COMMON PEDIATRIC NUTRITIONAL DISORDERS 2015.ppt
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Transcript of COMMON PEDIATRIC NUTRITIONAL DISORDERS 2015.ppt
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Wilfredo Santos, MD.Neonatology
Rebecca Abiog Castro, M.D.
Pediatric Gastroenterology & Nutrition
Faculty of Medicine & Surgery, S!
Prepared by:
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A pathological state resulting from a relative or
absolute deficiency or excess of one or more
essential nutrients.
This state being clinically manifested or detected
only by biochemical, anthropometric or
physiological tests.
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ndernutrition"
pathological state resulting from the consumptionof an inadequate quantity of food over anextended period of time
S#ecific Deficiency
absolute or relative lack of an individual nutrient
$%ernutrition"
consumption of an excessive quantity of food foran extended period of time
'balance"
disproportionate intake among essential nutrients
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Diagnostic Criteria:
Anthropometric easurements:
!eight for age: Underweight"ength#$eight for age: Stunted
$ead circumference %until & years of age only'
!eight for length#height: Wasted
(ody mass index %()': Overweight/Obese
WHO Standard Deviation Growth Curve
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Z ScoreGrowth Indicators
Lt/Ht or a!e Wt or a!e Wt or Lt or Ht "#I or a!e
Above 3 (See Note 1)
(See Note 2)
Obese Obese
Above 2 Normal Overwei!ht Overwei!ht
Above 1 Normal Possib$e ris% o
overwei!ht(See Note 3)
Possib$e ris% ooverwei!ht(See Note 3)
0 (median) Normal Normal Normal Normal
Below - 1 Normal Normal Normal Normal
Below - 2Stunted(See Note 4)
Underweight Wated Wated
Below - 3Severel! tunted
(See Note 4)Severel! underweight
(See Note ")Severel! wated Severel! wated
*. A child in this range is very tall. This is rarely a problem unless the child is +excessivelytall, in -hich case, he should be referred for possible endocrine -orkup especially if bothhis parents are not tall.
/. A child in this range may have a problem but this is better assessed -ith -t for "t#$t or ()for age.
&. A plotted point above * sho-s possible risk. A trend to-ard the / 0score sho-s definite risk.
1. )t is possible for a stunted or severely stunted child to become over-eight.
2. This is referred to as very lo- -eight in )C) training modules.
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Maras'us %)nfantile atrophy, 3balanced starvation,
3old man face4': Due to severe deprivation of protein, energy, vitamins 5 minerals
Maras'ic()*as+ioror" $ave clinical findings of both marasmus 5 k-ashiorkor $ave edema, gross -asting and stunting
)*as+ioror %3sugar baby4': Due to a diet of a decreased protein but increased carbohydrate
intake -ith#-ithout superimposed infection
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Maras'us )*as+ioror
sual Age -( years /(0 years
1de'a None lo*er legs, face or
generali2ed
Wasting Gross loss so'eti'es +idden
of Sub3 fat
Muscle Wasting ob%ious so'eti'es +idden
Gro*t+ retardation ob%ious so'eti'es +idden
Mental C+anges a#at+etic, 4uiet irritable, alsoa#at+etic
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Maras'us )*as+ioror
Appetite good poor
Diarrhea often often
6kin Changes seldom flakypaint
dermatoses
$air Changes seldom sparse,
dyspigmentation
oon face seldom often
$epatic seldom al-ays
enlargement
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Maras'us )*as+ioror
6erum albumin 7 or lo- lo-
8rea#creatinine 7 or lo- lo-$ydroxyproline lo- lo-
9ssential AA normal lo-
Anemia uncommon common
"iver biopsy normal or fatty change atrophic
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A generali0ed excessive accumulation of fattysubcutaneous tissue
ay be due to overeating, genetic constitution,psychic disturbances, insufficient exercise,endocrine and metabolic disturbances
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Z ScoreGrowth Indicators
Lt/Ht or a!e Wt or a!e Wt or Lt or Ht "#I or a!e
Above 3 (See Note 1)
(See Note 2)
Obese Obese
Above 2 Normal Overwei!ht Overwei!ht
Above 1 Normal Possib$e ris% o
overwei!ht(See Note 3)
Possib$e ris% ooverwei!ht(See Note 3)
0 (median) Normal Normal Normal Normal Below - 1 Normal Normal Normal Normal
Below - 2Stunted(See Note 4)
Underweight Wated Wated
Below - 3Severel! tunted
(See Note 4)Severel! underweight
(See Note ")Severel! wated Severel! wated
*. A child in this range is very tall. This is rarely a problem unless the child is +excessivelytall, in -hich case, he should be referred for possible endocrine -orkup especially if bothhis parents are not tall.
/. A child in this range may have a problem but this is better assessed -ith -t for "t#$t or ()for age.
&. A plotted point above * sho-s possible risk. A trend to-ard the / 0score sho-s definite risk.
1. )t is possible for a stunted or severely stunted child to become over-eight.
2. This is referred to as very lo- -eight in )C) training modules.
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!+ree 'ost co''on nutrients, of #ublic +ealt+concern, t+at afflicts Fili#ino c+ildren"
5ita'in A Deficiency 65AD7
Ane'ia 6ron Deficiency Ane'ia 8DA97
Goiter 6odine Deficiency Disoder 8DD97
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Carotenoids, the precursors of it. A is ;
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Ma:or nutritional concern in #oor societies,es#ecially in de%elo#ing countries
Assessed by 'easuring t+e #re%alence of deficiencyin a #o#ulation, re#resented by"
s#ecific bioc+e'ical 'arers 6lo* seru' retinol7
clinical indicators of status 6;ero#+t+al'ia7
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G$oba$ preva$ence o vita&in ' deiciency in popu$ations at ris% ())*+,--*
WHO Global Database on Vitamin A Deficiency
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5ision
1#it+elial differentiation
Gro*t+
Re#roduction Pattern for'ation during e'bryogenesis
one de%elo#'ent
e'ato#oiesis
rain de%elo#'ent ''une syste' function
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7yctalopia or night blindness >hotophobia ?erosis con@unctivae
(itot4s spot Corneal xerosis ?eropthalmia 6kin signs: branny desquamation, follicular
hyperkeratois, defective teeth enamel
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Clinical 'anifestations"Nig+t blindness
Eero#t+al'ia 6itots s#ot, erato'alacia7
Dar ada#tation tests assess early(stage %ita'in A
deficiency
5ita'in A le%els 6N5"-- gHdI7
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Bitot #ot $ero#hthalmia
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N$ sign of %ita'in A deficiency" Prophylaxis ?-,--- single dose 6J 'ont+7 /--,--- single dose 6(/ 'ont+7 --,--- single dose 6K/ 'ont+7
Gi%en e%ery 'ont+s until ris factor disa##ears
Sign of %ita'in A deficiency Treatment: J 'ont+s" /?-,--- (/ 'ont+s" /--,--- K / 'ont+s" --,---
Gi%en on day /, day and *ees fro' first dose
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%he #revalen&e o' anemia among month to 1 !earha remained unabated in&e 1**3+ and in&reaed 'rom
4*,2 to an alarming rate o' ,
Anemia among 1-" !.o remained at 2*,1,
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/. ron de#letionStorage iron is absent or decreased
Nor'al seru' iron conc and gb le%els
. ron deficiency *it+out ane'ia
Decreased or absent iron storage
Io* seru' iron concentration
Io* transferrin
No fran ane'ia0. ron deficiency ane'ia
Io* gbHct %alue
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A significant body of causal e%idence e;ists for"
*. )rondeficiency anemia and -ork productivity
/. 6evere anemia and child mortality
&. 6evere anemia and maternal mortality
1. )rondeficiency anemia and child development
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!issue effects of DA"
*. B)T: anorexia, pica, atrophic glossitis, leakygutsyndrome %exudative enteropathy'
/. C76: irritability, conduct disorder, cognitive↓function
&. C6: $ 5 C, cardiac hypertrophy, plasma↑ ↑volume
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egular response to adequate amounts of iron is animportant diagnostic and therapeutic feature.
ral administration of simple ferrous salts %e.g.,sulfate, gluconate, fumarate' provides inexpensiveand satisfactory therapy.
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Therapeutic dose
1E; mg#kg of elemental iron in & divided doses
Ferrous sulfate /
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Therapeutic dose
1E; mg#kg of elemental iron in & divideddoses
Ferrous sulfate /
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*. 8npleasant taste can be camouflaged by mixing -ithflavored syrup
/. lder children and adolescents sometimes have B)complaints
Constipation can be minimi0ed by -ater 5↑
fiber intake
Abdominal discomfort can be minimi0ed byadministering iron -ith food, but may
decrease iron absorption to some extent.
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nade4uate intae or 'etabolis' of iodine. t directlyaffects t+yroid secretions, *+ic+ influence +eartaction, ner%e res#onse, gro*t+ rate, and 'etabolis'
Si'#le goitre, t+e 'ost fre4uent result, is 'ost co''on inareas *it+out access to salt *ater and is rare along seacoasts.
Se%ere, #rolonged deficiency can cause +y#ot+yroidis'.
1ating seafood regularly or using iodi2ed table salt *ill#re%ent iodine deficiency. So'e countries +a%e 'ade dietaryiodine additi%es 'andatory.
http://www.britannica.com.ph/chemistry/iodine-368131.htmlhttp://www.britannica.com.ph/medicine/thyroid-gland-380708.htmlhttp://www.britannica.com.ph/medicine/goitre-365772.htmlhttp://www.britannica.com.ph/medicine/goitre-365772.htmlhttp://www.britannica.com.ph/medicine/thyroid-gland-380708.htmlhttp://www.britannica.com.ph/chemistry/iodine-368131.html
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A fe* salient facts
)odine deficiency is one of the main cause of impaired
cognitive development in children.
The number of countries -here iodine deficiency is apublic health problem has halved over the past The
number of countries -here iodine deficiency is apublic health problem has halved over the past decadeaccording to a ne- global report on iodine status.
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21 countries are still iodinedeficient.
9fforts are required to strengthen sustainable salt
iodi0ation programmes.
)odine deficiency is the -orld4s most prevalent, yeteasily preventable, cause of brain damage. Today -e
are on the verge of eliminating it E an achievementthat -ill be hailed as a ma@or public health triumphthat ranks -ith getting rid of smallpox andpoliomyelitis
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+nearly / billion individuals had insufficientiodine intake, a third being of school age. ...
Thus iodine deficiency, as the single greatestpreventable cause of mental retardation, is animportant publichealth problem.4
The Lancet !$, in /
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"o- dietary iodine 6elenium deficiency >regnancy 9xposure to radiation )ncreased intake#plasma levels of goitrogens, such as calcium Bender %higher occurrence in -omen' 6moking tobacco Alcohol %reduced prevalence in users' ral contraceptives %reduced prevalence in users' >erchlorates Thiocyanates
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6igns and symptoms
>resence of possible risk factors
/1hour urine iodine collection %approximatelyL
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Food supplements fortified -ith iodine
ild cases may be treated by using iodi0ed
salt in daily food consumption, or eatingmore of milk, egg yolks, and salt-ater fish
)n an adult, *2< Mg#d is sufficient for normal
thyroid function.J/
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)odine supplementation results -ith shrinkage ofgoiters caused by iodine deficiency in very youngchildren and pregnant -omen
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>reventive easures:8se of iodi0ed salts:
Addition of small amounts of iodine to table salt in formof sodium iodide, potassium iodide, and#or potassium
iodate,
Food fortification such as flour, -ater and milk inareas of deficiency.
)ntake of seafood, a good source thus, iodinedeficiency is more common in mountainous regions-here food is gro-n in soil poor in iodine.
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(eriberi
Types: Dry (eriberi E the infant may appear -ell
nourished but pale, listless, flabby, cyanotic anddyspneic, tachycardic -ith enlarged liver
!et (eriberi the infant is edematous, pale,
undernourished, dyspneic -ith vomiting andtachycardia
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ther types:
*. Acute cardiac type E occurs at age /1months. !ith cyanosis, dyspnea, systolic
murmur, pulmonary edema/. Aphonic type E develops at age 2H months
-ith hoarseness, dysphonia or aphonia
&. >seudomeningeal type E develop at N*<
months -ith apathy, dro-siness and signs ofmeningeal irritation
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Diagnosis: therapeutic test of parenteralthiamine results in dramatic symptom andsign improvement
>revention: thiamine at
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8sually occurs -ith other deficiencies ofitamin ( complex
Angular stomatitis, cheilosis, glossitis,
fissuring of the tongue
6crotal or vulval dermatosis, nasolabialseborrhea
>hotophobia, blurred vision cornealvasculari0ation
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Diagnosis: 8rinary riboflavin determination and(C riboflavin load test
>revention: O *< years old
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Cause"
A deficiency disease caused by diets lo- in niacinand#or tryptophan
Clinical 'anifestations"Triad of diarrhea, dermatitis and dementiaG also
depression, irritability, insomnia and delirium
Diagnosis" signs and symptoms
Pre%ention:;*< mg for infants and less than *< years old. lder is
*
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Cause"Deficiency occurs due to losses of pyridoxine from
refining, processing, cooking and storing of food
Clinical Manifestations:Convulsion, depression, seborrheic dermatitis,
intertrigo, angular stomatitis, glossitis, poor response toinfection
Diagnosis"
tryptophan load testG response of sei0ure to (;treatment
!reat'ent: ) pyridoxine in@ection /*< mg or *
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6curvy
Due to it C deficient diet
6#6x: >seudoparalysis, spongy gum bleeding, rosary
of scorbutic beads at the costochondral @unctions,petechiae, orbital or subdural hemorrhages
Diagnosis: ?ray of the long bones: atrophy of the
boneG it C blood levels
Treatment: /
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Deficiency of it Q dependent factors%prothrombin, factors )), )?, ?', exclusivelybreastfed infants, antibiotic adminstration
6#6x: (leeding from cord, B) bleeding, intracranialbleeding, anemia, hematuria
>revention and Treatment: it Q administration at
birth. Transfusion of deficient factors
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"ack of vitamin D in the diet and lack of access ofthe skin from ultraviolet irradiation
6#6x: rachitic rosary, craniotabes, gro-th
impairment, mental retardation, bo-ing of legs,knockknees
Diagnosis: ?ray of the involved bones
Treatment: 1
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Del undo, et.al Textbook of >ediatrics andChild $ealth, 1th edition