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NUTRITIONAL PROBLEMS
JENITA JOYCE JOHNI YEAR M.Sc., (N)
APOLLO CON, CHENNAI
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.
HISTORY OF NUTRITION• 400 B.C. -- Hippocrates, the
"Father of Medicine", said to his students, "Let thy food be thy medicine and thy medicine be thy food". He also said A wise man should consider that health is the greatest of human blessings. One story describes the treatment of eye disease, now known to be due to a vitamin A deficiency, by squeezing the juice of liver onto the eye. Vitamin A is stored in large amounts in the liver.
• 1747 Dr. James Lind, a physician in the British Navy, performed the first scientific experiment in nutrition. At that time, sailors were sent on long voyages for years and they developed scurvy. In his experiment, Lind gave some of the sailors sea water, others vinegar, and the rest limes. Those given the limes were saved from scurvy. As Vitamin C wasnt discovered until the 1930s, Lind didnt know it was the vital nutrient.
• Early 1800s It was discovered that foods are composed primarily of four elements: carbon, nitrogen, hydrogen and oxygen, and methods were developed for determining the amounts of these elements.
• 1930s William Rose discovered the essential amino acids, the building blocks of protein.
• 1940s The water soluble B and C vitamins were identified
• 1950s to the Present -- The roles of essential nutrients as part of bodily processes have been brought to light. For example, more became known about the role of vitamins and minerals as components of enzymes and hormones that work within the body
TERMINOLOGIES
• NUTRITION - The word Nutrition is the science of foods, the study of nutrients and other substances therein, their action, interaction and balance in relationship to disease.
• 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
CLA
SS
IFIC
ATIO
N O
F FO
OD
BASED ON FUNCTIONS
ENERGY YIELDING FOOD
CARBOHYDRATES
FATS
BODY BUILDING FOOD PROTEINS
PROTECTIVE FOOD
VITAMINS
MINERALS
BASED ON NUTRIENTS
MACRONUTRIENTS
MICRONUTRIENTS
CA
RB
OH
YD
RA
TES
MONOSACCHARIDES
GLUCOSE
FRUCTOSE
GALACTOSE
DISACCHARIDES
SUCROSE
MALTOSE
LACTOSE
POLYSACCHARIDES
STARCH
GLYCOGEN
DIETARY FIBER
LIPIDS (FATS)SIMPLE• FATS & OILS• WAXES
COMPOUND• PHOSPHOLIPID• GLYCOLIPIDS
DERIVED• STEROLS• FATTY ACIDS• LIPOPROTEINS
VITAMINS FAT
SOLUBLE
VITAMIN A
VITAMIN D
VITAMIN E
VITAMIN K
WATER SOLUBLE
THIAMIN B1
RIBOFLAVIN B2
NIACIN B3
PANTOTHENIC ACID B5
PYRIDOXINE B6
BIOTIN B7
FOLATE B9
CYANOCOBALAMINE B12
VITAMIN C (ASCORBIC ACID)
FOOD GUIDE PYRAMID
FATS, OILS &
SWEETSMILK & MEAT
PRODUCTS, EGGS & NUTSFRUITS &
VEGETABLE GROUP
BREAD, CEREALS AND RICE GROUP
ASSESSMENT OF NUTRITIONAL STATUS
• Clinical Examination• Anthropometry• Biochemical evaluation• Assessment of dietary intake• Vital statistics – morbidity and
mortality• Ecological factors
NUTRITIONAL PROBLEMS
NUTRITIONAL PROBLEMS
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• 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
PROTEIN ENERGY MALNUTRITION
PEM
KWASHIORKOR
MARASMUS
MARASMIC - KWASHIORKO
R
CAUSES AND RISK FACTORS
Inadequate intake of food
DiarrheaRespiratory
infectionsMeaslesIntestinal wormsInfants and pre
schoolers
CONTRIBUTORY FACTORS
Poor envt. HygieneLarge family sizePoor maternal healthFailure of lactationPremature termination
of breast feedingDelayed
supplementary feedingUse 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 yearsRapid, acute onsetSome weight lossHigh mortality
MARASMUSSevere prolonged
starvation, chronic/recurring infections
Calories and protein are principal nutrients
6 months to 2 yearsChronic, slow onsetSevere weight lossLow mortality unless
related to underlying disease condition
BIRTH
BREAST FEEDING
EARLY ABRUPT WEANING
DILUTE DIRTY FORMULA
REPEATED INFECTIONS
STARVATION THERAPY
NUTRITIONAL MARASMUS
MARASMIC KWASHIORKOR
LATE GRADUAL WEANING
STARCHY FAMILY DIET
ACUTE INFECTIONS
KWASHIORKOR
COMPARISON OF CLINICAL FEATURES KWASHIORKOR
Edema, pot belly, swollen legs
Mild to moderate growth retardation
Weight masked by edemaLow subcutaneous fatMuscle atrophyRound face (moon face)Dry, flaky peeling skinThin dry easily plucked
hairEnlarged liverXerophthalmiaAnemia, diarrhea, infection
MARASMUSNo edemaWeight loss upto 40%Severe growth failure
Severe emaciationSevere loss of subcut fatSevere muscle atrophyWrinkled face (old man’s
face)Rare skin changesCommon hair changesMildly enlarged liverAnemia, 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 StatusBetween 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 FACTORSoMaternal
malnutritionoAnemia
CAUSESo Illness/infectionsoShort maternal
statureoVery young ageoHigh parityoClose birth intervalso IUGRoHard physical labor
during pregnancyoSmoking
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
MIC
RO
NU
TR
IEN
TS
VITAMINS
VITAMIN A
VITAMIN B COMPLEXES
VITAMIN C
VITAMIN D
VITAMIN K
MINERALS
MAJOR MINERALS
CALCIUM
PHOSPHORUS
SODIUM
POTASSIUM
MAGNESIUM
TRACE ELEMENTS
IRON
IODINE
FLUORINE
ZINC
VITAMIN A DEFICIENCY
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 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.
XEROPHTHALMIA
Xerophthalmia i.e., dry eyes refers to all the ocular manifestations of vitamin A deficiency in manIt is the most widespread and serious nutritional disorder leading to blindness
RISK FACTORSPoor SE statusFaulty feeding
practicesWeaningPEMInfections1-3 years
CLINICAL FEATURES
Corneal ulcersSoftening of corneaKeratomalaciaBitot 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
• Anemia can be aggravated by parasitic infections like malaria, intestinal parasites• Iron deficiency may repair cellular
response and immune functions
• More severe the anemia, greater the reduction in work performance
INFECTION
WORK CAPACI
TY
PREVENTIONEstimation of Hb to assess degree of
anemiaBlood transfusion in severe cases of
anemia (<8g/dL)Iron and folic acid supplementsFood fortification with ironChanging dietary habitsControl of parasitesNutritional 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
DISORDERSGoiterHypothyroidismSubnormal intelligenceDelayed motor milestonesMental deficiencyHearing defectsSpeech defectsMental retardationNeuromuscular weaknessEndemic cretinismIntrauterine 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.
ENDEMIC FLUOROS
IS
DENTAL FLUOROS
IS
SKELETAL
FLUOROSIS
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 lathyrus seed 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 to conserve energy
• Hypotension and/or orthostatic hypotension
• 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
CONCLUSION
Good nutritional habits and a balanced diet aren't developed in one day, nor are they destroyed in one unbalanced meal. Healthful eating means a lifestyle of making choices and decisions, planning, and knowing how to make quick and wise choices when you haven't planned.
INTERNET INFORMATION
• Metformin is a drug commonly used to treat type 2 diabetes. But new research published in the Proceedings of the National Academy of Sciences (PNAS) finds the medication may also slow the aging process and increase lifespan.
JOURNAL INFORMATION
• Overweight and obesity among children – TNNMC journal of CHN• Nutritional status of pre school
children attending balwadi – Indian Journal of nutrition and dietetics
BIBLIOGRAPHY• Dudek Susan G – Nutrition essentials for nursing
practice• K Park – Textbook of preventive and social
medicine• John Sheila – Essentials of nutrition and dietetics
for nursing• Fraser Diane, Cooper Margaret A – Myles textbook
for midwives• Swaminathan K – Nutrition and dietetics