Nutritional problems 2

NUTRITIONAL PROBLEMS

Neethu liza jose

Msc nursing

INTRODUCTION• Nutrition is the selection

of foods and preparation of foods, and

their ingestion to be assimilated by the

body. By practicing a healthy diet, many

of the known health issues can be

avoided. The diet of an organism is what

it eats, which is largely determined by the

perceived palatability of foods.

• HEALTH – It is the state of complete physical, mental and emotional well being and not merely the absence of disease or infirmity.

• NUTRIENTS – These are the components of food that help to nourish the body. The basic nutrients are CHO, proteins, vitamins, lipids (fats), minerals and water.

• NUTRITIONAL STATUS – It is the condition of the body as it relates to

consumption and utilization of food.

• Malnutrition – defined as a pathological state

resulting from a relative or absolute deficiency or

excess of one or more essential nutrients

• Undernutrition - condition that results when

insufficient food is consumed over an extended

period of time

• Overnutrition – pathological state resulting from

the consumption of excessive quantity of food over

an extended time

• Imbalance – pathological state resulting from

disproportion among essential nutrients with or

without the absolute deficiency of any nutrient

• Specific deficiency – pathological state resulting

from a relative or absolute lack of specific nutrients



PROTEIN ENERGY MALNUTRITION

(PEM)

MICRONUTRIENT DEFICIENCY

CHRONIC DISEASES

EATING DISORDERS

NUTRITION PROBLEMS IN INDIA

WHO IS AT RISK??

PREGNANT WOMEN LACTATING WOMEN INFANTS PRESCHOOL CHILDREN ADOLESCENT GIRLS ELDERLY

.

Vijayaraghavan


• Protein–energy malnutrition (or protein–calorie malnutrition) refers to a form of malnutrition where there is inadequate protein and calorie intake

• It is considered as the primary nutritional problem in India

• PEM is due to the “food gap” between the intake and requirement

• Causes childhood morbidity and mortality


PEM

KWASHIORKOR

MARASMUS

MARASMIC -KWASHIORKOR

CAUSES AND RISK FACTORS

Inadequate intake of food

Diarrhea

Respiratory infections

Measles

Intestinal worms

Infants and pre schoolers

CONTRIBUTORY FACTORS

Poor envt. Hygiene

Large family size

Poor maternal health

Failure of lactation

Premature termination of breast feeding

Delayed supplementary feeding

Use of over diluted cow’s milk

KWASHIORKOR

Kwashiorkor is the most common and widespread nutritional disorder in developing countries. It is a form of malnutrition caused by not getting enough protein in the diet.

MARASMUS

• Marasmus is a severe form of malnutrition that consists of the chronic wasting away of fat, muscle, and other tissues in the body.

• Malnutrition occurs when the body does not get enough protein and calories.

• This lack of nutrition can range from a shortage of certain vitamins to complete starvation.

• Marasmus is one of the most serious forms of protein-energy malnutrition (PEM) in the world.

MARASMIC KWASHIORKOR

A malnutrition disease, primarily of children, resulting from the deficiency of both calories and protein.

The condition is characterized by severe tissue wasting, dehydration, loss of subcutaneous fat, lethargy, and growth retardation

KWASHIORKOR AND MARASMUS – A COMPARATIVE CHART

KWASHIORKORAcute

illness/infections, measles, AGE, trauma, sepsis are some causes

Protein is principal nutrient

18 months to 3 years Rapid, acute onset Some weight lossHigh mortality

MARASMUS Severe prolonged

starvation, chronic/recurring infections

Calories and protein are principal nutrients

6 months to 2 years Chronic, slow onset Severe weight loss Low mortality unless

related to underlying disease condition

COMPARISON OF CLINICAL FEATURES KWASHIORKOR

Edema, pot belly, swollen legs

Mild to moderate growth retardation

Weight masked by edema

Low subcutaneous fat

Muscle atrophy

Round face (moon face)

Dry, flaky peeling skin

Thin dry easily plucked hair

Enlarged liver

Xerophthalmia

Anemia, diarrhea, infection

MARASMUSNo edema

Weight loss upto 40%

Severe growth failure

Severe emaciation

Severe loss of subcut fat

Severe muscle atrophy

Wrinkled face (old man’s face)

Rare skin changes

Common hair changes

Mildly enlarged liver

Anemia, diarrhea, infection

ASSESSMENT OF PEM

Gomez Classification

• Weight for age (%) = Weight of child 100

Wt. of normal child of same age

Between 90 – 110%Normal Nutritional Status

Between 75 – 89% Mild malnutrition (1st degree)

Between 60 – 74% Moderate Malnutrition (2nd degree)

Under 60% Severe Malnutrition (3rd degree)

WEIGH CALCULATION FORMULAE

• Infant – Weight (Kg) = Age in months + 9

2

• Pre schooler – Weight (Kg) = 2 x (Age in years) + 5

PREVENTION

• Oral rehydration therapy helps to prevent dehydration caused by diarrhea

• Exclusive breast feeding for 6 months there after supplementary foods may be introduced along with breast feeds

• Immunization for infants and children

• Nutritional supplements

• Early diagnosis and treatment

• Promotion and correction of feeding practices

• Family planning and spacing of birth

• Periodic surveillance

• Nutritional rehabilitation

LOW BIRTH WEIGHT

An LBW newborn is any newborn with a birth weight of less than 2.5kg (including 2.499kg) regardless of gestational age.

RISK FACTORS

o Maternal malnutrition

o Anemia

CAUSES

o Illness/infections

o Short maternal stature

o Very young age

o High parity

o Close birth intervals

o IUGR

o Hard physical labor during pregnancy

o Smoking

LOW BIRTH WEIGHT

PRE TERM BABIES

SGA BABIES

SPONTANEOUS PRE TERM

BIRTH

PROVIDER INITIATED PRE TERM BIRTH

PREVENTION• Identification of mothers at risk –

malnutrition, heavy work load, infections, disease and high BP

• Increasing food intake of mother, supplementary feeding, distribution of iron and folic acid tablets

• Avoidance if smoking

• Improved sanitation methods

• Improving health and nutrition of young girls

• Early detection and treatment of medical disorders – DM HTN

• Controlling infections – UTI, rubella, syphillis, malaria

MICRONUTRIENT

DEFICIENCY

VITAMIN A DEFICIENCYOverweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. A crude population measure of obesity is the body mass index (BMI), a person’s weight (in kilograms) divided by the square of his or her height (in meters). A person with a BMI of 30 or more is generally considered obese. A person with a BMI equal to or more than 25 is considered overweight.

XEROPHTHALMIAXerophthalmia i.e., dry

eyes refers to all the ocular

manifestations of vitamin A

deficiency in man

It is the most widespread

and serious nutritional

disorder leading to

blindness

RISK FACTORS

Poor SE status

Faulty feeding practices

Weaning

PEM

Infections

1-3 years

CLINICAL FEATURES

Corneal ulcers

Softening of cornea

Keratomalacia

Bitot spot

PREVENTION AND CONTROL

Administering large doses of vitamin A orally on a periodic basis

Regular and adequate intake of vitamin A

Fortification of certain food with vitamin A –sugar, salt, tea and skimmed milk

NUTRITIONAL ANEMIA

Nutritional anemia is a condition where the hemoglobin content of blood is lower than normal as a result of a deficiency of one or more essential nutrients, regardless of the cause of such deficiency.

RISK FACTORS Infants and children

Pregnant women

Pre menopausal women

Adolescent girls

Older adults

Alcoholism

Chronic/ critically ill

Excessive exercise

CAUSES

Inadequate diet

Insufficient intake of iron

Iron malabsorption

Pregnancy

Excessive menstrual bleeding

Hook worm infestation

Malaria

Close birth intervals

GI bleed

CLINICAL MANIFESTATIONS

EFFECTS OF ANEMIA

• Increases risk of maternal and fetal morbidity and mortality

• Abortions, premature births, PPH, low birth weight are associated with anemia during pregnancy

PREGNANCY

PREVENTIONEstimation of Hb to assess degree of anemia

Blood transfusion in severe cases of anemia (<8g/dL)

Iron and folic acid supplements

Food fortification with iron

Changing dietary habits

Control of parasites

Nutritional education and awareness

IODINE DEFICIENCY

DISORDERS (IDD)

IDD leads to a much

wider spectrum of

disorders commencing

with the intrauterine

life and extending

through childhood to

adult life with serious

health and social

implications

DISORDERS

Goiter

Hypothyroidism

Subnormal intelligence

Delayed motor milestones

Mental deficiency

Hearing defects

Speech defects

Mental retardation

Neuromuscular weakness

Endemic cretinism

Intrauterine death

PREVENTION

• Iodized salt

• Iodine monitoring

• Public awareness and education

COMPLICATIONS

• Thyrotoxicosis

• Iodide goiter

• Iodinism

• Lymphocytic thyroiditis

ENDEMIC FLUOROSIS

In many parts of the world where drinking water contains excessive amounts of fluorine (3-5mg/L), endemic fluorosis has been observed.

DENTAL FLUOROSIS

• It occurs when excess fluoride is ingested during the years of tooth calcification – first 7 years of life

• Characterized by molting of dental enamel which has been reported above 1.5mg/L intake

• Fluorosis seen on the incisors of upper jaw

SKELETAL FLUOROSIS

• Associated with life time daily intake of 3-6mg/L or more

• Heavy deposition of fluoride in skeleton

• Crippling occurs leading to disability

PREVENTION

• Changing the water sources

• Chemical defluorination

• Preventing use of fluoridated toothpaste

• Fluoride supplements not prescribed for children consuming fluoridated water

LATHYRISM• It is a paralyzing disease of

human and animals• Also referred to as

Neurolathyrism as it affects the nervous system

• Lathyrus Sativus is commonly known as ‘khesari dhal’, a good source of protein but its toxins affects the nerves

• The toxin present in lathyrusseed has been identified as BETA OXALYL AMINO ALANINE (BOAA) which has blood brain barrier

STAGES OF LATHYRISM

• Latent stage

• No stick stage

• One stick stage

• Two stick stage

• Crawler stage

INTERVENTIONS

• Vitamin C prophylaxis

• Banning the crop

• Removal of toxin

• Education and awareness

• Genetic approach – producing low toxin variety of crop

• Socio economic changes

NUTRITIONAL PROGRAMS

• Vitamin A Prophylaxis Program

• Prophylaxis against Nutritional Anemia

• IDD Control Program

• Specific Nutrition Program

• Balwadi Nutrition Program

• Integrated Child Development Scheme

• Mid – day Meal Program

• Mid – day Meal Scheme

CHRONIC DISEASES

OBESITY

Obesity is an epidemic diseases, which consists of body weight that is in excess of that appropriate for a person’s height and age standardized to account for differences, leading to an increased risk to health related problems

Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. A crude population measure of obesity is the body mass index (BMI), a person’s weight (in kilograms) divided by the square of his or her height (in metres). A person with a BMI of 30 or more is generally considered obese. A person with a BMI equal to or more than 25 is considered overweight.

EATING DISORDERS

ANOREXIA NERVOSA

• Anorexia nervosa is an eating disorder characterized by immoderate food restriction, inappropriate eating habits or rituals, obsession with having a thin figure, and an irrational fear of weight gain, as well as a distorted body self-perception.

BULIMIA NERVOSA

• Bulimia nervosa is an eating disorder characterized by binge eating and purging, or consuming a large amount of food in a short amount of time followed by an attempt to rid oneself of the food consumed (purging), typically by vomiting, taking a laxative, diuretic, or stimulant, and/or excessive exercise, because of an extensive concern for body weight.

CLINICAL MANIFESTATIONS• Amenorrhea

• Obvious, rapid, dramatic weight loss at least 15% under normal body weight[

• May engage in frequent, strenuous, or compulsive exercise

• Perception of self as overweight despite being told by others they are too thin

• Intolerance to cold and frequent complaints of being cold. Body temperature may lower in an effort

• Bradycardia or tachycardia

• Depression: may frequently be in a sad, lethargic state

• Solitude: may avoid friends and family; becomes withdrawn and secretive

• Swollen joints

• Abdominal distension

• Halitosis (from vomiting or starvation-induced ketosis)

• Dry hair and skin, as well as hair thinning

• Fatigue

• Rapid mood swings