SAM | Symptoms & Causes | Diagnosis
 


What this section contains?
1. What is SAM?
2. Cause
3. Diagnosis & Tests
4. Prevention & Risk Factors
5. Treatments & Therapies
SAM

What is SAM?

Malnutrition commonly represents under-nutrition resulting from inadequate consumption, poor absorption or excessive loss of nutrients. The term can also be used to refer to over-nutrition resulting from excessive intake of specific nutrients. A child will experience malnutrition if the child does not consume the appropriate amount or quality of nutrients, comprising a healthy diet over a period of time. Types of malnutrition

  1. Underweight-Low weight for age (Composite indicator: measure of acute and chronic malnutrition)
  2. Stunting-Low height for age (indicator of chronic malnutrition)
  3. Wasting-Low weight for height (indicator of acute malnutrition) - age independent (6-59 month)

Cause

Major causes of malnutrition include poverty and food prices, dietary practices and agricultural productivity, with many individual cases being a mixture of several factors. Clinical malnutrition, such as cachexia, is a major burden also in developed countries. Various scales of analysis also have to be considered in order to determine the sociopolitical causes of malnutrition. For example, the population of a community that is within poor governments, may be at risk if the area lacks health-related services, but on a smaller scale certain households or individuals may be at an even higher risk due to differences in income levels, access to land, or levels of education.

Diseases
Malnutrition can be a consequence of health issues such as gastroenteritis or chronic illness, especially the HIV/AIDS pandemic. Diarrhea and other infections can cause malnutrition through decreased nutrient absorption, decreased intake of food, increased metabolic requirements, and direct nutrient loss. Parasite infections, in particular intestinal worm infections (helminthiasis), can also lead to malnutrition. A leading cause of diarrhea and intestinal worm infections in children in developing countries is lack of sanitation and hygiene.

People may become malnourished due to abnormal nutrient loss (due to diarrhea or chronic illness affecting the small bowel). This conditions may include Crohn's disease or untreated coeliac disease. Malnutrition may also occur due to increased energy expenditure (secondary malnutrition).

Diagnosis & Tests

Malnutrition is diagnosed based on certain factors like duration and precipitating causes if any. Clinical history and symptoms of malnutrition are often the major determinants of malnutrition and there is little role of diagnostic and imaging studies in evaluation of malnutrition.

Diagnostic tests and imaging studies may be needed to rule out deeper causes or illnesses that may have led to the malnourished state.

Outline of diagnosis of malnutrition includes BMI, routine blood tests and so forth.
Body mass index (BMI)
This is calculated by the weight in kilograms divided by the height in metres squared. A healthy BMI for adults usually lies between 18.5 and 24.9. Those with a BMI between 17 and 18.5 could be mildly malnourished, those with BMIs between 16 and 18 could be moderately malnourished and those with a BMI less than 16 could be severely malnourished.

Prevention & Risk Factors

Food security
The effort to bring modern agricultural techniques found in the West, such as nitrogen fertilizers and pesticides, to Asia, called the Green Revolution, resulted in increased food production and corresponding decreases in prices and malnutrition similar to those seen earlier in Western nations. This was possible because of existing infrastructure and institutions that are in short supply in Africa, such as a system of roads or public seed companies that made seeds available. Investments in agriculture, such as subsidized fertilizers and seeds, increases food harvest and reduces food prices. For example, in the case of Malawi, almost five million of its 13 million people used to need emergency food aid. However, after the government changed policy and subsidies for fertilizer and seed were introduced against World Bank strictures, farmers produced record-breaking corn harvests as production leaped to 3.4 million in 2007 from 1.2 million in 2005, making Malawi a major food exporter. This lowered food prices and increased wages for farm workers. Such investments in agriculture are still needed in other African countries like the Democratic Republic of the Congo. The country has one of the highest prevalence of malnutrition even though it is blessed with great agricultural potential John Ulimwengu explains in his article for D+C. Proponents for investing in agriculture include Jeffrey Sachs, who has championed the idea that wealthy countries should invest in fertilizer and seed for Africa's farmers.

In Nigeria, the use of imported Ready to Use Therapeutic Food (RUTF) has been used to treat malnutrition in the North. Soy Kunu, a locally sourced and prepared blend consisting of peanut, millet and soya beans may also be used.
New technology in agricultural production also has great potential to combat undernutrition. By improving agricultural yields, farmers could reduce poverty by increasing income as well as open up area for diversification of crops for household use. The World Bank itself claims to be part of the solution to malnutrition, asserting that the best way for countries to succeed in breaking the cycle of poverty and malnutrition is to build export-led economies that will give them the financial means to buy foodstuffs on the world market.

Treatments & Therapies

Food
The evidence for benefit of supplementary feeding is poor. This is due to the small amount of research done on this treatment.
Specially formulated foods do however appear useful in those from the developing world with moderate acute malnutrition. In young children with severe acute malnutrition it is unclear if ready-to-use therapeutic food differs from a normal diet. They may have some benefits in humanitarian emergencies as they can be eaten directly from the packet, do not require refrigeration or mixing with clean water, and can be stored for years.
In those who are severely malnourished, feeding too much too quickly can result in refeeding syndrome. This can result regardless of route of feeding and can present itself a couple of days after eating with heart failure, dysrhythmias and confusion that can result in death.
Manufacturers are trying to fortify everyday foods with micronutrients that can be sold to consumers such as wheat flour for Beladi bread in Egypt or fish sauce in Vietnam and the iodization of salt.
For example, flour has been fortified with iron, zinc, folic acid and other B vitamins such as thiamine, riboflavin, niacin and vitamin B12.