MalnutritionMalnutrition

SupervisionProf. Dr.Mervat Salah

By the end of this lecture, By the end of this lecture, students will be able to :students will be able to :

Define malnutrition and identify its formsDefine malnutrition and identify its forms Understand the physical findings of malnutritionUnderstand the physical findings of malnutrition Understand how malnutrition affects the bodyUnderstand how malnutrition affects the body Identify some tips for managing an individual Identify some tips for managing an individual

with malnutritionwith malnutrition Develop awareness of refeeding syndromeDevelop awareness of refeeding syndrome Identify some of the complications associated Identify some of the complications associated

with malnutritionwith malnutrition

WHAT IS MALNUTRITION?WHAT IS MALNUTRITION?

Malnutrition is:Malnutrition is: poor nutrition due to an insufficient, poor nutrition due to an insufficient,

poorly balanced diet, faulty digestion poorly balanced diet, faulty digestion or poor utilization of foods. (This can or poor utilization of foods. (This can result in the inability to absorb foods.)result in the inability to absorb foods.)

Malnutrition is not only Malnutrition is not only insufficientinsufficient intake of nutrients. It can occur when intake of nutrients. It can occur when an individual is getting an individual is getting excessiveexcessive nutrients as well. nutrients as well.

WHAT IS MALNUTRITION?WHAT IS MALNUTRITION?

Malnutrition is caused by an inadequate Malnutrition is caused by an inadequate availability of nutrients, because of either availability of nutrients, because of either poor intake or deficiency as a result of poor intake or deficiency as a result of disease.disease.

It results from inadequate consumption, It results from inadequate consumption, poor absorption, or excessive loss of poor absorption, or excessive loss of nutrientsnutrients

WHAT CAUSES WHAT CAUSES MALNUTRITION?MALNUTRITION?

Human beings need Human beings need a wide variety of a wide variety of nutrients to supply nutrients to supply essential energy. Do essential energy. Do you know what you know what nutrients we need?nutrients we need?

proteinprotein vitamins vitamins mineralsminerals

If any one of these If any one of these nutrients is deficient nutrients is deficient in a person's diet, in a person's diet, he/she may suffer he/she may suffer from malnutritionfrom malnutrition

WHAT CAUSES WHAT CAUSES MALNUTRITION?MALNUTRITION?

(continued)(continued)

Malnutrition also occurs when there Malnutrition also occurs when there is an imbalance of energy and protein is an imbalance of energy and protein in an individual’s diet. The body may in an individual’s diet. The body may become unable to absorb the become unable to absorb the nutrients it requires to function nutrients it requires to function properly.properly.

**For example, if a child is suffering from For example, if a child is suffering from energy and protein malnutrition, they will energy and protein malnutrition, they will most likely have deficiencies in iron, most likely have deficiencies in iron, calcium, and other vitamins and minerals.calcium, and other vitamins and minerals.

WHO IS AFFECTED BY WHO IS AFFECTED BY MALNUTRITION?MALNUTRITION?

Individuals who are dependent on others Individuals who are dependent on others for their nourishment. (infants, children, for their nourishment. (infants, children, the elderly, prisoners)the elderly, prisoners)

Mentally disabled or ill because they are Mentally disabled or ill because they are not aware of what to eat.not aware of what to eat.

People who are suffering from People who are suffering from tuberculosis, eating disorders, HIV/AIDS, tuberculosis, eating disorders, HIV/AIDS, cancer, or who have undergone surgical cancer, or who have undergone surgical procedures are susceptible to procedures are susceptible to interferences with appetite or food uptake interferences with appetite or food uptake which can lead to malnutrition.which can lead to malnutrition.

BUT DO YOU KNOW THE BUT DO YOU KNOW THE NUMBER ONE FACTOR THAT NUMBER ONE FACTOR THAT

CAUSES MALNUTRITION?CAUSES MALNUTRITION?

POVERTY!

POVERTY…POVERTY…

Nearly 3 billion people in the world are living on Nearly 3 billion people in the world are living on less than $1 a day. They have little access to less than $1 a day. They have little access to their basic needs, including adequate nutrition to their basic needs, including adequate nutrition to help their bodies stay in balance. Poverty may help their bodies stay in balance. Poverty may also prevent individuals from accessing also prevent individuals from accessing education, which can lead to misinformation education, which can lead to misinformation about adequate nutrition.about adequate nutrition.

Effects of malnutritionEffects of malnutrition

Nutritional deficiencies can contribute Nutritional deficiencies can contribute to various diseases which can be to various diseases which can be found everywhere, but most often go found everywhere, but most often go without cures/treatment in Less without cures/treatment in Less Developed Countries (LDCs).Developed Countries (LDCs).

How Malnutrition Affects the How Malnutrition Affects the BodyBody

Digestive system: Decreased production of Digestive system: Decreased production of HCL,and frequent diarrhea that could be fatal.HCL,and frequent diarrhea that could be fatal.

Cardiovascular system: Reduced heart size, Cardiovascular system: Reduced heart size, reduced amount of blood pumped, bradycardia, reduced amount of blood pumped, bradycardia, and heart failure.and heart failure.

Respiratory system: Slow breathing, reduced lung Respiratory system: Slow breathing, reduced lung capacity, and, ultimately, respiratory failure.capacity, and, ultimately, respiratory failure.

Reproductive system: Reduced size of ovaries and Reproductive system: Reduced size of ovaries and testes, loss of libido, cessation of menstruation.testes, loss of libido, cessation of menstruation.

Nervous system: Apathy and irritability, mental retardation in children sometimes, mental dysfunction in older people.Muscles: Reduced muscle mass and strength and reduced ability to exercise or work.Blood: AnaemiaMetabolism: Hypothermia, fluid accumulation in arms, legs, and abdomen, and disappearance of subcutaneous fat.Skin and hair: As in slide 8Immune system: Impaired ability to fight infections and repair wounds

Physical Findings ofMalnutritionPhysical Findings ofMalnutritionHair that is dull, brittle, dry, or falls out easilySwollen glands of the neck and cheeksDry, rough, or spotty skinPoor or delayed wound healing or soresThin appearance with lack of subcutaneous fatMuscle wasting (decreased size and strength)Edema of lower extremitiesWeakened hand graspDepressed moodAbnormal heart rhythm, or BPEnlarged liver or spleenLoss of balance and coordination

Forms of malnutritionForms of malnutrition

1.1. Macronutrient malnutrition protein-Macronutrient malnutrition protein-calorie malnutrition (PCM)calorie malnutrition (PCM)

Kwashiorkor, marasmus, and mixed marasmus-Kwashiorkor, marasmus, and mixed marasmus-kwashiorkor.kwashiorkor.

2. micronutrient2. micronutrient malnutrition malnutrition particularly vitamin A deficiency (VAD), iron particularly vitamin A deficiency (VAD), iron

deficiency anemia (IDA), and iodine deficiency deficiency anemia (IDA), and iodine deficiency disorders (IDD) disorders (IDD)

Kwashiokor/MarasmusKwashiokor/Marasmus Kwashiokor, which means “disease of the displaced Kwashiokor, which means “disease of the displaced

child” in the Ga language of Ghana is a protein child” in the Ga language of Ghana is a protein deficiency which results is characterized by deficiency which results is characterized by inability to gain weight, diarrhea, lethargy and a inability to gain weight, diarrhea, lethargy and a swollen belly. Kwashiokor can lead to comatose as swollen belly. Kwashiokor can lead to comatose as well as death.well as death.

Similarly, Marasmus is a disease resulting from Similarly, Marasmus is a disease resulting from protein deficiency which affects children early in protein deficiency which affects children early in life (typically in the 1life (typically in the 1stst year) slowing growth, year) slowing growth, decreasing weight and hindering proper decreasing weight and hindering proper development.development.

Nutrition supplements, rehydration and education Nutrition supplements, rehydration and education all can all serve to cure and prevent these all can all serve to cure and prevent these diseases.diseases.

KwashiorkorKwashiorkor Kwashiorkor results from inadequate protein Kwashiorkor results from inadequate protein

intake or may be precipitated by an illness, intake or may be precipitated by an illness, such as measles. such as measles.

Patients appear well nourished or over Patients appear well nourished or over nourished because of edema.nourished because of edema.

Treatment is mainly to correct protein Treatment is mainly to correct protein deficiency by giving 2.5-3.0 gm/kg/daydeficiency by giving 2.5-3.0 gm/kg/day

MarasmusMarasmus Marasmus results from chronic deprivation or Marasmus results from chronic deprivation or

impaired absorption of energy, protein, vitamins, impaired absorption of energy, protein, vitamins, and minerals. For example, patients with cancer and minerals. For example, patients with cancer may experience gradual wasting. may experience gradual wasting.

Patients with marasmus present with severe weight Patients with marasmus present with severe weight loss and wasting of both muscle and adipose tissue. loss and wasting of both muscle and adipose tissue.

Initial treatment of marasmus may consist of IV or Initial treatment of marasmus may consist of IV or oral glucose followed by liquids. Multivitamins oral glucose followed by liquids. Multivitamins and mineral supplements may be indicatedand mineral supplements may be indicated

Mixed Marasmus-KwashiorkorMixed Marasmus-Kwashiorkor

This condition develops in This condition develops in chronically starved patients who chronically starved patients who experience stress (surgery, trauma).experience stress (surgery, trauma).

Patients may have edema that masks Patients may have edema that masks wasted appearance.wasted appearance.

Anthropometric measurements and Anthropometric measurements and proteins are depletedproteins are depleted

Nutrition supplements, rehydration and education all can all serve to cure and prevent these diseases.

BeriberiBeriberi Beriberi is a thiamine (vitamin B1) deficiency Beriberi is a thiamine (vitamin B1) deficiency

which is common in South East Asia where many which is common in South East Asia where many diets consist solely of white rice. diets consist solely of white rice.

Beriberi affects the proper functioning of the Beriberi affects the proper functioning of the nervous system as well as the circulatory system nervous system as well as the circulatory system and heart.and heart.

Pregnancy, breast feeding mothers and those Pregnancy, breast feeding mothers and those who are ill with fever may have a heightened who are ill with fever may have a heightened dependency on thiamine and may develop a dependency on thiamine and may develop a deficiency.deficiency.

Thiamine is best acquired through foods such as Thiamine is best acquired through foods such as pork, beef and whole grain (unrefined) breads pork, beef and whole grain (unrefined) breads and grains.and grains.

PellagraPellagra

Pellagra ”rough skin” is a niacin (or Pellagra ”rough skin” is a niacin (or Tryptophan) deficiency which often Tryptophan) deficiency which often results in the “3 Ds”; diarrhea, results in the “3 Ds”; diarrhea, dementia and dermatitis. dementia and dermatitis.

The large scale consumption of corn The large scale consumption of corn has resulted in many cases of pellagra has resulted in many cases of pellagra because corn is poorly absorbed in because corn is poorly absorbed in the body. The best sources of Niacin the body. The best sources of Niacin are broccoli, eggs, dates, beef, are broccoli, eggs, dates, beef, salmon, seeds and peanuts.salmon, seeds and peanuts.

ScurvyScurvy

Scurvy is a disease which is born of Scurvy is a disease which is born of Vitamin C deficiency. It is Vitamin C deficiency. It is characterized by bleeding around characterized by bleeding around hair follicles, anemia and gingivitis. hair follicles, anemia and gingivitis.

Scurvy may occur in those who Scurvy may occur in those who consume large amounts of junk consume large amounts of junk foods, smokers (as smoking depletes foods, smokers (as smoking depletes Vitamin C) and those who don’t have Vitamin C) and those who don’t have proper access to sources of vitamin proper access to sources of vitamin C. Namely, the poor.C. Namely, the poor.

RicketsRickets

Vitamin D deficiencies may result in Vitamin D deficiencies may result in “Rickets” which is a lack of proper “Rickets” which is a lack of proper calcium characterized by poorly calcium characterized by poorly developed and deformed bones. developed and deformed bones.

Vitamin D can be best found in beef Vitamin D can be best found in beef products (especially cows milk) but is very products (especially cows milk) but is very low in breast milk. Thus, women in low in breast milk. Thus, women in developing countries are contributing to developing countries are contributing to this disease if their babies sole source of this disease if their babies sole source of nourishment is breast milk.nourishment is breast milk.

Assignment Hadeer kamal abo bakr in deficiency of

iron Nourhan Ashraf in deficiency of calcium Soha Hesham Badr in deficiency of zinc

Recommended text bookRecommended text book

Manual dietetic bookManual dietetic book