In addition,
malnutrition is frequently classified on the basis of deficits of
weight-for-age (w/a) or height-for-age [Gomez, et al., 1955], [Water Low J.;
et al., 1977]. In this system, children are classified into groups according
to malnutrition severity based on their weight compared to the weight average
for their age.
1. First degree or mild cases
of malnutrition include children whose weight
76-90% of averaged weight.
76-90% of averaged weight.
2. Children with the second
degree or moderates cases have weights between 61-75% of the average, and
3. Children with third degree
of severe malnutrition weight 60% or less than their peers (Gomez, F.; et al., 1955].
With time, the
so called “Gomez classification” has been used widely both to classify
individual children for clinical referral and to assess malnutrition in
communities [de Onis, M.; et al.,
2000]. The satisfaction of malnutrition as mild, moderate or severe has helped
to systematize clinical observation and has allowed for the comparison of
finding between different researchers [Arroyo, P.; and Mandujanb Cravioto
(1922-1998), 2000]. Moreover, the risk of death is directly correlated with the
degree of malnutrition [Van den Brock, J.; et
al., t 1993].
In developing
countries about 3.5% of children under the age 5 of suffer from severe
malnutrition. Although mild and moderate types of childhood malnutrition are
even more prevalent, their significance in childhood morbidity and mortality is
less well recognized [Ahmed, T.; et al.,
2009].
Severe PCM appears in the principal clinical forms
1. Marasmus, characterized by chronic
wasting condition and a gross underweight status that is habitant, associated
with early weaning;
2. Kwashiorkor, characterized by moderate
growth retardation, changes to hair and skin color, edema, moon facies, and
hepatosplenomegaly; and
3. Merasmic kwashiorkor, characterized by severe
wasting and the presence of edema.
Marasmus appears by caloric and
protein in sufficiency whereas kwashiorkor develops from protein deficiency
[water low, J. C. 1996]
Epidemiological and experimental observations have proven
that malnourished children are more susceptible to infectious disease;
therefore PCM is considered a strong risk factor for higher morbidity and
mortality rates in infectious diseases [Wiodward, B., 1998]. Several studies on
the effect of malnutrition at the immunological level been conducted in humans
and in experiment animal models. Multiple immune system abnormalities,
including lymphoid organ atrophy, profound T-cell deficiency, altered ratios of
T-cells function, cytokine production and the ability of lymphocytes to respond
appropriately to cytokines. In several malnourished children, both acquired
immunity as well as innate host defense mechanism are affected [Bhaskaram,
P. 1992]; [Rodrguez, L.;. et al.,
2005].
In children under 5 years of age, malnutrition is
responsible, directly or indirectly, for 54% of the 10.8 million death per year
and contributes to every second death (53%) associated with infectious disease
among this age group in developing countries (figure 2) [Benguiui, Y.; and
Stein, F. 2005]. Additionally, mud and moderate forms of malnutrition primarily
account for the burden of malnutrition world wide. For the surviving children,
malnutrition has lifelong implications because it severely reduces child
ability to learn and grow their full potential. Thus malnutrition leads to less
productive adults and weaker national economic performance [Benguigui, Y.; and Stein,
F .2006].
Figure 2: Distribution of
0.5 million deaths among children younger than 5 years of age in all developing
countries. Adapted from Benguigui and stein [Benguigui, Y.; Sten, F. integrated
management of childhood illness: An emphasis on the management of infectious
diseases Sem.prediatr. infect. Dis. 2006, 17, 80-98].
The
malnutrition infection complex can be viewed under two aspects, malnutrition
compromising host defense, or infection either aggravating existing, deficient
nutrition status or triggering malnutrition through diseases pathogenesis.
Malnutrition can facilitate pathogen invasion and propagation; further, it can
increase the probability of secondary infection occurring thus modifying both
disease pathogenesis and prognosis [Borelli, P.; et al., 2004]. Certain
infectious diseases also cause malnutrition. It appears in that there is a
vicious cycle involved, where malnutrition increases disease susceptibility and
diseases cause reduction in food intake.
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