like night blindness, beriberi, scurvy, osteomalacia and impact of malnutrition in Bangladesh

1. Towkir Ahmed Ove
M.S in Food Science & Nutrition

2. Micro nutrient
, beriberi,
, ;
impact of
malnutrition

3. DEFINITION
• Micronutrients are essential elements required by organisms in small quantities
throughout life to orchestrate a range of physiological functions to maintain
health
• Vitamins are organic compounds that are needed in small quantities to sustain
life.
• Most vitamins need to come from food. This is because the human body either
does not produce enough of them, or it does not produce any at all.
• Each organism has different vitamin requirements.

5. NIGHT BLINDNESS
• Also termed as ‘nyctalopia’.
• It is defined as diminution of vision in dim light.
• It occurs due to defect in transition from photopic to scotopic vision.
• Apart from adaptation of mainly photoreceptor rods and then cones,
the neural adaptation mechanism also plays role in dark adaptation
‘nyctalopia’.

6. Continued
• Each day about 88 children become blind in Bangladesh due to vitamin 'A'
deficiency. Vitamin 'A' associated night blindness in children of 1-6 years of age is
about 2 percent.
• Night blindness in children under five years has reduced from 3.76% in 1983 to
0.04% in 2005 and is being maintained well below the WHO-recommended 1%
threshold level

7. Causes
• Vitamin A deficiency
• Retinitis Pigmentosa & other tapetoretinal degenerations
• Congenital night blindness
• Pathological myopia
• Peripheral cortical cataract & Corneal opacities
• Advanced Primary open angle glaucoma
• Vitamin A Deficiency Inhibits the production of rhodopsin (the eye pigment
responsible for sensing low light situations) found in the retina, composed of
retinal (active form of Vitamin A).
• The decreased amount of rhodopsin in the eye implies that there is inadequate
retinal to bind to opsin. Therefore, night blindness results.

8. Treatment
• The treatment method depends on the cause of the night blindness:
• Vitamin A deficiency - treated by giving Vitamin A supplement
• Retinitis Pigmentosa – not completely curable, but the rate of
progression of this disease can be reduced by intake of vitamin A
supplements and surgeries (retinal transplant)
• Myopia – use of corrective glasses or lenses or refractive surgery
• Glaucoma – switching of glaucoma medicines may help
• Peripheral Cataract – Cataract surgeries

9. What is thiamin, or vitamin B1?
• vitamin B1 is a water-soluble vitamin
• Vitamins are classified according to the materials they dissolve in. Some dissolve
in water, and others dissolve in fat. Water-soluble vitamins are carried through
the bloodstream. Whatever the body does not use is eliminated in urine
Benefits
• Vitamin B1, or thiamin, helps prevent complications in the nervous system, brain,
muscles, heart, stomach, and intestines. It is also involved in the flow of
electrolytes into and out of muscle and nerve cells.
• It helps prevent diseases such as beriberi, which involves disorders of the heart,
nerves, and digestive system.

10. Function
• All B vitamins are water-soluble. They help to convert carbohydrates, fats, and
protein into energy, or glucose.
• B vitamins are necessary for keeping the liver, skin, hair, and eyes healthy. They
also play a role in the nervous system, and they are needed for good brain
function.
• The B vitamins are sometimes called anti-stress vitamins, because they boost the
body's immune system in times of stress.

11. Deficiency symptoms
• A deficiency of vitamin B1 commonly leads to
beriberi, a condition that features problems with the
peripheral nerves and wasting.
• Weight loss and anorexia can develop.
• There may be mental problems, including confusion
and short-term memory loss.
• Muscles may become weak, and cardiovascular
symptoms can occur, for example, an enlarged heart.

12. Who is at risk of B1 deficiency?
• People with poor diet, cancer, ”morning sickness" during pregnancy, bariatric
surgery, and hemodialysis are at risk of thiamin deficiency.
• People who regularly drink alcohol to excess may have a deficiency, as they may
not absorb thiamin from their food.
• Wernicke-Korsakoff syndrome is a disorder that affects people with
chronic alcoholism . It is linked to a lack of thiamin, and it can be fatal if not
treated.
• Other diseases, such as HIV, can reduce the absorption of nutrients, and this can
lead to a deficiency of vitamin B1.

13. How much vitamin B1 do we need?
• In the U.S., the recommended daily allowance (RDA) of thiamin taken by mouth
is 1.2 mg for males and 1.1 mg for females over the age of 18 years. Pregnant or
breastfeeding women of any age should consume 1.4 mg each day.

14. SCURVY
• Scurvy is a condition caused by a lack of vitamin C in the diet. In the past scurvy
was common among sailors and other people deprived of fresh fruits and
vegetables for long periods of time.
• Symptoms
• a feeling of discomfort, tiredness,
• Nausea
• muscle and joint pain
• easy bruising,
• swollen and bleeding gums,
• loosening of teeth,

15. Continued
• wounds healing slowly and poorly,
• dry skin and hair, and
• bleeding into muscles and joints causing pain
Lacking Nutrient
The only cause of scurvy is a diet that is lacking in an adequate amount of vitamin C.
Another important cause of scurvy is stress which increases the utilization of ascorbic
acid.

17. Treatment & Prevention
• Treatment is simply with vitamin C supplements taken orally.
• The adult dose is 800-1000mg/day for at least 1 week, then 400mg/day until
complete recovery.
• In the U.S., the recommended dietary allowance (RDA) for vitamin C was recently
revised upward from 60 mg daily for men and women. The RDA continues to be
based primarily on the prevention of deficiency disease, rather than the
prevention of chronic disease and the promotion of optimum health.
• Infants who are being weaned from breast milk to cow's milk need a supplement
containing vitamin C.

18. OSTEOMALACIA
• Osteomalacia is the softening of the bones caused by defective bone
mineralization secondary to inadequate levels of available phosphate and
calcium, or because of overactive resorption of calcium from the bone which can
be caused by hyperparathyroidism (which causes hypercalcemia).
• Osteomalacia in children is known as rickets, and because of this, use of the term
"osteomalacia" is often restricted to the milder, adult form of the disease.
• Signs and symptoms can include diffuse body pains, muscle weakness, and
fragility of the bones.

19. Causes
• Osteomalacia is a generalized bone condition in which there is inadequate
mineralization of the bone. Many of the effects of the disease overlap with the
more common osteoporosis, but the two diseases are significantly different.
• dietary deficiency of vitamin D + lack of solar irradiation
• deficiency of metabolism of vitamin D
• decreased absorption of vitamin D
• decreased deposition of calcium in bone
• chronic renal disease and chronic liver disease
There are two main causes of osteomalacia:
1. insufficient calcium absorption from the intestine because of lack of dietary
calcium or a deficiency of, or resistance to, the action of vitamin D; and
2. phosphate deficiency caused by increased renal losses.

20. Signs & symptoms
• Diffuse joint and bone pain (especially of spine, pelvis, and legs)
• Muscle weakness
• Difficulty walking, often with waddling gait
• Hypocalcaemia (positive Chvostek sign)
• Compressed vertebrae and diminished stature
• Pelvic flattening
• Weak, soft bones
• Easy fracturing
• Bending of bones
• Osteomalacia in adults starts insidiously as aches and pains in the lumbar (lower
back) region and thighs before spreading to the arms and ribs.

21. Treatment
• Nutritional osteomalacia responds well to administration of 10,000 IU or 250 mcg
weekly of vitamin D for four to six weeks.
• Osteomalacia due to malabsorption may require treatment by injection or daily oral
dosing ofsignificant amounts of vitamin D.
• Calcitriol supplement for CKD.
• Diet and nutrition
A diet that includes vitamin D and calcium can help, but this won’t prevent the
condition by itself. Nevertheless, a diet that provides vitamin D is especially important if
patients don’t get enough exposure to sunlight.
• Sunlight
Where possible, going outside and exposing arms and face to sunlight is the best way to
get vitamin D.

23. Impact of Malnutrition
• Brown & Pollitt (1996) cited in UNICEF (2011) found that the intellectual
development of children is correlated with their nutritional status; any type of
Under nutrition in the first two years of life interrupts normal brain development
and thereby perpetuates lasting damage.
• It is estimated that investing in nutrition can increase a country’s GDP by at least
3 percent annually.
• For the millions of children who are stunted and/ or underweight, it translates to a
huge socio-economic burden on the economy.
• However, the concern lies behind huge current child malnutrition as these affected
children will enter the labour market with diminished human capital potential and
thus lead to low per capita GDP.

26. Continued
• Over the last decade, Bangladesh has made remarkable progress in fighting
malnutrition. In 1997, the stunting rate was 58%, which declined to 41% in 2011,
according to the Bangladesh Demographic Health Survey, 2011.
• The number of stunting cases among children below five years of age also came
down to 35% from 45% in 2010, according to Food Security and Nutritional
Surveillance Project.
• National Micronutrient Survey 2011-12 says only 20% of young children aged
between 6 and 23 months receive the minimum acceptable diet.

27. Conclusion
• There is need to strengthen internal nutrition capacity and leadership across
government departments and agencies so that support can be optimized for
achieving national nutrition targets.
• In particular, this is essential to meet the nutrition objectives and measures that
have to be more purposefully applied across all relevant programmes in multiple
sectors.