Malnutrition

Question 1

Environmental Factors leading to malnutrition

Answer 1

Inadequate food intake, environmental dangers, social inequality, disease, maternal factors, gender issues, other (dysbiosis and inflammation)

Question 2

Clinical Findings of Malnutrition:

Answer 2

History:
- poor weight gain, low linear growth
- irritability, apathy, decreased social responsiveness, anxiety, attention deficient, learning disability, behavioral disorders, decreased IQ
- impaired healing, immune dysfunction
- related to micronutrient deficiency: iron, iodine, vitamin D, vitamin A, folate, zinc

Question 3

Malnutrition: Physical Exam findings

Answer 3

General: decreased subcutaneous tissues in elgs, arm, buttocks, face, muscle loss, edema, anasarca
Eyes: pallor, xerophthalmia, bitot’s spots
Neck: goiter
Mouth: cheilosis, angular stomatitis, glossitis, pallor and papillary atrophy
ABD: distension due to HSM From fatty infiltration and decreased tone of abdominal wall
Skin: pallor, dry peeling skin with raw exposed areas, hyperpigmented plaques over areas of trauma.
Nails: fissured or ridged nails, flat nails.
Hair: thin sparse brittle hair, easily pulled out, turns a dull brown or reddish color, flag sign

Question 4

Lab findings:

Answer 4

Hematology, Protein status, retinol binding protein,

Question 5

Malnutrition treatment

Answer 5

evaluate status, edema may mask severity of underlying malnutrition.
assess and treat macronutrient and micronutrient deficiencies

Question 6

treatment of refeeding

Answer 6

increase calories slowly: 10-20% of calories a day based on electrolytes

Question 7

metabolic adaptation to malnutrition

Answer 7

Acute malnutrition:
- increased use of body fat as fuel with depletion of fat stores first, glycogen stores depleted second.
- decreased use of glucose, decreased body nitrogen losses, decreased energy expenditure and PE.
cortisol increases insulin decreases. during protein deprivation skeletal muscle is lost

Question 8

Short term effects of malnutrition

Answer 8

• Weight loss
• Growth faltering
• Nutritional deficiency and consequences
• Malabsorption
• Increased susceptibility to infection
• Increased mortality

Question 9

Long term effects of malnutrition

Answer 9

• Do not achieve full growth potential
• Cognitive defects, poor school achievement
• Increased morbidity and mortality
• Central obesity, insulin resistance, metabolic syndrome in adulthood

Question 10

Effects of malnutrition on GI tract: Anatomic changes

Answer 10

reduced gastric acid, thinning of small intestinal mucosa, flattening/disappearance of the villi with relative sparing of the crypts, increased cellularity of the lamina propria; this results in impaired mucosal function, increased permeability, malabsorption (disaccharidase deficiency, fat malabsorption, SIBO, bile salt deconjugation)