Malnutrition Clinical Presentation

  • Author: Harohalli R Shashidhar; Chief Editor: Jatinder Bhatia, MBBS   more...
 
Updated: Oct 25, 2011
 

History

  • Clinical signs and symptoms of protein-energy malnutrition (PEM) include the following:
    • Poor weight gain
    • Slowing of linear growth
    • Behavioral changes - Irritability, apathy, decreased social responsiveness, anxiety, and attention deficits
  • Clinical signs and symptoms of micronutrient deficiencies: Some of the clinical signs and symptoms of specific micronutrient deficiencies may closely resemble those observed in PEM. Deficiencies of micronutrients, including vitamins, minerals, and trace elements have been well described. The most common and clinically significant deficiencies 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, poor wound healing
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Physical

Physical findings that are associated with PEM include the following:[8]

  • 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
    • Papillar atrophy
  • Abdominal findings
    • Abdominal distension secondary to poor abdominal musculature
    • Hepatomegaly secondary to fatty infiltration
  • Skin changes
    • Dry peeling skin with raw exposed areas
    • Hyperpigmented plaques over areas of trauma
  • Nail changes: Nails become fissured or ridged.
  • Hair changes: Hair is thin, sparse, brittle, easily pulled out, and turns a dull brown or reddish color.
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Causes

  • Inadequate food intake is the most common cause of malnutrition worldwide. In developing countries, inadequate food intake is secondary to insufficient or inappropriate food supplies or early cessation of breastfeeding. In some areas, cultural and religious food customs may play a role. Inadequate sanitation further endangers children by increasing the risk of infectious diseases that increase nutritional losses and alters metabolic demands.
  • In developed countries, inadequate food intake is a less common cause of malnutrition. Instead, diseases and, in particular, chronic illnesses play an important role in the etiology of malnutrition. Children with chronic illness are at risk for nutritional problems for several reasons, including the following:
    • Children with chronic illnesses frequently have anorexia, which leads to inadequate food intake.
    • Increased inflammatory burden and increased metabolic demands can increase caloric need.
    • Any chronic illness that involves the liver or small bowel affects nutrition adversely by impairing digestive and absorptive functions.
  • Chronic illnesses that commonly are associated with nutritional deficiencies include the following:
    • Cystic fibrosis
    • Chronic renal failure
    • Childhood malignancies
    • Congenital heart disease
    • Neuromuscular diseases
    • Chronic inflammatory bowel diseases
  • In addition, the following conditions place children at significant risk for the development of nutritional deficiencies:
    • Prematurity
    • Developmental delay
    • In utero toxin exposure (ie, fetal alcohol exposure)
  • Children with multiple food allergies present a special nutritional challenge because of severe dietary restrictions. Patients with active allergic symptoms may have increased calorie and protein needs.
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Contributor Information and Disclosures
Author

Harohalli R Shashidhar  Associate Professor, Department of Pediatrics, Chief, Division of Pediatric Gastroenterology and Nutrition, University of Kentucky Medical Center

Harohalli R Shashidhar is a member of the following medical societies: American Academy of Pediatrics, Kentucky Medical Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Coauthor(s)

Donna G Grigsby, MD  Associate Professor, Department of Pediatrics, University of Kentucky College of Medicine

Donna G Grigsby, MD is a member of the following medical societies: American Academy of Pediatrics and Kentucky Pediatric Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Maria Rebello Mascarenhas, MBBS  Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Section Chief of Nutrition, Division of Gastroenterology and Nutrition, Director, Nutrition Support Service, Children's Hospital of Philadelphia

Maria Rebello Mascarenhas, MBBS is a member of the following medical societies: American Gastroenterological Association, American Society for Parenteral and Enteral Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Jatinder Bhatia, MBBS  Professor of Pediatrics, Chief, Section of Neonatology, Department of Pediatrics, Medical College of Georgia

Jatinder Bhatia, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Dietetic Association, American Pediatric Society, American Society for Clinical Nutrition, American Society for Parenteral and Enteral Nutrition, Society for Pediatric Research, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

References

  1. WHO. Malnutrition-The Global Picture. World Health Organization. Available at http://www.who.int/home-page/.

  2. Blossner, Monika, de Onis, Mercedes. Malnutrition: quantifying the health impact atnational and local levels. Geneva, Switzerland: World Health Organization; 2005. Environmental Burden of Disease Series. [Full Text].

  3. Hendricks KM, Duggan C, Gallagher L, et al. Malnutrition in hospitalized pediatric patients. Current prevalence. Arch Pediatr Adolesc Med. Oct 1995;149(10):1118-22. [Medline].

  4. Benitez-Bribiesca L, De la Rosa-Alvarez I, Mansilla-Olivares A. Dendritic spine pathology in infants with severe protein-calorie malnutrition. Pediatrics. Aug 1999;104(2):e21. [Medline].

  5. Mendez MA, Adair LS. Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. J Nutr. Aug 1999;129(8):1555-62. [Medline].

  6. Heywood AH, Marshall T, Heywood PF. Motor development and nutritional status of young children in Madang, Papua New Guinea. P N G Med J. Jun 1991;34(2):109-16. [Medline].

  7. Martorell R, Rivera J, Kaplowitz H, Pollitt E. Long-term consequences of growth retardation during early childhood. In: Hernandez M, Argente J. Human growth:basic and clinical aspects. Amsterdam: Elsevier Science Publishers; 1992:143-149.

  8. Balint JP. Physical findings in nutritional deficiencies. Pediatr Clin North Am. Feb 1998;45(1):245-60. [Medline].

  9. De-Regil LM, Suchdev PS, Vist GE, Walleser S, Peña-Rosas JP. Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Cochrane Database Syst Rev. Sep 7 2011;9:CD008959. [Medline].

  10. US Department of Health and Human Services, US Department of Agriculture. Dietary guidelines for Americans, 2005. Washington, DC: US Department of Health and Human Services; 2005. 71.

  11. [Best Evidence] Zeng L, Dibley MJ, Cheng Y, et al. Impact of micronutrient supplementation during pregnancy on birth weight, duration of gestation, and perinatal mortality in rural western China: double blind cluster randomised controlled trial. BMJ. Nov 7 2008;337:a2001. [Medline].

  12. [Best Evidence] Roberfroid D, Huybregts L, Lanou H, et al. Effects of maternal multiple micronutrient supplementation on fetal growth: a double-blind randomized controlled trial in rural Burkina Faso. Am J Clin Nutr. Nov 2008;88(5):1330-40. [Medline].

  13. [Best Evidence] Lazzerini M, Ronfani L. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. Jul 16 2008;CD005436. [Medline].

  14. Scrimgeour AG, Lukaski HC. Zinc and diarrheal disease: current status and future perspectives. Curr Opin Clin Nutr Metab Care. Nov 2008;11(6):711-7. [Medline].

  15. Blecker U, Mehta DI, Davis R, et al. Nutritional problems in patients who have chronic disease. Pediatr Rev. Jan 2000;21(1):29-32. [Medline].

  16. Caulfield LE, de Onis M, Blossner M. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr. Jul 2004;80(1):193-8. [Medline].

  17. Chandra RK. 1990 McCollum Award lecture. Nutrition and immunity: lessons from the past and new insights into the future. Am J Clin Nutr. May 1991;53(5):1087-101. [Medline].

  18. de Onis M, Blossner M, Borghi E. Estimates of global prevalence of childhood underweight in 1990 and 2015. JAMA. Jun 2 2004;291(21):2600-6. [Medline].

  19. de Onis M, Frongillo EA, Blossner M. Is malnutrition declining? An analysis of changes in levels of child malnutrition since 1980. Bull World Health Organ. 2000;78(10):1222-33. [Medline].

  20. Hay WW Jr, Lucas A, Heird WC, et al. Workshop summary: nutrition of the extremely low birth weight infant. Pediatrics. Dec 1999;104(6):1360-8. [Medline].

  21. Islam S, Abely M, Alam NH, et al. Water and electrolyte salvage in an animal model of dehydration and malnutrition. J Pediatr Gastroenterol Nutr. Jan 2004;38(1):27-33. [Medline].

  22. Kleinman RE, Murphy JM, Little M, et al. Hunger in children in the United States: potential behavioral and emotional correlates. Pediatrics. Jan 1998;101(1):E3. [Medline].

  23. Kleinmann R, Committee on Nutrition. Pediatric Nutrition Handbook. 4th ed. American Academy of Pediatrics; 1998.

  24. Koerner CB, Hays TL. Food allergy: current knowledge and future directions. Immunol Allergy Clin North Am. 1999;19.

  25. Man WD, Weber M, Palmer A, Schneider G, Wadda R, Jaffar S. Nutritional status of children admitted to hospital with different diseases and its relationship to outcome in The Gambia, West Africa. Trop Med Int Health. Aug 1998;3(8):678-86. [Medline].

  26. Muller O, Krawinkel M. Malnutrition and health in developing countries. CMAJ. Aug 2 2005;173(3):279-86. [Medline].

  27. Rosenfield RL. Essentials of growth diagnosis. Endocrinol Metab Clin North Am. Sep 1996;25(3):743-58. [Medline].

 
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