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v e r e a c u te m a ln u tr itio n
S e v e re a c u te m a ln u tritio n
S ever e a c ut e m a ln ut r itio n is c a us ed b y a s ig n if ic a n t im b a la n c e b etw een
n utr itio n a l
in ta k e a n d in d ivid ua l n eed s . It is m o s t o ften c a us ed b y b o th q ua n tita tive
(n um b er o f
k ilo c a lo r ies / d a y) a n d q ua lita tive (vita m in s a n d m in er a ls , etc .) d efic ien c ies .
C h ild r e n o v e r 6 m o n t h s o f a g e
T h e tw o p r in c ip a l fo r m s o f s ever e m a ln utr itio n a r e:
– M a r a s m u s : s ig n if ic a n t lo s s o f m us c le m a s s a n d s ub c ut a n eo us f a t ,
r es ult in g in a
s k eleta l a p p ea r a n c e.
– K w a s h io r k o r : b ila ter a l o ed em a o f th e lo w er lim b s / o ed em a o f th e fa c e,
o ften a s s o c ia ted
w ith c uta n eo us s ig n s (s h in y o r c r a c k ed s k in , b ur n -lik e a p p ea r a n c e;
d is c o lo ur ed a n d
b r ittle h a ir ).
T h e tw o fo r m s m a y b e a s s o c ia ted (m a r a s m ic -k w a s h io r k o r ).
In a d d itio n to th es e c h a r a c ter is tic s ig n s , s ever e a c ute m a ln utr itio n is
a c c o m p a n ied b y
s ig n ific a n t p h ys io p a th o lo g ic a l d is o r d er s (m eta b o lic d is tur b a n c es ,
a n a em ia , c o m p r o m is ed
im m un ity, lea d in g to s us c ep tib ility to in fec tio n s o ften d iffic ult to d ia g n o s e, etc .).
C o m p lic a tio n s a r e fr eq uen t a n d p o ten tia lly life-th r ea ten in g .
M o r ta lity r a tes m a y b e eleva ted in th e a b s en c e o f s p ec ific m ed ic a l
m a n a g em en t.
A d m is s io n a n d d is c h a r g e c r it er ia f o r t r ea t m en t p r o g r a m m es f o r
s ev er e a c ut e
m a ln utr itio n a r e b o th a n th r o p o m etr ic a n d c lin ic a l:
• M id - up p er a r m c ir c um f er en c e ( M U A C ) is t h e c ir c um f er en c e,
m ea s ur ed in m id -
p o s itio n , o f th e r ela x ed lef t up p er a r m , ta k en in c h ild r en o f 6 to 5 9
m o n th s (6 5 to
1 1 0 c m in h eig h t ) . M U A C m ea s ur es t h e d eg r ee o f m us c le w a s t in g . A
M U A C of
< 1 1 5 m m in d ic a tes s ever e m a ln utr itio n a n d s ig n ific a n t m o r ta lity r is k .
• W eig h t fo r h eig h t (W / H ) in d ex a s s es s es th e d eg r ee o f w eig h t lo s s b y
c o m p a r in g th e
w eig h t o f t h e m a ln o ur is h ed c h ild w it h n o n - m a ln o ur is h ed c h ild r en o f
th e sa m e
h eig h t. S ever e m a ln utr itio n is d efin ed a s a W / H in d ex o f < – 3 Z w ith
S e v e re a c u te m a ln u tritio n
S ever e a c ut e m a ln ut r itio n is c a us ed b y a s ig n if ic a n t im b a la n c e b etw een
n utr itio n a l
in ta k e a n d in d ivid ua l n eed s . It is m o s t o ften c a us ed b y b o th q ua n tita tive
(n um b er o f
k ilo c a lo r ies / d a y) a n d q ua lita tive (vita m in s a n d m in er a ls , etc .) d efic ien c ies .
C h ild r e n o v e r 6 m o n t h s o f a g e
T h e tw o p r in c ip a l fo r m s o f s ever e m a ln utr itio n a r e:
– M a r a s m u s : s ig n if ic a n t lo s s o f m us c le m a s s a n d s ub c ut a n eo us f a t ,
r es ult in g in a
s k eleta l a p p ea r a n c e.
– K w a s h io r k o r : b ila ter a l o ed em a o f th e lo w er lim b s / o ed em a o f th e fa c e,
o ften a s s o c ia ted
w ith c uta n eo us s ig n s (s h in y o r c r a c k ed s k in , b ur n -lik e a p p ea r a n c e;
d is c o lo ur ed a n d
b r ittle h a ir ).
T h e tw o fo r m s m a y b e a s s o c ia ted (m a r a s m ic -k w a s h io r k o r ).
In a d d itio n to th es e c h a r a c ter is tic s ig n s , s ever e a c ute m a ln utr itio n is
a c c o m p a n ied b y
s ig n ific a n t p h ys io p a th o lo g ic a l d is o r d er s (m eta b o lic d is tur b a n c es ,
a n a em ia , c o m p r o m is ed
im m un ity, lea d in g to s us c ep tib ility to in fec tio n s o ften d iffic ult to d ia g n o s e, etc .).
C o m p lic a tio n s a r e fr eq uen t a n d p o ten tia lly life-th r ea ten in g .
M o r ta lity r a tes m a y b e eleva ted in th e a b s en c e o f s p ec ific m ed ic a l
m a n a g em en t.
A d m is s io n a n d d is c h a r g e c r it er ia f o r t r ea t m en t p r o g r a m m es f o r
s ev er e a c ut e
m a ln utr itio n a r e b o th a n th r o p o m etr ic a n d c lin ic a l:
• M id - up p er a r m c ir c um f er en c e ( M U A C ) is t h e c ir c um f er en c e,
m ea s ur ed in m id -
p o s itio n , o f th e r ela x ed lef t up p er a r m , ta k en in c h ild r en o f 6 to 5 9
m o n th s (6 5 to
1 1 0 c m in h eig h t ) . M U A C m ea s ur es t h e d eg r ee o f m us c le w a s t in g . A
M U A C of
< 1 1 5 m m in d ic a tes s ever e m a ln utr itio n a n d s ig n ific a n t m o r ta lity r is k .
• W eig h t fo r h eig h t (W / H ) in d ex a s s es s es th e d eg r ee o f w eig h t lo s s b y
c o m p a r in g th e
w eig h t o f t h e m a ln o ur is h ed c h ild w it h n o n - m a ln o ur is h ed c h ild r en o f
th e sa m e
h eig h t. S ever e m a ln utr itio n is d efin ed a s a W / H in d ex o f < – 3 Z w ith
