Protein energy malnutrition is one of the major manifestations of nutritional deficiencies. Signs and symptoms include the following:

• Diminished growth
• Inappropriate weight gain
• Significant changes in behavior, characterized by anxiety, poor attention, apathy, irritability and decreased attention span

Other signs and symptoms differ, based on the type of micronutrient deficiency that has set in. These include the following [7]:

• Iodine: Development of goiter and mental retardation 
• Iron: Anemia, fatigue, tiredness, reduced cognitive functioning and headache
• Vitamin A: Poor eye sight, night blindness and poor hair growth [8]
• Vitamin D: Poor bone health, hypocalcemia and rickets

• Malnutrition

  Abstract Malnutrition remains a serious health problem in Cambodia with over 10% of children less than five years of age suffering from acute malnutrition. [ncbi.nlm.nih.gov]

  […] in diagnosing pediatric malnutrition. [emedicine.medscape.com]

• Weight Loss

  If they experience weight loss or wasting — low weight relative to their height — they are diagnosed with acute malnutrition. [msf.ca]

  The double insult of IBD and GBP resulted in severe malnutrition, with a serum albumin concentration of 0.9 g/dL (reference range, 3.5 to 5.0), weight loss, and watery diarrhea necessitating 6 hospital admissions during a period of 7 months. [ncbi.nlm.nih.gov]

  Presentation Presentation in adults Adults tend to lose weight, often insidiously. Oedema may mask weight loss. BMI is a key measure (weight in kg divided by height in metres squared): 17-18.5 - mild malnutrition. 16-17 - moderate malnutrition. [patient.info]

  Cachexia, or wasting syndrome, encompasses a severe weight loss, along with muscle atrophy, fatigue, weakness and loss of appetite. [richmondvale.org]

  Weight Loss Surgery is a Big Decision Our specialists provide the expertise and support you need to reach your weight loss goals. [uhhospitals.org]

• Underweight

  RESULTS: The univariate Moran's I statistics was 0.65, 0.51 and 0.74 for stunting, wasting and underweight respectively suggesting spatial heterogeneity of malnutrition in India. [ncbi.nlm.nih.gov]

  Children with low weight-for-age are known as underweight. A child who is underweight may be stunted, wasted, or both. [who.int]

• Anemia

  If she is malnourished the baby risks being stunted, which can happen when anemia and malnutrition is combined. If the food intake is higher than needed and high in calories, she may suffer from gestational diabetes. [hemocue.com]

  Blood tests for anemia, electrolytes, calcium, phosphorus, magnesium, ferritin, vitamin B 12, and folate should be considered for assessment of major micronutrients. [ncbi.nlm.nih.gov]

  A deficiency in this vitamin may cause pernicious anemia. This is a type of anemia caused by a decreased ability to absorb B-12 efficiently. Pernicious anemia is more common in people with autoimmune disorders and inflammatory or digestive diseases. [healthline.com]

  We visited the mill, and managers said that the fortification costs virtually nothing — a tiny fraction of a penny per loaf of bread — yet it will reduce anemia, maternal mortality and cognitive impairments around the country. [nytimes.com]

• Fatigue

  General symptoms include fatigue, dizziness, and weight loss. Testing depends on the specific disorder. Most health care providers will do a nutritional assessment and blood work. [nlm.nih.gov]

  An 18-yr-old adolescent male presented to the clinic with symptoms of fatigue and low endurance, low libido, and lack of morning erections. [ncbi.nlm.nih.gov]

  Symptoms: Some of the major symptoms include weight loss, fatigue, retarded growth, anemia, and developmental delay. In addition, affected individuals also suffer from poor cognitive functioning, along with decreased attention span. [symptoma.com]

  An unbalanced diet Certain medical problems, such as malabsorption syndromes and cancers Symptoms may include fatigue, dizziness, and weight loss. Or, you may have no symptoms. [medlineplus.gov]

• Diarrhea

  Most adults with mild to moderate dehydration from diarrhea, vomiting or fever can improve their condition by drinking more water or other liquids. Diarrhea may be worsened by full-strength fruit juice and soft drinks. [mayoclinic.org]

  The double insult of IBD and GBP resulted in severe malnutrition, with a serum albumin concentration of 0.9 g/dL (reference range, 3.5 to 5.0), weight loss, and watery diarrhea necessitating 6 hospital admissions during a period of 7 months. [ncbi.nlm.nih.gov]

  Diarrhea is usually mild and resolves; however, diarrhea in patients with severe PEU occasionally causes severe dehydration or death. [merckmanuals.com]

  Severely wasted children are, on average, 11 times more likely to die than their healthy counterparts, as wasting is shown to increase the risk of death from infectious diseases such as diarrhea, pneumonia and measles. [thousanddays.org]

• Constipation

  We report a case of a 21 y old man who was diagnosed as CIPO with a history of recurrent intestinal colic and obstructive symptoms, slow transit type of constipation, bilateral hydronephrosis (non-obstructive), motor dysphagia without any evidence of [ncbi.nlm.nih.gov]

  Some patients suffer from persistent diarrhea or long term constipation. Menstruation may be irregular or stop completely in malnourished women. Depression is common in malnutrition. This could be both a cause as well as an effect of malnutrition. [news-medical.net]

  Poor nutritional status may cause specific vitamin deficiencies, constipation, tooth decay, osteopenia or osteoporosis, poor growth or delayed growth, and failure to thrive in infants. [cerebralpalsyguidance.com]

  Make sure to mention if you’ve experienced any periods of constipation or diarrhea, or if blood has been present in your stool. Your nutritional deficiency may also be diagnosed during routine blood tests, including a complete blood count (CBC). [healthline.com]

• Failure to Thrive

  Poor nutritional status may cause specific vitamin deficiencies, constipation, tooth decay, osteopenia or osteoporosis, poor growth or delayed growth, and failure to thrive in infants. [cerebralpalsyguidance.com]

  Failure to Thrive. American Family Physician [On-line journal]. Available online at http://www.aafp.org/afp/20030901/879.html through http://www.aafp.org. Chapter 2. Malnutrition. Merck Manual of Diagnosis and Therapy, Section 1. [labtestsonline.org]

  Children Symptoms of malnutrition in children can include: failure to grow at the expected rate, both in terms of weight and height (known as "failure to thrive") changes in behaviour, such as being unusually irritable, sluggish or anxious changes in [nhsinform.scot]

• Heart Disease

  From how ‘broken heart syndrome’ can also be triggered by happy events, to how cardiologists are now using 3D printing to personalise treatment for heart disease. [oxfordjournals.org]

  Participants suffering from kidney, respiratory or heart disease were at higher risk of malnutrition than those with no history of such illnesses. [ncbi.nlm.nih.gov]

• Hypertension

  Levels of obesity, diabetes and hypertension were “skyrocketing in pretty much every country ... and the center of all these things is diets,” he said. [reuters.com]

  Patients with ascites, encephalopathy and portal hypertension presented malnourishment more frequently. Malnutrition was associated with greater liver dysfunction and lower grip strength. [ncbi.nlm.nih.gov]

  Although a calculated value may seem an easy alternative, it should be used with caution, especially in patients with hypertension, heart failure or malnutrition. [dictionary.cambridge.org]

• Sparse Hair

  Physical examination findings included generalized nonpitting edema, widespread desquamative plaques, and sparse hair with a reddish tinge. Laboratory abnormalities included low levels of zinc, albumin, alkaline phosphatase, and iron. [ncbi.nlm.nih.gov]

  The hair becomes dry and sparse, falling out easily. Severe wasting away of muscle and fat tissue is called cachexia. [merckmanuals.com]

• Hunger

  Given the scale of the crisis, the case for aid organisations redirecting money and attention to the problem of hunger looks compelling. [economist.com]

  Millions face severe hunger but DRC funding crisis threatens delivery of aid 13 December 2017 Millions of people facing severe hunger and acute malnutrition in one of the worst hit areas of the Democratic Republic of Congo risk having life-saving aid [oxfam.org]

  We enable entire communities to be free from hunger. [actionagainsthunger.org]

  Get the facts about global hunger ▸ For families around the world, hunger means more than going to bed with an empty stomach. [mercycorps.org]

• Stroke

  CONCLUSIONS: Malnutrition has a negative impact on prognosis in patients with stroke even after rehabilitation. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved. [ncbi.nlm.nih.gov]

  The other is overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and cancer). [who.int]

  For neurologic nystagmus forms, CRC statistics could be used only for multiple sclerosis and stroke in adults because there was no overlap between sources in children. Figure 3. [iovs.arvojournals.org]

• Apathy

  Other features include reduced physical activity, mental apathy, and retarded psychomotor and mental development [ 4-6 ]. Literature review current through: Dec 2017. | This topic last updated: Jun 28, 2017. [uptodate.com]

  Signs and symptoms include the following: Diminished growth Inappropriate weight gain Significant changes in behavior, characterized by anxiety, poor attention, apathy, irritability and decreased attention span Other signs and symptoms differ, based on [symptoma.com]

  —Brain: Mental health illnesses can cause malnutrition and malnutrition can be a decisive factor in the development of mental health illnesses, such as apathy, depression, introversion, self-neglect and deterioration in social interactions. [richmondvale.org]

  Other symptoms include fatigue, an inability to stay warm, diarrhea, loss of appetite, irritability, and apathy. In very severe cases, people may become unresponsive (called stupor). People feel weak and are unable to do their normal activities. [merckmanuals.com]

• Seizure

  This would be associated with a possible addition of 10,000 seizures per million episodes of diarrhoea with some dehydration, almost all in young children. In other words, the estimated number of seizures per death averted would be 0.7. [rehydrate.org]

  These include the anti-seizure medicine gabapentin (Neurontin), the muscle relaxant baclofen (Lioresal), and onabotulinumtoxina (Botox). For people who are very nearsighted, LASIK or Visian ICL can help improve eyesight. [webmd.com]

  For example, Dilantin and Phenobarbital, medications given to prevent seizures, may cause nystagmus. This acquired condition may cause the patient to experience oscillopsia, a sensation of movement in their vision that causes a vertigo effect. [eyeassociates.com]

  Rumors inevitably swirl: iodine has been blamed for AIDS, diabetes, seizures, impotence and peevishness. Iodized salt, according to different national rumor mills, will make pickled vegetables explode, ruin caviar or soften hard cheese. [nytimes.com]

The following tests are carried out, to diagnose the type of malnutrition and its associated conditions that have set in:

• Blood work to obtain complete blood profile of the affected individual. This would include sedimentation rate, and serum electrolyte analysis.
• Urinalysis and stool culture are also carried out, to determine the cause of infection that has caused malnutrition to develop.
• Thyroid functions tests, and sweat chloride tests, would also be required, if the high velocity values are abnormal.
• In children who have also developed liver disorders, levels of triglyceride and vitamins are determined [9] [10].

Mild cases of malnutrition can effectively be treated with dietary modifications, and nutritional supplements, to correct the deficiencies. In such situations, MNPs – micronutrient powders can be used, to replenish the lost stores of the nutrients. MNPs are combinations of various vitamins and minerals in powder form, which needs to be mixed with any type of semisolid food. Such a type of method has been found to correct, as well as prevent nutritional deficiencies in children aged 6 to 23 months [11].

In case of moderate to severe cases, hospitalization may be indicated. It is necessary in cases when a severe form of dehydration has set in, along with clinical signs indicating the onset of other types of associated complications. Children or individuals with severe malnutrition, have to be administered enteral tube feeding to correct nutritional deficiencies [12].

Prognosis of the condition majorly depends on the cause of malnutrition. If primarily nutritional deficiencies are the culprit, then these can easily be corrected. However, if malnutrition has set in due to underlying disease conditions, then the disease needs to be treated to correct nutritional deficiencies [6].

Malnutrition stems from several factors which include:

• Poor diet habits: Diet which is deficient in several micronutrients and macronutrients. In many cases, malnutrition can also develop, if the diet is deficient in single vitamins.
• Underlying medical conditions such as gastroenteritis, worm infections, chronic diarrhea and HIV/AIDS, can also cause malnutrition to set in. Various disease conditions, also lead to disturbances in the processes of digestion and absorption, which have a major role to play in the development of malnutrition [2].
• Poverty and food prices: Financial crisis and poor socioeconomic status of the individuals prevents them from purchasing nutritious food. In many parts of the world, especially developing countries, people often do not get even one complete meal in a day. To add to this, increase in food prices, also prevents the population to reach out for nutritious food stuffs, such as milk, poultry, fruits, vegetables and meat [3].
• Agricultural productivity: Poor agricultural productivity due to various factors, significantly contributes to shortage of food, giving rise to malnutrition [4].

Worldwide, malnutrition is known to be a major risk for illness and death. Statistics indicate that more than 54% deaths of children occurred due to malnutrition in the year 2001. In addition, children less than 5 years of age, fall easy preys to this condition, and this accounts for 300,000 deaths per years [5].

Pregnant women affected by malnutrition, are at an increased risk of giving birth to low birth weight babies. On the other hand, low birth weight infants have a difficult time in struggling for life, and also have to face consequences during their developmental years.

Malnutrition does not spare even a single organ system. Protein is required for growth and maintenance of body tissues. Energy is of utmost importance for various physiologic processes of the body. In addition, various micronutrients are essential for optimal functioning of the enzymatic processes. Therefore, nutrient deficiency in any, or all of these nutrients, has grave consequences. Malnutrition also causes poor immunity, which in turn predisposes the affected individual to develop other types of diseases conditions.

The best way through which malnutrition can be prevented, is by adopting healthy and correct dietary practices: The following measures can be followed:

• Eating a nutritionally balanced diet, a diet that has all macro- and micronutrients. 
• Consumption of at least 5 servings of fruits and vegetables on a daily basis.
• Seek immediate medical intervention for any type of underlying disease conditions.
• If dietary modifications aren’t a possibility, then supplementation would be necessary.

Malnutrition is most commonly used for referring to undernutrition. It is one of the leading causes of morbidity, and mortality, across the globe. The condition can cause protein energy malnutrition to set in, and can also give rise to micronutrient deficiencies. Children and women are more affected by this condition. Retarded growth, behavioral changes, and wasting, are some of the major effects of malnutrition [1].

• Definition: Malnutrition occurs due to inadequate dietary practices, wherein either there is too little, or excessive amounts of nutrients. If the condition is not treated on time, it can cause severe life threatening complications.
• Cause: Inadequate access to food, either due to poverty, or high food prices, is the major cause of malnutrition. In addition, certain underlying disease conditions and infections that interfere with the body’s digestion and absorption process, can also lead to malnutrition.
• Symptoms: Some of the major symptoms include weight loss, fatigue, retarded growth, anemia, and developmental delay. In addition, affected individuals also suffer from poor cognitive functioning, along with decreased attention span.
• Diagnosis: Preliminary blood tests to obtain complete blood count and levels of iron and other nutrients are done. Stool cultures and urinalysis are also indicated, to find out the causative factors.
• Treatment: Malnutrition is treated through supplementation of nutrients, and correction of underlying disease conditions. If dehydration has developed in case of severe diarrhea, then correcting electrolyte imbalances would be the primary goal of treatment.

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