MALNUTRITION

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 MALNUTRITION: INTRODUCTION

● Malnutrition essentially means “bad nourishment”. It

concerns not enough as well as too much food, the wrong
types of food, or the inability to use nutrients properly to
maintain health.

● The World Health Organization cites malnutrition as the

greatest single threat to the world's public health.

● Malnutrition in all its forms is a considerable public health

concern and is associated with increases risk of disease and
early death.

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 MALNUTRITION: : INTRODUCTION

● The malnourished are unable to live a normal life, are less

likely to fulfill their potential as human beings and cannot
contribute fully to the development of their own countries.

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 MALNUTRITION

● The World Health Organization defines malnutrition as "the

cellular imbalance between supply of nutrients & energy and
the body's demand for them to ensure growth, maintenance,
and specific functions”.

● Malnutrition comprises both;

1. Under nutrition
2. Over nutrition

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 TYPES OF MALNUTRITION

• Under nutrition is depletion of energy (calories) resulting

form insufficient food intake over an extended period of time.

• In extreme cases under-nutrition is called Starvation. While

Famine is severe food shortage of a whole community.

● Specific Deficiency is the pathological state resulting form a

deficiency of an individual nutrient such as vitamin A
deficiency, iodine deficiency.

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 TYPES OF MALNUTRITION

● Over nutrition:

● Many tend to think malnutrition only in terms of hunger,

however, overeating is also a contributing factor.

• “Over nutrition is the pathological state resulting from the

consumption of excessive quantity of food over an extended
period of time”.

• Overweight and obesity are very common conditions in

developed society and are becoming more common in
developing societies and those in transition.
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 NUTRITIONAL DEFICIENCY DISEASES

● On global scale the five principal nutritional deficiency

diseases are:

1. Kwashiorkor (Protein Energy Deficiency)

2. Marasmus (Protein Energy Deficiency)
3. Xerophthalmia (Vitamin A Deficiency)
4. Nutritional anemia (Iron Deficiency)
5. Endemic goiter (Iodine Deficiency)

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MALNUTRITION IN CHILDREN: PROTEIN-ENERGY
MALNUTRITION

⚫ In children, protein–energy malnutrition is defined by

“measurements that fall below 2 standard deviations under
the normal weight for age (underweight), height for age
(stunting) and weight for height (wasting)”.

● Protein– energy malnutrition usually manifests early, in

children between 6 months and 2 years of age and is
associated with early weaning, delayed introduction of
complementary foods, a low-protein diet and severe or
frequent infections.

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 TYPES OF UNDERNUTRITION

UNDERNUTRITION

ACUTE CHRONIC
UNDERNUTRITION UNDERNUTRITION

• Marasmus
• kwashiorkor
• Stunting
• Marasmic-
• Underweight
kwashiorkor
• Wasting
PROTEIN-ENERGY MALNUTRITION

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KWASHIORKOR MARASMUS

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MANIFESTATIONS OF
MALNUTRITION

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 MANIFESTATIONS OF UNERNUTRITION
● Under nutrition results in the loss of body weight. The loss of
weight is a manifestation of energy depletion.

● Malnutrition from any cause retards normal growth.

Malnourished children grow up with worse health and lower
educational achievements.

● Decrease in immunity increases the susceptibility to infections

such as T.B, which add to the morbidity and mortality.

● Malnutrition is also associated with lowered vitality of the

people leading to lowered productivity and reduced life
expectancy. 16
 PEOPLE AT RISK

● Protein-energy malnutrition (PEM) occurs more commonly in

three situations:

1. In young children in poor communities, usually in developing

countries.
2. In adults, even in affluent countries, due to severe illness
(hospital malnutrition).
3. In people of all ages in a famine.

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 PEOPLE AT RISK

● Although the under nutrition affects all age groups; however

the most vulnerable groups are pregnant women, lactating
women and young children, mainly because they have a
relatively greater nutritional requirements and are more
susceptible to the harmful consequences of deficiencies.

● Under nutrition affects all age groups, but it is especially

common among the poor and those with inadequate access to
health education and to clean water and good sanitation.

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 MANIFESTATIONS OF OVERNUTRITION

● In the more developed countries of the world, over nutrition is

encountered much more frequently than under nutrition.

● The health hazards from over nutrition are:

1. Obesity,
2. Diabetes,
3. Hypertension,
4. Cardiovascular diseases,
5. Renal diseases,
6. Disorders of liver and gall bladder.

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 GLOBAL BURDEN OF MALNUTRITION

● Despite the fact that the world already produces enough food
to feed everyone — 6 billion people — and could feed the
double — 12 billion people.

● There were 925 million undernourished people in the world in

2010, an increase of 80 million since 1990.

● Nearly 17% of people in the developing world are

undernourished.

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Percentage Population Undernourished World Map 21
 GLOBAL BURDEN OF MALNUTRITION

● 1 out of 3 people in developing countries are affected by

vitamin and mineral deficiencies and therefore more subject to
infection, birth defects and impaired physical and
psycho-intellectual development.

● Under nutrition, an important part of the complex, affects

millions of people, mainly in Africa, Asia and Latin America.

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 SCOPE OF THE PROBLEM

● Directly or indirectly the concurrent vicious life cycle of

malnutrition contributes to almost 35% of the estimated 7.6
million deaths under-5 deaths; consequently affecting the
future health and socioeconomic development and productive
potential of the society.

● South Asia is the worst affected region with half of the world’s
malnourished children are to be found in just 3 countries
Bangladesh, India and Pakistan.

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 GLOBAL BURDEN OF MALNUTRITION

● This is one side of picture. 2 out of 3 overweight and obese

people now live in developed countries, the vast majority in
emerging markets and transition economies.

● Under-and over-nutrition problems and diet-related chronic

diseases account for more than half of the world's diseases and
hundreds of millions of dollars in public expenditure.

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DETERMINANTS OF
MALNUTRITION

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 INFECTION AND MALNUTRITION

● Malnutrition is primarily due to:

1. An inadequate intake of food (food gap) both in quantity and

quality.
2. Infections, particularly diarrhea, measles, intestinal worms and
respiratory infections.

● In fact it is a vicious circle – Infections make malnutrition

worse and poor nutrition increases the severity of infectious
diseases.

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 MALNUTRITION CYCLE

Inadequate dietary intake

Appetite loss Weight loss

Nutrient loss Growth flattering
Malabsorption Decreased immunity
Altered metabolism Mucosal damage

Disease: increase in incidence,

duration, severity 27
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DETERMINANATS OF MALNUTRITION
PREVENTION OF MALNUTRITION

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 PREVENTION OF MALNUTRITION

● Since malnutrition is the outcome of several factors, it requires

a coordinated approach of many disciplines at various levels;

1. Family
2. Community
3. National
4. International

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 ACTION AT FAMILY LEVEL

● The principal target of nutritional improvement in the

community is family.

● The instrument for combating malnutrition at the family level

is “Nutrition Education”.

● The community health workers can play an important role in

nutrition education to the families in their respective areas.

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 ACTION AT FAMILY LEVEL

● Nutrition education should educated family on :

1. Selection of right kind of local foods.

2. Planning of nutritionally adequate diets within limits of their
purchasing power.
3. Identification and correction of harmful food taboos & dietary
prejudice.
4. Promotion of breast feeding and adequate infant & child
feeding .
5. Consider the nutritional needs of expectant & nursing mothers
and children in the family.
6. Planning a kitchen garden or keeping poultry.
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 ACTION AT COMMUNITY LEVEL

● The solutions to malnutrition can be assisted by governments,

but in the end communities will often have the leading role in
reducing malnutrition and promoting social development.

● People's participation is essential. It is necessary to recognize

that the poor will be the principal actors in their own
development and to foster policies and programs that empower
the underprivileged.

● Empowerment and participation of women are particularly

important, because women have the most important role in
food security (and often in food production), in child care and
in family health. 34
 ACTION AT NATIONAL LEVEL

● The burden of improving the nutritional status of the people,

by and large, is the responsibility of the State.

● Prevalent malnutrition in a country is clear evidence of poor

development.

● Several approaches and strategies at the national level,

suggested by FAO/WHO are as follow:

1. Rural development
2. Increase agricultural production, distribution and storage
3. Stabilization of population
4. Nutrition related health services 35
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 ACTION AT THE INTERNATIONAL LEVEL

● Food and nutrition are global problems, and international

cooperation can play an important role in reducing the
nutrition problems worldwide.

● The multilateral World Food Program was established in 1963

as a mean of providing enough safe food to those in need and
to come to the aid of victims in acute emergencies caused by
floods, earth quick, droughts, wars, etc.

● In September 2000, the United Nations Millennium

Declaration was endorsed by 190 countries and was translated
into eight Millennium Development Goals (MDGs) to be
achieved by 2015.
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 MILLENNIUM DEVELOPMENT GOAL 1

Health Targets Health Indicators

Goal 1:
Eradicate extreme poverty and
hunger

Target 1: The proportion of people whose income is

Halve, between 1990 and 2015, the less than one dollar a day.
proportion of people who live
below poverty line

Target 2: Prevalence of underweight children under

Halve, between 1990 and 2015, the five years of age
proportion of people who suffer
from hunger Proportion of population below minimum
level of dietary energy consumption
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 CONCLUSION
● Under nutrition and malnutrition are widespread problem of
poverty and deprivation that affects millions of people,
perhaps the majority, in developing countries.

● The poor, the hungry and the malnourished are unable to live a
normal life, are less likely to fulfill their potential as human
beings and cannot contribute fully to the development of their
own countries.

● Political actions, more than political will, to implement well

conceived policies and programs at the national level, while
simultaneously acting internationally, can serve to greatly
reduce nutrition problems worldwide.
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