Page 232 - Concise Pathology for Exam Preparation ( PDFDrive )

9 Environmental and Nutritional Pathology 217

Q. Define protein energy malnutrition (PEM).

Ans. Inadequate consumption of protein and/or energy resulting in a range of clinical
syndromes, namely, kwashiorkor and marasmus.

Q. Differentiate between kwashiorkor and marasmus.

Ans. Differences between kwashiorkor and marasmus are enlisted in Table 9.3.

TABLE 9.3. Differences between kwashiorkor and marasmus

Features Kwashiorkor Marasmus
Definition Protein deficiency with adequate calorie intake Starvation with a lack of overall calories
Age ,3 years 0–2 years
Clinical features
Skeletal muscle Relatively spared Catabolized, loss of muscle mass
Subcutaneous fat Spared Mobilized for energy
Liver protein stores Markedly deprived/reduced—sometimes Depleted only marginally
life-threatening
Serum protein levels Markedly decreased Normal/slightly decreased
Oedema Present; may be generalized or dependent Absent
Extremities Oedematous Patient looks emaciated; head appears too
large as compared to body
Growth/mental Present but much less Present; more severe
retardation
Weight loss 60–80% of normal weight for the age and sex Falls below the 60% of normal range
Skin lesions ‘Flaky paint’ appearance (alternating zone of Not generally seen
hyperpigmentation, desquamation and hypo
pigmentation)
Hair changes Loss of colour, alternating bands of pale and Not generally seen
darker hair (flag sign), excessive hair fall
Hepatomegaly Presents with fatty change Not seen
Appetite Lost; patient is apathetic, listless Hungry and alert
Small bowel Decrease in mitotic index in crypts, associated Rarely seen
with mucosal atrophy and loss of villi
Thymic and More marked Less marked
lymphoid atrophy
Immune deficiency/ Present, lesser Immune deficiency (mostly T cell) present,
recurrent prone to recurrent infection
infections

Q. Write briefly about the metabolism of vitamin A.
Ans. Vitamin A (fat-soluble vitamin) is the generic term used for a group of related
compounds namely, retinal, retinol and retinoic acid.
• Retinol (an alcohol): Chemical name for vitamin A is the transport form; storage form
is a retinol ester.
• Retinal (an aldehyde): Can be converted by the body to retinoic acid.
• Retinoids: Refers to both natural and synthetic chemicals that are structurally related
to vitamin A but may not have similar activity.
• Animal sources: Liver, fish, eggs, milk and butter are important dietary sources of
preformed vitamin A.
• Yellow and green leafy vegetables (spinach, carrots and squash) supply large
amounts of beta-carotene and other carotenoids that can be converted by the body
into retinol and are referred to as provitamin A carotenoids (Flowchart 9.1).

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