Emaciation and Malnutrition

Malnutrition is classified according to weight. The Indian Academy of Paediatrics considers a weight of more than 80% of the expected weight for a particular age as normal. Depending on the weight, malnutrition is classified in grades 1 to 4 as given in the following table

Weight of the individual in percentage of expected weight for age	Grade of malnutrition
71% to 80%	1
61% to 70%	2
51% to 60%	3
Less than 50%	4

1.  Causes

The common causes of malnutrition are given below –

   A.   Poverty

B.   Malnutrition in the mother : If a pregnant lady is under-nourished, the newborn baby is also underweight.

   C.  Chronic infection, e.g. tuberculosis.

D.  Chronic diseases, e.g. malabsorption.

E.   Population growth and large families.

F.   Poor feeding habits : Giving very diluted milk or only Cerelac.

2.   Mild to moderate malnutrition and marasmus

If the dietary intake is deficient for a short period, the body tries to save energy by reducing the activity. If there is food deficiency for a long duration, initially the fat deposits are utilised which is associated with loss of weight. Initially, fat is lost from the hips and thighs. Later, fat is lost from the abdomen and back and lastly, fat is lost from the cheeks and face. In children, their growth is affected. If the food deficit continues, initially the muscles are wasted and later the internal organs are affected. The brain and heart are affected last and to a minimum extent. The skin appears dry and loses its elasticity. The hair becomes light coloured. The abdomen gets distended and the bones appear prominent. The individual becomes irritable.

Grade IV malnutrition, i.e. when the weight is less than 50% of the expected weight for that age, the condition is called marasmus.

3.  Protein energy malnutrition – kwashiorkar

The causes are the same as those of malnutrition wherein the diet is inadequate. Hence there is a deficiency of calories. In protein energy malnutrition, the diet is deficient in calories but the protein deficiency is more marked. Proteins constitute the structure of the body cells and indirectly of the body. The symptoms in protein energy malnutrition are due to deficiency of both, proteins as well as calories. The clinical manifestations are –

A.   Marked retardation of growth.

  B.   Oedema, i.e. swelling of the body : This is caused by a low level of blood proteins, particularly albumin. The oedema starts in the legs and later involves the face.

  C.  Mental changes : The child becomes lethargic and woeful.He is not interested in playing. He appears miserable.

  D.  Skin and hair changes : The hair becomes thin, dry, brittle and sparse. The hair changes its colour. The skin becomes dry and loses its elasticity.

E.   Associated deficiency of vitamins and minerals.

  F.   Recurrent infections like diarrhoea due to decrease in body resistance.

4.  Complications

  A.   Low body temperature : Cold body and shock.

  B.   Hypoglycaemia : Low levels of blood glucose.

  C.  Severe diarrhoea

   D.  Infection

  E.   Anaemia

F.   Liver failure

  G.  Heart failure

H.  Dehydration

5.  Treatment

An easily digestible diet containing all the essential nutrients and providing adequate calories for the present weight should be taken. Later, as the appetite improves, the diet should be stepped up till one gets a balanced diet adequate for the expected weight for that age. The diet should be rich in calories and proteins. The associated vitamin and mineral deficiencies should be treated. Infections and worm infestation should also be treated.

6.  Ayurvedic concept

In Ayurveda, malnutrition is called ‘karshya’ which is derived from the word ‘krushata’ which means a thin and lean body.

7.  Aetiology

  The aetiological factors are –

A.   Old age

B.   Diet : Inadequate diet, fasting, dry diet, food items with astringent, bitter and pungent taste.

  C.  Activity : Exertion and excessive indulgence in sex.

D.  Massage with dry powders. Have a bath with warm water medicated with dry medicines.

E.   Psychological : Sorrow, worry, anger, fear and suppression of natural urges of passing stools and urine, sleeping and studying under tension.

F.   Chronic diseases

G.  Individuals with Vata and Pitta constitutions (prakruti) are generally affected.

8.  Clinical manifestations

A.   An emaciated person loses weight and subcutaneous fat and his muscles undergo wasting.

B.   The body feels cold to touch and the skin appears wrinkled and lustre less.

C.  The veins and joints appear prominent.

D.  The semen and sexual drive are affected.

E.   Tolerance to hunger, thirst, hot and cold environment, breeze  and exertion decreases. Immunity and resistance to diseases become less.

  F.   There is swelling all over the body if the quantity of proteins is very less in the diet.

9.  Associated illness or complications

An emaciated person is prone to suffer from oedema, bleeding disorders, diseases of the nervous system including weakness of hearing and other sense organs, delirium, insanity, respiratory infections, pleurisy, breathlessness, cardiac pain, distension of the abdomen, splenomegaly, anorexia, weak digestive power, muscular pain and backache, intense pain in the bones and joints and suppression of the urge to pass urine and stools.

10.  Treatment

A.   Diet : Sweet and sour food items which have a high caloric value should be given.

Cereals : Rice and wheat.

Pulses : Mung (green gram), chana (Bengal gram), til (sesame seeds) and udid (black gram).

Meat : Fish, eggs and meat (mutton and chicken).

Milk products : Milk, butter, curds, barfi and pedha.

Fat : Ghee, oil and animal fat.

Sugar based products : Sugar, jaggery and sugarcane.

Fruits : Grapes, dates and pomegranate.

The diet should be gradually stepped up according to the digestive power of the patient. Cashewnuts, almonds, walnuts and groundnuts should be taken. Nothing is more nourishing than meat, milk and ghee.

B.   Activity : Rest and adequate sleep are necessary. Sleeping during the day, exertion, exercise and indulging in sexual inter-course are contraindicated.

C.  Oil massage
D. Psychological : A carefree & happy attitude.

E.   Medicines

 1.   Ashvagandha, kshirakakoli, vidari, shatavari, bala, atibala, nagabala and medicines belonging to the sweet group are indicated.

2.   Roasted corn flour medicated with ghee, oil, honey, sugar and pippali in an equal quantity should be taken.

3.   Anabolic agents and tonics (rasayana) : Amalaka, chyavanprasha and loha bhasma (iron salt) should be taken.

4.  Appropriate tonics along with an adequate and a well balanced diet constitute the basis of treatment.