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Hospital Based Practice Nutrition.
Biological effects of malnutrition
An extended period can result in starvation or deficiency
disease.
Malnutrition increases risk of infection and infectious
disease.
Major risk factor for TB Malnutrition increases activity and
movement in many animals.
Experiment in spiders showed increased activity and predation,
resulting in larged weight
gains.
Kwashiorkor
Cause is controversial
Thought to be due to insufficienct protein intake.
Virulent form of childhood malnutrition characterised by.
Oedema
Irritability
Anorexia Ulcerating dermatoses
Enlarged, fatty liver.
Kwashiorkor is defined by presence of oedema due to poor
nutrition.
Often presents in a child soon after it is weaned.
Compared to mothers milk, the weaned diet is often high in
starches and other carbohydrates,
and low in protein.
Name is derived from the Ghanian word Kwa which means first
second, reflecting the
development of the condition in the first child when a younger
sibling arrives and requires
breast milk.
Symptoms.
Swollen, pot bellied abdomen.
Ascites due to reduced oncotic pressure.
Hepatomegaly.
Due to inability to transport lipids away from the liver with
deficiency of
apolipoprotiens.
Alternating bands of pale and dark hair.
Weight loss.
Skin signs.
Dermatitis
Depigmented skin
Failure to produce antibodies following vaccination.
Diptheria
Typhoid.
Failure to thrive.
Mental retardation
Loss of teeth.
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Cause.
Controversial.
Known that protein deficiency is important, but this may not be
the key factor.
Likely to be due to deficiency of several nutrients,
particularly those involves in anti oxidant
production. Iron
Folic aicd
Iodine
Selenium
Vitamin C
This suggestion is supported by the fact that children with
kwashiorkor tend to deficienct in.
Glutathione
Albumin
Vitamin E
Polyunsaturated fatty acids.
Children can be sub clinically deficient in nutrients, but then
pushed into kwashiorkor by
stresses (eg. Infection or toxin).
One of the reasons that kwashiorkor is common in the developing
world is because of the high
carbohydrate, low protein, content of staple foods like
cassava.
Another factor which seems to play a large part is the
prevalence of moulds producing aflatoxins.
Kwashiorkor only tends to develop in warm, humid areas where
mould growth is encourages.
People in drier areas tend to develop maramus instead.
Aflatoxin are toxified by the cytochrome P450 system.
They cause liver damage, and so predispose to
hypoprotienaemia.
Management.
Replace protein for anabolic purposes only.
Catabolic needs should be satisfied with fat and carbohydrates.
Protein catabolism involves the urea cycle, and so will strain a
damaged liver.
Resulting liver failure may be fatal.
Marasmus.
Form of severe protein energy malnutrition.
Characterised by energy deficiency.
Children with marasmus look emaciated.
Body weight may be reduced to less than 80% of normal weight for
height.
Although the child looks far worse, prognosis in marasmus is
better than that in kwashiorkor
Signs & symptoms.
Extensive tissue and muscle wasting.
Variable amounts of oedema
Dry skin
Skin folds on.
Glutei
Axillae
Dramatic loss of adipose tissue from
Buttocks
Thigh
Frefulness
Irritability
Voraciously hungry
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Complications.
Often lethal.
Lead to a high mortality.
Infection Dehydration
Circulation disorders.
Permanent loss of the ability to synthesise proteins.
The pathway itself involves proteins, which are lost.
Treatment.
Treat both disorder and complications.
Once the patient has lost the ability to synthesise proteins,
attempts to reverse the disorder are
futile.
Catabolism.
Biological process by which the body breaks down fat and muscle
tissue in order to survive. Only occurs when there is no longer any
other source of protein, carbohydrate or vitamins to feed all
the body systems.
Is the most severe type of malnutrition.
Disease setting.
Seen in starved and malnourished people.
Over 20,000 people a day die from starvation.
A child dies every 5 seconds from starvation.
There are about 800,000,000 people who are chronically
undernourished.
Mechanism.
Due to normal metabolic rate of humans (which requires going 12
hours a day without food),
catabolysis only becomes life threatening after 1 2 months of
starvation.
After this time, muscles and organs can become permanently
damaged.
Eventually causes death if left untreated.
Catabolism is the last resort of the body to keep itself,
particularly the nervous system, alive.
Prognosis is poor when the patient starts to lose muscle
mass.
This is a sign that body fat has been broken down and the body
is now breaking
down muscle tissue.
This results in loss of muscle strength.
Investigations.
Fever.
Due to body working hard to break down muscles and fat.
High blood levels of products of muscle and fat breakdown.
Lipids
Proteins
Amino acids.
Treatment.
While catabolysis can be deadly over time, early medical
treatment can reverse the process.
Patient may require.
Intravenous nutrition
Blood transfunion.
Oxygen replenishment.
May require weeks to months for muscle mass to return.
If disease was severe, muscle mass may never fully recover.
