Protein Calorie Undernutrition

Question 1

General information

Answer 1

Common in children in poor countries. Malnourishment is considered when weight is below 80% of normal. Malnutrition manifests as a range of clinical syndromes. The two ends of the spectrum of syndromes are known as Marasmus and Kwashiorkor.

Question 2

Marasmus

Answer 2

Weight falls below 60% of normal for the specific sex, age and height.
Growth retardation.
Somatic protein compartment depletion, loss of muscle mass.
Subcutaneous fat mobilization, leptin low, cortisol high
Adaptive responses to provide the body with amino acids and fat as fuel, preserving the visceral protein compartment: serum albumin is normal or slightly decreased
Emaciated extremities; head looks too big for body
Anemia and multivitamin deficiency
Immune deficiency

Question 3

Kwashiorkor

Answer 3

Most common in Africa. Seen in children whose mother stopped breast feeding too early and has been given an almost exclusive carbohydrate diet.

Visceral protein compartment deprivation - hypoalbuminemia and thus edema
Weight of the children is between 60-80% of normal, it can be masked due to the edema
Skin lesions with alternating areas of hyper and hypopigmentation
Fatty and enlarged liver
Apathy and loss of appetite
vitamine deficiencies
Immune deficiencies
Kwashiorkor can be seen in less severe forms in patients with chronic diarrheal diseases

Question 4

Malnutrition associated with chronically ill patients

Answer 4

Cachexia. Often develops in patients with cancer as tumors may secrete proteolysis-inducing factors and lead to host responses such as producing cytokines and TNF. All this leads to stimulation of degradation of skeletal muscle proteins and mobilization of fatty storages. Loss of appetite also follows.

Question 5

Diagnosis of undernutrition

Answer 5

It is obvious in severe forms
In milder to moderate forms:
BMI, fat stores (measured skin fold thickness - if reduced it means fat loss), muscle mass measurements - circumference of mid arm - if reduced it means a loss if muscle mass, serum proteins (albumin and transferritin) -

Question 6

Treatment

Answer 6

Food

treatment of the underlying disorder