nu14132592, PMID 35807772.
  30. Crichton M, Craven D, Mackay H, Marx W, devan der Schueren M, Marshall S.A systematic review, meta-analysis and meta-regression of the prevalence of protein-energy malnutrition: associations with geographical region and sex. Age Ageing. 2019;48(1):38-48. doi: 10.1093/ageing/afy144, PMID 30188972.
  31. McDonald CM, Olofin I, Flaxman S, Fawzi WW, Spiegelman D, Caulfield LEet al.The effect of multiple anthropometric deficits on child mortality: meta-analysis of individual data in 10 prospective studies from developing countries. AmJ ClinNutr. 2013;97(4):896-901. doi: 10.3945/ajcn.112.047639, PMID 23426036.
  32. Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton Set al.Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452-77. doi: 10.1016/S0140-6736(13)60996-4, PMID 23746776.
  33. Bhutia DT.Protein-energy malnutrition in India: the plight of our under-five children, Fam. Med. Prim. 2014;3(1):63-7.
  34. Christian P.Maternal height and risk of child mortality and undernutrition. JAMA. 2010;303(15):1539-40. doi: 10.1001/jama.2010.469, PMID 20407066.
  35. Ghosh S.Factors responsible for childhoodmalnutrition, A review of the literature, curr. Res. Food Sci. 2020;8(2):360-70.
  36. Ahmed T, Hossain M, Mahfuz M, ChoudhuryN, Hossain MM, Bhandari Net al.Severe acute malnutrition in Asia, JFND. 2014;35(2):S14-26.
  37. Trehan I, Goldbach HS, LaGrone LN, Meuli GJ, Wang RJ, Maleta KMet al.Antibiotics as part of the management of severe acute malnutrition. N Engl J Med. 2013;368(5):425-35. doi: 10.1056/NEJMoa1202851, PMID 23363496.
  38. Trehan I, Manary MJ.Management of severe acute malnutrition in low-income and middle-income countries. Arch Dis Child. 2015;100(3):283-7. doi: 10.1136/archdischild-2014-306026, PMID 25421910.
  39. Frison S, Checchi F, Kerac M.Omitting edema measurement: how much acute malnutrition are we missing? AmJClinNutr. 2015;102(5):1176-81. doi: 10.3945/ajcn.115.108282, PMID 26377162.
  40. Mishra K, Kumar P, Basu S, Rai K, Aneja S.Risk factors for severe acute malnutrition in children below 5 y of age in India: a case-control study. Indian JPediatr. 2014;81(8):762-5. doi: 10.1007/s12098-013-1127-3, PMID 23873300.
  41. Trehan I, O’Hare BA, Phiri A, Heikens GT.Challenges in the management of HIV-infectedmalnourishedchildren in sub-SaharanAfrica. AIDS Res Treat. 2012;2012:790786. doi: 10.1155/2012/790786, PMID 22606378.
  42. Contreras G, Hu B, Astor BC, Greene T, Erlinger T, Kusek JWet al.Kendrick CA, Gassman J, Bakris G.KoppleJD, and Appel LJ, African-American Study of Kidney Disease, and hypertension Study Group Malnutrition-inflammation modifies the relationship of cholesterol with cardiovascular disease, JASN. 2010;21(12):2131-42.
  43. Abdalla MA, Sulieman SA, El-Tinay AH, Khattab AGH.Socio-economic aspects influencing food consumption patterns among children under the age of five in the rural area of Sudan.PakJNutr. 2009;8(5):653-9.
  44. Traub J, Reiss L, Aliwa B, Stadlbauer V.Malnutrition in patients with livercirrhosis. Nutrients. 2021;13(2):540. doi: 10.3390/nu13020540, PMID 33562292.
  45. Nabeta HW, Kasolo J, Kiggundu RK, Kiragga AN, Kiguli S.Serum vitamin D status in children with protein-energy malnutrition admitted to a national referral hospital in Uganda. BMC Res Notes. 2015;8:418. doi: 10.1186/s13104-015-1395-2, PMID 26346815.
  46. Mahaman YA, Akuyam SA, Danborno B, Galadima OM, Belemsigri M, Moussa SM.Evaluation of some laboratoryparameters of malnourishedchildren in Magaria District, Zinder, Niger Republic. 2014;1(2):77-81.
  47. Haji IM, Parveen D, Sarfaraj S.Serum Electrolyte pattern in children with protein energy malnutrition, IJPCBS., (e-ISSN: 2278-5191). 2013;2(3):10-5.
  48. Grover Z, Looi C, Ee.Protein energymalnutrition.PediatrClinNAm. 2009;56:1055-68.
  49. Govender I, Rangiah S, Kaswa R, Nzaumvila D.Malnutrition in children under the age of 5 years in a primary health care setting. S Afr Fam Pract (2004). 2021;63(1):e1-6. doi: 10.4102/safp.v63i1.5337, PMID 34677078.
  50. Clark H, Coll-Seck AM, Banerjee A, Peterson S, Dalglish SL, Ameratunga Set al.A future for the world’s children? A WHO-UNICEF-Lancet Commission.Lancet. 2020;395(10224):605-58. doi: 10.1016/S0140-6736(19)32540-1, PMID 32085821.
  51. Nigatu G, Assefa Woreta S, Akalu TY, Yenit MK.Prevalence and associated factors of underweight among children 6-59 months of age in Takusa district, Northwest Ethiopia. IntJ Equity Health. 2018;17(1):106. doi: 10.1186/s12939-018-0816-y, PMID 30041638.
  52. Shahrin L, Chisti MJ, Ahmed T.3.1 Primary and secondary malnutrition. World RevNutrDiet. 2015;113:139-46. doi: 10.1159/000367880, PMID 25906873.
  53. Dipasquale V, Cucinotta U, Romano C.Acute malnutrition in children: pathophysiology. ClinEff Treat Nutrients. 2020;12(8):2413.
  54. James WPT.From treatingchildhoodmalnutrition to publichealthnutrition.AnnNutrMetab. 2018;72(3):202-9. doi: 10.1159/000487273, PMID 29518765.
  55. Sozeri B, Mir S, Kara OD, Dincel N.Growth impairment and nutritional status in children with chronic kidney disease. IranJPediatr. 2011;21(3):271-7. PMID 23056801.
  56. Uwaezuoke SN.The prevalence of urinary tract infection in children with severe acute malnutrition. a narrative review.Pediatr Health MedTher. 2016;4(7):121-7.
  57. Galler RJ, Maria LBV, TangQ, Arielle GR, Kamarul IM, Wen JCet al.Neurodevelopmental effects of childhood malnutrition, A neuroimaging.Perspective, 231. 2021;8119:(117828): 1053.
  58. Bossi P, Delrio P, Mascheroni A, Zanetti M.The spectrum of malnutrition/cachexia/sarcopenia in oncologyaccording to differentcancertypes and settings. A narrativereview. Nutrients.2021;13(6). doi: 10.3390/nu13061980, PMID 34207529.
  59. Diakatou V, Vassilakou T.Nutritional status of pediatriccancerpatients at diagnosis and correlations with treatment. Clin OutcomeLong-Term GrowthHealthSurvivors Child (Basel, Switzerland). 2020;7(11):218-43.
  60. FischerCL, Lamberti L, Adair L, Guerrant RL, Lescano AG, Martorell Ret al.Does childhooddiarrheainfluencecognitionbeyond the diarrhea-stuntingpathway?PLOSONE. 2012;7(10):e47908-e4714. doi: 10.1371/journal.pone.0047908, PMID 23118906.
  61. Checkley W, Buckley G, Gilman RH, Assis AM, Guerrant RL, Morris SSet al.A multi-country analysis of the effects of diarrhea on childhood stunting. IntJ Epidemiol. 2008;37(4):816-30. doi: 10.1093/ije/dyn099, PMID 18567626.
  62. Iddrisu I, Monteagudo-Mera A, Poveda C, Pyle S, Shahzad M, Andrews Set al.Malnutritionand gutmicrobiota in children. Nutrients. 2021;13(8):2727-48. doi: 10.3390/nu13082727, PMID 34444887.
  63. Agostoni C, Baglioni M, La Vecchia A, Molari G, Berti C.Interlinkages between climatechange and foodsystems. The Impact on childmalnutrition-narrativereview. Nutrients. 2023;15(2):416-31. doi: 10.3390/nu15020416, PMID 36678287.
  64. Myers SS, Smith MR, Guth S, Golden CD, Vaitla B, Mueller NDet al.Climate change and globalfoodsystems. Potential impacts on foodsecurity and undernutrition. AnnuRev Public Health. 2017;38(38):259-77. doi: 10.1146/annurev-publhealth-031816-044356, PMID 28125383.
  65. Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JRet al.The globalsyndemic of obesity. Undernutrition, and climatechange. The Lancet Commission report. Lancet. 2019;393(10173):791-846.
  66. Spoelstra MN, Mari A, Mendel M, Senga E, Van RP, Van DTHet al.Kwashiorkor and marasmus are both associated with impaired glucose clearance related to pancreatic β-cell dysfunction. MetabClinExp. 2012;61(9):1224-30.
  67. Alcoba G, Kerac M, Breysse S, Salpeteur C, Galetto LA, Briend Aet al.Do children with uncomplicated severe acutemalnutrition need antibiotics? A systematic review and meta-analysis. PLoS One. 2013;8(1):e53184-e53193. doi: 10.1371/journal.pone.0053184, PMID 23326395.
  68. Kelsey DJ, Jones JA, Berkley.Severe acute malnutrition and infection.PaediatrInt Child Health. 2014;34(1):S1-S29.
  69. Mueller C, Compher C, Ellen DM, ASPEN. Clinical guidelines. JPEN J Parenter Enter Nutr. 2011;35(16):16-24.
  70. Keller U.Nutritional laboratorymarkers in malnutrition. JClinMed. 2019;8(6):775-66. doi: 10.3390/jcm8060775, PMID 31159248.
  71. Ng TP, Nyunt MSZ, Gao Q, Wee SL, Yap P, Yap KB.Elderly nutritionalindicators for geriatricmalnutritionassessment (ENIGMA). Development and validation of a nutritional prognostic index. ClinNutr ESPEN. 2017;22:54-63. doi: 10.1016/j.clnesp.2017.08.012, PMID 29415835.
  72. Sirkka O, Abrahamse-Berkeveld M, van der Beek EM.Complementary feedingpractices among youngchildren in China, India, and Indonesia. A narrativereview.CurrDevNutr. 2022;6(6):2475-991. doi: 10.1093/cdn/nzac092.
  73. World Health Organization. Children. improving survival and well-being. Available from [Internet] [citedJun 12020].Available from: https://www.who.int/news-room/fact-sheets/detail/children-reducing-mortality.
  74. Global Nutrition Report: action on Equity to end malnutrition. Bristol (UK), evelopment Initiatives;2020.
  75. Manikam L, Prasad A, Dharmaratnam A, Moen C, Robinson A, Light Aet al.Systematic review of infant and young child complementary feeding practices in South Asian families. The India perspective. Public Health Nutr. 2018;21(4):637-54. doi: 10.1017/S136898001700297X, PMID 29166956.
  76. Senarath U, Agho KE, Akram DE, Godakandage SS, Hazir T, Jayawickrama Het al.Comparisons of complementary feeding indicators and associated factors in children aged 6-23 months across five South Asian countries. Matern Child Nutr. 2012;8(1);Suppl 1:89-106. doi: 10.1111/j.1740-8709.2011.00370.x, PMID 22168521.
  77. United Nations Children’s Fund, World Health Organization, World Bank Group. Joint child malnutrition estimates. WHO;2017.
  78. Puri S.Transition in infant and youngchildfeedingpractices in India. Curr Diabetes Rev. 2017;13(5):477-81. doi: 10.2174/1573399812666160819152527, PMID 27550056.
  79. Dhami MV, Ogbo FA, Osuagwu UL, Agho KE.Prevalence and factors associated with complementary feeding practices among children aged 6-23 months in India. a regional analysis. BMC Public Health. 2019;19(1):1034. doi: 10.1186/s12889-019-7360-6, PMID 31370827.
  80. Caleyachetty A, Krishnaveni GV, Veena SR, Hill J, Karat SC, Fall CHet al.Breastfeeding duration, age of starting solids and high BMI risk and adiposity in Indian children. Matern Child Nutr. 2013;9(2):199-216. doi: 10.1111/j.1740-8709.2011.00341.x, PMID 21978208.
  81. Fall CH, Borja JB, Osmond C, Richter L, Bhargava SK, Martorell Ret al.Infant-feeding patterns and cardiovascular risk factors in young adulthood. data from five cohorts in low- and middle-income countries.IntJEpidemiol. 2011;40(1):47-62. doi: 10.1093/ije/dyq155, PMID 20852257.
  82. Jain S, Bhan BD, Bhatt GC.Complementary feeding practices and their determinants among children 6-23 months of age in an outpatient hospital setting in CentralIndia. A cross-sectional study. JFamMedPrim Care. 2020;9(2):1187-90. doi: 10.4103/jfmpc.jfmpc_958_19, PMID 32318490.
  83. Ahmad I, Khalique N, Khalil S.Urfi and Maroof M, Complementary feeding practices among children aged 6-23 months in Aligarh, Uttar Pradesh. JFamMedPrim Care. 2017;6(2):386-91.
  84. Sandjaja S, Budiman B, Harahap H, Ernawati F, Soekatri M, Widodo Yet al.Food consumption and nutritional and biochemical status of 0·5-12-year-old Indonesian children: the seanuts study.BrJNutr. 2013;110(3);Suppl 3:S11-20. doi: 10.1017/S0007114513002109, PMID 24016762.
  85. Wong AY, Chan EW, Chui CS, Sutcliffe AG, Wong IC.The phenomenon of micronutrient deficiency among children in China. a systematic review of the literature. Public Health Nutr. 2014;17(11):2605-18. doi: 10.1017/S1368980013002978, PMID 25248458.
  86. Gonmei Z, Toteja GS.Micronutrient status of Indian population.Indian JMedRes. 2018;148(5):511-21. doi: 10.4103/ijmr.IJMR_1768_18, PMID 30666978.
  87. Koletzko B.Pediatric nutrition in practice. World RevNutrDiet. 2015;113:139-46.
[Download PDF]
Welcome to IJPBS,Pharmaceutics, Novel, drug, delivery, system, Nanotechnology, Pharmacology, Pharmacognosy
Pharmaceutical Fields
Welcome to IJPBS,Pharmaceutics, Novel, drug, delivery, system, Nanotechnology, Pharmacology, Pharmacognosy Pharmaceutics
Welcome to IJPBS,Pharmaceutics, Novel, drug, delivery, system, Nanotechnology, Pharmacology, Pharmacognosy Novel drug delivery system
Welcome to IJPBS,Pharmaceutics, Novel, drug, delivery, system, Nanotechnology, Pharmacology, Pharmacognosy Nanotechnology
Welcome to IJPBS,Pharmaceutics, Novel, drug, delivery, system, Nanotechnology, Pharmacology, Pharmacognosy Pharmacology
Welcome to IJPBS,Pharmaceutics, Novel, drug, delivery, system, Nanotechnology, Pharmacology, Pharmacognosy Pharmacognosy
© Copyright 2009-2015 IJPBS, India. All rights reserved. Specialized online journals by ubijournal. Website by Ubitech Solutions
         Home I Contact I Terms & Conditions