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Nutrition end of week 9

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winniesmith2's version from 2018-01-23 21:19

Section 1

Question Answer
Nutritional diseases (3 types)PEM, Kwashiorkor and marasmus
What does PEM stand for Protein-Energy Malnutrition (PEM)
What is PEM due tooPoverty, ignorance and recurrent infections commonly in late infancy and early childhood (6 months- 2 years). most common in sub Saharan Africa and India. Poverty and ignorance are main factors.
What is PEM a spectrum ranging from mild undernutrition (FTT, growth retardation) to severe undernutrition (marasmus and kwashiokor).
What is the primary type of PEM Due to inadequate food intake. It accounts for the major percentage in developing countries.
What is the secondary type of PEMDue to increased nutrient needs, decreased nutrient absorption and/or increased nutrient losses. It accounts for a higher percentage in developed countries.
Causes of severe childhood PEMChronic, severely low energy and protein intake Exclusive breast feeding for too long Dilution of formula feed Poor water quality Unclean/non-nutritious, complementary foods of low energy and micronutrient density Infection (e.g. measles, diarrhoea, etc.) Environmental toxins (Xenobiotics)
What does marasmus look likeTypically very thin child
what does kwashiorkor look likeLook fatter but it's not fat it's water retention
what is marasmusPhysiological adaptations and long term undernutrition. Also known as non-oedematous PEM
What is marasmus characterised byDepletion of fat reserves and muscle protein. Which is an adaptation to reduce energy expenditure. Investigations: the metabolic functions are not disturbed because of the balance deficiency, so laboratory abnormalities are minimal.
Marasmus; inadequate energy intake due to:Scantly breast milk secretion with no supplementation (in breast fed infants). Diluted formula or infrequent feeding (in bottle-fed infants)
Marasmus; clinical presentationsUnderweight, loss of weight on repeated measures, loss of subcutaneous fat and muscle wasting. However, they are alert with good appetite.
Marasmus clinical grade 1Loss of subcutaneous fat over the abdominal wall
Marasmus clinical grade 2Loss of subcutaneous fat over the buttocks and thighs
Marasmus clinical grade 3Loss of subcutaneous fat over the face (senile face)
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Section 2

Question Answer
Kwashiorkor (oedematous PEM) Aetiology;Inadequate protein intake (faulty weaning) due to: Scanty breast milk secretion with wrong supplementation on low protein-high carbohydrate diet e.g. rice water, sugary fluids, or starchy products Sudden weaning on low protein high carbohydrate diet usually following the delivery of a new sibling Aetiology: Ga – the disease of the deposed baby Prolonged restriction of milk in severe cases of gastroenteritis.
Kwashiorkor is also known as Disease of the deposed baby
Symptoms of kwashiorkor•change in skin and hair color (to a rust color) and texture •fatigue •diarrhea •loss of muscle mass •failure to grow or gain weight •edema (swelling) of ankles, feet, and belly •damaged immune system, which can lead to more frequent and severe infections •irritability •flaky rash •shock. Poor appetite and fatigued.
KvW Feature; Growth failurepresent in both
KvW: wastingK= Present. W= Present, marked.
KvW: Oedema K=Present (sometimes mild). M= absent.
KvW: Hair changesK=Common. W= less common
KvW: Mental changesK=Very common. W= uncommon
KvW: Dermatosis; flaky-paintK= common. W=Does not occur.
KvW: AppetiteK= poor. W= Good
KvW: AnaemiaK= Severe(sometimes) W= Present, less severe
KvW: Subcutaneous fat K= Reduced but present. W=Absent
KvW: FaceK= may be oedematous. W= Drawn in, monkey like
KvW: Fatty infiltration of liverK= Present. W= Absent
Treatment for Kwashiorkor-Milk-based feeds or ready-to-use therapeutic food RUTF (peanut butter, milk powder, sugar, vegetable oil, and added vitamins and minerals). More intensive treatment in hospital in severe cases or where there are already complications e.g. infections. (6-8 weeks) •treating or preventing low blood glucose •keeping the person warm – kwashiorkor can make it harder to generate body heat •treating dehydration with specially formulated rehydration solution •treating infections with antibiotics – kwashiorkor greatly increases the risk of infections •treating vitamin and mineral deficiencies – vitamin supplements are usually included in the special milks or RUTF •slowly introducing small amounts of food before gradually increasing the amount of food
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Section 3

Question Answer
What are the health consequences of undernurition and PEM Stunting, Wasting and a higher relative risk of other diseases.
Study of tanzanian children 6-60 months of Age- within 2 years of hospitalization for pneumonia, what were the adjusted mortality rates for each groupHighest was wasted group at 2.9. Next was Stunted group at 2.0. Then MUAC (mid upper arm circumference) 1.9 and then underweight 1.6
Relative risk of preschool child death; by weight for age Relative risk for each disease increases with severity of malnutrition. Lecture 9 page 50
HIV infection and mortality by level of wasting status in tanzanian children 6-60Mo of ageThose who were wasted and were HIV positive had a higher mortality risk of 5.2, than those who were normal weight and hiv positive at 1.6
When is the best time to break the cycle of undernutrition through education, primarily by educating girls young.
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