WEEK 3: Assessing Nutrition & Hydration

Question 1

Outline the clinical effects of malnutrition.

Answer 1

*Compromised immunity resulting in increased risk of infection
*Decreased cardiac output
*Hypothermia
*Loss of strength
*Impaired renal function
*Anorexia
*Impaired gut integrity and immunity
*Impaired wound healing
*Loss of muscle and hypoxic responses
*Liver fatty change, functional decline necrosis, fibrosis

Question 2

What is anthropometry?

Answer 2

Anthropometry is the scientific study of the measurements and proportions of the human body.

Question 3

State the 6 Anthropometry measurements used to access nutrition and health.

Answer 3

*Weight-for-age
*Weight-for-height
*Height-for-age
*Mid-upper arm circumference
*Body mass index
*Headcircumference

Question 4

What does weight for age access?

What is underweight?

Answer 4

The weight for age index represents the weight of a child in relation to his or her age.

A precision scale is required for weight measurement

Underweight:
weight for age less than –2 standard deviations (SD) of the WHO Child Growth Standards median

Question 5

What elements can affect the weight when determining the index?

Answer 5

Consider the presence of dehydration and edema, which can alter the weight when determining the index.

Question 6

What does the weight for weight for height assess?

What is it used to diagnose?

What 2 instruments are used to take the measurements?

Answer 6

The weight for height index represents the weight of a child in relation to the height.

It reflects the current nutritional status of the child and is the index used to diagnose acute (wasting) or malnutrition.

It also requires a precision scale (weight) and a measuring board or tape (length/height)

Question 7

Define the following:
*Moderate acute malnutrition
*Severe acute malnutrition
*Overweight

Answer 7

Wasting:
Moderate acute malnutrition: weight for height between -3SD and –2 SD of the WHO Child Growth
Standards median

Severe acute malnutrition: less than -3 SD of the
WHO Child Growth Standards median

Overweight: weight for height > +2 SD of the WHO Child Growth Standards median

Question 8

What does Height/length for age assess?

What does it reflect?

Answer 8

The height for age index represents the height of a child in relation to his or her age.

This index reflects the nutritional history over time

Stunting: height for age less than –2 SD of the WHO Child Growth Standards median

Remember that height, however, is also strongly determined by genetic factors as well as mothers’ nutritional status

Question 9

What is stunting?

Answer 9

Stunting: height for age less than –2 SD of the WHO Child Growth Standards median

Question 10

What does Mid upper arm circumference (MUAC) give a measure of?

Where is it measured?

Children of what age group are assessed using the MUAC?

Answer 10

The MUAC gives a measure of the amount of fat and muscle in the upper arm.

It is measured with a standard tape on the left arm, midpoint between the shoulder and the tip of the elbow.

It is used in children 6 months to 5 years of age

For children from 10-18 years of age, MUAC is an unreliable method to identify malnutrition.

Question 11

State the formula for calculating BMI.

What age groups are assessed using BMI?

Answer 11

BMI is the weight in kilograms divided by the height in meters, squared (weight in kg/[height in m]2).

BMI reference tables are now available to be used in children and adolescents from 2 to 20 years old.

Question 12

State the BMI for the following.
*Underweight
*Normal
*Overweight
*Obese
-Class I
-Class II
-Class III

Answer 12

Underweight: BMI less than 18.5
Normal weight: BMI 18.5 to 24.9
Overweight: BMI 25 to 29.9
Obese: BMI 30 or greater

When considering obesity, it is often further classified into three classes:

Class I obesity: BMI 30 to 34.9
Class II obesity: BMI 35 to 39.9
Class III obesity: BMI 40 or greater

Question 13

Outline the markers for acute malnutrition.

Answer 13

1. Weight Loss:
   Rapid weight loss is a key indicator of acute malnutrition. It is often measured as a percentage of weight loss over a short period, commonly expressed as a loss of body weight greater than 5% within a month or 10% within six months.
2. Edema (Swelling):
   Edema, especially in the feet and lower limbs, is a classic sign of severe acute malnutrition. This condition is often referred to as kwashiorkor.
3. Wasting (Low Weight-for-Height):
   Wasting is characterized by a low weight-for-height ratio. It indicates recent and severe weight loss, typically resulting from acute food shortage or illness.
4. Mid Upper Arm Circumference (MUAC):
   MUAC is a practical and widely used marker for acute malnutrition. A measurement below a certain threshold (e.g., 11.5 cm for children) is indicative of severe acute malnutrition.
5. Reduced Muscle Mass:
   Acute malnutrition often leads to a visible reduction in muscle mass, contributing to wasting.

Question 14

Outline markers for chronic malnutrition.

Answer 14

1. Short Stature (Low Height-for-Age):
   Stunting is primarily identified by a low height-for-age ratio. This reflects long-term nutritional deprivation and impaired growth.
2. Delayed Developmental Milestones:
   Chronic malnutrition can impact cognitive and physical development, leading to delays in reaching developmental milestones.
3. Low Weight-for-Age:
   While weight-for-age is a marker for acute malnutrition, chronic malnutrition may also result in low weight-for-age, especially if the malnutrition is severe and prolonged.
4. Delayed Puberty:
   In adolescents, chronic malnutrition can lead to delayed onset of puberty and slower sexual maturation.
5. Reduced Cognitive Function:
   Chronic malnutrition can adversely affect cognitive function, leading to impaired learning and academic performance.
6. Poor Immune Function:
   Long-term malnutrition weakens the immune system, increasing susceptibility to infections and illnesses.

Question 15

State some of the symptoms of malnutrition a child can have.

Answer 15

*Thin body with reduced subcutaneous fat
*Distended belly
*Thin, yellow and sparse hair that falls off easily
*Dry scaly skin
*Puffy or moon face
*Oedema on ankles and feet
*Fatigue and weakness: Inadequate nutrition can lead to a lack of energy, making children lethargic and weak.

Question 16

What is dehydration?

What are the most common causes of dehydration?

Answer 16

A condition that results from excessive loss of body water.

Most common cause is vomiting and diarrhea (acute gastroenteritis)

Dehydration is a major cause of morbidity and a leading cause of mortality in infants and young children worldwide.

Question 17

The total body water (TBW) in humans is distributed in two major compartments.

State the body water TBW in the ECF and ICF.

The total body water is higher in infants and children as compared to the adults.

State the TBW % for the following:
*Infants
*Children
*Adults

Answer 17

2/3rd the of TBW is in the intracellular compartment and the other 1/3rd is distributed between interstitial space (75%) 3/4 and plasma (25%). 1/4

In infants, it is 70% of the total weight, whereas it is 65% and 60% respectively in children and adults.

Question 18

State signs and symptoms of dehydration.

Answer 18

*Crying without tears
*Sunken fontanelle
*Dry mucous membranes
*Delayed skin recoil
*Sunken eyes
*Low urine output
*Tachycardia
*Hypotension
*Low volume of pulses

Question 19

What is kwashiorkor?

Answer 19

Kwashiorkor is a severe form of malnutrition that primarily affects children. It is caused by a deficiency of protein in the diet, often in the presence of adequate or even excess calories from carbohydrates.

Kwashiorkor is most commonly observed in regions where there is a lack of access to a balanced and protein-rich diet, particularly in developing countries.

Question 20

State the etiology of kwashiorkor.

Answer 20

Protein Deficiency:
Kwashiorkor is primarily caused by a severe deficiency of protein in the diet, despite adequate caloric intake.
The lack of essential amino acids, which are the building blocks of proteins, leads to impaired growth and maintenance of body tissues.

Question 21

State the risk factors for kwashiorkor.

Answer 21

1. Malnutrition:

Kwashiorkor is most prevalent in areas where malnutrition is widespread, particularly in developing countries with limited access to a diverse and protein-rich diet.

2. Inadequate Weaning Practices:
   Early introduction of a protein-deficient diet, especially during the weaning period, increases the risk of kwashiorkor.
3. Food Insecurity:
   Lack of access to a balanced and nutritious diet due to poverty and food insecurity increases the risk of kwashiorkor.

Question 22

State the signs and symptoms of kwashiorkor.

Answer 22

Edema (Fluid Retention): Swelling, especially in the feet, ankles, face, and abdomen.

Skin and Hair Changes: Dry, flaky skin; changes in hair color and texture.

Fatigue and Weakness: Due to insufficient energy and nutrient intake.

Enlarged Liver: Hepatomegaly contributing to a distended abdomen.

Anorexia and Irritability: Loss of appetite and behavioral changes.

Muscle Wasting: Despite edema, there may be signs of muscle wasting.

Impaired Immune Function: Increased susceptibility to infections.

Gastrointestinal Symptoms: Diarrhea, distended abdomen.

Question 23

Flag Sign: Hair may take on a reddish tint.
Moon Face: Swelling of the face, particularly around the eyes.

The following are physical attributes for what malnutrition disease?

Answer 23

Kwashiorkor

Question 24

What is marasmus?

Answer 24

Marasmus is another severe form of malnutrition, distinct from kwashiorkor. It is characterized by overall energy deficiency, with insufficient intake of both calories and protein.

Marasmus often results from a prolonged period of inadequate food intake and can occur in situations of extreme poverty, famine, or when individuals are unable to access sufficient food.

Question 25

State the causes of marasmus.

Answer 25

Caloric Deficiency: Marasmus is primarily caused by a severe deficiency of both calories and protein in the diet.

Prolonged Inadequate Food Intake: A chronic lack of food over an extended period, leading to wasting and depletion of body fat and muscle.

Question 26

State the risk factors for marasmus.

Answer 26

Poverty: Lack of access to a sufficient quantity and variety of foods.

Famine or Food Shortages: Periods of food scarcity and limited access to nutritional resources.

Infections: Concurrent infections can exacerbate nutritional deficiencies.

Question 27

State the signs and symptoms of marasmus.

Answer 27

*Severe Wasting: Significant loss of body weight and muscle mass.

*Visible Bones: Prominence of bones due to loss of muscle and fat.

*Sunken Eyes: Hollow appearance around the eyes.

*Loose, Wrinkled Skin: Skin appears loose and wrinkled due to loss of subcutaneous fat.

*Growth Stunting: Impaired growth in children.

*Weakness and Fatigue: Due to overall energy deficiency.

Question 28

Prominent Ribs and Spine: Visible due to loss of muscle and fat.

Sunken Abdomen: Abdominal hollowing due to loss of visceral fat.

Loss of Subcutaneous Fat: Skin appears thin, and fat stores are depleted.

Name the disease described above.

Answer 28

Marasmus