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Malnutrition
- 3. MALNUTRITION
- 7. Malnutrition Derived from malus (bad) and nutrire (to nourish) Includes both Under nutrition (deficiency of one or more essential nutrients) Over nutrition (an excess of a nutrient or nutrients)
- 8. DEFINITION MALNUTRITION WHO defines Malnutrition as "the cellular imbalance between the supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions.“ Malnutrition is the condition that develops when the body does not get the right amount of the vitamins, minerals, and other nutrients it needs to maintain healthy tissues and organ function
- 9. WHAT CAUSES MALNUTRITION? Human beings need a wide variety of nutrients to supply essential energy. Do you know what nutrients we need? protein vitamins minerals If any one of these nutrients is deficient in a person's diet, he/she may suffer from malnutrition
- 10. WHAT CAUSES MALNUTRITION? Malnutrition is poor nutrition due to: An insufficient food, Poorly balanced diet, Faulty digestion or poor utilization of foods. (This can result in the inability to absorb foods.) Malnutrition is not only insufficient intake of nutrients. It can occur when an individual is getting excessive nutrients as well.
- 11. WHAT CAUSES MALNUTRITION? (continued) Malnutrition also occurs when there is an imbalance of energy and protein in an individual’s diet. The body may become unable to absorb the nutrients it requires to function properly. *For example, if a child is suffering from energy and protein malnutrition, they will most likely have deficiencies in iron, calcium, and other vitamins and minerals.
- 12. WHO IS AFFECTED BY MALNUTRITION? Individuals who are dependent on others for their nourishment. (infants, children, the elderly, prisoners) Mentally disabled or ill because they are not aware of what to eat. People who are suffering from tuberculosis, eating disorders, HIV/AIDS, cancer, or who have undergone surgical procedures are susceptible to interferences with appetite or food uptake which can lead to malnutrition.
- 13. BUT DO YOU KNOW THE NUMBER ONE FACTOR THAT CAUSES MALNUTRITION? POVERTY!
- 14. Effects of malnutrition Nutritional deficiencies can contribute to various diseases which can be found everywhere, but most often go without cures/treatment in Less Developed Countries (LDCs).
- 15. Malnutrition Undernutrition Lack of nutrients Calories Protein Micronutrients Low income countries Overnutrition Obesity Too many calories High and middle income countries http://i105.photobucket.com/albums/m203/sspasha/Malnutrition.jpg
- 16. Undernutrition Undernutrition Secondary Malnutrition Micronutrient Malnutrition Protein Energy Malnutrition Most important Severe Protein Energy Malnutrition http://www.bio.davidson.edu/people/kabernd/seminar/2002/tech/ma lnutrition.jpg
- 17. Micronutrient Malnutrition Deficiency in: Vitamin A Iodine Iron Zinc Calcium Vitamin D B Vitamins Vitamin C Rickets (Vitamin D deficiency) http://www.talkorigins.org/faqs/homs/rickets.jpg
- 18. Vitamin A Deficiency Night Blindness 500,000 children/year xerophthalmia Half of these will die within a year of becoming blind Rice diet lacking green vegetables Vitamin supplements Eggs,milk&carotenoids could help http://www.vitaminsdiary.com/UserFiles/Image/keratomalacia.jpg xerophthalmia
- 19. Rickets Vitamin D deficiencies may result in “Rickets” which is a lack of proper calcium characterized by poorly developed and deformed bones. Vitamin D can be best found in beef products (especially cows milk) but is very low in breast milk. Thus, women in developing countries are contributing to this disease if their babies sole source of nourishment is breast milk. Sun exppsure,cod liver oil & eggs could help
- 21. Beriberi Beriberi is a thiamine (vitamin B1) deficiency which is common in South East Asia where many diets consist solely of white rice. Beriberi affects the proper functioning of the nervous system as well as the circulatory system and heart. Pregnancy, breast feeding mothers and those who are ill with fever may have a heightened dependency on thiamine and may develop a deficiency. Thiamine is best acquired through foods such as beef and whole grain (unrefined) breads and grains.
- 23. Pellagra Pellagra ”rough skin” is a niacin (or Tryptophan) deficiency which often results in the “3 Ds”; diarrhea, demetia and dermatitis. The large scale consumption of corn has resulted in many cases of pellagra because corn is poorly absorbed in the body. The best sources of Niacin are broccoli, eggs, dates, beef, salmon, seeds and peanuts.
- 25. Scurvy Scurvy is a disease which is born of Vitamin C deficiency. It is characterized by bleeding around hair follicles, anemia and gingivitis. Scurvy may occur in those who consume large amounts of junk foods, smokers (as smoking depletes Vitamin C) and those who don’t have proper access to sources of vitamin C. Namely, the poor.
- 27. Iodine Deficiency Iodine deficiency affects 740 million people worldwide single greatest cause of preventable brain damage in babies(cretinism) Goiter Stillbirth Miscarriages Mental Retardation Prevented by iodized salt Best sources of natural iodine Sea weed Sea food Goiter (thyroid enlargement) http://www.voanews.com/english/images/emory_edu_goiter_Iodine_Deficiency_Disorder _195_eng_11may06_0.jpg
- 28. Iron Deficiency Anemia Affects 2 billion people, 90% live in developing countries 39% of preschool children 52% of pregnant women Reduced physical activity mental activity Increased birth mortality Worms Malaria HIV High iron flour &milk could help http://www.micronutrient.org/reports/images/Page16Image.jpg
- 29. Other Deficiencies Zinc Growth retardation delayed sexual maturation skin and eye lesions 48% of world at risk for zinc deficiency Calcium Osteoporosis: bone loss Vitamin D Rickets: bone malformation Not enough sunlight exposure: Swaddled babies http://www.ulanbatoronline.org/cammp_section/article_images_lamc_lati mes/scans/latimes_images/thumbnails/babyswaddle.jpg Swaddled babies at risk for Rickets: not enough sunlight
- 30. Other Deficiencies Vitamin C Causes Scurvy: problem in refugee camellaps Niacin Causes Pgra: dermatitis, diarrhea, dementia Due to diet high in maize (low in tryptophan) Thiamin Causes Beriberi Due to diet high in polished rice Folate Birth defects: Anancephaly and Spina Bifida http://www.athropolis.com/arctic-facts/misc/scurvy.jpg Scurvy
- 32. Kwashiokor/Marasmus Kwashiokor, is “the disease of the Weaning child” is an extreme protein deficiency (affects after 1 years) which is characterized by inability to gain weight, diarrhea, lethargy and a swollen belly. Kwashiokor can lead to coma as well as death. Marasmus is a disease resulting from caloric & protein deficiency which affects chidlren early in life (typically in the 1st year) due to use of diluted milk,characterized by slowing growth, decreasing weight and hindering proper development. Nutrition supplements, rehydration and education all can all serve to cure and prevent these diseases.
- 34. Kwashiorkor - Definition It is an acute form of childhood protein-energy malnutrition characterized by inadequate protein intake with reasonable caloric (energy) intake; it tends to occur after weaning, when children change from breast milk to a diet consisting mainly of carbohydrates. Studies suggest that kwashiorkor represents a maladaptive response to starvation 35
- 35. KWASHIORKOR The term kwashiorkor is taken from the Ga language of Ghana and means "the sickness of the weaning”. Williams first used the term in 1933, and it refers to an inadequate protein intake with reasonable caloric (energy) intake. Kwashiorkor, also called wet protein-energy malnutrition, is a form of PEM characterized primarily by protein deficiency. This condition usually appears at the age of about 12 months when breastfeeding is discontinued, but it can develop at any time during a child's formative years. It causes fluid retention (edema); dry, peeling skin; and hair discoloration.
- 36. Kwashiorkor was thought to be caused by insufficient protein consumption but with sufficient calorie intake, distinguishing it from marasmus. More recently, micronutrient and antioxidant deficiencies have come to be recognized as contributory. Victims of kwashiorkor fail to produce antibodies following vaccination against diseases, including diphtheria and typhoid. Generally, the disease can be treated by adding food energy and protein to the diet; however, it can have a long-term impact on a child's physical and mental development, and in severe cases may lead to death.
- 37. SYMPTOMS Changes in skin pigment. Decreased muscle mass Diarrhea Failure to gain weight and grow Fatigue Hair changes (change in color or texture) Increased and more severe infections due to damaged immune system Irritability Large belly that sticks out (protrudes) Lethargy or apathy Loss of muscle mass Rash (dermatitis) Shock (late stage) Swelling (edema)
- 38. Marasmus Calorie deficiency Lack of food Poorest populations Neglected Infants children Protein used for energy Results in wasting Deterioration of tissues Brain development impaired
- 39. MARASMUS The term marasmus is derived from the Greek word marasmos, which means withering or wasting. Marasmus is a form of severe protein-energy malnutrition characterized by energy deficiency and emaciation. Primarily caused by energy deficiency, marasmus is characterized by stunted growth and wasting of muscle and tissue. Marasmus usually develops between the ages of six months and one year in children who have been weaned from breast milk or who suffer from weakening conditions like chronic diarrhea.
- 40. Etiology: Dietary Inadequacy: occurs when there is a rapid period of transition from the balanced diet supplied by the breast milk to an unbalanced inadequate diet, which is very low in protein, and consists mainly of carbohydrates due to socio - economic status such as: 41
- 41. Cont.. Poverty Ignorance Inadequate weaning practice Lack of basic health education and nutritional knowledge. Child abuse 42
- 42. SYMPTOMS Severe growth retardation Loss of subcutaneous fat Severe muscle wasting The child looks appallingly thin and limbs appear as skin and bone Shriveled body Wrinkled skin Bony prominence Associated vitamin deficiencies Failure to thrive Irritability, fretfulness and apathy Frequent watery diarrhoea and acid stools Mostly hungry but some are anoretic Dehydration Temperature is subnormal Muscles are weak Oedema and fatty infiltration are absent
- 43. Marasmus Severely wasted (emaciated) & stunted Very low WAZ “Balanced”starvation “Old Man”face, wrinkled appearance, sparse hair No edema, fatty liver, skin changes Alert bur Miserable Hungry Diarrhea and dehydration CLINICAL FEATURES
- 44. CAUSES OF MARASMUS Seen most commonly in the first year of life due to lack of breast feeding and the use of dilute animal milk. Poverty or famine and diarrhoea are the usual precipitating factors Ignorance & poor maternal nutrition are also contributory Too little breast milk or complementary foods •< 2 yrs of age
- 45. DIFFERENCE IN CLINICAL FEATURES BETWEEN MARASMUS AND KWASHIORKOR
- 48. CLINICAL FEATURES -MUSCLE WASTING -FAT WASTING -EDEMA -WEIGHT FOR HEIGHT -MENTAL CHANGES MARASMUS Obvious Severe loss of subcutaneous fat None Very low Irritable, moaning, Sometimes quite and apathetic KWASHIORKOR Sometimes hidden by edema and fat Fat often retained but not firm Present in lower legs, and usually in face and lower arms May be masked by edema apathetic DIFFERENCE IN CLINICAL FEATURES BETWEEN MARASMUS AND KWASHIORKOR
- 49. CLINICAL FEATURES -APPETITE -DIARRHOEA -SKIN CHANGES -HAIR CHANGES -HEPATIC ENLARGEMENT MARASMUS Usually good Often Usually none Seldom None KWASHIORKOR Poor Often Diffuse pigmentation, sometimes ‘flaky paint dermatitis’ Sparse, silky, easily pulled out Sometimes due to accumulation of fat DIFFERENCE IN CLINICAL FEATURES BETWEEN MARASMUS AND KWASHIORKOR
- 50. A severely malnourished child with features of both marasmus and Kwashiorkor. The features of Kwashiorkor are severe oedema of feet and legs and also hands, lower arms, abdomen and face. Also there is pale skin and hair, and the child is unhappy. There are also signs of marasmus, wasting of the muscles of the upper arms, shoulders and chest so that you can see the ribs. MARASMIC-KWASHIORKOR
- 52. PREVENTION Promotion of breast feeding Development of low cost weaning Nutrition education and promotion of correct feeding practices Family planning and spacing of births Immunization Food fortification Early diagnosis and treatment
- 53. TREATMENT 1. Hospital Treatment The following conditions should be corrected. Hypothermia, hypoglycemia, infection, dehydration, electrolyte imbalance, anaemia and other vitamin and mineral deficiencies. 2. Dietary Management The diet should be from locally available staple foods - inexpensive, easily digestible, evenly distributed throughout the day and increased number of feedings to increase the quantity of food. 3. Rehabilitation The concept of nutritional rehabilitation is based on practical nutritional training for mothers in which they learn by feeding their children back to health under supervision and using local foods
- 54. Overnutrition Global problem Overnutrition has surpassed undernutrition Worst in middle and high income countries Rising in low income countries Can co-exist with undernutrition Same country Same household Projected to get worse as incomes rise Industrial food High in calories http://i.dailymail.co.uk/i/pix/2008/05/16/article-0-064EFCA50000044D-848_468x296.jpg
- 55. Overnutrition Consumption of too many calories Obesity Medical problems Heart disease Diabetes Cancer http://www.mercola.com/images/blog/2005/01.01.junkfood.gif