malnutrition Flashcards
define malnutrition
malnutrition is the cellular inbalance between the supply of nutrients and energy and the body’s demand for them to ensure growth, maintenance and specific functions.
The greatest risk of under-nutrition occurs in the first ……. days of life
why?
1000
because brain development hapens in this time
CAUSES OF UNDER-NUTRITION
Nutritional status is determined by three factors:
o Immediate cause: act on the individual, these are inadequate food intake and infection with their vicious cycle.
o Underlying cause: influence the households and the community; these
are drought, flooding, household food insecurity…
o Basic cause: influence communities and society these include the
country’s economy and political status.
ASSESSMENT OF NUTRITION by what
We can use the ABCDs to assess nutritional status of an individual;
Anthropometry, Biochemistry, Clinical, Dietary.
- There are two ways of classifying malnutrition; these are
community survey
and clinical.
COMMUNITY SURVEY CLASSIFICATION OF MALNUTRITION
Gomez underweight weight for age
mild moderate sever
waterlow wasting weight for height
mild severe
waterlow stunting height for age
mild moderate severe
who wasting weight for height
-2 -3 moderate
< -3 severe
who stunting height for age
-2 -3 moderate
<-3 sd severe
clinical classification
-Marasmus: severe wasting; severe weight loss and muscle mass leaving ‘skin
and bones.
* Kwashiorkor: characterized by edema (nutritional edema) that is a clinical
indicator for SAM.
* Marasmic-kwash: severe wasting + edema; combination of kwashiorkor and
marasmus.
- Severe Acute Malnutrition (SAM)
is severe wasting (MUAC<11.5cm for children aged 6-59monthes, weight for height<-3SD) and/or bilateral edema.
CLINICAL PRESENTATION
kwashiorkor and marasmic- kwashiorkor (edematous SAM) and
marasmus (non-edematous SAM)
reductive adaptation
The functions of different organs are preserved more in
non-edematous
SAM than edematous.
Age at presentations is 12-36 months for kwashiorkor. It usually occurs at the time of …………… because …………….
weaning, when the diet is suddenly changed to that of the adult diet, which is high in CHO but low in protein.
SYMPTOMS DIRECTLY RESULTING FROM UNDER-NUTRITION:
* KWASHAKOR
O Generalized body swelling staring from the legs.
O Loss of appetite, vomiting, diarrhea(mal-absorption), abdominal
distention
O Growth retardation and mental changes together with GBS are the three
essential features of kwashiorkor.
O Symptoms of anemia; vertigo, easy fatigability, light headiness, tinnitus,
pica (craving for non-edible matters; feature of iron deficiency)
For marasmus, age at presentation is usually…………………….and…………………….. and why
6-12 mo (“infantile marasmus”)
when the amount of breast milk is markedly reduced, or more frequently in those who are artificially fed.
* Marasmus is also seen in older children living on inadequate diets for prolonged periods. This is described as “late marasmus” and is similar to chronic
starvation in adults
MARASMUS
O Growth retardation; failure to gain weight is the earliest manifestation.
O Irritability, continuously crying b/c of hunger
O Good appetite, unlike kwashiorkor.
O Diarrhea and symptoms of micronutrient deficiencies are also present.
SYMPTOMS RESULTING FROM THE COMPLICATIONS OF UNDER-NUTRITION
infection
hypoglycemia
hypothermia
shock
dehydration
severe anemia
skin lesions
CHF
Corneal ulceration
Electrolyte imbalance
4 factors that contribute
malabsorbtion
icreased demand
reduced intake
physical findings * G/A
moon face and apathy (kwashiorkor), simian face (marasmus, visible
wasting
phsyical findings VS
o BP; hypotension b/c shock is one complication,
o PR; bradycardia or tachycardia,
o RR; tachypnea b/c of pneumonia,
o T◦; fever T◦≥37.5◦c (for axillary) due to infection or hypothermia T◦<35◦c
(for axillary) b/c low energy for heat production.
Anthropometry: wt, ht/length for <2yrs
o BMI: < -2SD (thinness), b/n +1SD and +2SD (overweight) and >+2SD
(obesity).
o WFH/WFL: is an indicator of acute malnutrition ;( see WHO
classification)
o WFA: easy to measure but doesn’t differentiate b/n stunting and
wasting. (See Gomez classification)
o HFA/LFA: is a measure of linear growth, deficit represents the
cumulative impact of adverse events, usually in the first 1,000 days from
conception (critical period for child growth) which shows stunting. (See
WHO classification)
o MUAC: for community level screening
physical findings in heent
Head: craniotabes, frontal bossing, delayed fontanel closure (vit D)
Eyes: dry eyes, pale conjunctiva, icteric sclera, periorbital edema
(kwashiorkor), broom stick eyelashes
▪ Sunken eye balls (marasmus)
Bitot spot, xeropthalmia or keratomalacia
o Ear: signs of otitis media, tragus and ante-tragus tenderness.
o Nose: bleeding nasal mucosa,
o Mouth and throat: dry oral mucosa and oral trash, angular cheilosis,glotitis (Vit B2), spongy bleeding gums (vitamin C), parotid enlargement, enamel mottling, delayed eruption (Vit D)
▪ Sunken eye balls (marasmus) because of what
due to atrophy of retro-orbital
tissue also seen in dehydration b/c vasoconstrictions of orbital
Veinous plexus.
bitots spot , xeropthalmia , keratomalacia because of
vit a
LGS
There may be a Significant LAP: may be present b/c infection.
▪ NB: lymphatic organs; thymus, spleen, LN, atrophy in SAM
patients
respiratory system
o visible wasting, costo-chondral bead (Vit C; sharp and vit D dull),
Harrison’s groove and signs of pneumonia.