Department of Biochemistry, SJMC

1st MBBS II Term (Batch 2019)

NUTRITION-Self Directed Learning.

Questions:
1. Compare and contrast Marasmus and Kwashiorkor.
2. Milk is a complete protein -Justify.
3. Mr. Hari is a 35-year-old Male, working in a Private bank as General manager, visited the
hospital for a Health Check. His height is 170cm & Weight: 60kg.
The laboratory investigations were as follows:
Hb: 16.2g/dL
RBS: 104mg/dL
Total Cholesterol: 160mg/dL
HDL Cholesterol: 40mg/dL
LDL Cholesterol: 134mg/dL
Serum Triglycerides: 127mg/dL

Discuss the different steps in prescribing diet for this individual. Also, plan a vegetarian
diet for him.

4. Sagar is a 4-year-old boy. His mother has brought to the primary health centre. She says
that the boy appears ’swollen’ and that he is highly irritable. The boy has a half a ‘pav’
and half a glass of milk for breakfast, his lunch consists 1 small chapatti. In the night he
eats half a cup of rice. On examination, the positive findings are
Weight 11kg
Reddish colour hair
Generalized oedema
Moon facies
Abdominal distension
Hepatomegaly.
Skin- dark, dry, with crazy pavement dermatosis
Systemic examination is normal

Based on the above history and examination, the diagnosis is

a) Marasmus
b) Kwashiorkor
c) Marasmic kwashiorkor
d)None of the above

What are the causes of protein energy malnutrition?

 How would you investigate this child?

5. 2 years old Munni, Youngest of the four children of Yashoda, Belongs to Scheduled
caste, Resident of urban slum, Family belongs to Below Poverty Line.
Munni is currently suffering from loose stools, vomiting. She had experienced recurrent
episode of diarrhea and ARI in past one year Born at home with low birth weight, Ghutti
was given at the time of birth Exclusive breast feeding for four Undernourished for age
at present. Incomplete immunization as per age. Her sisters are also suffering from
loose stools, worms in stools, vomiting and are undernourished for their age.
Yashoda 24 yrs., illiterate, married 7 years back has four daughters, out of which 2 are
under five yrs. age She delivered four girl children in a hope of male child, Not adopted
any family planning method due to fear of its complications. Migrated in urban slum
area from village 5 years back Lives in - jhuggi area in rented jhopadi, Yashoda and her
husband are daily wage labourers. Eldest daughter takes care of younger ones
There is no government health facility in an urban slum Yashoda was unable to take
Munni to General Hospital which is 10 kms away as it will lead to daily wage loss.
Yashoda had sought treatment for her children from unqualified private practitioner in
an urban slum. None of her daughter are going to anganwadi as it remains closed all the
time. Family belongs to BPL, but they do not possess BPL card. Able to provide food to
their daughters once a day only
On Examination, the child had a shrunken wasted appearance, loss of muscle mass and
subcutaneous fat mass especially in buttocks and upper limb muscles. The child was
irritable and whining who cannot be comforted or separated from the mother.

a. Identify this case.

b. What are the causes of protein energy malnutrition?
c. Is this condition preventable?
 6. Mr. Ganesh is an accountant, 54 years of age, with a past medical history of
hypertension. At his yearly physical, he reports that he is doing well overall, with no
complaints other than some dyspnea on exertion, which has been long-standing.
Current medications include a thiazide diuretic and aspirin. He does not get much
physical activity during the day. On examination, Mr. Ganesh is 5'11" and 90 kgs. His
BMI is 29. His waist circumference is 40.5 inches, and his blood pressure is 135/80 mm
Hg (sitting) and 130/80 mm Hg (standing). His heart rate is 86 beats per minute, his
temperature is 98.6° Fahrenheit, and his respiration is 18 breaths per minute. His
physical exam is unremarkable. Laboratory data as follows:
Total cholesterol: 230 mg/dL
HDL: 38 mg/dL
LDL: 152 mg/dL
Triglycerides: 200 mg/dL
Glucose (fasting): 120 mg/dL

Discuss the case under the following headings:

Diagnosis
Definition and criteria