Bianca Galvan Maeve Bisain March 8, 2012 Kwashiorkor

Background Kwashiorkor is a word that originated from Ghana which means “the disease that the first child gets when the new child comes.”

Background… From birth, an infant in developing areas of the world is usually breastfed. Often by the time the child reaches 1 to 1.5 years of age, the mother is pregnant again, and the new child gets the preference for breastfeeding. The older child’s diet then abruptly changes from nutritious human milk to starchy roots and gruels, a thin mixture of grains or legumes in milk or water.

Protein-Calorie Malnutrition In developing areas of the world, people often have diets low in calories and also in protein. This state of under nutrition stunts the growth of children and makes them more susceptible to disease throughout life. People who consume too little protein calories can eventually develop protein-calorie malnutrition (PCM). When an inadequate intake of nutrients, including protein, is combined with an already existing disease, especially an infection, a form of malnutrition called Kwashiorkor can develop.

Causes, incidence, and risk factors Kwashiorkor is most common in areas where there is: Famine Limited food supply Low levels of education (when people do not understand how to eat a proper diet) This disease is more common in very poor countries. It often occurs during a drought or other natural disaster, or during political unrest. These conditions are responsible for a lack of food, which leads to malnutrition. Kwashiorkor is very rare in children in the United States. There are only isolated cases. However, one government estimate suggests that as many as 50% of elderly people in nursing homes in the United States do not get enough protein in their diet. When kwashiorkor does occur in the United States, it is usually a sign of child abuse and severe neglect.

Protein is found in… meats, poultry, and fish legumes (dry beans and peas) tofu eggs nuts and seeds milk and milk products grains, some vegetables, and some fruits (provide only small amounts of protein relative to other sources)

Grams of protein needed each day RDA Grams of protein needed each day Children ages 1-3 13 Children ages 4-8 19 Children ages 9-13 34 Girls ages 14-18 46 Boys ages 14-18 52 Women ages 19-70+ Men ages 19-70+ 56

RDA… DV 2-3 years 4-8 years 9-13 years 14-18 yr girls 14-18 yr boys Calories 2000 1000-1400 1400-1600 Girls: 1600-2000 Boys: 1800-220 2200-2400

Symptoms Changes in skin pigment Decreased muscle mass Diarrhea Failure to gain weight and grow Fatigue Hair changes (change in color or texture) Increased and more severe infections due to damaged immune system Irritability Large belly that sticks out Lethargy or apathy Loss of muscle mass Rash (dermatitis) Shock (late stage) Swelling (edema)

Treatment Getting more calories and protein will correct kwashiorkor, if treatment is started early enough. However, children who have had this condition will never reach their full potential for height and growth. Treatment depends on the severity of the condition. People who are in shock need immediate treatment to restore blood volume and maintain blood pressure. Calories are given first in the form of carbohydrates, simple sugars, and fats. Proteins are started after other sources of calories have already provided energy. Vitamin and mineral supplements are essential.

Treatment… Since the person will have been without much food for a long period of time, eating can cause problems, especially if the calories are too high at first. Food must be reintroduced slowly. Carbohydrates are given first to supply energy, followed by protein foods. Many malnourished children will develop intolerance to milk sugar (lactose intolerance). They will need to be given supplements with the enzyme lactase so that they can tolerate milk products. Getting treatment early generally leads to good results. Treating kwashiorkor in its late stages will improve the child's general health. However, the child may be left with permanent physical and mental problems. If treatment is not given or comes too late, this condition is life-threatening.

Day 1 Breakfast 1 Omelette w/ cheese and ham = 156 kcals & 11g protein 1 cup of 2% milk = 122 kcals & 8g protein Morning snack 1 cup Fresh orange juice = 112 kcals & 2g protein 1 Almond granola bar = 117 kcals & 2g protein

Day 1… Lunch 1 cup Cream of chicken = 220 kcals & 6g protein 1 cup water Afternoon Snack 2 tbs Creamy peanut butter = 188 kcals & 8g protein ½ Fresh apple = 55 kcals & ½g protein 4 oz apple juice w/ water = 55 kcals

Day 1… Dinner 1 Sloppy Joe = 358 kcals & 18g protein 1 cup of 2% milk = 122 kcals & 8g protein Total: 1505 kcals & 63.5g protein

Day 2 Breakfast 1 Omelette w/ sausage =167 kcals & 11g protein 1 cup of 2% milk = 122 kcals & 8g protein Morning Snack 6 pieces of Honey Graham crackers 184 kcals & 4g protein

Day 2… Lunch 1 Turkey sandwich w/ whole wheat = 360 kcals & 27g protein. 1 cup of 2% milk = 122 kcals & 8g protein. Afternoon Snack 1 cup Fresh Kiwi =108 kcals & 2g protein 1 cup water

Day 2… Dinner 1 corndog = 460 kcals & 17g protein 1 cup Fresh orange juice = 112 kcals & 2g protein Total: 1451 kcals & 87 grams protein

Day 3 Breakfast ½ cup of Cheerios = 55.5 kcals & 2g protein 1 cup of 2% milk = 122 kcals & 8g protein Morning Snack 4 oz apple juice w/ water = 55 kcals 1 medium banana = 105 kcals & 1g protein

Day 3… Lunch 1 grilled cheese sandwich w/ whole wheat = 431 kcals & 20g of protein 1 cup of 2% milk = 122 kcals & 8g protein. Afternoon Snack ½ cup Broccoli w/ cheese sauce (cooked) = 115 kcals & 7g protein 4 oz apple juice w/ water = 55 kcals

Day 3… Dinner ½ cup White rice long grain = 102.5 kcals & 2g protein 1.5 oz Chicken breast teriyaki = 59 kcals & 9g protein 1 cup water Total: 1222 kcals & 57g protein

Questions What does Kwashiorkor mean? -The disease that the first child gets when the new child comes. Kwashiorkor affects ______ and _____. -Children and elderly   What is the obvious symptom for Kwashiorkor? -Large belly that sticks out

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