Nutritional problems 2
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This document discusses various nutritional problems including protein-energy malnutrition, micronutrient deficiencies, and eating disorders. Protein-energy malnutrition manifests as kwashiorkor or marasmus depending on whether there is edema or wasting. Common micronutrient deficiencies in India are vitamin A deficiency which can cause blindness, and anemia. Prevention strategies include breastfeeding, immunization, supplementation, and food fortification. The document provides details on the causes, risk groups, clinical features and management of various nutritional problems.
Nutritional problems 2
- 1. NUTRITIONAL PROBLEMS Neethu liza jose Msc nursing
- 2. 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.
- 3. • 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.
- 4. • 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
- 6. NUTRITION PROBLEMS IN INDIA WHO IS AT RISK?? PREGNANT WOMEN LACTATING WOMEN INFANTS PRESCHOOL CHILDREN ADOLESCENT GIRLS ELDERLY . Vijayaraghavan
- 7. 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
- 8. PROTEIN ENERGY MALNUTRITION PEM KWASHIORKOR MARASMUS MARASMIC - KWASHIORKOR
- 9. CAUSES AND RISK FACTORS Inadequate intake of food Diarrhea Respiratory infections Measles Intestinal worms Infants and pre schoolers CONTRIBUTORY FACTORS Poor envt. Hygiene Large family size Poor maternal health Failure of lactation Premature termination of breast feeding Delayed supplementary feeding Use of over diluted cow’s milk
- 10. 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.
- 11. 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.
- 12. 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
- 13. KWASHIORKOR AND MARASMUS – A COMPARATIVE CHART KWASHIORKOR Acute illness/infections, measles, AGE, trauma, sepsis are some causes Protein is principal nutrient 18 months to 3 years Rapid, acute onset Some weight loss High mortality MARASMUS Severe prolonged starvation, chronic/recurring infections Calories and protein are principal nutrients 6 months to 2 years Chronic, slow onset Severe weight loss Low mortality unless related to underlying disease condition
- 15. COMPARISON OF CLINICAL FEATURES KWASHIORKOR Edema, pot belly, swollen legs Mild to moderate growth retardation Weight masked by edema Low subcutaneous fat Muscle atrophy Round face (moon face) Dry, flaky peeling skin Thin dry easily plucked hair Enlarged liver Xerophthalmia Anemia, diarrhea, infection MARASMUS No edema Weight loss upto 40% Severe growth failure Severe emaciation Severe loss of subcut fat Severe muscle atrophy Wrinkled face (old man’s face) Rare skin changes Common hair changes Mildly enlarged liver Anemia, diarrhea, infection
- 17. ASSESSMENT OF PEM Gomez Classification • Weight for age (%) = Weight of child 100 Wt. of normal child of same age Between 90 – 110%Normal Nutritional Status Between 75 – 89% Mild malnutrition (1st degree) Between 60 – 74% Moderate Malnutrition (2nd degree) Under 60% Severe Malnutrition (3rd degree)
- 18. WEIGH CALCULATION FORMULAE • Infant – Weight (Kg) = Age in months + 9 2 • Pre schooler – Weight (Kg) = 2 x (Age in years) + 5
- 19. 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
- 20. 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.
- 21. RISK FACTORS o Maternal malnutrition o Anemia CAUSES o Illness/infections o Short maternal stature o Very young age o High parity o Close birth intervals o IUGR o Hard physical labor during pregnancy o Smoking
- 22. LOW BIRTH WEIGHT PRE TERM BABIES SGA BABIES SPONTANEOUS PRE TERM BIRTH PROVIDER INITIATED PRE TERM BIRTH
- 23. 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
- 25. 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.
- 26. XEROPHTHALMIA Xerophthalmia i.e., dry eyes refers to all the ocular manifestations of vitamin A deficiency in man It is the most widespread and serious nutritional disorder leading to blindness
- 27. RISK FACTORS Poor SE status Faulty feeding practices Weaning PEM Infections 1-3 years CLINICAL FEATURES Corneal ulcers Softening of cornea Keratomalacia Bitot spot
- 28. 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
- 29. 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.
- 31. 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
- 33. 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
- 34. PREVENTION Estimation of Hb to assess degree of anemia Blood transfusion in severe cases of anemia (<8g/dL) Iron and folic acid supplements Food fortification with iron Changing dietary habits Control of parasites Nutritional education and awareness
- 35. 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
- 36. DISORDERS Goiter Hypothyroidism Subnormal intelligence Delayed motor milestones Mental deficiency Hearing defects Speech defects Mental retardation Neuromuscular weakness Endemic cretinism Intrauterine death
- 37. PREVENTION • Iodized salt • Iodine monitoring • Public awareness and education COMPLICATIONS • Thyrotoxicosis • Iodide goiter • Iodinism • Lymphocytic thyroiditis
- 38. ENDEMIC FLUOROSIS In many parts of the world where drinking water contains excessive amounts of fluorine (3- 5mg/L), endemic fluorosis has been observed.
- 39. 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
- 40. 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
- 41. PREVENTION • Changing the water sources • Chemical defluorination • Preventing use of fluoridated toothpaste • Fluoride supplements not prescribed for children consuming fluoridated water
- 42. 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
- 43. STAGES OF LATHYRISM • Latent stage • No stick stage • One stick stage • Two stick stage • Crawler stage
- 44. INTERVENTIONS • Vitamin C prophylaxis • Banning the crop • Removal of toxin • Education and awareness • Genetic approach – producing low toxin variety of crop • Socio economic changes
- 45. 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
- 46. CHRONIC DISEASES
- 47. 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
- 48. 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.
- 51. EATING DISORDERS
- 52. 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.
- 53. 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.
- 54. 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
- 55. • 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