Pem

PROTEIN ENERGY MALNUTRITION It is defined by WHO as a weight for age below the median-2 S D of the NCHS reference population. Incidence - 1 to 2% In India 0-5 yr children – 53.4% are underweight Only 10% are normal

MALNUTRITION CYCLE Inadequate Dietary Intake Appetite loss Nutrient loss Malabsorption Altered Metabolisms

Wt loss Growth Faltering Immunity lowered Mucosal Damage

Disease

KWASHIORKAR

MARASMUS

CLINICAL FEATURES Wt for age Wt for height Muscle wasting Mental changes Fat wasting Appetite Diarrhoea Skin changes Hair changes Hepatic enlargement Mid-arm circumference

GOMEZ CLASSIFICATION wt of child Wt for Age =

* 100 wt of normal child of same age

Between 90 and 110% : NORMAL Between 75 and 89%

: 1 DEGREE

Between 60 and 74%

: 2 DEGREE

Under 60%

: 3 DEGREE

WATERLOW’S CLASSIFICATION Wt of Child Wt/Ht

=

* 100 Wt of Normal child of same height

Ht/Age

=

Ht of the child Ht of normal at same age

* 100

CASE CONTROL STUDY NORMAL CHILD Normal delivery Weight : 3 kg Vaccines at regular intervals Mile stones developed normally Weight at 38 months=13.450 kg Lactation for 18 months Weaning given properly No episodes of diarrhoea or recurrent RTI Growth chart normal Socio economic status class 5

GRADE TWO Normal delivery Weight : 3kg Milestones : walking at 2½ years speech after 2 years Weight at 38 months=10.350 kg Lactation for 18 months Weaning started at 8 months After 1½ years recurrent diarrhoea present Brownish discolouration of hair present In growth chart there is decline after 1½ years Socio economic status class : 5

FACTORS Economic status Diet Hygiene Ignorance Cultural factors Family environment