Protein energy malnutrition and the nervous system
Protein energy malnutrition (PEM), a natural ramification of poverty, continues to be a perennial source of concern to a large segment of the world population. The developing nervous system of a child is a specially vulnerable to deprivations in nature. Peripheral nerve and muscle dearrangements are clinically evident by weakness ,hypotonia and hyporeflexia in accordance with severity and duration of PEM .The human sural nerve histology in cases of severe PEM is characterized by persistence of small myelinated fibres ,striking failure of intermodal elongation and significant segmental demyelination .Young Rhesus monkeys are deal experimental PEM Models and they show myopathic EMG changes amenable to rehabilitation ,muscle pathology comprises obliteration of cross-striations ,streaming of Z bands ,increased interfibrillary spaces, mitochondriomegaly and small for age fibres .Radioisotope assays reveal anomalous incorporation into various nerve and muscle constituents .Central nervous system ,specially the neuropsychological functions are affected in a lasting manner. Learning deficits, behavioral problems and manual indexterity are most obstructive features.
Many of the things can wait, the child cannot
To him we cannot answer –‘Tomorrow’ His name is ’today’
(Gabriela Mistral ‘Today’)
Food insecurity , a logical precursors of protein-energy malnutrition (PEM) ,remains an existential preoccupation of a vast majority of third world populace .Ravages of debilitating ailments like acquired immune deficiency syndrome (AIDS) and perpetual famines in tropics abet the steadfast continuance of PEM ,parallel with prosperity ,pursuit of food has receded from the realms of anxious deliberations of developed world ,yet PEM persists to wield its haunting specter (Schreiber and Adelson 1985 :” protein calories malnutrition “(PCM) to embrace two extreme expressions of common childhood undernutrition . Kwashiorkor and marasmus. Marasmus is a consequence of chronic semistaravtion presenting as wasting of muscle and adipose tissue with a reduction of body weight below 60 % of normal expectation for age. Kwashiorkor is characterized by muscle tissue loss with preservation of adipose tissue and in particular by hypoalbuminemia and ocdema. The determinants of type PEM (kwashiorkor or marasmus ) to manifest in a particular infant are yet to clucidated (Trusswell 1981 : waterlow 1984) the concept of failed adaptation is relatively new and children with marasmus are said to adapt normally to protein-energy deficiency ,whereas those with kwashiorkor fail to do so (Ausman et al 1989 : Benjamin 1989 ).
Failure of lactation, use of dilute breast milk substitutes (Baritrop and Sandhu 1985) or just the dire straits of poverty curtailing food purveyance to the growing child are serious enough reasons to engender a state of PEM .however, miscellaneous additional factors have also been implicated in the pathogenesis of PEM .These include aflatoxin (Hendrickse 1984) ,free radicles (Golden an Ramdath 1986 ) essential.
