Chapter 4 Nutritional disease
Nutritional Disease Chapter 4
rotein-energy Malnutrition (PEM
Protein-energy Malnutrition (PEM)
Definition PEM is a kind of malnutrition caused by inadequate dietary intake or some diseases occurs commonly in children under 3 years of age. Kwashiorkor Marasmus
Definition ➢ PEM is a kind of malnutrition caused by inadequate dietary intake or some diseases, occurs commonly in children under 3 years of age. Kwashiorkor Marasmus
Etiology The Primary PEM Inadequate food intake Children under 3 yrs The Secondary causes Increased nutrient needs Disorder in nutrient absorption Increased body metabolism
Etiology ➢ The Primary PEM Inadequate food intake Children under 3 yrs ➢ The Secondary causes Increased nutrient needs Disorder in nutrient absorption Increased body metabolism
Pathophysiology Metabolism disorder Protein metabolism anabolism catabolism I; hypoalbuminemia Fat metabolism mobilized fat store, acetone body t; metabolism acidosis; fatty liver Carbohydrate: low hepatin, hypoglycemia o Fluid electrolyte disorders hypernatremia; edema; potassium disorder; acid-base disturbances
Pathophysiology ➢ Metabolism disorder ⚫ Protein metabolism anabolism & catabolism ; hypoalbuminemia ⚫ Fat metabolism mobilized fat store, acetone body ; metabolism acidosis; fatty liver ⚫ Carbohydrate: low hepatin, hypoglycemia ⚫ Fluid & electrolyte disorders hypernatremia; edema; potassium disorder; acid-base disturbances
Pathophysiology Disorders of Organ Tissue function ● Failure to thrive Lower digested function: diarrhea e Central nerve system: apathy, or irrita bility Cardiovascular system: pulse slow, Low BP o lower renal function: urine amount decrease low immunologic function: easy to be infected
Pathophysiology ➢ Disorders of Organ & Tissue function ⚫ Failure to thrive ⚫ Lower digested function：diarrhea ⚫ Central nerve system: apathy, or irritability ⚫ Cardiovascular system：pulse slow, Low BP ⚫ lower renal function: urine amount decrease ⚫ low immunologic function: easy to be infected
Clinical manifestations Y History: Feeding history NonedematouS PEM Edematous PEM marasmus (Kwashiorkor)
Clinical manifestations ✓ History：Feeding history Nonedematous PEM (marasmus) Edematous PEM (Kwashiorkor)
Physical measurement v underweight WHO Z score chronic or acute malnutrition X-3SDSW/A<X-2SD moderate W/A<X-3SD severe v stunting long-term chronic malnutrition X-3SD≤H/A<X-2SD moderate H/A<X-3SD severe v wasting recent acute malnutrition X-3SDSW/H<X-2SD moderate W/H<X-3SD severe
WHO Zscore system ✓ underweight chronic or acute malnutrition X－3SD≤W/A<X－2SD moderate W/A<X－3SD severe ✓ stunting long-term chronic malnutrition X－3SD≤H/A<X－2SD moderate H/A<X－3SD severe ✓ wasting recent acute malnutrition X－3SD≤W/H<X－2SD moderate W/H<X－3SD severe Physical measurement
Laboratory examination plasma albumin concentration Normal: >35g/L; Diagnose: 25g/L v Serum Pre-albumin concentration Normal: 150- 296mg/L; Mild deficiency: 100 w 150mg/L; Moderate: 50 w 100mg/L; Severe: <50mg/L Y Urine hydroxy-proling concentration
Laboratory examination ✓ plasma albumin concentration Normal: >35g/L; Diagnose:< 25g/L ✓ Serum Pre-albumin concentration Normal: 150～296mg/L; Mild deficiency: 100～150mg/L; Moderate:50～100mg/L; Severe:<50mg/L ✓ Urine hydroxy-proling concentration
Diagnosis History Clinical manifestations Anthropometric indicators Laboratory examination
Diagnosis ✓ History ✓ Clinical manifestations ✓ Anthropometric indicators ✓ Laboratory examination
