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    Malnutrition

    • Malnutrition
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      An orange ribbon—the awareness ribbon for malnutrition.
      Classification and external resources
      Specialty Critical care medicine
      ICD-10 E40-E46
      ICD-9-CM 263.9
      MedlinePlus 000404
      eMedicine ped/1360
      Patient UK Malnutrition
      MeSH D044342
      []

      Malnutrition or malnourishment is a condition that results from eating a diet in which nutrients are either not enough or are too much such that the diet causes health problems. It may involve calories, protein, carbohydrates, vitamins or minerals. Not enough nutrients is called undernutrition or undernourishment while too much is called overnutrition. Malnutrition is often used specifically to refer to undernutrition where there is not enough calories, protein, or micronutrients. If undernutrition occurs during pregnancy, or before two years of age, it may result in permanent problems with physical and mental development. Extreme undernourishment, known as starvation, may have symptoms that include: a short height, thin body, very poor energy levels, and swollen legs and abdomen. People also often get infections and are frequently cold. The symptoms of micronutrient deficiencies depend on the micronutrient that is lacking.

      Undernourishment is most often due to not enough high-quality food being available to eat. This is often related to high food prices and poverty. A lack of breastfeeding may contribute, as may a number of infectious diseases such as: gastroenteritis, pneumonia, malaria, and measles, which increase nutrient requirements. There are two main types of undernutrition: protein-energy malnutrition and dietary deficiencies. Protein-energy malnutrition has two severe forms: marasmus (a lack of protein and calories) and kwashiorkor (a lack of just protein). Common micronutrient deficiencies include: a lack of iron, iodine, and vitamin A. During pregnancy, due to the body's increased need, deficiencies may become more common. In some developing countries, overnutrition in the form of obesity is beginning to present within the same communities as undernutrition. Other causes of malnutrition include anorexia nervosa and bariatric surgery.


      Degree of PEM  % of desired body weight for age and sex
      Normal 90%-100%
      Mild: Grade I (1st degree) 75%-89%
      Moderate: Grade II (2nd degree) 60%-74%
      Severe: Grade III (3rd degree) <60%
      SOURCE:"Serum Total Protein and Albumin Levels in Different Grades of Protein Energy Malnutrition"
      Degree of PEM Stunting (%) Height for age Wasting (%) Weight for height
      Normal: Grade 0 >95% >90%
      Mild: Grade I 87.5-95% 80-90%
      Moderate: Grade II 80-87.5% 70-80%
      Severe: Grade III <80% <70%
      SOURCE: "Classification and definition of protein-calorie malnutrition." by Waterlow, 1972
      Site Sign
      Face Moon face (kwashiorkor), simian facies (marasmus)
      Eye Dry eyes, pale conjunctiva, Bitot's spots (vitamin A), periorbital edema
      Mouth Angular stomatitis, cheilitis, glossitis, spongy bleeding gums (vitamin C), parotid enlargement
      Teeth Enamel mottling, delayed eruption
      Hair Dull, sparse, brittle hair, hypopigmentation, flag sign (alternating bands of light and normal color), broomstick eyelashes, alopecia
      Skin Loose and wrinkled (marasmus), shiny and edematous (kwashiorkor), dry, follicular hyperkeratosis, patchy hyper- and hypopigmentation, erosions, poor wound healing
      Nail Koilonychia, thin and soft nail plates, fissures or ridges
      Musculature Muscles wasting, particularly in the buttocks and thighs
      Skeletal Deformities usually a result of calcium, vitamin D, or vitamin C deficiencies
      Abdomen Distended - hepatomegaly with fatty liver, ascites may be present
      Cardiovascular Bradycardia, hypotension, reduced cardiac output, small vessel vasculopathy
      Neurologic Global development delay, loss of knee and ankle reflexes, poor memory
      Hematological Pallor, petechiae, bleeding diathesis
      Behavior Lethargic, apathetic
      Source: "Protein Energy Malnutrition"
      Number of undernourished globally
      Year 1970 1980 1990 1995 2005 2007/08 2014/16
      Number in millions 843 788 848 923 793
      Percentage in the developing world 37% 28% 20% 16% 17% 13.5%

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