What Is Severe Malnutrition?

Malnutrition is a term that describes a health condition, caused by inappropriate or inadequate diet. Usually refers to undernutrition caused by insufficient intake, malabsorption or excessive depletion of nutrients, but may also include excess nutrients caused by overeating or excessive intake of specific nutrients. Without a long-term intake of a healthy diet consisting of the appropriate amount, type, or quality of nutrients, individuals will be malnourished. Prolonged malnutrition can lead to starvation deaths.

Basic Information

English name

dystrophy

Visiting department

Pediatrics

Common causes

Improper feeding, poor eating habits, disease factors,

Common symptoms

Weight loss and edema

Causes of malnutrition

Improper feeding

Insufficient food intake for a long time, such as insufficient breast milk and failure to add supplementary foods early. In artificial feeding, the quality and quantity of food cannot meet the needs, such as excessive dilution of milk, or simply feeding with starchy food. Sudden weaning, the baby cannot adapt to new foods, etc.

2. Poor eating habits

Irregular diet, partial eclipse, ruminant habits, or vomiting.

3. Disease factors

Illness affects appetite, hinders food digestion, absorption, and utilization, and increases body consumption. Common diseases that are prone to malnutrition are persistent infant diarrhea, chronic enteritis or dysentery, malabsorption syndrome caused by various enzyme deficiency, intestinal parasitic disease, tuberculosis, measles, repeated respiratory infections, chronic urinary tract infections, etc. Some congenital malformations of the digestive tract (such as cleft lip, palate, congenital hypertrophic pyloric stenosis or laxative cardia, etc.) and severe congenital heart disease can cause feeding difficulties, and some hereditary metabolic disorders and immune deficiency diseases can also affect food. Digestion, absorption and utilization.

Premature birth and twins are prone to malnutrition, intrauterine infections, maternal diseases or low nutrition, and abnormal structure and function of the placenta and umbilical cord can cause fetal malnutrition and intrauterine growth retardation, which are prerequisites for infant malnutrition.

Severe malnutrition is mostly caused by a variety of factors.

Clinical manifestations of malnutrition

There are two typical symptoms. One is a weight-loss type, which is caused by severe lack of thermal energy. Children are short and thin, subcutaneous fat disappears, the skin pushes elasticity, hair is dry and easy to fall off, weak and weak. The other is edema type, which is caused by severe lack of protein, edema around the body, edema on the eyelids and low-hanging parts of the body, dry and atrophic skin, keratinization and desquamation, or pigmentation, fragile hair, easy to break and fall off, fragile nails with transverse grooves , No appetite, large liver, often with diarrhea and watery stools. There are also hybrids in between. And can be accompanied by the manifestation of other nutrients deficiency.

Physical measurement

Physical measurement is the most reliable indicator for assessing malnutrition. At present, there are major changes in the measurement indicators for assessing malnutrition in the world. It includes three parts.

(1) The age and sex of underweight children are lower than the median minus 2 standard deviations, but higher than or equal to the median minus 3 standard deviations. Low, if lower than the median of the reference population minus 3 standard deviations is severe low weight, this indicator reflects that children have and / or now have chronic and / or acute malnutrition. This indicator alone cannot distinguish between acute and Chronic malnutrition.

(2) The age, sex, and height of children with stunted growth are lower than the median minus 2 standard deviations, but higher than or equal to the median minus 3 standard deviations. Stagnation. If it is lower than the median of the reference population by 3 standard deviations, it is considered as severe growth retardation. This indicator mainly reflects past or long-term chronic malnutrition.

(3) Compared with the standard of the same age and same gender, the weight and weight of wasting children are lower than the median and 2 standard deviations, but higher than or equal to the median and 3 standard deviations. If it is lower than the median of the reference population by 3 standard deviations, it means severe wasting. This indicator reflects the recent acute malnutrition in children.

2. Diagnosis criteria for malnutrition

(1) Medical history has a long history of insufficient dietary intake, improper feeding, digestive system diseases, chronic wasting disease or low birth weight.

(2) Typing shows that energy malnutrition is characterized by weight loss, protein malnutrition is characterized by edema, and both weight loss and edema are mixed.

(3) Clinically divided into three degrees of first-degree weight loss of 15% to 25%, abdominal skin fold thickness of 0.8cm to 0.4cm; second-degree weight loss of 25% to 40%, abdominal skin fold thickness of <0.4cm; third-degree body weight Reduced by> 40%, and the abdominal skin folds disappeared.

(4) Comorbidities often include anemia, vitamin A, B and C deficiency, and zinc deficiency; in severe cases, growth and development are stagnant, and organs and immune functions in the body are disturbed.

Malnutrition check

Malnutrition is a chronic nutritional deficiency caused by insufficient calories or protein, which is more common in infants and young children. With the continuous improvement of people's lives, the incidence of malnutrition has decreased significantly. The malnutrition seen so far is mostly caused by improper feeding methods or disease factors in infancy.

Blood glucose and cholesterol levels decreased, albumin and total protein decreased, transferrin was more sensitive than albumin decrease, thyroxine bound prealbumin, plasma ceruloplasmin decreased, and alkaline phosphatase decreased.

Malnutrition diagnosis

Children's dietary intake and eating habits should be mastered. Dietary surveys should be conducted to evaluate the intake of protein and heat energy, whether they affect digestion, absorption, and the existence of chronic wasting diseases. They should also understand the general situation of the family, the growth patterns of their families, Parents' height, weight, and concern for their children.

Malnutrition treatment

Cause treatment

Treatment of primary diseases such as chronic digestive diseases and wasting diseases such as tuberculosis and heart, liver and kidney diseases. Promote scientific feeding knowledge to parents, encourage breastfeeding, add supplementary food appropriately, and wean in time. Change bad eating habits such as picky eaters and partial eclipses.

2. Emergency treatment

(1) Anti-infection malnutrition and infection are inextricably linked. The most common are gastrointestinal, respiratory and / or skin infections, and sepsis is also common. Both need to be treated with appropriate antibiotics.

(2) Correction of water and electrolyte imbalances In the emergency treatment of malnutrition, the treatment of dehydration and electrolyte imbalances is particularly important, especially in children with diarrhea and malnutrition, pay attention to the following: Pay attention to the amount of fluid In case of heart failure. Adjust and maintain the electrolyte balance in the body: Malnourished children often have severe potassium deficiency. When urine output is normal, potassium can be given to 6 to 8 mmol / (kg · d) for at least 5 days. There is also a lack of calcium, magnesium, zinc, and phosphorus. If left untreated, the hypertonic parenteral nutrition solution will be further worsened when high heat energy is given.

(3) Nutrition support After the fluid and electrolyte imbalances are corrected, the treatment of malnutrition depends on the degree of damage to the intestinal absorption function. If the intestinal absorption function is poor, central or peripheral venous nutrition can be used as required. The former retention time Long, the input nutrient solution concentration is high, and the latter can not exceed 5 days. The composition and amount of parenteral nutrition solution should be based on the children's fluid needs, generally 100ml / (kg · d). Protein is generally 2g / (kg · d). Fat is the main source of thermal energy, providing 60% of the total thermal energy. When applying parenteral venous nutrition, serum glucose should be monitored every 6 hours to prevent hyperglycemia. Follow up with liver function every week.

3. Recovery period treatment

(1) Provide sufficient heat energy and protein. When calculating heat energy and protein needs, it should be calculated based on the average weight of the corresponding age (or P50), not the actual weight of the child. The amount of heat and protein required per kilogram of body weight multiplied by the ideal body weight is the daily intake.

(2) Food selection Choose foods suitable for children's digestive ability and nutritional needs. Choose foods with high protein and high heat energy, such as dairy products and animal proteins such as eggs, fish, meat, poultry and soy products, and fresh vegetables. fruit.

(3) Functional drug therapy to promote digestion and improve metabolism : administer various digestive enzymes such as pepsin and pancreatin to aid digestion. Appropriate application of anabolic steroids such as nandrolone phenylpropionate can promote protein synthesis and appetite in the body, but sufficient heat energy and protein should be supplied during medication.

4. Complication treatment

(1) Hypoglycemia is especially common in the wasting type. Generally, 10ml of 505 glucose can be injected intravenously after blood collection in the hospital for treatment. In the future, 5% to 10% glucose solution can be used in the fluid replacement.

(2) Low body temperature, severe weight loss and high body temperature mortality, mainly due to insufficient heat energy. Should pay attention to the ambient temperature (30 ~ 33 ), and use a hot water bottle or other methods to keep warm (pay attention to burns), while monitoring the body temperature, if necessary, once every 15 minutes.

(3) Anemia Severe anemia can be transfused such as Hb <40g / L, the weight loss type is generally 10-20ml / kg, and the edema type is generally not transfused except for collapse or heart failure due to anemia. Mild to moderate anemia can be treated with iron, 2 to 3 mg / (kg · d) for 3 months.

5. Diet Therapy

(1) Emphasize that breastfeeding is more comprehensive because of the nutrition in breast milk, but we must pay attention to getting enough vitamin A and vitamin D for breastfeeding. We can also take 500 to 1,000 international units of vitamin D daily from the baby's 1 to 2 weeks after birth. Take it continuously until 2 to 3 years old.

(2) Timely add supplementary foods rich in vitamin D and calcium to infants and young children such as egg yolk, liver mud, cod liver oil preparation, shrimp skin, minced vegetables, fruit juice, rice soup and so on. Toddlers over 1 year of age should comprehensively improve the quality of their diet, and regularly consume milk, eggs, tofu, green leafy vegetables, sugar, and staple foods.

(3) Eat more digestible foods, such as rice porridge, milk, chicken, duck, chicken liver, hawthorn, eel, quail, and silver fish. The diet should be soft, rotten and thin to facilitate digestion and absorption.

(4) Avoid eating To prevent malnutrition, young children should eat less hard and indigestible foods such as beans, peanuts and corn. Avoid fried, fried, smoked, grilled and fatty, overly sweet food. Use less sesame, sesame oil, spring onion, ginger, and various flavoring seasonings.

Malnutrition prevention

1. Strengthen nutrition guidance

Breastfeeding is encouraged. Those with insufficient or no breastmilk should be supplemented with high-quality protein substitutes (cow, goat's milk, soy milk, fish meat, etc.) to prevent feeding exclusively with starchy foods, condensed milk or malted milk. Older children should pay attention to the correct mix of food ingredients, properly supply meat, eggs, soy products, and supplement enough vegetables.

2. Actively prevent and treat diseases

Prevent infectious diseases, eliminate lesions, and correct congenital malformations.

3. Good habits

Pay attention to physical exercise, correct poor health and eating habits, eat regularly, and ensure adequate sleep.