Chronic and acute malnutrition

What is acute malnutrition? Which two types of acute malnutrition exists?

Acute malnutrition is when the amount of one or more macronutrients available to body tissues is inadequate to sustain optimal function. It is typically assessed by wasting.

Acute malnutrition can be classified into: Moderate acute malnutrition (moderate wasting without severe complications) and severe acute malnutrition (Severe wasting, often with additional signs like edema (in kwashiorkor) or extreme thinness (in marasmus), and a high risk of mortality if not treated promptly).

What is chronic malnutrition?

Chronic malnutrition s defined as a long-term deficiency in the intake of essential nutrients, leading to impaired growth and development. It is often assessed by stunting. Chronic malnutrition can affect not only physical growth but also cognitive development, immune function, and overall health. It typically results from persistent food insecurity, poor dietary quality, recurrent infections, or a combination of these factors over an extended period.

How do you assess acute malnutrition/wasting?

It can be assessed if a child is wasted by measuring the mid upper-arm circumference with MUAC tape, with weight-for-height z scores, and by determining if odema is present. ·       Weight-for-height z-scores are used to assess nutritional status. We distinguish between moderate (weight-for-height z-score between 2 and 3 SD below mean) and severe (weight-for-height z-score more than 3 SD below mean) acute malnutrition.

Why is measuring mid-upper-arm circumference sometimes prefered over weight-for-heigt z-scores to assess nutritional status?

Determining the weight-for-height z-score are much more complicated than MUAC, which possibly are the reason many prefer MUAC over z-score. Many more people can be screened. However, more are identified as severely malnourished using MUAC compared to weight-for-height z-scores.

How do you assess chronic malnutrition/stunting?

By using height-for-age z-scores.

Describe the concept of a PEA POD (BOD POD) - method

The PEA POD (Air displacement plethysmography) can be used to determine fat mass and fat free mas. It is a little chamber, where the volume of air displaced by the infant’s body are measured. It is very expensive and non-portable, why there may be limited use of PEA PODS in low-income settings.

Describe the deuterium dilution method

The deuterium dilution method is the gold standard for determining total body water, fat free mass, and fat mass. The person drinks a known dose of deuterium-labeled water (a stable, non-radioactive isotope of hydrogen). After a few hours (allowing for equilibration), saliva, urine, or blood samples are collected. The dilution of deuterium in body fluids is measured using infrared spectroscopy or mass spectrometry.

It requires specialized, expensive equipment and technical expertise, therefore possibly not widely used in low-income settings.

What are the general causes of acute malnutrition?

Inadequate diet leading to macronutrient deficiencies, poor nutrient absorption (e.g., due to gastrointestinal disorders), inflammatory conditions increasing nutrient requirements.

How do you treat uncomplicated severe acute malnutrition?

It is treated at home with ready-to-use therapeutic food. It has high-energy density, it is rich in micronutrients, and it is water free to avoid bacterial growth.

What are the key management phases of treating complicated severe acute malnutrition?

·       Initial phase (first 1-2 days): Prevent hypoglycemia, dehydration, and hyperthermia. Start treatment for infections.

·       Stabilization phase (first 3-7 days): Gradually increase feeding volumes as tolerance improves. Begin iron supplementation after stabilization.

·       Recovery phase: Focus on correcting electrolyte imbalances, continuing antibiotics if needed, promoting steady weight gain and monitoring for complications.

What can symptoms like sunken eyes and dry skin be a sign of in severe acute malnutrition?

Symptoms that appear as dehydration (e.g., sunken eyes, dry skin) often reflect wasting and muscle loss, NOT true dehydration. Careful assessment is needed to avoid overhydration.

What is environmental enteric dysfunction (EED)?

It is a condition where the intestinal lining is damaged, leading to:

• Flattened villi and thereby reduced nutrient absorption

• Increased intestinal permeability (“leaky gut”) → allows bacteria and toxins to enter the bloodstream.

• Chronic immune activation → persistent inflammation in the gut.

What can the causes of environmental enteric dysfunction (EED) be?

Poor diet (nutritional deficiencies), unhygienic environments leading to repeated infections, pathogens (frequent exposure to contaminated food and water), food-borne mycotoxins (toxins from mold-contaminated grains), indoor air pollution (e.g., from indoor cooking with biomass fuels).

What is Marasmus?

Extreme wasting (loss of fat and muscle). It gives a skin and bones look with prominent ribs, no edema. Energy deficiency dominates, body breaks down its own tissue for survival.

What is Kwashiorkor (nutritional edema)?

A form of severe acute malnutrition characterized by edema (swelling) due to fluid retention. Symptoms are bilateral pitting edema (especially in legs and feet), distended belly (swollen abdomen), changes in skin (dark patches, peeling) and hair (light-colored, brittle).

What is refeeding syndrome?

A potentially life-threatening condition that can occur when feeding is reintroduced too quickly after severe malnutrition or starvation. It can be prevented by slowly introducing small, frequent meals. Monitor electrolytes closely (especially phosphate, potassium, magnesium). Supplement electrolytes as needed.

Pathology:

·       Sudden increase in food intake → shift from fat metabolism back to carbohydrate metabolism.

·       This triggers an increase in insulin, causing rapid uptake of electrolytes like (from blood to cells – concentration in bloodstream declines): Phosphate (↓), Potassium (↓), Magnesium (↓) → dangerous imbalances. (Causing hypophosphataemia, hypokalaemia, hypomagnesaemia). Furthermore, it creates retention of sodium and water causing hyperglycemia.

Can in the end cause multi-organ failure and death