NTR321 - Malnutrition - Malnutrition Malnutrition...

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Unformatted text preview: Malnutrition Malnutrition Undernutrition Macronutrients Micronutrients (hidden) Overnutrition Becoming more prevalent Sometimes combined with under nutrition Not the same for everyone Vulnerable populations Fetus Infant Child Pregnant & lactating women Undernutrition Macronutrients Marasmus, Kwashiorkor Micronutrient deficiencies Protein-energy malnutrition (PEM) Vitamin A deficiency & disorders Iron deficiency anemia Zinc deficiency Iodine deficiency & disorders Other micronutrient deficits Infection and disease Macronutrients Major roles/function of: Carbohydrate Fat Protein Functions of Proteins Structural Enzymes Hormones Transporters Fluid balance Acid/base balance Antibodies Visual pigment Blood clotting Structural Collagen Matrix of bones and teeth Ligaments and tendons Scar tissue Strengthening glue between the cell of the arterial wall Protein deposition In cells Skin GI tract Hair and fingernails Enzymes Definition A protein that facilitates chemical reactions (buildup or breakdown) without itself being changed in the process - a protein catalyst Hormones Messenger molecules Secreted by one tissue/organ, carried in the blood to a target tissue to elicit a response (on or off) Insulin Growth hormone Thyroid hormone Glucagon Transporters Blood transporters Hemoglobin Lipoproteins Transferrin Albumin carries molecules of all sorts Membrane bound transporters Fluid Compartments Albumin Acid/base balance Proteins act as buffers to help maintain pH Buffer a solution that can tolerate addition of an acid/base with a minimal change in pH (can neutralize acid/base to a certain extent without a change in pH) Antibodies Large proteins produced by the body in response to invasion by a foreign particle (bacteria, virus, pollen) Visual Opsin Protein of visual pigment Blood Clotting Damage to tissue Stabilized Fibrin (clot) Fibrinogen Loose Fibrin Measurements of Nutritional Status Anthropometric Measures used for Nutritional Status Weight Length/height Mid upper arm circumference Chest circumference Head circumference Skinfold measures Growth Charts Growth Charts Specific to age and gender Weight for age Length/Height for age Weight for Length/Height BMI for age OK135S071 Anthropometric classifications Underweight: Low weight for age Stunted: Low height for age Wasting: Low weight for height Interpreting Growth Charts z Score Notes: 1. A child in this range is very tall. Tallness is rarely a problem, unless it is so excessive that it may indicate an endocrine disorder such as a growth-hormone-producing tumor. Refer a child in this range for assessment if you suspect an endocrine disorder (e.g. if parents of normal height have a child who is excessively tall for his or her age). 2. A child whose weight-for-age falls in this range may have a growth problem, but this is better assessed from weight-for-length/height or BMI-for-age. 3. A plotted point above 1 shows possible risk. A trend towards the 2 z-score line shows definite risk. 4. It is possible for a stunted or severely stunted child to become overweight. Some Stats on Undernutrition Mothers and children < 5 years old > 3.5 million die each year Underlying cause is undernutrition Mental and physical disability for more Absolute number Percentages of populations Where in the world Majority South-central Asia Sub-Saharan Africa South Central Asia South Asia Central Asia Sub-Saharan Africa Models for Malnutrition and Disease Cycle of LBW Vicious Cycle of Infection and Undernutrition Diarrhea Causes of PEM Chronic shortage of energy and/or protein Illness Measles Diarrhea Other Aflatoxins? Marasmus Dry Form State of starvation over a long period of time caused by inadequate kcal and protein intake Very little food Symptoms Very wasted appearance Little fat or muscle No growth / stunted brain development Anemia Impaired immune function Diarrhea Marasmus More common form than Kwashiorkor Very little food Breastfeeding short duration exclusive past 6 months Fed diluted and unsanitary formula Unclean and/or low nutrient complementary foods No CHO so no insulin Use fat for energy first Ketones, muscle conservation Use muscle/protein when fat is depleted Amino acids used to make plasma proteins Normal adaptations to starvation Kwashiorkor Wet Form State of starvation due to sudden deprivation of food Often seen when new baby is born or precipitated by infection (measles or other infections) Symptoms No growth Edema Swollen limbs Fatty liver Swollen abdomen Apathy Kwashiorkor Some CHO in diet Insulin Muscle protein synthesis plasma protein albumin, lipoproteins ATP production (enzymes) GI function Immune function Less common, perhaps maladaptation More aflatoxin in kwashiorkor Refeeding During starvation Electrolytes shift from inside cell to outside cell Blood tests may show normal levels even though nutrients are very depleted When refeeding occurs Body adapts to using CHO for fuel In the presence of insulin Electrolytes shifts back into cells Hypophosphotemia and fluid retention occur Risk of cardiac, neuromuscular, kidney and GI disorders and/or failure Refeeding Rehydrate Stabilize electrolytes Potassium and magnesium most common Calcium and phosphate Treat infections Prevent hypothermia May remain NPO for 24-48 hours Feed orally or by tube Goal: 3-4 grams/kg actual wt of protein 200 kcals/kg wt of energy Milk based formula is preferred Vicious Cycle of Undernutrition and Infection International Organizations UN United Nations UNICEF United Nations Children's Fund: Seeks to meet the needs of children by supplying food, safe water, medicine and shelter. WHO World Health Organization: Coordinates programs aimed at solving health problems and the attainment by all people of the highest possible level of health. It works in areas such as immunization, health education and the provision of essential drugs. FAO Food and Agriculture Organizations of the United Nations: Works to improve agricultural productivity and food security, and to better the living standards of rural populations. NGOs ...
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