Malnutrition PDF

Malnutrition ▪ Malnutrition is defined as an imbalance between the body’s needs and the intake of nutrients, which can lead to nutritional disorders. ▪ Malnutrition is divided into two main types 1. Undernutrition: A condition where the body does not receive a sufficient amount of...

Malnutrition ▪ Malnutrition is defined as an imbalance between the body’s needs and the intake of nutrients, which can lead to nutritional disorders. ▪ Malnutrition is divided into two main types 1. Undernutrition: A condition where the body does not receive a sufficient amount of nutrients from food. 2. Overnutrition: A condition where the body receives excess nutrients from the food intake. Types of malnutrition 1. Undernutrition: A. Protein Energy Malnutrition (PEM) ▪ Kwashiorkor ▪ Marasmus B. Hypovitaminosis and Mineral Deficiencies 2. Overnutrition: A. Obesity B. Hypervitaminoses  Dr. AHMED Soliman Undernutrition: A. Protein Energy Malnutrition (PEM): It develops in children and adults whose consumption of protein and energy (or calories) is insufficient to satisfy the body's nutritional needs. There are two forms of severe PEM: kwashiorkor and marasmus Kwashiorkor ▪ Kwashiorkor is common between 1-3 yrs old ▪ Etiology: 1. Very low protein but high carbohydrates diets 2. In places where starchy foods are the main staple ▪ Symptoms 1. Edema 2. Muscle wasting 3. Hair changes 4. Depigmentation of skin 5. Moon face 22  Clinical nutrition Marasmus ▪ Marasmus is common in the 1st year of life ▪ Etiology: 1. Insufficient breast milk 2. Dilute milk mixture because of poverty or ignorance 3. lack of hygiene leads to gastroenteritis, diarrhea, and vomiting ▪ Symptoms: 1. The child is very thin. 2. Marked muscle wasting. 3. Growth retardation 4. Mental changes 5. There is no edema. 6. There is loss of almost all the adipose tissue ▪ Treatment of Protein Energy Malnutrition: Severe PEM is an emergency, hospitalization 1-3 months desirable 1. Treatment of acute complications: correction of dehydration and/or very low blood glucose and/or low body temperature (hypothermia) and the start of treatment for infections. 2. Initiation of cure: refeeding, gradually working up the energy and protein intake, and giving multi-vitamin drops and potassium and magnesium supplements. 23  Dr. AHMED Soliman B. Hypovitaminosis and Mineral Deficiencies Undernutrition of minerals Undernutrition of vitamins Calcium Thiamine (Vitamin B1) – Rickets – Beriberi Iodine deficiency Niacin (Vitamin B3) – Goiter – Pellagra Iron deficiency Vitamin C – Anemia – Scurvy Zinc Vitamin D – Growth retardation – Rickets A goiter is a swelling of the neck Iron-deficiency anemia is common resulting from enlargement of the anemia caused by insufficient dietary thyroid gland, associated with a thyroid intake and absorption of iron, and/or gland that is functioning properly or not iron loss from bleeding leading to decrease normal red blood cell (RBC) production 24  Clinical nutrition Overnutrition 1. Obesity ▪ Obesity is a medical condition characterized by the excessive accumulation and storage of fat in the body Diagnosis ▪ It is defined by body mass index (BMI) Causes Of Obesity ▪ Physical inactivity: without activity, you don’t burn as many calories ▪ Diets: some bad eating habits like high calories diets epically at the night, or skipping a healthy breakfast, and replacing it by junk fast food ▪ Pregnancy: some women after the baby is born to have an increase in their weight ▪ Drugs: as steroids ▪ Genetics makes a person more or less likely to gain or lose weight when overeating or under-eating Complications Of Obesity ▪ Type 2 diabetes. ▪ High blood pressure. ▪ Stroke. ▪ Heart disease. ▪ Osteoarthritis. ▪ Cancer. ▪ Depression. 25  Dr. AHMED Soliman Classification of obesity according to fat distribution ▪ There are two types of obesity according to body shape pear shape and apple shape ▪ Pear shape is associated with the accumulation of fat in the pelvis, thighs, and gluteal region. ▪ Apple shape, central obesity, characterized by fat accumulation in shoulders and upper abdomen ▪ In relation to the health risk, the apple shape, appears to bring more risk. Individuals with this body shape are at greater risk of developing a metabolic, cardiovascular, or malignant disorder Management of Obesity 1. Dietary Therapy: Restrictions of calories represent the first-line therapy in all cases except in cases with pregnancy, lactation, terminal illness, anorexia nervosa, and osteoporosis. (Low-calorie diets, which provide 1000-1500 kcal/day. Very low calories diets, which provide 300-800 kcal/day) 26  Clinical nutrition 2. Physical Activity: All individuals can benefit from regular exercise. Physical activity, which increases energy expenditure, has a positive role in reducing fat storage and adjusting energy balance in obese patients. 3. Behaviour Therapy: Patients need to be trained in gaining self-control in their eating habits. Behavior modification programs that seek to eliminate improper eating behaviors (eating while watching TV, eating too rapidly, eating when not hungry…. etc.,) 4. Pharmacotherapy: Drug treatment is advised only for subjects with BMI > 30 and or with BMI > 27 and with associated risk factors (hypertension, DM, etc) thus at medical risk because of their obesity. 1. Amphetamines are no longer used in the treatment of obesity because of their high potential for abuse. 2. Inhibitors of serotonin reuptake, fenfluramine is licensed for obesity but proved to cause pulmonary hypertension and increased valvular heart disease. It has been withdrawn from the market. 3. Sibutramine is the serotonin and norepinephrine reuptake inhibitor, which induces decreased food intake and increased thermogenesis, also was withdrawn in 2010 due to the risk of heart attack and stroke 4. Orlistat is a potent and irreversible inhibitor of gastric and pancreatic lipases. It blocks the digestion of approximately 30% of the ingested dietary TAG. 5. Surgery Apart from drug treatment, surgery is also indicated when BMI is exceedingly high (> 40 or > 30 with obesity-related medical co-morbidities) and when other treatment modalities have failed. The most popular surgical procedures used for the treatment of severe obesities involve gastric portioning or Gastroplasty and Gastric bypass. 27  Dr. AHMED Soliman The gastroplasty procedures create a small gastric pouch, which is drained through a narrow calibrated stoma. Gastric by-pass surgery creates a larger pouch emptied by an anastomosis directly into the jejunum, bypassing the duodenum. It is considered the most effective and safe surgery for morbid obesity. 2. Hypervitaminoses ▪ Hypervitaminosis is a condition of abnormally high storage levels of vitamins ▪ Hypervitaminosis usually occurs more with fat-soluble vitamins (D, E, K, and A), which are stored in the liver and fatty tissues of the body. ▪ For example, Vitamin D Overdose can lead to hyper calcification of bones, heart, and kidneys. The symptoms of hypervitaminosis D include a decreased appetite, dehydration, constipation, irritability, vomiting, muscle weakness, and fatigue. 28