NUTRITIONAL DISORDERS OF PUBLIC HEALTH IMPORTANCE Malimu EZ KIU
NUTRITIONAL DISORDERS OF PUBLIC HEALTH IMPORTANCE
Malimu EZ
KIU
DEFINITIONS
• Nutrition• Scientific understanding of how food works in
the body
Importance of food (nutrients)
• Food and health– Necessary for body function– Source of energy: carbohydrates and fats– Body building and repair: proteins– Regulation: vitamins– Pleasure
• Food and infections– Prevention– Healing
• Food and environment– 10-20 metric tones per person
Group of nutrients
• Macronutrients (needed in large amounts)– Carbohydrates– Fats– Proteins
• Micronutrients (trace amounts)– Vitamins – Minerals
Classification of nutritional disorders
• Macronutrient deficiencies– Under-nutrition (inadequate, malabsorption,
abnormal systemic loss of nutrients due to diarrhea, hemorrhage, renal failure, excessive sweating, infection, drug addiction)
– PEM• Kwashiorkor• Marasmus• Marasmus-kwashiorkor
– Over-nutrition (over-eating, insufficient exercise, over-prescription of therapeutic diets)
• Macronutrient deficiencies– Vitamin A def (VAD)– Iodine deficiency disorder (IDD)– Iron Deficiency Anaemia
• Other minor deficiencies– Niacin, vitamin B1, C, D, zinc excess of flourine
(flourosis)
Nutritional disorders of PH importance
• PEM (def of carbohydrates, fats and proteins)• Vitamin A deficiency• Iodine Deficiency Disorder• Nutritional anaemia
Why PH importance?
• They have a wide spread prevalence• They have an enormous burden of disability• Have a staggering cost to the society• Affect vulnerable groups or population
segments
PEM
• Commonest nutritional problem in developing countries
• Results from consumption of inadequate food and frequently aggravated by infections
• Possible etiological factors in Africa:– Shortage of calories and protein– Inadequate breast feeding– Ignorance– Superstition– Cultural taboos
PEM contd…
• Underfives mostly affected– Increases their risk of morbidity and mortality– Related to impaired mental development
• Known risk factors:– Non-exclusive breast feeding for the first 6
months of life– HIV/AIDS, diarrheal diseases and food diversity
and availability
Micronutrient deficiencies
• Insufficient intake- vitamin A, iron and iodine• Mild/moderate forms-not always recognized• Often referred to as “hidden hunger”• Most commonly reported deficiencies in both
adults and children are:– Iron– Vitamin– Iodine deficiency
• All three are highly prevalent in Tanzania• Affect the health and survival of more than 2
billion people world wide• Most at risk- women and children
Vitamin A deficiency
• Vitamin A (retinol) is fat soluble• Found mainly in fish, liver oils, liver egg yolks,
butter, green leafy and yellow vegetables• Most are stored in the liver if they are in
excess
• VAD is a major PH problem:– Main cause of preventable childhood blindness– Increases risk of mortality and morbidity
• Contributing factors– Low intake of Vitamin A intake– Vitamin A deficient mothers-low Vitamin A in
breast milk– High demand during infection– High losses during diarrhea
• WHO classifies VAD in Tanzania as a clinical health problem– Country wide an estimated 10,000 children are
likely to suffer from VAD– Common in areas with little access to Vitamin A
rich foods
Strategies to combat VAD (WHO/UNICEF)
• Food fortification• Supplementation• Dietary diversification
Public health measures
All approaches are complementary and should not be used in isolation
Complementary PH measures
• IMCI- Intergrated Management of Childhood lllinesses
• Immunization (EPI)• Safe motherhood initiative• Improve malnutrition and other micronutrient
deficiencies- (iron, iodine)• Promotion of breast feeding• Improve water and sanitation• Poverty alleviation programmes
Iodine deficiency
• Iodine is present in minute amounts in the body• Essential for synthesis of thyroid hormone• Deficiency causes a spectrum of disorders-IDDs-
are a world wide PH problem• Affects 7% of the worlds population• Children and pregnant women- most susceptible• Impairs brain development- low IQ– 1st preventable brain damage problem
Effect of ID
• Goitre- most common visible effect• Severe ID- cretinism which is manifested by
irreversible mental retardation– Can only be prevented by adequate intake of
iodine during pregnancy
Prevention and control of IDDs
• Supplementation with iodized oil• Food fortification– SALT-recommend food vehicle for iodization (others-
bread, milk, water)– Consumed by everyone – Production is generally centralized– Iodization is easy to implement-reasonable cost– Color, taste and odour of salt are not affected– Salt quality can be easily monitored at production,
retail and household level (using field tests)
• Recommended level of iodine in salt is 20-40 mg/iodine/kg salt assuming:– 20% loss-production point household– 20% loss during cooking
• For programme to be sustainable- salt intake of 10 g/person/day
Iron Deficiency Anaemia
• The most common form of anaemia• Affects about 20% of children, 50% of
pregnant women and 3% of men• A prevalent public health problem• The most widespread nutritional disorder in
Tanzania• Increases the risk of poor pregnancy outcome
prematurity, LBW and maternal mortality
Control of IDA
• Food diversification:– Nutrition education, cultivation of iron-rich foods
and vegetables
• Food fortification:– Cereal flour-wheat and maize
• Supplementation:– FeFo to pregnant mothers
• Public health measures:– De-worm school children