Malnutrition and/or Malnourished - Medtick
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Malnutrition and/or Malnourished

What is it?

The World Health Organization defines malnutrition as “the cellular imbalance between supply of nutrients and energy and the body’s demand for them to ensure growth, maintenance, and specific functions.”

WHO. Malnutrition-The Global Picture. World Health Organization. Available at https://www.who.int/home-page/.

Cause

  • Inadequate food intake
  • Early stopping of breastfeeding
  • Cultural and religious food customs may play a role.
  • Inadequate sanitation further endangers children by increasing the risk of infectious diseases that increase nutritional losses and alters metabolic demands.
  • Chronic illness are at risk for nutritional problems for several reasons, including the following:
    • Children with chronic illnesses frequently have anorexia, which leads to inadequate food intake
    • Increased inflammatory burden and increased metabolic demands can increase caloric need.
    • Any chronic illness that involves the liver or small bowel affects nutrition adversely by impairing digestive and absorptive functions.

Fruit juice consumption in malnourished children

  • Fruit juice consumption as excessive juice consumption may be associated with malnutrition

Heyman MB, Abrams SA, SECTION ON GASTROENTEROLOGY, HEPATOLOGY, AND NUTRITION., COMMITTEE ON NUTRITION. Fruit Juice in Infants, Children, and Adolescents: Current Recommendations. Pediatrics. 2017 May 22. [QxMD MEDLINE Link].

Signs and symptoms

The most common and clinically significant micronutrient deficiencies and their consequences include the following:

Iron deficiency

  • Fatigue
  • Anaemia
  • Decreased cognitive function
  • Headache
  • Glossitis (red, swollen tongue)
  • Nail changes

Iodine deficiency (similar symptoms to hypothyroidism)

  • Goitre (lump or swelling at the front of the neck caused by a swollen thyroid)
  • Developmental delay
  • Intellectual disability

Vitamin D deficiency

Vitamin A deficiency

  • Night blindness
  • Xerophthalmia (dry eye disease that can lead to night blindness and/or spots in the eye)
  • Poor growth
  • Hair changes

Folate deficiency

  • Glossitis (red, inflamed tongue)
  • Anaemia (megaloblastic)
  • Neural tube defects (in foetuses of women without folate supplementation)

Zinc deficiency

  • Anaemia
  • Dwarfism
  • Hepatosplenomegaly (enlargement of liver and spleen)
  • Hyperpigmentation
  • Hypogonadism
  • Acrodermatitis enteropathica (distinctive rash from zinc deficiency)
  • Diminished immune response
  • Poor wound healing

Physical examination and signs

Physical findings that are associated with protein-energy malnutrition (PEM) include the following:

  • Decreased subcutaneous tissue: Areas that are most affected are the legs, arms, buttocks, and face

  • Oedema: Areas that are most affected are the distal extremities (swollen wrists, hands and ankles and feet) and anasarca (generalized oedema).

  • Oral changes:  angular stomatitis, and papillar atrophy (changes in colour and fissures/cracks of tongue)

  • Abdominal findings: Abdominal distention secondary to poor abdominal musculature and hepatomegaly secondary to fatty infiltration

  • Skin changes: Dry, peeling skin with raw, exposed areas; hyperpigmented plaques over areas of trauma

  • Hair changes: Thin, sparse, brittle hair that is easily pulled out and that turns a dull brown or reddish colour

Balint JP. Physical findings in nutritional deficiencies. Pediatr Clin North Am. 1998 Feb. 45(1):245-60. [QxMD MEDLINE Link].

Detailed Information

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