This document discusses malnutrition, including its definition, types, causes, assessment, and prevention/control. Malnutrition refers to deficiencies or excesses of nutrients and can take several forms, such as undernutrition, overnutrition, or micronutrient deficiencies. It is caused by factors like infectious diseases, poverty, lack of knowledge, and cultural food habits/taboos. Assessment methods include clinical exams, anthropometry, biochemical tests, and dietary analyses. Prevention focuses on identifying at-risk individuals and providing special feeding programs to rehabilitate the malnourished.

1. MALNUTRITION
PRESENTED BY :
MRS.,V.RAMYA.,
TUTOR.

2. Malnutrition
Malnutrition is a health problem especially in
children under 5 years of age.
Globally, there are 15 percent of world's
population, who are having problem of
malnutrition according to FAO reports.
It is a problem created by man occurring in human
societies.

3. definition
Malnutrition is a health problem occurring due to
relative or absolute deficiency or excess of
nutrients in human body and causing pathological
changes.
In other words, malnutrition can be defined as the
condition due to absence, deficiency or excess of
one or more essential nutrients.

4. Types of problem of malnutrition
Malnutrition is of four types :
 Under nutrition
 Over nutrition
 Disproportional nutrients causing imbalance
 Specific nutrient deficiency.

5. UNDER NUTRITION

6. OVER NUTRITION

7. types of malnutrition
There are two types of malnutrition
that can occur are
 Protein Energy Malnutrition (PEM)
Micro Nutrient Malnutrition.

8. Protein Energy Malnutrition

9. Micro Nutrient Malnutrition

10. Causes of Malnutrition
Infectious disease :
Diarrhoea,
 Intestinal parasites,
Malaria,
Tuberculosis

11. Food habits
Food habits are passed from generation to generation
because of culture.
 These food habits are deeply entrenched in the culture.
The food habits of Southern states of India are different
from northern states.
 Even religion plays an important role n developing food
habits such as Hindus do not eat beef and Muslims do not
eat pork.

12. Food Taboos
Food taboos also play an important role
in developing malnutrition.
Food taboos prevent people from
consuming certain foods such as
orthodox Hindus do not eat onion, Garlic
etc.

13. Personal choice for food
Personal likes & dislikes for foods,
preference for one particular type of food is
also the factor causing malnutrition.
Customs,
Beliefs,
Culture,
Attitude etc.

14. Cooking practices
 Cooking practices such as :
 Throwing the water in which the rice or pulses were soaked.
 Peeling the vegetables such as peeling of cucumber, apple etc.
 Cutting the vegetables into smaller pieces & cooking for a longer
time.
 Throwing away the part of fruit or vegetables having nutritive value
such as throwing of leaves of radish.

15. Women's status
 In some communities or some part of India
especially in rural Communities, women do not get
the same status as men.
They are advised to eat at last the left out food.
This affects the health by developing malnutrition
among girl children & women.

16. Lack of knowledge
The people lack knowledge
regarding the nutritive value of
foods due to which they are
unable to take appropriate
nutrition

17. Poverty
 Poverty loses the purchasing power
of the individual, due to which an
individual is unable to eat food
which is required to maintain the
health.

18. Poor sanitary environment
 Poor sanitary environment
causes disease to occur more
frequently, thereby
contributing to malnutrition.

19. Assessment
Various techniques are used to assess the
nutritional status of people.
These techniques will help in making
decisions to improve the nutrition. These
assessment methods are clinical examination,
anthropometry and biochemical etc.

20. Clinical Examination
 Clinical examination is practical method to determine the
nutritional status.
 In this method, various signs & symptoms associated with
undernutrition, over nutrition are assessed.
 In case of undernutrition, the signs & symptoms related to
deficiency of proteins, vitamins & minerals are assessed as each
deficiency has its own clinical manifestations while in over
nutrition, the signs & symptoms occurring due to increased amount
of protein, mineral & vitamins causing toxicity are assessed.

21. Clinical examination
WHO Expert Committee has classified signs into
three categories in nutritional surveys
i.e. signs which are not related to nutrition
(alopecia, pyorrhoea), signs which need further
investigation (malar pigmentation) & the signs
which are of value (calf tenderness, absence of
knee jerks, enlargement of thyroid gland, Bitot's
spot).

22. Anthropometry
 Anthropometric measurements are valuable measurements to
determine the nutritional status.
 The parameters used are weight, height, skin fold thickness arm
circumference, head and chest circumference to assess nutritional
status.
 These measurements are measured with reference standards and are
compared by using three methods
 Mean or median
 Weight for height and weight/height.

23. Mean or median
Median is used to assess growth and development and a
variation of +2 standard deviation is considered as within
normal limits.
__2.S.D _ +2.S.D _______
Median value
_______________________
Normal Limits

24. Weight for height
It helps in assessing whether the child is within normal
range.
 An expected weight is there for height which is taken as
reference for comparison.
Reference value has been complied by WHO which guides
in assessing the weight according to height A child who is
less than 70% of expected weight for height is considered
as severely malnourished.

25. PARAMETERS USED TO ASSESS NUTRITIONAL
STATUS
Weight measurement is one of the parameter to assess physical
growth in children.
It should be measured at intervals till 5 years of age as this age
group is at risk from growth deviation due to nutrition
inadequacy.
Jelliffe has given 80 percent of median weight per age of the
reference as cut off point.
Below this cut off point, the children should be considered
malnourished.

26. INTERVAL OF CHECKING WEIGHT
Year
/Weight
From birth to 1 year 13 months to 2
years
25th month till
5 years
Weight
recording
Monthly Every two months Every 3 month
Weight
increment
0-3 4-6 7-9 10-12
200 150 100 50-75
G G G G
Per Per Per Per
Week week week week
2.5 kg in year 2.0 kg per year

27. Height for age
 Height of an individual / child should be
compared with reference standard.
 It should increase according to age.
Low height for age is known as nutritional stunting
which reflects the past malnutrition.
The cut off point is 90 percent of height for age
values.

28. Head & chest circumference
Head and chest circumference at birth has
shown that the head circumference is 2cm
more than chest circumference.
 Within 6 to 9 months these become equal
and then afterwards chest circumference is
more than head circumference.

29. INCREASE IN HEIGHT BY AGE
At birth During 1st year During 2nd year
50 cm Increases by 25 cm Increases by 12 cm

30. HEAD CIRCUMFERENCE
Note : Measure head circumference above eyebrows and at
most prominent part of the occipital region.
At birth 6 months One year 2nd year 2- 6 years
34-35 cm 42-43 cm 46-47 cm Increases by
2cm
Increases by
2cm

31. Chest circumference
 circumference Ratio
Chest head > 1
Note : If it is <1, it means chest has failed to
develop.
 Measured in mid respiration on sitting posture at
level of nipples.

32. Mid arm circumference
Mid arm circumference is
measured of upper arm which
gives muscle mass &
subcutaneous tissue information.

33. Mid arm circumference
 Note - * It is measured with arm hanging on side.
 *It is measured between elbow and shoulder
At birth At end of 1 year From 1 year to 5 years At end of 5 year
10 Cms 16 cms 0.15 cm per year 16.75- 17 cms

34. CLASSIFICATION OF UPPER MID ARM
CIRCUMFERENCES
Circumference Normal Under developed Malnourished
Mid –upper
arm
circumference
14- 16.5 cms 13.5 to 12.5 cms < 12.5 cms

35. Biochemical Tests
 Biochemical tests are required to assess the concentration of
nutrients in body fluid. These tests detect the presence of abnormal
amount of metabolites and measure the enzymes.
 These biochemical tests are:
 Prothrombin time
 Serum folate
 Serum retinol
 Leucocyte ascorbic acid

36. Assess the dietary intake
 Assessing the dietary intake provides the information on the food
consumption.
 This can be done either by weighing the food which is cooked &
consumed and by asking the type of food with quantity eaten for the
previous 24 or 48 hours.
 Then the nutritive value of the food is calculated, by which it can be
assessed that how many calories, proteins, vitamins, minerals, fats &
carbohydrate are consumed.
 So, this assessment provides the information that whether the intake
is adequate or not.

37. Morbidity & mortality data
 The nutritional status of population can be
assessed by morbidity & mortality in relation
to deficiency of protein & CHO ( Carbon,
hydrogen and oxygen ) (Protein, energy
malnutrition, anaemia, measles & vitamin
deficiencies.)

38. Types of Malnutrition
Protein Energy Malnutrition
 It is a major public health nutritional problem and
is the most common among 1 year of life.
Protein energy malnutrition is of two types
Kwashiorkor
Marasmus

39. Kwashiorkor
Kwashiorkor occurs due to
decreased intake of proteins.
In Kwashiorkor.; deficiency is
limited to protein intake.

40. Clinical features
 The clinical manifestation of Kwashiorkor are
 Irritability.
Oedema in lower leg & usually in face & lower arms.
 Poor appetite.
Sparse, silky, easily pulled out hairs.
Hepatic enlargement due to accumulation of fat.

41. Marasmus
This is a condition caused by
decreased intake of total calories.
A deficiency of total calories is
called marasmus and is often
accompanied by Kwashiorkor.

42. Clinical manifestations
Loss of subcutaneous fat
 Muscle wasting present
 Weight for height is low
 Often have diarrhoea
Quiet & apathetic.

43. Assessment of PEM
 Growth chart:-
 Protein energy malnutrition can be detected by assessing the weight
for age.
 If the weight for age is under the reference standard, it means the
child is losing the weight.
 Health workers are maintaining growth chart for children and while
looking at this maintained growth chart, malnutrition can be
assessed.

44. Comparison of weight of child with the weight of
normal child of same age
This is based on Gomez classification.
According to this classification
Weight for age = Weight of child / Weight of
normal child of same age *100
This is measured in percentage.

45. Comparison of weight of child with the weight of normal child of
same age
 By this, on the basis of percentage malnutrition is calculated as given in table.
Degree /
Percentage
90-110% 75-89% 60-74% Under 60%
Degree of
malnutrition
Normal 1st degree 2 nd Degree 3rd Degree
Severity Normal Mild Moderate Severe

46. Comparison of height of child with height of normal child at
same age
 It is done to assess the development in relation to height.
 It is calculated by the given formula
 Height / age % = Height of child / Height of normal child of same age * 100
 Nutritional status according to % Height / age
Ratio Normal Mild Moderate Severe
Height/ age > 95 87.5-95 80-87.5 < 80

47. WEIGHT /HEIGHT
It is also measured in percentage and is
calculated through the formula.
weight/Height % =Weight of child /
Weight of a normal child of same height
*100

48. NUTRITIONAL STATUS ACCORDING TO
WEIGHT / HEIGHT
Ratio Normal Mild Moderate Severe
Weight / Height > 90 80-90 70-80 < 70

49. Micronutrient malnutrition
Diseases caused by deficiency of vitamins &
mineral.
The person should take a well-balanced diet which
contains all the vitamins & minerals along with
protein, fats & carbohydrates.
In the absence of these, the individual can suffer
from a variety of diseases.

50. Deficiency of vitamin A cause disease
Bitot's spots
Conjuctival xerosis
Corneal xerosis
Keratomalacia
 Night blindness

51. Deficiency of vitamin D causes
 Rickets
 Osteomalacia

52. Vitamin E deficiency causes
No clear indication of dietary deficiency disease.
The role of vitamin E at the molecular level is little
understood.
Cytotoxic effect of vitamin E on human lymphocytes in
vitro at high concentration has been reported.
So mega dose of vitamin E should be used cautiously.

53. Vitamin K deficiency
Prothrombin level of blood is
decreased and blood clotting time
is increased.
 So causes bleeding disorders.

54. Deficiency of vitamin B 1-
Thiamine deficiency
causes :-
Beri – beri Wernick’s
encephalopathy

55. Riboflavin (vitamin B2) deficiency
The most common lesion
associated with riboflavin
deficiency is angular
stomatitis.

56. Niacin
Niacin deficiency results in:-
Pellagra - Which is characterised by 3D's –
Diarrhoea,
dermatitis and
dementia.

57. Pyridoxine deficiency
 It is associated with
the diseases such as
Peri- pheral neuritis.

58. DEFICIENCY OF FOLATE
 Its deficiency results in ;
Megaloblastic anaemia
Glossitis
Cheilosis
 Gastro intestinal disturbances such as
diarrhoea, distention & flatulence

59. Deficiency of vitamin B12
Deficiency of vitamin B12 is associated with :
Pernicious anaemia
Demyelinating neurological leisons.
Infertility

60. Deficiency of vitamin C
Deficiency of vitamin C results in
scurvy which has signs of swollen and
bleeding gums, subcutaneous bruising or
bleeding into skin or joints, delayed
wound healing, anaemia & weakness.

61. Diseases Caused by Deficiency of
Minerals : -
Deficiency of calcium
No clear cut disease due to deficiency of calcium
has ever been observed but it has been established
that if the intake of vitamin D is adequate, the
problems of rickets and osteomalacia do not rise
with even low calcium intake.

62. Deficiency of phosphorous
 Phosphorus plays an
important role in all
metabolisms.
 Its deficiency rarely occurs.

63. Deficiency of sodium
Deficiency of sodium
causes muscular cramps.

64. Deficiency of magnesium
The principal clinical features of magnesium
deficiency are :-
Tetany
Irritability
Hyper reflexia

65. Deficiency of Iron
Deficiency of iron causes the health
problems such as –
 Anaemia
 Reduced resistance to infection.
 Impaired cell mediated immunity

66. Iodine deficiency
Iodine deficiency causes
Deaf-mutism
Severe mental retardation
 Goitre.

67. Iodine deficiency
Spontaneous abortion in
pregnant ladies & also still births
Hypothyroidism
 Cretinism in children

68. Fluorine deficiency
Fluorine deficiency
causes Dental caries.

69. Other trace elements deficiency
Other trace elements deficiency such as
deficiency of zinc, copper, cobalt etc.
 causes health problems such as
deficiency of copper causes neutropenia.

70. Prevention and Control of Malnutrition (A)
Undernutrition
 Identification of affected individuals :-
 A survey should be carried out in the community to identify the
affected individuals through clinical examination and body
measurements.
 The survey will provide the data about the nutritional status of the
community.
 This survey should be continued so as to plan the strategies to
reduce the number of affected people & to control & prevent the
malnutrition.

71. Special feeding programmes
The affected individuals should be rehabilitated by
focusing on special feeding programmes.
Disaster relief agencies should provide special feeding
programme in which about 400-600 kcal/person/day
should be provided
 The children suffering from severe PEM may be
admitted to hospital & less severly cases treated through
special nutrition rehabilitation programmes.

72. Health education
 Health education is one of the way to improve the
nutritional status of community by creating
awareness about the type of foods to be eaten &
the to calorie intakes according to energy needs of
body.
Informing & motivating the general public about
the importance of micronutrients.

73. Health education
Promotion of breast feeding and
improvement in infant and child feeding
practices
 Improving the purchasing power of people.
 Educating the selection of right kind of
food.

74. Health education
Correction of harmful taboos and dietary
prejudices.
 Decreasing the infectious diseases by appropriate
measures.
 Kitchen gardening.
 Proper planning of budget with expenditure on
food.

75. Over nutrition
Due to over nutrition , obesity results.
Increased intake of energy giving food leads to prolonged
post-prandial hyperlipidemia.
Due to this, triglycerides in adipose tissue are deposited.
This results in obesity.
So obesity is defined as abnormal deposition of adipose
tissue.
The obesity is found in relation to body mass index.

76. Obesity
Obesity is a form of malnutrition which is
prevalent in developed & developing
countries.
It is a risk factor for chronic, non
communicable diseases such as hypertension,
coronary artery disease, diabetes mellitus.

77. Risk factors
Obesity is caused by multiple
factors.
The associated risk factors are :
Over eating
Physical inactivity

78. Risk factors
Genetic factors
Emotional disturbances
Endocrinological factors
Alcohol intake
 Drugs such as corticosteroids.

79. Assessment of obesity
Obesity assessment is based on
following criteria.
Body weight
Skin fold thickness
Waist circumference & waist hip ratio

80. Body weight
 The indicators used for assessment of obesity are :
 Body Mass Index : It is defined as the ratio of
weight in kg to square of height in metre.
The formula used is
B.M.I. = Weight (kg) /Height2(m)

81. Broca Index
 Broca index is used to assess the
ideal weight, through which it can be
calculated that the individual is over
weighed or not.
 Broca Index = Height in cm -100

82. Corpulence Index
 It is the ratio of Actual weight to
desirable weight and it should not
exceed 1.2.
 Corpulence Index = Actual
weight /Desirable weight

83. Skin fold thickness
Harpenden skin callipers are used to measure the
mid-triceps, biceps, subscapular and suprailiac
region.
For boys, the sum of these measurements should
be 40mm & for girls it should be 50mm.
Waist hip ratio : It should not be more than 1.0 in
men and 0.85 in women.

84. Prevention And Control of Over nutrition
 Identification of people having obesity.
 Creating awareness among public regarding dietary
habits.
 Regular physical exercise.
Surgical treatment.
 Health education.
Food intake according to energy requirement

85. BIBLIOGRAPHY
 Neelam Kumari A Textbook of Community Health Nursing - I
,2011 Edition , Published by Pee Vee ( Regd .), Page reffered to
565- 574.
 https://www.slideshare.net/saurabhsingh1153/malnutrition-
236674839
 https://www.slideshare.net/LamiaaGamal/malnutrition-47406428
 https://www.slideshare.net/amjadkhanafridi4all/malnutrition-
61554629