Materials for practical classes for 4-years student

Chronic disorders of nutrition (CDN)

CDN are seen predominantly in infants and may be of 3 types:

1.With low body weight (hypotrophy)

2.With high body weight (paratrophy or adiposity)

3.With proportional decrease of the body weight and height (hypostature).

The main, most often variant of hypotrophy is protein energy malnutrition (PEM). As a rule, there are hypovitaminoses and sometimes trace elements deficiency in such children.

Protein energy malnutrition (PEM)

PEM— is a chronic disorders of nutrition, which characterized by body weight deficiency, thickness of adipose layer, disturbance of body proportion, metabolism, appear immunodeficiency, retardation of psycho- and locomotor's development.

Undernutrition is widely recognized as a major health problem in the developing countries of the world. The frequency of undernutrition cannot be easily estimated from the prevalence of commonly recognized clinical syndromes of malnutrition such as marasmus and kwashiorkor because these constitute only proverbial tip of the iceberg. Cases with mild to moderate undernutrition are likely to remain unrecognized because clinical criteria for their diagnosis are imprecise and difficult to interpret accurately.

Undernutrition is often diagnosed by comparing the weight, height and mid-arm circumference of an individual with the anthropometrical norms for the corresponding age in that community. Reliable anthropometry is not easily available in most developing counties. It is difficult to define "what constitutes an appropriate and optimum body size". Children who receive less food do remain small. The prevalence of undernutrition cannot be judged solely from an estimation of the quantity of food consumed by an individual in the recent past. Human body has a remarkable capacity to adjust its metabolism to meet some variations in the daily intake of food. Unless nutritional deprivation is severe and prolonged, short-term deficit may not produce any significant physiological disturbance.

By data of WHO there are 20-30% of infants in developing countries who have PEM and other variants of undernutrition.

Causes of undernutrition

Inability to pay for food.

The most common cause of malnutrition is poverty. The poor cannot purchase adequate amount of food of the desired quality for meeting their and their family nutritional requirements. This deprivation adversely affects their capacity for physical work and endurance. They earn less and this starts a vicious cycle of poverty: undernutrition - diminished work capacity - low earning and poverty. In the new social milieu, competing demands for non-food expenditure, such as on housing, clothing and entertainment, have gone up significantly often at the cost of the expenditure on food.

Feeding habits.

Exclusive breast-feeding gives a nutritional advantage to the babies during the first few months of life. If the lactation fails or,if the breast milk supply is not sufficient to satisfy the nutritional needs of the infant, artificial feeding is employed. In most rural household weaning is delayed, often beyond one year. Diluted cow or buffalo’s milk in small quantities supplements breast feeds. Solid energy dense and protein rich foods are started late. Enteric infections, especially diarrhea, are not unusual during the weaning period. The weaning diarrhea is wrongly attributed to teething by parents, who often withhold food supplements or dilute the milk still further during episodes of diarrhea. Prevailing dietary practices and cultural taboos on consumption of certain types of foods are the other conditioning factors leading to malnutrition.

Advertising of baby foods high pressure.

High pressure of advertising by baby food manufacturers and social demands on the urban educated working women has encouraged early discontinuation of breast-feeding. Unfortunately evaporated dry milk powders and packaged foods are expensive. Poor mother tends to economize on their use and offers diluted milk formula to the infant. Unhygienic feeding practices on the preparation of milk formula result on frequent episodes of diarrhea and diminished absorption of food by the infant.

Infections

Infections such as malaria and measles precipitate acute malnutrition and aggravate the existing nutritional deficit. Recurrent attacks of diarrhea on preschool children are a major contributory factor in etiology. During infections, child's appetite is impaired. There may be iatrogenic restriction of food by the parents. The patient catabolizes his own tissues to produce the additional heat energy, which is lost during fever. Therefore such infants lose weight. Metabolic demands for protein during infections are higher. Protein is lost because of tissue breakdown and in pus and exudates. Malnutrition may adversely affect the immune status and make the malnourished individuals more vulnerable to infections. This sets up a vicious cycle of malnutrition - infection - malnutrition.