This document provides an overview of pediatric malnutrition from the American Society for Parenteral and Enteral Nutrition (ASPEN). It defines pediatric malnutrition based on 5 domains: anthropometric parameters, growth, chronicity, etiology/pathogenesis, and functional/developmental outcomes. The introduction also outlines ASPEN's multidisciplinary and holistic perspective. The document further discusses the epidemiology, risk factors, classification (acute vs. chronic; primary vs. secondary vs. tertiary), grading scales, detection, manifestations of acute severe malnutrition, pathophysiology of marasmus vs. kwashiorkor, and important anthropometric measurements.

1. DESNUTRICIÓN
PEDIÁTRICA
6to año de Medicina
Pediatría III.
Dra. Yelitza Rocca.
Bh: Guadarrama Adolfo
Sambrano Kaína

2. Introducción
La ASPEN (American Society for
Parenteral and Enteral Nutrition) define
la desnutrición pediátrica, desde un
enfoque multidisciplinar e integral,
alrededor de 5 dominios:
1. Parámetros
antropométricos.
2. Crecimiento.
3. Cronicidad de la
desnutrición.
4. Etiología y patogenia.
5. Resultados funcionales o
sobre el desarrollo

3. DESNUTRICIÓN
“Desequilibrio entre los
requerimientos de nutrientes y la
ingesta, lo que da lugar a déficits
acumulativos de energía, proteínas
y/o micronutrientes que pueden
afectar negativamente al
crecimiento y desarrollo e inducir
cambios fisiológicos y metabólicos
que pueden alterar la capacidad de
respuesta ante los procesos
patológicos o implicar el deterioro
de la respuesta inmunitaria”

4. EPIDEMIOLOGÍA
45% del total a
nivel mundial
8.500 muertes
diarias
50 M de niños
(2015, UNICEF)
Muertes
Afecta a:

5. FACTORES DE RIESGO

6. CLASIFICACIÓN
● Aguda: Pérdida
ponderal. Relac.
Peso/talla.
● Crónica:
Dismunición de talla.
Talla/Edad
Según su
cronicidad
● Primaria: Ingesta
insuficiente
● Secundaria:
Alteración en la
utilización y
absorción
● Terciaria: Mixta.
Según su
etiología
Waterlow. (Peso- P/E x100)
● Grado I: >90%
● Grado II: 80 y 89%
● Grado III: <79%
Según grado
01 02 03
04
Según fisiopatología
● Calórica
● Proteica
● Mixta
● Específica

7. DETECCIÓN
Las HCN deben ser un
método sencillo, rápido,
no invasivo y fácil de
aplicar, y deben utilizarse
en todos los pacientes
hospitalizados en las
primeras 24-48 horas del
ingreso (y repetirse en
función de la patología y
el riesgo nutricional).

8. DESNUTRICIÓN
AGUDA
• Moderada: P/T en -2 y -3 DE
• Severa: P/T < -3 DE

9. MANIFESTACIÓN DE LA DESNUTRICIÓN
AGUDA SEVERA
Kwashiorkor
Marasmo
Edema en miembros con signos de
deficiencias nutricionales.
Atrofia de masa grasa y muscular
Marasmo-
Kwashiorkor

10. FISIOPATOLOGÍA
Marasmo
Bajo aporte proteico-
calórico por lactancia
insuficiente + cuadros
de diarrea y vómito.
M. adaptativos
S. Endocrino,
actividad física,
crecimiento y
metabolismo basal.
Proteínas y absorción
intestinal normales
Kwashiorkor
Ablactación precoz
con carbohidratos o
lactancia insuficiente.
M. Adaptativos
Funciones metabólicas
estables. Ahorro de nitrógeno,
lesión de enterocitos-
esteatorrea. Hierro y folato,
hipoalbuminemia- presión
oncótica

11. MEDICIONES ANTROPOMÉTRICAS
Edema
• Leve: Pies
• Moderado:
Pies, manos y
tercio de
piernas y
brazos
• Grave:
Generalizado
Peso y
longitud
Perímetro
braquial
Predictor de
riesgo de muerte.
Entre 6 y 59
meses < 11.5cm

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