Malnutrition, macronutrients

Notes
  • It presents as protein - energy malnutrition (PEM)
  • It includes such conditions as being underweight, Marasmus and Kwashiorkor
  • Malnutrition occurs due to either chronic lack of food or lack of the protective foods that are required for a healthy life, or a combination of both situations.
  • Marasmus is caused by deficiency of protein as well as energy nutrients while Kwashiorkor is caused by the deficiency of protein.
  • In the first 2 years of life, infants born of malnourished mothers die either of malnutrition alone or from gastrointestinal and respiratory infections to which they are easily susceptible.
  • When malnutrition occurs during growth and adolescent stage of life, it leads to poor stature, a low state of health and a generally low working capacity.
  • Statistics: It is estimated that between 50 - 66% of the world's population suffers from malnutrition; it is the 5th major cause of death in Kenya.

##Classification of macronutrient malnutrition;

  • Mild malnutrition (applies to a child below 5 yrs of age who has failed to gain weight for 2 consecutive months)
  • Moderate malnutrition (-2SD ≤ weight to height Z-score ≥ -3SD and / or 11.0cm ≥ Mid Upper Arm Circumference [MUAC] ≤12.5cm
  • Severe malnutrition (weight to height Z -score ≤ -3SD and /or MUAC ≤ 11.0cm with or without edema)

##A part from the lack of adequate and well-balanced food, malnutrition can be caused by the following conditions:

  • Cancer
  • Liver disease
  • Persistent pain or nausea
  • Depression
  • Schizophrenia
  • Old age
Symptoms
  • Sometimes, a child may have symptoms of both Marasmus and Kwashiorkor. This is termed as Marasmic Kwashiorkor.

##Kwashiorkor;

  • Poor weight gain (worse in Marasmus)
  • Occurs mainly in children below the age of 1-5 years
  • Edema (that is caused by reduced levels serum albumin that lower serum osmotic pressure). This symptom is absent in Marasmus
  • Protruded abdomen in Kwashiorkor (but shrunken in Marasmus).
  • Retarded growth (worse in Marasmus)
  • Anemia
  • Apathy
  • Moonface (this symptom is absent in Marasmus)
  • Wasting of muscles (worse in Marasmus than in Kwashiorkor)
  • Discoloration of hair and skin
  • Diarrhea (due to reduced synthesis of immunoglobulins and hence increased susceptibility to infections)
  • Poor appetite (but good in Marasmus)

##Marasmus;

  • Very poor weight gain (more in Marasmus than Kwashiorkor)
  • Occurs mainly in children below the age of 1 year.
  • Minimal subcutaneous fat remain (in marasmus but some may remain in Kwashiorkor)
  • Shrunken abdomen (while it is protruded in Kwashiorkor)
  • Wasting of muscles (worse in Marasmus than in Kwashiorkor)
  • “Wise old man look”
  • Good appetite (but poor in Kwashiorkor)

## Other symptoms in both Marasmus and Kwashiorkor include:

  • Fever
  • Hypothermia
  • Diarrhea
  • Vomiting
  • Severe anemia
  • Altered consciousness
  • Other infections such as LRTIs
  • Fatigue
  • Rapid hair loss
  • Amenorrhea (in adults)
Diagnosis
  • Clinical review including MUAC and weight to height Z- score

## Other tests to exclude other diseases;

  • HIV testing
  • Full Blood Count
  • Test for TB
  • Blood glucose
Differential
  • Cancer
  • Diabetes
Prevention
  • Eating adequate and well-balanced diet
Management
'-Deoxy-" '-Difluorocytidine
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