Protein energy malnutrition

Malnutriton

1. PROTEIN-ENERGY MALNUTRITION PRESENTED BY : Manzar Bashir  Manzar Bashir

2. Definitions MALNUTRITION : WHO defines Malnutrition as "the cellular imbalance between the supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions.“ Malnutrition is the condition that develops when the body does not get the right amount of the vitamins, minerals, and other nutrients it needs to maintain healthy tissues and organ function. PROTEIN ENERGY MALNUTRITION :  Protein–energy malnutrition  , sometimes called  protein-energy undernutrition  is a form of malnutrition that is defined as a range of pathological conditions arising from coincident lack of dietary-protein and/or energy(calories) in varying proportions. The condition has mild, moderate, and severe degrees. MARASMUS : is a form of severe malnutrition characterized by lack of food energy. Represents simple starvation It can occur in anyone with severe malnutrition but usually occurs in children. KWASHIORKOR : is a form of severe protein malnutrition characterized by edema and an enlarged liver with fatty infiltrates. It is caused by sufficient calorie intake, but with insufficient protein consumption, which distinguishes it from Marasmus. Manzar Bashir

3. Description Manzar Bashir

4. Protein-Energy Malnutrition PEM is also referred to as protein-calorie malnutrition. It is considered as the primary nutritional problem in India. Also called the 1st National Nutritional Disorder. The term protein-energy malnutrition (PEM) applies to a group of related disorders that include marasmus, kwashiorkor or, and intermediate states of marasmus-kwashiorkor PEM is due to “food gap” between the intake and requirement. Manzar Bashir

5. Protein-energy malnutrition’ (PEM) developed from the local name ‘Kwashiorkor’. The central feature of severe PEM is edema; the classical theory suggests that the cause is a deficiency of protein, but other factors are also involved. In the community mild-moderate PEM is defined by deficits in growth. A distinction has to be made between low weight for height (wasting) and low height for age (stunting), Stunting in particular affects some 50% of children worldwide. In adults, severe PEM has essentially the same features as in children and includes the condition famine edema or ‘hunger edema; there are again controversies about its cause. In the community, chronic malnutrition is assessed by the body mass index (BMI) (Wt./Ht 2 ). Grades of deficiency have been defined and examples are given of functional consequences of a low BMI. Manzar Bashir

6. AETIOLOGY Social and Economic Factors Biological factors Environmental factors Role of Free Radicals & Aflatoxin Age of the Host Manzar Bashir

7. Amongst the Social, Economic, Biological and Environmental Factors the common causes are: Manzar Bashir

8. AETIOLOGY OF Protein energy malnutrition: Manzar Bashir

9. PREVALENCE: Protein-energy malnutrition is a basic lack of food (from famine) and a major cause of infant mortality and morbidity worldwide. Children under five years is an important public health problem due to associated high mortality and long-term health consequences Severe acute malnutrition (SAM), defined as severe wasting [weight-for-height Z score <−3 based on World Health Organization (WHO) reference standard] and/or the presence of nutritional edema, is a life-threatening condition which needs urgent attention and appropriate management to reduce mortality and promote recovery. India has a high prevalence of SAM, representing a huge burden, and intriguingly, the recent National Family Health Survey-4 indicates a higher prevalence of severe wasting (7.5%) compared to the previous report (6.4%). A large volume of research in the first few decades of the 20 th  century dealt with Kwashiorkor or edematous malnutrition, which had very high mortality with median case fatality rates of 20-30 per cent Protein-energy malnutrition caused 0.46% of all deaths worldwide in 2002, an average of 42 deaths per million people per year. Manzar Bashir

10. The clinical presentation depends upon the type, severity and duration of the dietary deficiencies. The five forms of PEM are : Manzar Bashir

11. KWASHIORKOR The term kwashiorkor is taken from the Ga language of Ghana and means "the sickness of the weaning”.  Williams first used the term in 1933, and it refers to an inadequate protein intake with reasonable caloric (energy) intake.  Kwashiorkor, also called wet protein-energy malnutrition, is a form of PEM characterized primarily by protein deficiency. This condition usually appears at the age of about 12 months when breastfeeding is discontinued, but it can develop at any time during a child's formative years. Manzar Bashir

12. It causes fluid retention (edema) dry, peeling skin and hair discoloration. More recently, micronutrient and antioxidant deficiencies have come to be recognized as contributory. Kwashiorkor was thought to be caused by insufficient protein consumption but with sufficient calorie intake, distinguishing it from marasmus. Victims of kwashiorkor fail to produce antibodies following vaccination against diseases, including diphtheria and typhoid. Generally, the disease can be treated by adding food energy and protein to the diet; however, it can have a long-term impact on a child's physical and mental development, and in severe cases may lead to death. Manzar Bashir

13. SYMPTOMS Manzar Bashir

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15. MARASMUS The term Marasmus is derived from the Greek word marasmus, which means withering or wasting.  Marasmus is a form of severe protein-energy malnutrition characterized by energy deficiency and emaciation. Primarily caused by energy deficiency, marasmus is characterized by stunted growth and wasting of muscle and tissue. Marasmus usually develops between the ages of six months and one year in children who have been weaned from breast milk or who suffer from weakening conditions like chronic diarrhea. Manzar Bashir

16. SYMPTOMS Manzar Bashir

17. DIFFERENCEs IN BETWEEN MARASMUS AND KWASHIORKOR: Manzar Bashir

18. DIFFERENCE IN CLINICAL FEATURES BETWEEN MARASMUS AND KWASHIORKOR CLINICAL FEATURES MARASMUS KWASHIORKOR -MUSCLE WASTING Obvious Sometimes hidden by edema and fat -FAT WASTING Severe loss of subcutaneous fat Fat often retained but not firm -EDEMA  None Present in lower legs, and usually in face and lower arms WEIGHT FOR HEIGHT Very low May be masked by edema MENTAL CHANGES  Sometimes quite and apathetic Irritable, moaning, apathetic -APPETITE Usually good Poor -DIARRHOEA Often Often -SKIN CHANGES Usually none Diffuse pigmentation, sometimes „flaky paint dermatitis‟ -HAIR CHANGES Seldom Sparse, silky, easily pulled out -HEPATIC ENLARGEMENT None Sometimes due to accumulation of fat Manzar Bashir

19. MARASMIC -KWASHIORKOR A severely malnourished child with features of both marasmus and Kwashiorkor.  The features of Kwashiorkor are severe oedema of feet and legs and also hands, lower arms, abdomen and face. Also there is pale skin and hair, and the child is unhappy. There are also signs of marasmus, wasting of the muscles of the upper arms, shoulders and chest so that you can see the ribs. Manzar Bashir

20. NUTRITIONAL DWARFING OR STUNTING Some children adapt to prolonged insufficiency of food-energy and protein by a marked retardation of growth Weight and height are both reduced and in the same proportion, so they appear superficially normal.  Manzar Bashir

21. UNDERWEIGHT CHILD Children with subclinical PEM can be detected by their weight for age or weight for height, which are significantly below normal. They may have reduced plasma albumin. They are at risk for respiratory and gastric infections Manzar Bashir

22. BIOCHEMICAL & METABOLIC CHANGES Manzar Bashir

23. TREATMENT Manzar Bashir

24. There are three stages of treatment. Manzar Bashir

25. PREVENTION Promotion of breast feeding Development of low cost weaning Nutrition education and promotion of correct feeding practices Family planning and spacing of births Immunization Food fortification Early diagnosis and treatment Manzar Bashir

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27. THE END THANKYOU SO MUCH MANZAR Manzar Bashir