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Malnutrition
SupervisionProf. Dr.Mervat Salah
Malnutrition of Children Eradication of
poverty and hunger
Intended Learning Outcomes
- By the end of this lecture, students will
have a general overview on malnutrition in
children.
Definition of malnutrition
”People are malnourished if their diet does not provide adequate calories and protein for growth and maintenance or they are unable to fully utilize the food they eat due to illness (undernutrition). They are also malnourished if they consume too many calories (overnutrition).” (Unicef)
Malnutrition
”Malnutrition is a contributing factor in over 50% of deaths in children under five”World Bank
Population Density of Underweight Children(UN)
MUACMid Upper Arm Circumferance
SAM <110mm
Children 6m-5yrsMeasures Acute
malnutrtion
Measure of acute malnutrition
W/H
WASTING
SAM <70% W/H (<-3 Z-scores)
MAM 70-79% W/H(<-2 and >= -3 Z-scores)
Measuring Chronic Malnutrition
H/A
STUNTING<90% of median
Growth of Children <5 years
”all children, regardless of ethnic background or regional origin, grow similarly when their needs are met.”(MGRS)
WHO
NCHS 1978 Child Growth References
• Measures made 1960-75• American Children- geographically
restricted area.• With formula milk• High socioeconomic background
WHO 2006 Child Growth Standards 1997-2003
de Onis et al. 2004 MDGR
Causes of Malnutrition
Malnutrition/Death
Inadequate dietary intake Disesase
InsufficientHousehold food
MANIFESTATIONS
IMMEDIATECAUSES
UNDERLYINGCAUSES
BASIC CAUSES
Political and Economical powers
Inadequate Maternal Childcare
Insufficient HealthServices/Unhealthy
Environment
Modified from UNICEF 1998
Severe MalnutritionW/H <70% or bilateral oedema
Impaired immune system and electrolyte inbalance
Kwashiorkor
Marasmus
Kwashiorkor• 2-4yrs• Comes suddenly after some time
of Moderate Malnutrition• Low protein intake• HÖG MORTALITET!
http://www.asnom.org/image/510_nutrition/116_327_kwashiorkor.jpg
Symtoms:• Bilateral Oedema•Apathy•Depigmented corse hair, easy to pull.• Skin lesions•Poor aptetite•Diarrhoea
Marasmus•1st year of life, often failure to breastfeed.
•Lack of proteins and calories.
•Body creates energy by dissolving its own tissues Loss of subcutanous fat and muscles.
Symtoms: •Wasting W/H <70%•Face o an old person•Pot belly due to lack of abd. muscles.•Anorexia, irritability.•Hunger
The evil cycle of Malnutrition
Adapted from Andrew Tomkins and Fiona Watson, Malnutrition and Infection, ACC/SCN, Geneva, 1989 , State of the World’s Children 1998
Apetite lossNutrient LossMalabsorbtion
Altered metabolism
Disease:Incidence SeverityDuration
Inadequate Dietary Intake
Weight lossImmunity loweredGrowth faltering
Mucosa damaged
Fever as a main cause of child death in developing countries :----------------------------------------------- Fever incease in body energy use ,if the body doent get the need energy from diet the body protein and fat will be used for energy these incease the serum fatty acids and amino acids lead to increase in blood acidity which cause loss of appetite ,dehydration ,fatigue
seizures soetimes retardation and finaly DEATH
Iodine Deficiency-Most important cause of brain damage and
mental retardation, 760milj have goitre• Deficiency gives
hypothyreosis and goitre.• Stillbirth and miscarriage • Cretinism: mental retardation,
stunted, hypothyroidis, deaf-mutism.
• Lower IQ by 10-15%• Iodising salt
SOURCE: UNICEF
Source:Sea fish, sea weed,Iodized salt
5cents/person/year
Vit A Deficiency- Most important cause of blindness in developing countries • Protects skin and mucosa.
Increases leucocyte activity.• Vit A protects against death in
measles with 50% and diarrhoea with 30%.
• Vit A to newly delivered mothers protects infants <6m against infection.
• Vision: Scars on conjunctivatotal blindness. Night blindness
• Treatment lowers the child’s risk of dying by 23%!
http://www.milesresearch.com/
Bitot spots
Source:• Egg,• Liver• Butter, cow’s milk• Breast milk.• Carotene.SOURCE: UNICEF
10 cents/child/year
Vitamin A is a generic term for many related compounds. Retinol (alcohol), Retinal (aldehyde) are often called preformed vitamin A. Retinal can be converted by the body to retinoic acid which is known to affect gene transcription.
Body can convert b-carotene to retinol, thus called provitamin A.
FUNCTIONS
•Vision: integrity of eye & formation of rodopsin necessary for dark adaptation. Regulation of gene expression: vital to cell differentiation & physiologic processes
•Immunity: important for activation of T lymphocyte, maturation of WBC & integrity of physiological barrier.
•Growth & developmen
•Deficiency of vitamin A leads to:Night blindness & xerophthalmia
Growth retardation
Acquired immune deficiency
Keritinization of epithelia in RT, GIT & UT with increased risk of RTI, malabsorption & UTI.
Assignment
Hadeer kamal abo bakr
Recommended text book
Manual dietetic book