PROTEIN ENERGY MALNUTRITION

It is defined by WHO as a weight for age below the

median-2 S D of the NCHS reference population.

Incidence - 1 to 2%
In India 0-5 yr children – 53.4% are underweight
Only 10% are normal
 MALNUTRITION CYCLE
Inadequate Dietary Intake

Appetite loss
Nutrient loss Wt loss
Malabsorption Growth Faltering
Altered Metabolisms Immunity lowered
Mucosal Damage

Disease
KWASHIORKAR MARASMUS
 CLINICAL FEATURES
Wt for age
Wt for height
Muscle wasting
Mental changes
Fat wasting
Appetite
Diarrhoea
Skin changes
Hair changes
Hepatic enlargement
Mid-arm circumference
 GOMEZ CLASSIFICATION

wt of child
Wt for Age = * 100
wt of normal child
of same age
Between 90 and 110% : NORMAL
Between 75 and 89% : 1 DEGREE
Between 60 and 74% : 2 DEGREE
Under 60% : 3 DEGREE
 WATERLOW’S CLASSIFICATION

Wt of Child
Wt/Ht = * 100
Wt of Normal child
of same height

Ht of the child
Ht/Age = * 100
Ht of normal at same age
 CASE CONTROL STUDY
NORMAL CHILD

Normal delivery
Weight : 3 kg
Vaccines at regular intervals
Mile stones developed normally
Weight at 38 months=13.450 kg
Lactation for 18 months
Weaning given properly
No episodes of diarrhoea or recurrent RTI
Growth chart normal
Socio economic status class 5
 GRADE TWO

Normal delivery
Weight : 3kg
Milestones :
walking at 2½ years
speech after 2 years
Weight at 38 months=10.350 kg
Lactation for 18 months
Weaning started at 8 months
After 1½ years recurrent diarrhoea present
Brownish discolouration of hair present
In growth chart there is decline after 1½ years
Socio economic status class : 5
 FACTORS

Economic status
Diet
Hygiene
Ignorance
Cultural factors
Family environment