Malnutrition is even more worrying in children and the elderly, according to doctors

In his 22-year career, doctor Marco Túlio Ribeiro has never come across cases of severe malnutrition and has always resorted to images from books to talk about the subject. That changed last week, with the announcement of the emergency situation in the Yanomami territory.

“In Brazil, we didn’t see cases like this anymore. Thinking that people got to that point because of negligence by the federal government, that they could be in another situation and that deaths could have been avoided generated a feeling of great anger, indignation and sadness”, says Ribeiro, professor of medicine at the Federal University of Ceará and vice president of the SBMFC (Brazilian Society of Family and Community Medicine).

The entity has an indigenous health working group with professionals who care for the original peoples, but Ribeiro claims that they had no idea of ​​the seriousness of the situation. “We knew that there was a divestment crisis by the federal government regarding DSEIs [Distritos Sanitários Especiais Indígenas]whether due to lack of medication or investment in infrastructure, such as cars to transport people, but we had no idea of ​​the level of lack of assistance”, he says.

Ribeiro says that the images and reports of the last few days indicate that the population that lives in the DSEI Yanomami, a region that covers the northwest of Roraima and the north of Amazonas, has been without access to adequate food for a long time, which leads to a sequence of problems.

When malnutrition persists, the body begins a process to try to obtain nutrients from the body itself. First, it consumes the fat reserve. Then it starts consuming its own muscles.

“That’s the big problem”, says doctor Durval Ribas Filho, president of Abran (Brazilian Association of Nutrology). “Muscle is protein and the reduction in protein levels directly interferes with the immune system, resulting in infections.”

The process leads to a reduction in strength and inadequate functioning of the body, which tries its best to preserve vital functions. The body prioritizes breathing, heartbeat and the performance of the kidneys and liver, but if hunger remains, they also begin to fail.

In earlier cases, diarrhea is common —the “good bacteria” present in the intestine are no longer fed and harmful bacteria predominate—, anemia, hypothyroidism and hypovitaminosis, which impair growth, intellectual development and vision.

The situation, say doctors, is even more worrying in children and the elderly, who are naturally more susceptible to infections, and sequelae vary according to the start of treatment. The sooner it is started, the lower the chances of definitive effects.

But it is also not possible to reverse the situation immediately, experts say. When malnutrition is severe, the person has difficulty eating.

“The body is not metabolically prepared, that is, it does not produce enough insulin to metabolize carbohydrates and enough enzymes to break down fat molecules and proteins”, says Ribas Filho.

For this reason, it is common to promote a gradual increase in calories ingested with small meals several times a day —there are up to 12 moments, says the nutrologist— and, little by little, expand the supply and reduce the frequency.

“When this patient is unable to ingest solid foods, liquid supplements or a diet blended in a blender are used. In the most serious cases, it is necessary to hospitalize and offer an enteral diet. Parenteral diets are avoided as much as possible because the possibility of infection is low. great in these people with already very fragile immune systems”, says Ribas Filho.

“Right now, it is necessary to evaluate these patients and provide adequate treatment, not only in relation to food, but also in relation to diseases related to nutritional deficiencies”, adds Ribeiro.

For him, it is fundamental to think about the coordinated and lasting care of the original peoples. “It’s no use having one-off care and then leaving the population unassisted. We recommend a project that is long and continuous. Physical care, with nutrition and medication; psychological care, because they are suffering; and social care.”