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1、Nutritional Disease,Chapter 4,Protein-energy Malnutrition(PEM),Definition,PEM is a kind of malnutrition caused by inadequate dietary intake or some diseases,occurs commonly in children under 3 years of age.,Kwashiorkor,Marasmus,Etiology,The Primary PEM Inadequate food intake Children under 3 yrs The
2、 Secondary causes Increased nutrient needs Disorder in nutrient absorption Increased body metabolism,Pathophysiology,Metabolism disorderProtein metabolism anabolism acid-base disturbances,Pathophysiology,Disorders of Organ&Tissue function,Failure to thriveLower digested function：diarrheaCentral nerv
3、e system:apathy,or irritabilityCardiovascular system：pulse slow,Low BPlower renal function:urine amount decreaselow immunologic function:easy to be infected,Clinical manifestations,History：Feeding history,Nonedematous PEM(marasmus),Edematous PEM(Kwashiorkor),WHO Z-score system,underweight chronic or
4、 acute malnutrition X3SDW/AX2SDmoderate W/AX3SDsevere stunting long-term chronic malnutrition X3SDH/AX2SDmoderate H/AX3SDsevere wasting recent acute malnutrition X3SDW/HX2SDmoderate W/HX3SDsevere,Physical measurement,Laboratory examination,plasma albumin concentration Normal:35g/L;Diagnose:25g/L Ser
5、um Pre-albumin concentration Normal:150296mg/L;Mild deficiency:100150mg/L;Moderate:50100mg/L;Severe:50mg/L Urine hydroxy-proling concentration,Diagnosis,History Clinical manifestations Anthropometric indicators Laboratory examination,Treatment,To treat the primary disease To provide adequate nutrien
6、ts intakes To supply energy and protein To keep the Fluid&electrolyte balance To supply multi-vitamins To provide the accelerant for protein synthesize Support therapy,Prevention,promotion the skills for breast-feeding and the introduction of supplementary Food Nutrition education Growth monitoring
7、Prevention and treatment of infectious diseases,Childhood Obesity,Definition,Body Mass Index(BMI)kg/m2 Overweight:BMI P85 P95 Obesity:BMI P95,Degree of Obesity W/HW/H(P50)Degree of Obesity 100 W/H(P50)Overweight：1019.9 Mild Obesity：2029.9 Moderate Obesity:3049.9 Severe Obesity：50 以上,Prevalence,In US
8、A:1015%Girls Boys,In China:1986 0.91%;1996 1.71%Girls Boys,Etiology,GeneticGenetic backgroundVariation in metabolismEnvironmental stimuliDietary habits Physical activityPsychological and emotional,Good appetite Low physical activity High Risk age:infancy,preschool age&adolescence Physical growth:Tal
9、l stature,slightly advanced bone age,and somewhat early puberty Psychological disorders:Self-contempt,timidity,lonely anxiety,discrimination in social life Laboratory examination:Plasma lipid profiles，cholesterol，lipoprotein,Clinical manifestations,Diagnosis,Precluded other diseases Hypothyroidism H
10、ypercortisolemia Anthropometric indicators Weight,Height,BMI BMI=Weight/Height2 Kg/M2,Treatment,Good lifestyle Control dietary intake Physical exercise Psychological treatment Medications Not approved for Children,Control energy intake Increase energy expenditure,Food selection,肉松香肠猪油植物油腰果花生米瓜子,猪脚猪大
11、肠鸡心红豆绿豆,鳕鱼各类肉螃蟹吐司馒头油豆腐葡萄干,鸡蛋鲜奶米饭面条番薯黑枣香蕉红枣,蓝灯猪血脱脂奶稀饭马铃薯豆腐水果蔬菜,Food not recommend,Barbecue food Deepfry food Bloat food High sugar food Tin food,Prevention,Prevent high-birth-weight babies born Nurture good lifestyle Routinely exercise Less TV watching A well-balance diet Avoiding over-feeding Growth
12、 monitoring,Vitmain D deficiency,Rickets Infantile tetany,Skin:7-dehydrocholesterol,Vitamin D3(an inactive form),25-hydroxy vitamin D3,Foods intake,1,25-hydroxy vitamin D3(active form),Vitamin D Sources and Activation,Ultraviolet,Etiology,Inadequate direct exposure to sunlight Inadequate vitamin D i
13、ntake Higher requirement Disorder in vitamin D absorption,or activation Others:genetic,Ca,P Homeostasis,+1,25(OH)2D,+PTH,-CT,+1,25(OH)2D,-PTH,-CT,+1,25(OH)2D,Bone,Intestine,Parathormone(PTH),Calcitonin(CT),1,25(OH)2D,Ca,PHomeostasis,Pathogenesis,+PTH,Vitamin D deficiency,Osteoid tissue failure to mi
14、neralize,Osteoid tissue accumulation,Ca absorbed from the intestine,Urine P,Parathormone secreted,CaP Value,Mobilized bone Ca,P,Vitamin D-deficientRickets,Serum Ca concentration,Serum P,Disorder of Ca&P metabolism During Vit.D Deficiency,Serum Ca:Normal,or,Unmobilized bone Ca,P,Serum Ca,Vitamin D-de
15、ficientInfantile tetany,Rare in industrialized countries Common in China,&developing Country 20%in South China 30-40%in North China,Epidemiology of Rickets,General manifestations Irritability,Eclampsia at night,Sweaty,Unease sleep Delayed in teeth eruption&anterior fontanel closure,Cliniacl manifest
16、ations,Bone manifestations,ChestBeading of the ribsPigeon breast deformityHarrison groove,HeadCraniotabesPing-Pong BallCaput quadratum,LimbThickening of the wrists&anklesBow-legs,knock-knees,Pigeon breast deformity,Biochemical changes,Normal or low serum calcium Serum phosphorus level less than 4mg/
17、dl Serum AKP level elevated Low serum 25-hydroxycholecalciferol,Active rickets:Distal ends,cupping and fraying of the radius and ulna Healing rickets:Zones of preparatory calcificaiton(ZPC);rachitic metaphysis calcification taken place,Radiographic findings,Based ona history of inadequate intake of
18、vitamin D、inadequate exposure to sunlight Characteristic clinical signs of rickets.Confirmed by Chemical and radiographic examination,Diagnosis,Differential Diagnosis,Cretinism Chondrodystrophy Hydrocephalus Vitamin D-resistant Rickets,Vitamin D-resistant Rickets,Familial Hypophosohatemia(X-linked H
19、ypophosphatemia)Vitamin D-Dependent Rickets(Hypocalcemic Vitamin D-Resistant Rickets)Rickets Associated with Renal Tubular Acidosis Renal Rickets,Treatment,Both natural and artificial light of the appropriate wavelength are effective therapeutically Oral adiministration of Vitamin D is preferred.5,0
20、00-10,000IU/d 300,000IU im;repeat one months later,if needed.,Prevention,Adequate exposure to ultraviolet light Oral administration of Vitamin D 400IU daily,Tetany of Vitamin D Deficiency(infantile tetany),Accompaning rickets Serum ionized calcium concentration falls below 3-4mg/dl Muscular irritabi
21、lity Diagnosis based on the combined presence of rickets,low serum calcium concentration,and symptoms of tetany,Hypervitaminosis D,Excessive amounts of Vitamin D intake,usually develop after 1-3 mo of excessive intakeAnorexia,irritability,constipation,polydipsiaChemical examination：Hypercalcemia and hypercalciuriaradiographs:metastatic calcification and generalized osteopetrosis in long boneTreatment:discontinuing vitamin D intake and decreasing calcium intake,谢 谢！,
