Posts Tagged With: malnutrition

Cameroonian Diet and Kwashiorkor

If you watched the Olympic Opening Ceremony in London last night, you might have noticed Cameroon’s athletes and their elaborate attire.

Cameroon’s Olympic Athletes, London 2012

Cameroon has over 30 athletes, in a variety of sports– weightlifting, swimming, boxing, table tennis, rowing, judo, wrestling, track & field, and soccer.   Seeing all of the elaborate costumes and the Cameroon flag reminded me of my trip to Cameroon 6 years ago.  Since this is a blog about nutrition/food, I thought I’d share some of the food I ate while in Cameroon as well as what type of problems the typical Cameroonian diet can cause.

Peeling plantains for 170+ people. Plantains were a main-stay of the diet in Cameroon.

More peeling of the plantains…

Annnnd more peeling plantains. Can you tell it’s a common food in Cameroon?

Peeling carrots. We also used garlic and ginger root in many of the traditional dishes.

Mixing fufu– Water Fufu is made from cassava root, a main staple in the diet in Cameroon. After it is boiled, you can form it into a play-dough like consistency.

Water fufu, aero, and watermelon for lunch. Aero is a type of green. Here it is cooked in a lot of oil– typical of many of the dishes in Cameroon.

Traditional Cameroonian meal of cornchaf

 

Chewing on sugar canes…yum! Pretty much the only “dessert” we had readily available.

A meal ordered at a restaurant in Bamenda: Cheeseburger, carrots, and fried plantains with a glass of D’jino (a fruit-flavored soda). I was craving protein-rich hamburger, what can I say!

Belly distented– an example of a child with Kwashiorkor, a form of malnutrition where there is not enough protein in the diet.

As you can see, the typical diet in rural Cameroon is made of carbohydrates.  We had a lot of corn, cassava root, and plantains, which are all very starchy foods.  The only protein I saw in the typical Cameroonian diet came from beans (a dish called cornchaf, which was basically corn and beans cooked in lots of oil), but there was also chicken, pork, beef, and monkey available for those who can afford it.

In the more rural areas that we traveled, it was not rare to come across many children with Kwashiorkor. Kwashiorkor is a form of malnutrition that results when a person is consuming enough energy (calories) but consuming little or no protein. It usually occurs in individuals who are consuming carbohydrates almost entirely. “Kwashiorkor” is a Ghanian word for the disease that develops when a mother’s child is weaned from protein-rich breast milk to a protein-poor carbohydrate food source (ie: cassava root, corn, rice, and plantains).

Kwashiorkor isn’t common in the US. In fact, in the US it occurs mainly in connection with acute life-threatening illnesses such as trauma and sepsis, where the body’s protein needs are significantly increased.

When a physiological stress is produced, it increases protein and energy requirements at a time when intake is limited. During stress, the body needs extra protein to synthesize additional hormones, immune factors to fight infection, collagen to rebuild damaged tissue and bone, and muscle cells to maintain the physical work of organs.

In children, kwashiorkor can result when poor dietary intake is added to the stress of growth, infections, or other illnesses.  Characteristics of kwashiorkor include significantly decreased serum proteins, pitting edema, swollen abdomen, flaky appearance of the skin, thin muscles but fat is present, “moon face”, and hair which can be easily plucked from the head.  The child may have a well nourished appearance because they are getting enough calories in their diet, but they are still malnourished.  In fact, kwashiorkor can take just weeks to develop and the mortality is high.

The treatment for kwashiorkor is to provide adequate calories and protein for the child/patient.  Carbohydrates may be given first, and then protein slowly added afterwards. The condition can correct itself, but for those who have had kwashiorkor for a long time, permanent physical and mental problems may still exist, such as a child not reaching their full height potential.

It is interesting to see how those in 3rd world countries eat on a day-to-day basis, and how that differs from America.  The athletes from Cameroon may eat their cassava root and plantains, but in order to become top athletes, it’s obvious they had to make sure to get enough protein in their diet, specifically from animal sources such as chicken, beef, and pork.

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Clinical Nutrition: Edema

So today was the first day of my 2-week clinical rotation at Mon General Hospital. I followed a Registered Dietitian around today, which included going on rounds and speaking to patients referred by a physician or nurse.  One simple clinical term I came across today was edema.  Edema is an abnormal accumulation of fluid in the intercellular tissue spaces or body cavities.  The edema I saw today was present in the feet and ankles, but edema can also be found on other places in the body, such as periorbitally, or around the eyes.  (I didn’t include a photo in this blog, but if you feel like googling “pitting edema,” go right ahead!)

Edema can happen when fluid intake exceeds fluid loss, and can lead to a rapid weight gain. Just a weight gain of 2.2 pounds can mean 1 liter of fluid retention. So if a patient has gained 25 pounds in the last week, it could mean that the patient has retained 11 liters of water in their intercellular tissue spaces or body cavities.

The disease states associated with edema include cardiac failure, hypoalbuminemia (albumin osmotic force- lower albumin releases water into tissue spaces), malnutrition, liver failure, or kidney failure.  These conditions can cause a patient’s body to hold onto excess sodium and water.  In heart failure, renal blood flow is decreased.  This leads to renal retention of sodium and water in order to increase blood flow.  In addition, edema can also be caused by rapid administration of fluids, especially intravenous (IV) fluids.  Edema is treated with diuretics, which can rid the body of excess water. Low-sodium diets can also given to the patients, at 2g or less per day.

Pitting edema is measured on a 4-point scale, with 1+ being the least severe edema and 4+ being the most severe. A physician can press a finger onto the patient’s site of edema and a “pit” will form which will remain indented for anywhere from a brief second to over 30 seconds.  Examples of the 4-point scale are included below:

Pitting Edema – measurement

1+
Barely detectable impression when finger is pressed into skin.   
2+
Slight indentation.15  seconds to rebound
3+
Deeper indentation. 30  seconds to rebound.
4+
> 30  seconds to rebound.

O’Sullivan, S.B. and Schmitz T.J. (Eds.). (2007). Physical rehabilitation: assessment and treatment (5th ed.). Philadelphia: F. A. Davis Company. p.659


1+
2mm depression, barely detectable.Immediate rebound.
2+
4mm deep pit.A few seconds to rebound.
3+
6mm deep pit.10-12 seconds to rebound.
4+
8mm: very deep pit.>20 seconds to rebound.

Hogan, M (2007) Medical-Surgical Nursing (2nd ed.). Salt Lake City: Prentice Hall

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