Child Nutrition and Malnutrition Overview

Introduction

• Nutrition is crucial for child health and influences long-term eating habits, metabolism, and weight.
• Malnutrition, a significant public health issue, encompasses undernutrition (wasting, stunting, micronutrient deficiencies) and overnutrition (overweight, obesity).
• It affects all age groups but children, the elderly, and those with chronic illnesses are especially vulnerable.
• The Convention on the Rights of the Child emphasizes every infant's right to good nutrition.

Malnutrition Statistics

• 45% of child deaths are associated with undernutrition.
• In 2022, 149 million children under 5 were stunted, 45 million wasted, and 37 million overweight or obese.
• Only 1 in 5 children from the poorest households and rural areas receive the minimum diverse diet for healthy growth and development.
• Many adolescents consume highly processed foods, with 42% drinking sugary drinks and 46% eating fast food regularly.
• Malnutrition can threaten survival, growth, and development of children, impacting economies and nations.

Acute Malnutrition

• It results from insufficient energy or protein intake.
• Primary acute malnutrition is commonly seen in developing countries due to inadequate food supply.
• Secondary acute malnutrition arises from underlying diseases causing nutrient loss, increased energy expenditure, or decreased food intake.
• Primary acute malnutrition is often rooted in socioeconomic and environmental factors, including household food insecurity, poverty, and poor breastfeeding practices.
• Environmental enteropathy, caused by exposure to pathogens, contributes to malnutrition through intestinal damage and malabsorption.

Pathophysiology of Acute Malnutrition

• Inadequate energy intake leads to growth restriction, loss of muscle and fat, reduced basal metabolic rate, and decreased energy expenditure.
• Biochemical changes affect thyroid hormones, insulin, and growth hormone.
• T3, insulin, and IGF-1 levels are reduced, while GH and cortisol levels increase.
• Glucose initially decreases, followed by gluconeogenesis and protein conservation with fat mobilization.
• Electrolyte imbalances include sodium retention and potassium depletion.
• Acute malnutrition negatively impacts brain development, reducing neuron numbers, synapses, and myelination, leading to smaller brain size.
• These brain effects may be irreversible after the age of 3-4 years.

Clinical Syndromes of Acute Malnutrition

• Marasmus - caused by prolonged inadequate energy intake, characterized by wasting of muscle and fat, appearing emaciated and lethargic.
• Kwashiorkor - thought to result from insufficient protein but relatively normal calorie intake, characterized by edema, skin lesions, and hair changes.

Management of Malnutrition

• Nutritional Interventions:
  • Dietary adjustments: Calorie and protein supplements with nutrient-dense foods.
  • Oral Nutritional Supplements (ONS): Individualized based on preferences and tolerance.
  • Enteral Nutrition: For patients unable to take oral nutrition due to medical conditions.
  • Parenteral Nutrition: For severe cases when enteral feeding is not possible.
• Pharmacological Interventions:
  • Appetite Stimulation: Medications like megestrol acetate or dronabinol might be used to increase hunger.
  • Micronutrient Stimulation: Supplementation of vitamins and minerals based on deficiencies.
• Monitoring and Follow-Up:
  • Regular monitoring of weight, intake, biochemical markers, and clinical signs to evaluate progress.
  • Adjustments to interventions based on evaluations.