STEP TO PG-MD/MS -DR.AKIF A.B

PROTEIN ENERGYMALNUTRITION

NUTRITIONAL STATUSINDICATORS

Weight for Age Height for age Weight for Height

Indicates Both Acute and Chronic Malnutrition

Indicates chronic malnutrition

Indicates acute malnutrition

Stunting Wasting

STEP TO PG-MD/MS -DR.AKIF A.B

IAP CLASSIFICATIONOF MALNUTRITION

Normal >80%

Grade 1 malnutrition 71-80%

Grade 2 61-70%

Grade 3 51-60%

Grade 4 <50%

-Based on weight for age

-Weight of a child is compared with weight of normal expected for that age

STEP TO PG-MD/MS -DR.AKIF A.B

GOMEZ CLASSIFICATIONBased on weight for age

Weight for age % = weight of child 100 weight of normal child of same age

90-110% Normal nutritional status

75-89% Mild malnutrition 60-74% Moderate malnutrition< 60 % Severe malnutrition

STEP TO PG-MD/MS -DR.AKIF A.B

WATERLOW’S CLASSIFICATION

-Based on Weight for Height and Height for age

STEP TO PG-MD/MS -DR.AKIF A.B

SEVERE ACUTE MALNUTRITION

1)Weight for Height <3SD of median WHO growth reference

2)Visible severe wasting

3)Presence of bipedal edema

4)Mid Arm Circumference < 11.5 cm

STEP TO PG-MD/MS -DR.AKIF A.B

MID ARM CIRCUMFERENCE-Used for below 5 years of age

- <13.5 cm : Malnutrition

-Shakir tape is used to measure MAC

>13.5 cm Green Normal

12.5-13.5 Yellow Borderline malnutrition

< 12.5 cm Red Wasted

STEP TO PG-MD/MS -DR.AKIF A.B

AGE INDEPENDENTINDICES

Kanawati Index MAC/ Head circumference

Rao and Singh Weight (kg)/ Height in cm2

Dugdale Weight (kg) / Height in cm 1.6

Quac stick MAC expected for a particular Height

STEP TO PG-MD/MS -DR.AKIF A.B

DIFFERENCES BETWEENKWASHIORKAR AND

MARASMUSMarasmus Kwashiorkar

Occurrence More common Less common

Edema Absent Present

Activity Active apathetic

Appetite Good Poor

Liver enlargement Absent Present

Mortality Low chances high

STEP TO PG-MD/MS -DR.AKIF A.B

STEP TO PG-MD/MS -DR.AKIF A.B

MARASMUS-Gross wasting of muscles and subcutaneous tissue resulting in emaciation and marked stunting

-Body weight <60% expected

-There is no edema

-Fat is severely depleted but buccal fat is preserved till last.

-Skin = dry , inelastic, wrinkles +

-Hair = Hypopigmented

-Abdomen = Distended due to wasting and hypotonia

-Appetite = Good

-Represents compensated phase of PEM

STEP TO PG-MD/MS -DR.AKIF A.B

KWASHIORKARTRIAD

1) Edema (due to Hypoalbuminemia)

2) Markedly retarded growth

3) Psychomotor changes

Hepatomegaly : Due to fatty infiltration

Skin Flaky paint dermatosis

Hair

Flag sign(Alternate band of hyperpigmented and hypopigmented hairs)

-Impaired appetite

-Increase chance of Infections

STEP TO PG-MD/MS -DR.AKIF A.B

Flaky Paint Dermatosis Flag Sign

STEP TO PG-MD/MS -DR.AKIF A.B

COMPLICATIONS OF PEMS = Sugar deficiency (Hypoglycemia)

H = Hypothermia

I = Infections

E

L

D

E

D = Deficiency of micronutrients

Dehydration

ELectrolyte abnormality

STEP TO PG-MD/MS -DR.AKIF A.B

TREATMENT OF PEMFIRST STAGE SECOND STAGE THIRD STAGEFirst 24-48 hours Next 7-10 days > 10days

Infection and dehydration is treated first

-Diet of 75 kcal/kg/day

-antibiotics

-Aim is to restore patients protein and fat contents

-Diet : 175-200kcal/kg/day for Severe Malnutrition

-150kcal/kg/day for Moderate malnutrition