Malnutrition

SupervisionProf. Dr.Mervat Salah

Malnutrition of Children Eradication of

poverty and hunger

Intended Learning Outcomes

- By the end of this lecture, students will

have a general overview on malnutrition in

children.

Definition of malnutrition

”People are malnourished if their diet does not provide adequate calories and protein for growth and maintenance or they are unable to fully utilize the food they eat due to illness (undernutrition). They are also malnourished if they consume too many calories (overnutrition).” (Unicef)

Malnutrition

”Malnutrition is a contributing factor in over 50% of deaths in children under five”World Bank

Population Density of Underweight Children(UN)

MUACMid Upper Arm Circumferance

SAM <110mm

Children 6m-5yrsMeasures Acute

malnutrtion

Measure of acute malnutrition

W/H

WASTING

SAM <70% W/H (<-3 Z-scores)

MAM 70-79% W/H(<-2 and >= -3 Z-scores)

Measuring Chronic Malnutrition

H/A

STUNTING<90% of median

Growth of Children <5 years

”all children, regardless of ethnic background or regional origin, grow similarly when their needs are met.”(MGRS)

WHO

NCHS 1978 Child Growth References

• Measures made 1960-75• American Children- geographically

restricted area.• With formula milk• High socioeconomic background

WHO 2006 Child Growth Standards 1997-2003

de Onis et al. 2004 MDGR

Causes of Malnutrition

Malnutrition/Death

Inadequate dietary intake Disesase

InsufficientHousehold food

MANIFESTATIONS

IMMEDIATECAUSES

UNDERLYINGCAUSES

BASIC CAUSES

Political and Economical powers

Inadequate Maternal Childcare

Insufficient HealthServices/Unhealthy

Environment

Modified from UNICEF 1998

Severe MalnutritionW/H <70% or bilateral oedema

Impaired immune system and electrolyte inbalance

Kwashiorkor

Marasmus

Kwashiorkor• 2-4yrs• Comes suddenly after some time

of Moderate Malnutrition• Low protein intake• HÖG MORTALITET!

http://www.asnom.org/image/510_nutrition/116_327_kwashiorkor.jpg

Symtoms:• Bilateral Oedema•Apathy•Depigmented corse hair, easy to pull.• Skin lesions•Poor aptetite•Diarrhoea

Marasmus•1st year of life, often failure to breastfeed.

•Lack of proteins and calories.

•Body creates energy by dissolving its own tissues Loss of subcutanous fat and muscles.

Symtoms: •Wasting W/H <70%•Face o an old person•Pot belly due to lack of abd. muscles.•Anorexia, irritability.•Hunger

The evil cycle of Malnutrition

Adapted from Andrew Tomkins and Fiona Watson, Malnutrition and Infection, ACC/SCN, Geneva, 1989 , State of the World’s Children 1998

Apetite lossNutrient LossMalabsorbtion

Altered metabolism

Disease:Incidence SeverityDuration

Inadequate Dietary Intake

Weight lossImmunity loweredGrowth faltering

Mucosa damaged

Fever as a main cause of child death in developing countries :----------------------------------------------- Fever incease in body energy use ,if the body doent get the need energy from diet the body protein and fat will be used for energy these incease the serum fatty acids and amino acids lead to increase in blood acidity which cause loss of appetite ,dehydration ,fatigue

seizures soetimes retardation and finaly DEATH

Iodine Deficiency-Most important cause of brain damage and

mental retardation, 760milj have goitre• Deficiency gives

hypothyreosis and goitre.• Stillbirth and miscarriage • Cretinism: mental retardation,

stunted, hypothyroidis, deaf-mutism.

• Lower IQ by 10-15%• Iodising salt

SOURCE: UNICEF

Source:Sea fish, sea weed,Iodized salt

5cents/person/year

Vit A Deficiency- Most important cause of blindness in developing countries • Protects skin and mucosa.

Increases leucocyte activity.• Vit A protects against death in

measles with 50% and diarrhoea with 30%.

• Vit A to newly delivered mothers protects infants <6m against infection.

• Vision: Scars on conjunctivatotal blindness. Night blindness

• Treatment lowers the child’s risk of dying by 23%!

http://www.milesresearch.com/

Bitot spots

Source:• Egg,• Liver• Butter, cow’s milk• Breast milk.• Carotene.SOURCE: UNICEF

10 cents/child/year

Vitamin A is a generic term for many related compounds. Retinol (alcohol), Retinal (aldehyde) are often called preformed vitamin A. Retinal can be converted by the body to retinoic acid which is known to affect gene transcription.

Body can convert b-carotene to retinol, thus called provitamin A.

FUNCTIONS

•Vision: integrity of eye & formation of rodopsin necessary for dark adaptation. Regulation of gene expression: vital to cell differentiation & physiologic processes

•Immunity: important for activation of T lymphocyte, maturation of WBC & integrity of physiological barrier.

•Growth & developmen

•Deficiency of vitamin A leads to:Night blindness & xerophthalmia

Growth retardation

Acquired immune deficiency

Keritinization of epithelia in RT, GIT & UT with increased risk of RTI, malabsorption & UTI.

Assignment

Hadeer kamal abo bakr

Recommended text book

Manual dietetic book