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MALNUTRITION (PEM)
MALNUTRITION
Results
FORMS OF MALNUTRITION
UNDERNUTRITION-results
TYPES OF MALNUTRITION
ACUTE-
CHRONIC-
Effects of Malnutrition:
1. Increase mortality unless treated on time
2. Increased susceptibility to infection ( synergism between
malnutrition & infection)
3. Poor mental performance
4. Impaired national development
Health additional burden of medical services,
hospitalization
Education more school drop-outs, school absences,
leading to reduced manpower potential
Agriculture & industry - losses due to poor
performance, absenteeism, accidents
Socio-cultural greater unrest, disorders
infectious disease
Loss of appetite
SYNERGISM BETWEEN
MALNUTRITION & INFECTION
-Under most circumstances, malnutrition and infection
SYNERGISM
EFFECTS OF MENTAL
PERFORMANCE
-
EFFECTS OF MENTAL
PERFORMANCE
B.INDIRECT- Loss of learning
- Interference with learning
- Motivation and personality changes
CLASSIFICATION OF DEGREES
OF MALNUTRTION
Gomez
Classification (according to
percentage of EBW)
> 110% - obesity
91-110% - normal
76-90% - first degree (mild)
61-75% - second degree (moderate)
</=60% - third degree (severe)
WATERLOW CLASSIFICATION
Uses
BELOW
<80
ABOVE
> 90
NORMAL
ACUTE OR
RECENT
MALNUTRITION
BELOW
< 90
NUTRITION
AL
DWARFISM
SEVERE
CHRONIC
MALNUTRIT
ION
WT.FOR
HT (80%
EBW)
WELLCOME CLASSIFICATION OF
SEVERE PEM
WEIGHT FOR EDEMA
AGE
PRESENT
% OF EBW
60-80%
EDEMA
ABSENT
KWASHIORKOR UNDERNOUR
ISHED
</= 60%
MARASMIC
KWASHIORKOR
MARASMUS
PROTEIN-ENERGY
MALNUTRITION (PEM)
-
Infants
Preschoolers
Those
Vulnerable
rivalry
In infants- usually due to inadequate
breastfeeding
CAUSES OF PEM:
The main cause - quantitatively insufficient &
qualitatively inadequate diet
Causes of PEM.
TYPES OF PEM
KWASHIORKOR-
first used in
Ghana, Africa
-comes from the Ghan language
meaning red boy
- also means the sickness of the
older child when the next baby is
born
- a qualitative deficiency state
NUTRITIONAL MARASMUS
gross muscle
wasting
- comes from a Greek word meaning wasting
- a quantitative deficiency state
MARASMIC
KWASHIORKOR- combination
Marasmus
Calorie deficiency
(lack of protein,
vitamins, and
minerals)
Affects very young
children
Emaciated, no
edema, hair is dull
and dry, skin thin
and wrinkled.
PRINCIPAL FEATURES OF
SEVERE PEM
CLINICAL FEATURES
(always present)
MARASMUS
KWASHIORKOR
MUSCLE WASTING
Obvious
Sometimes hidden by
edema & fat
FAT WASTING
Severe loss of
Often retained but not firm
subcutaneous fats
EDEMA
Very low
MENTAL CHANGES
Sometimes quiet
and apathetic
VARIABLE
FEATURES
(sometimes
present)
MARASMUS
KWASHIORKOR
APPETITE
Usually good
Poor
DIARRHEA
Often
Often
SKIN CHANGES
Usually none
Diffuse pigmentation,
sometimes flaky paint
dermatosis
HAIR CHANGES
Seldom
HEPATIC
ENLARGEMENT
None
Sometimes due to
accumulation of fats
BIOCHEMICAL SERUM
ALBUMIN
Normal or slightly
decreased
Low-<3 gms/100 ml
MANAGEMENT OF PEM
PREVENTIVE
A. Maintenance of good nutritional status
with emphasis on the high risk
1. Breastfeeding
2. Supplementary feeding
3. Proper nutrition for all age group
C. Nutrition Education
D. Multidisciplinary Approach
1. Family Planning
CURATIVE
MILD-
ambulatory- OPD/housecall
MODERATE- ambulatory
SEVERE- hospital
B. Treatment of dehydration
C. Treatment of Infection
D. Diet- high CHO
high CHON
REHABILITATION
1.
2.
3.
4.
5.
END OF
TOPIC