25% of children are having PEM.

Definition: “a range of clinical syndromes

characterized by an inadequate intake of protein and

calories to meet the body’s needs”

SOMATIC PROTEIN COMPARTMENT:

=skeletal muscle: affected in MARASMUS. (Calorie

deficiency)

VISCERAL PROTEIN COMPARTMENT:

=organs (Liver): affected in KWASHIORKER.(Protein deficiency)

PEM:

Compare body weight to height with standard tables.

Thickness of skin fold (skin+SCT)

Circumference of mid arm.

Measurement of serum proteins (albumin, transferrin)

DIAGNOSTIC PARAMETRES:

“Malnutrition caused primarily by severe reduction in

the calorie intake”

>60% reduction in the body weight.

History of chronic weight loss, muscle wasting due to

catabolism, chronic illness (COPD’s).

C/F: Absent subcutaneous mass (used as fuel),

muscle wasting, extremities are emaciated,

head appears too large for the body.

Anemia, multivitamin-def, immune def: prone

for infections.

MARASMUS

Lab findings: reduced protein (serum albumin) levels.

Microcytic hypochromic anemia, mixed micro+ macrocytic

anemia, hypoplastic BM.

Brain: Cerebral atrophy, Reduced no of neurons, impaired

myelination of white matter.

COMPLICATIONS:

Recurrent infections, Iodine def- MR, Multivitamin def.

“Occurs when protein deprivation is relatively greater than

the reduction in total calories”

Weaning too early- is most common cause.

Subsequently fed with exclusively with carbohydrate diet.

“More severe form of malnutrition than the marasmus”

Marked protein deprivation associated with severe loss of

visceral protein compartment, with subsequent

HYPOALBUMINEMIA giving rise to generalized, dependent

EDEMA.

True weight loss is masked by the increased fluid retention

(edema).

Relative sparing of subcutaneous fat and muscle mass.

SKIN LESIONS: characteristic alternative zones of

hyperpigmentation, areas of desquamation, and

hypopigmentation giving ‘FLAKY PAINT’ appearance.

HAIR CHANGES: loss of color, alternate bands of pale and

darker hairs, silky texture, loss of firm attachment to scalp

(easily pluckable).

ENLARGED FATTY LIVER

Defects in immunity, secondary infections, Parasitic

and worm infestations.

Peripheral EDEMA, growth failure, Intestinal mucosal

atrophy, loss of villi, enzyme (disaccharidase) def,

Hypoplastic BM, Cerebral atrophy, thymic and

lymphoid atrophy.

Hunger

Poverty

Population

Explosion Environmental

Deteriorations

Increased pressure on Limited food

resources

Lack of Birth Control

Large families, limited income

PollutionIncreased Fossil &

fuel use

Global Epidemic

Etiology is 70% genetic, 30% Environmental.

Sedentary, life style, High calorie, Junk foods.

Obesity in children- Needs primordial prevention.

Behavior & Dietary Measures are indicated

prosperity : calories

technology: exertion

indoor entertainment: sedentary behavior

marketing of food: improper nutrition

Body Mass Index

BMI= Weight (kg)/ height in sq.mtre

Overweight is defined as a BMI of 25.0 to 29.9.

Obesity is defined as a BMI of 30.0 or greater

Coronary Artery disease

MI

Cerebrovascular Disease

LVH & CHF

Hyperlipidemia

Type 2 Diabetes Mellitus

Osteoarthritis

Complications of Obesity……..,

Cholelithiasis, Cholecystitis

Obstructive Sleep Apnoea

Restrictive lung disease

Cancer

Gout

Avoid Diet fat & Diet Revolutions.

Change Diet composition

Maintain Carbo, Protein & Fat ratio

Avoid simple sugars

Regular Dietician appointment

Calorie decrease by 500Kcal /day

More aerobic exercise & support from family.

Behavior Modification Techniques:

Self Monitoring

Stimulus Control

Behavioral Contracting

Stress Management

Relapse Prevention

Social Support