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PROTEINS AND AMINO ACIDS: CLINICAL PROBLEMS
Protein deficiency is not common in the United States. Under certain circumstances an individual might be in negative nitrogen balance. This means that his body is breaking down protein tissues faster than they are being replaced. Thus the excretions contain more nitrogen than is being supplied by the diet. Just as overdrawing a bank account is not a good thing, so the excess removal of nitrogen from the tissue is also harmful. When negative nitrogen balance exists, the individual is less able to resist infections, he may withstand the stress of injury or surgery poorly, and his general health will deteriorate.
Negative nitrogen balance can exist when an individual does not eat enough protein-containing foods, or eats protein foods of poor quality, or obtains insufficient calories. Some persons use crash diets for reducing and thus have a very low protein intake. Many elderly persons are unable to chew well, or don’t like milk, or believe they don’t need protein foods such as meat or eggs. Injury, infections, and surgery increase the protein need but patients in these situations often have a poor appetite. Nurses and dietitians should be particularly alert to the possibility of protein malnutrition in patients with poor appetites. They should take steps to improve food intake before serious problems arise.
Protein-calorie malnutrition
Two forms of protein-calorie malnutrition (PCM), kwashiorkor marasmus, are seen in infants and young children in Africa, Central and Latin America, and parts of the Orient. Although rare in the United States, these conditions are sometimes seen in conditions of severe poverty, or as a result of parental ignorance regarding infant feeding, or in child neglect.
Kwashiorkor usually appears after the child is weaned from the mother’s breast. Usually the infant obtains enough calories, but the high-carbohydrate foods do not supply enough protein. The infants fail to grow, the appetite is poor, the skin and hair change in texture and color, diarrhea follows, the tissues hold water (edema), and death sometimes follows if there is no treatment.
Marasmus occurs in infants who are weaned very early and who are fed diets that are low in calories as well as protein. These infants are emaciated in appearance. Because the severe malnutrition has occurred very early in life, the brain cells have had less opportunity to develop. If the infant survives, there is the possibility of mental retardation taking place.
Protein-calorie malnutrition can be prevented or treated with inexpensive sources of protein-rich foods. Dry milk supplied through UNICEF to many infants and children has been highly effective. Many countries have developed protein-rich foods by combining locally available plant foods. Incaparina, the best known of these, is a food powder that can be mixed with water for child feeding. It is made from corn, cottonseed, sorghum, and mineral-vitamin supplements. Soybean protein, peanut protein, and others have been used in various mixtures.
Some fallacies and facts
1. Fallacy. Athletes need more protein than non-athletes.
Fact. The protein requirement of the adult depends on the body size and not on the amount of exercise.
2. Fallacy. Older people need less protein than young adults.
Fact. The need for replacing the protein of tissues continues throughout life. Older people need the same amount of protein as the young adult of the same body size.
3. Fallacy. Gelatin is an excellent source of protein.
Fact. Dry gelatin is about 90 per cent protein, but the average gelatin dessert would furnish about 2 gm protein. Gelatin lacks some of the essential amino acids; as a sole source of protein it cannot maintain life or support growth.
4. Fallacy. Protein foods should not be eaten in the same meal as starches.
Fact. There is no reason to separate protein foods and starches. In fact, many common foods contain both protein and carbohydrate. The digestive tract efficiently digests protein, carbohydrate, and fat components of the diet at the same time. Each meal should contain one fourth to one third of the day’s protein so that the amino acids will be most efficiently used for tissue synthesis.
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