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Protein energy malnutrition (PEM), brain and various facets of child development
1Department of Pediatrics, Bombay Hospital, Institute of Medical Sciences.
Insights
Protein energy malnutrition (PEM) significantly impacts children
Area of Science:
- Neuroscience
- Pediatrics
- Public Health
Background:
- Protein energy malnutrition (PEM) affects millions of children globally, with severe forms like marasmus and kwashiorkor.
- PEM has detrimental effects on the developing brain, impacting biochemistry, tissue integrity, and overall neural development.
Purpose of the Study:
- To highlight the adverse neurological consequences of PEM in children.
- To emphasize the combined impact of malnutrition and lack of psychosocial stimulation on child development.
- To advocate for comprehensive interventions for prevention and rehabilitation.
Main Methods:
- Review of experimental animal studies and clinical data from developing countries.
- Analysis of biochemical, histological, and neuroimaging findings in children with PEM.
- Consideration of factors like maternal health, literacy, and environmental stimulation.
Main Results:
- PEM leads to brain tissue damage, impaired growth, reduced synapses, and altered myelination.
- Clinical manifestations include reduced brain size and morphological changes in cerebellar cells.
- The severity of effects correlates with PEM duration, child's age, and maternal factors.
Conclusions:
- Early and sustained nutritional rehabilitation, alongside psychosocial support, is crucial for improving physical, mental, and academic outcomes.
- Interventions must involve families, schools, communities, and healthcare professionals.
- Training healthcare providers and educators on developmental stimulation is essential for comprehensive child care.
Abstract:
Protein energy malnutrition (PEM) is a global problem. Nearly 150 million children under 5 years in the world and 70-80 million in India suffer from PEM, nearly 20 million in the world and 4 million in India suffer from severe forms of PEM, viz., marasmus, kwashiorkor and marasmic kwashiorkor. The studies in experimental animals in the west and children in developing countries have revealed the adverse effects of PEM on the biochemistry of developing brain which leads to tissue damage and tissue contents, growth arrest, developmental differentiation, myelination, reduction of synapses, synaptic transmitters and overall development of dendritic activity. Many of these adverse effects have been described in children in clinical data, biochemical studies, reduction in brain size, histology of the spinal cord, quantitative studies and electron microscopy of sural nerve, neuro -CT scan, magnetic resonance imaging (MRI) and morphological changes in the cerebellar cells. Longer the PEM, younger the child, poorer the maternal health and literacy, more adverse are the effects of PEM on the nervous system. Just like the importance of nutrients on the developing brain, so are the adverse effects on the child development of lack of environmental stimulation, emotional support and love and affection to the child. When both the adverse factors are combined, the impact is severe. Hence prevention of PEM in pregnant and lactating mothers, breast feeding, adequate home based supplements, family support and love will improve the physical growth, mental development, social competence and academic performance of the child. Hence nutritional rehabilitation, psychosocial and psychomotor development of the child should begin in infancy and continue throughout. It should be at all levels, most important being in family, school, community and various intervention programmes, local, regional and national. Moreover medical students, health personnel, all medical disciplines concerned with total health care and school teachers should learn and concentrate on the developmental stimulation and enrichment of the child.