Brief description about malnutrition

1. Malnutrition
7th semester mbbs
Nischal Shrestha
3/21/2019
@Nischal Shrestha
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2. • 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 “
3/21/2019
@Nischal Shrestha
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3. • Malnutrition
Undernutrition overnutrition
Protein energy
malnutrition (PEM)
> kwashiorkor: cause by inadequate
protein intake
> Marasmus: d.t inadequate protein
& calorie ( energy)
3/21/2019
@Nischal Shrestha
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4. e.g. A child presents with
diarrhea for 3 days
e.g. a child presents with
chronic malabsorption
Weight for age (WFA) low Low
Height for age (HFA) normal Low
Weight for height (WFH) low Normal (since both
quantities decrease)
WFA denotes undernutrition
HFA is specific for chronic
undernutrition cases
WFH is specific for acute
undernutrition cases
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@Nischal Shrestha
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5. Gomez ‘ Classification 
WFA (we know if child is undernourished, normal or overnourished)
Waterlow Classification (cut off criteria is -2 SD)
WFH
HFA
Drop in ratio (k/a wasting) indicates
acute malnutrition
Drop in ratio (k/a stunting)= chronic
malnutrition
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6. 3/21/2019
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7. • Marasmus  very lean, thin wasting
• Kwashiorker (more severe undernutrition)  edema +nt  no such
drop in WFA or normal WFA ( negative Gomez classification inspite of
severely malnourished)
So malnutrition with edema is
classified under Wellcome
Trust classification
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@Nischal Shrestha
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8. Standard deviation
• a quantity expressing by how much the members of a group differ from the mean value
for the group.
Z-score or standard score
(Obtained)
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9. Z score
For example: if the z-score of weight for height for a child is -3, it
means that he/she has a weight which is lesser than mean by a factor of
almost 3 times of SD.
-2 or more No acute malnutrition
-3 to -2 Moderate
< -3 Severe
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@Nischal Shrestha
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10. MUAC Tape
No malnutrition
Moderate
malnutrition
Severe acute malnutrition
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11. Ready-to-Use Therapeutic Food (RUTF)
• High energy, fortified ready to eat (w/o cooking) food suitable for treatment
of severely malnourished children (> 6 months of age).
• ( At least half of the proteins contained in the product should come from milk products.)
• There are four basic ingredients in RUTF:
- Sugar - Dried Skimmed Milk - Oil
- Vitamin and Mineral Supplement (CMV)
If child > 6 month can not finish RUTF, then condition is considered to be a
complicated severe acute malnutrition.
3/21/2019
@Nischal Shrestha
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12. RUTF sachet
For child < 6 months of age, if
there is breast feeding problem 
complicated severe acute
malnutrition
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@Nischal Shrestha
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13. Classification of nutritional status acc to IMCI
 Oedema of both feet
OR
 WFH less than -3 z-scores OR MUAC < 11.5 cm
AND any of the following:
- Medical complication +nt
- Not able to finish RUTF or
- Breastfeeding problem
(pink )
complicated severe acute
malnutrition
 WFH less than -3 z-score OR MUAC less than 11.5 cm
AND
 Able to finish RUTF
(yellow)
Uncomplicated severe acute
malnutrition
 WFH between -3 and -2 z-scores
OR
 MUAC 11.5 – 12.5 cm
(yellow)
Moderate acute malnutrition
 WFH -2 z-score or more
OR
 MUAC 12.5 cm or more
(green)
No acute malnutrition
3/21/2019
@Nischal Shrestha
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14. Medical complications
• Any general danger signs
• Pneumonia with chest indrawing
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15. t/t strategy (stabilization + rehabilitation)
A) Stabilization
1) Blood sugar level
2)Temperature
3) Immune status
4) Hydration status
5) Electrolyte status
6) Micronutrient
ORS+ zinc
antibiotics
Keep child warm. 1°F/hour increase by
Kangaroo method
Incase of deficiency, 10 % glucose 5-10
ml/kg i.v.
Fe, vitamin & other micronutrients
3/21/2019
@Nischal Shrestha
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16. B) Rehabilitation
i) Feed to rebuild wasted tissue : 150-220 kcal/kg/day
ii) Follow up ,care and examination
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@Nischal Shrestha
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