NUTN 301: Protein Energy Malnutrition Lecture Notes PDF

14/01/2024 NUTN 301: Nutrients and their metabolism I LECTURE 21: PROTEIN ENERGY MALNUTRITION 1 Learning objectives 1. Define protein energy malnutrition 2. Distinguish between kwashiorkor and marasmus 3. Describe the features of ◦ Kwashiorkor ◦ Marasmus...

14/01/2024 NUTN 301: Nutrients and their metabolism I LECTURE 21: PROTEIN ENERGY MALNUTRITION 1 Learning objectives 1. Define protein energy malnutrition 2. Distinguish between kwashiorkor and marasmus 3. Describe the features of ◦ Kwashiorkor ◦ Marasmus ◦ Marasmic kwashiorkor 4. Calculate protein requirement 2 Overview  PEM ranges from mild to severe  Mild to moderate forms are typically subclinical and are detected through anthropometric measurements  Severe forms are clinical conditions ◦ Marasmus ◦ Kwashiorkor ◦ Marasmic kwashiorkor 3 1  14/01/2024 Selected indicators for assessing subclinical PEM  Anthropometry (measurements of physical growth)  Weight; Height; weight and height ◦ Z-Scores (WAZ; HAZ; WHZ) ◦ BMI  Head circumference  Mid-upper arm circumference (MUAC)  Waist-to-Hip ratio 4 Clinical malnutrition: Kwashiorkor  First described in Ghana (Cicely Williams 1930s)  The disease the old baby gets when the new baby is born ◦Was associated with abrupt weaning  More associated with poor quality of diet rather than quantity of diet 5 Kwashiorkor (poor diet quality) Outward signs ◦ Swollen feet/legs and hands ◦ Extended stomach ◦ Child is irritable ◦ Apathy ◦ Sparse hair ◦ Poor appetite ◦ High mortality risk 6 2  14/01/2024 Kwashiorkor Decreased muscle mass Swollen belly (oedema and lipid build-up around the liver) Changes in skin pigment; may lose pigment where the skin has peeled away (desquamated) and the skin may darken where it has been irritated or traumatized Hair lightens and thins, or becomes reddish and brittle. Increased infections and increased severity of normally mild infection, diarrhoea Apathy, lethargy, irritability Edema and flaky paint dermatosis Death does not occur from actual starvation but from secondary infection 7 Marasmus  Severe wasting (emaciation) ◦ Inadequate food intake ◦ Maybe associated with prolonged BF without adequate complementary feeding (dilute and unhygienic) ◦ May be associated with famine situations  Wrinkled ‘old man’ appearance  Usually occurs 50 0.80 0.80 12 12 4  14/01/2024 How to calculate your protein requirement  Look up the healthy weight for a person of your height  Convert pounds to kilograms, if necessary (pounds divided by 2.2 equals kilograms)  Multiply kilograms by 0.8 to get your RDA in grams per day 13 13 Example  If your healthy body weight is 150 Ib., calculate your protein RDA/day. Solution  150 Ib. ÷ 2.2 Ib. = 68.2 kg  68 kg x 0.8 g/kg = 54.5 g protein 14 14 5