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Malnutrition Protein / Energy.

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Presentation on theme: "Malnutrition Protein / Energy."— Presentation transcript:

1 Malnutrition Protein / Energy

2 Definitions of Malnutrition
Kwashiorkor: protein deficiency Marasmus: energy deficiency Marasmic/ Kwashiorkor: combination of chronic energy deficiency and chronic or acute protein deficiency Failure to thrive: marasmus in U. S. children under 3.

3 Definitions of Malnutrition
PEM Primary: inadequate food intake Secondary: result of disease FTT In-organic: inadequate food intake Organic: result of disease

4 History Marasmus well known for centuries Kwashiorkor: Cicely Williams
Ga tribe in Ghana “the sickness the older child gets when the next baby is born” Starch edema, sugar babies Similar but different diseases

5 How many? 36% of children in the world are underweight 43% stunted
9% wasted Better nutrition, but more children in high risk areas, yields more children affected.

6 Causes Social and Economic Poverty Ignorance
Inadequate weaning practices Child abuse Cultural and social practices Vegan Low fat diets

7 Biologic factors Maternal malnutrition, prematurity Infectious disease
Start life with poor stores Infectious disease Diarrhea, Aids, TB, measles Environmental Unsanitary living, poor quality water Agricultural/cultural patterns Droughts, floods, wars, forced migrations

8 Age of child Infants and young children Marasmus < 1 year
High nutritional needs Early weaning or late weaning Poor hygiene Marasmus < 1 year Kwashiorkor >18 months with starchy weaning foods

9 Pathophysiology Develops slowly, adapts to decreased intake
Marasmus Less fragile metabolic equilibrium Less effective adaption or acute problem Kwashiorkor, mixed

10 Energy Decreased intake yields decreased activity
Decreased play and physical activity Mobilization of body fat, weight loss, Subcutaneous fat Muscle wasting Maintains visceral protein in marasmus Nl albumin Larger protein deficit leads to faster visceral protein falls and edema.

11 Biologic differences Marasmus Kwashiorkor Weight loss
Nl or low protein Boarderline hgb, hct NL AA profile Nl blood glucose Nl enzymes Nl transaminase Kwashiorkor NO weight loss High extracellular water Low hgb, hct Low protein Elevated AA profile Low enzymes High transaminase

12 Pathophysiology Cardiac Immune system Cytokines (glycoproteins)
Output, heart rate and blood pressure decrease Postural hypotension Immune system T lymphocytes and complement decreased Susceptible to bacterial infection Cytokines (glycoproteins) Poor immune response TNF inc leading to anorexia, muscle wasting and lipid changes

13 Pathophysiology Decreased total body potassium GI function
Not electrolytes, but problem in rehabilitation GI function Poor absorption of lipids, and sugars Decreased enzyme and bile production Increase incidence of diarrhea, and bacterial overgrowth

14 Pathophysiology CNS Parental adaptation
Decreased brain growth and myelnation Electrical changes similar to dylexia Parental adaptation Increased breastfeeding Altered expectations

15 Diagnosis Anthropometry 4 groups Acute: Wasting: low weight for height
Chronic: Stunted: low height for age 4 groups Normal Wasted not stunted: acute PEM Wasted and stunted: acute and chronic PEM Stunted not wasted: past PEM, nutritional dwarfs

16 Diagnosis Normal: ± 1 SD Mild: -1.1 to -2 SD Moderate -2.1 to -3 SD
Severe greater than -3 Less than 5th percentile in US BMI in adolescents Moderate <15 ages 11-13, <16.5 ages 14-17 Severe <13 ages 11-13, <14.5 ages 14-17

17 Diagnosis Mild to moderate Marasmus
Weight loss if acute, decreased growth velocity of chronic Decreased activity Marasmus Skin and bones, thin hair, monkey face Hypoglycemia, hypothermia

18 Diagnosis Kwashiorkor Soft pitting edema, starting in feet and legs
Skin lesions Skin dry, with hyperkeratosis and hyperpigmentation Preserved fat layer, small weight deficit, ht may be normal Dry brittle hair Anorexia, with vomiting and diarrhea

19 Diagnosis Mixed Edema, with or without skin lesions
Muscle wasting and loss of subcutaneous fat

20 Treatment Acute/ life threatening Fluid and electrolyte
K and Mg shifts Oral rehydration, slowly ml/kg Infections: main cause of death Aggressive treatment, but disease alters metabolism of drugs Other deficiencies Anemia and heart failure, care with transfusions and no diurretics Vitamin A: immediate treatment

21 Treatment Slow re-feeding Nutritional rehabilitation
Small frequent feeding around the clock Patient encouragement of food Nutritional rehabilitation Play and teaching controlinfections

22 Recovery? At home Reach weight for height and replete muscle mass
Normal is 25-75% weight for height and continue for one months after Treat other deficiencies Family problems Who does this include here? Tube feeding. Disabilities FTT

23 What does it mean? Poverty Brain development
Correlation of income, wt, ht and hgb in US What is wealth? Importance of food choice Brain development Iron deficiency: neuro transmitters Brain waves:

24 What does it mean? Learning: Difference in treatment by parents
Duration of breastfeeding Expectations Long term effects INCAP two villages, one protein and one calorie At 18 protein supplemented group had higher performance scores irrespective of educational exposure. They had taught themselves.

25 What does it mean? Learning: Difference in treatment by parents
Duration of breastfeeding Expectations Slums of Kingston, Jamaica Educational intervention, early rise plateau Nutritional intervention, late rise Additive effect Education lasts, not nutrition, but high IQ mom’s and nutrition group did as well as education.

26 Implications Children learn by interacting with the environment
Poverty: limited environment Malnutrition: limited interaction Additive effect! Loss to society of human potential Lead graph

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