Malnutrition-1 2022-2023 PDF

University of Baghdad College of Medicine 2022-2023 Title: Malnutrition- 1 Grade: Fifth years Module: Pediatrics Speaker: Prof. Dr. Mohammad Fadhil Ibraheem Date: September 2023  University of Bag...

University of Baghdad College of Medicine 2022-2023 Title: Malnutrition- 1 Grade: Fifth years Module: Pediatrics Speaker: Prof. Dr. Mohammad Fadhil Ibraheem Date: September 2023  University of Baghdad/ College of Medicine 2022-2023 Learning objectives To define malnutrition and know its causes To assess malnutrition by using the indicators and anthropometric measures. To know different types of malnutrition classification.  University of Baghdad/ College of Medicine 2022-2023 INTRODUCTION Malnutrition essentially means “bad nourishment”. It concerns not enough as well as too much food, the wrong types of food, or the inability to use nutrients properly to maintain health. The World Health Organization cites malnutrition as the greatest single threat to the world's public health. Malnutrition in all its forms is a considerable public health concern and is associated with increases risk of disease and early death. University of Baghdad/ College of Medicine 2022-2023 Wasting malnutrition still affects 8% of all children University of Baghdad/ College of Medicine 2022-2023 under 5 years old. Wasted children are at substantial increased risk of severe acute malnutrition and death, with malnutrition accounting for over 50% of all child deaths worldwide. Although at least one million child deaths are directly caused by malnutrition , acute malnutrition may predispose up to 3.5 million children under 5 years old to death. If malnutrition were properly addressed, at least one third University of Baghdad/ College of Medicine 2022-2023 of child mortality and morbidity could be averted. It is also speculated about 11% of the total global disability- adjusted life-years are due to childhood malnutrition. Geographically 70-80% of undernourished children of the world live in developing countries. Definitions University of Baghdad/ College of Medicine 2022-2023 Malnutrition is a general term for the medical condition caused by an improper or insufficient diet. Under nutrition (deficiency of one or more essential nutrients); Resulting from inadequate consumption, poor absorption, or excessive loss of nutrients. Over nutrition (an excess of a nutrient or nutrients); resulting from overeating or excessive intake of specific nutrients. Undernutrition (malnutrition) University of Baghdad/ College of Medicine 2022-2023 Structural and functional changes due to inadequate intake of nutrients and energy sources. Deficiency of a single nutrient is an example of under nutrition, e.g. iron and iodine. All children with PEM have micronutrient deficiency Causes University of Baghdad/ College of Medicine 2022-2023 Primary Malnutrition: resulting from inadequate food intake. Secondary Malnutrition: resulting from increased nutrient needs, decreased nutrient absorption, and/or increased nutrient losses. Developing countries 1 °> 2 ° malnutrition Developed countries 2 ° > 1 ° malnutrition University of Baghdad/ College of Medicine 2022-2023 University of Baghdad/ College of Medicine 2022-2023 University of Baghdad/ College of Medicine 2022-2023 Causes of 1 ° Malnutrition University of Baghdad/ College of Medicine 2022-2023 Accounts for the vast majority of cases: Nutrition: Inadequate food intake due to:-  Insufficient or inappropriate food supplies.  Early cessation of breastfeeding.  Cultural and religious food customs (in some areas). Causes of 2 ° Malnutrition University of Baghdad/ College of Medicine 2022-2023 Children with chronic illness are at risk for nutritional problems for several reasons, including the following: 1-Anorexia, which leads to inadequate food intake. 2- Increased inflammatory burden and increased metabolic demands can increase caloric need. 3- Any chronic illness that involves the liver or small bowel affects nutrition adversely by impairing digestive and absorptive functions. Like: Cystic fibrosis Chronic renal failure Childhood malignancies Congenital heart disease Neuromuscular diseases Chronic inflammatory bowel diseases Protein-Energy Malnutrition University of Baghdad/ College of Medicine 2022-2023 The term PEM applies to a group of related disorders that include marasmus, kwashiorkor, and intermediate states of marasmus-kwashiorkor. The distinction between the 2 forms of PEM is based on the presence or absence of oedema. Marasmus; inadequate intake of protein and calories (absence of oedema) Kwashiorkor; fair-to-normal calorie intake with inadequate protein intake (presence of oedema). University of Baghdad/ College of Medicine 2022-2023 University of Baghdad/ College of Medicine 2022-2023 Measuring malnutrition University of Baghdad/ College of Medicine 2022-2023 Malnutrition is assessed by a combination of clinical features and anthropometry(body measurements). The indicators used are: Wasting: Weight for height. Mid upper arm circumference (MUAC). Body mass index (BMI). Stunting: height for age. Wasting and stunting combined: weight for age. Protein Energy malnutrition University of Baghdad/ College of Medicine 2022-2023 (anthropometric measurements) Underweight Measurements that fall below 2 standard deviations under the normal weight for age. Stunting Measurements that fall below 2 standard deviations below height for age. Wasting Measurements that fall below 2 standard deviations below weight for height. University of Baghdad/ College of Medicine 2022-2023 University of Baghdad/ College of Medicine 2022-2023 University of Baghdad/ College of Medicine 2022-2023 Diagnosis University of Baghdad/ College of Medicine 2022-2023 Anthropometry Acute: Wasting: low weight for height Chronic: Stunted: low height for age skin fold thickness University of Baghdad/ College of Medicine 2022-2023 Skinfold thickness (SFT) measurement is a reliable, cheap, simple, noninvasive method of body fat estimation at all ages including the newborn period. It measures the thickness of subcutaneous fat at various sites of the body from which total body fat and hence contribution of fat to body mass can be estimated. It involves using a device called Herpenden's caliper to lightly pinch the skin and underlying fat in several places (Triceps, Subscapular, quadriceps). This quick and simple method of estimating body fat requires a high level of skill to get accurate results. The skinfold with subcutaneous fat is picked up thumb and Triceps University of Baghdad/ College of Medicine 2022-2023 The measurement of the triceps skinfold is taken halfway between the top of the shoulder and the elbow (halfway along the upper arm). Subscapular University of Baghdad/ College of Medicine 2022-2023 The measurement of the subscapular skinfold is taken at the bottom right corner of the left shoulder blade. Quadriceps University of Baghdad/ College of Medicine 2022-2023 The Measurement of the quadriceps (thigh) skinfold is taken halfway along the top of the upper leg. Fat thickness University of Baghdad/ College of Medicine 2022-2023 >10 mm – healthy children 1-6 years