Protein Malnutrition Paper

Introduction

This week’s case study is about a client who is 83 years of age and is a skilled nursing amenity resident. The patient presented to the facility with generalized lower limb and abdominal edema. The interaction with the patient revealed a history of malabsorption syndrome and poor feeding from a lack of dentures. Thus, a diagnosis of protein malnutrition was arrived at.

Protein Malnutrition Paper

Malnutrition is a serious health crisis resulting in increased morbidity and mortality risk. Broadly, malnutrition can be classified into marasmus, an inadequate supply of energy to meet the body’s requirement, or kwashiorkor, which is the supply of adequate energy with insufficient protein intake (McCance et al., 2019). Classification can also be based on the severity, with malnutrition being classified as mild, moderate, or severe.

Role of Genetics In Protein Malnutrition

Protein malnutrition is etiologically multi-factorial. Its causes include inadequate/improper food intake, impaired absorption, increased gastrointestinal loss of nutrients, increased nutritional needs from various stressors, increased protein loss, and inadequate protein synthesis (Dipasquale et al., 2020). This particular patient’s protein malnutrition is likely due to impaired absorption from the history of the maladaptive syndrome and inadequate food intake based on the difficulty feeding attributed to lack of dentures.

Genetics plays a role in the causation of protein malnutrition. Human genetic variations can alter host genes that impact food absorption and metabolism, including proteins, through many mechanisms. Some studies have identified nutrition-associated genes that influence macronutrient intake, such as FTO and single-nucleotide polymorphism genes, which cause reduced protein intake (Duggal et al., 2018). The genetic variation of individuals also determines the gut microbe composition, which may, in turn, contribute to malnutrition.

Reason For Patient’s Presenting Symptoms

The patient came to the emergency department presenting with generalized lower limb edema and abdominal edema. Protein malnutrition is typically characterized by low serum albumin levels due to the decreased synthesis and storage of serum proteins. Low albumin levels lead to an imbalance between oncotic pressure and hydrostatic pressure across vascular walls. Albumin contributes to oncotic pressure, which maintains the intravascular fluid within the blood vessels. Its deficiency thus leads to loss of fluid to the extra-vascular spaces and tissues, which presents clinically as edema.

Physiologic Response To The Stimulus

Reduced oncotic pressure due to low serum albumin level leads to edema from extra-vascular movement of intravascular fluid. In serious cases, this results in intravascular volume depletion, leading to hypovolemia and even shock. The body responds to this by increasing the antidiuretic hormone levels to replace the depleted intravascular fluid.  This is achieved by water retention by the renal system through the action of this hormone.

Cells Involved In The Process

Antidiuretic hormone is secreted by the posterior pituitary gland. This hormone acts in the distal renal and collecting tubules and leads to water reabsorption by causing the expression of water transport channels. This leads to intravascular fluid repletion. In addition to decreasing urine output, this hormone also acts on the endothelial cells of blood vessels to cause vasoconstriction in cases of hypotension.

Influence of Other Characteristics

In addition to genetics, several other factors contribute to the development of malnutrition. Aging, for example, has been shown to increase the risk of malnutrition, as is the case with the patient in this study. This is attributed to factors such as lack of dentures, loss of taste, and reduced movement (Besora-Moreno et al., 2020). This leads to reduced food intake with resultant malnutrition. This may necessitate measures such as nutritional support and screening of the elderly population for early diagnosis and interventions.

References

  • Besora-Moreno, M., Llauradó, E., Tarro, L., & Solà, R. (2020). Social and Economic Factors and Malnutrition or the Risk of Malnutrition in the Elderly: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients, 12(3), 737. https://doi.org/10.3390/nu12030737
  • Dipasquale, V., Cucinotta, U., & Romano, C. (2020). Acute Malnutrition in Children: Pathophysiology, Clinical Effects, and Treatment. Nutrients, 12(8), 2413. https://doi.org/10.3390/nu12082413
  • Duggal, P., & Petri, W. (2018). Does Malnutrition Have a Genetic Component? Annual Review Of Genomics And Human Genetics, 19(1), 247–262. https://doi.org/10.1146/annurev-genom-083117-021340
  • McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Protein Malnutrition Paper Instructions

Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier in the references.  Learning Resources Required Readings (click to expand/reduce)  McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.  Chapter 1: Cellular Biology; Summary Review Chapter 2: Altered Cellular and Tissue Biology: Environmental Agents (pp. 46-61; begin again with Manifestations of Cellular Injury pp. 83-97); Summary Review Chapter 3: The Cellular Environment: Fluids and Electrolytes, Acids, and Bases Chapter 4: Genes and Genetic Diseases (stop at Elements of formal genetics); Summary Review Chapter 5: Genes, Environment-Lifestyle, and Common Diseases (stop at Genetics of common diseases); Summary Review Chapter 7: Innate Immunity: Inflammation and Wound Healing Chapter 8: Adaptive Immunity (stop at Generation of clonal diversity); Summary Review Chapter 9: Alterations in Immunity and Inflammation (stop at Deficiencies in immunity); Summary Review Chapter 10: Infection (pp. 289–303; stop at Infectious parasites and protozoans); (start at HIV); Summary Review Chapter 11: Stress and Disease (stop at Stress, illness & coping); Summary Review Chapter 12: Cancer Biology (stop at Resistance to destruction); Summary Review Chapter 13: Cancer Epidemiology (stop at Environmental-Lifestyle factors); Summary Review  Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/  Credit Line: Immediate Hypersensitivity Reactions - StatPearls - NCBI Bookshelf. (2019, June 18). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/. Used with permission of Stat Pearls  Required Media (click to expand/reduce)  Module 1 Overview with Dr. Tara Harris   Dr. Tara Harris reviews the structure of Module 1 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Discussion and Assignment. (4m)   Accessible player  Foundational Concepts of Cellular Pathophysiology - Week 1 (14m)   Accessible player  Immunity and Inflammation Khan Academy (2010, February 24). Inflammatory response | Human anatomy and physiology | Health & medicine [Video file]. Retrieved from https://www.youtube.com/watch?v=FXSuEIMrPQk    Note: The approximate length of the media program is 14 minutes.  Soo, P. (2018, July 28). Pathophysiology Ch 10 alterations in immune function [Video file]. Retrieved from https://www.youtube.com/watch?v=Jz0wx1-jTds     Note: The approximate length of the media program is 37 minutes.  Acid-Base Balance #1 MedCram. (2012, April 28). Medical acid base balance, disorders & ABGs explained clearly [Video file]. Retrieved from https://www.youtube.com/watch?v=4wMEMhvrQxE   Note: The approximate length of the media program is 13 minutes.   Scenario 3: An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has history of malabsorption syndrome and difficulty eating due to lack of dentures. The patient has been diagnosed with protein malnutrition.  Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:  1. The role genetics plays in the disease. 2. Why the patient is presenting with the specific symptoms described. 3. The physiologic response to the stimulus presented in the scenario and why you think this response occurred. 4. The cells that are involved in this process. 5. How another characteristic (e.g., gender, genetics) would change your response.