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Chronic eating disorders
Chronic eating disorders or dystrophy (Greek. dys – disorder, trophe – nutrition) – these are pathological conditions, accompanied by impaired physical development of the child.
Dystrophy – a general concept that includes eating disorders of various types (malnutrition, hypostatura, paratrophy).
Hypotrophy – chronic eating disorder characterized by lagging body weight from growth.
There are three degrees of hypotrophy:
- 1 degree – the lack of body weight 10-20%,
- 2 degree – 20-30%,
- Grade 3 – body mass deficiency of more than 30%.
In the Anglo-American literature, the term malnutrition – malnutrition (cachexia) is used instead of the term hypotrophy.
In ICD 10 hypotrophy of I and II Art. called protein-caloric deficiency (E43), and hypotrophy III Art. – Alimentary marasmus or cachexia (E41).
As a rule, the diagnosis of hypotrophy is exposed to children under 2 years of age, after 2 years of age they speak of low physical development with a deficiency of body weight. According to WHO, in developing countries, up to 20–30% or more of young children have protein-calorie or other types of malnutrition.
Hypostatura – uniform lag of the child in body weight and height. This form of chronic eating disorders is characteristic of children with congenital heart defects, brain developmental defects, encephalopathies, endocrine pathology, bronchopulmonary dysplasia, intrauterine infections, with alcoholic fetopathy, with 3 degrees of hypotrophy.
Paratrophy – chronic eating disorder characterized by an excess of body weight of more than 10% but less than 25%.
Obesity – excess body weight over 25%.
- with normal body weight and height, with an excessively developed subcutaneous fat layer;
- with overweight;
- with overweight and height (acceleration).
Etiology and pathogenesis of malnutrition
There are congenital (prenatal) and acquired (postnatal) hypotrophy. The term prenatal or prenatal malnutrition is currently, according to ICD 10, replaced by IUGR – intrauterine growth retardation.
In the English-language literature, instead of the term hypotrophic version of the IUGR, the term asymmetric IUGR is used.
Congenital (prenatal) malnutrition has now become more common (in 20-30% of newborns).
All reasons are divided into 4 groups:
- Maternal – nutritional deficiencies (insufficient nutrition of the pregnant), chronic maternal diseases leading to fetal hypoxia, maternal age (too young or elderly), prolonged infertile period, miscarriages, stillbirth, severe gestosis (toxicosis) of the second half of pregnancy, bad habits – smoking , alcoholism, drug addiction and
The cause of congenital hypotrophy can be not only the mother’s diseases before pregnancy and during it, but also the father’s diseases, and it’s not about hereditary diseases, but about acquired diseases that spermatogenesis and ovogenesis break in the future father or mother. 40% of children can not identify the cause of IUGR.
Among the causes of acquired (postnatal) hypotrophy exogenous and endogenous.
TO exogenous Causes of acquired hypotrophy include:
- Alimentary factors – quantitative or qualitative underfeeding. It is possible with hypogalactia in the mother, with difficulties in feeding – flat or retracted nipple, “tight” breast, with late (later than 6 months) introduction of complementary foods, if the child has regurgitation, vomiting, giving insufficient amount (or not age appropriate) ) mixtures with mixed and artificial feeding, etc.
- Infectious factors. Acute and chronic infections, especially intestinal (colienteritis, salmonellosis, dysentery), severe forms of pneumonia, pyelonephritis, sepsis cause morphological changes in the intestinal mucosa, inhibit the activity of lactase, lead to dysbiosis and therefore can lead to the development of hypotrophy.
- Toxic factors. The use of low-quality or expired milk formulas, hypervitaminosis D and A, poisoning, including medicinal, etc.
- Mode violations, parenting defects and other adverse factors: inadequate care, poor sanitary and hygienic conditions, when a child does not receive sufficient attention, caress, psychogenic stimulation of development, walks, etc. Such conditions in foreign literature are called “social deprivation” (deprivation). The main contingent is abandoned children, orphans, children of refugees, children from families of alcoholics and drug addicts.
Endogenous Causes of acquired hypotrophy can be:
- Anomalies of the constitution: exudative-catarrhal and neuro-arthritic diathesis.
- Endocrine diseases: hypothyroidism, adrenogenital syndrome, hypophysial nanism and
Diagnosis of these diseases is difficult. It is hypotrophy before other pathological symptoms that attract attention and can be the first step in identifying a hereditary or congenital disease.
The basis of the pathogenesis of malnutrition is the reduction in the utilization of nutrients with impaired digestion, absorption and absorption processes under the influence of various factors.
Various etiological factors lead to a decrease in the enzymatic activity of the gastrointestinal tract, there is a violation of the absorption of food ingredients, vitamins, changes in motility of the digestive tract. The excitability of the cerebral cortex decreases, dysfunction of the subcortical structures develops, the activity of the hypothalamus centers decreases, including the regulating appetite, and the vegetative regulation is disturbed. The body begins to use the reserves of fat and glycogen of the subcutaneous fat, muscles, internal organs, and after they are used, the decomposition of internal organs begins, the ratio of anabolism and catabolism processes is disturbed, and a disorder of chemical heat production occurs. With the breakdown of cells, many alkaline valences are lost, which contributes to the development of acidosis. A decrease in the enzymatic activity of the blood is observed, the antitoxic, deaminating, glycogen and prothrombin forming functions of the liver and the functions of internal organs are disturbed, and immunological reactivity is reduced, which leads to the development of septic and toxic states. The functional insufficiency of the endocrine glands 5 increases, polyglandular insufficiency develops, which ultimately leads to death.