PROTEIN ENERGY MALNUTRITION have been discussed here in a simplified manner to help u understand the topic well.....Do make use of it

1. STEP TO PG-MD/MS -DR.AKIF A.B

2. Weight for Age Height for age Weight for Height
Indicates Both
Acute and Chronic
Malnutrition
Indicates chronic
malnutrition
Indicates acute
malnutrition
Stunting Wasting

3. STEP TO PG-MD/MS -DR.AKIF A.B
Normal >80%
Grade 1 malnutrition 71-80%
Grade 2 61-70%
Grade 3 51-60%
Grade 4 <50%
-Based on weight for age
-Weight of a child is compared with weight of normal expected for that age

4. STEP TO PG-MD/MS -DR.AKIF A.B
Based on weight for age
Weight for age % = weight of child 100
weight of normal
child of same age
90-110% Normal nutritional status
75-89% Mild malnutrition
60-74% Moderate malnutrition
< 60 % Severe malnutrition

5. STEP TO PG-MD/MS -DR.AKIF A.B
-Based on Weight for Height and Height for age

6. STEP TO PG-MD/MS -DR.AKIF A.B
1) Weight for Height <3SD of median WHO growth reference
2) Visible severe wasting
3) Presence of bipedal edema
4) Mid Arm Circumference < 11.5 cm

7. STEP TO PG-MD/MS -DR.AKIF A.B
-Used for below 5 years of age
- <13.5 cm : Malnutrition
-Shakir tape is used to measure MAC
>13.5 cm Green Normal
12.5-13.5 Yellow Borderline
malnutrition
< 12.5 cm Red Wasted

8. STEP TO PG-MD/MS -DR.AKIF A.B
Kanawati Index MAC/ Head circumference
Rao and Singh Weight (kg)/ Height in cm2
Dugdale Weight (kg) / Height in cm 1.6
Quac stick MAC expected for a particular
Height

9. STEP TO PG-MD/MS -DR.AKIF A.B
Marasmus Kwashiorkar
Occurrence More common Less common
Edema Absent Present
Activity Active apathetic
Appetite Good Poor
Liver enlargement Absent Present
Mortality Low chances high

10. STEP TO PG-MD/MS -DR.AKIF A.B

11. STEP TO PG-MD/MS -DR.AKIF A.B
-Gross wasting of muscles and subcutaneous tissue resulting in emaciation and
marked stunting
-Body weight <60% expected
-There is no edema
-Fat is severely depleted but buccal fat is
preserved till last.
-Skin = dry , inelastic, wrinkles +
-Hair = Hypopigmented
-Abdomen = Distended due to wasting and
hypotonia
-Appetite = Good
-Represents compensated phase of PEM

12. STEP TO PG-MD/MS -DR.AKIF A.B
TRIAD
1) Edema (due to Hypoalbuminemia)
2) Markedly retarded growth
3) Psychomotor changes
Hepatomegaly : Due to
fatty infiltration
Skin
Flaky paint dermatosis
Hair
Flag sign
(Alternate band of
hyperpigmented and
hypopigmented hairs)
-Impaired appetite
-Increase chance of Infections

13. STEP TO PG-MD/MS -DR.AKIF A.B
Flaky Paint Dermatosis Flag Sign

14. STEP TO PG-MD/MS -DR.AKIF A.B
S = Sugar deficiency (Hypoglycemia)
H = Hypothermia
I = Infections
E
L
D
E
D = Deficiency of micronutrients
Dehydration
ELectrolyte abnormality

15. STEP TO PG-MD/MS -DR.AKIF A.B
FIRST STAGE SECOND STAGE THIRD STAGE
First 24-48 hours Next 7-10 days > 10days
Infection and
dehydration is treated
first
-Diet of 75 kcal/kg/day
-antibiotics
-Aim is to restore
patients protein and fat
contents
-Diet : 175-
200kcal/kg/day for
Severe Malnutrition
-150kcal/kg/day for
Moderate
malnutrition