Malnutrition & Undernutrition
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Transcript of Malnutrition & Undernutrition
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MALNUTRITION AND UNDERNUTRION
Presented byPaul N.
TOLEFAC, MDIntern,
FMBS/UY1 Supervised by
Innocent Takougang, MD
Associate Professor, FMBS
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Objectives At the end of the presentation we should understand:
Understand the difference between malnutrition and undernutrition
Classification of malnutrition The 3 phase approach in the management of severe
acute malnutrition
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Outline Definitions epidemiology Pathophysiology Clinical features management
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Definitions Malnutrition: An abnormal physiological condition caused by
inadequate, unbalanced or excessive consumption of macronutrients and/or micronutrients. It includes undernutrition and over-nutrition and obesity.
Undernutrition: it is a subset of malnutrition that results from undernourishment, and/or poor absorption. It includes: Underweight: a child has low weight for age. Composite measure includes
chronic and acute malnutrition. Stunting: child short for their age as a result of chronic under nutrition during
the most critical periods of growth and development in early life (< -2 SD HFA). Wasting: child’s weight is too low for their height as a result of acute under
nutrition (< -2SD WFH).
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Definitions Hunger: A state, lasting for at least one year, of inability to acquire
enough food, defined as a level of food intake insuffiecient to meet dietary energy requirements.
Famine is the state in which significant proportion (at least 20%) of a defined population lacks access to food in sufficient quantity and quality, such that epidemics of infectious disease become more frequent, acute malnutrition rates in children under 5 are above 30% and death rates rise.
Starvation occurs when the individual’ nutrient intake drops below the minimum needed to maintain body mass leading to consumption of muscles and lean body tissue for energy production.
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Definitions Protein – Energy Malnutrition (PEM): This is
the manifestation of inadequate dietary intakes of protein and or energy. Most common forms are marasmus and kwashiorkor.
Primary malnutrition: Malnutrition resulting from an inadequate food intake such as in starvation and famine.
Secondary malnutrition: Malnutrition resulting from increased nutrient needs, decreased nutrient absorption, and/or increased nutrient losses
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Epidemiology In 2000, 26.7% of preschoolers in the developing world
were estimated to be underweight, as reflected by a low weight for age, and 32.5% were estimated to be stunted based on a low height for age.
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Epidemiology: World & Africa
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Epidemiology: world
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Epidemiology: Stunting worldwideGlobally, about 1 in 5 (26% in 2011) children are stunted of whom 80% live in 40 countries.
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Epidemiology: World and Africa
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Epidemiology: Cameroon Author , Year Journal Objective Results Jesson J et al, 2015
BMC infectious diseases
Prevalence of malnutrition amongst HIV infected children in central & west Africa
Prevalence was 42% (n = 1350) with acute chronic and mixed malnutrition 9%, 7% and 26%.
Georges Nguefack-Tsague et al, 2014
Pan African Medical journal
Using underweight to predict wasting
Wasting in 5.5% and underweight in 12,9%
Sobze SM et al, 2014
Pan African Medical journal
assess the nutritional status of infants from mothers tested positive to HIV in the Dschang HD
SD was noticed in height-for-age z-score of girls between 1 to 2 years compared to 1-year old girls as well as to boys of all ages, defining them as stunted.
Sumbele IU et al, 2015
BMC public health
examines the prevalence, severity and predictors of malnutrition on malaria parasitaemia.
The overall prevalence of malnutrition was 22.8 %, with stunting being the most common form (17.1 %), followed by underweight (8.2 %) and wasting (5.5 %
Mbuh JV et al, 2013
Journal of helminthology
The prevalence of intestinal helminth infection was 47.2% (n = 265) The prevalence of malnutrition was 30.2%
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Causes of malnutrition Primary: Starvation, famine
aand hunger resulting from food scarcity, poverty and unemployment and natural disasters
Secondary: GI disorders Malabsorption syndromes Hyper-catabolic state
such as hyperthyroidism
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Pathophysiology
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Clinical Features• Oedema• Loss of muscle & fat often
masked by the oedema• Anorexia• Abdominal distention• Hair losing color• Apatic/irritable, miserable• Skin cracks/fragile, prone to
infections• Acutely sick
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Clinical features•Severe Wasting, very thin•Loss of Muscle Bulk,•No subcutaneous Fat
• Loose skin folds, floppy buttocks
• Often reasonable appetite when no med complication•Miserable, restless•Apathy
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Classification of Malnutrition Classification Definition classes Class definitionGomez Weight below % median WFA Mild 75%-90% WFA
Moderate 60%–74% WFASevere <60% WFA
waterlow z score below median WFH Mild 80%–90% WFHModerate 70%-80% WFHSevere <70% WFH
WHO (wasting)
z score below median WFH Moderate -3%</= z-score < -2Severe z-score < -3
WHO (wasting)
z score below median HFA -3%</= z-score < -2 z-score < -3
Kanawati MUAC/OFC Mild <0.31Moderate <0.28Severe <0.25
cole z score of BMI for age Grade 1 BMI for age z-score < -1Grade 2 BMI for age z-score < -2Grade 3 BMI for age z-score < -3
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Classification of malnutrition
Classification Mild Moderate Severe
Albumin (g/dL) 2.8-3.4 2.1-2.7 < 2.1
Transferrin (mg/dL) 150 - 200 100 - 149 < 100
Total Lymphocyte Count (per µL)
1200 - 2000 800 - 1199 < 800
Wellcamb Classification
Weight for Age (Gomez)
With Edema
Without Edema
60-80% kwashiorkor
undernutrition
< 60%marasmic-kwashiorkor
marasmus
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Management SAM Severe acute malnutrition is defined as the presence of
oedema of both feet or severe wasting (WFH <-3SD or MUAC < 11.5 cm).
The patient should be evaluated clinically for the presence of other conditions. Criteria for admission in children 6-59 months include: MUAC < 11.5cm Z score < -3SD Presence of oedema Lack of appetite
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Management: 3 Phases
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managementReSoMal• 2 litres water• WHO ORS 1 sachet• Sugar 50g• KCl 40mlOthers• Vitamin A: Give vitamin A
orally on days 1, 2 and 14 (age < 6 months, 50 000 IU; age 6–12 months, 100 000 IU; older children, 200 000 IU).
• Severe Anaemia: Blood transfusion should be given in the first 24 h only if: Hb is < 4 g/dl or Hb is 4–6 g/dl and the child has respiratory distress.
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Management
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ConclusionChild 6-
59months
SAM
Criteria for admission
present
Hospitalised and treat
Absent
Administer specific outpatient treatment
No SAM
Specific assessment & treatment
Back to objectives Understand the
difference between malnutrition and undernutrition
Classification of malnutrition
The 3 phase approach in the management of severe acute malnutrion
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The hidden truth about success