SGU S2017 NUT 9-10 Undernurished / Kwashiorkor & Marasmus

What is the key diagnostic feature of kwashiorkor?

edema (pitting)

What are the 2 goals of the initial stabilization period for severe malnutrition?

edema cured - LOW protein diet given appetite returns

Which 3 steps of the 10 steps for routine treatment of severe malnutrition must be ongoing from start to finish.

electrolytes micronutrients sensory stimulation

What macromolecules are required for repair due to oxidative damage?

essential fatty acids

How does stem cell recruitment in endochondral ossification act as an autocrine process?

expression of IGF-1 and IGF-1 receptors

What hepatic disorder is associated with kwashiorkor?

fatty liver

What is the main driver (hormone) of IGF-1 production in bone during childhood?

growth hormone

Describe the level of plasma ferritin levels in children who die due to kwashiorkor.

high plasma ferritin

Infant length growth reflects _____ nutritional status and is independent of _____ intake.

maternal-intrauterine protein - childhood IS sensitive to nutrition and environmental stress.

List 4 types of food rich in bioavailable micronutrients and minerals.

milk meat fish eggs

childhood growth is sensitive to what two environmental stresses

nutrition (type 2 nutrients) infections

When does stunting develop?

post-weaning

Malnutrition due to lack or poor quality of food

primary malnutrition - relatively rare compared to secondary malnutrition in developed countries

Which 2 nutrients are known to be directly involved in height growth?

protein zinc

List the 3 phases of treatment for severe malnutrition.

resuscitate, repair, replete

Review the role of iron in kwashiorkor.

*Low hemoglobin due to lack of cytokine synthesis*

Review INITIAL stabilization of severe malnutrition.

*INITIAL stabilization:* *- FIRST Antibiotics if infection present / Fever* *- SECOND Rehydrate with ReSoMal solution*

What micronutrient deficiency causes acrodermatitis hepaticus in kwashiorkor?

- acrodermatitis hepaticus caused by zinc deficiency.

Review New Guinea children study.

- dietary background was taro and potatoes. - freedom to roam about the forest was less than that of the village. - children in the village had the same diet, but were of normal height. - KEY DIFFERENCE: additional use of animal protein in the diets of children that mainly came from insects in the forest

Review rat protein study.

- increasing deficiency of dietary protein for rats - all changes associated with changes in IGF-1 levels in the growth plate.

What percent of energy is provided in the form of protein in the initial stabilization period for severe malnutrition?

4-6.5% of energy

Review Karamojoa/Buganda study.

Buganda are stunted and over weight from primary high starch diet.

Should kwashiorkor be treated with high protein tube-feeding?

NO! Protein deficiency is NOT the CAUSE - it is due to the disease - can be fatal.

Review oxidative stress and kwashiorkor.

i

How does zinc affect height and weight of children?

increase in height normal weight

What is the most likely noxious insult that causes kwashiorkor?

infection

What is the most likely cause of stunting in the developing world?

infection due to lack of clean water and unsanitary home environment - diarrhea

How does infection and inflammation (IL-1, TNF, IL-6) affect chondrogenesis?

inhibition of chondrogenesis - can completely shut down chondrocyte proliferation and maturation.

What is the main driver (hormone) of IGF-1 production in bone during infancy?

insulin

Which micronutrient must not be administered during the initial stabilization period for severe malnutrition?

iron

What mineral is responsible for forming hydroxyl radical?

iron - converts peroxide and superoxide anion.

Does marasmus or kwashiorkor present with multiple pathology?

kwashiorkor - black child = reddish hair - white child = bleach white hair

What is the primary driver of whole body growth? skeletal muscle growth? visceral organ growth?

long bone growth passive stretch food intake, metabolic work - brain not included in generalized mechanism.

What is stunting?

low height for age

Malnutrition that accompanies disease which disturbs appetite or food digestion/absorption/utilization

secondary malnutrition

Is stunting or wasting a bigger problem worldwide?

stunting

What free radical is produced by T lymphocytes?

superoxide anion - converted to hydroxyl radical.

Review current view of kwashiorkor etiology.

the "noxious insult" in addition to the low protein is what tips the scales to induce kwashiorkor

List 3 antioxidant micronutrients required for protection against free radical production.

vitamin E vitamin A vitamin C selenium zinc manganese copper sulphur amino acids