Transcript Malnutrition

Malnutrition
Supervision
Prof. 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)
MUAC
Mid Upper Arm
Circumferance
SAM <110mm
Children 6m-5yrs
Measures 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
Insufficient
Household food
Inadequate Maternal
Childcare
MANIFESTATIONS
Disesase
Insufficient Health
Services/Unhealthy
Environment
IMMEDIATE
CAUSES
UNDERLYING
CAUSES
Political and Economical powers
BASIC
CAUSES
Modified from UNICEF 1998
Severe Malnutrition
W/H <70% or bilateral oedema
Impaired immune system and electrolyte inbalance
Marasmus
Kwashiorkor
Kwashiorkor
• 2-4yrs
• Comes suddenly after some time
of Moderate Malnutrition
• Low protein intake
• HÖG MORTALITET!
Symtoms:
• Bilateral Oedema
•Apathy
•Depigmented corse hair, easy to pull.
• Skin lesions
•Poor aptetite
•Diarrhoea
http://www.asnom.org/image/510_nutrition/116_327_kwashiorkor.jpg
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
Weight loss
Immunity lowered
Growth faltering
Mucosa damaged
Inadequate
Dietary Intake
Apetite loss
Nutrient Loss
Malabsorbtion
Disease:
Incidence
Severity
Duration
Altered metabolism
Adapted from Andrew Tomkins and Fiona Watson, Malnutrition and Infection, ACC/SCN, Geneva, 1989 , State of the World’s Children 1998
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, deafmutism.
• Lower IQ by 10-15%
• Iodising salt
Source:
Sea fish, sea weed,
Iodized salt
SOURCE: UNICEF
Vit A Deficiency
- Most important cause of blindness in developing
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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 conjunctivatotal
blindness. Night blindness
Treatment lowers the child’s risk of
dying by 23%!
SOURCE: UNICEF
Bitot spots
http://www.milesresearch.com/
Source:
• Egg,
• Liver
• Butter, cow’s milk
• Breast milk.
• Carotene.
 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