CM5.3 | CM5.3 | Nutrition Related Disorders — Summary & Reflection

KEY TAKEAWAYS

Nutrition-related disorders constitute India's double burden: undernutrition (PEM, micronutrient deficiency) and overnutrition (obesity, NCDs). PEM presents as kwashiorkor (bilateral pitting oedema + 'flaky paint' skin + moon face + apathy, primarily protein deficiency) vs marasmus (severe wasting, 'old man face', NO oedema, combined energy-protein deficiency) vs marasmic-kwashiorkor (wasting + oedema — worst prognosis). SAM = MUAC <11.5 cm OR WHZ <-3 OR bilateral oedema; managed via WHO 10-step protocol at NRCs using F-75→F-100/RUTF. IDA (Hb <12 g/dL non-pregnant woman) is India's most prevalent micronutrient disorder — controlled by IFA supplementation, WIFS, rice fortification. IDD ranges from goitre to cretinism — controlled by Universal Salt Iodisation (15 ppm; >93.7% household coverage, NFHS-5). VAD (xerophthalmia: XN→X1A→X1B=Bitot's spots→X2→X3=corneal ulceration emergency→XS) — controlled by biannual Vitamin A megadose (200,000 IU, 12-59 months). Nutrition-infection cycle makes simultaneous nutritional rehabilitation and infection treatment essential for PEM management.

REFLECT

In a community health camp, you encounter three children in succession: (1) a 2.5-year-old with bilateral leg oedema, reddish hair, and 'flaky paint' skin; (2) a 2-year-old with severe wasting, prominent ribs, and an alert, crying child with no oedema; (3) an 18-month-old with night blindness and Bitot's spots who is moderately wasted. Rank these three children by urgency of referral and intervention, justify your ranking, and outline the first-line management step for each. How would you communicate the seriousness of the first child's condition to a mother who insists her child is 'healthy because she eats well'?