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]

• Weight Gain

  Mean rate of weight gain was 4.4 g/kg/day and MUAC gain 0.3 mm/cm/day; median duration of treatment 44.5 days. [ncbi.nlm.nih.gov]

  Secondary outcomes Weight gain Oakley 2010 measured weight gain during the intervention period. [doi.org]

• 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. [msdmanuals.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]

• Nausea

  Gastroparesis (GP) is a chronic debilitating dysmotility characterized by unrelenting nausea, vomiting, bloating, early satiety, postprandial fullness and abdominal pain. [ncbi.nlm.nih.gov]

  High fiber foods, such as fresh fruits and vegetables, may become blocked or stuck in this area, causing pain, bloating, or nausea. Low fiber or liquid diets may be needed to reduce symptoms if the stricture is very narrow. [crohnscolitisfoundation.org]

  Some medicines have unpleasant side effects – such as loss of appetite, diarrhoea or nausea – that could mean you eat less or don't absorb as many nutrients from your food. [nhs.uk]

• Vomiting

  Gastroparesis (GP) is a chronic debilitating dysmotility characterized by unrelenting nausea, vomiting, bloating, early satiety, postprandial fullness and abdominal pain. [ncbi.nlm.nih.gov]

  Erosion of dental enamel and tooth loss due to vomiting. Post-vomiting facial petechiae – tiny red, purple, or brown spots due to breakage of small blood vessels and bleeding into the skin. [dermnetnz.org]

  If you or the person you're caring for has been vomiting or has had diarrhea, the doctor will want to know when it began and how frequently it's been occurring. [mayoclinic.org]

• Loss of Appetite

  Malnutrition may result from inadequate food intake secondary to the uremic condition, nausea, vomiting, loss of appetite, altered taste and other physiologic conditions that impede food intake or metabolism. [ncbi.nlm.nih.gov]

  Some medicines have unpleasant side effects – such as loss of appetite, diarrhoea or nausea – that could mean you eat less or don't absorb as many nutrients from your food. [nhs.uk]

  Loss of appetite. Common causes of loss of appetite include cancers, tumours, depressive illness and other mental illnesses, liver or kidney disease, chronic infections etc. [news-medical.net]

  Some of the symptoms and signs to watch out for include: Loss of appetite Weight loss – clothes, rings, jewellery, dentures may become loose Tiredness, loss of energy Reduced ability to perform normal tasks Reduced physical performance – for example, [bapen.org.uk]

• 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]

• Night Blindness

  The ocular manifestations of xerophthalmia include conjunctival and corneal xerosis (drying), keratomalacia (corneal necrosis/ulceration), nyctalopia (night blindness), and Bitot's spots (conjunctival lesions). [ncbi.nlm.nih.gov]

  Night blindness Twenty years ago, Huib Simonsz, a pediatric ophthalmologist at the Sophia Children’s Hospital in Rotterdam, discovered a group of patients who presented with different types of congenital night blindness and the same type of congenital [nin.nl]

  Night blindness Twenty years ago, Huib Simonsz, a pediatric ophthalmologist at the Sophia Children's Hospital in Rotterdam, discovered a group of patients who presented with different types of congenital night blindness and the same type of congenital [sciencedaily.com]

  These include the following: 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 Vitamin D: Poor bone health, [symptoma.com]

  Visual disturbances include night blindness and increased sensitivity to light and glare. [medical-dictionary.thefreedictionary.com]

• Ulcer

  Nutritional intervention in pressure ulcer management is truly "healing from the inside out." [ncbi.nlm.nih.gov]

  If you have Crohn’s disease or ulcerative colitis, you may have difficulty maintaining healthy nutrition due to intestinal inflammation, disease-related complications, and use of certain medications. [crohnscolitisfoundation.org]

  Malnutrition and impaired muscle strength in patients with Crohn's disease and ulcerative colitis in remission. Nutrition. 2008;24:694-702. Sousa Guerreiro C, Cravo M, Costa AR, et al. [inflammatoryboweldisease.net]

• Delayed Wound Healing

  It has been associated strongly with impaired immune response, impaired muscle and respiratory function, delayed wound healing, overall increased complications, longer rehabilitation, greater length of hospital stay and increased mortality. [healthdirect.gov.au]

  Other signs of malnutrition may include: feeling tired all the time and lacking energy frequently getting infections taking a long time to recover from infections delayed wound healing poor concentration difficulty keeping warm depression A good way of [nhsinform.scot]

  Other symptoms include: weakening of the muscles, which then begin to waste away feeling tired all the time and lacking energy increased vulnerability to infection delayed wound healing dizziness irritability your nails become brittle your skin becomes [hse.ie]

• 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. [msdmanuals.com]

• Suggestibility

  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]

  Image caption Dark clouds hang over future farming under climate change, the study suggests Global warming is set to cut rice yields in Asia, research suggests. [bbc.co.uk]

  The condition of the bones suggests the specimen died of old age and malnutrition. By some estimates up to 43% of the resettled population died of diseases and malnutrition. [tr-ex.me]

• Fear

  […] positioning, frequent acute illnesses with gastrointestinal losses, medications that decrease appetite or increase nutrient losses, polypharmacy, decreased thirst response, decreased ability to concentrate urine, intentional fluid restriction because of fear [ncbi.nlm.nih.gov]

  They did not seek medical help for religious reasons, fear of having Child Protective Services called and a lack of trust in medical services,” according to court records. [independent.co.uk]

  Small salt makers who fear extra expense often lobby against it. So do makers of iodine pills who fear losing their market. Rumors inevitably swirl: iodine has been blamed for AIDS, diabetes, seizures, impotence and peevishness. [nytimes.com]

• Kidney Failure

  These include people with: A poor appetite Illnesses that increase nutritional needs such as kidney failure, respiratory disorders, HIV or cancer Eating disorders Elderly people. [daa.asn.au]

  Doctors periodically measure the blood levels of dissolved minerals (electrolytes), glucose, and urea (a measure of kidney function) to identify certain nutritional imbalances. They can then adjust the solution accordingly. [msdmanuals.com]

  Nutrient loss can be accelerated by diarrhea, excessive sweating, heavy bleeding (hemorrhage), or kidney failure. [medical-dictionary.thefreedictionary.com]

• Incontinence

  […] frequent acute illnesses with gastrointestinal losses, medications that decrease appetite or increase nutrient losses, polypharmacy, decreased thirst response, decreased ability to concentrate urine, intentional fluid restriction because of fear of incontinence [ncbi.nlm.nih.gov]

  A child may also experience urinary tract infections, incontinence, diarrhea, bowel obstruction, halitosis, and irritable bowel syndrome from being malnourished or undernourished. [cerebralpalsyguidance.com]

• 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. [msdmanuals.com]

• Responsiveness Decreasing

  […] or increase nutrient losses, polypharmacy, decreased thirst response, decreased ability to concentrate urine, intentional fluid restriction because of fear of incontinence or choking if dysphagic, psychosocial factors such as isolation and depression [ncbi.nlm.nih.gov]

• Cognitive Disorder

  Here we describe cases of scurvy and vitamin D deficiency in 2 children with cognitive disorders. [ncbi.nlm.nih.gov]

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].

• Hypophosphatemia

  Persistent hypophosphatemia unresponsive to supplements should raise clinical alertness. With complete resection of the neoplasm, the symptoms rapidly reverse. [ncbi.nlm.nih.gov]

  This potentially fatal condition is associated with electrolyte disturbances including hypokalemia and hypophosphatemia In moderate to severe cases of malnutrition, enteral supplementation via tube feedings may be necessary. [emedicine.medscape.com]

• Hypophosphatemia

  Persistent hypophosphatemia unresponsive to supplements should raise clinical alertness. With complete resection of the neoplasm, the symptoms rapidly reverse. [ncbi.nlm.nih.gov]

  This potentially fatal condition is associated with electrolyte disturbances including hypokalemia and hypophosphatemia In moderate to severe cases of malnutrition, enteral supplementation via tube feedings may be necessary. [emedicine.medscape.com]

• Hypoglycemia

  Wasting can affect both children and adults. 7. the child at risk for:  Hypoglycemia  Hypothermia  Fluid overload/ heart failure  Infection A wasted child can be classified as either moderately or severely acutely malnourished based on body measurements [de.slideshare.net]

  Hypoglycemia (low blood sugar) can result from a child not eating for 4 to 6 hours. Hypoglycemia should be considered if there is lethargy, limpness, convulsion, or loss of consciousness. [en.wikipedia.org]

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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