child undernutrition

malnutrition definition - colloquial use

meaning undernutrition

define undernutrition

inadequate nutritional intake

define hunger:

physical symptom of undernutrition

define food poverty

lack of diversity in the diet (in regard to food groups)

define food insecurity

physical and economic access to nutritious foods

what is a z score equal to?

1 standard deviation

what are z scores used for ?

compare an individual to population standards

what are z scores a good tool for?

clinical prognostic indicator for future health and increasingly associated with mortality

what does underweight refer to - z score defintion:

weight for age (WAZ)

<-2 = underweight

<-3 = severely underweight

what does stunting refer to and z score defintion:

height for age (HAZ)

<-2= stunted

<-3= severely stunted

what des wasting refer to and z score definition:

weight-for-height (WHZ)

<-2=wasted

<-3= severely wasted

what does stunting relate to?

chronic protein energy malnutrition

describe what oedema is

fluid in the intracellular space

what is an indicator of a nutritional cause of oedema?

bilateral oedema

what is considered a significant public health concern for % of children underweight

>10%

what is considered a significant public health concern for % of children stunted?

>20% of children affected

what is considered a significant public health concern for % of children wasted?

>5%

where is stunting prevalent?

over 30% in africa and south east asia - WHO 2024

what is the SOFI report

shows global food security and nutrition trajectories

what did the SOFI REPORT show?

Stunting -> decreasing from 33 % to 23%

And then starting to increase from 2023

COVID- healthy countries redirected health investment - reduced overseas development aid

2022-2023 - war , Ukraine war, impact on global food supplies

Meant price was increased due to lower supply-

what statistic did the SOFI 2025 report say about hunger?

between 7-8% of the global population faced hunger

what policy options did the 2025 SOFI report suggest?

temporary and targeted financial support - not specified

longer focus on strategic food reserves

investment in resilient agri-food systems

prevalence of wasting in southern asia:

30-40% classified as wasted

what are 3 reasons for child undernutriton?

conflict - displacement, reduced agricultural production

poverty - women and children most affected

environment - climate change, more likely to affect those in LICs

what are tools for diagnosis of severe malnutrition:

1. anthropometry -WHZ <-3

2. mid upper arm circumferences <11.5cm

3. bilateral pitting oedema

what identifies severe malnutrition using MUAC?

less than 11.5 cm - WHO

what is an issue with these diangostic tools?

known that MUAC-SM and WFH-SM diagnoses do not agree in many cases

some recommended higher cut offs with MUAC e.g 13 cms and in different ethnic or geographic regions

what is a feature of MUAC?

high specificity but low sensitivity - missed cases of SM

describe marasmus/ non-oedematous SM

no oedema

severe wasting , adipose reserves are used as metabolic fuel , protein used for gluconeogenesis and essential functions

describe kwashiorkor/oedematous SM

characterized by bilateral pitting oedema

skin pigmentation

high levels of albumin in the intracellular space due to gaps appearing in blood vessels

what are the metabolic and hormonal adaptation for SM:

reduced BMR and total energy expenditure, loss of fat/muscle/visceral tissue. Reduced insulin, IGF-1 and increased cortisol and growth hormone

How is glucose regulation and substrate use altered during SM?

hypoglycaemia with glycogen depletion pivots to gluconeogenesis using amino acid, pyruvate and lactate substrates leading to further muscle loss. In prolonged starvation, lipolysis and ketogenesis increase.

what happens to electrolyte and cellular membranes during SM :

dysfunction: Na retention and intracellular K+ from reduced Na/K ATPase activity and increased permeability

what happens to immunity in SM?

becomes impaired and increased susceptibility to infection

what happens to the gut during SM?

villi reduces

Have gut morphology changes, absorptive capacity changes, more likely to get diarrhoea ,

disaccharides deficiency - harder to digest

how are cardiac, respiratory and neurological functions affected?

reduced function across all systems due to tissue loss, potential irreversible cognitive deficits

when should SM be treated in a hospital setting?

with no appetite or complications like impaired consciousness

what is complicated SM associated with ?

high in-hospital mortality rates and poor long term outcomes

what's not true about anthropometric recovery?

poor predictor of survival

what's catch up growth ?

growing at an accelerated rate to catch up to average

BUT - evidence shows still lower W for H z scores and 100% cathc up does not occur

what is a window for catch up growth?

first 1000 days BUT now have adolescents may offer second window - contrasting with previous strict window