7. Malnutrition
Derived from malus (bad) and nutrire (to
nourish)
Includes both
Under nutrition (deficiency of one or more essential nutrients)
Over nutrition (an excess of a nutrient or nutrients)
8. DEFINITION
MALNUTRITION
WHO defines Malnutrition as "the cellular
imbalance between the supply of nutrients
and energy and the body's demand for them
to ensure growth, maintenance, and specific
functions.“
Malnutrition is the condition that develops
when the body does not get the right amount
of the vitamins, minerals, and other nutrients
it needs to maintain healthy tissues and
organ function
9. WHAT CAUSES
MALNUTRITION?
Human beings need a wide
variety of nutrients to supply
essential energy. Do you
know what nutrients we
need?
protein
vitamins
minerals
If any one of these nutrients
is deficient in a person's diet,
he/she may suffer from
malnutrition
10. WHAT CAUSES
MALNUTRITION?
Malnutrition is poor nutrition due to:
An insufficient food,
Poorly balanced diet,
Faulty digestion or poor utilization of foods.
(This can result in the inability to absorb
foods.)
Malnutrition is not only insufficient intake of
nutrients. It can occur when an individual is
getting excessive nutrients as well.
11. WHAT CAUSES
MALNUTRITION?
(continued)
Malnutrition also occurs when there is an imbalance of energy and
protein in an individual’s diet. The body may become unable to
absorb the nutrients it requires to function properly.
*For example, if a child is suffering from energy
and protein malnutrition, they will most likely
have deficiencies in iron, calcium, and other
vitamins and minerals.
12. WHO IS AFFECTED BY
MALNUTRITION?
Individuals who are dependent on others for
their nourishment. (infants, children, the
elderly, prisoners)
Mentally disabled or ill because they are not
aware of what to eat.
People who are suffering from tuberculosis,
eating disorders, HIV/AIDS, cancer, or who
have undergone surgical procedures are
susceptible to interferences with appetite or
food uptake which can lead to malnutrition.
13. BUT DO YOU KNOW THE NUMBER
ONE FACTOR THAT CAUSES
MALNUTRITION?
POVERTY!
14. Effects of malnutrition
Nutritional deficiencies can contribute to various diseases
which can be found everywhere, but most often go
without cures/treatment in Less Developed Countries
(LDCs).
15. Malnutrition
Undernutrition
Lack of nutrients
Calories
Protein
Micronutrients
Low income countries
Overnutrition
Obesity
Too many calories
High and middle income
countries
http://i105.photobucket.com/albums/m203/sspasha/Malnutrition.jpg
16. Undernutrition
Undernutrition
Secondary
Malnutrition
Micronutrient
Malnutrition
Protein Energy
Malnutrition
Most important
Severe Protein
Energy Malnutrition
http://www.bio.davidson.edu/people/kabernd/seminar/2002/tech/ma
lnutrition.jpg
17. Micronutrient Malnutrition
Deficiency in:
Vitamin A
Iodine
Iron
Zinc
Calcium
Vitamin D
B Vitamins
Vitamin C
Rickets (Vitamin D deficiency)
http://www.talkorigins.org/faqs/homs/rickets.jpg
18. Vitamin A Deficiency
Night Blindness
500,000 children/year
xerophthalmia
Half of these will die
within a year of becoming
blind
Rice diet lacking green
vegetables
Vitamin supplements
Eggs,milk&carotenoids
could help
http://www.vitaminsdiary.com/UserFiles/Image/keratomalacia.jpg
xerophthalmia
19. Rickets
Vitamin D deficiencies may result in
“Rickets” which is a lack of proper calcium
characterized by poorly developed and
deformed bones.
Vitamin D can be best found in beef
products (especially cows milk) but is very
low in breast milk. Thus, women in
developing countries are contributing to
this disease if their babies sole source of
nourishment is breast milk.
Sun exppsure,cod liver oil & eggs could
help
20.
21. Beriberi
Beriberi is a thiamine (vitamin B1) deficiency
which is common in South East Asia where many
diets consist solely of white rice.
Beriberi affects the proper functioning of the
nervous system as well as the circulatory system
and heart.
Pregnancy, breast feeding mothers and those who
are ill with fever may have a heightened
dependency on thiamine and may develop a
deficiency.
Thiamine is best acquired through foods such as
beef and whole grain (unrefined) breads and
grains.
22.
23. Pellagra
Pellagra ”rough skin” is a niacin (or Tryptophan)
deficiency which often results in the “3 Ds”; diarrhea,
demetia and dermatitis.
The large scale consumption of corn has resulted in
many cases of pellagra because corn is poorly absorbed
in the body. The best sources of Niacin are broccoli,
eggs, dates, beef, salmon, seeds and peanuts.
24.
25. Scurvy
Scurvy is a disease which is born of Vitamin C
deficiency. It is characterized by bleeding around hair
follicles, anemia and gingivitis.
Scurvy may occur in those who consume large
amounts of junk foods, smokers (as smoking depletes
Vitamin C) and those who don’t have proper access to
sources of vitamin C. Namely, the poor.
26.
27. Iodine Deficiency
Iodine deficiency
affects 740 million people
worldwide
single greatest cause of
preventable brain damage in
babies(cretinism)
Goiter
Stillbirth
Miscarriages
Mental Retardation
Prevented by iodized salt
Best sources of natural iodine
Sea weed
Sea food
Goiter (thyroid enlargement)
http://www.voanews.com/english/images/emory_edu_goiter_Iodine_Deficiency_Disorder
_195_eng_11may06_0.jpg
28. Iron Deficiency Anemia
Affects 2 billion people,
90% live in developing countries
39% of preschool children
52% of pregnant women
Reduced
physical activity
mental activity
Increased
birth mortality
Worms
Malaria
HIV
High iron flour &milk could help
http://www.micronutrient.org/reports/images/Page16Image.jpg
29. Other Deficiencies
Zinc
Growth retardation
delayed sexual maturation
skin and eye lesions
48% of world at risk for zinc
deficiency
Calcium
Osteoporosis: bone loss
Vitamin D
Rickets: bone malformation
Not enough sunlight
exposure:
Swaddled babies
http://www.ulanbatoronline.org/cammp_section/article_images_lamc_lati
mes/scans/latimes_images/thumbnails/babyswaddle.jpg
Swaddled babies at risk for
Rickets: not enough sunlight
30. Other Deficiencies
Vitamin C
Causes Scurvy: problem in refugee
camellaps
Niacin
Causes Pgra: dermatitis, diarrhea,
dementia
Due to diet high in maize (low in
tryptophan)
Thiamin
Causes Beriberi
Due to diet high in polished rice
Folate
Birth defects: Anancephaly and
Spina Bifida
http://www.athropolis.com/arctic-facts/misc/scurvy.jpg
Scurvy
32. Kwashiokor/Marasmus
Kwashiokor, is “the disease of the Weaning child”
is an extreme protein deficiency (affects after 1
years) which is characterized by inability to gain
weight, diarrhea, lethargy and a swollen belly.
Kwashiokor can lead to coma as well as death.
Marasmus is a disease resulting from caloric &
protein deficiency which affects chidlren early in
life (typically in the 1st year) due to use of diluted
milk,characterized by slowing growth, decreasing
weight and hindering proper development.
Nutrition supplements, rehydration and
education all can all serve to cure and prevent
these diseases.
33.
34. Kwashiorkor - Definition
It is an acute form of childhood protein-energy malnutrition
characterized by inadequate protein intake with reasonable caloric
(energy) intake; it tends to occur after weaning, when children
change from breast milk to a diet consisting mainly of
carbohydrates.
Studies suggest that kwashiorkor represents a maladaptive response
to starvation
35
35. KWASHIORKOR
The term kwashiorkor is taken from the Ga language of Ghana and
means "the sickness of the weaning”.
Williams first used the term in 1933, and it refers to an inadequate
protein intake with reasonable caloric (energy) intake.
Kwashiorkor, also called wet protein-energy malnutrition, is a form of
PEM characterized primarily by protein deficiency.
This condition usually appears at the age of about 12 months when
breastfeeding is discontinued, but it can develop at any time during a
child's formative years.
It causes fluid retention (edema); dry, peeling skin; and hair
discoloration.
36. Kwashiorkor was thought to be caused by
insufficient protein consumption but with sufficient calorie
intake, distinguishing it from marasmus.
More recently, micronutrient and antioxidant deficiencies
have come to be recognized as contributory.
Victims of kwashiorkor fail to
produce antibodies following vaccination against diseases,
including diphtheria and typhoid.
Generally, the disease can be treated by adding food energy
and protein to the diet; however, it can have a long-term
impact on a child's physical and mental development,
and in severe cases may lead to death.
37. SYMPTOMS
Changes in skin pigment.
Decreased muscle mass
Diarrhea
Failure to gain weight and grow
Fatigue
Hair changes (change in color or
texture)
Increased and more severe
infections due to damaged immune
system
Irritability
Large belly that sticks out
(protrudes)
Lethargy or apathy
Loss of muscle mass
Rash (dermatitis)
Shock (late stage)
Swelling (edema)
38. Marasmus
Calorie deficiency
Lack of food
Poorest populations
Neglected
Infants
children
Protein used for energy
Results in wasting
Deterioration of tissues
Brain development
impaired
39. MARASMUS
The term marasmus is derived from the Greek word marasmos, which
means withering or wasting.
Marasmus is a form of severe protein-energy malnutrition characterized
by energy deficiency and emaciation.
Primarily caused by energy deficiency, marasmus is characterized by
stunted growth and wasting of muscle and tissue.
Marasmus usually develops between the ages of six months and one
year in children who have been weaned from breast milk or who suffer
from weakening conditions like chronic diarrhea.
40. Etiology:
Dietary Inadequacy:
occurs when there is a rapid period of transition from the
balanced diet supplied by the breast milk to an
unbalanced inadequate diet, which is very low in
protein, and consists mainly of carbohydrates due to
socio - economic status such as:
41
41. Cont..
Poverty
Ignorance
Inadequate weaning practice
Lack of basic health education and nutritional
knowledge.
Child abuse
42
42. SYMPTOMS
Severe growth retardation
Loss of subcutaneous fat
Severe muscle wasting
The child looks appallingly thin and
limbs appear as skin and bone
Shriveled body
Wrinkled skin
Bony prominence
Associated vitamin deficiencies
Failure to thrive
Irritability, fretfulness and apathy
Frequent watery diarrhoea and acid
stools
Mostly hungry but some are anoretic
Dehydration
Temperature is subnormal
Muscles are weak
Oedema and fatty infiltration are
absent
43. Marasmus
Severely wasted (emaciated) & stunted
Very low WAZ
“Balanced”starvation
“Old Man”face, wrinkled appearance, sparse hair
No edema, fatty liver, skin changes
Alert bur Miserable
Hungry
Diarrhea and dehydration
CLINICAL FEATURES
44. CAUSES OF MARASMUS
Seen most commonly in the first year of life due to
lack of breast feeding and the use of dilute animal
milk.
Poverty or famine and diarrhoea are the usual
precipitating factors
Ignorance & poor maternal nutrition are also
contributory
Too little breast milk or complementary foods •< 2
yrs of age
48. CLINICAL
FEATURES
-MUSCLE
WASTING
-FAT WASTING
-EDEMA
-WEIGHT FOR
HEIGHT
-MENTAL CHANGES
MARASMUS
Obvious
Severe loss of
subcutaneous fat
None
Very low
Irritable, moaning,
Sometimes quite and
apathetic
KWASHIORKOR
Sometimes
hidden by edema
and fat
Fat often retained
but not firm
Present in lower
legs, and usually in
face and lower arms
May be masked by
edema
apathetic
DIFFERENCE IN CLINICAL FEATURES BETWEEN MARASMUS AND KWASHIORKOR
49. CLINICAL FEATURES
-APPETITE
-DIARRHOEA
-SKIN CHANGES
-HAIR CHANGES
-HEPATIC
ENLARGEMENT
MARASMUS
Usually good
Often
Usually none
Seldom
None
KWASHIORKOR
Poor
Often
Diffuse pigmentation,
sometimes ‘flaky
paint dermatitis’
Sparse, silky, easily
pulled out
Sometimes due to
accumulation of fat
DIFFERENCE IN CLINICAL FEATURES BETWEEN MARASMUS AND KWASHIORKOR
50. A severely malnourished child with
features of both marasmus and
Kwashiorkor.
The features of Kwashiorkor are
severe oedema of feet and legs
and also hands, lower arms,
abdomen and face. Also there is
pale skin and hair, and the child is
unhappy.
There are also signs of
marasmus, wasting of the
muscles of the upper arms,
shoulders and chest so that you
can see the ribs.
MARASMIC-KWASHIORKOR
52. PREVENTION
Promotion of breast feeding
Development of low cost weaning
Nutrition education and promotion of correct feeding
practices
Family planning and spacing of births
Immunization
Food fortification
Early diagnosis and treatment
53. TREATMENT
1. Hospital Treatment
The following conditions should be corrected.
Hypothermia, hypoglycemia, infection, dehydration,
electrolyte imbalance, anaemia and other vitamin and
mineral deficiencies.
2. Dietary Management
The diet should be from locally available staple foods -
inexpensive, easily digestible, evenly distributed
throughout the day and increased number of feedings to
increase the quantity of food.
3. Rehabilitation
The concept of nutritional rehabilitation is based on
practical nutritional training for mothers in which they
learn by feeding their children back to health under
supervision and using local foods
54. Overnutrition
Global problem
Overnutrition has surpassed
undernutrition
Worst in middle and high income
countries
Rising in low income countries
Can co-exist with undernutrition
Same country
Same household
Projected to get worse as
incomes rise
Industrial food
High in calories
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55. Overnutrition
Consumption of too
many calories
Obesity
Medical problems
Heart disease
Diabetes
Cancer
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