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Malnutrition

Malnutrition Syndrome

Malnutrition is a condition, characterized by consumption of a diet, containing too less, or excessive amounts of nutrients. Such a condition, can lead to either undernutrition or overnutrition.


Presentation

Protein energy malnutrition is one of the major manifestations of nutritional deficiencies. Signs and symptoms include the following:

Other signs and symptoms differ, based on the type of micronutrient deficiency that has set in. These include the following [7]:

Anemia
  • Blood tests for anemia, electrolytes, calcium, phosphorus, magnesium, ferritin, vitamin B 12 , and folate should be considered for assessment of major micronutrients.[ncbi.nlm.nih.gov]
  • Confirmed associated disorders compounding the malnutrition include alcoholic cirrhosis, protein deficiency, and megaloblastic anemia.[ncbi.nlm.nih.gov]
  • ., 1.39 g/dL), anasarca (increase of 15 kg in 79 d), and normocytic and normochromic anemia (e.g., hemoglobin 9.2 g/dL). In July 2013 the RYGB partial reversal technique was performed with a reduction of 100 cm in the Roux-en-Y arm.[ncbi.nlm.nih.gov]
  • Laboratory findings evidenced anemia (107 g/l). The serum albumin concentration indicated a reduced level (28 g/l). Search for antinuclear antibodies, anti-SSA antibodies, anti-SSB, -Sm, -RNP and anti-double-stranded DNA antibodies was negative.[ncbi.nlm.nih.gov]
  • If she is malnourished the baby risks being stunted, which can happen when anemia and malnutrition is combined. If the food intake is higher than needed and high in calories, she may suffer from gestational diabetes.[hemocue.com]
Fatigue
  • General symptoms include fatigue, dizziness, and weight loss. Testing depends on the specific disorder. Most health care providers will do a nutritional assessment and blood work.[nlm.nih.gov]
  • Symptoms: Some of the major symptoms include weight loss, fatigue, retarded growth, anemia, and developmental delay. In addition, affected individuals also suffer from poor cognitive functioning, along with decreased attention span.[symptoma.com]
  • An unbalanced diet Certain medical problems, such as malabsorption syndromes and cancers Symptoms may include fatigue, dizziness, and weight loss. Or, you may have no symptoms.[medlineplus.gov]
Hypothermia
  • However, the ketosis was accompanied by hypothermia and malnutrition as well as diabetic ketoacidosis (DKA). Therefore, we retrospectively collected biochemical data on cases of hypothermia and malnutrition and compared them with the present case.[ncbi.nlm.nih.gov]
  • —Impaired temperature regulation: Especially seen in people with cachexia, people who endure severe weight loss due to undernutrition find themselves unable to store body heat, which can lead to hypothermia.[richmondvale.org]
  • Cases showing hypothermia require warming. Rehabilitation phase of treatment: starts as the child's appetite returns, usually a week after treatment is started. Many essential nutrients are still deficient.[patient.info]
  • Hypothermia can occur. To prevent or treat this, the child can be kept warm with covering including of the head or by direct skin-to-skin contact with the mother or father and then covering both parent and child.[en.wikipedia.org]
Constipation
  • She gradually stopped drinking and developed severe constipation and encopresis. A new behavior of collecting saliva in her mouth and spitting onto napkins also emerged. Vital signs and electrolytes were normal on admission.[ncbi.nlm.nih.gov]
  • Some patients suffer from persistent diarrhea or long term constipation. Menstruation may be irregular or stop completely in malnourished women. Depression is common in malnutrition. This could be both a cause as well as an effect of malnutrition.[news-medical.net]
  • It is well known for its high fiber content which is the best remedy for constipation and also plays a vital role in the cholesterol management and smoothens the digestive process. It also helps you in loosing body weight.[medical-dictionary.thefreedictionary.com]
Failure to Thrive
  • Failure to Thrive. American Family Physician [On-line journal]. Available online at through . Chapter 2. Malnutrition. Merck Manual of Diagnosis and Therapy, Section 1. Nutritional Disorders [On-line journal]. Available online at through .[labtestsonline.org]
  • Differential diagnosis Elderly failure-to-thrive (weight loss 5% of baseline, decreased appetite, poor nutrition, inactivity) - consider in addition to malnutrition [ 9 ] : Impaired physical function (for example, infection, malignancy, renal or heart[patient.info]
Bitot's Spots
  • The ocular manifestations of xerophthalmia include conjunctival and corneal xerosis (drying), keratomalacia (corneal necrosis/ulceration), nyctalopia (night blindness), and Bitot's spots (conjunctival lesions).[ncbi.nlm.nih.gov]
Skin Lesion
  • The severity of the skin lesions in this case can be explained by the coexistence of two metabolic diseases causing complex malnutrition.[ncbi.nlm.nih.gov]
Apathy
  • Other features include reduced physical activity, mental apathy, and retarded psychomotor and mental development [ 4-6 ]. Literature review current through: Dec 2017. This topic last updated: Jun 28, 2017.[uptodate.com]
  • Signs and symptoms include the following: Diminished growth Inappropriate weight gain Significant changes in behavior, characterized by anxiety, poor attention, apathy, irritability and decreased attention span Other signs and symptoms differ, based on[symptoma.com]
  • —Brain: Mental health illnesses can cause malnutrition and malnutrition can be a decisive factor in the development of mental health illnesses, such as apathy, depression, introversion, self-neglect and deterioration in social interactions.[richmondvale.org]
  • Clinical findings Weakness, apathy, anorexia, diarrhoea, skin pigmentation and/or ulceration. Lab Reduced folic acid, iron, magnesium, bile synthesis, disaccharidase activity, protein, vitamin B12.[medical-dictionary.thefreedictionary.com]

Workup

The following tests are carried out, to diagnose the type of malnutrition and its associated conditions that have set in:

  • Blood work to obtain complete blood profile of the affected individual. This would include sedimentation rate, and serum electrolyte analysis.
  • Urinalysis and stool culture are also carried out, to determine the cause of infection that has caused malnutrition to develop.
  • Thyroid functions tests, and sweat chloride tests, would also be required, if the high velocity values are abnormal.
  • In children who have also developed liver disorders, levels of triglyceride and vitamins are determined [9] [10].

Treatment

Mild cases of malnutrition can effectively be treated with dietary modifications, and nutritional supplements, to correct the deficiencies. In such situations, MNPs – micronutrient powders can be used, to replenish the lost stores of the nutrients. MNPs are combinations of various vitamins and minerals in powder form, which needs to be mixed with any type of semisolid food. Such a type of method has been found to correct, as well as prevent nutritional deficiencies in children aged 6 to 23 months [11].

In case of moderate to severe cases, hospitalization may be indicated. It is necessary in cases when a severe form of dehydration has set in, along with clinical signs indicating the onset of other types of associated complications. Children or individuals with severe malnutrition, have to be administered enteral tube feeding to correct nutritional deficiencies [12].

Prognosis

Prognosis of the condition majorly depends on the cause of malnutrition. If primarily nutritional deficiencies are the culprit, then these can easily be corrected. However, if malnutrition has set in due to underlying disease conditions, then the disease needs to be treated to correct nutritional deficiencies [6].

Etiology

Malnutrition stems from several factors which include:

  • Poor diet habits: Diet which is deficient in several micronutrients and macronutrients. In many cases, malnutrition can also develop, if the diet is deficient in single vitamins.
  • Underlying medical conditions such as gastroenteritis, worm infections, chronic diarrhea and HIV/AIDS, can also cause malnutrition to set in. Various disease conditions, also lead to disturbances in the processes of digestion and absorption, which have a major role to play in the development of malnutrition [2].
  • Poverty and food prices: Financial crisis and poor socioeconomic status of the individuals prevents them from purchasing nutritious food. In many parts of the world, especially developing countries, people often do not get even one complete meal in a day. To add to this, increase in food prices, also prevents the population to reach out for nutritious food stuffs, such as milk, poultry, fruits, vegetables and meat [3].
  • Agricultural productivity: Poor agricultural productivity due to various factors, significantly contributes to shortage of food, giving rise to malnutrition [4].

Epidemiology

Worldwide, malnutrition is known to be a major risk for illness and death. Statistics indicate that more than 54% deaths of children occurred due to malnutrition in the year 2001. In addition, children less than 5 years of age, fall easy preys to this condition, and this accounts for 300,000 deaths per years [5].

Pregnant women affected by malnutrition, are at an increased risk of giving birth to low birth weight babies. On the other hand, low birth weight infants have a difficult time in struggling for life, and also have to face consequences during their developmental years.

Sex distribution
Age distribution

Pathophysiology

Malnutrition does not spare even a single organ system. Protein is required for growth and maintenance of body tissues. Energy is of utmost importance for various physiologic processes of the body. In addition, various micronutrients are essential for optimal functioning of the enzymatic processes. Therefore, nutrient deficiency in any, or all of these nutrients, has grave consequences. Malnutrition also causes poor immunity, which in turn predisposes the affected individual to develop other types of diseases conditions.

Prevention

The best way through which malnutrition can be prevented, is by adopting healthy and correct dietary practices: The following measures can be followed:

  • Eating a nutritionally balanced diet, a diet that has all macro- and micronutrients. 
  • Consumption of at least 5 servings of fruits and vegetables on a daily basis.
  • Seek immediate medical intervention for any type of underlying disease conditions.
  • If dietary modifications aren’t a possibility, then supplementation would be necessary.

Summary

Malnutrition is most commonly used for referring to undernutrition. It is one of the leading causes of morbidity, and mortality, across the globe. The condition can cause protein energy malnutrition to set in, and can also give rise to micronutrient deficiencies. Children and women are more affected by this condition. Retarded growth, behavioral changes, and wasting, are some of the major effects of malnutrition [1].

Patient Information

  • Definition: Malnutrition occurs due to inadequate dietary practices, wherein either there is too little, or excessive amounts of nutrients. If the condition is not treated on time, it can cause severe life threatening complications.
  • Cause: Inadequate access to food, either due to poverty, or high food prices, is the major cause of malnutrition. In addition, certain underlying disease conditions and infections that interfere with the body’s digestion and absorption process, can also lead to malnutrition.
  • Symptoms: Some of the major symptoms include weight loss, fatigue, retarded growth, anemia, and developmental delay. In addition, affected individuals also suffer from poor cognitive functioning, along with decreased attention span.
  • Diagnosis: Preliminary blood tests to obtain complete blood count and levels of iron and other nutrients are done. Stool cultures and urinalysis are also indicated, to find out the causative factors.
  • Treatment: Malnutrition is treated through supplementation of nutrients, and correction of underlying disease conditions. If dehydration has developed in case of severe diarrhea, then correcting electrolyte imbalances would be the primary goal of treatment.

References

Article

  1. Martorell R, Rivera J, Kaplowitz H, Pollitt E. Long-term consequences of growth retardation during early childhood. In: Hernandez M, Argente J. Human growth:basic and clinical aspects. Amsterdam: Elsevier Science Publishers; 1992:143-149.
  2. Bandsma RH, Spoelstra MN, Mari A, et al. Impaired glucose absorption in children with severe malnutrition. J Pediatr 2011; 158:282.
  3. Bergen DC. Effects of poverty on cognitive function: a hidden neurologic epidemic. Neurology 2008; 71:447.
  4. Rao KS, Khan L. Basal energy metabolism in protein-calorie malnutrition and vitamin A deficiency. Am J Clin Nutr 1974; 27:892.
  5. Blossner, Monika, de Onis, Mercedes. Malnutrition: quantifying the health impact atnational and local levels. Geneva, Switzerland: World Health Organization; 2005. Environmental Burden of Disease Series.
  6. Page AL, de Rekeneire N, Sayadi S, et al. Infections in children admitted with complicated severe acute malnutrition in Niger. PLoS One 2013; 8:e68699.
  7. Kleinman RE, Murphy JM, Little M, et al. Hunger in children in the United States: potential behavioral and emotional correlates. Pediatrics. Jan 1998;101(1):E3
  8. Hussain A, Lindtjørn B, Kvåle G. Protein energy malnutrition, vitamin A deficiency and night blindness in Bangladeshi children. Ann Trop Paediatr 1996; 16:319.
  9. WHO Guideline. Updates on the mangagement of acute severe malnutrition in infants and children, World Health Organization; 2013.
  10. World Health Organization (WHO) and United Nations Children's Fund (UNICEF). WHO child growth standards and the identification of severe acute malnutrition in infants and children. World Health Organization Press; Department of Child and Adolescent Health and Development, Geneva, 2009.
  11. Collins S, Myatt M, Golden B. Dietary treatment of severe malnutrition in adults. Am J Clin Nutr 1998; 68:193.
  12. Man WD, Weber M, Palmer A, Schneider G, Wadda R, Jaffar S. Nutritional status of children admitted to hospital with different diseases and its relationship to outcome in The Gambia, West Africa. Trop Med Int Health. Aug 1998;3(8):678-86.

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Last updated: 2017-08-09 17:28