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与儿童营养不良相关的微量营养素缺乏

Authors
Sarah M Phillips, MS, RD, LD
Craig Jensen, MD
Section Editor
Kathleen J Motil, MD, PhD
Deputy Editor
Alison G Hoppin, MD
Translators
侯新国, 副主任医师

引言

严重营养不良的儿童通常在发生了健康问题(如，感染)，从营养不良性消瘦(一种营养适应状态)转变为恶性营养不良病时才会被送往就医，此时患儿的营养适应已不再充足。世界卫生组织(World Health Organization, WHO)根据消瘦或生长迟缓的程度以及是否存在水肿来对营养不良进行分类，相关内容见其他专题。 (参见“发展中国家儿童营养不良：临床评估”)

营养不良的评估和处理取决于临床环境和营养不良的病因。虽然发达国家与发展中国家对儿童营养不良的评估和处理原则相似，但具体的细节可能因当地习俗及资源情况的不同而有所差异。 (参见“儿童营养状况的实验室和影像学评估”和“两岁以下儿童生长迟滞(营养低下)的病因及评估”)

本文将讨论儿童中最常与蛋白-能量营养不良(protein-energy malnutrition, PEM)相关的微量营养素缺乏。脂溶性维生素、铁和锌的缺乏尤为常见，但也可能出现其他水溶性维生素、矿物质和微量元素的缺乏，因地区和营养不良慢性程度的不同而有所差异[1]。关于这些微量营养素的生物化学及其缺乏状态的更详细信息将单独讨论。有关这些患儿的临床评估和治疗，包括定义和人体测量，将单独讨论。 (参见“发展中国家儿童营养不良：临床评估”)

必需脂肪酸缺乏

PEM患儿可能存在两种主要的必需脂肪酸(essential fatty acid, EFA)即亚油酸和亚麻酸的缺乏。EFA的水平可能因膳食、疾病或早熟而改变。EFA缺乏的生化效应是三烯/四烯的比值增加，并会在任何躯体变化出现之前就显现出来。EFA缺乏的体征包括鳞屑性皮炎、脱发和血小板减少。EFA缺乏可影响婴儿的生长、认知功能和视功能[2]。

脂溶性维生素缺乏

PEM患儿也可能存在脂溶性维生素的缺乏，即维生素A、D、E、K(表 1)。 (参见“儿童营养状况的实验室和影像学评估”)

                    

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Literature review current through: 2017-06 . | This topic last updated: 2016-07-01.
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