Secondary Malnutrition Quiz
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Questions and Answers

Which condition can lead to secondary malnutrition due to interference with nutrient absorption?

  • Anorexia
  • Liver disease
  • End-stage heart failure
  • Renal failure (correct)

    • Which physiological factor does NOT directly promote secondary malnutrition?

  • Abundant food supply (correct)
  • Interference with lymphatic transport
  • Compromised digestive conditions
  • Increased metabolic demand

    • Which disorder is associated with the wasting aspect of secondary malnutrition?

  • Chronic obstructive pulmonary disease (COPD) (correct)
  • Diabetes mellitus
  • Celiac disease
  • Anorexia nervosa

    • What type of conditions primarily contribute to secondary malnutrition?

    <p>Gastrointestinal disorders (B)</p> Signup and view all the answers

    Which of the following best describes secondary malnutrition?

    <p>Nutrient deficiency despite food availability (D)</p> Signup and view all the answers

    What is the significance of the weight range 85-40 in diagnosing conditions?

    <p>It suggests moderate protein energy undernutrition. (A)</p> Signup and view all the answers

    Which weight range corresponds to severe protein energy undernutrition?

    <p>13-45 (B)</p> Signup and view all the answers

    How does the term 'universal weight' relate to assessing protein energy undernutrition?

    <p>It serves as a baseline measure regardless of height or age. (C)</p> Signup and view all the answers

    Which of the following weight ranges indicates the highest likelihood of normal protein energy status?

    <p>9-110 (B)</p> Signup and view all the answers

    What is a common criterion for evaluating moderate protein energy undernutrition?

    <p>Weight falling in the 85-40 range. (B)</p> Signup and view all the answers

    What is the primary cause of primary protein-energy undernutrition?

    <p>Inadequate nutrient intake (D)</p> Signup and view all the answers

    Which form of protein-energy undernutrition is characterized by weight loss and depletion of fat and muscle?

    <p>Marasmus (A)</p> Signup and view all the answers

    What is a key characteristic of kwashiorkor?

    <p>Swollen or oedematous appearance (D)</p> Signup and view all the answers

    In which demographic is marasmus most commonly observed?

    <p>Developing countries (D)</p> Signup and view all the answers

    What effect does protein-energy undernutrition have on cell-mediated immunity?

    <p>Impairment of immunity (B)</p> Signup and view all the answers

    Which condition can influence nutrient use in secondary protein-energy undernutrition?

    <p>Interference from drugs or disorders (C)</p> Signup and view all the answers

    What can trigger a worsening of muscle wasting in children suffering from protein-energy undernutrition?

    <p>Release of cytokines (A)</p> Signup and view all the answers

    Which is more often caused by a lack of protein than by energy in children?

    <p>Kwashiorkor (D)</p> Signup and view all the answers

    What is a characteristic sign of Marasmus?

    <p>Wasting of subcutaneous fat and muscle (A)</p> Signup and view all the answers

    Which symptom is associated with Kwashiorkor?

    <p>Thin, reddish-brown hair (C)</p> Signup and view all the answers

    What does abdominal protrusion indicate in a patient with Kwashiorkor?

    <p>Decreased muscle strength (A)</p> Signup and view all the answers

    Which diagnostic method helps check the severity of malnutrition?

    <p>Measurement of total lymphocyte count (C)</p> Signup and view all the answers

    What is the role of serum albumin in diagnosing malnutrition?

    <p>Indicates the presence of edema (B)</p> Signup and view all the answers

    Why might hair changes occur in malnutrition?

    <p>From periods of undernutrition (D)</p> Signup and view all the answers

    Which method is NOT used for diagnosing malnutrition?

    <p>Histological examination of muscles (C)</p> Signup and view all the answers

    What skin condition might occur in Kwashiorkor?

    <p>Hyperpigmentation and fissures (C)</p> Signup and view all the answers

    What is the initial metabolic response in children with PEU?

    <p>Decrease in metabolic rate (C)</p> Signup and view all the answers

    Which substance does the body predominantly break down first to supply energy?

    <p>Adipose tissue (A)</p> Signup and view all the answers

    What occurs after adipose tissue has been depleted in the body?

    <p>Protein is used for energy (D)</p> Signup and view all the answers

    What is a symptom associated with marasmus?

    <p>Hunger (B)</p> Signup and view all the answers

    What happens to visceral fat and muscle in the body during severe malnutrition?

    <p>They are broken down for energy (D)</p> Signup and view all the answers

    Signup and view all the answers

    Flashcards

    Secondary Malnutrition

    A lack of nutrients despite food availability, often due to medical conditions.

    GI Function Disorders

    Conditions that disrupt digestion, absorption, or nutrient transport in the gastrointestinal tract.

    Wasting Disorders

    Health conditions that cause significant weight loss and nutrient deficiency.

    Renal Failure

    A condition where the kidneys cannot filter waste effectively, impacting nutrient balance.

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    End-stage Heart Failure

    Severe chronic heart condition that can lead to malnutrition due to inadequate blood flow.

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    Protein Energy Undernutrition

    A condition resulting from insufficient protein and energy intake, affecting growth and health.

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    Grading Severity

    The system used to assess the intensity of protein energy undernutrition.

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    Universal Weight Classifications

    Weight ranges used to categorize protein energy undernutrition severity.

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    Common Weight Ranges

    Weight classifications typically used in assessments.

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    Nutritional Assessment

    A process to evaluate dietary intake and health to identify undernutrition.

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    Nutritional Disorders

    Health issues arising from inadequate nutrient intake or absorption.

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    Protein-Energy Undernutrition (PEU)

    Energy deficit due to chronic deficiency of macronutrients.

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    Primary Nutritional Disorder

    Disorders caused by insufficient nutrient intake.

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    Kwashiorkor

    Wet, swollen form of PEU, common in children with short breastfeeding.

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    Marasmus

    Dry form of PEU, characterized by weight loss and muscle depletion.

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    Secondary Nutritional Disorder

    Nutritional issues resulting from diseases or drug interference.

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    Cell-mediated Immunity in PEU

    Impaired immunity in both marasmus and kwashiorkor, increasing infection risk.

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    Cytokine Release in PEU

    Cytokines released during infection worsen muscle wasting and appetite.

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    Metabolic Response in PEU

    In children with Protein Energy Undernutrition (PEU), the initial response is a decrease in metabolic rate.

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    Energy Source in PEU

    The body first uses adipose tissue for energy before breaking down proteins as a later stage.

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    Negative Nitrogen Balance

    Occurs when protein is used for energy, leading to more nitrogen loss than intake.

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    Symptoms of Marasmus

    Marasmus is characterized by hunger, significant weight loss, and lack of energy.

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    Breaking Down Muscle

    During severe malnutrition, visceral fat and muscle are broken down for energy.

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    Growth Retardation

    A condition where physical growth is slower than normal, often due to malnutrition.

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    Signs of Marasmus

    Characterized by wasting of subcutaneous fat and muscle, leading to a thin appearance.

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    Peripheral Edema

    Swelling in the extremities due to fluid retention, often seen in malnutrition.

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    Hair Changes in Malnutrition

    Hair may become thin, discolored, and fall out easily due to nutrient deficiencies.

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    Diagnosis of PEM

    Diagnosis of Protein-Energy Malnutrition relies on history, BMI, serum albumin, and lymphocyte counts.

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    Anthropometric Measurements

    Measurements of body size, weight, and proportions used to assess nutritional status.

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    Total Lymphocyte Count

    A blood test that measures the number of lymphocytes, important in diagnosing malnutrition.

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    Study Notes

    Nutritional Disorders in Children's Health

    • Objectives:
      • Differentiate the cause, characteristics, and pathophysiology of various nutritional disorders.
      • Create a plan to treat and prevent nutritional disorders.

    Protein-Energy Undernutrition (PEU)

    • Previously called protein-energy malnutrition.
    • An energy deficit due to chronic deficiency of all macronutrients.
    • Often includes micronutrient deficiencies.
    • Severity ranges from subclinical to obvious wasting and starvation.
    • Multiple organ systems are frequently impaired.
    • Classification:
      • Primary: Caused by inadequate nutrient intake.
        • Kwashiorkor: Characterized by edema, a "wet" form, and often affects children who have had a short period of breastfeeding. Children with this form tend to be older than those with marasmus. It can result from acute illnesses or infections, leading to cytokine release.
        • Marasmus: Characterized by a "dry" form of weight loss and depletion of fat and muscle. Most common in developing countries. This form affects children who start off as older children than those with kwashiorkor.
      • Secondary: Results from disorders or drugs that interfere with nutrient use. This form is related to the balance between nonprotein and protein sources of energy. Starvation can be a form of primary PEU.
    • Pathophysiology:
      • Initial metabolic response is decreased metabolic rate.
      • The body first breaks down adipose tissue for energy.
      • Later, protein is used, resulting in negative nitrogen balance.
      • Significant loss of weight, particularly in the liver and intestines.
      • Other organs affected, but to a lesser extent, include the heart and kidneys.
      • The central nervous system (CNS) is least affected.

    Marasmus

    • Also called the dry form of PEU.
    • Characterized by weight loss and depletion of fat and muscle.
    • Most common form of PEU in developing countries.
    • Usually affects older children than those with kwashiorkor.
    • Symptoms include: hunger, weight loss, growth retardation, wasting of subcutaneous fat and muscle, prominent ribs and facial bones, and loose, thin skin.

    Kwashiorkor

    • Also called the wet, swollen, or edematous form of PEU.
    • Commonly found in children who were breastfed for short periods.
    • Tends to affect children older than those with marasmus.
    • Can result from acute illness or infection, triggered potentially by cytokine release.
    • More often caused by a deficiency in protein compared to energy.
    • Common in regions where staple foods like sweet potatoes and green bananas are prevalent.
    • Symptoms: edema (swelling), protruding abdomen, enlarged liver, ascites (fluid in the abdomen), dry, thin, and wrinkled skin (often with hyperpigmentation or discoloration), and hair changes (thinning, reddish brown or gray color, possibly loss). Other symptoms include apathy (lack of enthusiasm), but they may also be irritable when held.

    Causes of Secondary PEU

    • Disorders affecting the gastrointestinal (GI) tract:
      • Problems with digestion.
      • Problems with absorption.
      • Problems with lymph transport of nutrients
    • Wasting disorders:
      • Renal failure
      • End-stage heart failure
    • Increased metabolic demands.

    Diagnosis of PEU

    • Severity Check:
      • BMI.
      • Serum albumin.
      • Total lymphocyte count.
      • CD4+ count.
    • Complications:
      • Complete blood count (CBC).
      • Electrolytes.
      • Blood urea nitrogen (BUN).
      • Glucose.
      • Calcium (Ca++).
      • Magnesium (Mg++).
      • Phosphate (P04).

    Physical Examination & Lab Tests for PEU

    • Physical Exam: Height, weight measurements, body fat distribution, lean body mass assessments.
    • Lab Tests:
      • Dietary history (inadequate intake).
      • Serum albumin.
      • Total lymphocyte count.
      • CD4+ lymphocytes.
      • Transferrin levels.
      • Skin response to antigens (to indicate immune function).

    Grading PEU Severity

    • Based on weight as a percentage of expected weight for length or height using international standards.

    Treatment of PEU

    • General:
      • Usually oral feeding initially.
      • Adjust to lactose avoidance if needed.
      • Supportive care.
      • Delay feeding for 24-48 hours in some cases.
    • Mild to Moderate: Balanced diet, liquid oral supplements if needed, possibly yogurt-based formulas for diarrhea cases, multivitamin supplement.
    • Severe: Requires hospitalization, controlled diet, correcting fluid/electrolyte imbalances, treating infections, supplying macronutrients orally or through nasogastric tube (NGT), giving micronutrients at twice the recommended daily allowance until recovery is complete.
    • Feeding delays up to 24-48 hours.
    • Oral or intravenous rehydration.
    • Frequent feedings in small amounts (less than 100 ml).
    • Progressively increasing the amount of milk-based formula supplementation with supplements in the first week.
    • Supplementing with 175 kcal/kg + 4g protein/kg after one week.
    • Supplementing micronutrients twice the recommended allowance.
    • Gradually switch to whole milk, supplemental foods like eggs, fruits, and meats after a few weeks.

    Nutrient Distribution for PEU Treatment

    • Macronutrients: 16% protein, 50% fat, and 34% carbohydrate.
    • Supplements: Magnesium (IM), B-complex, vitamin A, phosphorus, zinc, manganese, copper, iodine, fluoride, molybdenum, selenium, and iron (IM or oral).

    Complications of PEU Treatment

    • Refeeding Syndrome: Fluid overload, electrolyte deficits, hyperglycemia, cardiac arrhythmias, and diarrhea.

    Vitamin A Deficiency

    • Symptoms: Nyctalopia (night blindness), xerophthalmia (dry eyes), keratomalacia (corneal damage), and complete blindness.
    • Management: Improved vitamin A intake through the diet, continuation of breastfeeding for infants and young children, and increased access to vitamin A-rich foods for vulnerable families and older children.
    • Prevention: Periodic use of high-dose vitamin A capsules, integrating vitamin A supplementation with routine immunizations, and food fortification.

    Iron Deficiency Anemia

    • Description: Condition where the blood lacks sufficient healthy red blood cells.
    • Risk Factors: Babies born prematurely or with low birth weight, babies who drink cow's or goat's milk before one year of age, breastfed babies not introduced to iron-containing complementary foods after 6 months, infants fed iron-deficient formulas, children consuming excessive cow's milk/formula, children with infections or restricted diets, lead exposure, poor iron-rich food intake, and being overweight or obese. The recommendation in iron intake is dependent on the age of the child.
    • Signs and Symptoms: Pallor, fatigue, cold hands and feet, growth and developmental delay, poor appetite, abnormally rapid breathing, behavioral problems, frequent infections, unusual cravings for non-nutritive substances (e.g., ice, dirt, paint).
    • Diagnosis: Decreased mean corpuscular volume (MCV), increased central pallor, anisocytosis (variation in RBC size), and poikilocytosis (variation in RBC shape), decreased hematocrit, decreased hemoglobin, and decreased ferritin.
    • Prevention: Iron supplementation for pregnant women, delayed umbilical cord clamping, iron supplementation for infants (especially preterm), and iron supplementation for exclusively breastfed infants starting at 4 months.

    Zinc Deficiency

    • Description: Insufficient zinc in the body.
    • Risk Factors: Inadequate dietary intake, reduced absorption from diarrhea or malabsorption syndromes, a high-phytate diet, and chronic liver or kidney disease.
    • (Potential) exclusive breastfeeding.
    • Symptoms: Impaired immune function, increased susceptibility to pneumonia, impaired wound healing, diarrhea.
    • Treatment: The recommended dietary allowance (RDA) for zinc ranges from 2 to 11 mg/day, based on age.

    Iodine Deficiency Disorder

    • Description: Lack of iodine in the body.
    • Symptoms: Endemic goiter, cretinism, developmental delays, and intellectual disability (mental retardation, deaf-mutism, impaired ability to learn).
    • Diagnosis: Urine iodine tests, blood tests, iodine patch tests, and iodine loading tests.
    • Prevention:
      • Iodine supplements.

    Vitamin B Complex Deficiencies

    • Types: Vitamin B1 (thiamine), vitamin B6, and vitamin B12.
    • Deficiency Syndromes: Conditions associated with B vitamin deficiencies causing various symptoms: such as extreme cases of beriberi associated with Wernicke-Korsakoff syndrome in infants.
    • Treatment: Supplementing with B vitamins via oral or IM routes.

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    Nutritional Disorders PDF

    Description

    Test your knowledge on secondary malnutrition, including its causes, effects, and diagnostic criteria. This quiz covers physiological factors, weight ranges associated with different types of malnutrition, and the significance of protein-energy undernutrition. Challenge yourself with these key concepts!

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