1. pem & obesity dr. sinhasan, mdzah
TRANSCRIPT
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