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Malnutrition

Marwa Abdelrehim Lecturer of public health and preventive medicine

What is Malnutrition?

• Malnutrition covers a broad spectrum of diseases, including all deviations from adequate nutrition, including: under-nutrition, over-nutrition and specific deficiencies (or excesses) of essential nutrients such as vitamins and minerals.

• Food insecurity: lack of secure access to sufficient amounts of safe nutritious food for normal growth and development, and lack of active and healthy life.

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Classification of malnutrition

• Balanced over-nutrition: like obesity• Balanced under-nutrition: like marasmus• Unbalanced over-nutrition: such as hyper-

vitaminosis• Unbalanced under-nutrition: such as

vitamin deficiencies

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Classification of malnutrition

inadequate vitamins or mineralsfolate deficiency zinc deficiency calcium deficiency and osteoporosis beriberi, pellagra, scurvy selenium deficiencies

IUGR Overweight Obesity Diet-related NCD

wasting, stunting, underweight

Double burden, Stages and Consequences of malnutrition

Double burden of malnutrition means coexistence of undernutrition and overnutrition and may manifest within the community, household or individual in many developing countries

Malnutrition has four basic stages:First stage:↓ nutrient intake (poor diet,..) or ↑ losses (chronic diarrhea,.) → limit nutrient availability.

Second stage: nutrient stores depleted

Third stage: metabolic or biochemical changes→ marginal malnutrition

Fourth stage: deficiency symptoms appeared.

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Malnutrition Key facts (WHO, 2018)

•1.9 billion adults are overweight or obese, while 462 million are underweight.

•52 million children under 5 years of age are wasted, 17 million are severely wasted and 155 million are stunted, while 41 million are overweight or obese.

•Around 45% of deaths in children < 5 years linked to undernutrition These mostly occur in low- and middle-income countries. At the same time, in these same countries, rates of childhood overweight and obesity are rising.

•The developmental, economic, social, and medical impacts of the global burden of malnutrition are serious and lasting, for individuals and their families, for communities and for countries.

The major nutrition problems in the world

• Protein-energy malnutrition (PEM)• Iron deficiency • Vitamin A deficiency or

hypovitaminosis A (VAD)• Iodine deficiency disorders (IDD)• Nutrition-related chronic diseases

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Causes of malnutritionThe causes of malnutrition are multidimensional:

I-Failure to take proper quantity and quality of foods to meet individual requirements:

1. Economic2. Food shortage3. Psychologic (anorexia nervosa)4. Cultural food practices 5. Inability to obtain, prepare and serve foods (handicapping, elderly)6. Iatrogeneic, anorexiants7. Educational ignorance of food selection and preparation8. Dizasters9. Infections

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II Defective absorption:1. Chronic diarrhea2. Malabsorption syndrome3. Intestinal parasitism4. Protein losing entropathy5. Antacids

III Impaired metabolism1. Hereditary and acquired biochemical disorder2. prematurity and infection

IV Increased needs for foods:1. Growth, pregnancy and lactation2. Physical work and exercise3. Chronic febrile state (infection)4. increased metabolism as in hyperthyroidism3. Nausea and vomiting

Interactions of malnutrition and infections

Malnutrition increases the risk of infection and infectious diseases. Infection worsens nutritional status.

* Malnutrition ----> Infection:- It affects variety of immune and disease resistance mechanism- It leads to poor wound healing- It decreases protective bowel secretions

* Infection ----> Malnutrition:- It can lead to anorexia- It increases metabolism- It leads to malabsorption- Lead to dietary taboos during infections-Increase losses from stools, vomitus

The consequences depend on the previous nutritional status, nature of infectious agents and diet during the recovery period.

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Forms of malnutrition (undernutrition):-Acute malnutrition -Chronic malnutrition -Micronutrient deficiencies.

Acute malnutrition (wasting)

-Deterioration of nutritional status in a short time -It poses more severe health risks than chronic malnutrition and may cause death

-It leads to weight loss and specific micronutrient deficiencies in both children and adults impaired bodily functions ↓resistance to disease.

-Increased levels of acute malnutrition in a population ↑increased illness and death nutrition emergencies and famine situations.

Marasmus vs Kwashiorkor

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Chronic malnutrition (stunting )

- Occurs over long-term due to insufficient intake of nutrients - Children < 5 years are particularly affected. -Frequent infections --> slow down growth and stunting

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• Short-term implications of chronic malnutrition In children: growth faltering and weight loss with associated

micronutrient deficiencies. In adults: weight loss and various micronutrient deficiencies

which all lead to poor health.

Chronic malnutrition also makes people more susceptible to disease and infection.

• Longer-term effects of chronic malnutrition: - Impaired physical and mental development in children. - Stunted women are more likely to have low birth weight babies (<

2.5 kg) with compromised health at birth.

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Prevention of malnutrition and food insecurity:

1. At the family/individual level2. At the Community level3. At the National level4. At the International level

I- At the individual/family level:

Nutritional education on healthy eating habits, adequate feeding, healthy food choices, food preparation. Promotion of breast feedingcomplementary feeding at 6 monthsvaccination spacing between pregnancies

Prevention of malnutrition and food insecurity:

II- At the community level:

Health promotion & nutrition education. Socioeconomic development Environmental sanitation: to stops infectious diarrhea, which is a perpetrator of malnutrition. Prevention & control of infectious diseases: e.g. diarrheal, acute respiratory diseases. Improve status of women: Hunger disproportionately affects females more so than males. Growth monitoring Screening for malnutrition Promotion of family planning programIntegrated health services

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III- At the national level:

Agricultural development: agricultural/food production.

Nutrition intervention programs:•Supplementation•Food Fortification•Immunization

Nutritional surveillance: define character and magnitude of nutritional problems and strategies to tackle

Nutritional planning: Control food pricing and increasing market availability, ensure distribution

Nutrition intervention programs

• Supplementation• Food Fortification• Immunization

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Supplementation:

Addition of pharmaceutical preparations of nutrients to the diet. e.g. capsules, tablets, or syrups

Supplementation used for iron deficiency anemia in the form of syrup or tablets. Usually this starts as treatment and is maintained as a preventive measure.

For vitamin A deficiency,both low and high dose repeat supplementation programs havebeen used in various locations worldwide.

Food Fortification:

Public health measure where nutrients are added to food (small quantities) to maintain/improve quality of diet for a group or population

Is highly effective for preventing micronutrient deficiencies.

Food Fortification is an example of ‘Primary Level of Prevention’

Examples: - Iodization of salt, -Vitamin A and Vitamin D in Milk-Fluoridation of water

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Criteria for food fortification:- Vehicle to be fortified must be consumed regularly in diet by population- Amount of nutrient added must not cause deficiency or toxicity -There should be no change in taste odour consistency or appearance-on addition of nutrient- Cost of fortification must be affordable by consumers

Immunization: Most infectious diseases of childhood potentiate malnutrition.

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IV- At the international level:

International collaboration: The UN World Food Program, and several agenices such as FAO, WHO and UNICEF work for improving the nutrition in underdeveloped countries, and to provide emergency nutrition during disasters.