Malnutrition: Sign and symptoms, Cause, Diagnosis, Management......

I.Overview
Malnutrition is directly responsible for 300,000 deaths per year in children younger than 5 years in developing countries and contributes indirectly to more than half of all deaths in children worldwide. In addition, it increases health care costs.  See the image below.

II.Sign and Symptoms

The most common and clinically significant micronutrient deficiencies and their consequences include the following:

• Iron: Fatigue, anemia, decreased cognitive function, headache, glossitis, and nail changes
• Iodine: Goiter, developmental delay, and mental retardation
• Vitamin D: Poor growth, rickets, and hypocalcemia
• Vitamin A: Night blindness, xerophthalmia, poor growth, and hair changes
• Folate - Glossitis, anemia (megaloblastic), and neural tube defects (in fetuses of women without folate supplementation)
• Zinc: Anemia, dwarfism, hepatosplenomegaly, hyperpigmentation and hypogonadism, acrodermatitis enteropathica, diminished immune response, and poor wound healing.

III.Physical Exam

Physical findings that are associated with PEM include the following ^[2] :

• Decreased subcutaneous tissue: Areas that are most affected are the legs, arms, buttocks, and face
• Edema: Areas that are most affected are the distal extremities and anasarca (generalized edema)
• Oral changes: Cheilosis, angular stomatitis, and papillar atrophy
• Abdominal findings: Abdominal distention secondary to poor abdominal musculature and hepatomegaly secondary to fatty infiltration
• Skin changes: Dry, peeling skin with raw, exposed areas; hyperpigmented plaques over areas of trauma
• Nail changes: Fissured or ridged nails
• Hair changes: Thin, sparse, brittle hair that is easily pulled out and that turns a dull brown or reddish color.

IV.Diagnosis

Initial diagnostic laboratory studies include the following:

• Complete blood count
• Sedimentation rate
• Serum electrolytes
• Urinalysis
• Culture

Measures of protein nutritional status include levels of the following:

• Serum albumin
• Retinol-binding protein:  
• Prealbumin:
• Transferrin
• Creatinine
• Blood urea nitrogen

V.Management

Children with chronic malnutrition may require caloric intakes of more than 120-150 kcal/kg/day to achieve appropriate weight gain.

Most children with mild malnutrition respond to increased oral caloric intake and supplementation with vitamin, iron, and folate supplements. The requirement for increased protein is met typically by increasing the food intake.