Chapter 072. Malnutrition and Nutritional Assessment (Part 1) ppt

Malnutrition and Nutritional Assessment Part 1 Harrison's Internal Medicine > Chapter 72.. Malnutrition and Nutritional Assessment Malnutrition and Nutritional Assessment: Introductio

Chapter 072 Malnutrition and Nutritional Assessment

(Part 1)

Harrison's Internal Medicine > Chapter 72 Malnutrition and Nutritional

Assessment

Malnutrition and Nutritional Assessment: Introduction

Malnutrition can arise from primary or secondary causes, with the former resulting from inadequate or poor-quality food intake and the latter from diseases that alter food intake or nutrient requirements, metabolism, or absorption Primary malnutrition occurs mainly in developing countries and under conditions of war or famine Secondary malnutrition, the main form encountered in industrialized countries, was largely unrecognized until the early 1970s, when it became appreciated that persons with adequate food supplies can become malnourished as

underscores the importance of preventing, detecting, and treating malnutrition

Protein-Energy Malnutrition

The two major types of PEM are marasmus and kwashiorkor These

conditions are compared in Table 72-1 Marasmus and kwashiorkor can occur

singly or in combination, as marasmic kwashiorkor Kwashiorkor can occur

rapidly, whereas marasmus is the end result of a gradual wasting process that passes through stages of underweight, then mild, moderate, and severe cachexia

Table 72-1 Comparison of Marasmus and Kwashiorkor

Clinical

setting

Energy intake Protein intake during

stress state

Marasmus Kwashiorkora

Time course

to develop

Months or years Weeks

Clinical

features

Starved appearance Well-nourished

appearance

Weight <80%

standard for height

Easy hair pluckabilityb

Triceps skinfold <3

mm

Edema

Mid-arm muscle

circumference <15 cm

Laboratory Creatinine-height Serum albumin <2.8

Total iron-binding

capacity <200 µg/dL Lymphocytes <1500/µL

Clinical

course

Reasonably preserved responsiveness to short-term stress

Infections

Poor wound healing,

decubitus ulcers, skin breakdown

Marasmus Kwashiorkora

Mortality Low unless related to

underlying disease

High

Diagnostic

criteria

Triceps skinfold <3

mm

Serum albumin <2.8 g/dL

Mid-arm muscle

circumference <15 cm

At least one of the following:

Poor wound healing,

decubitus ulcers, or skin breakdown

Easy hair pluckabilityb

Edema

a

The findings used to diagnose kwashiorkor must be unexplained by other causes

b

Tested by firmly pulling a lock of hair from the top (not the sides or back),

grasping with the thumb and forefinger An average of three or more hairs removed easily and painlessly is considered abnormal hair pluckability