Protein Energy Malnutrition (PEM)
if undernutrition is short term, this is
wasting
when you start to complementary feed a baby you should still ______ for protein
breastfeed
doctors don't spend much times on breast feeding related problems - consult a pediatric _____
dietician
what does the word kwashiorkor mean in the Ga language
disease of the first child when the second child is born
an instant indicator of kwashiorkor
edema
population that experiences PEM the most in the US
elderly
The most important strategy to rid protein energy undernutriton in developing countries is to
eliminate poverty and improve nutrition education
food fortification should be _______ in diets
encouraged
F75 and F100 IV allows child to build ____ ____, after being starved: you don't have the energy to eat as much as you would like to - body requires energy to digest food
energy stores
nutrition education with a dietician - lots of bad (fad) info on the
internet
yellow around a babies ears can be from _______ which can be caused by inadequate breastmilk (lack of colostrum and hind milk - both high in protein)
jaundice
1 egg a day ensures no way that a child will develop
kwashiorkor
PEM that begins during complementary feeding introduction, lack of knowledge to give protein foods, instead giving child foods like rice milk or maize/corn
kwashiorkor
PEM that occurs mostly in 6 months - 2 years old
kwashiorkor
extended belly, fatty liver, extreme form is edema, parents think the child is growing based on the belly and swelling but they are wrong
kwashiorkor
first identified in Ghana, disease of the first child when the second child is born
kwashiorkor
focus is on the new child and the first child is left unsupervised and not getting adequate nutrients
kwashiorkor
is dermatitis kwashiorkor or marasmus
kwashiorkor
is hair losing pigment kwashiorkor or marasmus
kwashiorkor
is not only dietary in origin: Infective, Psycho-social, Cultural factors are also operative
kwashiorkor
low hemoglobin (anemia) = indicator of
kwashiorkor
older infants and young children (1-3 yr), inadequate protein intake or infections, rapid onset: acute PEM, some weight loss, some muscle wasting, with retention of some body fat, loss of appetite, edema, skin develops lesions
kwashiorkor
proteins undernutrition can cause loss of hair pigmentation in
kwashiorkor
represents a maladaptive response to starvation
kwashiorkor
skin loses elasticity (edema) - if your press on the skin it indents
kwashiorkor
swelling (edema) in extreme forms is a symptom of this due to electrolyte balances from PEM
kwashiorkor
lack underlying adipose tissue - if you pinch skin it stays
marasmus
represents an adaptive response to starvation
marasmus
Growth retardation, Muscle wasting, Impaired immunity, Lethargy, Vomiting, Delayed wound healing, Loss of fat stores
marasmus symptoms
protein intake for healthy 4-8 year olds: _____ g/kg/day bodyweight or ___ g/day
.95, 19
protein intake for healthy 1-3 year olds: _____ g/kg/day bodyweight or ___ g/day
1.1, 13
a British nurse, had introduced the word Kwashiorkor to the medical literature in 1933 - she named and diagnosed kwashiorkor
Cecilly Williams
The word kwashiorkor is taken from the ___ language in _______ & used to describe the sickness of weaning.
Ga, Ghana
kwashiorkor was first diagnosed in _______, lack of nutritional knowledge - not necessarily poverty
Ghana
Dietary/Medical management of PEM: __ ____ treatment to correct fluid and electrolyte deficits, Treat infections with antibiotics, Gradual introduction of nutrients - preferrably through food and calories taken orally
IV fluid
primary malnutrition should be treated with the
IV fluids
protein deficiency
Kwashiorkor
Lack of food & clean water, poor sanitation, infection & social unrest leading to
LBW and PEM
the in between or combination of Kwashiorkor and Marasmus is called
Marasmic-Kwashiorkor
protein and energy deficiency
Marasmus
applies to a group of related disorders that include marasmus, kwashiorkor, and intermediate states of marasmus-kwashiorkor
PEM
the leading cause of death in children in developing countries and most widespread form of undernutrition in the world, can be sudden and total (starvation) or gradual
PEM
vaccines do not cause _____ - this paper was false and papers published that are false cause writers to be fired (there has only been one paper on a correlation between vaccines and autism)
autism
the majority of the worlds children live in
developing countries
food can be available but parents don't have the time to let the child ____ the food (picky)
accept
main goal once edema is detected
balance the electrolytes
low caloric intake, lack of nutritional knowledge, not enough protein in diet
causes of PEM
population that experiences PEM the most in developing countries
children
Most common in children - ones that do not get enough protein or calories, Mortality ranges from 5-40%
developing countries
can cause preterm deliveries or SGA
deficiencies
Treat _______ especially in elderly patients to encourage food intake
depression
Most common in elderly - in institutions or nursing homes, Surgical patients, Also in people with physical and mental disorders: ones that decrease appetite or impairs nutrient uptake by organs
developed countries (US)
'perceived' milk intolerance can actually just be too much _____ in breastmilk that causes similar symptoms
foremilk
IV fluid: F100 - 100 mL contains 100 kcals
given after F75
IV fluid: F75 - 100 mL contains 75 kcals
given first
Early detection & adequate treatment are associated with a ____ outcome
good
cholesterol free is not always
good
______ feeding is necessary so that the child does not develop refeeding syndrome which is deadly
gradual
Kwash & Marasmic-Kwash have _____ risk of morbidity & mortality compared to Marasmus and under weight
greater
Both short-term and long-term hunger exert negative effects on behavior and
health
person gets enough calories but not enough micronutrients (vitamins and minerals) - can effect both undernutrition and overnutrition, might not be from parent neglect, could be from an underlying condition
hidden hunger
prevents diseases that cause secondary malnutrition
immunization
_____ need cholesterol
infants
kwashiorkor: due to insufficient protein intake or _______, can result from a child being ______ from breast milk to a diet composed of starches and carbohydrates that contain little or no protein, maladaptive response to starvation, presence of edema, _____ _____ resulting in a bulging of the abdomen, thinning hair, skin depigmentation, fail to produce antibodies for diseases even after vaccine received
infections, weaned, fatty liver
Changes in skin pigment, Coma (late stage), Decreased muscle mass, Diarrhea, Failure to gain weight and grow, Fatigue, Hair changes (change in color or texture), Increased and more severe infections due to damaged immune system, Irritability, Large belly that sticks out (protrudes), Lethargy or apathy, Loss of muscle mass, Rash (dermatitis), Shock (late stage), Swelling (edema)
kwashiorkor symptoms
Children with __________ have nutritional edema and metabolic disturbances, including hypoalbuminemia and hepatic steatosis, whereas _______ is characterized by severe wasting
kwashiorkor, marasmus
management: family planning - in _____ families there is not enough money for nutrient dense food for children
large
parents must know what the child _____ and incorporate nutrient dense components
likes
hunger that impairs growth and immune defenses
long term
undernutrition all of pregnancy (pSGA) is
long term
Marasmus: severe energy undernutrition, adaptive response to starvation, tissue and muscle wasting and extremely ______ for _____, ____ adipose (fat) tissue, _____ skin, may eventually lead to the body's inability to synthesize and utilize any _______, at this point, giving protein in diet will not help to prevent death
low body weight, height, less, loose, protein
WHO defines ______ as "the cellular imbalance between the supply of nutrients and energy, and the bodys demand for them to ensure growth, maintenance and specific functions"
malnutrition
a state of deficiency or excess of energy, protein and other nutrients - encompasses both undernutrition and overnutrition
malnutrition
PEM associated with wasting and extreme skininess
marasmus
PEM that occurs most commonly in older children because it is breaking fat stores and muscles for energy
marasmus
infants and toddlers (less than 2 yr), severe deprivation or impaired absorption of nutrients, develops slowly: chronic PEM, severe weight loss, severe muscle wasting with fat loss, appetite mat be normal or impaired, no detectable edema, skin is dry, thin and wrinkled
marasmus
first poop of a baby: _____, it is black because it contains _______ from the excess of red blood cells the baby had to have while in the womb because it didn't have acesss to air, once birthed these red blood cells are broken down and excreted, if not excreted, the broken down red blood cells are reabsorbed which causes ______
meconium, bilirubin, jaundice
secondary PEM: some sort of underlying nutrient problem like having HIV - they need ____ protein and calories
more
some children with PEM may have a disorder where they require ____ _____ than what is recommended for their age group
more protein
PEM in children is from parent
neglect
extreme form of protein malnutrition, parents can be charged for
neglect
PEM grade is determined by calculating weight as a percentage of expected weight for length or height using international standards- ______: 90% to 110%, ______: 85% to 90%, ______: 75% to 85%, _______:<75%
normal, mild, moderate, severe
peanut paste with micronutrients, used to treat kwashiorkor and marasmus, child will be better within weeks of consuming if undernourished
plumpy nut
therapy for kwashiorkor: oral or IV rehydration, gradual refeeding through tube due to severe anorexia, supplements of ________, ________, mulitvitamins, ____, and ______ (because of depletion)
potassium, phosphorus, zinc, folic acid
breastfeeding and complementary feeding not going well can cause ______ ________
predisposed malnutrition
- Diet that lacks adequate protein - Diet that lacks adequate calories - Diet that lacks both protein & calories - more likely in developing countries
primary PEM
caused by inadequate nutrient intake
primary PEM
occurs in children and adults whose intake of protein and/or calories do not meet their nutritional needs, Commonly includes deficiencies of many micronutrients
protein energy malnutrition (PEM)
Late ill-effects on IQ, behavior & cognitive functions are doubtful and not ______
proven
if you dont give F75 or F100 IV fluids, the child will develop ____ ____ (deadly) because digestive system has shut down
refeeding syndrome
Kwashiorkor can occur in infancy, but its maximal incidence is in the ____ year of life following abrupt ______
second, weaning
- More common in the United States - Complication of AIDS, cancer, inflammatory bowel disease, severe burns, and other illnesses - Body's ability to absorb nutrients is impaired - Disease(s) that: prevent access to food, impede ingestion, digestion and/or absorption, increase demand for energy and/or protein
secondary PEM
results from disorders/conditions or drugs that interfere with nutrient use
secondary PEM
undernutrition in some of pregnancy (dSGA) is
short term
when a child misses a meal, impairs the child's ability to pay attention and to be productive - Irritable, apathetic, and uninterested in their environment
short term hunger
eating with family to ensure adequate nutrition
social eating
SES/family environment =
stable family
if undernutrition is long term, this is
stunting
blend of corn, legumes and fish powder (carb, protein, fat) - used in Ghana as complementary food for babies (porridge)
weanimix
are both primary and secondary PEM preventable by adequate and nutrient dense foods?
yes
is Failure to Thrive visible?
yes
