Poor Nutrition

Poor nutrition is a status of someone who has a lack of nutrition or whose nutritional
status is under the standard values. Poor nutritional status can be classified into 3 categories,
which are poor nutrition due to a lack of protein (Kwashiorkor), poor nutrition due to lack of
calories and carbohydrates (Marasmus) or poor nutrition due to lack of both. Poor nutrition
usually occurs in toddlers under the age of and is signified by the swelling of the stomach.
!evere malnutrition is the technical term used by nutritionists and those in the health and medical
fields, it is the worst form of poor nutrition which has gone on for years. ("ency, #$$) .
Classification of Poor Nutrition
%here are 3 types of poor nutrition, and they are Marasmus, Kwashiorkor and Marasmus&
Kwashiorkor. %he differences between each type is defined by the differences in their clinical
symptoms and characters.
'. Marasmus
Marasmus is poor nutrition due to a deficiency of carbohydrate intake. !ymptoms which
appear include (old man)s appearance*, bones becoming visible under the skin due to decreasing
fats and muscle, frail and reddish hair, skin problems, digestive problems (such as diarrhea), liver
enlargement and other things. %he child will cry significantly more than usual even after they)ve
been fed because they still feel hungry. %hese are the following symptoms of marasmus
according to +epkes ,-, #$$$ .
/. the child will appear considerably thinner due to loss of fats and muscles
0. 1ld man appearance
2. 3idening of ribs and and bulging of stomach
+. 4oosening of thigh muscle (0aggy pants)
5. 2hild will remain fussy even after being fed
#. Kwashiorkor
%he appearance of children with kwashiorkor is similar to that of a sugar baby, where the
child appears overweight due to the diet containing enough energy but a lack of protein.
6owever, other parts of the child)s body, mainly the buttocks, will undergo atrophy. %he child
may also appear very thin and have edema on both feet or throughout his whole body. 1ther
symptoms include .
/. 2hanges in mental status
0. 6air becomes frail and significantly things
2. 7ace becomes circular and swells
+. +rowsy eyes
5. 5nlargement of liver
7. !kin abnormalities such as red blotches which may widen and become easy to peel
3. Marasmik&Kwashiorkor
%he symptoms include a combination of those found in Kwashiorkor and Marasmus.
Patients with Marasmik&Kwashiorkor will have a weight loss of 89$: than normal and they will
also show signs of kwashiorkor such as edema, hair and skin abmormalities along with
biochemical changes. (+epkes ,-, #$$$)
Pathophysiology of Poor nutrition
%he pathophysiology of poor nutrition in children is associated with difficulties in
feeding or anore;ia and is also affected by psychological factors such as the eating habits and
environment. 7re<uent hair loss is due to the deficiency of protein, vitamin /, vitamin 2 and
vitamin 5, because these = elements are most important in hair growth. !ome patients will also
have "yctalopia, or night blindness. "yctalopia is due to the deficiency of >itamin / and
protein. -n the ,etina there are stem&shaped cells and cone&shaped cells. 1nly the stem&shaped
cells have the ability to differentiate light and darkness. %hese stem&shaped cells, also called
,odopsin cells, is made up of vitamin / and proteins. -f light shines on these ,odopsin cells, it
will cause them to unravel. 3hen darkness hits these cells, they will accumulate. %his process is
called ,odopsin /daptation. "ight blindness occurs when the rodopsins fail to adapt.
Poor skin turgor and elasticity is due to dehydration. "egative patellar refle; occurs due
to a deficiency in actin myosin at the patellar tendon and the degeneration of motoric nerves due
to the deficiencies of protein, 2opper and Magnesium. 6epatomegaly is also due to protein
deficiency. 3hen there is inade<uate protein, the formation of lipoprotein will in turn also
decrease. %his will cause a decrease of 6+4 and 4+4, which will cause difficulties in the
transportations of fat from the liver to other tissues. %his will result in the accumulation of fat in
the liver which will eventually cause enlargement.
%he most specific symptom in kwashiorkor patients is pitting edema. Pitting edema is due
to a lack of protein, which causes the intravascular oncotic pressure to lower. 3hen this happens,
the e;travasation of plasma to the interstitial will occur. 5dema is usually apparent in the lower
e;tremities because of gravitational force, hydrostatic pressure and oncotic pressure.
/ccording to "elson (#$$?), the main cause of marasmus is the deficiency of caloric
proteins which takes place due to inade<uacies of diet, improper eating habits, metabolic defects
or congenital malformations. 1ther than environmental factors, congenital factors is also said to
have an effect on the occurrence of marasmus. 1verall, the main causes of marasmus are as
follows .
/. -nade<uacies in food intake
0. 2hronic and severe infections, mainly enteral infections such as infantile
gastroenteritis, bronchopneumonia, pielonephritis and congenital syphilis
2. 2ongenital structural defects such as . congenital heart diseases, hirschprung
disease, palatum deformities, palatoschi@is, mocrognathia, stenosis pylorus,
6iatus hernia, hydrocephalus and pancreatic cystic fibrosis.
+. Prematurity and diseases during neonatal period. +uring these conditions, the
feeding of breastmilk is insufficient because of inade<uate sucking refle;es.
5. Metabolic abnormalities such as renal acidosis, idiopathic hypercalcemia,
galactosemia and lactose intolerance.
7. 6ypothalamic tumor
Etiologic factors of poor nutrition
') +irect causes . 4ack of consumption, infectious diseases, congenital abnormalities and
cancer.
#) -ndirect causes . 4ack of available food sources and health care, low education, poverty and
so forth
(+inkes !A, #$$?)
Hospital management of Poor nutrition in infants
%he treatment process of 5nergy Protein Malnutrition is achieved through 3 phasesB
stabili@ation phase, transition phase and rehabilitation phase. / health care provider has to be
able to choose the proper action for each phases. %his method of management is used in patients
with kwashiorkor, marasmus and Marasmic Kwashiorkor
') 2ompliance Phase
%he goal of this phase is to slowly comply the patient to a high energy and high protein
diet. %he compliance phase can take place over '&# weeks or longer, depending on the
patient)s ability to receive and digest food. -f the patient weighs below ? kg, the type of food
that should be received is baby food, the main one being modified formula. 7or e;ample .
4ow lactose milk. !ofter foods will then be gradually added to the diet. -f available, breast
milk should also be given.
-f the patient weighs ? kg or more, the food given should be similar to that of a child over
the age of '. 2onsumption should begin with the feeding of fluid foods, followed by soft
foods and then normal foods, with the following criteria .
/. %he feeding of foods should start with a calorie count of $ kkalCkg body weight daily
0. 7luid intake #$$ mlCkg body weight daily
2. %he main source of protein is milk which is given in phases with the dilution of 'C3,
#C3 and 3C3, each phase taking #&3 days
+. 7ood is given in small and fre<uent portions, around D&'$ times per day per #&3
hours.
(,!2M, #$$3)

#) 6ealing Phase
-f appetite and tolerance towards food improves, the food given should increase
gradually every '&# days until caloric consumption reaches '$&#$$ kkalCkg body
weight per day and protein consumption reaches #& gram of proteinCkg body weight
per day.
3) 7urther Phase
0efore the patient is sent home, they should be used to receiving normal foods
rather than diets containing high energy and high protein. %he parents should
receive education regarding health and nutrition beforehand, specifically on how
to regulate meal times, choose the proper ingredients and how to prepare them.
"utritional supplements that may be needed include .
a. Elucose, usually given intravenously when there are signs of hypoglycemia
b. K2-, given according to specific needs
c. Magnesium, in the form of Mg!1= $:, given intramuscularly if there are
signs of hypomagnesemia
d. >itamin /
e. >itamin 0 and 2
Reference
'. "ency F, #$$. Ei@i 0uruk /ncaman Eenerasi Fang 6ilang. http.CCio.ppi&
Gepang.orgCarticle.phpHidI''3 J4ast /ccessed K
th
"ovember #$'3L
#. +epkes ,-, #$$$. Pedoman %atalaksana Kekurangan 5nergi Protein Pada /nak
di ,umah !akit KabupatenCKodya. Makarta
3. +inas Kesehatan Propinsi !umatera Atara, #$$?. PetunGuk %eknis %atalaksana
/nak Ei@i 0uruk. Makarta
=. "elson, 3.5, #$$?. Malnutrition. 30 !aunders 2o. Philadelphia and 4ondon
. ,umah !akit +r.2ipto Mangunkusumo dan Persatuan /hli Ei@i -ndonesia,
#$$3. Penuntun +iet /nak. P% Eramedia Pustaka Atama . Makarta.