Although it is not common across the United States, kwashiorkor, a severe form of protein malnutrition can be found in children of very poor families, in the elderly who live in nursing homes or other long term care facilities, and in patients that are in the hospital for surgery (one in every two surgical patients has some form of protein deficiency), or for extended admissions (about half of the general hospital populace are affected). Primary protein deficiency, the lack of enough overall calories or the lack of enough specific protein calories is far less rare than secondary protein malnutrition.
Secondary protein malnutrition is the most common type in the United States and is typically a complication of diseases like AIDS, cancer, chronic kidney failure, or inflammation bowel disease. It can either develop slowly in chronic illnesses or in the case of chronic semi-starvation. It can also develop very rapidly in the case of sudden or acute illnesses.
Kwashiorkor, which gets its name from Ghana, means “red boy” and is one of the most common forms of protein deficiency in developing countries. It most often appears when breastfeeding ceases, however it can develop at any time and is noted by edema (swelling) and dry, peeling skin. Hair discoloration, typically reddish or yellow can also be noted at this time.
Symptoms can range from mild to severe and can depend on a number of additional factors. Severe protein deficiency can alter both, the form and the function of every organ in the body. How bad it becomes and how seriously its effects are felt can depend on prior nutritional status, nature of the disorder, and the speed of its progression. There is no definitive criteria for determining the level of the deficiency, however it is typically accepted that a loss of ten to twenty percent of the body weight is enough to constitute moderate protein deficiency. A loss of twenty percent of the body weight or more is severe. It is typically accepted that a loss of forty percent of the body weight is almost always fatal.
At the moderate to severe levels of protein deficiency, the body cannot handle normal sized meals and other physical symptoms will begin to manifest including: a very slow heart rate, a greatly lowered blood pressure, lowered core body temperature, baggy, wrinkled skin, constipation, dry, thin, brittle hair, lethargy, pressure sores and other skin lesions which are slow to heal and increase the risk of infection overall.
Those who have kwashiorkor typically have extremely thin arms and legs. A combination of ascites (abnormal accumulation of fluid in the peritoneal cavity) and an enlarged liver may distend the abdomen and in adults may disguise the initial, severe weight loss. Electrolyte imbalances become very common and may lead to serious problems with heart rhythms which can often be fatal. Diarrhea may worsen this imbalance.
The immune system is weakened and opportune infections or illness can be even more serious than they would be considered in a healthy person. Behavioral and mental retardation is a very real possibility in children who may grow to be of normal height, but will be very thin. The characteristic symptom of extreme protein deficiency is reddish or yellow discoloration of the hair.
Hospital patients, especially those who are admitted for longer periods, may not be able to get enough calories or nutrition for a variety of reasons. They may not be able to chew or swallow. Others may not be able to digest the foods that they are given. Many will be nauseous or may have no appetite. Additional nutrition can be lost through bleeding, diarrhea, high sugar levels, kidney disease, and some malabsorptive disorders. Some conditions require extra nutrition including fevers, infections, surgeries, tumors, traumas, and burns. Some medications may also increase the nutritional needs.
In death that is not directly related to the primary disease, kwashiorkor or other protein deficiencies can lead to death by heart failure, electrolyte imbalance which can cause systemic failure, and extremely low core body temperature (hypothermia). Certain additional symptoms, including semi-consciousness, chronic or persistent diarrhea, jaundice, and decreased blood sodium levels can mean a poorer prognosis.
Many of the people who have any level of protein deficiency will not be able to achieve better health on their own and will likely need supplementation of not only protein but other nutrients as well. In the most serious cases, it is likely that feeding via mechanical or surgically placed means will have to be included and may be the primary source of nutrition, until some strength has been restored. Feeding types include:
– Total parenteral feeding (TPN): all feeding is done through a tube with all of the nutrition supplied via special nutrient rich solutions. This type of feeding is typically done when the patient is unable to swallow on their own and can be either permanent (for end stage patients) or temporary. There are a number of conditions and diseases that are not indicated for TPN
– Naso-gastric tube (NG tube): This tube can be used to both feed a patient or can also be used to remove fluid and secretions from the stomach. It is a small plastic or rubber tube that is first fed, up the nose and then down the throat and into the stomach.
– Gastrostomy Tube (GT tube, G tube): The gastrostomy tube is inserted via an incision through the skin and into the stomach so that feedings and medications can be fed directly. G tube feedings can be total or can be used to supplement oral feedings.
– Jejunostomy tube (J tube, JT): similar to the G tube, the J tube is inserted directly into the jejunum and is used in the same way.
Source: Bednash, PhD, RN and FAAN. 2001
Using the right supplement type is important for those who have any level of protein deficiency, including kwashiorkor. It must be able to be assimilated by the body without causing the body to have to work extra hard. Protein takes the most effort for the body to break down- increasing the thermic effort by as much as 30%. The more energy that the body expends to break down a nutrient, the less energy it will have to restore its systems to working order. It is important then that the body get high quality protein that is easy to break down and use.
Profect from Protica is a liquid protein supplement that has been pre-digested to form peptides which are easier for the body to use. The process of hydrolysis allows the allergens that are common to proteins to be removed making it hypoallergenic. It is available in a number of different strengths and different flavors and can be used for feeding and a supplement to oral feeding. It is beneficial not only because of its high level of quality protein but because it can be used while in the hospital and while at home. It can be used as is or can be mixed with fruit juice, water, or other supplements as needed for each patient’s individual requirements.
Protica Research (Protica, Inc.) specializes in the development of Capsulized Foods. Protica manufactures Profect, IsoMetric, Pediagro, Fruitasia and over 100 other brands, including Medicare-approved, whey protein liquid for weight loss surgery patients. You can learn more at Protica Research – Copyright