Measuring Malnutrition

“How sweet!  She looks so healthy with her chubby cheeks!”

Sometimes malnutrition is easy to spot– a three month old clocking in at only 3 pounds, her ribs prominent, her crying only consoled by a bottle of milk that she quickly consumes.

But in other cases, malnutrition can be very difficult to detect to the untrained eye.  Clothed and standing on a scale, a child can sometimes meet all the criteria to be deemed ‘healthy’, but through skillful assessment and observation, you can gain a more accurate picture of what is going on ‘beneath the surface.’  This type of malnutrition is silent and insidious and is claiming the lives of many children here in remote Guatemala.  Hope of Life is fighting daily to reverse the statistics.

So, heads up… NERD ALERT.  This purpose of this blog post is to give a little bit of medical perspective to what we see and treat daily here in Guatemala.  Today, I am only focusing on the two types of acute malnutrition we treat most often here in rural Guatemala– Marasmus and Kwashiorkor.

 

MARASMUS:

• Marasmus is usually very obvious to detect.  These are the “skin and bone” type of patients.  These patients lack vital nutrients and calories from all food groups, and is more or less a form of starvation.
• It most often occurs in children under the age of 18 months, when they should be breastfeeding.  What we usually see here in rural Guatemala is that the mama is malnourished herself and unable to produce adequate breast milk.  Baby formula is both expensive and difficult to access in the mountains.  As a result, the baby loses important subcutaneous fat.
• Because of the subcutaneous fat loss, baby takes on the appearance of an “old man” — wrinkled, loose skin is not only a sign of their dehydration, but also of their nutritional state.
• These patients are irritable, sometimes inconsolable, and have insatiable appetites.  They are literally starving.

 

KWASHIORKOR:

• Kwashiorkor can be very difficult to detect in its beginning stages.  It is caused by a severe protein deficiency with normal caloric intake.  These patients are eating “Arroz y tortillas, nada más.”  Rice and tortillas, nothing else.
• The beginning signs and symptoms are hair changes (hair becomes brittle- breaking off or falling out, and can even lighten in color), enlarged liver, pale / flakey skin, and swelling in the cheeks and abdomen.  This can progress to severe pitting edema in the extremities, severe skin desquamation, and even death.
• These patients are lethargic and often appear “sad” or “depressed”.  Their immune system is very weakened, so it is not uncommon to encounter a kwashiorkor patient with an underlying infection as well.
• These patients are water logged with unhealthy fluids.  Although they weigh more and their malnutrition isn’t quite as jarring to see, it’s actually more dangerous and more difficult to treat.  These patients sometimes need diuretics to pull off excess fluids and will often LOSE weight the first week receiving treatment.  Underneath all of the fluid, they have the appearance of a marasmus patient– wasted muscle mass and thin.

 

Treating malnutrition is not without its risks, either.  Introduced too quickly, food and nutrition can sort of ‘shock’ the body through metabolic disturbances known as ‘refeeding syndrome’.  A complete lab workup should be done to check a patient’s CBC and CMP.  Albumin and serum protein levels should be monitored and electrolyte levels should be closely followed and corrected.  Even after being treated, malnutrition can have lifetime effects– from growth stunting, to learning abilities, and even causing physical or mental handicaps in some of the more severe cases.

This is really just the tip of the iceberg when it comes to malnutrition, feel free to comment below any specific questions or comments you may have and I will answer them later in a follow up post!

Every single photo is a real patient that I have held in my arms. Although some of these examples are something you’d only ever see in a textbook, we face it every day here in Guatemala.  If you would like to support St Luke’s Hospital in the rescue and treatment of malnourished children, CLICK HERE.

Have a wonderful Sunday, and never forget…

You are loved.
-Whitney