Malnutrition

Question 1

The TRUMP?

Answer 1

Energy requirements

Question 2

Categories of PEM (protein energy malnutrition)

Answer 2

Marasmus - slow onset, severe wasting, due to energy defic

Kwashiorkor - edematous PEM, w/o wasting, protein defic, rapid onset

Question 3

Other forms of PEM

Answer 3

Starvation: pure caloric defic
Cachexia: accos with infl and neoplasia NOT reversed by feeding (assoc with anorexia)
Sarcopenia: subnormal amount of skel musc (w/o weight loss)

Question 4

More common? Stunting or wasting?

Answer 4

Stunting! 26% to 8%

20% of world’s children are underweight

Question 5

Causes

Answer 5

Social and economic (poverty, ignorance, diet etc.)
Biologic
Environmental

Question 6

Who is at risk?

Answer 6

Infants

Question 7

Underweight (SD below median)

Answer 7

> 2 SD below median (50th%)

Question 8

Stunting?

Answer 8

Short for age aka chronic malnutrition
BUT they don't grow taller if you feed them
Normal 50th% 95-105% of MEDIAN
Mild 90-94% of MEDIAN
Mod 85-89%
Sever

Question 9

Wasting?

Answer 9

BMI equivalent, decrease in weight relative to length
90-110 normal (% of median)
80-89 mild (Failure to Thrive)
75-79 mod

Question 10

Metabolic response to starvation

Answer 10

blood sugar remains in normal range, incr in ketone bodies, increase in fatty acids

Question 11

Marasmus effect on organs

Answer 11

NORMAL STARVATION RESPONSE
Muscles: incr TG use, decr in protein degrad
Brain: incr ketone use (decr glucose)
Liver: decr gluconeogenesis
Liver/kidney: decr urea production and excretion
UTILIZATION OF FAT STORES, MINIMIZE MUSCLE WASTING AND DECREASE BASAL METABOLIC RATE
so hypothermia, hypotension, bradycardia
decr insulin, thyroid, physical activity, cardiac output, secretion in GI etc.

Question 12

Kwashiorkor - signs?

Answer 12

HYPERALBUMINEMIA & EDEMA
NOT a normal adapteive resposne to starvation
High insulin so decreased lipolysis
HEPATOMEGALY massive
Erythema (flaky paint) hyperpigmentation - LOOKS like PELLEGRA
“Flag sign”

Question 13

Marasmus vs Kwashiorkor

Answer 13

Marasmus: weight loss, loss of muscle and fat, maybe some psych changes
Kwashiorkor: edema (so less weight loss), psych changes, anorexia, hepatomegaly

Question 14

Treatment

Answer 14

GO SLOWLY!
Resolve life threats (eg infx)
Restore nutritional status without abruptly disturpting homeostasis

Question 15

Refeeding syndrome

Answer 15

common derangements: K down, P down, Mg, Thiamine
Happens with rapid reinstatement of nutrients
Resolution of edema before full feedings