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Journal of Tropical Pediatrics 1988 34(5):238-243; doi:10.1093/tropej/34.5.238
© 1988 by Oxford University Press
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Skeletal Muscle Changes in Protein Energy Malnutrition

M. M. A. Faridi, MD, DCH, Z. Ansari, MD, DCH(Lond), DRCOG(Eng) and S. P. Tyagi, MD, MRCP(Path)*

Departments of Paediatrics, J.N. Medical College A.M.U. Aligarh
* Departments of Paediatrics and * Pathology, J.N. Medical College A.M.U. Aligarh

Skeletal muscle changes in PEM were studied in 70 children of both sexes below the age of 6 years. Fifty children were suffering from PEM of which 64 per cent were severely malnourished weighing >>60 per cent of the reference weight for age. Twenty healthy children served as controls. The skeletal muscles were clinically assessed in all children. Then a histopathological study of the calf muscle was done in all the malnourished and four healthy children by standard methods. The flabbiness of the muscles was the earliest clinical manifestation followed by hypotonia. In extremely malnourished cases on the other hand, stiffness of the muscles was the prominent finding.

Histopathological study revealed thinning of the muscle fibres, loss of sarcoplasm, and cross-striations leading to myotube or Sarcolemmal tube formation. The latter change was found in 75–90 per cent cases and was maximum in grade III PEM. The attenuated muscle fibres were found only in early malnutrition (subgroup A) whereas fatty degeneration of the muscle fibres was confined to moderate to severely malnourished cases (subgroup B). In chronic and severely affected cases significant fibrotk changes (P >> 0.05) were also found in comparison to subgroup A. The shape and size of the subsarcolemmal nuclei were preserved, but their peripheral position was altered in a majority of the cases which can be described as ‘no definite pattern of nuclear arrangement’. There was no pericapillary infiltration by lymphocytes, but we have, for the first time, observed perivascular oedema and hyalinization of the vessel wall in 5 per cent to 10 per cent of cases. These changes were inversely proportional to the severity of PEM.

The size of the nerves and muscle spindles were normal in both malnourished and control cases.


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