This document discusses several key nutritional disorders that are important public health issues. It defines nutrition and the importance of nutrients for health. Micronutrients and macronutrients are classified. Protein-energy malnutrition (PEM), vitamin A deficiency, iodine deficiency disorder, and nutritional anemia are identified as major nutritional disorders of public health importance due to their wide spread prevalence and impact on vulnerable groups like women and children. The document outlines the causes, effects, and strategies for preventing each of these disorders.

1. NUTRITIONAL DISORDERS OF
PUBLIC HEALTH IMPORTANCE
Malimu EZ
KIU

2. DEFINITIONS
• Nutrition
• Scientific understanding of how food works in
the body

3. Importance of food (nutrients)
• Food and health
– Necessary for body function
– Source of energy: carbohydrates and fats
– Body building and repair: proteins
– Regulation: vitamins
– Pleasure
• Food and infections
– Prevention
– Healing
• Food and environment
– 10-20 metric tones per person

4. Group of nutrients
• Macronutrients (needed in large amounts)
– Carbohydrates
– Fats
– Proteins
• Micronutrients (trace amounts)
– Vitamins
– Minerals

5. Classification of nutritional disorders
• Macronutrient deficiencies
– Under-nutrition (inadequate, malabsorption,
abnormal systemic loss of nutrients due to diarrhea,
hemorrhage, renal failure, excessive sweating,
infection, drug addiction)
– PEM
• Kwashiorkor
• Marasmus
• Marasmus-kwashiorkor
– Over-nutrition (over-eating, insufficient exercise,
over-prescription of therapeutic diets)

6. • Macronutrient deficiencies
– Vitamin A def (VAD)
– Iodine deficiency disorder (IDD)
– Iron Deficiency Anaemia
• Other minor deficiencies
– Niacin, vitamin B1, C, D, zinc excess of flourine
(flourosis)

7. Nutritional disorders of PH importance
• PEM (def of carbohydrates, fats and proteins)
• Vitamin A deficiency
• Iodine Deficiency Disorder
• Nutritional anaemia

8. Why PH importance?
• They have a wide spread prevalence
• They have an enormous burden of disability
• Have a staggering cost to the society
• Affect vulnerable groups or population
segments

9. PEM
• Commonest nutritional problem in developing
countries
• Results from consumption of inadequate food
and frequently aggravated by infections
• Possible etiological factors in Africa:
– Shortage of calories and protein
– Inadequate breast feeding
– Ignorance
– Superstition
– Cultural taboos

10. PEM contd…
• Underfives mostly affected
– Increases their risk of morbidity and mortality
– Related to impaired mental development
• Known risk factors:
– Non-exclusive breast feeding for the first 6
months of life
– HIV/AIDS, diarrheal diseases and food diversity
and availability

11. Micronutrient deficiencies
• Insufficient intake- vitamin A, iron and iodine
• Mild/moderate forms-not always recognized
• Often referred to as “hidden hunger”
• Most commonly reported deficiencies in both
adults and children are:
– Iron
– Vitamin
– Iodine deficiency

12. • All three are highly prevalent in Tanzania
• Affect the health and survival of more than 2
billion people world wide
• Most at risk- women and children

13. Vitamin A deficiency
• Vitamin A (retinol) is fat soluble
• Found mainly in fish, liver oils, liver egg yolks,
butter, green leafy and yellow vegetables
• Most are stored in the liver if they are in
excess

14. • VAD is a major PH problem:
– Main cause of preventable childhood blindness
– Increases risk of mortality and morbidity

15. • Contributing factors
– Low intake of Vitamin A intake
– Vitamin A deficient mothers-low Vitamin A in
breast milk
– High demand during infection
– High losses during diarrhea

16. • WHO classifies VAD in Tanzania as a clinical
health problem
– Country wide an estimated 10,000 children are
likely to suffer from VAD
– Common in areas with little access to Vitamin A
rich foods

17. Strategies to combat VAD
(WHO/UNICEF)
• Food fortification
• Supplementation
• Dietary diversification
Public health measures
All approaches are complementary and should not be used in isolation

18. Complementary PH measures
• IMCI- Intergrated Management of Childhood
lllinesses
• Immunization (EPI)
• Safe motherhood initiative
• Improve malnutrition and other micronutrient
deficiencies- (iron, iodine)
• Promotion of breast feeding
• Improve water and sanitation
• Poverty alleviation programmes

19. Iodine deficiency
• Iodine is present in minute amounts in the body
• Essential for synthesis of thyroid hormone
• Deficiency causes a spectrum of disorders-IDDs-
are a world wide PH problem
• Affects 7% of the worlds population
• Children and pregnant women- most susceptible
• Impairs brain development- low IQ
– 1st
preventable brain damage problem

20. Effect of ID
• Goitre- most common visible effect
• Severe ID- cretinism which is manifested by
irreversible mental retardation
– Can only be prevented by adequate intake of
iodine during pregnancy

21. Prevention and control of IDDs
• Supplementation with iodized oil
• Food fortification
– SALT-recommend food vehicle for iodization (others-
bread, milk, water)
– Consumed by everyone
– Production is generally centralized
– Iodization is easy to implement-reasonable cost
– Color, taste and odour of salt are not affected
– Salt quality can be easily monitored at production,
retail and household level (using field tests)

22. • Recommended level of iodine in salt is 20-40
mg/iodine/kg salt assuming:
– 20% loss-production point household
– 20% loss during cooking
• For programme to be sustainable- salt intake
of 10 g/person/day

23. Iron Deficiency Anaemia
• The most common form of anaemia
• Affects about 20% of children, 50% of
pregnant women and 3% of men
• A prevalent public health problem
• The most widespread nutritional disorder in
Tanzania
• Increases the risk of poor pregnancy outcome
prematurity, LBW and maternal mortality

24. Control of IDA
• Food diversification:
– Nutrition education, cultivation of iron-rich foods
and vegetables
• Food fortification:
– Cereal flour-wheat and maize
• Supplementation:
– FeFo to pregnant mothers
• Public health measures:
– De-worm school children