Idea de Investigación

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IDEA DE INVESTIGACIÓN
Johan Paucar Castro

Escuela de Medicina, Universidad de las Américas
1898-Metodología De Titulación
Dr. Fabián Oña
01 de noviembre de 2022
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Introducción y Ejemplo:
Lino, un ilustre joven médico, estudiante de una maestría en ciencias de la salud, se interesó
por el tema de nutrición en niños en etapa escolar (5 a 12 años) y su objetivo profesional es
dedicarse a asesorar a padres y madres de familia, así como a rectores de unidades educativas
sobre nutrición y prevención de enfermedades metabólicas.
Así, su idea de investigación vinculada a lo que quiere hacer cuando egrese fue: Evaluar el valor
nutricional de los alimentos que se expenden en bares de unidades educativas y asociarlo al IMC
de los niños que consumen dichos alimentos. Además, se cuestionó respecto de la relación que
pudiere existir entre el IMC y los hábitos alimenticios familiares.
Lino, primero, revisó la existencia de modelos de análisis e instrumentos validades para evaluar
comportamientos humanos relacionados a nutrición, así como metodologías relacionadas con la
determinación de IMC y su interpretación. Lugo, hizo una propuesta, la está implementados y
valorará sus resultados en varias dimensiones.
Se Requiere. -
1. Complete la idea de Lino respecto de los modelos de análisis e instrumentos validades para
evaluar comportamientos humanos relacionados a nutrición, así como metodologías relacionadas
con la determinación de IMC y su interpretación.
Existen diversos modelos de análisis en los que la investigación de Lino puede hallar su eje
central como son: la determinación de ingesta de nutrientes, la estructura corporal, evaluar
bioquímicamente o clínicamente el estado nutricional de cada niño y la determinación del Índice
de Masa Corporal, todo esto con el fin de poder detectar la existencia o no de un déficit nutricional
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grave que en muchas situaciones puede desencadenar en enfermedades graves como el escorbuto
o la anemia ferropénica. (CDC, 2021)
La metodología utilizada para la determinación del IMC consiste en la aplicación de una fórmula
sencilla donde se hace uso de dos datos importantes que son la talla y peso:
𝑃𝑒𝑠𝑜 (𝐾𝑔)
𝐼𝑀𝐶 =
𝑇𝑎𝑙𝑙𝑎2 (𝑚)
En niños y adolescentes los resultados obtenidos se muestran en percentiles y deben interpretarse
en relación con otros niños o adolescentes del mismo sexo y edad. (CDC, 2021) Las categorías del
nivel de peso del IMC por edad y sus percentiles se detallan a continuación:
Tabla 1
Categorías del nivel de peso del IMC por edad y sus percentiles
Categoría de estado de peso Rango percentil
Bajo peso Menos del percentil 5
Peso saludable Percentil 5 hasta por debajo del percentil 85
Sobrepeso Percentil 85 hasta por debajo del percentil 95
Obesidad Igual o mayor al percentil 95
Para tener una idea más clara de esto se detalla el siguiente ejemplo:
Figura 1
Interpretación de IMC para un varón de 10 años

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2. Piense en una idea de investigación que se relacione con la idea de Lino y coméntela con su
grupo de trabajo. Elaboren y escriban, en conjunto, una idea de trabajo que complemente a la
de Lino.
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El incremento de tendencias actuales al consumo excesivo de alimentos procesados (comida
chatarra), altos en calorías y azúcar, propuestos y promovidos mediante el uso de medios de
comunicación y redes sociales, así como también el aumento del uso de tecnología en niños y
adolescentes lo que incrementa el sedentarismo que conjuntamente contribuyen a un deterioro de
la salud y estado físico de niños y adolescentes desde tempranas edades son factores de riesgo
actuales que se deben tener en consideración en la investigación de estado nutricional de niños
debido al gran impacto que estos representan sobre la salud de los mismos.
3. Piense y escriba una idea de investigación propia enfocada en sus intereses personales,
profesionales o laborales. La idea deberá ser expresas en un máximo de 500 caracteres
incluido espacios.
Es importante intervenir efectivamente en la nutrición de los niños durante los primeros años de
vida, pues es en su infancia donde la ingesta de energía es más alta, así como también es mayor la
capacidad de responder a una buena nutrición por parte de los niños. Al igual que en muchos
países, en Ecuador también muchos niños están expuestos a factores de riesgo que incrementan la
probabilidad de malnutrición como la pobreza, la desigualdad y la falta de seguridad alimenticia.
La falta de buenas prácticas alimentarias se ha convertido en causas claves para el retraso en el
crecimiento y desarrollo, en el mundo son más de trecientos millones de niños menores de 5 años
que se encuentran en condiciones crónicas de desnutrición. La alimentación y la malnutrición
afectan de manera significativa el bienestar humano en especial para aquellas familias que forman
parte de poblaciones pobres que viven en zonas rurales.
Los niños en condiciones vulnerables de pobreza y desigualdad social se convierten en blanco de
malas prácticas alimenticias debido a la falta de acceso productos básicos que les brinden el aporte
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de vitaminas y proteínas necesarios para su crecimiento y la correcta y normal realización de sus
actividades diarias, muchos de estos niños se ven privados de por lo menos ingerir las 3 comidas
diarias debido a su situación económica o en un gran número de veces debido al trabajo infantil al
que se ven sometidos como una alternativa de ayuda en la sostenibilidad económica de sus hogares.
Es por esta razón que nace mi idea de reconocer la existencia de mala nutrición en niños de etapa
escolar de segundo a séptimo año de educación básica de la parroquia de Tambillo mediante la
aplicación de métodos investigativos que permitan establecer la necesidad de impulsar programas
en conjunto con la sociedad y padres de familia que nos faciliten la erradicación de futuros
problemas de salud y aprendizaje de los niños durante su desarrollo cognitivo en las instituciones
educativas.
El objetivo de mi investigación será promover un programa de capacitación nutricional para padres
de familia y estudiantes en la unidad educativa de la parroquia de Tambillo así como también
incentivar a aquellas familias en mejor posición económica para la creación de un banco de
alimentos institucional donde después de una encuesta socioeconómica se establezca el destino de
canastas básicas alimenticias con el fin de disminuir la desnutrición infantil que pueda estar
presente.
Para realizar este estudio será necesario utilizar un modelo estadístico que nos permita determinar
una media de la cantidad de niños de etapa escolar en situación de desnutrición mediante la
utilización de medidas de IMC y los respectivos percentiles que estos representen de acuerdo a
grupos de edad y género de los estudiantes de la institución educativa.
4. Seleccione una revista científica, seleccione un artículo científico (escrito en inglés)
relacionado con su idea de investigación y elabore un resumen escrito de un máximo de 2000

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caracteres incluidos espacios. Al final del resumen, exprese por escrito según su criterio,
la idea de investigación original que motivo el estudio publicado en el artículo científico
seleccionado.
Desnutrición en niños de países con recursos limitados: evaluación clínica
La desnutrición es un factor crítico de mortalidad y morbilidad en niños en todos los países del
mundo y se encuentra asociado con muertes de niños menores de 5 años de edad principalmente,
muchos países de bajos recursos económicos e incluso los de medianos recursos económicos tienen
problemas importantes con la desnutrición infantil como con el sobrepeso u obesidad que también
es denominada “la doble carga de la malnutrición”. Las principales formas de malnutrición son el
marasmo o la desnutrición edematosa que pueden intervenir o no en el retraso del crecimiento
normal de los niños.
La principal causa de desnutrición primaria infantil en países con recursos económicos bajos es la
falta de suministro de alimentos adecuados debido a diferentes factores entre los que se encuentran
principalmente: los socioeconómicos, políticos y ambientales. Por otro lado, se encuentra la
desnutrición secundaria que resulta como consecuencia del padecimiento de enfermedades
crónicas.
Un marcador de desnutrición crónica y que a menudo es el más frecuente entre los niños es el
retraso en el crecimiento, así como también existen otras características a tomar en cuenta como
son: la actividad física reducida, apatía mental, retraso psicomotor y retraso del desarrollo mental.
Criterio
Al ser la desnutrición infantil un tema comúnmente asociado a la falta de recursos económicos que
permitan a las familias adquirir por lo menos los alimentos básicos en una dieta saludable, este
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tema de investigación nace de la relación misma entre la economía de un país y su capacidad de
proveer alimentos necesarios a su población, es decir un país desarrollado económicamente a nivel
mundial va a poseer tasas de desnutrición infantil significativamente bajas en relación a un país
subdesarrollado donde prevalezca la pobreza, pues es esta brecha socioeconómica la que incide de
manera significativa en el crecimiento de los números de niños con desnutrición a edades muy
tempranas debido a la falta de acceso a un trabajo que provea a sus familias de los recursos
económicos necesarios para poder solventar sus necesidades básicas en alimentación.
5. En un texto escrito, exprese una idea de investigación en otro campo de estudio lejano al que
usted ha escogido que guarde relación con experiencias vividas en la próxima semana. Exprese
esta idea en un máximo de 500 caracteres incluido espacios.
BULLYNG
El acoso escolar o bullyng ha ido cobrando mayor fuerza con el pasar de los años y ha conllevado
a un sinnúmero de problemas psicológicos y sociales en las personas que sufren de este tipo de
abuso que muchas de las veces empieza desde etapas escolares muy tempranas y que terminan con
consecuencias sumamente negativas. El bullyng no solo afecta a quienes son acosados sino
también a quienes acosan y a quienes son testigos de lo ocurrido, tiene un gran impacto negativo
sobre la salud mental, incita el comienzo de uso de sustancias tóxicas e incluso a pensamientos y
actos suicidas.
Sería importante el saber por qué razón comienza el abuso escolar, cuáles son los factores que
determinan a una persona como acosador, a otra como víctima y a otra más como testigo, pues
todo esto influye en el incremento de la probabilidad de sufrir depresión, ansiedad, tristeza,

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soledad, cambios en los patrones de alimentación y de sueño, bajo desempeño escolar que en
muchas ocasiones termina con el abandono de los estudios.

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Referencias
CDC. (15 de septiembre de 2021). Obtenido de Acerca del IMC para niños y adolescentes:
https://www.cdc.gov/healthyweight/spanish/assessing/bmi/childrens_bmi/acerca_indice_
masa_corporal_ninos_adolescentes.html#percentil-del-IMC
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ANEXO
ARTÍCULO CIENTÍFICO
Malnutrition in children in resource-limited countries: Clinical... https://www-uptodate-com.bibliotecavirtual.udla.edu.ec/cont...
Malnutrition in children in resource-limited countries:

Clinical assessment
Author: Praveen S Goday, MBBS
Section Editors: Kathleen J Motil, MD, PhD, B UK Li, MD
Deputy Editor: Alison G Hoppin, MD
Contributor Disclosures
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Sep 2022. | This topic last updated: Aug 15, 2022.
INTRODUCTION
Undernutrition is a critical determinant of mortality and morbidity in young children

worldwide: It is associated with approximately one-half of all deaths in children under five
years of age [1].
In this topic review, we use the term "malnutrition" in its traditional sense, referring to
undernutrition (wasting, stunting, or micronutrient deficiencies), although some authors
use the term more broadly to encompass overnutrition/obesity. Indeed, many low- and
middle-income countries have substantial problems with both undernutrition and
overweight/obesity, sometimes termed the "double burden of malnutrition" [2].
The major forms of malnutrition are marasmus (wasting) and kwashiorkor (edematous
malnutrition), with or without associated stunting. The clinical assessment of the child with
malnutrition includes distinguishing between these types, assessing their severity, and
identifying acute life-threatening complications, including sepsis and acute dehydration.
These children are at risk for micronutrient deficiencies, as detailed in a separate topic
review. (See "Micronutrient deficiencies associated with malnutrition in children".)
Traditionally, malnutrition in resource-limited settings is primary malnutrition that results

from inadequate food supply caused by socioeconomic, political, and environmental
factors. However, secondary malnutrition due to chronic diseases can also exist
concurrently in these settings.
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Treatment of malnutrition in resource-limited settings is discussed in the following topic

reviews:
● (See "Management of moderate acute malnutrition in children in resource-limited

countries".)
● (See "Management of uncomplicated severe acute malnutrition in children in
resource-limited countries".)
● (See "Management of complicated severe acute malnutrition in children in resource-
limited countries".)
EPIDEMIOLOGY
● Acute malnutrition – Approximately 31.8 million children (4.5 percent of all children
under five years of age worldwide) have moderate wasting (indicating moderate acute
malnutrition [MAM]) [3]. An additional 13.6 million children in this age group have
severe wasting (indicating severe acute malnutrition [SAM]) [4]. MAM and SAM are
primarily a problem in resource-limited regions and especially South Asia (including
Afghanistan, India, Pakistan, Bangladesh, and Nepal) and sub-Saharan Africa. They
are uncommon in North America, Australia, and other resource-rich regions.
● Chronic malnutrition – Many more children (149.2 million; approximately 22 percent)

have stunting (faltering linear growth), reflecting chronic undernutrition [3]. The
prevalence of stunting has gradually declined in most regions during the past three
decades (from 39.3 percent in 1990 to 22 percent in 2020), associated with
improvements in education, socioeconomic status, sanitation, access to maternal
health services, and family planning [5]. Nonetheless, the prevalence of stunting
remains unacceptably high in many regions, particularly South Asia and sub-Saharan
Africa, where it affects more than 30 percent of children [3,5]. Stunting rates in sub-
Saharan Africa have finally begun to decline [4].
CHRONIC MALNUTRITION
Stunting is a marker for chronic malnutrition and is often present in children with acute
malnutrition. Stunting is often accompanied by features of acute malnutrition, such as poor
weight gain and deficits in lean body mass and adipose tissue. Other features include
reduced physical activity, mental apathy, and retarded psychomotor and mental
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development [6-8].
ACUTE MALNUTRITION
Severe acute malnutrition (SAM) is associated with one of two classical syndromes:
marasmus (wasting syndrome) and kwashiorkor (edematous malnutrition), or a
combination of the two (marasmic kwashiorkor). Children with acute malnutrition appear
wasted (or show a decrease in mid-upper arm circumference [MUAC], weight-for-length,
and/or body mass index), whereas children with chronic malnutrition have stunted linear
growth and/or are underweight. Malnourished children may also suffer from numerous
associated complications, including dehydration, infection, and vitamin deficiencies. (See
'Evaluation for comorbid conditions' below and 'Specific nutrient deficiencies' below.)
The division into acute (wasting) and chronic malnutrition (stunting) is an

oversimplification. In one study, many children who were either wasted or stunted at two
years of age had suffered from the other form of malnutrition earlier in life [9]. Hence,
wasting and stunting should be taken to represent different ways to adapt to suboptimal
nutrition, either by restraining weight (wasting) or height (stunting) [10].
Clinical subtypes — SAM can be divided into clinical subtypes based on the presence or
absence of edema. Malnutrition without edema is known as marasmus or wasting, and
malnutrition with edema is known as kwashiorkor (or edematous malnutrition).
Distinguishing physical features are listed in the table ( table 1). In the past, children with
kwashiorkor were previously thought to have worse outcomes compared with those with
marasmus, but more recent large studies demonstrate that children with kwashiorkor tend
to have better outcomes, perhaps due to the additional burden of higher rates of human
immunodeficiency virus (HIV) and diarrheal dehydration among those with marasmus
[11-13].
Marasmus — Marasmus is characterized by low weight-for-height and reduced MUAC,

reflecting wasting of muscle mass and depletion of body fat stores. It is the most common
form of protein-energy malnutrition and is thought to be caused by inadequate intake of all
nutrients but especially dietary energy sources (total calories).
Other physical examination findings may include:
● Head that appears large relative to the body, with staring eyes
● Emaciated and weak appearance
3 de 27 31/10/2022, 18:29
● Irritable and fretful affect

● Bradycardia, hypotension, and hypothermia
● Thin, dry skin
● Shrunken arms, thighs, and buttocks, with redundant skin folds caused by loss of
subcutaneous fat ( picture 1)
● Thin, sparse hair that is easily plucked
Kwashiorkor (edematous malnutrition) — Kwashiorkor is characterized by symmetric

peripheral pitting edema that begins in the most dependent regions and proceeds
cranially as time progresses, often involving the presacral area, genitalia, and periorbital
area, with or without anasarca (severe generalized edema). There is marked muscle
atrophy with normal or even increased body fat. Malnutrition is considered severe if any
edema is present, regardless of other anthropometric values.
Other physical examination findings include:
● Apathetic, listless affect

● Rounded prominence of the cheeks ("moon face")
● Pursed appearance of the mouth
● Thin, dry, peeling skin with confluent areas of hyperkeratosis and hyperpigmentation
( picture 2)
● Dry, dull, hypopigmented hair that falls out or is easily plucked
● Hepatomegaly (from fatty liver infiltrates)
● Distended abdomen with dilated intestinal loops
● Bradycardia, hypotension, and hypothermia
● Despite generalized edema, most children have loose inner inguinal skin folds
Edema is assessed by pressing down firmly on the third to fourth tarsal bones on the
dorsum of the foot for three to five seconds and then assessing for pitting edema for two
to three seconds [14].
Edema in malnutrition is graded in the following manner [15]:
● Mild (1+) – Edema involves only the feet

● Moderate (2+) – Edema involves the feet and legs and/or the upper limbs
● Severe (3+) – Generalized edema or moderate plus facial edema
Intermittent periods of adequate dietary intake restores hair color, occasionally resulting in
alternating loss of hair color interspersed between bands of normal pigmentation ("flag
4 de 27 31/10/2022, 18:29
sign") ( picture 3). Stunting (reduced height for age) is often superimposed on both
marasmus and kwashiorkor, reflecting not only inadequate caloric intake but also the
cumulative effects of chronic poverty, food insecurity, and infectious risks that these
children face.
Some children have features of both marasmus and kwashiorkor, sometimes known as
marasmic kwashiorkor.
Pathophysiology — SAM affects many organ systems ( figure 1):
● Cardiovascular system – Children with either marasmus or kwashiorkor have

precarious fluid balance; the infusion of saline may cause an increase in venous
pressure and acute heart failure, whereas a decrease in blood volume can
compromise tissue perfusion. In children with marasmus, cardiac output and stroke
volume are reduced in proportion to the loss of lean body mass; hence, cardiac index
(which relates cardiac output to body surface area) is normal. However, there is a
threshold beyond which cardiac dysfunction occurs [16]. Another study documented
that cardiac function measurements, including myocardial mass, return to normal by
day 7 of hospitalization [17]. All children with SAM tolerated boluses of intravenous
fluids, and some may have actually had hypovolemia. The exact approach to fluid
management and cardiac dysfunction in children with SAM needs to be further
elucidated.
● Lungs – Surprisingly, children treated for SAM do not experience negative effects with
regard to later lung function [18].
● Liver – Hepatomegaly from fatty liver is common, especially in kwashiorkor [19].

Hepatic gluconeogenesis is reduced in patients with hypoalbuminemia, which
increases the risk of hypoglycemia, and energy production from substrates such as
galactose and fructose is also impaired. There is severely reduced hepatic metabolism
and excretion of toxins, as well as reduced hepatic synthesis of proteins including
albumin and production of abnormal metabolites of amino acids.
● Genitourinary system – Glomerular filtration rate is reduced, and the capacity of the
kidney to excrete sodium, excess acid, or a water load is greatly reduced. Urinary tract
infections are common [20].
● Gastrointestinal tract – Production of gastric acid is reduced. Exocrine pancreatic

insufficiency is almost universal in severe malnutrition; children with kwashiorkor
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have more severe pancreatic insufficiency than those with severe wasting [21].
However, pancreatic enzyme replacement therapy does not improve weight gain [21].
The mucosa of the small intestine is atrophied, and production of digestive enzymes
and membrane nutrient transporters is reduced. Lactase deficiency is common,
leading to lactose malabsorption [22], and absorption of all nutrients is reduced.
Intestinal motility is reduced, and this can be worsened by potassium and magnesium
deficiencies, potentially leading to ileus. Environmental enteric dysfunction, also
known as malnutrition enteropathy, is associated with villous atrophy, mucosal
thinning, increased intestinal permeability, loss of tight junction proteins (leading to
loss of gut barrier function), lymphocytic infiltration, and gut dysbiosis [23-25].
Luminal bacterial overgrowth is common, and the diminished gut barrier function,
which normally limits translocation of bacteria and their toxins, can lead to
bacteremia and sepsis.
● Immune system – Immune dysfunction and infections are closely associated with
malnutrition and are probably both a cause and consequence of malnutrition [26,27].
Severely malnourished children are at extremely high risk for superimposed infections
[28]. Multiple immune functions are diminished in marasmus; the mechanisms
include alterations in gut barrier function, intestinal dysbiosis and mucosal immunity,
reduced production of proinflammatory cytokines by adipose tissue ("adipokines"),
and micronutrient deficiencies [29]. Lymph glands, tonsils, and the thymus are
atrophied. Thymus size is inversely proportional to the duration of malnutrition [30]
and improves with treatment of malnutrition [31]. Cell-mediated (T cell) immunity,
immunoglobulin A (IgA) levels in secretions, complement levels, and phagocytosis are
all diminished. Although the acute phase immune response is intact, the typical signs
of infection, such as leukocytosis and fever, are frequently absent [32]. Septic shock is
often associated with hypoglycemia and hypothermia (see 'Sepsis' below). Other
inflammatory mediators (including interleukin-6 and C-reactive protein) are increased,
particularly in kwashiorkor (edematous malnutrition) [32,33].
● Endocrine system – Insulin levels are reduced, and the child may be glucose
intolerant. Growth hormone levels are increased, but levels of its downstream
effector, insulin-like growth factor 1 (IGF-1), are reduced. Cortisol levels are usually
increased.
● Central nervous system – Approximately 20 percent of children have abnormal

findings on brain magnetic resonance imaging (MRI), such as cerebral atrophy, dilated
ventricles, and periventricular white matter changes [34]. In the majority of patients,
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these gross changes resolve with treatment.
● Metabolism and circulation – The basal metabolic rate is reduced by approximately

30 percent but rises markedly during the recovery period [35,36]. Both heat
generation and heat loss are impaired, so that the child becomes hypothermic in a
cold environment and hyperthermic in a hot environment [37]. Intestinal absorption
of nutrients and blood glucose clearance are reduced in edematous malnutrition and
marasmus, but endogenous glucose production is significantly reduced in children
with hypoalbuminemia, with or without edematous malnutrition [38-40].
● Cellular function – Sodium pump activity is reduced, and cell membranes are more
permeable than normal, resulting in an increase in intracellular sodium and a
decrease in intracellular potassium and magnesium. Protein synthesis is reduced.
● Skin and glands – The skin and subcutaneous fat are atrophied, which causes loose
skin folds. Many signs of dehydration are unreliable. As examples, the eyes may
appear sunken because of loss of subcutaneous fat in the orbit and the child may
have dryness of mouth and eyes as well as reduced sweat production because of
atrophied sweat, tear, and salivary glands. (See 'Distinguishing sepsis from
dehydration' below.)
Pathogenesis — Multiple theories have been advanced to explain the edema in edematous

malnutrition:
● Protein deficiency/hypoalbuminemia – In the past, dietary protein deficiency was

thought to be the key factor underlying edematous malnutrition. This assumption was
based on observations that many patients with kwashiorkor have hypoalbuminemia,
which was thought to be a consequence of inadequate nutrients for protein synthesis.
In addition, albumin concentrations generally increase within the first two weeks of
refeeding (albeit subtly), and edematous malnutrition has features similar to
congenital nephrotic syndrome, in which the primary pathology is renal loss of
albumin [41]. However, multiple lines of evidence have shown that inadequate intake
of dietary protein is not the primary trigger for edematous malnutrition. As examples,
some patients have edematous malnutrition without hypoalbuminemia, others
develop edematous malnutrition despite adequate proportion of protein in the diet
(eg, in exclusively breastfed infants), and others recover from edematous malnutrition
with supportive care even without enhancing the protein content of the diet [42-44].
Thus, neither protein deficiency nor hypoalbuminemia appear to be the primary cause
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of the edema in kwashiorkor. Instead, hypoalbuminemia appears to be a common

complication and may contribute to the edema in many patients by permitting
movement of fluid from the vascular space into the interstitium; this is compounded
by retention of sodium and water by the kidneys. The carbohydrate component of the
diet increases insulin levels, which further enhances renal reabsorption of sodium and
water. (See "Pathophysiology and etiology of edema in children".)
● Oxidant stress – Excessive oxidant stress has been proposed as a cause of

edematous malnutrition. However, a trial to prevent this form of malnutrition with
antioxidant supplementation was not successful [45], leading to the conclusion that
antioxidant depletion may be a consequence rather than a cause of kwashiorkor.
● Microbiome – Strong evidence suggests that edematous malnutrition is caused by

changes in the intestinal microbiome, in conjunction with a specific diet. In one study,
malnutrition was induced in mice by transfer of the fecal microbiota from
malnourished children if they were also fed the local nutrient-poor diet eaten by the
children [46]. Neither the fecal microbiota transfer nor the local diet alone was
sufficient to cause the malnutrition. This and other studies support the concept that
changes in fecal microbiota and/or virome observed in malnutrition are causes rather
than effects of malnutrition and that the dysbiosis might be reversible with specially
designed therapeutic foods [46-50]. Severe malnutrition may interfere with the
normal development of the intestinal microbiome, leading to an immature bacterial
population that could potentially lead to other health consequences [46,51]. More
recently, studies have shown that specific "families" of microbiota are associated with
normal maturation of the infant microbiome and may serve as the "scaffolding" upon
which the rest of the normal microbiome thrives [52]. These microbiota are disrupted
by malnutrition, but the return of these bacteria may serve as a strong signal of future
health. Finally, changes in the duodenal microbiome mediate the environmental
enteric dysfunction seen in malnutrition [25].
CLINICAL ASSESSMENT
Anthropometrics — The degree of acute and chronic malnutrition, manifested as wasting

or edema, and linear stunting, respectively, is assessed clinically using various
anthropometric measurements ( table 2) [53]. The assessment methods are based upon
the assumption that during periods of nutritional deprivation, weight deficits occur initially,
followed by faltering length or height and, finally, by lagging head circumference growth.
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Estimates of the severity and duration of nutritional deprivation provide guidelines for the
nutritional rehabilitation of the malnourished child [54].
Z-scores — The severity of wasting or stunting is defined by comparing a child's weight

and height measurements with those of a population reference standard. Population
growth standards were developed by the World Health Organization (WHO) in 2006; these
describe normal child growth from birth to five years from a variety of populations, under
optimal environmental conditions. The individual's weight-for-height and height-for-age
relative to the population mean are expressed as Z-scores. These charts are available online
at the WHO website. (See "Measurement of growth in children".)
Z-scores also may be determined using the following calculators, which are based on the
WHO child growth standards:
● For ages 0 to 23 months – Boys (calculator 1); girls (calculator 2). These calculators
return Z-scores and percentiles for weight-for-length and length-for-age, which can
also be obtained from these WHO charts ( figure 2A-D).
● For ages 24 to 59 months – Boys (calculator 3); girls (calculator 4). These calculators
return Z-scores and percentiles for weight-for-height and height-for-age, which can
also be obtained from these WHO charts ( figure 3A-D)
Mid-upper arm circumference — The mid-upper arm circumference (MUAC) is an

accurate and efficient way to screen for malnutrition [55]. It is especially valuable in
settings during which time, equipment, or trained personnel are limited, such as famines
and refugee crises.
A MUAC of <115 mm is generally used for malnutrition screening for children 6 to 59

months of age. A single cutoff can be used because it is reasonably independent of age and
sex in young children. This cutoff is fairly sensitive for detecting severe wasting [56].
However, one study suggests that higher cutoffs based on age group may better capture
the vulnerability and risk of severe and moderate wasting [57]. This study suggested the
following cutoffs for MUAC:
● Age 6 to 24 months – Severe wasting <120 mm, moderate wasting <125 mm

Advantages of the MUAC compared with weight-for-length Z-scores (WLZ) are that it is a
better predictor of mortality, is easier to perform, and is not as affected by dehydration
9 de 27 31/10/2022, 18:29
[55]. On the other hand, WLZ may detect another 40 percent of children with severe acute
malnutrition (SAM) who have normal MUAC values and WLZ scores are better correlated
with a number of biochemical indices of malnutrition associated with clinical morbidity [58].
Thus, the combination of both MUAC and WLZ is optimal for sensitivity and identifying
children at greatest risk [58,59].
Diagnostic criteria — WHO has developed criteria for the classification of moderate or

severe malnutrition in children [53]. These criteria are based upon the degree of wasting
and stunting and the presence of edema, which are not mutually exclusive ( table 2).
Children 6 through 59 months — For this age group, diagnostic criteria are:
● Severe acute malnutrition (SAM):
• MUAC <115 mm, or

• Weight-for-length Z-score <-3, or
• Bilateral pitting edema
● Moderate acute malnutrition (MAM):
• MUAC 115 to 124 mm, or

• Weight-for-length Z-score -2 to -3
● Stunting (indicates chronic malnutrition):
• Moderate stunting – Height or length Z-score -2 to -3

• Severe stunting – Height or length Z-score <-3
These definitions of SAM are recommended by the WHO as criteria for identifying patients
who require urgent treatment [60]. The type of treatment program (outpatient or inpatient)
depends on the patient's overall clinical status, appetite, and comorbid disease. (See
"Management of complicated severe acute malnutrition in children in resource-limited
countries", section on 'Classification'.)
When possible, both parameters should be considered in the assessment of malnutrition

[61].
Infants <6 months — For infants younger than six months of age, there is no gold
standard for assessing the severity of malnutrition [62]. Both the weight-for-length Z-score
and MUAC have advantages and disadvantages in this population [55,63]. The most
common approach in this age group is to define severe malnutrition using the same weight
10 de 27 31/10/2022, 18:29
and height criteria used for older infants and children (weight-for-length Z-score <–3 or the
presence of bilateral pitting edema) [60].
Three studies now confirm that MUAC <110 mm is highly associated with mortality in this
age group [64-66]. One of these studies showed that MUAC and weight-for-age Z-score <-3
are better predictors of mortality than weight-for-length Z-score [66].
Children 5 years and older — For children over five years of age and adolescents, the
WHO recommends the use of body mass index-for-age Z-scores to screen for malnutrition.
Alternatively, MUAC-for-age Z-score charts for children between 5 and 19 years have been
developed. In these charts, when cutoffs of -2 for moderate malnutrition and -3 for severe
malnutrition are used, they have been shown to correlate with mortality in Africa [67].
Hence, MUAC-for-age Z-scores may be an alternative method to screen for malnutrition in
children 5 to 19 years of age.
ADMISSION AND DISCHARGE CRITERIA
The World Health Organization (WHO) has suggested criteria for management of severe
malnutrition in various settings [60]. These guidelines enumerate criteria for admission and
discharge from an inpatient nutrition rehabilitation program for children 6 through 59
months ( algorithm 1B) or infants younger than six months ( algorithm 1A). They also
enumerate criteria for discharge from outpatient monitoring of a child who has recovered
from severe malnutrition. Hospital admission is indicated for children who have acute
complications, fail an appetite test, or have untreated HIV or tuberculosis or when other
considerations preclude safe and effective outpatient management. Note that the appetite
test is not a good predictor of treatment outcomes and thus should not be used as the sole
determinant of suitability for outpatient management [68]. (See "Management of
uncomplicated severe acute malnutrition in children in resource-limited countries", section
on 'Indications for inpatient care'.)
The parameter(s) used to monitor for recovery from malnutrition should be based on those
used to make the diagnosis of severe malnutrition. Thus, children with a low mid-upper
arm circumference (MUAC) should be monitored for gains in MUAC and children with low
weight-for-length Z-score should be monitored for gains in weight [69].
EVALUATION FOR COMORBID CONDITIONS
11 de 27 31/10/2022, 18:29
A summary of the history and physical examination that should be used in the assessment
of a malnourished child is presented in the tables ( table 3A-B). Details of the assessment
are discussed in the sections below.
Distinguishing sepsis from dehydration — For children with malnutrition, an important

initial step is to determine whether dehydration and/or septic shock is present.
Distinguishing between these conditions can be difficult but is important, particularly in the
fragile child with edematous malnutrition. This is because both conditions manifest signs of
hypovolemia and because many of the classical signs of dehydration are unreliable [70,71].
However, there are also some key distinguishing characteristics, as outlined in the table
( table 4).
When clear distinguishing features are not present, it is often necessary to treat the child
for both dehydration and septic shock. The World Health Organization (WHO) recommends
antibiotic treatment for children with severe malnutrition, but the choice and course
depends on whether there is clinical evidence of infection. (See "Management of
complicated severe acute malnutrition in children in resource-limited countries", section on
'Infection'.)
● Common features of dehydration and septic shock – In patients with severe

malnutrition, the following findings can be caused by either dehydration or septic
shock [70,71]:
• Weak or absent radial pulse – This is a sign of shock from either severe
dehydration or sepsis. As hypovolemia develops, the pulse rate increases and the
pulse becomes weaker. If the pulse in the carotid, femoral, or brachial artery is
weak, the child is at risk of dying and must be treated urgently.
• Cold hands and feet – This is a sign of both severe dehydration and septic shock. It
should be assessed with the back of the hand.
• Urine flow – Urine flow diminishes as dehydration or septic shock worsens. In

severe dehydration or full-blown septic shock, no urine is formed.
● Features suggesting dehydration
• History of diarrhea – A child with dehydration usually has a history of watery

diarrhea. Small mucoid stools are commonly seen in severe malnutrition but do
not cause dehydration. A child with signs of dehydration but without watery
diarrhea should be treated as having septic shock [70,71].
12 de 27 31/10/2022, 18:29
• Thirst – Drinking eagerly is a reliable sign of mild dehydration. In infants, this may
be expressed as restlessness. Thirst is not a symptom of septic shock [70].
• Sunken eyes – This is a helpful sign of dehydration but only if the onset is recent,
according to the parent or caregiver [70].
Many other traditional signs of dehydration are unreliable in a malnourished child

[70], as discussed below. (See 'Evaluation for dehydration' below.)
● Features suggesting septic shock
• Hypothermia – When present, hypothermia can be a sign of serious infection,

including septic shock. It is not a sign of dehydration [70,71]. However, children
with severe malnutrition also may be hypothermic in the absence of infection.
• Features of incipient septic shock – The child is usually limp, apathetic, and
profoundly anorexic but is neither thirsty nor restless [70,71].
• Features of established septic shock – The superficial veins, such as the external
jugular and scalp veins, are dilated rather than constricted. The veins in the lungs
also may become engorged, making the lungs stiffer than normal. For this reason,
the child may groan, grunt, have a shallow cough, and appear to have difficulty
breathing. As shock worsens, kidney, liver, intestinal, or cardiac failure may occur.
There may be vomiting of blood mixed with stomach contents ("coffee-ground"
vomit), blood in the stool, and abdominal distension with "abdominal splash";
intestinal fluid may be visible on radiograph. When a child reaches this stage,
survival is unlikely [70,71].
Sepsis — The severely malnourished child is typically exposed to infection because of

inadequate sanitation and food preservation and is at increased risk for sepsis because of
impaired immune defenses. The acute phase immune response is reduced in the setting of
malnutrition, so typical signs of infection, such as leukocytosis and fever, are frequently
absent [32]. Septic shock is often associated with hypoglycemia and hypothermia. (See
'Pathophysiology' above.)
Diarrhea and dehydration — Diarrhea is a serious and often fatal event in children with
severe malnutrition. Its presence is also a strong predictor of mortality among children with
complicated severe acute malnutrition (SAM) [72]. Although treatment and prevention of
dehydration are essential, care of these children must also focus on careful management of
their malnutrition and treatment of other infections [70,71].
13 de 27 31/10/2022, 18:29
Definitions and types of diarrhea — Diarrhea is the passage of loose or watery stools

three or more times daily, as defined by the WHO.
The consistency and volume of the stools are the most important characteristics for
distinguishing diarrhea from normal stool patterns. Diarrheal stools are watery or loose.
Frequent passing of formed stools is not diarrhea. Babies fed only breast milk often pass
loose, "pasty" stools; this also is not diarrhea [73,74]. Starved infants pass frequent, small-
volume (less than 10 grams), green liquid stools. These "starvation stools" can be
differentiated from diarrhea by inspection [71].
When a child presents with malnutrition and diarrhea, the type of diarrhea helps to predict
potential complications [71,75]:
● Acute watery diarrhea, which lasts several hours or days. The main danger is
dehydration; acute malnutrition occurs if feeding is not continued.
● Acute bloody diarrhea, which is also called dysentery. The main dangers are intestinal
damage, sepsis, and acute malnutrition; dehydration may also occur.
● Persistent diarrhea that lasts 14 days or longer. The main danger is chronic
malnutrition and serious nonintestinal infection; dehydration and vitamin deficiencies
may also occur.
An approach to assessing the cause of diarrhea in a child in resource-limited countries is

discussed in a separate topic review. (See "Persistent diarrhea in children in resource-
limited countries", section on 'Diagnostic approach'.)
Evaluation for dehydration — Assessment of hydration status in malnourished children

is difficult because many of the above signs are unreliable [70]. Skin turgor appears poor in
children with marasmus, owing to the absence of subcutaneous fat; their eyes may also
appear sunken. Conversely, children with edematous malnutrition may have normal skin
turgor despite dehydration. In both types of malnutrition, the child's irritability or apathy
makes assessment difficult [71].
It is often impossible to distinguish reliably between mild dehydration and severe

dehydration in children with severe malnutrition [70]. Signs that remain useful for
assessing hydration status include eagerness to drink (a sign of mild dehydration), lethargy,
cool and moist extremities, weak or absent radial pulse, and reduced or absent urine flow
(signs of severe dehydration) [70,71]. It can also be difficult to distinguish severe
dehydration from septic shock because both conditions reflect hypovolemia and reduced
14 de 27 31/10/2022, 18:29
blood flow to vital organs [70,71]. (See 'Distinguishing sepsis from dehydration' above.)
Management of dehydration in a child with more than mild malnutrition should take place
in a hospital. Rehydration and refeeding are discussed in a separate topic review. (See
"Management of complicated severe acute malnutrition in children in resource-limited
countries", section on 'Dehydration'.)
Children with diarrhea who do not meet criteria for malnutrition should be evaluated for
dehydration using standard clinical signs and symptoms. Signs of early (mild) dehydration
include thirst, decreased skin turgor, dry mucus membranes, sunken eyes, and absence of
tears when crying. Signs of severe dehydration include altered consciousness, lack of urine
output, weak pulse, and poor perfusion ( table 5) [70,71]. (See "Clinical assessment and
diagnosis of hypovolemia (dehydration) in children".)
Other infections — In addition to assessing hydration, the child should be evaluated for
evidence of infection by assessing for fever, bloody stools, and respiratory distress. Fever
may be caused by severe dehydration or by a nonintestinal infection, such as malaria or
pneumonia [71]. However, the absence of fever does not exclude the possibility of infection,
because the acute phase response is attenuated in malnutrition. (See 'Pathophysiology'
above.)
Shigella and Campylobacter infections often present with bloody diarrhea, and both should
be treated in malnourished children [71]. Empiric therapy generally should be directed
against Shigella, based on the known sensitivities of local strains. (See "Persistent diarrhea
in children in resource-limited countries", section on 'Antimicrobials'.)
Children with respiratory distress should be evaluated with a chest radiograph if available,
but the radiographic signs of pneumonia may be less prominent in malnourished children
than in well-nourished children [70]. Children with presumed or established pneumonia
should be treated with antibiotics. (See "Management of complicated severe acute
malnutrition in children in resource-limited countries" and "Management of complicated
severe acute malnutrition in children in resource-limited countries", section on 'Infection'.)
Dermatosis of kwashiorkor — Kwashiorkor (edematous malnutrition) may be

accompanied by a nonspecific scaly dermatitis, which is often reddish-brown and resembles
flaking paint ( picture 2 and table 3B) [76,77]. It often involves the perineum, groin,
limbs, ears, and armpits. The presence of widespread lesions with depigmentation, flaking,
and cracked skin indicates worse disease. The lesions may weep and easily become
infected.
15 de 27 31/10/2022, 18:29
These lesions should be washed with an antibacterial solution (eg, potassium

permanganate) and covered with sterile dressings. Affected infants and children should be
treated with systemic antibiotics to prevent infection, but the antibiotic coverage is similar
to that for children with acute malnutrition without dermatosis. (See "Management of
complicated severe acute malnutrition in children in resource-limited countries", section on
'Infection'.)
SPECIFIC NUTRIENT DEFICIENCIES
The initial evaluation of a malnourished child should assess for the following stigmata of
specific micronutrient deficiencies ( table 6 and table 7). When present, these require
specific treatment in addition to usual nutritional rehabilitation:
● Vitamin A deficiency – Characterized by ocular findings with corneal cloudiness,

ulceration and xerosis ( picture 4), and Bitot spots ( picture 5).
● Vitamin D deficiency – Characterized by skeletal changes with beading of the ribs

(rachitic rosary), widening of the wrists, or bowed legs ( picture 6). (See "Overview of
rickets in children".)
● Thiamine deficiency – Characterized by neurologic changes with aphonia, peripheral

neuropathy, nystagmus, ophthalmoplegia, cerebellar ataxia, confusion, or coma (dry
beriberi) or by cardiovascular dysfunction, with cardiomegaly and congestive heart
failure (wet beriberi). (See "Overview of water-soluble vitamins", section on 'Vitamin
B1 (thiamine)'.)
● Zinc deficiency – Characterized by bullous dermatitis, affecting the perioral and

perianal areas of the body, with pustular, moist, flaming red, easily denuded skin
( picture 7).
Assessment for these nutrients in malnourished children is discussed in a separate topic

review. (See "Micronutrient deficiencies associated with malnutrition in children".)
Essential nutrient deficiencies are sometimes grouped by those that interfere with growth
(type 2) or those that do not (type 1). Isolated deficiencies of vitamins A and D, thiamine,
folate, and iron are characterized by biochemical abnormalities or specific clinical
symptoms without anthropometric changes, a pattern that has been termed a "type 1"
nutrient deficiency ( table 7) [74]. Deficiencies of other nutrients, including protein,
16 de 27 31/10/2022, 18:29
potassium, sodium, phosphorus, sulfur, zinc, and magnesium tend to cause reduced
growth rate without specific signs or diagnostic biochemical changes; this pattern is
sometimes termed a "type 2" nutrient deficiency. Affected children frequently have
persistent diarrhea and anorexia and usually are deficient in multiple nutrients. The
diagnosis of this type of deficiency is made by a growth response to a complete diet that
includes sufficient quantities of these nutrients [74]. Zinc deficiency can be considered both
type 1 and type 2 deficiency because it is also associated with some specific signs and
symptoms (eg, acral dermatitis, hypogeusia) and appears to increase risk for diarrhea
through unclear mechanisms.
Most cases of malnutrition in resource-limited countries involve deficiencies of multiple

micronutrients in addition to protein and energy; treatment requires restoration of all
nutrients rather than targeted supplementation. Treatment protocols designed by the
World Health Organization (WHO) for children with severe malnutrition include multiple
vitamin supplementation as part of the therapeutic nutritional approach. A variety of other
vitamins and minerals, including zinc, are also included in the standard vitamin and mineral
supplements used for nutritional rehabilitation. The dose of zinc used is usually sufficient to
cover the needs of malnourished children with or without diarrhea [71]. (See "Management
of complicated severe acute malnutrition in children in resource-limited countries" and
"Zinc deficiency and supplementation in children".)
SOCIETY GUIDELINE LINKS
Links to society and government-sponsored guidelines from selected countries and regions
around the world are provided separately. (See "Society guideline links: Pediatric
malnutrition".)
SUMMARY AND RECOMMENDATIONS
● Clinical types of malnutrition – Acute malnutrition (undernutrition) can be divided

into clinical subtypes of marasmus (malnutrition without edema) or kwashiorkor
(malnutrition with edema) ( table 1). Many children have features of both of these
subtypes. (See 'Clinical subtypes' above.)
• Marasmus is characterized by the wasting of muscle mass and depletion of body

fat stores. It is the most common form of protein-energy malnutrition and is
17 de 27 31/10/2022, 18:29
caused by inadequate intake of all nutrients but especially dietary energy sources
(total calories). Affected children usually have some degree of stunting (suggesting
chronic malnutrition), as well as wasting. (See 'Marasmus' above.)
• Kwashiorkor (edematous malnutrition) is characterized by peripheral or

generalized edema, with marked muscle atrophy with normal or increased body
fat. Because any degree of edema in a malnourished child significantly worsens
the child's prognosis, kwashiorkor is by definition severe malnutrition. Affected
children usually have hepatomegaly and may have anorexia, dermatoses, and hair
changes. (See 'Kwashiorkor (edematous malnutrition)' above.)
Children with either type of malnutrition are at risk for secondary infections and for
fluid overload. (See 'Pathophysiology' above.)
● Clinical assessment – A summary of the history and physical examination that should
be used in the assessment of a malnourished child is presented in the tables
( table 3A-B).
• Severity and classification – Acute malnutrition typically causes wasting (with

reduced weight-for-length), while chronic malnutrition causes both wasting and
stunting (with reduced height-for-age). The severity of the malnutrition can be
categorized based on mid-upper arm circumference (MUAC) and/or standard
deviations below the population mean (Z-scores) ( table 2). (See
'Anthropometrics' above and 'Diagnostic criteria' above.)
• Evaluation for sepsis and dehydration – Children with malnutrition should be

evaluated for sepsis and severe dehydration. The features of dehydration and
shock often overlap, particularly in advanced stages, so empiric treatment for both
disorders is often appropriate. Both sepsis and severe dehydration cause poor
tissue perfusion with weak pulses, cold hands and feet, and reduced urine flow
( table 4). Children with dehydration tend to be thirsty, have a history of
diarrhea, and may have sunken eyes ( table 5). Specific signs of septic shock
include hypothermia and lack of thirst. (See 'Distinguishing sepsis from
dehydration' above.)
In malnourished children, skin turgor is not always a reliable measure of hydration

status. Skin turgor may give the false appearance of dehydration in children with
marasmus (because of absent subcutaneous fat) or the false appearance of normal
hydration in children with kwashiorkor (because of edema). (See 'Evaluation for
18 de 27 31/10/2022, 18:29
dehydration' above.)
• Other infections – The child should be evaluated for evidence of infection by

assessing for fever, bloody stools, and respiratory distress. (See 'Other infections'
above.)
● Disposition – Criteria for admission and discharge from nutrition rehabilitation

programs depend upon anthropometry and the child's appetite and clinical condition,
or anthropometry alone for infants younger than six months ( algorithm 1A-B). (See
'Admission and discharge criteria' above and 'Evaluation for comorbid conditions'
above.)
● Specific nutrient deficiencies – Malnourished children usually have deficiencies of

specific nutrients, particularly vitamins A and D, folate, and iron, which are sometimes
associated with specific clinical symptoms ( table 7). In addition, they are deficient in
one or more nutrients required for growth, including protein, electrolytes, and zinc.
(See 'Specific nutrient deficiencies' above and "Micronutrient deficiencies associated
with malnutrition in children".)
Vitamin and mineral supplements are routinely included in nutritional rehabilitation

protocols. (See "Management of complicated severe acute malnutrition in children in
resource-limited countries".)
ACKNOWLEDGMENT
The UpToDate editorial staff acknowledges Buford L Nichols, MD, who contributed to
earlier versions of this topic review.
Use of UpToDate is subject to the Terms of Use.
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Topic 5883 Version 39.0
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1

Johan Paucar Castro

por el tema de nutrición en niños en etapa escolar (5 a 12 años) y su objetivo profesional es

sobre nutrición y prevención de enfermedades metabólicas.

pudiere existir entre el IMC y los hábitos alimenticios familiares.

comportamientos humanos relacionados a nutrición, así como metodologías relacionadas con la

determinación de IMC y su interpretación. Lugo, hizo una propuesta, la está implementados y

valorará sus resultados en varias dimensiones.

evaluar comportamientos humanos relacionados a nutrición, así como metodologías relacionadas

con la determinación de IMC y su interpretación.

central como son: la determinación de ingesta de nutrientes, la estructura corporal, evaluar

bioquímicamente o clínicamente el estado nutricional de cada niño y la determinación del Índice

o la anemia ferropénica. (CDC, 2021)

En niños y adolescentes los resultados obtenidos se muestran en percentiles y deben interpretarse

Categoría de estado de peso Rango percentil

Bajo peso Menos del percentil 5

Peso saludable Percentil 5 hasta por debajo del percentil 85

Sobrepeso Percentil 85 hasta por debajo del percentil 95

Obesidad Igual o mayor al percentil 95

Interpretación de IMC para un varón de 10 años

El incremento de tendencias actuales al consumo excesivo de alimentos procesados (comida

chatarra), altos en calorías y azúcar, propuestos y promovidos mediante el uso de medios de

adolescentes lo que incrementa el sedentarismo que conjuntamente contribuyen a un deterioro de

actuales que se deben tener en consideración en la investigación de estado nutricional de niños

profesionales o laborales. La idea deberá ser expresas en un máximo de 500 caracteres

probabilidad de malnutrición como la pobreza, la desigualdad y la falta de seguridad alimenticia.

La falta de buenas prácticas alimentarias se ha convertido en causas claves para el retraso en el

que se encuentran en condiciones crónicas de desnutrición. La alimentación y la malnutrición

parte de poblaciones pobres que viven en zonas rurales.

Los niños en condiciones vulnerables de pobreza y desigualdad social se convierten en blanco de

de vitaminas y proteínas necesarios para su crecimiento y la correcta y normal realización de sus

escolar de segundo a séptimo año de educación básica de la parroquia de Tambillo mediante la

aplicación de métodos investigativos que permitan establecer la necesidad de impulsar programas

El objetivo de mi investigación será promover un programa de capacitación nutricional para padres

de familia y estudiantes en la unidad educativa de la parroquia de Tambillo así como también

incentivar a aquellas familias en mejor posición económica para la creación de un banco de

alimentos institucional donde después de una encuesta socioeconómica se establezca el destino de

una media de la cantidad de niños de etapa escolar en situación de desnutrición mediante la

grupos de edad y género de los estudiantes de la institución educativa.

4. Seleccione una revista científica, seleccione un artículo científico (escrito en inglés)

relacionado con su idea de investigación y elabore un resumen escrito de un máximo de 2000

la idea de investigación original que motivo el estudio publicado en el artículo científico

Desnutrición en niños de países con recursos limitados: evaluación clínica

marasmo o la desnutrición edematosa que pueden intervenir o no en el retraso del crecimiento

normal de los niños.

principalmente: los socioeconómicos, políticos y ambientales. Por otro lado, se encuentra la

desnutrición secundaria que resulta como consecuencia del padecimiento de enfermedades

tema de investigación nace de la relación misma entre la economía de un país y su capacidad de

proveer alimentos necesarios a su población, es decir un país desarrollado económicamente a nivel

mundial va a poseer tasas de desnutrición infantil significativamente bajas en relación a un país

económicos necesarios para poder solventar sus necesidades básicas en alimentación.

esta idea en un máximo de 500 caracteres incluido espacios.

todo esto influye en el incremento de la probabilidad de sufrir depresión, ansiedad, tristeza,

muchas ocasiones termina con el abandono de los estudios.

Malnutrition in children in resource-limited countries:

Undernutrition is a critical determinant of mortality and morbidity in young children

Traditionally, malnutrition in resource-limited settings is primary malnutrition that results

Treatment of malnutrition in resource-limited settings is discussed in the following topic

● (See "Management of moderate acute malnutrition in children in resource-limited

● Chronic malnutrition – Many more children (149.2 million; approximately 22 percent)

The division into acute (wasting) and chronic malnutrition (stunting) is an

Marasmus — Marasmus is characterized by low weight-for-height and reduced MUAC,

Other physical examination findings may include: