Hypotrophy

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

The effect of hypotrophy on an actively growing and developing children's organism is particularly 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, degeneration of the type of hypotrophy, malnutrition syndrome, malnutrition syndrome, hypostature, malnutrition.

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

ICD-10 codes

In the ICD-10, Protein-energy deficiency is included in Class IV "Diseases of the endocrine system, eating disorders and metabolic disorders."

• E40-E46. Insufficient nutrition.
• E40. Kwashiorkor.
• E41. Alimentary insanity.
• E42. Marasmatic kwashiorkor.
• E43. Severe protein-energy deficiency, unspecified.
• E44. Protein-energy insufficiency, unspecified moderate and weak.
• E45. Delayed development due to protein-energy deficiency.
• E46. Protein-energy insufficiency, unspecified.

Hypotrophy: epidemiology

There is no exact information on the prevalence of hypotrophy at present, since patients with mild and moderate course of this disease are not registered in most cases. In Russia, severe hypotrophy is diagnosed in about 1-2% of children, in underdeveloped countries this indicator reaches 10-20%.

What causes hypotrophy?

Hypotrophy can be a consequence of various exogenous and endogenous etiological factors, causing either insufficient intake of food in the body, or its lack of assimilation. Among exogenous factors, the value of alimentary in both early and old age is still very high. 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 a quantitative underfeeding.

What happens with hypotrophy?

Despite the diversity of etiological factors that cause the development of hypotrophy in children, the pathogenesis is based on a chronic stress reaction - one of the universal nonspecific pathophysiological reactions of the organism that arise in many diseases, as well as with the long-term action of various damaging factors. All nerve, endocrine and immune mechanisms of human body regulation are combined by modern researchers into a single system that ensures the permanence of homeostasis.

Symptoms of hypotrophy

For the clinical picture of each of the 3 main clinical and pathogenetic variants of hypotrophy: marasmus, kwashiorkor and transitional variant - marasmus-kwashiorkor - are characterized not only by their own characteristics, but also by common features. Hypotrophy of any form has the following main clinical syndromes:

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

Types of hypotrophy

Until now, in our country, children's hypotrophy does not have a generally accepted classification, approved at congresses of pediatricians. In the world literature and pediatric practice, the classification proposed by J. Waterloe became most widespread.

How is hypotrophy recognized?

The diagnosis of "Protein-energy deficiency" (hypotrophy) in children is based on history, clinical manifestations of the disease, anthropometric evaluation and laboratory data.

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

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

Treatment of hypotrophy

Treatment of children with grade I hypotrophy is usually performed in outpatient settings, and children with grade II and III hypotrophy are hospitalized. Hypotrophy should be treated in a comprehensive way, that is, treatment should include balanced nutritional support and diet therapy, pharmacotherapy, adequate care and rehabilitation of a sick child.

How is hypotrophy prevented?

In the prevention of hypotrophy in infants, great importance is the struggle 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 the elderly, great importance is given to timely diagnosis and adequate treatment of diseases leading to the development of hypotrophy. In the country's medical and preventive institutions, it is necessary to introduce modern schemes of nutritional support for patients who underwent surgery, patients with acute and chronic diseases, as well as with trauma.

Hypotrophy is a social disease. Measures for its prevention include improving the living standards of the population and fighting poverty, as well as ensuring access to qualified medical care for a wide range of people.

What is the prognosis of hypotrophy?

Hypotrophy of the primary alimentary-dependent form has, as a rule, a favorable prognosis. Often an unfavorable prognosis is noted in children with secondary forms of hypotrophy, especially genetically determined. The most severe prognosis is characteristic for chromosomal pathology. So, with the syndromes of Patau and Edwards, in most cases, children do not live to be a year old.