Under nutrition is widely recognized as a
major health problem in the developing
countries of the world ,food is a major concern
of the mankind beginning from the time of
conception & extending through the entire life
span of the individual.
Food supply the energy for physical activity &
other metabolic for maintaining growth of the
individual & for repair of the ageing tissues.
Nutritional problem or malnutrition is the
condition of improper or inadequate food
intake or inadequate absorption of food.
And it manifests in so many diseases.
It comprises four forms under nutrition,
over nutrition, imbalance and the specific
B7 – Biotin deficiency
B9 – Folate deficiency
B12- Vitamin B 12 deficiency
Other Vitamins deficiency-
A- Bitot spots
D- Ostiomalacia/ Rickets
3)Hyper alimentation –
METHODS OF ASSESSMENTS
Assessment of dietary intake by details history of
dietary patterns, specific food consumed and its
amount, quality and adequacy in relation of nutrient
Anthropometric examinations of the child including
weight, length/height, mid upper arm circumference,
skin fold thickness, are valuable indicators of
nutritional status. In young children, head
circumference and chest circumference are also
measured to assess patterns of growth and
development and deviation from average size.
Clinical examination of the child to assess deficiency
signs and associated problems. Through head to foot
examination is done to detect the classical signs of
various deficiency states.
Assessment of associated problems like
tuberculosis, mal-absorption syndrome,
any infection or infestations should be
made to find out the probable cause of
Laboratory investigations to be done to
exclude the underlying cause including
routine examination of stool, urine, blood
and x- rays. Estimation of HB, serum
proteins, enzymes, blood level of
nutrients like vitamins, iron, amino acid,
CAUSES OF NUTRITIONAL PROBLEM
Assessments of ecological factors, morbidity and
mortality patterns in the community help to detect the
nutritional status of the particular community, as these
situations influence the nutritional status of an
Causesof Nutritional Problem–
Low birth weight
PROTEIN ENERGY MALNUTRITION
Protein–energy malnutrition (PEM) or
protein–calorie malnutrition refers to a
form of malnutrition where there is
inadequate calorie or protein intake.
Kwashiorkor (protein malnutrition
Marasmus (deficiency in calorie intake)
Marasmic Kwashiorkor (marked protein
deficiency and marked calorie insufficiency
signs present, sometimes referred to as the
most severe form of malnutrition)
PEM is also referred to as protein-calorie
malnutrition. It develops in children and
adults whose consumption of protein and
energy is insufficient to satisfy the body's
nutritional needs. While pure protein
deficiency can occur when a person's diet
provides enough energy but lacks the
protein minimum. PEM may also occur in
persons who are unable to absorb vital
nutrients or convert them to energy
essential for healthy tissue formation and
Although PEM is not prevalent among the
general population of the United States, it is
often seen in elderly people who live in nursing
homes and in children whose parents are poor.
PEM occurs in one of every two surgical
patients and in 48% of all other hospital
PEM is fairly common worldwide in both
children and adults and accounts for 6 million
WHO classification: -
WHO recommended three terms: stunting,
under weight and wasting for assessing the
magnitude of malnutrition in under five
children. The classification is based on deficit
in body weight for age and presence or absence
of edema. Children weighing b/w 60-80%
percent of their expected weight for age with
edema are classified as kwashiorkor.
Protein calorie malnutrition is lacking
of calorie and other nutrients in child
as they are growing.
Main two protein deficiency problems are :-
It is a clinical syndrome that results from a severe deficiency
of protein and an inadequate caloric intake characterized by
edema, irritability, anorexia, and an enlarged liver with fatty
infiltrates. Either from lack of intake or from excessive losses
of or increases in metabolic rate caused by chronic infections
secondary vitamin and mineral deficiency may contribute to
sign and syndrome.
It is most serious and prevalent form of
malnutrition in the world today. Especially in
the industrially underdeveloped countries.
The term "kwashiorkor" comes from a word
used in Ghana that means a "disease of a baby
deposed from the breast when the next one is
born." Kwashiorkor usually happens when a
baby is weaned from protein-rich breast milk
(for any reason) and switched to protein-poor
foods. In impoverished countries, protein-rich
foods are difficult to acquire.
Early PEM manifest vague but does include:
Lack of stamina
Loss of muscular tissue
Increased susceptibility for infection.
Secondary immunodeficiency is one of the most serious and
Failure to gain weight.
Loss of muscle tone.
Renal functions decreases.
Hairs often sparse and thin and loses its
Dispigmentations of hairs. Dark hairs changes
in streaky red or gray color.
Vomiting and diarrhea.
Mental changes like irritability and apathy are
common, stupor, coma and death may follow.
Decrease in concentration of serum albumin is the
most characteristics change.
Ketonuria is common in early stage but frequently
disappears by later stage.
Blood glucose level is low, but glucose tolerance curve
may be diabetic in type.
Plasma values of essential amino acid are decrease
and increased aminoaciduria.
Serum cholesterol level is low.
Bone growth is usually delayed.
Growth hormone secretion may be increased.
Diet containing an adequate quantity of
protein of good biological quality.
Adequate dietary instructions and food
distribution are urgently needed in endemic
Immediate management of acute problems such as
severe diarrhea, renal failure or shock.
Replacements of missing nutrients.
All symptoms must be treated.
For dehydration intravenous fluid must be
Ringer lactate solution may be life saving.
Effective antibiotic should be given parenterally for
Yogurt and cow’s milk for lactose intolerant child.
Vitamins and minerals, especially vita A, potassium
and magnesium are necessary from the outset of
treatment. Iron and folic acid usually corrects the
Marasmus is a from of under nutrition caused
by inadequate caloric intake occurring chiefly
during the first year of life.
Marasmus is a form of severe malnutrition
characterized by energy deficiency. A child
with marasmus looks emaciated.
Both kwashiorkor and Marasmus are common in
underdeveloped countries and in areas in which
dietary amino acid content is insufficient to
satisfy growth requirements. Kwashiorkor
typically occurs at about age 1, after infants are
weaned from breast milk to a protein-deficient
diet of sugar water, but it can develop at any time
during the formative years.
Marasmus affects infant’s ages 6 to 18 months as
a result of breast-feeding failure, or a debilitating
condition such as chronic diarrhea.
Inadequate caloric intake..
Disturbed parent child relationship.
Severe impairment of any body system
Failure to gain weight.
Loss of skin turgor .
Distend abdomen or flat.
Atrophy of the muscle.
Subnormal temp, slow pulse
Red cell production reduced
Fatty liver characterize this.
There is typical appearance of a Pot belly which
gives a false impression of health or over
The best treatment for improving digestive power is
to give regular massage with Vata palliating oils like
bala oil, narayan oil, and dhanvantari oil every day
and exposure to early morning sun for 15 minutes.
Herbs of choice are bala , shatavari , ashwgandha ,
and guduchi . These should be given in dose of 1
gram times day with milk or water. Balarishta 10
ml. 3 times a day for 1 month with chyavan 1
teaspoon 3 times a day.
B1 - BERIBERI
Beriberi is a vitamin deficiency disease in which
the body does not have enough thiamine (vitamin
Causes-> There are two major types of beriberi:
Wet beriberi affects the cardiovascular system. is
an adult with difficulty in walking Tingling or loss
of sensation (numbness) in hands and feet.
Dry beriberi and Wernicke-Korsakoff syndrome
(with both neurologic and psychiatric symptoms)
with dyspnea (shortness of breath) on exertion.
Loss of feeling (sensation) in hands and feet
Muscle damage with loss of muscle function
or paralysis of the lower legs
Mental confusion/speech difficulties
Swelling of the lower legs
Increased heart rate
Enlarged heart related to congestive heart failure
Shortness of breath with activity
Awakening at night short of breath
This is done with thiamine supplements. Thiamine
supplements are given through a shot (injection) or
taken by mouth.
Other types of vitamins may also be recommended.
Blood tests may be done after the person is given
thiamine supplements to see how well they are
responding to the medicine.
Congestive heart failure
B2 - ARIBOFLAVINOSIS
Ariboflavinosis is the medical condition caused by
deficiency of riboflavin (vitamin B2).
Ariboflavinosis is most often seen in association
with protein-energy malnutrition and also in
cases of alcoholism.
Signs and symptoms
Sore throat with redness and swelling of the
Throat mucosa, cheilosis and angular
stomatitis(cracking of the lips and corners of the
Decreased red blood cell count with normal cell
size and hemoglobin content
B3 - PELLAGRA
Pellagra is a vitamin deficiency disease most frequently caused
by a chronic lack of niacin
The symptoms of pellagrainclude:
High sensitivity to sunlight
Smooth, beefy red glossitis
Red skin lesions
The main results of pellagra can easily be remembered
as "the four D's": diarrhea, dermatitis, dementia, and
B6 – PYRIDOXINE DEFICIENCY
Signs and symptoms
Irritability and neurologic symptoms, such as
confusion, are common place. Anemia has also
been documented as a symptom.
Treatment of pyridoxine deficiency lies with
replacing the missing vitamin. Penicillamine or
hydrazides, such as isoniazid, are rarely used
due to their ability to provoke deficiency
B7 - BIOTIN DEFICIENCY
Biotin deficiency is quite rare. Bacteria in the intestines
make biotin, or vitamin B7, is a water soluble vitamin.
Many foods also contain biotin, such as liver,
cauliflower, carrots, soy products.
Rashes including red, patchy ones near the mouth
Hair loss or total baldness (alopecia)
Biotin deficiency is easily corrected by biotin tablets,
which are inexpensive and readily available.
Folate deficiency is the lack of folic acid (one of the B vitamins) in
the blood, which can cause a type of anemia known as megaloblastic
The following are the most common symptoms of folate-deficiency
anemia. However, each individual may experience symptoms
Symptoms may include the following:
abnormal paleness or lack of color in the skin
lack of energy or tiring easily (fatigue)
smooth and tender tongue
The symptoms of folate-deficiency anemia may resemble other
blood conditions or medical problems. Always consult your
physician for a diagnosis.
Specific treatment for folate-deficiency anemia will be
determined by your physician based on:
your age, overall health, and medical history
extent of the disease
your tolerance for specific medications, procedures, or
expectations for the course of the disease
your opinion or preference
Treatment may include:
vitamin and mineral supplements
change in diet
treatment of the causative disease
Vitamin B12 deficiency, also known as
Osteomalacia: widespread bone pains and
sometimes muscle weakness. Fractures can occur.
Rickets: aches and pains, and sometimes visible
enlargement of bones at joints, such as the wrists.
Regular daily supplements of vitamin D and
calcium are usually used for people with simple
vitamin D deficiency.
VITAMIN C - SCURVY
vitamin C deficiency can occur as part of
general undernutrition, but severe
deficiency (causing scurvy) is uncommon.
Dark purplish spots on skin; especially the legs,
spongy gums; often leading to tooth loss, bleeding
from all mucous membranes,
Opening of healed scar , nosebleeds, non-
stopping diarrhea, and nail loss.
CAN VITAMIN C DEFICIENCY BE
Vitamin C deficiency can be
prevented by making sure that
you have a healthy, balanced diet
that contains plenty of fruit and
vegetables including those high
in vitamin C that are listed above.
As a rough guide, one large
orange a day will provide you
with enough vitamin C.
Hypervitaminosis A, or vitamin A toxicity, occurs when
you have too much vitamin A in your body.
Reduced bone mineral density that may result in
Coarse bone growths
Excessive skin dryness/peeling
Blurred vision, and
Loss of muscular coordination
Treatment involves simply stopping supplements (or
rarely, foods) that contain vitamin A.
Hypervitaminosis D is a rare but potentially serious
condition. It occurs when you take in too much vitamin
D. It’s usually the result of taking high-dose vitamin D
Too much vitamin D can cause abnormally high levels of
calcium in the blood. This can affect bones, tissues, and
other organs. It can lead to high blood pressure, bone
loss, and kidney damage without treatment.
Symptoms of vitamin D poisoning include:
WHAT IS THE TREATMENT FOR
Your doctor will likely advise you to stop
taking vitamin D supplements immediately.
They may also recommend that you reduce
the amount of calcium in your diet
temporarily. In some cases, corticosteroids or
bisphosphonates may suppress the release of
calcium from your bones.
Your doctor will monitor your vitamin D
levels frequently until they return to normal
Hypervitaminosis E is a state of vitamin
E toxicity. Since vitamin E can act as an
anticoagulant and may increase the risk
of bleeding problems,V
It is a state of Vitamin E toxicity.
Because vitamin E can act as an
anticoagulant and may increase the risk
of bleeding problems, many agencies
have set an upper tolerable intake level
for vitamin E at 1,000 mg .
SIGNS AND SYMPTOMS
Decreased production of thyroid
Decreased activity of vitamin K
Increased bleeding from aspirin or anti-