Malnutrition | Medical Science Optional Notes for UPSC PDF Download

Undernutrition

• Definition: Undernutrition occurs when there is insufficient intake, ineffective absorption, or excessive loss of essential nutrients.
• Causes: It results from inadequate consumption, poor nutrient absorption, or excessive nutrient loss.
• Terminology: The term "malnutrition" encompasses both undernutrition and overnutrition. Sometimes, it is used interchangeably with "protein-energy malnutrition (PEM)" specifically when referring to undernutrition.
• Immediate Causes of Undernutrition:
  • Low dietary intake.
  • Low birth weight.
  • Infections.

Overnutrition

• Definition: Overnutrition is characterized by excessive intake or overindulgence of specific nutrients.
• Causes: It is caused by the consumption of nutrients beyond the body's requirements.

Note: The term "malnutrition" is a comprehensive term covering both undernutrition and overnutrition. "Protein-energy malnutrition (PEM)" is often used synonymously with undernutrition.

Indicators of undernutrition

Severe Acute Malnutrition-Diagnostic criteria

• Definition of Severe Acute Malnutrition (SAM):
  • Severe acute malnutrition (SAM) in children aged 6-59 months is defined by the World Health Organization (WHO) and UNICEF based on specific criteria.
• Diagnostic Criteria for SAM:
  • SAM is diagnosed if any of the following criteria are met:
    • Weight for height is below -3 standard deviation (SD or Z scores) of the median WHO growth reference.
    • Visible severe wasting is observed.
    • Presence of bipedal edema is detected.
    • Mid-upper arm circumference (MUAC) is below 11.5 cm.
• SAM Diagnosis in Children Below 6 Months:
  • For children below 6 months of age, MUAC cannot be used for diagnosis.
  • SAM should be diagnosed in the presence of criteria (i), (ii), or (iii) in this age group.

Malnutrition-Management

• Severity-Based Management:
  • The management of malnutrition is determined by its severity.
  • Mild to moderate malnutrition can typically be treated on an outpatient basis.
  • Severe malnutrition is preferably treated in a hospital setting.
• Management of Mild to Moderate Malnutrition:
  • Provide sufficient protein and energy, aiming for at least 150 kcal/kg/day.
  • Encourage frequent feeding, up to seven times a day.
  • Therapeutic diets often include oil to boost energy content.
  • Ensure a protein intake of 3 g/kg/day, utilizing sources such as milk and vegetable protein mixtures.
  • Supply adequate minerals and vitamins.
  • Effectiveness of treatment for mild and moderate malnutrition is often assessed by monitoring weight gain.

Severe Acute Malnutrition-Management

The general treatment involves ten steps in two phases:

• The initial stabilization phase focuses on restoring homeostasis and treating medical complications and usually takes 2-7 days of inpatient treatment.
• The rehabilitation phase focuses on rebuilding wasted tissues and may take several weeks.

Diets

IMNCI-Feeding problem and Malnutrition

IMNCI-Malnutrition

Malnutrition-Repeats

Q1: Define "Severe stunting" and "Severe Wasting" in under-five children. (2016) 

Q2: Outline the diagnostic criteria for "Severe Acute Malnutrition"
(i) in children between 6 months -5 years of age; and
(ii) in infants below 6 months of age. (2016)

Q3: Enlist the diagnostic criteria for severe malnutrition according to WHO classification in under- five children. (2014)

Q4: Discuss the home/community-based management of children with moderate malnutrition. (2014)

Q5: An 18-month-old girl is diagnosed with Sever e Acute Malnutrition (SAM}. Outline the 4 diagnostic criteria for this condition. Write the 10 steps for appropriate management of severe malnutrition as per WHO guidelines. (2013) 

Q6: An 11-month-old infant is brought to hospital with delayed weaning and history of recurrent diarrheal episodes. The child is apathic, weighs 5.5kg, with depigmented hair and edema over the limbs.
(i) What is the most likely diagnosis?
(ii) Enumerate the clinical assessment and investigations that would be helpful in this infant?
(iii) Enumerate the essential steps and two phases of treatment for this child. (2015)

Q7: A 16-month-old child attending Pediatrics OPD with past history of diarrhea and respiratory infections was found to have loss of subcutaneous fat and weight of 5-5 kilograms. Which physical examination findings would help you to arrive at diagnosis in this child? Describe the two phases of treatment for this condition? (2018)