MALNUTRITION

Presented By:Sabita Paudel B.Sc Nursing 3rd Year BPKIHS,Dharan

WHAT IS MALNUTRITION?
Malnutrition is:
poor nutrition due to an insufficient, 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.

WHO 2009. Global health risks: mortality and burden of disease attributable to selected major risks.

CHILD MORTALITY
The major contributing factors are:
Diarrhea 20% ARI 20% Perinatal causes 18% Measles 07% Malaria 05% 55% of the total have malnutrition

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

WHAT CAUSES MALNUTRITION?

(continued)

Malnutrition also occurs when there is an imbalance of energy and protein in an individuals 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.

PRECIPITATING FACTORS
LACK OF FOOD (famine, poverty) INADEQUATE BREAST FEEDING WRONG CONCEPTS ABOUT NUTRITION DIARRHOEA & MALABSORPTION INFECTIONS (worms, measles, T.B)

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.

CLASSIFICATION
A. CLINICAL ( WELLCOME )
Parameter: weight for age + oedema Reference tandard (50th percentile) Grades:
80-60 % without oedema is under weight 80-60% with oedema is Kwashiorkor < 60 % with oedema is Marasmus-Kwash < 60 % without oedema is Marasmus

CLASSIFICATION (2)
B. COMMUNITY (GOMEZ) Parameter: weight for age Reference standard (50th percentile) WHO chart Grades:
I II III (Mild) : 90-70 (Moderate): 70-60 (Severe) : < 60

BUT DO YOU KNOW THE NUMBER ONE FACTOR THAT CAUSES MALNUTRITION?

POVERTY!

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).

Kwashiokor/Marasmus
Kwashiokor, which means disease of the displaced child in the Ga language of Ghana is a protein deficiency which results is characterized by inability to gain weight, diarrhea, lethargy and a swollen belly. Kwashiokor can lead to comatose as well as death. Similarly, Marasmus is a disease resulting from protein deficiency which affects chidlren early in life (typically in the 1st year) slowing growth, decreasing weight and hindering proper development. Nutrition supplements, rehydration and education all can all serve to cure and prevent these diseases.

KWASHIWORKER This disease is caused by the deficiency of protein in the diet of child. It occurs in children in the age group 1-5 years.

MARASMUS This disease is caused by deficiency of protein as well as energy nutrients (that is carbohydrates and fats) in the diet Marasmus occurs in children below the age of 1 year.

The disease is more common in villages where This disease is more common in towns and there is small gap period between successive cities where breast-feeding in discontinued pregnancies quite early. In this disease, swelling of body is observed due to retention of fluids. Wasting of muscles is not evident No swelling of body takes place in Marasmus. .In Marasmus, wasting of muscles is quite evident. The child is reduced to skin and bones. .Skin does not change color and does not break.

Skin changes color and become broken and scaly.

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 pork, beef and whole grain (unrefined) breads and grains.

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.

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 dont have proper access to sources of vitamin C. Namely, the poor.

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.

Infant Nutritional Status

Influenced by
Inadequate feeding Frequent infections Inadequate food Health Care
Defined as the behaviors and practices of caregivers to provide the food, health care, stimulation, and emotional support necessary for childrens health growth and development

Why Malnutrition Sets in

Poor feeding practices during first year like

Delayed start of breastfeeding

Lack of exclusive breastfeeding for first six months Increasing bottle- feeding/artificial feeding Delayed or early start of solid complementary feeding.

Breastfeeding and Infant Nutritional Status

Babies who breast feed usually have better nutritional status than those who do not
Infant does not compete with food supply for family Breast milk is a clean food supply Breast milk has immunologic benefits so decreases disease in this way, too

Diagnosis of Acute Malnutrition

Anthropometric Measurement Techniques Interpretation of Anthropometric Indicators Decision-making at a glance

Decision Chart for the Implementation of Selective Feeding Programmes (WHO, 2000/
Food availability at household Unsatisfactory situation: level <2100kcal/person/day. Malnutrition rate* 15% or more Serious situation: or 10-14% with aggravating General rations (unless situation is factors. Improve general rations until local food availability and access can be made adequate. .** limited to vulnerable groups); plus Supplementary feeding generalised for all members of vulnerable groups, especially children and pregnant and lactating women; Therapeutic feeding for severely acutely malnourished individuals No general rations; but Supplementary feeding targeted to individuals identified as malnourished in vulnerable groups; Therapeutic feeding for severely acutely malnourished individuals.

Malnutrition rate 10-14% or Risky situation: 5-9% with aggravating factors.

Malnutrition rate under 10% Acceptable situation: with no aggravating factors.

Acceptable situation: with no aggravating factors. No need for population interventions; Attention to malnourished individuals through regular community services

Priority health and nutrition interventions under 2 years

Vit A ORS/Diarrhoea Immunizations

1 2

3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Complementary Feeding and Continued Breastfeeding Exclusive Breastfeeding

30% 37%

50%

Babies die here

Malnutrition accelerates here

Supplementary Food

Breastfeeding is everyone's yet no ones responsibility

Appropriate Complementary Feeding

Timely: Additional food introduced when need for energy and nutrients exceeds that provided by BF Adequate: Should provide sufficient energy, protein, and micronutrients Properly Fed: Active feeding method and proper frequency according to age Safe: Should be hygienically prepared, stored and fed

Complications of P.E.M
Hypoglycemia Hypothermia Hypokalemia Hyponatremia Heart failure Dehydration & shock Infections (bacterial, viral & thrush)

TREATMENT
Correction of water & electrolyte imbalance Treat infection & worm infestations Dietary support: 3-4 g protein & 200 Cal /kg body wt/day + vitamins & minerals Prevention of hypothermia Counsel parents & plan future care including immunization & diet supplements

KEY POINT FEEDING

Continue breast feeding Add frequent small feeds Use liquid diet Give vitamin A & folic acid on admission With diarrhea use lactose-free or soya bean formula