Download prevention of malnutrition

PREVENTION OF
MALNUTRITION
INTRODUCTION
 Food has nutrients which are required for
protection of the body from diseases.
 According to 2011-2012 world population
report – 925 million people are starving in the
world.
 India’s population in 2011 – 1.21 billion.
 Karnataka’s population in 2011 – 6.1 crore.
Cont……..
 37.6% - underweight children.
 28.1% - undernourished.
 55% - death of under five due to hunger.
DEFINITION
 “A pathological state resulting from an
absolute or relative deficiency or excess of
one or more essential nutrients”.
 It may be an outcome of under nutrition, over
nutrition or imbalance.
CLASSIFICATION OF MALNUTRITION
1. Under nutrition - insufficient food is eaten.
2. Over nutrition – excessive quantity of food
consumption.
3. Imbalance – disproposition among essential
nutrients.
4. Specific deficiency – relative or absolute lack
of an individual nutrient.
ECOLOGY OF MALNUTRITION
 According to Jellief ecological factors are
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listed as:Conditioning influences
Cultural influences
Socio-economic factors
Food production
Health and other services
Cont………
 Conditioning influences:-
The inter- relationship between malnutrition
and infection such as diarrhoea, intestinal
parasites, measles, whooping cough, malaria,
TB are well documented.
 Cultural influences:-
People choose poor diets when good ones are
Cont………
available because of cultural influences which
vary widely from country to country and from
region to region.
 Food habits, customs, beliefs, traditions and
attitude.
 Religion has powerful influence on the food
habits of the people
 Cooking practices such as drawing water
from rice, prolonged boiling, peeling of
vegetables.
Cont……….
 Child rearing practices, premature curtail of
breast feeding, adoption.
 Socio-economic factors:Malnutrition is largely by the product of
poverty, ignorance, insufficient education,
lack of knowledge regarding the nutritive
value of foods, inadequate sanitary
environment, large family size.
Cont…………..
 Food production:-
The average Indian has 0.6 hectare of land surface
compared to 5.8 hectare per head in the
developed countries. The per capita available
land for an average Indian is only 0.3 hectare.
 Health and other services:Improper organization and inadequate resources
are the major factors responsible for
malnutrition.
REASONS FOR MALNUTRITION IN
INDIA
 FOOD AVAILABILITY AND RELATED
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PROBLEMS:Low per capita food availability
Low purchasing capacity of the masses
Mal distribution of the available food
Limited choice of food articles
Problems of storage and distribution of food
grains.
Cont……..
- Protein gap versus “food gap”
- Food gap and chronic starvation.
 POVERTY AND MALNUTRITION:- Low income of the masses
- Poverty and malnutrition interaction.
 POPULATION PROBLEM AND
MALNUTRITION:- Population explosion
- Effect on food availability
Cont………….
- Effects of uncontrolled fertility on nutrition
 SOCIAL FACTORS AFFECTING NUTRITIONAL
STATUS:- Customs superstitions and taboos
- Diet during illness
- Castes and false social status
- Food tastes and faculty cooling methods
- Ignorance and lack of education
- Alcohol and malnutrition.
MALNUTRITION AND INFECTION
CYCLE
Loss of appetite
mala absorption
altered
metabolism
nutrient loss
FOOD GAP
INFECTION/
ILLNESS
Wt loss growth
retardation
prone to
infection
mucosal
damage
PROTIEN ENERGY MALNUTRITION
[PEM]
 PEM is a disease due to the deficiencies of
protein and calories occur commonly among
weaned infants and preschool children in
India and other developing countries.
 PEM is divided into 3 groups: kwashiorkor
 nutritional marasmus
 Marasmus kwashiorkor
KWASHIORKOR
Its caused by deficiency of proteins in the diet.
The important symptoms of the disease by
deficiency of proteins in the diet muscle
wasting, fatty liver, loss of appetite and
diarrhoea, change in the colour the skin and
hair and anemia.
NUTRITIONAL MARASMUS
 This is caused by severe deficiency of proteins
and calories in the diet. The important
features of growth retardation and severe
wasting of muscle and loss of subcutaneous
fat. Eye lesions due to vitamin A deficiency
and anemia may also be present.
MARASMUS KWASHIORKOR
 Children suffering from this disease show the
signs of both kwashiorkor and marasmus.
FEATURES OF PEM
FEATURES
MARASMUS
KWASHIORKOR
Muscle wasting
Obvious
Hidden by edema and fat
Edema
None
Present in lower legs, face,
lower arms
Fat wasting
Loss of subcutaneous fat
Fat often retained but not
firm
Weight for height
Very low
Weight ma be less than
60% of standard.
Mental changes
Quite
Irritable
CLASSIFICATION OF PEM
 According to ICMR classification
 NORMAL--- 80 % & Above
 Grade I ---- 70-80%
 Grade II----- 60- 70 %
 Grade III----- 50-60 %
 Grade Iv---- Below 50 %
DIETARY MANAGEMENT OF PEM
1. PROTEIN ALLOWANCE
 Cereal & pulses protein about 4 to 5 gm per
kg
 Animal protein 3 to 3.5 gm/kg
 NPU of cereals & pulses is only 60 percent
CALORIES
 160-180 KCAL /KG OF WEIGHT
 Younger child – 175 to 200
 Older child – 150- 175
 One year old –1oookcal
 After one year add 100 kcal/year
TREATMENT OF PEM
 Adequate diet :- 125 -150 kcal & 3-4 gm of
good quality of protein/kg of body
weight/day.
 Treatment of infections
 Health education
 Rehabilitation
Indicators
 Weight/height = weight of the child x100

weight of normal child at same
age
PREVENTIVE MEASURES
 HEALTH PROMOTION
 Measures directed to pregnant & lactating
women
 Promotion of breast feeding
 development of low cost weaning foods
 measures to improve family diet
 Nutrition education
conti
 Family planning & spacing of births
 Family environment
 2) specific protection
 Childs diet should include protein & energy
rich foods
 Immunization
 Food fortification
Conti….
 Early diagnosis & treatment
 period surveillance
 Early diagnosis f any lag in growth
 Early diagnosis and treatment of infections &
diarrhea
 development of programmes for deworming
of heavily infested children
 Rehabilitation
 Nutritional rehabilitation services
 Hospital treatment & follow up.
Hyderabad mixture
 Whole wheat ( roasted )- --- 40 gm
 Bengal gram (roasted)---- 16 gm
 Ground nut (roasted) -----10gm
 Jaggery ----------------------20gm

 energy ----330kcal
 Protein ----11.3gm
86gm