MALNUTRITION

AS HEALTH PROBLEMS

M. NAZIR HZ
DEPARTEMENT OF CHILD HEALTH
FACULTY OF MEDICINE, SRIWIJAYA UNIVERSITY

NUTRITION PROBLEMS IN INDONESIA (1)

1. MACRONUTRIENT DEFICIENCY
1. PROTEIN ENERGY MALNUTRION
2. MICRONUTRIENT DEFICIENCY
2.1.VITAMIN A DEFICIENCY
2.2. NUTRITIONAL ANEMIA / IDA (IRON
DEFICIENCY ANEMIA)
2.3. JODIUM DEFICIENCY
3. OVER NUTRITION (OBESITY)

NUTRITION PROBLEMS IN INDONESIA (2)

a.
b.
c.
d.
e.
f.

STUNTED < 5 YEAR 36.8%

CHRONIC MALNUTR.
PREVALENCY OF ACUTE WASTED 13.6%
ACUTE
MALNUTRITION
PREVALENCY OF LBW 11.7%
PREGNANT WOMEN
MALNUTRITION
HIGH PREVALENT OF MICRONUT DEF: NUTRITIONAL
ANEMIA, JODIUM DEF AND DEFICIENCY OF VIT. A
PREVALENCY OF OBESITY INCREASE
RE-EMERGING OF INFECTION : TBC, HIV

NUTRITIONAL ANEMIA - IDA

Prevalency
Age Group

1995

Adolscent girl (15-19 th)

57,1%

26,5%

Pregnant

50,9%

40,1%

< 5 years

40,5%

47,0%

School age

47,2%

Survei Kesehatan Rumah Tangga (SKRT)

2001

Deficiency of Vitamin A
1. 50% (10 million) of under 5 years suffered subclinical
vitamin A deficiency (serum retinol < 20 g/L)
2. 0,33% (66.000) of under 5 years with Xeroptalmia
(bitots spot).
3. > 0,50% : Community health problem (WHO)

Survei Vitamin A (Suvita), 1992

5

JODIUM DEFICIENCY (GOITER)

45% Districts endemic:

30% mild
7 % moderate
8 % severe
87 milion people lives in endemic area
(prevalency 9.8%)
(mapping GAKY, 1998)

Prevalency Jod deficiency 11.1 %

(Survei GAKY, 2003)

OVER NUTRITION
o
o
o
o

ADULT IMT

(> 27 kg/m) 11,1%

(30 kg/m) 3,9%

(Survei IMT tahun 1997)

ADULT IMT

(Riskesdas 2007)

(> 27 kg/m) 8,8%

(30 kg/m) 10,3%

< 5 YEAR BW/A

(Susenas)

< 5 YEAR BW/BL

(>+2SD)

: 2,46% (2003)

(>+2SD)

: 3,50% (2005)
: 12,2% (2007)

(Riskesdas)

EFFECT OF MALNUTRITION
DECREASED OF IMMUNITY
INFECTION >>
SEVERE AND LONG DURATION OF ILLNESS
ALOS (AVERAGE LENGTH OF STAY) >>
POST OPERATIVE RECOVERY >>
POST OPERATIVE COMPLICATION >>
COST OF CARE >>

THE MOST COMMON CAUSES MORBIDITY AND MORTALITY

OF < 5 YEAR

Malnutrition as a main cause of child

mortality (WHO, 2000)
HIV

others
Diarrhe
29%
malnutritiona 28%
(underlying
factor)
Malaria
>50%
RTI
15%

7%
woughing
cough
4 Tetanus
Neonatus
%
6%
Measle

4
%

Diarrhea
12%

others
28%
malnutrition
(underlying factor)
60%

RTI
20%

s 11%
1990
Protecting the Worlds Children, A Call for Action, 1990;
Evidence and information for Policy/WHO, Child Adolescent Health and
Development, 2001
WHO, Child and Adolescent Health and Development. On line
www.who.int/child-adolescent-health/inegr.htm

Malaria
8%

Perinata
l
22%
measles
5%

2000

THE PREDISPOSSING FACTORS

1.
2.
3.
4.
5.
6.
7.

SOCIAL, ECONOMIC AND CULTURAL

CHRONIC INFECTION
MALABSORPTION
PERSISTENT/ CHRONIC DIARRHEA
CONGENITAL DISORDER
MALIGNANCY
IMMUNITY DISORDER

THE PATHOGENESIS AND THEIR HEALTH IMPACT

CATABOLISM

DECREASED
INTAKE

PREDISPOSSING
FACTORS

ORGAN ATROPHY
ORGAN DISFUNCTION
DECREASED IMMUNITY

SYMPTOM S OF
ORGAN DIFUNCTION/
INFECTION

HOSPITALIZED

PNEUMONIA
DIARRHEA
SYMPTOMS
OF DEF. MACRO/
MICRO NUTR
COMPLEXS

Epithelial cell intestine atrophy

Absorption and digestion disorder

Fatty liver

liver function disorder

* synthesis
* secretion
* excretion
* detoxification

Infection

PEM
anorexia
intake <<

immunity

Macro/Micronut. def
PEM

Reccurent infection

Helminthiasis

diarrhea

Vitamin A deficiency

Nutritional anemia/
Iron deficiency anemia (IDA)

pneumonia
Lung tuberculose

NUTRITIONAL
DEFECIENCY
CAUSES OF PROBLEMS

The State of the World Children , UNICEF, 1998

18

GROWTH AND DEVELOPMENT

MONITORING

GROWTH AND DEVELOPMENT CHART

21
Sumber: materi pelatihan pemantauan pertumbuhan, Dit. Bina Gizi Masyarakat

Body weight: Increase (N1= Catch up growth)

Body weight: Increase (N2= normal growth)

Body weight: Not increase

(T1=unappropriate growth)

24

Body weight: not increase

(T2= not growing)

25

Body weight not increase

(T3=Negatif growth)

26

KMS

WHO 2005, BW/A

Boy 0-24 months

Girl 0-24 months

Boy 24-59 months

Girl 59 months

NUTRITION ASSESSEMENT

1. Analysis of intake/day:
food recall, food freq
quantity and quality
calori/ prot/ fat/ vit & mineral
RDA
2. Anthropometry:
a. Measure
: BW (kg) L/Ht (Cm) Age (y/m)
b. Index : BW/A
L-Ht/A
BW/L-Ht
c. Standart
: NCHS/ WHO, 50 %-ile =100%
d. Local Stand: Lokakarya antropometri 1975
3. Clinical finding : a. Marasmus, Kwashiorkor, M-K
b. Deficiency
4. Biochemistry/ laboratorium:

Anthropometry:
1. Age
: BW/A, Ht-L/A, MUAC/A
2. Usia (-) : BW/L-Ht, MUAC/L-Ht
3. Combine:
Waterloo (2 index): BW/L-Ht, BW/A
WHO (3 index)
: BW/L-Ht, BW/A,
L-Ht/A
4. Anthropometric index, clinical finding, Lab
Wellcome trust
Mc Laren
5. BMI (Body Mass Index): BW (Kg)
Ht (Cm)2

PEM Classification (lokakarya 1975, Puslitbang Gizi 1978)

Category

BW/A

N
Mild
Severe

100-80
<80-60
<60

L-Ht/A
100-95
<95-85
<85

Classification (BW/BL-Ht):
>150%
: Severe Obesity
135-150%: Moderate Obesity
120-135%: Mild Obesity
>120%
: Obesity
110-120%: Over nutrition

MUAC/A BW/L-Ht
100-85
<85-70
<70

90-110%
70-90%
<70%

LLA/L-Ht

100-90
<90-70
<70

: Normal
: Mild
: Severe

100-85
<85-70
<70

NUTRITION DISORDER BASED ON

ANTHROPEMETRIC MEASUREMENT

WASTED

(ACUTE MALNUTRITION)

BW/A <<<
BL/A N
BW/BL <<<

STUNTED
WASTED

BW/A N
BL/A N
BW/BL N

STUNTED

(CHRONIC AND ACUTE

MALNUTRITION)

BW/A
BL/A
BW/BL

NORMAL

<<<
<<<
<<<

BW

(CHRONIC MALNUTRITION)

BW/A
BL/A
BW/BL

N/>
<<<
N/>>

WHO CDC 2000

OK135S056

Growth Chart WHO 2005

Girl 11 months
BW 9 kg, L 73 cm
Normal nutritional status
( 50th)
Normal 3rd - 97th

Girl 11 months
BW 9 kg, L 73 cm
Normal nutritional status
Z score Median
Normal + 2 SD

B
A

A: 2 th: BW/A
Ht/A
BW/Ht
B: 4 th: BW/A
Ht/A
BW/Ht
C: 5 th: BW/A
Ht/A
BW/Ht

:
:
:
:
:
:
:
:
:

N
N
N
N
N
N
Mild
Mild
N
Stunted