malnutrition

Question 1

Marasmus

Answer 1

Severe wasting of fat and muscle mass, due primarily to energy deficiency; slower onset, better adaptation. it is most equivalent to “simple” starvation

Question 2

Kwashiorkor

Answer 2

edematous Protein energy malnutrition, without wasting and classically attributed to “protein deficiency”; rapid onset, mal-adaptation. now clearly related to metabolic stress & inflammation

Question 3

Marasmic kwashiorkor

Answer 3

combination of chronic energy deficiency and chronic or acute protein deficit, and is manifested clinically with evidence of both wasting and edema.

Question 4

starvation

Answer 4

pure caloric deficiency- organism adapts to conserve lean body mass and increase fat metabolism

Question 5

Cachexia

Answer 5

associated with inflammatory or neoplastic conditions. Not reversed by feeding

Question 6

Sarcopenia

Answer 6

subnormal amount of skeletal muscle w/out weight loss

Question 7

social/economic causes of malnutrition

Answer 7

poverty, ignorance, inadequate breastfeeding and weaning practices

Question 8

biologic causes of malnutrition

Answer 8

maternal malnutrition (low birthweight infants), infectious diseases

Question 9

environmental causes of malnutrition

Answer 9

Overcrowded &/or unsanitary living conditions, agricultural patterns, droughts, floods, wars

Question 10

failure to thrive

Answer 10

mild protein energy malnutrition

Question 11

Malnutrition in hospitalized patients

Answer 11

Malnutrition secondary to chronic disease or to the acute effects of surgery, trauma, sepsis, etc. is estimated to occur in up to 50% of hospitalized patients.

Question 12

Who is most at risk for PEM

Answer 12

infants, acute weight loss, chronic illness, elderly

Question 13

What type of malnutrition is most common in 0-12 month olds

Answer 13

marasmus/severe wasting most common form of PEM, but stunting also very common, and often starts during first year of life

Question 14

What type of malnutrition is most common in 12-24 month olds

Answer 14

kwashiorkor/edematous PEM more common

Question 15

What type of malnutrition is most common in older children

Answer 15

stunting common; typically degree of wasting is milder;

Question 16

What type of malnutrition is most common in pregnant/lactating women

Answer 16

w/ PEM, effects primarily on fetus, neonates, and infants

Question 17

Malnutrition in elderly

Answer 17

tend to suffer from PEM

Question 18

Which groups have lowest rates of PEM

Answer 18

adolescents, adult men and non-pregnat/non lactating women

Question 19

What is wasting

Answer 19

decreased weight relative to length

Question 20

define severe vs mild wasting

Answer 20

severe : 65% IBW. Mild: 83% IBW

Question 21

compare clinical features of Marasmus vs kwashiorkor

Answer 21

marasmus: Mostly weight loss, loss of muscle, loss of fat, diarrhea. NO edema, hepatomegaly or skin lesions. Kwashiorkor: Mostly edema, psychological impairment, anorexia, infections, diarrhea, and hepatomegaly

Question 22

Pathophys of marasmus

Answer 22

Normal response to starvation. Muscle: utilize triglycerides and fatty acids. Brain: increase ketone utilization, decrease glucose. Liver: decrease gluconeogenesis. Muscle: decrease protein degradation. Liver/kideny: decrease urea production and excretion. Result: utilize fat stores, minimize muscle wasting, decrease basal metabolic rate

Question 23

Endocrine changes in response to starvation

Answer 23

decrease insulin, decrease thyroid, increase epi and corticosteroids.

Question 24

How does blood sugar change with starvation

Answer 24

it stays in normal range due to gluconeogensis

Question 25

How does GI tract change with starvation

Answer 25

mucosal atrophy, decreased secretions, decreased motility

Question 26

how does Heart change with starvation

Answer 26

myocardial atrophy, decreased cardiac output

Question 27

Pathophys of kwashiorkor

Answer 27

abnormal adaptive response to protein deficiency. Hypoalbuminemia, edema, increased insulin, decreased lipolysis, increased hepatic fatty acid synthesis (enlarged liver). Erythematous hyperpigmentation, and dry brittle depigmented hair (flag sign)

Question 28

Treatment of severe PEM

Answer 28

Especially for kwashiorkor- go slowly. Resolve infections, restore nutritional status w/out abruptly disrupting homeostasis.

Question 29

Refeeding syndrome

Answer 29

Broad range of metabolic consequences occurring due to rapid reinstitution of nutrients (& energy/substrate) in pt w/ PEM; can result in sudden death

Question 30

Pathophys of refeeding syndrome

Answer 30

Going from catabolic to anabolic state results in fluid shifts and heart failure. Requires E, nutrients, enzymes. K, P, Mg and thiamine often get deranged

Question 31

potassium in refeeding syndrome

Answer 31

Increased insulin secretion in response to feeding results in intracellular glucose and K, leading to decreased serum K and altered nerve/muscle function

Question 32

Phosphorus in refeedig syndrome

Answer 32

Increased insulin secretion leads to intracellular P and phosphorylated intermediates, such as glucose. Decreased serum P causes altered nerve and muscle function

Question 33

Mg in refeeding syndrome

Answer 33

increased requirement with increased metabolic rate (co Factor for ATPase)

Question 34

Thiamine in refeeding syndrome

Answer 34

rapid depletion due to being a co factor in glycolysis leads to cardiomyopathy +/- encephalopathy