Hypotrophy

Hypotrophy is an alimentary-dependent condition caused by predominant protein and/or energy starvation of sufficient duration and/or intensity. Protein-energy deficiency manifests itself as a complex disorder of homeostasis in the form of changes in the main metabolic processes, water-electrolyte imbalance, changes in body composition, disturbances in nervous regulation, endocrine imbalance, suppression of the immune system, dysfunction of the gastrointestinal tract and other organs and their systems.

The impact of hypotrophy on an actively growing and developing child's body is especially unfavorable. Hypotrophy causes a significant delay in the child's physical and neuropsychic development, resulting in disturbances in immunological reactivity and tolerance to food.

Hypotrophy has the following synonyms: protein-energy deficiency, dystrophy type of hypotrophy, malnutrition syndrome, malnutrition syndrome, hypostatura, malnutrition.

Malnutrition syndrome is a universal concept that reflects the processes occurring in the body with a deficiency of any of the essential nutrients (proteins and other energy sources, vitamins, macro- and microelements). Malnutrition can be primary, caused by inadequate intake of nutrients, and secondary, associated with impaired intake, assimilation or metabolism of nutrients due to disease or injury. The narrower concept of "protein-energy malnutrition" reflects changes in the body associated with a deficiency primarily of protein and/or another energy substrate.

ICD-10 codes

In ICD-10, protein-energy malnutrition is included in class IV “Diseases of the endocrine system, nutritional disorders and metabolic disorders”.

• E40-E46. Malnutrition.
• E40. Kwashiorkor.
• E41. Alimentary marasmus.
• E42. Marasmatic kwashiorkor.
• E43. Severe protein-energy malnutrition, unspecified.
• E44. Unspecified protein-energy malnutrition of moderate and mild degree.
• E45. Developmental delay due to protein-energy malnutrition.
• E46. Protein-energy malnutrition, unspecified.

Hypotrophy: Epidemiology

There is currently no precise information on the prevalence of hypotrophy, since patients with mild and moderate cases of this disease are not registered in most cases. In Russia, severe hypotrophy is diagnosed in approximately 1-2% of children, in underdeveloped countries this figure reaches 10-20%.

What causes hypotrophy?

Hypotrophy may be a consequence of various exogenous and endogenous etiological factors causing either insufficient food intake or insufficient absorption. Among exogenous factors, alimentary factors are still of great importance both at an early and older age. In children of the first year of life, hypotrophy may be associated with the high prevalence of hypogalactia in mothers and food allergies in children, leading to quantitative underfeeding.

What happens during hypotrophy?

Despite the diversity of etiological factors causing the development of hypotrophy in children, its pathogenesis is based on a chronic stress reaction - one of the universal non-specific pathophysiological reactions of the body that occurs in many diseases, as well as with long-term exposure to various damaging factors. Modern researchers combine all nervous, endocrine and immune mechanisms of regulation of the human body into a single system that ensures the constancy of homeostasis.

Symptoms of hypotrophy

The clinical picture of each of the 3 main clinical and pathogenetic variants of malnutrition: marasmus, kwashiorkor and the transitional variant - marasmus-kwashiorkor - is characterized not only by its own characteristics, but also by common features. Malnutrition of any form has the following main clinical syndromes:

• undernutrition;
• trophic disorders;
• decreased food tolerance;
• changes in the functional state of the central nervous system;
• disorders of immunological reactivity.

Types of hypotrophy

To date, in our country, hypotrophy in children has no generally accepted classification approved at pediatric congresses. In world literature and pediatric practice, the classification proposed by J. Waterlow has received the greatest distribution.

How is hypotrophy recognized?

The diagnosis of "Protein-energy malnutrition" (hypotrophy) in children is based on anamnesis data, clinical manifestations of the disease, assessment of anthropometric indicators and data from laboratory research methods.

Hypotrophy requires screening, which consists of constant monitoring of physical development indicators (height, body weight) in young children and in subsequent decreed periods. In sick children in hospitals and other medical institutions, it is necessary to monitor protein metabolism indicators:

• level of total protein and protein fractions;
• serum urea level;
• absolute number of peripheral blood lymphocytes.

Treatment of hypotrophy

Treatment of children with grade I hypotrophy is usually carried out on an outpatient basis, and children with grade II and III hypotrophy - in a hospital. Hypotrophy should be treated comprehensively, that is, treatment should include balanced nutritional support and diet therapy, pharmacotherapy, adequate care and rehabilitation of the sick child.

How is hypotrophy prevented?

In the prevention of hypotrophy in young children, great importance is attached to the fight for natural feeding, the organization of the correct regime and care for the child, the prevention and timely treatment of diseases complicated by the development of hypotrophy. In older age, great importance is attached to the timely diagnosis and adequate treatment of diseases leading to the development of hypotrophy. In medical and preventive institutions of the country, it is necessary to introduce modern schemes of nutritional support for patients who have undergone surgery, patients with acute and chronic diseases, as well as with injuries.

Hypotrophy is a social disease. Its prevention measures include raising the standard of living of the population and combating poverty, as well as ensuring the availability of qualified medical care to broad sections of the population.

What is the prognosis for hypotrophy?

Primary alimentary-dependent hypotrophy usually has a favorable prognosis. Often, an unfavorable prognosis is noted in children with secondary forms of hypotrophy, especially genetically determined ones. The most severe prognosis is characteristic of chromosomal pathology. Thus, with Patau and Edwards syndromes, in most cases, children do not survive to one year.