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Protein Energy Malnutrition
Module
Introduction to Nutrition
12 Documents
Students shared 12 documents in this course
University
Leeds Beckett University
Academic year: 2019/2020
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Protein Energy Malnutrition
Learning Objectives
- Discuss the causes of malnutrition in developing countries
- Describe the different forms of protein-energy malnutrition
- Describe the symptoms of severe protein-energy malnutrition in children
- Outline the treatment needed to treat a malnourished child
- Define the criteria that classifies protein-energy malnutrition
Malnutrition
=deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients - Undernutrition – deficiencies - Overweight – excesses
Causes of Malnutrition
- Infection and disease o Commonly seen in children in low socio-economical areas o E. malaria, whooping cough, diarrhoea
- Inadequate food supply o Impacts vulnerable groups [children, lactating female, elderly] on their body composition
- Inappropriate feeding – cessation of breast feeding due to having to return to work/caring for the family o Child becomes malnourished as doesn’t get essential nutrients from the milk o Milk supplies can dry up if the mother isn’t getting enough nutrition o Milk powders would be mixed with unclean water – making the child unwell
Nutrition and Immunity
Inadequate dietary intake weight loss/lowered immunity [don’t produce immunoglobulins] /mucosal damage [don’t feed microbiota] /impaired growth diarrhoea/malabsorption/loss of appetite diversion of nutrients for immune response instead of energy and reserves increased requirements due to fever - Cycle repeats over and over again
Factors contributing to malnutrition
Poverty
Poor feeding practises [stopping feeding baby via breast]
Lack of land
Insufficient food production
Ignorance on part of mothers
Exploitation
Diarrhoea
No potable water
High price of fertiliser
Drought
Measles
Too many children to feed
Lack of credit or credit too expensive to buy food
Health care too far away
Terms
- Undernutrition = inadequate food intake [precursor of PEM]
- Protein energy malnutrition [PEM] = a deficiency of both protein and energy [world’s most widespread malnutrition problem] including Kwashiorkor and Marasmus types [and possible overlap of the two]
- Acute PEM = caused by recent severe food restriction and characterised in children by thinness for height [WASTING]
- Chronic PEM = caused by long term food shortage and characterised in children by short height for age [STUNTING]
Marasmus
- Marasmus occurs more often in young children and babies. [6-18 months]
- It leads to dehydration and weight loss.
- Starvation is a form of this disorder.
- increased risk for marasmus living in a rural area where it’s difficult to get food or an area that has a food shortage.
- Babies, including babies who aren’t breast-fed, young children, or older adults also have an increased risk for marasmus. The symptoms of marasmus include:
- No water retention
- Lower than normal resting metabolic rate therefore not able to respond to change in temperature for instance (thermogenesis) so core temp remains low
- Subcutaneous fat is almost absent and muscle is great reduced.
- Low body temperature
- Hunger and irratibility
- Extreme weight loss
- Severe wasting of muscle
- No oedema – no water retained
- Dehydration – sunken eye look – old man
- Chronic diarrhea
- Stomach shrinkage
Kwashiorkor
Kwashiorkor occurs in people who have a severe protein deficiency.
IV feeding may be used if dehydration is very severe but can only be used for a minimum length of time due to overloading the heart by it having to pump fluid round the body
Preparation for High Energy Feeding
- This can begin when the infections, electrolytes and rehydration are controlled
- During the first week the strength and volumes of feeds are gradually increased, and the frequency of feeding decreased
- A plate is used to catch any spills from the cup when feeding to ensure all nutrition gets in to the child – education for the parents
Catch up diet: rehabilitation
- Aim: restore normal weight for height
- With careful feeding, a weight gain between 10-15x a normal weight can be achieved
- 150-200 kcal/kg/day are required [90-100 kcal/kg/day for 6months-4yrs old]
- Healthy child protein recommendations: 1-1/kg/day
- For catch up diet: 2g/kg/day should be adequate to provide enough energy and the protein source is of high biological value
Routine vitamin supplements
- Vitamin A, Vitamin C, folic acid and thiamine [in rice eating areas] are given routinely as most malnourished children are deficient in them
- Iron – given to correct anaemia
- UNICEF produce tablets containing 30mg and 100ug of folic acid – administered twice a day – to prevent relapse when returning to home environment
Follow up after discharge
- Reduces the risk of developing PEM again
- Allows the child to be immunised
- Provides an opportunity for continuing nutrition education for the family
Nutrition rehabilitation centres
- Ordinary house/community building that has been modified [some are residential, some are day care]
- Should include: o Suitable facilities for preparing and cooking food together o Adequate sleeping facilities for mothers and children [residential o Education on hygiene [hand washing and food prep]; utilise food products effectively; correct balanced diets; where to source food from o Nutrition demonstrators to help and encourage food prep using local foods o Support of medical and nursing staff
Anthropometry
Commonly used to assess PEM in developing countries
- Weight for age [W/A]
Weight for height [W/H]
Height for age [H/A]
Gomez Classification [Mexico]
- Childs weight / weight of healthy child of same age % expected weight for age Classification >90% Normal 76-90% Grade 1 mild malnutrition 61-75% Grade 2 moderate malnutrition <60% Grade 3 severe malnutrition
Problems:
- Not subdivided due to symptoms [e. oedema masks weight loss – preventing urgency of treatment]
- High cut off point of 90%
Wellcome Classification of Severe PEM
- Also takes into account whether oedema is present to prevent ill-information Weight for age [% of expected]
Oedema present Oedema absent
80-60 Kwashiorkor Under nutrition <60 Marasmic Kwashiorkor Marasmus
Mid-upper arm circumference [anthropometric measurement]
- Aged 1-5 children in developing countries
- Circumference remains constant between the age due to constant size of muscle and bone over this age period
- +ve – quick, cheap, non-invasive Colour Arm circumference [cm] Status Green 13.5-17 Normal Yellow 12.5-13 Mild malnutrition Red 7-12 Definite malnutrition
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Protein Energy Malnutrition
Module: Introduction to Nutrition
12 Documents
Students shared 12 documents in this course
University: Leeds Beckett University
Was this document helpful?
Protein Energy Malnutrition
Learning Objectives
- Discuss the causes of malnutrition in developing countries
- Describe the different forms of protein-energy malnutrition
- Describe the symptoms of severe protein-energy malnutrition in children
- Outline the treatment needed to treat a malnourished child
- Define the criteria that classifies protein-energy malnutrition
Malnutrition
=deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients
- Undernutrition – deficiencies
- Overweight – excesses
Causes of Malnutrition
- Infection and disease
oCommonly seen in children in low socio-economical areas
oE.g. malaria, whooping cough, diarrhoea
- Inadequate food supply
oImpacts vulnerable groups [children, lactating female, elderly] on their body
composition
- Inappropriate feeding – cessation of breast feeding due to having to return to
work/caring for the family
oChild becomes malnourished as doesn’t get essential nutrients from the milk
oMilk supplies can dry up if the mother isn’t getting enough nutrition
oMilk powders would be mixed with unclean water – making the child unwell
Nutrition and Immunity
Inadequate dietary intake weight loss/lowered immunity [don’t produce
immunoglobulins] /mucosal damage [don’t feed microbiota] /impaired growth
diarrhoea/malabsorption/loss of appetite diversion of nutrients for immune response
instead of energy and reserves increased requirements due to fever
- Cycle repeats over and over again
Factors contributing to malnutrition
- Poverty
- Poor feeding practises [stopping feeding baby via breast]
- Lack of land
- Insufficient food production
- Ignorance on part of mothers
- Exploitation
- Diarrhoea
