The document discusses malnutrition, defined as the imbalance between nutrient supply and body demand, leading to various disorders such as under-nutrition and over-nutrition. It highlights different forms of malnutrition, including kwashiorkor and marasmus, along with their symptoms, causes, and nursing care interventions. Additionally, it outlines prevention strategies for malnutrition, emphasizing education, immunization, and nutritional support for at-risk populations.

1. Malnutrition
SAURABH SINGH TOMAR
ASSIT.PROFESSOR
(COMMUNITY HEALTH NURSING)
E-MAIL-saurabh.singh406@gmail.com

2. Introduction
• Malnutrition is defined as imbalance between
the body’ s need and the intake of nutrients,
which can lead to nutritional disorders.
• Malnutrition is the condition that develops
when the body does not get the right amount of
the vitamins, minerals, and other nutrients it
needs to maintain healthy tissues and organ
function.

3. Definition
• Malnutrition as "the cellular imbalance
between the supply of nutrients and energy and
the body's demand for them to ensure growth,
maintenance, and specific functions”
According to WHO

4. Types of Malnutrition
Malnutrition is divided into two main types
• Under-nutrition
• Over-nutrition
• Nutritional deficiency malnutrition
In under-nutrition nutrients are undersupplied,
and in over-nutrition nutrients are over
supplied both causes nutritional disorders.

5. Causes of Malnutrition

7. Disorders due to Malnutrition
1.Protein-energy malnutrition
–Kwashiorkor
–Marasmus
2.Under nutrition of vitamins and minerals
3. Obesity.

8. Under nutrition of vitamins and
minerals
Under nutrition of minerals
• Calcium
Rickets
• Iodine deficiency
Goiter
• Iron deficiency
Anemia
• Zinc
Growth retardation
Under nutrition of vitamins
• Thiamine (Vitamin B1)
Beriberi
• Niacin (Vitamin B3)
Pellagra
• Vitamin C
Scurvy
• Vitamin D
Rickets

9. Kwashiorkor
(Between 1-3 years old children)
• Kwashiorkor is a form of severe protein
malnutrition characterized by edema and an
enlarged liver with fatty infiltrates. It is caused
by sufficient calorie intake, but with insufficient
protein consumption.
• Kwashiorkor is a serious condition that can
happen when a person does not consume
enough protein. Severe protein deficiency can
lead to fluid retention, which can make the
stomach look bloated.

10. Conti….
• Protein malnutrition, or kwashiorkor, is mostly
found in people living in geographical areas
that have limited food resources. It's most
commonly seen in children whose diets are
low in protein and calories.

11. EPIDEMIOLOGY
• Close to 50 million children younger than 5 years
have PEM
• Approximately 80% of these malnourished children
live in Asia, 15% in Africa, and 5% in Latin America.
MORTALITY/MORBIDITY
• 5 million children younger than 5 years die every
year of malnutrition.
• 70 million present with wasting, and 230 million
present with some stunting

12. INDIAN SCENARIO
• Childhood malnutrition underlying cause of
death in 35% of all deaths under 5.
• During 1st 6 months, when most babies are
breastfed, 20-30% are already malnourished.
• By 18-23 months, during weaning, 30% are
severely stunted, 1/5th are underweight.

14. SYMPTOMS
• Changes in skin pigment.
• Swelling (edema)
• Decreased muscle mass.
• Diarrhea .
• Failure to gain weight and
grow
• Fatigue
• Hair changes (change in
color or texture)
• Increased and more severe
infections due to damaged
immune system
• Irritability
• Large belly that sticks out
(protrudes)
• Lethargy or apathy
• Loss of muscle mass
• Rash (dermatitis)
• Shock (late stage)
• Moonface

15. Nursing care of Kwashiorkor
• Support the infant and parents
• Proper diet intake proteins and CHO vitamins
• Nursing care for vomiting, diarrhea or dehydration
• Skin care for child for edema , injuries.
• Avoid any infection and follow hygienic measures
for child.
• Frequent assessment of growth and development.
• Safety measures to avoid injuries.
• Nutritional counseling.
• Record intake and out put.
• Health education about medications and follow up.
• Frequent monitoring for any complications

16. Common nursing diagnoses
• Body image disturbance related to bone
deformities
• Altered nutritional requirements related to
deficiency of calcium
• High risk for infection related to low of
immunity.
• High risk for injury related to weakness of
bones and deformities.

17. Pics of Kwashiorkor

21. Marasmus
• The term marasmus is derived from the Greek word
Marasmos, which means “withering” or “wasting”.
• Marasmus is a form of severe protein-energy
malnutrition characterized by energy deficiency and
emaciation (abnormally thin or weak)
• Primarily caused by Energy deficiency, Marasmus is
characterized by stunted growth and wasting of
muscle and tissue.
• Marasmus usually develops between the ages of 6
months and 1 year in children who have been weaned
from breast milk or who suffer from weakening
conditions like chronic diarrhea.

22. SYMPTOMS
• Severe growth retardation
• Loss of subcutaneous fat
• Severe muscle wasting
• The child looks
appallingly thin and limbs
appear as skin and bone
• Shriveled body
• Wrinkled skin
• Bony prominence
• Associated vitamin
deficiencies
• Irritability, and apathy
• Frequent watery diarrhoea
and acid stools.
• Mostly hungry but some
are anoretic
• Dehydration
• Abnormal Temperature
• Muscles are weak
• Edema
• Failure to growth and
development

23. Causes
1. Poor feeding habits due to improper training.
2. lack of breast feeding and the use of dilute animal
milk.
2.A physical defect e.g. cleft lip or cleft palate or
cardiac abnormalities, which prevent the infant from
taking an adequate diet.
3. Diseases, which interfere with the assimilation of
food e.g. cystic fibrosis.
4. Infections, which produce anorexia.
5. Loss of food through vomiting and diarrhea.
6. Emotional problems e.g. disturbed mother- child
relationship.

24. Laboratory Findings:
• Blood glucose levels.
• Hemoglobin levels.
• Urinalysis.
• Stool tests.
• Electrolyte test.

25. Complications of Marasmus
• Lack of proper growth in children
• Joint deformities
• Severe weakness
• Permanent vision loss
• Organ failure
• Coma.

26. Nursing intervention
Support the infant and parents
• provide nutrition rich in essential nutrients
• Give small amounts of foods limited in proteins,
carbohydrates and fats
• Maintain body temperature
• Provide periods of rest and appropriate activity
and stimulation
• Record intake and output
• Weight daily

27. • Change position frequently
• Proper treatment is given for infection
• Protection from infected persons and injuries
• Refer family to social worker for financial
support
• Education for parents about proper nutrition

28. Nursing diagnosis
• Altered nutrition :less than body requirements
related to knowledge deficit, infection, emotional
problems, physical deficit
• Body temperature alteration (hypothermia)
related to low subcutaneous fat and deficiency of
food intake
• Impaired skin integrity related to vitamins
deficiency
• Fluid volume deficit related to diarrhea
• High risk for infection related to low body
resistance.

29. Pics of Marasmus

32. Differences between
Kwashiorkor and Marasmus

33. Thiamine (Vitamin B1) Deficiency
Beriberi
• Biochemically, there is accumulation of
pyruvic and lactic acid in body fluids, causing:
1. Cardiac dysfunction such as cardiac
enlargement especially right side, edema of
interstitial tissue.
2. Degeneration of myelin & axon cylinders
resulting in peripheral neuropathy.
3. Weakness of eye movement, ataxia of gait
and mental disturbance

34. TYPES OF BERIBERI
1. Wet beriberi: generalized edema, acute
cardiac symptoms and prompt response to
thiamine administration
2. Dry beriberi: edema not present and
neurological

35. Symptoms of beriberi
• Wet beriberi symptoms
include:
• Shortness of breath
during physical activity
• Waking up short of breath
• Rapid heart rate
• Swollen lower legs
• Dry beriberi symptoms
include:
• Decreased muscle function
particularly in the lower legs
• Tingling or loss of feeling in
the feet and hands
• Pain
• Mental confusion
• Difficulty speaking
• Vomiting
• Involuntary eye movement
• Paralysis

37. Death

38. Riboflavin (Vitamin B2) Deficiency
• Riboflavin deficiency (also called
ariboflavinosis) results in Stomatitis including
painful red tongue with sore throat, chapped
and fissured lips (cheilosis), and inflammation
of the corners of the mouth (angular
stomatitis).

39. Signs and symptoms
• The signs and symptoms of riboflavin deficiency (also
known as ariboflavinosis) include
• Skin disorders,
• Hyperemia (excess blood) and edema of the mouth and
throat,
• Angular stomatitis (lesions at the corners of the mouth),
• Cheilosis (swollen, cracked lips),
• Hair loss,
• Reproductive problems,
• Sore throat,
• Itchy and red eyes,
• Degeneration of the liver and nervous system.

41. Niacin (Vitamin B3) Deficiency
Pellagra
• Pellagra is a disease caused by a lack of
the vitamin niacin (vitamin B3). Symptoms
include inflamed skin, diarrhea, dementia, and
sores in the mouth

42. Niacin (Vitamin B3) Deficiency Pellagra
• CAUSES
1. Diets low in niacin &/or
tryptophan
2. Amino acid imbalance or as
a result of malabsorption
3. Excessive corn
consumption
• SIGN AND SYMPTOMS
1. weakness, irritability &
dizziness
2. dermatitis, diarrhea &
dementia
3. Dermatitis may develop
insidiously to sunlight or heat
a. First appears as
symmetrical erythema
b. Followed by drying, scaling &
pigmentation w/ vesicles &
bullae at times
4. diarrhea, Mental changes
include depression, irritability,

44. Goiter
• Goiter is a swelling of the neck resulting from
enlargement of the thyroid gland.
• A Goitre commonly develops as a result of
iodine deficiency or inflammation of the
thyroid gland.

45. Symptoms of a Goiter
• The primary symptom of a goiter is noticeable
swelling in your neck.
• Other symptoms include the following:
• Difficulty swallowing or breathing
• Coughing
• Hoarseness in your voice
• Dizziness when you raise your arm above your
head

46. Pics of Goiter

48. Anemia
• Iron-deficiency anemia is a common anemia caused
by insufficient dietary intake and absorption of iron,
and/or iron loss from bleeding which can originate
from a range of sources such as the intestinal, uterine
or urinary tract.
• Iron deficiency causes approximately half of all
anemia cases worldwide, and affects women more
often than men.
• This can result if:
• The body does not make enough red blood cells
• Bleeding causes loss of red blood cells more quickly
than they can be replaced

50. Rickets
• Rickets is a softening of bones in immature mammals
due to deficiency or impaired metabolism of vitamin
D, phosphorus or calcium.
• Rickets is most common in children who are between
6 and 36 months old.
• Children are at the highest risk of rickets because
they’re still growing.
• Children might not get enough vitamin D if they live
in a region with little sunlight, follow a vegetarian
diet, or don’t drink milk products.
• In some cases, the condition is hereditary.

51. Symptoms of rickets?
• Pain or tenderness in the
bones of the arms, legs, pelvis,
or spine
• Stunted growth and short
stature
• Bone fractures
• Muscle cramps
• Teeth deformities, such as:
– Delayed tooth formation
– Holes in the enamel
– Abscesses
– Defects in the tooth structure
– An increased number of cavities
• Skeletal deformities,
including:
• An oddly shaped skull
• Bumps in the ribcage
• A protruding
breastbone
• A curved spine
• Pelvic deformities

55. Treatment of Malnutrition
• Follow WHO Guidelines
1. Treat/prevent hypoglycemia
2. Treat/prevent hypothermia
3. Treat/prevent dehydration
4. Correct electrolyte imbalance
5. Treat/prevent infection
6. Correct micronutrient deficiencies
7. Initiate Refeeding
8. Facilitate catch-up growth
9. Provide sensory stimulation and emotional support.
10. Prepare for follow-up after recovery

56. Prevention of Malnutrition
• Primary Prevention
• Health Education to mothers about good nutrition and
food hygiene through Lady Health Workers
• Immunization of children
• Growth monitoring on Growth Charts specially of all
children under 3 years of age
• Secondary Prevention
• Mass Screening of high risk populations, using simple
tools like Weight for age or MUAC.
• Tertiary Prevention
• Good Nutritional Care, supplementary feedings and
rehabilitation, counselling of mothers.