The health issue mostly seen in adults and children is chronic kidney disease (CKD) impacted by protein-calorie malnutrition (PCM). Although they have different pathogenesis, protein-calorie (energy) malnutrition is caused by a deficiency of energy, protein, and micronutrients. Signs and symptoms of PCM include being underweight compared to the expected healthy weight or muscle wasting seen in certain disease conditions such as HIV/AIDS. Protein calorie malnutrition (PCM) is also common in older people as seen in aggressive weight loss programs or patients with CKD (Mathur, et al., 2022).
During recent research by Mathur, et al., 2022 in a large community cohort with CKD, studies have characterized the relationship between severe protein-calorie malnutrition and the appearance of metabolic syndrome (MS) in adulthood. With each rise in serum bicarbonate levels, the hazard ratios adjusted for age, sex, race, GFR rate, serum albumin, hemoglobin, diabetes, and cardiovascular comorbidities were noted as an outcome of protein-calorie malnutrition (Mathur, et al., 2022).
Experimental animal and human studies conducted by Mathur, et al., 2022 show that chronic kidney disease (CKD) is very high among geriatric patients with a risk of adverse effects such as metabolic acidosis associated with protein catabolism and bone loss. Research studies by Mathur, et al., 2022 sought to quantify the independent association of metabolic acidosis with adverse muscle, bone, and functional outcomes in patients with non-dialysis-dependent patients with stage 3–5 CKD who had low estimated glomerular filtration (GFR) and serum bicarbonate values. The presence and severity of metabolic acidosis were significant and independent risk factors for failure to thrive, protein-calorie malnutrition, and falls with a possible fracture (Mathur, et al., 2022).
The second type of protein-calorie malnutrition is edematous malnutrition known as Kwashiorkor and Marasmus. They are two clinical syndromes observed in severe acute malnutrition in young children primarily found in developing countries. Marasmus comprises of depletion of antioxidants, vitamins, and minerals. While Kwashiorkor is a severe and uncontrolled oxidative stress associated with the depletion of gut anaerobes and proliferation of aerotolerant gut pathogens (Pham, et al., 2021).
Nutrition improves health positively because, urgent correction of plasma glutathione depletion, alongside supply of specific essential amino acids, particularly methionine and cysteine, early suppression of gut Proteobacteria including K. pneumoniae, and the use of probiotics to restore the human gut anaerobic and mature microbiota open new avenues to develop more targeted and effective treatments modalities. We can use this knowledge to healthily educate our patients and their family that increasing the intake of protein-containing foods, using milk-based formulas, antioxidants, vitamins, minerals, and daily multivitamins are the treatment of choice for replacement therapy (Mathur, et al., 2022).
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