VARIOUS NUTRITIONAL PROBLEMS Nutrition may be defined as a science of food and its relationsi! to ealt" It is conc er ne d !r imar il y #it t e !ar t !la yed by nu tr ie nts in bo dy $r o# t % de&elo!ment and maintenance" Te #ord nutrient or 'food factor( is used for s!ecific dietary constituents su cas !r ot eins% &i tamins and minerals" )ietetics is t e !ractical a!!lication of te !rinci!les of nutrition* it includes te !lannin$ of meals for te #ell and te sic+" ,ood nutrition means -maintainin$ a nutrition status tat enables us to $ro# #ell and en.oy $ood ealt/" Nutrition !lays an im!ortant role in te !romotion and maintenanc e of ealtand in te !re&ention of ealtand in te !re&ention of uman disease" Malnutrition and undernutrition are te $reatest international ealt!roblems of te !resent day" A sound +no#led$e of nutrition is terefore essential for a nurse" In te $lobal cam!ai$n of ealtfor all% !romotion of !ro!er nutrition is one of te ei$t elements of !rimary eal tcare" ,re ater em! asis is no# !laced on inte$ratin$ nutrition into !rimary ealtcare systems #ene&er $oals to !romote ealtand nutritional status of families and communities" FOOD RELATION OF NUTRITION TO HEALTH ,ood relation of nutrition is a basic com!onent of ealt" Te relation of nutrition to ealtmay be seen from te follo#in$ &ie# !oints" • ,ood nutrition is es sential for t e at tainment of normal $r o# t an d de&elo!ment not only for !ysical $ro#tand de&elo!ment% but also for te intellectual de&elo!ment" • Malnutrition is directly res!onsible for certain s!ecific nutritional deficiency disease" Te commonly re!orted ones in India are* 0" +# as i or +o r 1" marasmu s" 2" blin dne ss d ue t o &i tami n a d efic ienc y 3" anemia 4" beri5beri 6" $o it er% et c $ood nutriti on ter efor e is essential for te !re& enti on of s!e cifi c nutr itional deficiency diseases and !romotion to ealt"
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attaced to te centre" Te moters ta+e !art in te treatment of te cild and
note te im!ro&e tat e or se s!eedily ma+es"
<2= Se&ere cases of PEM are admitted to a !ediatric os!ital or #ard" Te
!rinci!les of teir mana$ement are $i&en belo#7
<a= Pro&ision of 1 +calF+$ of ener$y and 3 $F+$ of !rotein $radually in
te case of marasmus and a$$ressi&ely in tat of +#asior+or" <b= Treatment of accom!anyin$ nutritional deficiencies"
<c= Treatment of underlyin$ or accom!anyin$ infections% if any"
<d= Early detections of com!lications li+e deydration% y!otermia%
y!o$lycemia% etc"% by +ee!in$ a continuity &i$il and teir !rom!t treatment
sould tey de&elo!"
<e= Nutrition education of te !arents"
$RE5ENTION OF $EM
).* Educate about ome made i$ !rotein mi9ture" Moters are educated to
!re!are te follo#in$ i$5 !rotein mi9 at ome and use it in cild feedin$75 Ra$i
14,
Deat or rice 14,
,reen ,ram 14,
,roundnuts 0,
Til <sesame= 4,
Su$arFGa$$ery 2,
All te items e9ce!t su$ar or .a$$ery are se!arately fried" Ten tey are
mi9ed to$eter% su$ar or .a$$ery added% and #ole $round" Te resultin$ !o#der
is stored in a tin #it a ti$t lid" Si9ty , is mi9ed #it a little #ater to form
!orrid$e and fed to te cild t#o times a day" Alternati&ely te !o#der is mi9ed
#it a little $ee and made into ladoos" T#o of tem are $i&en to te cild e&ery
day"
)/* Education about breast feedin$" Moters are educated to start breast Hfeedin$ te baby #itin our of its birt and continue for t#o years" ;or te first
four monts tey are told not to $i&e anytin$ to te baby oter tan moter(s
mil+" All os!itals and maternity omes are ad&ised to !romote e9clusi&e breast5
feedin$ as abo&e"
)0* Early detection of PEM" Tis is !ossible trou$ $ro#t monitorin$" If PEM is
intrauterine $ro#t restriction% and insufficient slee! can disturb #ei$tre$ulation" About 04@ of #omen !ermanently $ain K 1 lb #it eac !re$nancy"
Obesity tat !ersists beyond early cildood ma+es #ei$t loss in later life more
difficult"
)ru$s% includin$ corticosteroids% litium% traditional antide!ressants <tricyclics%
tetracyclics% and monoamine o9idase inibitors MAOIs=% ben?odia?e!ines% and
anti!sycotic dru$s% often cause #ei$t $ain"
Uncommonly% #ei$t $ain is caused by one of te follo#in$ disorders7
• Brain dama$e caused by a tumor <es!ecially a cranio!aryn$ioma= or aninfection <!articularly tose affectin$ te y!otalamus=% #ic can stimulateconsum!tion of e9cess calories
• 8y!erinsulinism due to !ancreatic tumors
• 8y!ercortisolism due to :usin$s syndrome% #ic !roduces
!redominantly abdominal obesity
• 8y!otyroidism <rarely a cause of substantial #ei$t $ain=
Eating disorders" At least 1 !atolo$ic eatin$ !atterns may be associated #it
obesity7
• %inge eating disorder is consum!tion of lar$e amounts of food >uic+ly
#it a sub.ecti&e sense of loss of control durin$ te bin$e and distress after it"Tis disorder does not include com!ensatory bea&iors% suc as &omitin$"Pre&alence is 0 to 2@ amon$ bot se9es and 0 to 1@ amon$ !eo!le
enterin$ #ei$t reduction !ro$rams" Obesity is usually se&ere% lar$e amountsof #ei$t are fre>uently $ained or lost% and !ronounced !sycolo$icdisturbances are !resent"
Night#eating syndro!e consists of mornin$ anore9ia% e&enin$ y!er!a$ia% and
insomnia" At least 14 to 4@ of daily inta+e occurs after te e&enin$ meal" About
0@ of !eo!le see+in$ treatment for se&ere obesity may a&e tis disorder"
Rarely% a similar disorder is induced by use of a y!notic suc as ?ol!idem
,o!2lications
:om!lications of obesity include te follo#in$7
• Metabolic syndrome
• )iabetes mellitus
• :ardio&ascular disease
• Nonalcoolic steatoe!atitis <fatty li&er=
• ,allbladder disease
• ,astroeso!a$eal reflu9
• Obstructi&e slee! a!nea
• Re!roducti&e system disorders
• Many cancers
• Osteoartritis
• Social and !sycolo$ic !roblems
Diagnosis
• BMI
• Daist circumference
• Sometimes body com!osition analysis
Treat!ent
• Nutrition mana$ement• Pysical acti&ity
• Bea&ioral tera!y
)ru$s <e$% sibutramine% orlistat=
Nutrition" A normal eatin$ !attern is im!ortant" Peo!le #o miss brea+fast tend
to !assi&ely consume too many calories later in te day" Patients sould eat
small meals and a&oid or carefully coose snac+s" Lo#5fat <!articularly &ery lo#
and substitution of some !rotein for carboydrate a!!ear to a&e te best lon$5
term outcome" ;res fruits and &e$etables and salads sould be substituted for
refined carboydrates and !rocessed food% and #ater for soft drin+s or .uices"
Alcool consum!tion sould be limited to moderate le&els"
$hysical acti3ity" E9ercise increases ener$y e9!enditure% BMR% and diet5
induced termo$enesis" E9ercise also seems to re$ulate a!!etite to more closely
matc caloric needs" Oter benefits include
• Increased insulin sensiti&ity
• Im!ro&ed !lasma li!id !rofile
• Lo#er BP
• Better aerobic fitness
• Im!ro&ed !sycolo$ic #ell5bein$
Stren$tenin$ <resistance= e9ercises increase muscle mass" Because muscle
tissue burns more calories at rest tan does fat tissue% increasin$ muscle mass!roduces lastin$ increases in BMR" E9ercise tat is interestin$ and en.oyable is
more li+ely to be sustained" A combination of aerobic and resistance e9ercise is
better tan eiter alone"
%eha3ioral thera2y" Bea&ioral tera!y aims to im!ro&e eatin$ abits and
!ysical acti&ity le&el" Ri$id dietin$ is discoura$ed in fa&or of ealty eatin$"
:ommon5sense measures include te follo#in$7
• A&oidin$ i$5calorie snac+s
• :oosin$ ealtful foods #en dinin$ out
• Eatin$ slo#ly
• Substitutin$ a !ysically acti&e obby for a !assi&e one
Social su!!ort% co$niti&e tera!y% and stress mana$ement may el!% !articularly
durin$ te la!ses usually e9!erienced durin$ any lon$5term #ei$t loss !ro$ram"
Self5monitorin$ is useful% and maintenance of a diet diary is !articularly effecti&e"
Drugs" )ru$s may be used if BMI is 2 or if BMI is 1 and !atients a&e
com!lications <e$% y!ertension% insulin resistance=" Most #ei$t loss due to dru$
treatment is modest <4 to 0@= at best and occurs durin$ te first 6 mo* not all
!atients benefit" )ru$s are more useful for maintainin$ #ei$t loss but must be
continued indefinitely for #ei$t loss to be maintained" Premeno!ausal #omen
ta+in$ systemically actin$ dru$s for #ei$t control sould use contrace!tion"
Metabolic syndrome <syndrome % insulin resistance syndrome= is caracteri?ed
by a clusterin$ of ris+ factors for cardio&ascular disease and ty!e 1 diabetes
-urgery" Sur$ery is te most effecti&e treatment for e9tremely obese !atients
mellitus" Tey commonly include e9cess intra5abdominal fat% insulin resistance%
and K 0 of te follo#in$7 ele&ated !lasma tri$lyceride le&els% decreased i$
density li!o!rotein <8)L= colesterol le&el% and y!ertension" :auses%
com!lications% dia$nosis% and treatment are similar to tose of obesity"
2+ I!4alance7 it is te !atolo$ical state resultin$ from a dis!ro!ortion amon$
essential nutrients #it or #itout te absolute deficiency of any nutrient"
Some of te common !roblems #ic lead to nutritional imbalance are discuss
belo# #it teir solutions"
• Decreased a22etite
• Heart4urn
• Nausea
• Diarrhoea
• ,onsti2ation
6+ -2ecific DeficiencyMenral deficiency and to;icity
Si9 macrominerals are re>uired by !eo!le in $ram amounts" ;our <Na% Q% :a%
and M$= are cations* t#o <:l and P= are accom!anyin$ anions" )aily
re>uirements ran$e from "2 to 1" $" Bone% muscle% eart% and brain function
de!end on tese minerals"
Nine trace minerals <microminerals= are re>uired by !eo!le in minute amounts7cromium% co!!er% iodine% iron% fluorine% man$anese% molybdenum% selenium%and ?inc"
TRACE ELEMENTSIRON
The iron is of great importance in human nutrition. The adult human body contains between 4 to 5 mg of iron, of which about 60-70 percent is present in blood as circulating
iron, and the rest as storage iron. Each gram haemoglobin contains about .4 mg of iron.EFFECTS OF IRON-DEFICIENCY
The end result of iron-deficiency is nutritional anaemia which is not a disease entity. !t israther a syndrome caused by malnutrition. besides anaemia there may be other functional
disturbance to infection, increased mobidity and mortality and diminished wor"
performance.
$re3ention of Iron Deficiency
It can el! to understand o# to !re&ent iron deficiency if you understand o#te body stores iron" Babies% unless tey are born !remature% are born #it all ofte iron tey need for te first 456 monts of life" After tat% unless tey are $i&enan iron su!!lement% tey can de&elo! iron deficiency% #ic means tat teydont a&e enou$ iron in teir body" If it continues% it #ill ten lead to irondeficiency anemia"
So to !re&ent iron deficiency% you sould breastfeed or $i&e your infant an ironfortified infant formula <a&oidin$ lo# iron formula= until tey are at least 01monts of a$e% and be$in an iron su!!lement by about 6 monts of a$e"
Startin$ an iron su!!lement doesnt necessarily mean startin$ tem on a &itamin#it iron tou$" Te usual su!!lement is sim!ly an iron fortified infant cereal$i&en once or t#ice a day" Remember tat !reemies or lo# birt #ei$t infantsdo usually also need a &itamin #it iron"
After you a&e introduced an iron fortified infant cereal% start one feedin$ a day of foods ric in &itamin : <e"$"% fruits% &e$etables% or .uice= to im!ro&e ironabsor!tion% !referably #it meals"
$re3ention of Iron Deficiency in Teens
To !re&ent iron deficiency in teens% tey sould be encoura$ed to eat iron5ricfoods and foods tat enance iron absor!tion" Tose #o are at ris+ of becomin$iron deficient sould be tested and $i&en an iron su!!lement if tey do a&e irondeficiency
,hro!iu!75Only 0 to 2@ of biolo$ically acti&e tri&alent cromium <:r= is
absorbed" Normal !lasma le&els are "4 to "4 $FL <0" to C"6 nmolFL="
:romium !otentiates insulin acti&ity and increases te $ro#t rate in
malnourised cildren" Su!!lements do not enance muscle si?e or stren$t in
To;icity" E9cess fluorine can accumulate in teet and bones% causin$ fluorosis"
)rin+in$ #ater containin$ 0 !!m is a common cause" Permanent teet tat
de&elo! durin$ i$ fluoride inta+e are most li+ely to be affected" E9!osure must
be muc $reater to affect deciduous teet"
Treatment in&ol&es reducin$ fluoride inta+e* e$% in areas #it i$ fluoride #ater
le&els% !atients sould not drin+ fluoridated #ater or ta+e fluoride su!!lements"
:ildren sould al#ays be told not to s#allo# fluoridated toot!astes
IODINE
In te body% iodine <I= is in&ol&ed !rimarily in te syntesis of 1 tyroid ormones%
tyro9ine <T3= and triiodotyronine <T2=" Iodine occurs in te en&ironment and in
te diet !rimarily as iodide" In adults% about @ of te iodide absorbed is
tra!!ed by te tyroid $land" Most en&ironmental iodine occurs in sea#ater as
iodide* a small amount enters te atmos!ere and% trou$ rain% enters $round
#ater and soil near te sea" Tus% !eo!le li&in$ far from te sea and at i$er
altitudes are at !articular ris+ of deficiency" ;ortifyin$ table salt #it iodide
<ty!ically $F$= el!s ensure ade>uate inta+e <04 $Fday=" Re>uirements are
i$er for !re$nant <11 $Fday= and lactatin$ <1C $Fday= #omen"
IODINE DEFI,IEN,(
)eficiency is rare in areas #ere iodi?ed salt is used but common #orld#ide"
Iodine deficiency de&elo!s #en iodide inta+e is 1 $Fday" In mild or moderate
deficiency% te tyroid $land% influenced by tyroid5stimulatin$ ormone <TS8=%
y!ertro!ies to concentrate iodide in itself% resultin$ in colloid $oiter" Usually%!atients remain eutyroid* o#e&er% se&ere iodine deficiency in adults may cause
y!otyroidism <endemic my9edema=" It can decrease fertility and increase ris+
of stillbirt% s!ontaneous abortion% and !renatal and infant mortality" Se&ere
maternal iodine deficiency retards fetal $ro#t and brain de&elo!ment%
sometimes resultin$ in birt defects% and% in infants% causes cretinism% #ic may
include mental retardation% deaf mutism% difficulty #al+in$% sort stature% and
sometimes y!otyroidism"
Treat!ent
• Iodide #it or #itout le&otyro9ine
Infants #it iodine deficiency are $i&en L5tyro9ine 2 $F+$ !o onceFday for a
#ee+ !lus iodide 4 to C $ !o onceFday for se&eral #ee+s to >uic+ly restore a
eutyroid state" :ildren are treated #it iodide C to 01 $ onceFday" Adults
are $i&en iodide 04 $ onceFday" Iodine deficiency can also be treated by $i&in$
u!ta+e of iodine by te tyroid may inibit tyroid ormone syntesis <called
Dolff5:ai+off effect=" Tus% iodine to9icity can e&entually cause iodide $oiter%
y!otyroidism% or my9edema" Very lar$e amounts of iodide may cause a brassytaste in te mout% increased sali&ation% ,I irritation% and acneiform s+in lesions"
Patients e9!osed to fre>uent lar$e amounts of radio$ra!ic contrast dyes or te
dru$ amiodarone
Manganese
Man$anese <Mn=% necessary for ealty bone structure% is a com!onent of
se&eral en?yme systems% includin$ man$anese5s!ecific $lycosyltransferases and
!os!oenol!yru&ate carbo9y+inase" Median inta+e is bet#een 0"6 and 1"2
m$Fday* absor!tion is 4 to 0@"
Deficiency as not been conclusi&ely documented% altou$ one e9!erimental
case in a &olunteer resulted in transient dermatitis% y!ocolesterolemia% and
increased al+aline !os!atase le&els"
To;icity is usually limited to !eo!le #o mine and refine ore* !rolon$ed
e9!osure causes neurolo$ic sym!toms resemblin$ tose of !ar+insonism or
Dilsons disease"
FI%RE DEFI,IEN,( DI-ORDER-"## ;oods tat are deficient in fiber <residue or rou$a$e= !redis!ose to consti!ation% iatus ernia% emorroids%
dee! &ein trombosis% &aricose &ein% inflammation of te a!!endi9 and cancer
of colon"
5ita!ins deficiency disorders"#
5ITAMIN A DEFI,IEN,(
Te si$ns of &itamin A deficiency are !redominantly ocular" Tey includes ni$t
blindness% con.uncti&al 9erosis% bitot(s s!ots% corneal 9erosis and +eratomalacia"
Te term -9ero!talmia/ <dry eye= com!rises all te te ocular manifestation of
&itamin A deficiency from ni$t blindness to +eratomalacia"
,i&en belo# is a sort descri!tion of te ocular manifestations"