disorders of malnutrition

1. Disorders of malnutrition
SUBMITTED BY:
AMRITHA JAMES
CRI

2. Contents
 What Is Malnutrition?
 Definition
 Indicators Of Malnutrition
 Classification Of Malnutrition
 Malnutrition In India
 Causes Of Malnutrition
 Protein Energy Malnutrition – General And Oral Manifestation
 Micronutrient Deficiency – Oral Manifestations
 Programs For Management Of Malnutrition

3. What is malnutrition?
 Malnutrition is a condition that results
from eating a diet in which nutrients are
either not enough or are too much such
that the diet causes health problems.
 It may involve calories, proteins,
carbohydrates, vitamins or minerals.
1-year old twins in Chittagong,
Bangladesh, Left: Male; Right: Female.
The female is severely malnourished.

4. Definition
The World Health Organization defines malnutrition as "The
cellular imbalance between supply of nutrients and energy
and the body's demand for them to ensure growth,
maintenance, and specific functions."

5. Indicators of malnutrition
 Wasting : Weight for height <-2SD of
the median weight at a given height of
the NCHS/WHO reference.
 Stunting: Height for age < -2SD of
the median age-sex specific height of
the NCHS/WHO reference.
 Underweight :Weight for age < -2SD
of the median age-sex specific weight
of the NCHS/WHO reference.
 Overweight: Weight for height > +2
SD of the WHO child growth
standards median
Weight < 90%
expected
Weight> 80%
expected
WastedNormalHeight >
90%
StuntedShortHeight <
90%

7. malnutrition
Under-nutrition
Protein energy
malnutrition
Micronutrient deficiency
Over-nutrition
obesity

8. Classification of malnutrition
 Gomez Classification
 The degrees were based on
weight below a specified
percentage of median weight
for age. The risk of death
increases with increasing
degree of malnutrition
Degree of PEM % of desired body weight
for age and sex
Normal 90%-100%
Mild: Grade I (1st degree) 75%-89%
Moderate: Grade II (2nd
degree)
60%-74%
Severe: Grade III (3rd
degree)
<60%

9.  Waterlow classification
 The classification established
by waterlow combines weight-
for-height (indicating acute
episodes of malnutrition) with
height-for-age to show the
stunting that results from
chronic malnutrition.
Degree of PEM
Stunting (%)
Height for age
Wasting (%)
Weight for
height
Normal: Grade 0 >95% >90%
Mild: Grade I 87.5-95% 80-90%
Moderate: Grade
II
80-87.5% 70-80%
Severe: Grade III <80% <70%

10.  WHO Classification
 (BMI) is a simple index of weight-for-height that is commonly used to classify underweight,
overweight and obesity in adults.
 It is defined as the weightin kilograms divided by the square of the height in metres (kg/m2).

11. Malnutrition in India
 The World Bank estimates that India is one of the highest
ranking countries in the world for the number of children
suffering from malnutrition.
 The 2015 Global Hunger Index (GHI) Report ranked
India 20th amongst leading countries with a
serious hunger situation the number of children suffering
from malnutrition.

13. causes

14. OTHER
CAUSES
MATERNAL
FACTOR:
1.Maternal
malnutrition
2.Ignorance about
feeding
SOCIO-
ECONOMICAL
FACTOR:
1.Poverty and
unemployment
2.Large family size
COMMUNITY
FACTOR:
1.Generalized
economic depression
2.Inadequate primary
health care
CULTURAL
FACTOR:
wrong beliefs

15. Protein energy malnutrition
Kwashiorkor:
 Kwashiorkor is a form of severe protein energy
malnutrition.
 Characterized by sufficient calorie intake but with
insufficient protein intake.
 Classic signs:
Stunted growth
Hepatomegaly
Anaemia
Oedema

16. Marasmus:
 Marasmus is the starvation in infants occurring
due to overall lack of calories.
 Common in the 1st year of life.
 Clinical features:
 Growth failure
 Wasting of all tissues including muscles and adipose
tissues
 Shriveled body
 Wrinkled skin
 Edema and fatty infiltration are absent

17. ORAL MANIFESTATIONS
 Bright reddening of tongue
 Loss of papillae: erythematous and smooth dorsum of tongue
 Bilateral angular cheilosis
 Fissuring of lip
 Loss of circumoral pigmentation
 Dry mouth
 Reduced caries activity due to lack of substrate carbohydrate.
 Reduced tooth size Decreased enamel solubility
 Salivary gland dysfunction
 Delayed eruption
 Deciduous teeth may show linear hypoplasia.

18. Micronutrient deficiency
VITAMIN A DEFICIENCY:
 TEETH:
1. Defective formation of enamel
2. Distortion of shapes of incisors and molars.
3. Enamel hypoplasia:
1. Enamel matrix is poorly defined.
2. Calcification is disturbed.
4. Increased caries susceptibility.
5. Delayed eruption.
 GINGIVA:
1. Hyperplastic gingival epithelium
2. In prolonged deficiency: shows keratinization
 Major and minor salivary glands show typical
keratinizing metaplasia.

19. VITAMIN D DEFICIENCY:
1. Developmental abnormalities of dentin and enamel.
2. Delayed eruption.
3. Malalignment of teeth.
4. Higher caries index.
5. Enamel: may be hypoplastic, mottled, yellow gray in colour.
6. Large pulp chambers.
7. High pulp horns.
8. Delayed closure of root apices.
9. Osteoid is so soft that the teeth are displaced, leading to malocclusion of the
teeth.
10. Absence of lamina dura, Abnormal alveolar bone patterns.

20. VITAMIN E DEFICIENCY:
1. Loss of pigmentation
2. Atrophic degenerative changes in enamel.
3. Prolonged deficiency causes loss of the normal orange
brown pigmentation in the enamel of the incisor
VITAMIN K DEFICIENCY:
1. Gingival bleeding
2. Petechiae, ecchymosis and heamatoma may occur in the
oral mucosa

21. VITAMIN B DEFICIENCY:
I. Vitamin B12
1. Sore painful tongue, glossitis and glossodynia
2. Beefy red tongue
3. Small shallow ulcers with atrophy of papillae
with a loss of normal muscle tone, called as
Hunter’s glossitis.
II. Vitamin B6
1. Periodontal disease
2. Anemia
3. Sore tongue Burning sensation in the oral
cavity

22. I. Vitamin B2 ( Riboflavin) Vitamin
B3 (Niacin)
1. Glossitis
2. Angular cheilosis
3. Ulcerative gingivitis
IV. Vitamin B1
1. Hyperesthesia of the oral
mucosa
2. Atypical neuralgias
3. Burning sensation in the
tongue, dentition, jaws and
face, and hypersensitive dentine

23. VITAMIN C DEFICIENCY:
 Interdental and marginal gingiva is bright red, swollen, smooth,
shiny surface producing an appearance called, “Scurvy bud”.
 In fully developed deficiency, gingiva becomes boggy, ulcerated
and bleeds easily.
 Typical fetid breath.

24. DEFICIENCY OF CALCIUM AND PHOSPHORUS:
 Malformed teeth and jaws
 Poor quality teeth that are subject to decay in later life
 In deficiency of phosphorus, the formation and mineralization of
dentine is severely retarded and the predentine is abnormally wide.
 The alveolar bone in the molar areas consists of a large amount of
osteoid and in the condyle head the cartilage fails to mineralize and
osteoid is formed.
 Carbonate levels of the tooth is increased in phosphorus deficiency
and since a tooth with a high carbonate level is relatively acid
soluble, it is thought that teeth may become more susceptible to
dental decay.
 High levels of phosphorus decrease magnesium absorption and
increase magnesium requirements thereby accentuating the
symptoms of magnesium deficiency.

25. DEFICIENCY OF MAGNESIUM :
 Enamel hypoplasia
 Complete cessation of enamel formation
 Calcification of dentine is disturbed
 The rate of growth of the alveolar bone is retarded
 There is gingival hypertrophy
 Delayed eruption of teeth
 Altered alveolar bone architecture
 Increased resorption
 Calculus formation
 Widening of the periodontal ligments and loosening of the teeth

26. DEFICIENCY OF FLUORIDE:
 Dental caries
DEFICIENCY OF IRON:
 The presenting oral symptoms are glossitis and fissures at the
corners of the mouth. Stomatitis, ulceration, and petechial
hemorrhages in the oral mucosa.
 First the filiform and then the fungiform at papillae undergo atrophy
in a patchy or diffuse pattern, thus giving the tongue a smooth,
shiny red appearance
DEFICIENCY OF IRON:
 Thickening of the oral epithelium
 In the tongue the epithelium of the anterior dorsum becomes thick,
parakeratotic and exhibits hyperchromatism and the underlying
muscles become atrophic.

27. DEFICIENCY OF IODINE:
 The orofacial changes occurring in cretinism include
maldevelopment of jaw bones, retarded tooth eruption.
DEFICIENCY OF IODINE:
 The condyle of the temporomandibular joint exhibits widening
with irregularly arranged cartilagenous layers and a decrease
in vascularity and trabeculae.

29. Programs for management of malnutrition in india
1. Midday meal scheme in Indian schools
 The Indian government started midday meal scheme on 15 August 1995.
 It serves millions of children with fresh cooked meals in almost all the
Government run schools or schools aided by the government fund.
 Apart from this Food for Life Annamrita run by ISKCON Food Relief
Foundation and the Akshaya Patra Foundation run the world's largest
NGO-run midday meal programs, each serving freshly cooked plant-based
meals to over 1.3 million school children in government and government-
aided schools in India.
 These programs are conducted with part subsidies from the Government
and partly with donations from individuals and corporations.

30. 2. Integrated child development scheme
 The government of India started a program called Integrated
Child Development Services (ICDS) in 1975.
 ICDS has been instrumental in improving the health of mothers
and children under age 6 by providing health and nutrition
education, health services, supplementary food, and pre-school
education.
 The ICDS program is one of the largest in the world. It reaches
more than 34 million children ages 0–6 years and 7 million
pregnant and lactating mothers.
 Other programs impacting under-nutrition include the National
Midday Meal Scheme, the National Rural Health Mission, and
the Public Distribution System (PDS). The challenge for these
programs and schemes is how to increase efficiency, impact, and
coverage.

31. 3. Applied Nutrition Programme
 One of the earliest nutritional programmes.
 This project was started in Orissa on 1963
 Later extended to Tamilnadu and UP
 1973 its extended to all states in INDIA
 Objectives:
Promoting production and of protective food such Vegetables and
fruits
Ensure their consumption by pregnant & lactating women and
children.

32. 4. Special Nutrition Programme:
 This special programme was started in 1970 for the nutritional benefit of
children below 6 years of age, pregnant and nursing mothers and is in
operation in urban slums, tribal areas and backward rural areas.
5. Balwadi Nutrition Programme:
 This programme was started in 1970 for the benefit of children in the
age group 3-6 years in rural areas. It is under the overall charge of the
Department of Social Welfare.
 Balwadis also provide pre-primary education to children.
6. Vitamin A prophylaxis program:
 One of the components of National Programme for control of
Blindness is to administer a single massive dose of an oily preparation
of Vitamin A orally to all pre-school children in the community every 6
months through peripheral health children in the community every 6
months through peripheral health workers.
Special Nutrition programe was held at Shanti Bhavan
Nutritious food distribution to Bebar village Balwadi
of Nani Singloti mission.