Nutritional Disirders In Adolescence And Childhood Flashcards
What is nutrition?
The intake of food necessary for the body’s dietary needs especially in growing children and adolescents.
• Good health is a combination of a well-balanced diet and regular physical activity.
Explain the effect of nutrition in children
• Strong hair : Protein, Vitamin D and Omega -3 fatty acids
• Beneficial for vision: Omega- 3 fatty acids, Lutein, zinc and vitamin C
and E
- Maintain healthy muscle mass: Protein, cholesterol, zinc, B vitamins and iron
- Protect against free radicals: Antioxidants such as beta- carotene and vitamins C, E and A
- Protects the skin from the effects of toxins: Omega- 3 fatty acids
- Build and maintain strong bones and teeth: Calcium
- Beneficial for the digestive system: Fiber, fruits and vegetables
What are the nutritional challenges in childhood?
Feeding development and behavioral:
• Self-feeding : toddlers play with food
• Picky eaters : resistant to trying new foods
• Food Restriction because of body image in adolescence • Overindulgence in Fast food
Socio-economical and pathological(Secondary)
• Eating environment: Meals without distractions
• Low economic status or orphaned/ homeless children • Diabetes, Cystic Fibrosis or Malabsorption Syndrome
Malnutrition may result from…
Undernutrition
– Insufficient intake of food
or of certain nutrients
– inability of the body to
absorb and use nutrients
Over nutrition
Overconsumption of certain foods
Whaat are the clinical effects of malnutrition?
Psychology- depression & apathy
Immunity-increased risk of infection
Decreased cardiac output
Loss of strength
Hypothermia
Renal function-loss of ability to excrete Na & H2O
Anorexia
Impaired gut integrity and immunity
Impaired wound healing
Liver fatty change, functional decline necrosis, fibrosis
Ventilation-loss of muscle & hypoxic responses
What is the viscous cycle of immunity and malnutrition?
Malnutrition impairs the development and function of the immune system. This leads to suboptimal immune responses that are also associated with a generalized increase in inflammatory mediators.
- A deficient immune system can contribute to the tissue damage by enteric infection and it also impairs tissue repair mechanisms so that infections tend to be more severe and of longer duration.
- Deficiencies of vitamin A and zinc are associated with persistent diarrhea which compromises the intestinal lining which leads to recurrent infection.
What are the most common types of wasting & stunting?
WASTING
The acute loss of weight, or failure to gain weight at the expected rate, resulting in a condition of reduced weight for height
STUNTING
The child is short for his age
Commonly seen in chronic malnutrition
What is cachexia?
is a hypercatabolic state and a chronic inflammatory response
which leads to illness-induced loss of body weight in an individual who
has access to food and is not trying to loose weight.
What are the causes of cachexia?
Causes:
- Cancer
- Infection
- Immunodeficiency
- COPD
- Rheumatoid Arthritis
In contrast to simple starvation, which is characterized by a caloric deficiency that can be reversed with appropriate feeding, cachexia is not reversed by the supplementation
of calories.
What is Protein energy malnutrition?
Protein-energy malnutrition (PEM), also called protein-energy undernutrition (PEU), is a result of energy deficit due to deficiency of macronutrients. It commonly includes deficiencies of some micronutrients.
PEM can be subdivided into?
PEM can be subdivided into:
• Marasmus
• Kwashiorkor
-Marasmic-kwashiorkor.
What are the symptoms of Marasmus (wasting syndrome)?
- Low weight for height
- Wasting of muscle mass leading to decrease mid-upper arm circumference (MUAC)
- Depletion of body fat stores
- Malnutrition without edema
- Gradual onset (months to years)
- Low Calorie intake
Explain the biochemistry of Marasmus
Low protein-caloric intake leads to adequate response of adrenal cortex
- Causes muscle breakdown, protein used for substrate for gluconeogenesis, releases glucose for brain and RBC
- Increases cortisol in plasma, this leads to low fat storage and both of these contribute to normal free fatty acid and allows no fat deposits in liver
- Decrease in insulin-like growth hormone causing growth retardation
How can an adaptation be seen in children for Marasmus?
Children adapt to energy deficiency with:
• decrease in physical activity,
• lethargy,
• decrease in basal energy metabolism, slowing of growth, and finally weight loss.
The overall metabolic adaptations that occur during marasmus are similar to those in starvation.
What is Kwashikor (Edematous malnutrition)?
- Significant protein deprivation despite of adequate energy intake
- Affects mainly children
- Symmetrical Peripheral Pitting Edema
- Thin, dry, peeling skin with areas of hyperkeratosis and hyperpigmentation • Dry, dull, hypopigmented hair which often leads to hair loss.
- Distended abdomen with dilated bowels
- Bradycardia, Hypotension and Hypothermia
Give a general between difference kwashikor and Marasmus
Kwashikor- irritable when picked up, apathetic when left alone
Appetite is poor
Marasmus- alert and irritable
-appaetite is good
What is Marasmus-Kwashikor?
This severe protein-calorie malnutrition is characterized by:
• extreme weight loss (wasting)
• weakness, and
• bilateral pitting edema
How is PEM managed?
First step:
• correct fluid and electrolyte abnormalities
• K+ Ca2+ Mg2+ PO43-
Second step:
• supply macronutrients by dietary therapy.
• Milk-based formula
Step-wise approach is important during correction to prevent a serious complication known as REFEEDING syndrome
What is Anorexia Nervosa?
• Eating Disorder
- Diagnosis requires the following criteria:
- Restriction of energy intake that leads to a low BMI < 18.5
- Fear of gaining weight/ persistent behavior to avoid weight gain • Distorted perception of body weight and shape
- Two Subtypes
- Restricting food intake
- Binge eating and Purgin
What are the causes of anorexia nervosa?
The cause of anorexia nervosa is unknown. However, it is believed that the following may play a role:
– Social attitudes toward body appearance – Family influences – Genetics – Brain chemical imbalances – Developmental issues
What is overnutrition?
Obesity
- Obesity refers to an excess of fat.
- Obesity is assessed by the BMI. BMI > 95th percentile for age and sex is considered obese for children between 2- 20 yrs.
- The prevalence of childhood and adolescent obesity has increased rapidly worldwide.
- The increasing prevalence of childhood obesity is related to a complex combination of socioeconomic, genetic, and biological factors
What is obesogenic environment?
• Risk factors in the home environment
offer targets for intervention:
– Consumption of sugar-sweetened beverages.
– Lack of family meals, large portion sizes and foods prepared outside the home.
- Television viewing and video gaming.
- Poor sleep, and lack of activity.
What are the considerations in the management of Obesity?
Should follow a “staged approach”
- Severity of overweight and age of the child
- Readiness of the family to implement changes
- Weight preferences of the parents and child and weight management goals
- Skills of the health care provider (Pediatrician and Nutritionist)
Contrast height and weight of Kwashikor(edematous malnutrition) and Marasmus
Marasmus-Low weight for height (wasting). Low height for age (stunting), if also chronically malnourished
Kwashikor-Weight for age is variable.
Low height for age (stunting) if also chronically malnourished
Contrast the head of Marasmus and Kwashikor
Marasmus- Appears large relative to body, with staring eyes.
Kwashikor- Moon face (rounded prominence of the cheeks), with or without facial edema. May appear plump.
Contrast the extremities of Marasmus and Kwashikor
Marasmus-Emaciated arms, thighs, and buttocks, with loose folds due to loss of subcutaneous fat.
Kwashikor-
• Edema:
• Mild (1+): involves only the feet
• Moderate (2+): involves feet, legs, and upper
limbs
• Severe (3+): either generalized edema or
moderate plus facial edema
Contrast the behavior in Marasmus and Kwashikor
Marasmus- Typically irritable, fretful
Kwashikor- Typically apathetic, listless; may be irritable when handled.
How does Kwashikor affect the abdomen?
Distended, dilated intestinal loops; hepatomegaly
How does skin contrast in Marasmus and Kwashikor?
Marasmus-Thin, dry skin.
Kwashikor- Thin, dry and peeling skin, with areas of hyperkeratosis and hyperpigmentation (dermatosis of kwashiorkor).
How does hair contrast Marasmus and Kwashikor?
Marasmus-Thin, sparse hair that is easily plucked
Kwashikor-Dry, dull and hypopigmented hair, which falls out or is easily plucked. Hypopigmentation may occur in stripes if malnutrition has been intermittent (“flag sign”).
What are the consequences of calcium?
limited calcium intake or in patients with
steatorrhea
Features: osteopenia, rickets
Where can calcium be found?
found in dairy products, legumes,
broccoli, green leafy vegetables.
Where can Phosphorus be found?
meats, eggs, dairy products, grains, legumes, and nuts; high in processed
foods and sodas.
What are the consequences of phosphorus?
seen in
patients with protein- energy malnutrition.
Features: Muscle weakness, bone pain, rhabdomyolysis, osteomalacia, and respiratory insufficiency
Where can magnesium be found?
Magnesium :
Vegetables, cereals, nuts
What are the consequences of magnesium deficiency?
Malabsorption, or magnesium wasting medications may lead to depletion.
Features: Neuromuscular excitability, neurologic abnormalities, ECG changes
Where can potassium be found?
Nuts, whole grains, meats, fish,
beans, fruits and vegetables, especially bananas, orange juice.
What are the consequences of potassium?
Occurs in protein-energy malnutrition and can cause cardiac
failure and sudden death.
Features: Muscle weakness, mental confusion,
arrhythmias.
Where can zinc be found?
Human milk, meats, shellfish, legumes, nuts, and whole- grain cereal
What are the consequences of zinc deficiencies?
Usually due to malabsorbtive diseases and also common in PEM.
Features:Increased susceptibility to infection; acro-orificial skin rash, diarrhea, alopecia
Where can selenium be found?
Seafood, meats, garlic, mushrooms
What are the consequences of selenium?
Inadequate dietary intake, Renal disease.
Features:Muscle pain and tenderness, macrocytosis, loss of hair pigment. cardiomyopathy in infants and children
Where can iodine be found?
Iodized salt
What are the deficiencies of iodine?
Inadequate dietary intake.
Features: Intellectual disability, deaf mutism, spastic diplegia, and strabismus
