CN: Protein energy malnutrition

nutritional status definition

Condition of health influenced by intake and utilization of nutrients

methods to assess nutritional status

Anthropometry, biochemical tests, clinical signs, dietary intake, functional capacity

limitation of clinical impression

Cannot rely solely on appearance, risk may not be visible

limitation of BMI alone

BMI does not capture nutrient deficiencies or functional decline

difference between screening and assessment

Screening is rapid risk identification, assessment is thorough evaluation

role of screening

Detect individuals at risk of undernutrition

role of assessment

Confirm diagnosis and guide intervention

detecting current underweight

Use BMI calculation and percentage weight loss

detecting risk of undernutrition

Assess current nutrient intake and predicted illness course

intake failure definition

Inability to get food into the gut

causes of intake failure

Poor dentition, poor appetite, cancer, trauma, neurological disease, psychological disorders, social circumstances

neurological causes of poor intake

Stroke, cerebral palsy, motor neurone disease, multiple sclerosis

psychological causes of poor intake

Dementia, depression, eating disorders

social causes of poor intake

Isolation, poverty, limited nutrition knowledge

bulimia nervosa signs

Parotid hyperplasia, dental erosions

anorexia nervosa signs

Severe undernutrition, muscle and fat loss

mouth sign glossitis

Deficiency of riboflavin, niacin, biotin, vitamin B6, vitamin B12, folate, iron, zinc

mouth sign angular stomatitis

Deficiency of riboflavin, niacin, biotin, vitamin B6, iron

mouth sign gingivitis with bleeding

Deficiency of vitamin C

mouth sign parotid hyperplasia

Bulimia nervosa

glossitis description

Swollen tongue, color change, papillae atrophy (slick tongue)

cheilosis description

Cracks at mouth corners, may bleed, ulcers or crusts

gingivitis description

Inflamed gums with bleeding

eye sign xerophthalmia

Deficiency of vitamin A

eye sign night blindness

Deficiency of vitamin A

eye sign Bitot’s spots

Deficiency of vitamin A

eye sign corneal ulceration

Deficiency of vitamin A

eye sign diplopia

Vitamin A toxicity

eye sign Kayser-Fleischer ring

Copper toxicity

skin sign seborrheic dermatitis

Deficiency of vitamin B6, zinc

skin sign impaired wound healing

Deficiency of vitamin C, zinc

skin sign Casal’s necklace

Deficiency of niacin

skin sign perifollicular petechiae

Deficiency of vitamin C

skin sign purpura

Deficiency of vitamin C, vitamin K

skin sign yellow orange discoloration

Excessive carotenoid intake

skin sign depigmentation

Protein energy malnutrition

skin sign follicular hyperkeratosis

Deficiency of vitamin A, vitamin C

skin sign pallor

Deficiency of iron, vitamin B12, folate

nail sign koilonychia

Deficiency of iron

nail sign thickened discolored nails

Selenium toxicity

hair sign corkscrew hairs

Deficiency of vitamin C

hair sign easy pluckability flag sign

Protein energy malnutrition

hair sign alopecia

Deficiency of protein, biotin, zinc or excess vitamin A

nutritional anemia profile tests

Hb, Hct, MCV, RBC folate, serum homocysteine, serum B12, serum folate, serum ferritin, serum iron, TIBC, transferrin saturation

haemoglobin role

Oxygen carrying pigment, screening tool for iron deficiency anemia

haemoglobin limitation

Decreases late in anemia, affected by blood volume changes

clinical signs of iron deficiency anemia

Pallor, koilonychia, glossitis, angular stomatitis

clinical signs of vitamin A deficiency

Xerophthalmia, night blindness, Bitot’s spots, corneal ulceration

clinical signs of iodine deficiency disorders

Goiter and related thyroid changes (from slides reference)

refeeding syndrome definition

Hypophosphatemia, hypokalemia, hypomagnesemia causing multi‑system disturbances

systems affected in refeeding syndrome

Cardiac, neurologic, gastrointestinal, respiratory, hematologic, skeletal, endocrine

causes of PEM

Poverty, lack of food, diseases, inappropriate feeding, environmental factors, lack of resources

community manifestations of PEM

Stunting, underweight in children

severe forms of PEM

Kwashiorkor and marasmus

hospital causes of PEM

Disease conditions, poor intake, trauma, cancer, neurological disorders

treatment of PEM stages

Acute hospital treatment followed by community rehabilitation

acute hospital treatment of PEM

Correct electrolyte imbalances, manage refeeding syndrome

community rehabilitation of PEM

Address stunting, underweight, improve food security and education

functional capacity in undernutrition

Poor functional status

functional capacity in overnutrition

Sedentary, inactivity

dietary intake in undernutrition

Inadequate intake

dietary intake in overnutrition

Excessive intake

biochemical test in undernutrition

Decreased protein levels, decreased enzyme activity

biochemical test in overnutrition

Normal protein, abnormal lipids and blood sugars

anthropometry in undernutrition

Decreased muscle and fat stores

anthropometry in overnutrition

Increased fat stores

clinical impression limitation example

Patient may appear normal but have biochemical deficiencies

screening example

Hb test for anemia risk

assessment example

Full dietary, anthropometric, biochemical, clinical evaluation

oral intake failure cancer examples

Head and neck cancer, oesophageal cancer

oral intake failure neurological examples

Stroke, cerebral palsy, motor neurone disease, multiple sclerosis

oral intake failure psychological examples

Dementia, depression, eating disorders

oral intake failure social examples

Isolation, poverty, limited nutrition knowledge

glossitis nutrient deficiencies

Riboflavin, niacin, biotin, vitamin B6, vitamin B12, folate, iron, zinc

cheilosis nutrient deficiencies

Riboflavin, niacin, biotin, vitamin B6, iron

gingivitis nutrient deficiency

Vitamin C

seborrheic dermatitis nutrient deficiencies

Vitamin B6, zinc

Casal’s necklace nutrient deficiency

Niacin

perifollicular petechiae nutrient deficiency

Vitamin C

purpura nutrient deficiencies

Vitamin C, vitamin K

follicular hyperkeratosis nutrient deficiencies

Vitamin A, vitamin C

pallor nutrient deficiencies

Iron, vitamin B12, folate

koilonychia nutrient deficiency

Iron

corkscrew hairs nutrient deficiency

Vitamin C

alopecia nutrient deficiencies

Protein, biotin, zinc; excess vitamin A

flag sign hair

Protein energy malnutrition

parotid hyperplasia cause

Bulimia nervosa

dental erosions cause

Bulimia nervosa

xerophthalmia cause

Vitamin A deficiency

night blindness cause

Vitamin A deficiency

Bitot’s spots cause

Vitamin A deficiency

corneal ulceration cause

Vitamin A deficiency

diplopia cause

Vitamin A toxicity

Kayser-Fleischer ring cause

Copper toxicity

yellow orange skin cause

Excess carotenoid intake

depigmentation cause

Protein energy malnutrition