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Undernutrition:
pathological state resulting from the consumption
of an inadequate quantity of food over an
extended period of time
Specific Deficiency
absolute or relative lack of an individual nutrient
Overnutrition:
consumption of an excessive quantity of food for
an extended period of time
Imbalance:
disproportionate intake among essential nutrients
Diagnostic Criteria:
Anthropometric Measurements:
Weight
for age:
Underweight
Length/Height for age:
Stunted
Head circumference (until 3 years of age only)
Weight for length/height:
Wasted
Body mass index (BMI):
Overweight/Obese
WHO Standard Deviation Growth Curve
Z Score
Growth Indicators
Lt/Ht for age
Wt for age
2.
3.
4.
5.
Above 3
(See Note 1)
Obese
Obese
Above 2
Normal
Overweight
Overweight
Possible risk of
overweight
(See Note 3)
Possible risk of
overweight
(See Note 3)
(See Note 2)
1.
Wt for Lt or Ht
Above 1
Normal
0 (median)
Normal
Normal
Normal
Normal
Below - 1
Normal
Normal
Normal
Normal
Below - 2
Stunted
(See Note 4)
Underweight
Wasted
Wasted
Below - 3
Severely stunted
(See Note 4)
Severely underweight
(See Note 5)
Severely wasted
Severely wasted
A child in this range is very tall. This is rarely a problem unless the child is excessively
tall, in which case, he should be referred for possible endocrine work-up especially if both
his parents are not tall.
A child in this range may have a problem but this is better assessed with wt for Lt/Ht or BMI
for age.
A plotted point above 1 shows possible risk. A trend toward the 2 z-score shows definite risk.
It is possible for a stunted or severely stunted child to become overweight.
This is referred to as very low weight in IMCI training modules.
Marasmic-Kwashiorkor:
Have
Marasmus
Usual Age
Edema
generalized
Kwashiorkor
0-2 years
None
Wasting
of SubQ fat
Gross loss
1-3 years
lower legs, face or
sometimes hidden
Muscle Wasting
obvious
sometimes hidden
Growth retardation
obvious
sometimes hidden
Mental Changes
apathetic
apathetic, quiet
irritable, also
Marasmus
Appetite
Diarrhea
Skin Changes
good
often
seldom
Hair Changes
seldom
Moon face
Hepatic
enlargement
seldom
seldom
Kwashiorkor
poor
often
flaky-paint
dermatoses
sparse,
dyspigmentation
often
always
Serum albumin
Urea/creatinine
Hydroxyproline
Essential AA
Anemia
Liver biopsy
Marasmus
Kwashiorkor
N or low
N or low
low
normal
uncommon
normal or
atrophic
low
low
low
low
common
fatty change
Z Score
Growth Indicators
Lt/Ht for age
Wt for age
2.
3.
4.
5.
Above 3
(See Note 1)
Obese
Obese
Above 2
Normal
Overweight
Overweight
Possible risk of
overweight
(See Note 3)
Possible risk of
overweight
(See Note 3)
(See Note 2)
1.
Wt for Lt or Ht
Above 1
Normal
0 (median)
Normal
Normal
Normal
Normal
Below - 1
Normal
Normal
Normal
Normal
Below - 2
Stunted
(See Note 4)
Underweight
Wasted
Wasted
Below - 3
Severely stunted
(See Note 4)
Severely underweight
(See Note 5)
Severely wasted
Severely wasted
A child in this range is very tall. This is rarely a problem unless the child is excessively
tall, in which case, he should be referred for possible endocrine work-up especially if both
his parents are not tall.
A child in this range may have a problem but this is better assessed with wt for Lt/Ht or BMI
for age.
A plotted point above 1 shows possible risk. A trend toward the 2 z-score shows definite risk.
It is possible for a stunted or severely stunted child to become overweight.
This is referred to as very low weight in IMCI training modules.
A Deficiency (VAD)
Anemia
Goiter
Vision
Epithelial differentiation
Growth
Reproduction
Pattern formation during embryogenesis
Bone development
Hematopoiesis
Brain development
Immune system function
Clinical manifestations:
Night
blindness
Xeropthalmia
Bitot spot
xerophthalmia
1. Iron depletion
Storage iron is absent or decreased
Normal serum iron conc and Hgb levels
2. Iron deficiency without anemia
Decreased or absent iron storage
Low serum iron concentration
Low transferrin
No frank anemia
3. Iron deficiency anemia
Low Hgb/Hct value
3.
Therapeutic dose
46 mg/kg of elemental iron in 3 divided doses
Ferrous sulfate - 20% elemental iron by weight.
Therapeutic dose
46 mg/kg of elemental iron in 3 divided
doses
Ferrous sulfate - 20% elemental iron by
weight.
1.
The Lancet , to WHO, in 2007, nearly 2billion individuals had insufficient iodine
intake, a third being of school age. ... Thus iodine deficiency, as the single greatest
preventable cause of mental retardation, is an important public-health problem."[1]
Preventive Measures:
Use
of iodized salts:
Food
Intake
Beri-beri
1.
2.
3.
Other types:
Acute cardiac type occurs at age 2-4
months. With cyanosis, dyspnea, systolic
murmur, pulmonary edema
Aphonic type develops at age 5-7 months
with hoarseness, dysphonia or aphonia
Pseudomeningeal type develop at 8-10
months with apathy, drowsiness and signs of
meningeal irritation
Cause:
A deficiency
Diagnosis:
signs
and symptoms
Prevention:
6-10
Cause:
Deficiency occurs due to losses of pyridoxine from
refining, processing, cooking and storing of food
Clinical Manifestations:
Convulsion, depression, seborrheic dermatitis,
intertrigo, angular stomatitis, glossitis, poor response to
infection
Diagnosis:
tryptophan load test; response of seizure to B6
treatment
Treatment:
IM pyridoxine injection 2-10 mg or 10-100 mg orally
Scurvy