Nutrition And Health

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Nutrition And Health

ByProf. Drs Asmaa Abdel Aziz Alla Hassan

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Malnutrition
It is a pathological state resulting from a
relative or absolute deficiency or excess of
one or more essential nutrients.
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Forms of Malnutrition
Under-nutrition
Over-nutrition
Macronutrient def.
Obesity
Micronutrient def
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• The main forms of Malnutrition are
• Under-nutrition
• a pathological state resulting when nutrient
  intake does not meet the requirements. It
  includes
• Macronutrient deficiency e.g., protein-energy
  malnutrition( marasmus kwashiorkor).
• Micronutrient deficiency as iron deficiency
  anaemia, vitamin A deficiency, vitamin D
  deficiency .etc.
• Over-nutrition
• a pathologic state resulting when nutritional
  intake exceeds the body needs
• Obesity

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Malnutrition
Primary Malnutrition due to community or
family factors related to food production,
distribution. etc
Secondary Malnutrition due to individual
factors affecting intake , absorption or
utilization of food
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Primary malnutrition It is due to reduced intake
as in case of the following 1- Insufficient food
production 2- Unequal distribution of foods 3-
Lack of leisure . The work of women, the duration
of work outside home and the transportation time
all are factors that affect the likelihood of
having proper meals at home. This indicates the
importance of school meals and provision of
canteens at work. 4- Housing and kitchen
facilities 5- Lack of transportation 6-Cultural
factors
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• 6-Cultural factors
• Food attitudes, habits, Values, behaviors,
• Religion .
• - Celebration food
• -Age group or sex linked foods
• -Disease linked foods
• -Modern foods ( Fast meals)
• -Duration of breast feeding
• -Food preparation
• -Pattern of diet during pregnancy
• lactation

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• Examples of Negative poor habits
• Unconsumption of satisfactory amounts of
  protective foods due to
• failure to promote the habit during childhood,
• local food customs,
• Religious or ethnic restrictions or economic
  restrictions
• Examples of Positive poor habits
• a) Excessive use of sweets . This replaces
  proteins , vitamin and mineral source foods
• b) Consumption of highly refined foods
  especially white flour and white sugar.
• The white toxic Tirade white Flour, Salts, sugar
  

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Secondary Malnutrition Deficient Intake due to
anorexia, in elderly and mentally ill Increased
food requirements during febrile diseases and
in hyperthyroidism Malabsorption in patients
with diarrhea or patients with gastrectomy in
elderly patients Malutilization Defects in
metabolism as in Liver diseases . Increased
excretion Chronic bleeding causes iron
deficiency anemia
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I-Macronutrient deficiency Protein Energy
malnutrition (PEM)
PEM is a range of pathological conditions caused
by a chronic deficiency of energy and / or
protein, occurring most frequently in infants
and young children and commonly associated with
infections.
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Wellcome classification of PEM
Type of Malnutrition Body ( of standard( Edema
Under weight (Mild) 60- 80 No
Marasmus (Mild) lt 60 No
Kwashiorkor (severe) 60- 80 yes
Marasmic-Kwashiorkor (severe) lt 60 yes
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• Underweight
• A child who does not eat enough to cover his
  nutrient needs is underweight.
• It is characterized
• weight loss 60-80 of the standard,
• low resistant to infection
• associated with nutrient deficiency
• ( Vitamin A, C, D, B and Minerals as Iron
  calcium)
• Example The weight of the child is 8 kgm while
  the standard weight for age is 12 kgm
• The wt standard is 8X 100 60.67
• 
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• Marasmus
• It occurs in any age particularly in early
  infancy and is characterized by
• severe muscle wasting ,
• The Wt. standard is lt 60
• loss of subcutaneous fat,

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Kwashiorkor It is the severe form of PEM
occurs principally in the weaning and post
weaning period when the diet is deficient in
protein and rich in carbohydrates The
Weight standard is 60- 80 in addition
to edema
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Marasmic Kwashiorkor The child has the
characteristics of both marasmus and Kwashiorkor.
It happens when a marasmic child develops edema
on top of marasmus The weight standard is lt
60 without edema
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Health consequences of childhood
Malnutrition 1-Growth failure as detected by the
growth curve (e.g. slowly rising, flat or going
down). 2-Lack of energy for daily activities
low scholastic achievement . 3-apathy the
child is less interested in the world around him
.He does not want to play. He sleeps more and
appears miserable. 3-Lack of immunity against
infection.
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Relation between Malnutrition infectious
diseases
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(3) Infection

• (4)
• Increased need for
• energy other nutrients
• Decreased appetite so
• less intake of nutrients
• Decreased absorption
• Of nutrients from gut
• Weight loss
• Slower growth

(2) Ineffective Immune
system Decreased resistance of tissue
(specially lining of gut respiratory tract
(1) Malnutrition
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Prevention of Malnutrition Primary
prevention 1-Increas food production 2-Establishme
nt of an efficient food distribution
system 3-Proper environmental sanitation and
raising the standard of living 4-Prevention and
control of infectious diseases (vaccination) 5-
Adequate services for vulnerable groups
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Secondary prevention Early detection and
treatment of malnutrition . This can be done
through periodic nutritional surveillance .i.e.
systematic collection , dissemination and
analysis of data related to malnutrition in order
to plan a program for prevention control of
this condition
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Tertiary prevention Rehabilitation services to
offer health education for mothers to care and
feed for the malnourished children to allow them
to live normal life.
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II-Micronutrient deficiencies Micronutrients are
the nutrients that enable the body to produce
enzymes, hormones and other substances essential
for proper growth development. As tiny as the
amounts are, the consequences of their
deficiencies are severe. Vitamin A D, iodine
and iron are the most important in global public
health terms their lack represents major threats
to the health and development of populations all
over the world, particularly low income
countries. It affects more under five children
and pregnant women
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Vitamin A deficiency (VAD) Functions of Vitamin
A a-Integrity of epithelial tissues in skin and
mucous membrane which are barriers against
external infections especially respiratory tract
infections b-Integrity of epithelial tissues
lining of urinary and biliary tracts ,conjunctiva
and lacrimal glands (preventing xerosis) c-
Synthesis of the visual purple (rhodopsin) from
protein (opsin) and vit. A itself d- Promoting
the proper growth.
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Important sources of vitamin A I Animal Milk
including human milk (colostrums), liver, poultry
, kidney eggs, butter Cod liver oil are the
richest source for the vitamin II- Plantorange
/ yellow fruits and vegetables (mangoes,
apricots, carrots) and dark green leaves.
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Clinical features I - For children, VAD
causes 1-Severe visual impairment and Bitots
spots, Conjunctival corneal xerosis,
keratomalacia night blindness (the most severe
total blindness). 2-Xerosis follicular
hyperkeratosis of skin 3-Increased the severity
mortality of illness (diarrheal diseases
measles)
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Mild subclinical
Prevalence of VAD
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1st stage of VAD
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II- For pregnant women in high-risk areas, VAD
occurs specially during the last trimester when
the demand by both the fetus and the mother is
highest. It is demonstrated by high prevalence
of night blindness during this period. These
women will secrete later breast milk, which is
deficient in vitamin A.
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• I - Short-term intervention
• Breast-feeding Promoting
• breast-feeding
• Vitamin A supplementation

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II- Long term approach a) Food fortification
(with sugar) maintains vitamin A status
especially for high-risk groups . b) Home
gardens. For vulnerable rural families, growing
vegetables in home gardens complements
fortification
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Iodine deficiency disorders (IDD) IDD remains a
major threat to the health of populations all
over the world, particularly among preschool
children and pregnant women in developing
countries. It is not only easy to control but it
can be eliminated.
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The main causes of IDD are 1-Lack of iodine in
food usually in places far from the sea. 2-
Goitrogens, which are chemical substances in
water or food leading to the development of
goiter by reducing the amount of iodine that the
thyroid gland takes up from the blood.
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Mild sporadic
Prevalence of I DD
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• Health consequences of IDD
• Hypothyroidism
• Retarded physical development
• Mental dysfunction
• Spontaneous abortion still birth
• Cretinism

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Health consequences of IDD
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• What are the Measures for prevention of iodine
  deficiency disorders?
• A-Primary prevention (Elimination of IDD)
• The primary intervention strategy for elimination
  of IDD is Universal Salt Iodization (USI).
• Salt was chosen because it is
• widely available and
• consumed in regular amounts
• low costs of iodizing.

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Universal Salt Iodization (USI). (For
Elimination of IDD)
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B- Secondary prevention (Screening for Neonatal
Hypothyroidism) Neonatal hypothyroidism is the
most common disorder that should be screened.
Congenital hypothyroidism leads to mental
retardation , which can be prevented if medical
treatment is given within the first 1-2 months of
life. All the neonates are routinely screened
for estimation of the level of the thyroid
hormones by taking blood sample from the heel of
the neonate within the first week of life.
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B- Secondary prevention (Screening for Neonatal
Hypothyroidism)
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Vitamin D deficiency ( Rickets and
osteomalacia) Rickets is a systemic disease of
the growing skeleton characterized by defective
calcification of the bones during growth. The
term osteomalacia is applied to the same
pathological condition when it affects a skeleton
that has completed its growth
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Function of vitamin D Vitamin D is needed at
times of rapid growth that is, in infants and
young children, adolescents, and pregnant women.
It has the following functions a) Promotion of
absorption of calcium and phosphorous from the
intestine. b) Calcification of bone matrix
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• Clinical signs
• Active rickets
• in young children
• Epiphyseal enlargement-
• Beading of ribs-
• Persistently open anterior fontanelles
• (after 18 months of age)
• Muscular hypotnia

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• Healed rickets
• in older children
• Frontal or parietal
• bossing,
• knock knees or bow knees
• Deformities of the thorax

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Osteomalacia (in adults women) Local or
generalized skeletal deformities of the pelvis
with tender bones .
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Sources of vitamin D a-The ultraviolet rays
(UVRs) activate the provitamin
(7-dehydrocholesterol) in the deep layers of the
skin , but it can be filtered by air pollution
and glass. b- Food sources are only of animal
origin e.g., milk, butter, cheese, fatty fish
(salmon and sardines), eggs, liver and cod-liver
oil. c- Fortified milk.
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I- Biological factors a- Order of the child
The later the child of an undernourished mother,
the higher the probability of developing Vit. D
deficiency. b- Twins c- Low birth weight d- High
parity will lead to osteomalacia
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II-Dietary factors a-Deficient intake of
Vitamin D or calcium b- Presence of phytic acid
and oxalates in diet preventing calcium
absorption. c- Artificially fed babies.
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III- Social Factors a-Poverty b-Ignorance of
mothers about proper feeding and rearing of
children c-Cultural factors as wrapping infants
and preventing exposure to sunshine, and early
marriages of girls who are still in need of
dietary calcium. d-Living in squatter areas.
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III- Environmental factors a-Amount of sunshine
and ultraviolet rays (UVRs). In cloudy and
dusty atmosphere the UVRs are absorbed . b- High
prevalence in Rural areas due to ignorance,
poverty and unhealthful social habits
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• Iron deficiency anemia (IDA)
• Iron deficiency is the most wide spread
  nutritional disorder, affecting both developed
  developing countries. The main clinical
  manifestations are
• pale conjunctivae,
• spoon shaped nails and
• atrophic lingual papillae.
• Easy fatigability
• Hematological tests will confirm the diagnosis.

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Atrophic Lingual papillae
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spoon shaped nails
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Pale skin
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Easy fatigability
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Hemoglobin levels in anemia
Target groups and level of anemia Hblevel (g/100 ml)
Children 6 months to 5 year Children 6 years to 14 years Men Women (not pregnant) Women (pregnant) lt11 lt12 lt13 lt12 lt11
Mild, moderate, and severe anemia Mild Moderate Severe Below the values given above, but more than 10 7 10 Below 7
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• High Risk For Iron Deficiency Anemia
• Pregnant women those with
• repeated pregnancy and delivery within a short
  intervals
• having parasitic diseases
• Growing children, low birth weight
• school age children
• The elderly,
• Any one suffering from parasitic diseases

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Iron Stores in the blood Two main components
Functional component It is in the circulating
hemoglobin (with a smaller quantity in body
tissue, myoglobin and enzymes). A deficiency of
iron in the functional component does not
ordinarily occur until iron stores are completely
exhausted. The storage component Found in the
liver, spleen and bone marrow in the form of
ferritin and haemosiderin in. It serves as
reserve source for the functional component.
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Etiology The diminishing of iron stores results
from Low iron intake Increased demand which
occurs in women due to pregnancy, blood loss
with menstruation, high parity, Short interbirth
interval and parasitic infestation. children due
to rapid growth, and low birth weight,
artificially-fed babies, recurrent infections and
parasitic infestation. Inadequate
absorption Tanic acid , phytates, oxalates,
carbonates, phosphates and some forms of dietary
fiber inhibit absorption. These are found mainly
in tea, coffee, some vegetables.
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Factors known to affect absorption of iron 1-
Tanic acid , phytates, oxalates, carbonates,
phosphates and some forms of dietary fiber
inhibit absorption. These are found mainly in
tea, coffee, some vegetables. 2-Absorption
increases when iron stores decreases as during
growth and pregnancy.
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Iron sources 1- Haem-iron is found in animal
foods (liver, kidney, spleen, meat,).
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2- Non-Haem iron is found in vegetables
, fruits, cereals, pulses,. It comprises the
major source of dietary iron in poor
Communities
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Health consequences of iron deficiency anaemia
Pregnant females increased risks of maternal
morbidity mortality.
Fetus and neonates of anemic mother
intrauterine growth retardation. increased
perinatal mortality
Adults Impaired work Capacity easy
fatigability, which affects
productivity
Children infectious diseases. vulnerable to
lead poisoning, Impaired physical activity
scholastic achievement
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• I- Iron Supplementation
• short-term strategy
• for countries with a significant
• problem of iron deficiency anaemia.
• Providing iron tablets to a target population
• The target groups for supplementation programs
  are
• Pregnant and lactating women, Women in the
  child-bearing period, and adolescent girls both
  iron folic acid tablets are recommended
• Infants and preschool age children (6-30 months)
  Oral iron preparation is given

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• II- Nutritional education
• to ensure that people eat
• more iron rich food
• to promoting the intake of iron absorption
  enhancers, reducing the ingestion of absorption
  inhibitors

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III- Prevention and control of of infectious and
parasitic diseases Immunization effective,
timely curative care can diminish the adverse
nutritional consequences of viral and bacterial
diseases, as well as parasitic infestations.
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IV- Adequate MCH services Routine laboratory
investigations during antenatal care to estimate
HB level, nutritional education, health care for
under five
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V- Food fortification The fortification of
widely consumed such as sugar and salts with iron
is one of the most effective ways of preventing
iron deficiency.
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Obesity
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Obesity is a disease in which excess body fat has
accumulated to such an extent that health may be
seriously affected (WHO,2000). It is a complex
condition one with serious social and
psychological dimensions that affects virtually
all age and socioeconomic groups
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Over weight (preobese) means a weight in excess
of the average for a given height and age. It is
usually due to obesity, but can arise from other
causes such as abnormal muscle development.
Generally, men have higher rates of overweight,
while women have higher rates of obesity
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Assessment of obesity 1-Body weight 10 increase
over the weight standards. It is considered a
rough measure. 2-Body mass index (BMI) It is a
simple index of weight for height that is
commonly used for adults. However, it does not
take into account factors such as gender and age.
Also it does not distinguish between weight
associated with muscle and that associated with
fat.
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3-Waist measurement It is a simple method of
identifying and recording central fat
distribution. People who are over-wight and have
central fat are at a greater risk of developing
heart disease and diabetes. 4-Brocas index
Height (cm) 100
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5-Skin fold thickness assessing body fat at
triceps, sub-scapular or suprailiac regions.
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BMI Weight in KG Height 2 (
meter )
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WHO Classification of obesity
Classification BMI
Underweight Normal weight Pre-obese Obese Below 18.5 18.5- 24.9 25.0- 29.9 more than 30
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1- Age Obesity can occur in any age , and
generally increases with age . Infants with
excessive weight gain have an increased
incidence of obesity in later life
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2-Sex women gain most between 45 and 49 of age.
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3-Genetic factors A close correlation is
recorded between the weights of identical twins
even when they are reared in dissimilar
environments
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4-Physical inactivity Physical inactivity may
cause obesity which in turn restricts activity
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5-Eatinmg habits Eating between meals
,preference to sweets and fats are established
early in life of obese subjects.
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6-Socioeconomic status There is an inverse
relationship between socioeconomic status and
obesity.
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7- Psychological factors emotional disturbance
is deeply involved in the etiology of obesity .
Overeating is a symptoms of depression,
anxiety,frustration and loneliness in childhood
and adult life.
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8-Familial tendency obesity runs in families
but this is not it is not necessarily explained
by the influence of genes
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9- Endocrine Factors Endocrinal disorders (as
hypothyroidism, Cushing's syndrome and
hypothalamic tumors) result in weight gain.
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10-Life changes Aging due to decline in
activity without a compensating decrease in food
intake Critical events after marriage-
pregnancy and retirement Smoking cessation
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Prevention of obesity Primary prevention 1-
Promoting healthy eating inducing dietary
changes 2-Proper feeding rearing of children
3-Increased physical activity
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• Secondary prevention
• Screening and assessment of the condition
• 2. Managing obesity by
• Behavior modification
• Dietary changes
• Physical activity
• Managing health consequences of obesity.

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Thank You