2167591_pem-protein energy malnutri.pptx

protein energy malnutrition

1. Guide- Dr.Meenakshi ma’am , presented by- Dr . K anishka T yagi . PROTEIN ENERGY MALNUTRITION

2. INTRODUCTION: World Health Organization ( WHO ) has defined , “Protein Energy Malnutrition ( PEM) ” as a range of pathological conditions arising from coincidental lack in varying proportion of proteins and calories , occurring most frequently in infants & young children & commonly associated with infection. Most cases PEM is caused by a combination of inadequate dietary intake, lack of good care and the adverse effect of infection

3. WHO has described malnutrition as a “global problem”, having adverse effect on the survival, health performance & progression of population group. In India 46 % of all children under the age of three are too small for their age, 47 % are underweight and 16 % are wasted. Prevalence of severe malnutrition varies across the states with MP recording the highest rate (55%) and Kerala, the lowest (27%).

4. AETIOLOGY A diet which is deficit in protein and energy or calories results in PEM.  Through prolonged breastfeeding of children should be the rule, the amount of breast milk secreted in poor Indian mothers is lower . Poverty is one of the major causes of PEM, which leads to low food availability and unsanitary living condition which is the root cause infections and other diseases. Improper distribution of food among the family members . Respiratory infection and diarrhoea are the common diseases that cause severe PEM and death

5. Pathophysiology PEM is caused by starvation. It is the disease that develops when protein intake or energy intake, or both, chronically fail to meet the body's requirements for these nutrients.  PEM has always been a common disease, and humans have adaptive mechanisms for slowing and, in most cases, arresting its progress. 

6. EPIDEMIOLOGY The term protein energy malnutrition has been adopted by WHO in 1976. Highly prevalent in developing countries among <5 children; severe forms 1-10 % & underweight 20-40% . All children with PEM have micronutrient deficiency. Seen most commonly in the first year of life due to lack of breast feeding and the use of dilute animal milk . Kwashiorkor can occur in infancy but its maximal incidence is in the 2nd yr of life following abrupt weaning.

7. Complications of P.E.M Hypoglycemia Hypothermia Hypokalemia Hyponatremia Heart failure Dehydration & shock Infections (bacterial, viral & thrush)

8. CLASSIFICATION A. CLINICAL ( WELLCOME ) Parameter: weight for age + oedema Grades: 80-60 % without oedema is under weig ht 80-60% with oedema is Kwashiorkor < 60 % with oedema is Marasmus-Kwash < 60 % without oedema is Marasmus

9. CLASSIFICATION (2) B. COMMUNITY (GOMEZ) Parameter: weight for age Grades: I (Mild) : 90-70 II (Moderate): 70-60 III (Severe) :< 60

10. KWASHIORKOR Cecilly Williams, a British nurse, had introduced the word Kwashiorkor to the medical literature in 1933 . The word is taken from the Ga language in Ghana & used to describe the sickness of weaning .

11. CLINICAL PRESENTATION Kwashiorkor is characterized by certain constant features in addition to a variable spectrum of symptoms and signs. Kwashiorkor is an example of lack of physiological adaptation to unbalanced deficiency where the body utilized proteins and conserve S/C fat. Clinical presentation is affected by: The degree of deficiency The duration of deficiency The speed of onset The age at onset Presence of conditioning factors Genetic factors

12. OCCASIONALLY PRESENT S IGNS HEPATOMEGALY FLAKY PAINT DERMAT ITI S CARDIOMYOPATHY & FAILURE D EHYDRATION ( Diarrh . & Vomiting) SIGNS OF VITAMIN DEFICIENCIES SIGNS OF INFECTIONS

13. MARASMUS The term marasmus is derived from the Greek marasmos , which means wasting. Marasmus involves inadequate intake of protein and calories and is characterized by emaciation. Marasmus represents the end result of starvation where both proteins and calories are deficient. Marasmus represents an adaptive response to starvation, whereas kwashiorkor represents a maladaptive response to starvation I n Marasmus t he body utilizes all fat stores before using muscles.

14. Clinical Features of Marasmus Severe wasting of muscle & s/c fats Severe growth retardation Child looks older than his age No edema or h air changes Alert but miserable Hungry Diarrhoea & Dehydration

15. Management: - Accurate history of social and economic factors. poverety,ignorance . environmental factors . diet history: maternal malnutrition, breast milk and other feeding habits .food allergies ,food taboos. chronic illness ,burns .HIV. cystic fibrosis .malignancies .inborn error of metabolism , - Evaluation of growth parameters: weight, height, head circumference - Evaluation of the degree of illness and dehydration: skin fold thickness - Biochemical evaluation * mild * moderate * severe

16. Children with mild to moderate dehydration can be treated by oral or nasogastric administration of fluids. Severely mal nourished children are deficient in potassium and have abnormally high levels of sodium. WHO has recommended a modified solution for severely malnourished children ( ReSoMal ). ReSoMal can be prepared by diluting the standard WHO ORS solution in 2 litres of water instead of 1 litre and adding 50g of sugar.

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