NUTRITION

DR. NGOZI C. EKELEME (MBBS, FWACP)

COMMUNITY MEDICINE DEPARTMENT,
GUU (AMACHARA CAMPUS)
7th November, 2023
 OUTLINE

 INTRODUCTION
 NUTRITION AND HEALTH
 CLASSES OF NUTRIENTS
 INFECTION AND NUTRITION
 EPIDEMIOLOGY AND CONTROL OF COMMON
NUTRITIONAL PROBLEMS IN NIGERIA
 MALNUTRITION; CAUSES
 CONTROL
 INTRODUCTION
 Nutrition is study of nutrients in food, how the body uses them, and the relationship between
diet, health and diseases.
 Good nutrition means getting the right amount of nutrients for the body to function
correctly.
 Food is essential to human because it provides vital nutrients for survival, and helps the
body function and stay healthy.
 The concept of quality of life is closely linked to PHD-poverty, hunger and disease.
 Therefore, adequate nutrition is required for the optimal functioning of an individual.
 The United Nations estimates the world's population will reach 9.7 billion by 2050.
 Food Security and Sustainability is imperative to feed the growing population and minimize
the effects of climate change.
 How food is grown and produced, what types of foods are consumed and how much food is
wasted have major impacts on the sustainability of the world's food system.
 NUTRITION AND HEALTH
 Good nutrition is essential for health and the prevention of diseases.
O “We are what we eat”.
 A balanced diet gives the body the required number of calories to carry out its basic
metabolic functions such as respiration and maintenance of body temperature.
 A balanced diet comprises of protein, carbohydrates, fats, fiber, vitamins, and
minerals.
 To obtain a balanced diet it is necessary to eat a wide variety of foods, as a shortage
of any of the main classes of food results in deficiency diseases.
 In developing countries, deficiency diseases are common for these reasons;
 shortage of the right kind of food, low incomes, superstition and lack of education
etc.
 CLASSES OF NUTRIENTS
 Nutrients are compounds in foods essential to life and health.
 provides the body with energy, the building blocks for repair and
growth and substances necessary to regulate chemical processes.
 They are classified as macronutrients including protein,
carbohydrate and fat that not only offer calories to fuel the body and
give it energy but play specific roles in maintaining health.
 Others are micronutrients (vitamins and minerals) and
phytochemicals that do not provide calories but serve a variety of
critical functions to ensure the body operates optimally.
 CLASSES OF NUTRIENTS../2
 There are six major nutrients: Carbohydrates (CHO), Lipids (fats),
Proteins, Vitamins, Minerals, Water.
 PROTEIN; Found in beef, pork, chicken, game and wild meats,
fish and seafood, eggs, soybeans and other legumes.
 protein provides the body with amino acids. Which are the
building blocks of proteins which are needed for growth,
development, and repair and maintenance of body tissues.
 Protein provides structure to muscle and bone, repairs tissues
when damaged and helps immune cells fight inflammation and
infection.
 CLASSES OF NUTRIENTS../3
O Carbohydrates: The main role of a carbohydrate is to provide energy and fuel the
body .
O Foods such as corn, plantains, rice, potatoes and other root vegetables bread and
fruit deliver sugars or starches that provide carbohydrates for energy.
O Energy allows the body to do daily activities as simple as walking and talking and as
complex as running and moving heavy objects.
O Fat: Dietary fat, which is found in oils, coconut, nuts, milk, cheese, meat, poultry
and fish.
O provides structure to cells and cushions membranes to help prevent damage.
O Oils and fats are also essential for absorbing fat-soluble vitamins including vitamin
A, a nutrient important for healthy eyes and lungs.
 CLASSES OF NUTRIENTS../4
 Vitamins and minerals are food components that help support overall health and play
important roles in cell metabolism and neurological functions.
 Vitamins aid in energy production, wound healing, bone formation, immunity, and eye
and skin health.
 Minerals help maintain cardiovascular health and provide structure to the skeleton.
 Consuming a balanced diet including fruits, vegetables, dairy, protein foods and whole
or enriched grains helps ensure the body has plenty of nutrients to use.
 Vitamin A helps with proper vision.
 Calcium and magnesium help muscles and blood vessels relax, preventing cramps
and high blood pressure
 Vitamin C helps wounds heal and the body’s ability to fight infections
 Iron helps the blood transport oxygen throughout the body and prevents anemia
INFECTION AND NUTRITION
 Ingested food, are broken down to molecules that are
required by the body.
 When these molecules are deficient or in excess, it
results in some diseases or death in extreme cases.
 Infection (parasitic) results in subtle reduction in
digestion and absorption, chronic inflammation.
 leading to loss of nutrients with resultant child under
nutrition.
INFECTION AND NUTRITION../2
 Harmful effect of poor nutrition includes.
 Overweight and obesity (excess food and inactivity).
 Heart disease and stroke(HTN, increased cholesterol and
salt intake).
 Type 2 DM (obesity/over weight).
 Deficient brain function (reduced iodine during pregnancy).
 Iron deficiency anaemia, vitamin A deficiency, and vitamin
B deficiency.
EPIDEMIOLOGY AND CONTROL OF COMMON
NUTRITIONAL PROBLEMS IN NIGERIA
 Nutritional problems are diseases resulting from poor nutrition
practices which has impacted largely to Nigeria health system.
 Common nutritional problems include;
O Malnutrition: Malnutrition refers to deficiencies, excesses or
imbalances in a person’s energy intake and/or nutrients. Broadly
grouped into 3 groups;
O -undernutrition (PEM): wasting, stunting, underweight & vitamins &
minerals deficiencies
O -overnutrition (Obesity): BMI used to classify overweight & obesity
O -specific micronutrient deficiencies
CONTROL OF COMMON NUTRITIONAL
PROBLEMS../2
 Globally in 2020, 149 million children under 5 were estimated
to be stunted (too short for age), 45 million were estimated to
be wasted (too thin for height), and 38.9 million were
overweight or obese.
 Under nutrition is the number one cause of mortality for all
age group accounting for 11% of the disease burden.
 Around 45% of deaths among children under 5 years of age are
linked to undernutrition. (WHO Report 2016)
CONTROL OF COMMON NUTRITIONAL
PROBLEMS../3
 Nigeria has the second highest burden of stunted children in the
world, with a national prevalence rate of 32% of children under
five.
O An estimated 2 million children in Nigeria suffer from severe
acute malnutrition (SAM)
O Seven percent of women of childbearing age also suffer from
acute malnutrition. (https://www.unicef.org/nigeria/nutrition)
 What is malnutrition?
OThe World Health Organization (WHO)
defines malnutrition as "the cellular
imbalance between the supply of
nutrients and energy and the body's
demand for them to ensure growth,
maintenance, and specific functions.
 Malnutrition../2
O Malnutrition can present in two scenarios- undernutrition and
overnutrition.
O Undernutrition is a common problem in developing countries
especially in children, pregnant and lactating women.
O Overnutrition- Obesity
O Undernutrition (PEM)- has 3 forms;
O Kwashiokor
O Marasmus
O Marasmic kwashiokor
 Malnutrition../3
 The immediate causes of under nutrition are lack of micronutrients
such as Vitamin A, Iodine, Iron and Zinc.
 Approximately 63% of women are anaemic,31% are Iodine deficient.
 Close to 30% of under five children are vitamin A deficient and 20%
are Zinc deficient.
 Malnutrition and nutrition related diseases continue to be a problem
of public health importance in Nigeria.
 Causes of malnutrition could be socioeconomic and or political.
 CAUSES OF MALNUTRITION
 Suboptimal infant and young child feeding practice.
 Inadequate health services/ lack of access to health care.
 Limited access to nutritious food.
 Poor immunization services.
 Low level of education.
 Poor environmental sanitation.
 Poverty (approx. 68% of Nigerians live below the international
poverty lines of USD1.25).
 Undernutrition
1. Undernutrition
This occurs when there is an inadequate intake of one or more
nutrients and /or when a disease disrupts intake and metabolism.
Undernutrition is further subdivided into;
O Multinutrient undernutrition(Protein Energy Malnutrition)
O Specific micronutrient deficiencies
 The most common and clinically significant micronutrient
deficiencies in children throughout the world include
deficiencies of iron, iodine, zinc, and vitamin A.
 Undernutrition../2
 Iron deficiency anemia, a nutritional disease resulting from
inadequate intake of iron.
 This is the leading cause of nutrient associated maternal mortality
contributing about 20% of estimated 536,000 death.
 Diagnosed when HB levels are below; adult male-13g, adult
female-12g, during pregnancy-11g,child <6yrs-11gm and those 6-
14-12g.
 Effect of anemia; during pregnancy (increased morbidity&
mortality, susceptibility to infections, decreased working capacity
and reduced GNP).
 Undernutrition../3
 Iodine deficiency; results in goiter in adult, originates from
intrauterine life in children up to adult life.
 Clinical manifestation is world wide.
 Control involves use of Iodized salt and oil, monitoring and
surveillance, mass campaign and training of manpower.
 Vitamin A deficiency(blindness, xerophthalmia).
 Risk factor includes low SES, ignorance, family feeding practice,
acute diarrohea.
 Prevention and control (short term- large dose of vit A orally, long
term- health education, immunization, promote breastfeeding etc.)
 PEM
O Protein-energy malnutrition (PEM) is defined as a
range of pathological conditions arising from lack of
proteins and/or calories in varying proportions
occurring most frequently in infants and young
children and commonly associated with infections.
O It ranges from mild, moderate to severe PEM
O The severe degree of PEM presents in a spectrum-like
fashion with 2 distinct syndromes -Marasmus &
Kwashiorkor
 PEM../2
O Studies suggest that marasmus represents an adaptive response
to starvation. Whereas kwashiorkor represents a maladaptive
response.
O The term kwashiorkor is taken from the Ga language of Ghana
and means "the sickness of the weaning“.
O Williams first used the term in 1933, and it refers to an
inadequate protein intake with reasonable caloric (energy)
intake.
O It is a severe form of protein energy malnutrition which occurs
in early childhood between 1-3 years due to inadequate intake
of dietary protein –especially animal protein which has a higher
biological value.
CLINICAL FEATURES OF KWASHIOKOR
CLINICAL PRESENTATION;KWASHIOKOR
O Failure to thrive is the earliest manifestation, associated with irritability or
apathy.
O Chronic diarrhea is the most frequent symptom, and infants generally
present with feeding difficulties.
O Presentation may be accelerated by an acute infection.
O Physical examination
O Fever (>37.5˚C),palor, dehydration
O Edema: (generalized edema), moon facies
O Oral changes
O Cheilosis(sore cracked lips)
O Angular stomatitis (cracks at corners of mouth)
O Papillar atrophy
 Clinical Presentation- kwashiokor../2
O Abdominal findings
O Abdominal distension secondary to poor abdominal musculature
O Hepatomegaly secondary to fatty infiltration
O The presentations are classified into;
O Always present
O Usually present
O Occasionally present
Features that are always present include-
O Growth retardation
O Oedema
O Muscle wasting
O Mental changes-Apathy, irritability
Clinical Presentation- kwashiokor../3
Features which are usually present include-
O Moon face
O Hair changes- Light colored,fluffy and sparse hair which is easily detached
O Dyspigmentation
O Diarrhea
O Anaemia
Features which are occasionally present include-
O Dermatosis ; Flaky paint rash
O Skin ulcerations and fissuration
O Signs of associated vitamin deficiency
O Hepatomegaly
 Marasmus
O The term marasmus is derived from the Greek word
marasmos, which means withering or wasting.
O This is a severe form of protein energy malnutrion
which is usually due to chronic starvation. The child
neither receives adequate protein nor adequate
calories and is characterized by emaciation.However
the child is alert with voracious appetite.
CLINICAL PRESENTATION-Marasmus

O Severe calorie malnutrition in a child

O “Wizened old man” look
O Anxious, alert, wasted
 Clinical presentation../2
O Skin changes
O Hypo- or hyperpigmentation
O Desquamation
O Ulceration
O Exudative lesions (resembling severe burns) often with
secondary infection
O Nail changes: Nails become fissured or ridged.
O Hair changes: Hair is thin, sparse, brittle, easily pulled out, and
turns a dull brown or reddish color.
 Features of marasmus
Physical examination
O Body temperature (measured with a thermometer) -
Allowing measurement of low temperatures to detect
hypothermia as well as fever
O Anemia - Pale mucosa
O Dehydration - Thirst, shrunken eyes
O Hypovolemic shock - Weak radial pulse, cold
extremities, decreased consciousness
Differences between Kwashiokor and
Marasmus
O Features Marasmus Kwashiokor
O Muscle wasting obvious concealed
O Fat wasting severe retained
O Edema none present
O Appetite good poor
O Diarrhea often often
O Skin changes none pigmented
O Hair changes seldom sparse fluffy
O Hepatomegaly none sometimes
 Laboratory findings
O Features kwashiokor Marasmus
O Serum albumin Normal low
O Urinary urea Normal low
O Hydroxyproline
Creatinine ratio low low
Plasma/
aminoacid ratio Normal Elevated
Classification of undernutrition
O Undernutrition can be classified as;
O Acute undernutrition: results in wasting
(low weight for height)
O Chronic under nutrition: results in stunting
(low height for age ).
 Underweight (low weight for height): may be due to stunting
and /or wasting
 General control
 Ban advertisement of junk food and sugar sweetened beverages.
 Ban the use of trans fat in food sold in schools.
 Encourage physicians to engage parents in conversation about child’s weight,
diet and level of activities.
 Improve and expand the number of parks and play ground .
 To increase the time allocated to recreational activities in schools.
 Increase farm-school connection allowing food services to purchase more local
food.
 Increase nutrition capacity within the Ministries of Health and Agriculture.
 Increase coverage of vitamin A supplementation and deworming for young
children and iron supplementation for pregnant women.
The United Nations Decade of Action on
Nutrition
O On 1 April 2016, the United Nations (UN) General Assembly
proclaimed 2016–2025 the United Nations Decade of Action on
Nutrition.
O The Decade was an opportunity to address all forms of malnutrition
through the implementation of the commitments made at the
Second International Conference on Nutrition (ICN2) to meet a set
of global nutrition targets and diet-related NCD targets by 2025 and
relevant targets in the SDG 2 (end hunger, achieve food security
and improved nutrition and promote sustainable agriculture) &
3(ensure healthy lives and promote wellbeing for all at all ages).