Malnutrition

Introduction to malnutrition Malnutrition is due to insufficient intake of energy and/or protein, resulting in poor nutritional status or failure to maintain normal growth and development, mainly in infants under 3 years of age. There are three types of clinical common: lack of energy supply, manifested as significant weight loss, subcutaneous fat reduction is called weight loss; lack of protein supply, characterized by edema called edema, between the two Weight loss - edema type. Malnutrition is a term used to describe a health condition caused by inappropriate or inadequate diet. It usually refers to nutritional deficiencies caused by insufficient intake, malabsorption or excessive loss of nutrients, but may also include overnutrition due to overeating or excessive intake of specific nutrients. If you cannot take a healthy diet consisting of the right amount, type or quality of nutrients for a long time, the individual will be malnourished. Long-term malnutrition can lead to hunger and death. basic knowledge The proportion of sickness: 0.1%, more common in partial eclipse and slimming hunger strikers Susceptible people: no special people Mode of infection: non-infectious Complications: anemia, nutritional anemia, respiratory infection, thrush, hypoglycemia

Malnutrition

Improper feeding method (35%):

When feeding artificially, the milking method is wrong. If there is too much water, the long-term supply of calories, protein and fat is insufficient. Breast-fed infants, if they do not add food supplements in time, can cause malnutrition in children.

Disease factors (40%):

Poor physical fitness, repeated colds, indigestion, chronic wasting diseases (parasites, long-term diarrhea, chronic diarrhea), will increase the body's need for nutrients, as parents do not know how to supplement the necessary nutrients.

Pediatric development is too fast (15%):

The child grows too fast, and various nutrients cannot be supplied, resulting in a shortage of supply.

Malnutrition prevention

The best way to avoid child malnutrition is to actively prevent it. It is best to breastfeed the baby within 6-7 months, add complementary foods on time, diversify the diet, give high calories, high protein, and rich in vitamins. food.

Malnutrition complications Complications anemia, nutritional anemia, respiratory infection, thrush, hypoglycemia

(1) Nutritional anemia, which is most common in small cell hypochromic anemia. Anemia is associated with the lack of iron, folic acid, vitamin B12, protein and other hematopoietic materials.

(2) Micronutrient deficiency Malnutrition can have multiple vitamin deficiency, especially fat-soluble vitamin A, D deficiency is common. In the case of malnutrition, the symptoms of vitamin D deficiency are not obvious, and the symptoms are more prominent when the growth and development of the recovery period is accelerated. About 3/4 of the sick children are associated with zinc deficiency.

(3) infection due to low immune function, it is susceptible to various infections, such as repeated respiratory infections, thrush, pneumonia, tuberculosis, otitis media, urinary tract infections; infant diarrhea often prolonged unhealed malnutrition, forming a vicious circle.

(4) children with spontaneous hypoglycemia may suddenly appear pale, unconscious, slow pulse, apnea, body temperature does not rise, but generally no convulsions, if not treated promptly, can cause death due to respiratory paralysis.

Malnutrition Symptoms Common Symptoms Whole body hair is grayish white cheeks, obvious invagination, facial muscle atrophy, facial skin wrinkles, increased embryonic development, slow energy, lack of water, thin skin, diarrhea, dry skin

Clinical manifestations of weight loss

More common in infants under 1 year old, weight loss is an early manifestation of malnutrition, after which the weight gradually declines, the child mainly manifests as weight loss, subcutaneous fat gradually decreases and disappears, dry skin, pale, facial skin shrinkage and relaxation, hair dry The limbs can be contracted. The order in which the subcutaneous fat layer is consumed is firstly the abdomen, followed by the trunk, buttocks, limbs, and finally the cheeks. The thickness of the subcutaneous fat layer is one of the important indicators for judging the degree of malnutrition. In the early stage of malnutrition, height is not affected, but as the condition worsens, bone growth slows down and the height is lower than normal. Mild malnutrition, normal mental state, severe debilitating, poor response, low body temperature, weak pulse, no appetite, diarrhea, constipation alternate. When the combined plasma albumin is significantly decreased, there may be depression edema, shiny skin, severe ulceration, infection and chronic ulceration. Severe malnutrition can have important organ dysfunction.

Clinical manifestations of edema-type malnutrition

Edema-type malnutrition caused by severe protein deficiency, also known as malignant malnutrition (Kwashiorkor), can be seen in children 1 to 3 years old. Due to edema, the nutritional status cannot be assessed by weight. Edema can be slightly depressed from the back of the foot to the general system, often accompanied by large liver, sparse hair, easy to fall off.

Clinical manifestations of weight loss-edema-type malnutrition

Between the above two types.

Malnutrition check

1. The decrease in serum albumin serum albumin concentration is the most important change, but its half-life is longer (19-21 days), so it is not sensitive enough. Retinol-binding protein (half-life 10 hours), prealbumin (half-life 1.9 days), thyroid-binding prealbumin (half-life 2 days) and transferrin (half-life 3 days) have early diagnosis of plasma proteins with shorter metabolic cycles value. Insulin-like growth factor 1 (IGF1) is not only sensitive but also less affected by other factors, and is a good indicator for diagnosing protein malnutrition.

2. The concentration of serum amino acid taurine and essential amino acids is reduced, while non-essential amino acids are not changed much.

3. Other serum amylase, lipase, cholinesterase, transaminase, alkaline phosphatase and other activities decreased, after treatment can return to normal; cholesterol, various electrolytes and trace elements decreased; growth hormone levels increased.

Malnutrition diagnosis

diagnosis

History

Should master the child's dietary intake, eating habits, conduct a dietary survey to assess the intake of protein and heat, whether it affects digestion, absorption, chronic wasting disease, and understand the general condition of the family, the growth pattern of the family, Parental height, weight and level of care for the child.

2. Clinical symptoms

There are two typical symptoms, marasmus, due to severe heat deficiency, children are short, thin, subcutaneous fat disappears, skin pushes elasticity, hair is dry and easy to fall off, weak and weak, wilting, and another type is edema Caused by severe protein deficiency, edema around the body, edema of the eyelids and lower body, dry and shrinking skin, keratinized desquamation, or pigmentation, fragile and fragile hair, fragile nails with lateral grooves, no appetite, large liver, There are often diarrhea and watery stools, but also mixed, between the two, and can be accompanied by other nutrient deficiencies.

3. Physical measurement

Physical measurement is the most reliable indicator for assessing malnutrition. At present, there are major changes in the measurement of malnutrition in the world. It consists of three parts.

(1) Low body weight: The child's age-specific body weight is less than the median minus 2 standard deviations, but higher than or equal to the median minus 3 standard deviations, which is moderate compared with the same age and gender reference population standard. Poor weight, such as a median of less than the standard population minus 3 standard deviations for severe weight loss, this indicator reflects the child's past and/or now has chronic and/or acute malnutrition, which alone cannot distinguish acute Still chronic malnutrition.

(2) Growth retardation: The age and gender height of children are 2 standard deviations below the median, but less than or equal to the median minus 3 standard deviations, which is moderate compared with the same age and gender reference population standard. Growth retardation, such as a median decrease of 3 standard deviations below the reference population, is a severe growth retardation. This indicator mainly reflects chronic malnutrition in the past or long-term.

(3) Weight loss: Children's height and weight are lower than the median minus 2 standard deviations compared with the same age and the same sex reference population standard, but higher than or equal to the median minus 3 standard deviations, which is moderate weight loss. If the median of the reference population is less than 3 standard deviations, it is severely wasted. This indicator reflects the child's recent acute malnutrition.

Identification

It is differentiated from weight loss and tumor malignant transformation.

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