Protein Energy Malnutrition

Question 1

What is Protein Energy Malnutrition?

Answer 1

Pathologic conditions resulting from lack of protein and/or energy (cal).

Question 2

List the different classification systems of PEM.

Answer 2

Clinical classification – Wellcome and modified wellcome

Community survey – Gomez, Jelliffe, Waterlow, Seoane & Latham

Question 3

What are the anthropometric indicators of nutritional health?

Answer 3

Weight for age
Weight for height
Height for age

Question 4

What classifications are based on weight for age index?

Answer 4

Wellcome
Modified Wellcome
Gomez
Jelliffe

Question 5

Waterlow’s classification is based on?

Answer 5

Weight for age

Height for age

Question 6

What classification is based on all 3 anthropometric indicators?

Answer 6

Seoane and Latham classification

Question 7

List etiologic causes of PEM?

Answer 7

Diet (inadequate food intake)
Childhood infectious diseases
Inadequate social and medical care in the household and community.

Question 8

What are the severe forms of PEM?

Answer 8

Kwashiokor
Marasmus
Marasmic kwashiokor

Question 9

Kwashiokor … define? Peak age? What type of adaptation?

Answer 9

There is protein def with relatively adequate calories
12 to 36 months (1-3 years)
MALADAPTION to nutritional stress

Question 10

Marasmus… define? Peak age? Adaptation?

Answer 10

Calories def with relatively adequate protein.
6 to 12 months
SUCCESSFUL ADAPTATION to nutritional stress.

Question 11

What are the MAIN clinical features of kwashiokor?

Answer 11

Growth retardation
Oedema (starts with feet, no asso effusions)
Muscle wasting
Apathetic (mental changes)

Question 12

List other clinical features of kwashiokor.

Answer 12

Anorexia/poor appetite 
Diarrhea
Flaky paint dermatosis
Flag sign
Hepatomegaly (fatty deposition)
Abdominal distension 
Signs of micronutrient def

Question 13

Reason for oedema of kwashiokor?

Answer 13

Hypoalbuminemia
Dec cortisol
Inc Growth hormone
…..leads to impaired hepatic function

Question 14

Reason for abdominal distension?

Answer 14

Flatulence
Flaccid abdominal muscles
(Ascites is uncommon)

Question 15

What is flag sign?

Answer 15

Seen in kwashiokor. Alternating horizontal band of hypopigmentation (a band perpendicular to its long axis).
Also, hair is dry, sparse, weak, easily pulled out and lustreless.

Question 16

List clinical features of marasmus.

Answer 16

Growth retardation 
Muscle wasting 
Prominent ribs and bones
Wrinkled skin
.....due to depleted subcut fat
Intact appetite 
Mentally alert
Irritability (crying cuz of hunger)
Anemia
Signs of micronutrient def

Question 17

What are the complications of PEM?

Answer 17

Infections (gastroenteritis, resp infx)
Hypoglycemia  (mainly marasmus)
Hypothermia
Cardiac failure (iatrogenic, anemic)
Anemia (protein, Fe, folate def)
Electrolyte derangement (dec K+)

Question 18

Tool for measuring MUAC?

Answer 18

Shakir tape
In 1- 5 year olds
Well-nourished (green) - > 13.5cm
Borderline (yellow) –12.5–13.5cm
Severe malnutrition (red) - < 12.5cm

Question 19

Criteria for Moderate acute malnutrition?

Answer 19

Weight for height blw:
70-80% or -3 to -2 SD
OR
MUAC 11.5 - 12.5cm

Question 20

Criteria for Severe acute malnutrition?

Answer 20

Weight for height:
          <70%  or  < -3 SD
        OR
MUAC <11.5cm
        OR
Presence of grade 2 oedema