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on Sep 20, 2012 Says :
on Aug 16, 2012 Says :
Nice ppt on protein energy malnutrition.
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Slide 1 :
PROTEIN ENERGY MALNUTRITION
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WHO:PEM is range of pathological conditions arising from coincidental lack of varying proportion of proteins and calories, occurring most frequently in infants & young children and commonly associated with infection Definition
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Gomez’s classification Classifications
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Classification based on national centre for health statistics standards
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Indian Academy of Pediatrics classification Add (k) for presence of edema
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Wellcome trust classification
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Childhood malnutrition- 35% of all deaths-under five National family health survey - 40% of Indian's children under the age of three are underweight, 45% are stunted, 23% are wasted.
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During first six months of life, 20 – 30% of children are malnourished. By18 – 23 months,30% of children are severely stunted and one-fifth are severely underweight.
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Poverty :- The poor cannot purchase adequate amount of food of the desired quality for meeting their and their family’s nutritional requirements. Etiology
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Low birth weight :- malnourished mothers have a high incidence of low birth weight and growth retarded babies with poor nutritional reserve.
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Infections :- Diarrhoea, pneumonia, malaria, measles, whooping cough, and tuberculosis precipitate acute malnutrition and aggravate the existing nutritional deficit Malnutrition-infection-malnutrition
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Population growth :- Increase in birth rate is disproportionate to increase in food production. Large families and higher birth order result in higher incidence of malnutrition
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Feeding habits :- Lack of exclusive breast feeding for first 6 months Introduction of complementary feeding is delayed, often beyond one year Irrational beliefs about the nutritional needs of infants and nutritional quality of common foods
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High pressure advertising of baby foods:- High pressure advertising of baby foods manufacturers and social demands on urban educated working women have encouraged early discontinuation of breast feeing
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Social factors:- Repeated pregnancies, inadequate child spacing, food taboos, broken homes and separation of child from parents Natural disasters like floods, earthquakes, and droughts shifts precarious nutritional balance towards negative side
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Upper GIT: mucosa shiny & atrophic. papillae of tongue flattened. Pathological changes in malnutrition in various organ systems
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Small & large intestine: Mucosa & villi atrophic, Brush border enzymes reduced, Hypotonic, Rectal prolapse Liver: Fatty liver, Deposition of triglycerides.
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Pancreas: Exocrine secretion depressed; Endocrine function less severely affected; Glucagon production reduced; Insulin levels low; Atrophy & degranulation or hypertrophy of islets seen
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Endocrine system: Elevated growth hormone; Thyroid involution & fibrosis ; Adrenal glands atrophic & cortex thinned; Increased cortisol; Catecholamine activity unaltered
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Lympholeticular system: Thymus involuted; Loss of distinction between cortex & medulla Depletion of lymphocytes; Paracortical area of lymph nodes depleted of lymphocytes; Germinal centers smaller & fewer
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Central nervous system: Head circumference & brain growth retarded, Changes seen in the dendritric arborization, morphology of dendritic spines, cerebral atrophy on CT/MRI; Abnormalities in auditory brain stem potentials & visual evoked potentials.
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Cardiovascular system: cardiac volume; muscle mass & electrical properties of the myocardium changes; systolic functions affected more than diastolic functions.
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Mild malnutrition Growth failure: Slowing or cessation of linear growth; State or decline in weight ; Decrease in mid arm circumference; Delayed bone maturation; Normal or diminished weight for height Z scores; Normal or diminished skin fold thickness Clinical features
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Infection: Gastroenteritis, pneumonia, tuberculosis. Anemia: may be mild to moderate & any morphological type may be seen.
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Activity: this may be diminished. Skin & hair changes: these may occur rarely
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Moderate to severe malnutrition Marasmus, kwashiorkor, or with manifestations of both.
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Severe wasting. Child appears very thin & has no fat. There is severe wasting of shoulders, arms , buttocks & thighs. monkey facies baggy pants appearance Axillary pad of fat may also be diminished Affected children may appear to be alert No edema MARASMUS
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Age 1-2yrs. Pitting edema General appearance: child may have fat “sugar baby” appearance edema: It ranges from mild to gross, and may represent up to 5-20% of body weight KWASHIORKOR
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Skin change: increased pigmentation desquamation & dyspigmentation Mucus membrane: smooth tongue, chelosis and angular stomatitis Hair: dyspigmentation loss of characteristic curls sparseness over temple & occipital regions. Flag sign
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Mental changes: Child becomes dull and apathetic and loses interest in the surroundings, intermittent cry. Gastrointestinal system: anorexia, sometimes with vomiting, abdominal distension Anemia with greater severity
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CVS:cold, pale extremities due to circulatory insufficiency, bradycardia, a diminished cardiac output & hypotension Renal function: glomerular filtration & renal plasma flow are diminished
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It is mixed form of PEM, and manifests as edema occurring in children who may or may not have other signs of kwashiorkor MARASMIC KWASHIORKOR
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Dehydration Hypothermia Hypoglycemia Infections Anemia Xeropthalamia Congestive heart failure complications
The prevalence of pr...
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etiology, classification and clinical features of protein energy malnutrition
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