Malnutrition refers to both undernutrition and overnutrition. Undernutrition is caused by a lack of nutrient intake and can increase risk of infection and chronic disease. It includes protein-calorie malnutrition like kwashiorkor and marasmus in children. Micronutrient deficiencies like vitamin A, iron, and iodine deficiencies can also cause health problems. Nutritional status can be assessed directly using anthropometric, clinical, dietary, and biochemical methods or indirectly using community indices.

1.  Malnutrition : bad of nutrition.
 Cause by INCORRECT Amount of nutrient
intake.

2. An optimal nutritional status is a powerful factor for
health and well being . It is a major, modifiable and
powerful element in promoting health, preventing and
treating diseases and improving the quality of life.
Malnutrition may increase risk of (susceptibility to)
infection and chronic diseases :
over-nutrition under-nutrition
may lead to obesity as may lead to increased
well as to metabolic infections and decreases
syndrome or type 2 in physical and mental
diabetes development.

3.  Nutritional deficiency diseases may
classified as:
 1-first type :that result directly from
dietary lack of a specific essential nutrient.
 2-second type :that result from the
inability of the body to use a specific
nutrient properly.

5.  in children of age 1-3 years in past
weaning years, which due to shift
from high biological value protein
to starchy food deficient in
proteins.
 characterized by edema.
 The classical syndrome is that of
retarded growth and development
with mental apathy , muscular
wasting , edema especially the
liver (become big) .

6.  in children under one year of age
 Marasmus is a severe form of
malnutrition that consists of the
chronic wasting away of fat, muscle,
and other tissues in the body.
 Malnutrition occurs when your body
does not get enough nearly all
nutrients, especially protein and
carbohydrates
 A child with marasmus looks
emaciated

7. kwashiorkor Marasmus
1- Definition : 1- Definition :
protein-energy malnutrition (PEM ) protein-energy malnutrition (PEM )
characterized by dificiency of protein characterized by severe and prolonged
e relatively adequate energy intake . restriction of all food i.e energy and
protein as well as other nutrients
2- Essential Features
a. Generalized oedema 2- Essential Features
b. Hair changes a. Muscle wasting.
c. Skin change b. Loss of sub-cutaneous fat
d. Psychomotor changes c. Very low body weight
3- Age Group 3- Age Group
Usually in children of 1-3 years Usually under one year of age
4- Important Cause 4- Important Cause
Late weaning after extending over two Early weaning
years

8. kwashiorkor Marasmus
5- Frequency 5- Frequency
Occures more frequently in rural area Occure in poor people in people in
under developed countries who
6- Clinical Features live in cities
a. Ordema
b. Hair become fine show flage sign 6- Clinical Features
c. Pigmentation desquamation and a. Oedema is absent
ulceration of skin b. Skin changes ,hair ,apathy and
d. Child is apathetic and measureable anorexia are seldon encountered
e. Anorexia c. Abdomen may be distended.
f. Liver may be enlarged and fatty. d. Liver is not fatty.

10. Vitamin A deficiency cause :
 Night blindness.
 Conjunctive xerosis : xerosis means dryness
 Active corneal lesion :
 Cornea scars .
 effects the eyes and the lining of gut and the
respiratory system.
 Increase risk of infection: children who lack Vit A are
more likely to get gut, respiratory, and other infection
and to die from them than children with enough Vit A.
even mild VitA deficiency , with no sign of
xerophthalmia may increase risk of infection and death
.

11.  The deficiency of thiamin (B₁) causing
beri-beri .
 The deficiency of riboflavim (B₂) causing
Ariboflavinosis .

12.  The deficiency of Niacin
causing pellagra.

13.  Scurvy: It result from dietary lack of Vit C ,
 scurvy usually occurs only on those
consumes extremely poor diet that have a
complete lack of fruit and vegetable
 scurvy can effect infant who is only source of
food is cow’s milk.

14.  Vitamin D deficiency can result :
 Osteomalacia : is the softening of the bones,
osteomalacia in children is known as rickets, . It
may show signs as diffuse body pains, muscle
weakness, and fragility of the bones.
 Osteoporosis : is a disease of bones that leads to
an increased risk of fracture.
 Rickets : is a softening of bones in children
potentially leading to fractures and deformity.
Rickets is among the most frequent childhood
diseases in many developing countries.

17.  Calcium deficiency : Osteomalacia,
osteoporosis, Rickets and tetany .
 Phosphorus deficiency : affect growth and
bone disease.
 Magnesium deficiency : cause problem in
acid-base problem, tremor, spasm and muscle
action.

18.  Iodine deficiency : Iodine participate in the
synthesis of thyroid hormones . Abnormal
thyroid function leads to hypothyroidism or
hyperthyroidism due to increase or decrease
intake of iodine . Goiter is due to iodine
deficiency .
 Iron deficiency & Copper
deficiency :
cause anemia .

19.  Mild deficiency :
 Stunted growth in children .
 Decreased tasting sensation .
 impaired immune function .
 Sever deficiency :
 dwarfism .
 delayed sexual maturation.
 Hypopigmented hair .

20.  Overnutrition is a type of malnutrition where
there are more nutrients than required for normal
growth, development, and metabolism..
 The term can refer to:
 1- obesity, brought on by general overeating of
foods high in caloric content,
 2- Vitamin poisoning Iron poisoning,
 3- Mineral overload : inborn errors of metal
metabolism, toxicity

22.  Nutritional Status :
- The state of a person’s health in terms of the
nutrients in his or her diet.
- Or the condition of health of a person that is
influenced by the intake and utilisation of
nutrients.
 The aim of nutritional assessment :
discover the nutritional problem in order to
suggest the possible solution.

23. Indirect
Direct
methods use community
methods deal with the
indices that reflect the
individual and measure
community nutritional
objective criteria
status/needs.

24. Indirect Methods of Nutritional Assessment
Ecological variables including agricultural crops
production
Economic factors e.g. household income,
population density, food availability and prices
Vital health statistics:
morbidity, mortality and other health indicators
e.g., infant and under-fives mortality, fertility
indices and sanitary conditions

25. direct Methods of Nutritional Assessment
 These are summarized as ABCD
 A nthropometric methods
 C linical methods
 D ietary evaluation methods
 B iochemical, laboratory methods

26.  It is the measurement of body height, weight, skin
fold thickness , circumference of (arm , head and
chest) & proportions .
 It is an essential component of clinical examination of
infants, children & pregnant women.
 These measurements are compared to the reference data
(standards) of the same age and sex group, in order to
evaluate the nutritional status

27.  Clinical assessment It is an essential feature of all
nutritional surveys.
 It is the simplest & most practical method of
ascertaining the nutritional status of a group of
individuals.
 It utilizes a number of physical signs, (specific & non
specific), that are known to be associated with
malnutrition and deficiency of vitamins &
micronutrients

28. D ietary evaluation methods
 Dietary assessment Nutritional intake of humans
is assessed by different methods.
 These are:
 24 hours dietary recall
 Food frequency questionnaire
 Dietary history
 food diary or record

29.  Laboratory Tests
- Hemoglobin estimation.
- Stool ( for intestinal parasites ) & Urine ( for
albumen and sugar ) .
 Biochemical Tests
 measure :
- Nutrient concentration ( e.g. serum )
- Detection of abnormal amounts of metabolites in urine
( e.g. urinary iodine )
- Enzymes concentration.

30.  Meaning of Malnutrition and his type
 Undernutrition Protein Calorie malnutrition
 1- kwashirkor
 2- Marasmus
 And the different
 Vitamin & micronutrient deficiency
 methods of assessment of nutritional
status
 In tow ways Direct & Indirect
 Direct summary in ABCD