Malnutrition and Micronutrient

programs

• food programs
  • general food distribution
  • selective food distribution
• nutritional programs
  • therapeutic feeding for SAM
  • supplementary feeding for MAM
    • targeted supplementary feeding programs - more curative
    • blanket supplementary feeding - more preventive

partners

• WFP
• UNHCR

viscious cycle

1. malnutrition
2. lowered resistance, immunity
3. infection
4. poor appetite, decreased ingestion
5. high energy utilization
6. circle back to 1

diagnosis

Dx of acute malnutrition

• weight for height (W/H)
  • low means wasting - acute malnutrition
• height for age (H/A)
  • low means stunting - chronic malnutrition
• W/A
  • low means complexity of acute and chronic - wasting and stunting "WaSt"
  • WaSt correlates with mortality
• BMI (W/H²)
• MUAC
  • <115mm severe acute malnutrition (SAM)
  • 115-125mm moderate acute malnutrition (MAM)
  • MUAC strongly correlates with mortality

reference standard of anthropometry

• National Center for Health S (NCHS) - older
• WHO Growth Standards 2006 - newer
• Z-score [math]\displaystyle{ =\frac{actual\ value - reference\ median\ value}{standard\ deviation\ of\ reference\ population} }[/math]

types of malnutrition

• acute m.
  • Marasmus
    • muscle atrophy
    • MUAC <115mm
  • Kwashiorkor
    • bilateral pitting edema
    • moon face
    • higher death risk than malasmus
• chronic m./stunting
  • low H/A
• micronutrient deficiency

• severe acute malnutrition SAM
• moderate acute malnutrition MAM
• global acute malnutrition GAM - SAM+MAM
• WHO sets interventional threshold at GAM in 15% of population

marasmus (waste)

• 45.4 mil. children estimated in wasting in 2021
  • 25.0 mil. in Asia
• "old man faces"

kwashiorkor

• West Africa and hos spot in Zimbabwe in 2016
• bilateral pitting edema
  • press for 3 seconds
  • grade 1 localized to feet, grade 2 extends to lower legs, grade 3 systemic (check forehead)
• apathetic, irritable
• pathogenesis is still controversial and indefinite
• often misdiagnosed

marasmus and kwashiorkor

• marasmic kwashiorkor may exist
• clinical intervention is same for both condition
• effort to distinguish is useful for epidemiology and investigation of pathogenesis of kwashiorkor

pathological change

• heart smaller weaker
• brain smaller

treatment

• dietary
  • therapeutic milk
  • ready to use therapeutic food (RUTF)
• systematic - for complications
  • antibiotics, HIV screening, etc.
• community-based management of acute malnutrition - CMAM

phases

1. stabilization phase
2. rehabilitation phase

forecasting emergency

• sentinel surveillance
• global early warning systems
  • Famine Early Warning Systems Network
• country-specific warning systems

definitions

• macronutrients
  • carbohydrates
  • protein
  • fats
• micronutrients
  • vitamins
    • water soluble - not stored in body
    • fat soluble - stored in body
• minerals

• combination of most staple foods provide sufficient protein

classification based on pathogenicity by deficiency

• type 1
  • deficiency causes direct symptoms but no effect on growth
• type 2
  • deficiency causes failure to growth but no direct symptoms

thiamine (vit.B1)

• Wernicke-Korsakoff syndrome in alcoholics

beriberi or thiamine deficiency disorder (TDD)

• polished rice diets
• peripheral neuropathy
• wet beriberi
• adult beriberi is decreasing
• infantile beriberi
  • continuous crying
  • pitting edema

untreated HIV increases vit.B group deficiency

riboflavin (vit.B2)

• no clear deficiency disorder

niacin (vit.B3)

pellagra

• maize (corn) based diets
• symptoms
  • 3Ds
    • dermatitis
      • photosensitivity/solar dermatitis
    • diarrhea
    • depression/dementia
  • insomnia, lethergy
• maize (corn) contains less bioavailable niacin and tryptophan that is precursor of niacin

pyridoxine (vit.B6)

• no clear deficiency disorder

cobalamin (vit.B12)

• megaloblastic anemia

folic acid

• megaloblastic anemia

vitamin A

• eye involvement
  • xerophthalmia
• scurvy
• subclinical vit.A deficiency is associated with decreased immunity and increased risk of infection of and/or death by measles

zinc

• zinc supplementation increase survival of diarrheal patients

Konzo

• diet with poorly processed bitter cassava
• high intake of cyanogenic glucosides from cassava
• acute myeloneuropathy

lathyrism

• grass pea, chickling pea, kesari dal, almorta
• Lathyrus spp., L. sativus
• Ethiopia, Bangladesh, India, Nepal
• scissoring gait - gluteal muscle atrophy