2. OBJECTIVES
1. Demonstrate the understanding of importance of nutrition in
disease prevention and maintenance of good health
2. Recognize and manage nutritional disorders
Areas:
• Definitions and Food classification
• Anthropometry
• Human nutritional requirements for different
groups
• Common nutritional disorders
3. DEFINITIONS
Nutrition: is the sum total of the processes involved in
the taking in and the utilization of food substances by
which growth, repair and maintenance of the body are
accomplished.It involves ingestion, digestion, absorption
and assimilation.
Nutrient- are compounds in foods that are needed by
human body for energy to work, for growth of body
tissue, for repair and maintenance of body tissues and
also to support body’s immune function all that works
towards a healthy living. Basically, nutrients are
substances required by the body to perform its basic
functions
Food: any nourishing substance that is eaten, drunk, or
otherwise taken into the body to sustain life, provide
energy, promote growth
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Balanced diet: a diet that provides the correct amount of nutrients for the
needs of an individual
Malnutrition: incorrect or unbalanced intake of nutrients, may be insufficient
or excess
Macronutrients: an essential nutrient required in relatively large amounts,
such as carbohydrates, fats, proteins, or water;
Micronutrients: A substance, such as a vitamin or mineral, that is essential in
minute/small amounts for the proper growth and metabolism of a living
organism.
Community Nutrition: Refers to the social, economic, cultural and
psychological implications of food and eating.
Human nutrition: is the study of food in relation to health of individual and
groups of people particularly the infants, adolescents, pregnant and lactating
mothers (vulnerable groups) and functioning of the body organs and provide
the energy the body requires.
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Food bio availability – reduced or increases effects due to
interaction eg when spinach is mixed with meat in anaemic patient
works excellent, spinach produces oxalic acids which binds to iron
thus increase iron absorption but when taken with tea it works bad
coz tea binds with iron preventing oxalic acid binding to iron
absorption to the body hence iron deficit
Junk foods- less important foods
Faddism – false information in a community done as a fashion
Nutritional status is a condition in the body resulting from intakes
absorption and use of food.
Malnutrition is a term encompassing under nutrition (wasting,
stunting, underweight and deficiencies of essential vitamins and
minerals) and over nutrition (obesity)
6. CT..
Acute malnutrition (wasting) is the result of recent
rapid weight loss or failure to gain weight and is
associated with an increased risk of mortality. can be
moderate or severe
Chronic malnutrition (stunting)is the result of
inadequate nutrition over a much longer period of
time and is associated with an increased risk of
disease/eventual death
Underweight is the outcome of wasting or stunting
or a combination of both and is associated with poor
growth and development
7. IMPORTANCE OF GOOD NUTRITION
Its especially important for:
Physical and mental dev. Of children and adolescents.
Healthy pregnancies and deliveries.
Resistance to infections
For energy for working well
To prevent deficiencies i.e. Kwashiorkor.
8. FACTORS INFLUENCING NUTRITION
1. Biological factors: –
Age – different age groups require different RDA e.g infant, adolescent, elderly
Sex – males require higher RDA than females
Growth – the size of a person determines the quantity of food to be taken, children with
poor developed milestone require high nutritive diet (energy and nutrient dense diet)
Diseases state/condition – worms, malaria cause blood loss thus increases in nutrient needs,
Pregnant/lactating mothers require increased RDA, DM/HTN require restricted diet, PLHIV
require special diet rich in vitamins etc
Genetic makeup – people have different growth hormone and different digestive juice
production thus nutrition process are different to specific people
2. Social economic – poverty – no variation in nutrient intake, household food insecurity, those of
low class may fail to afford balanced diet unlike the high class
9. CT..
3. Climatic condition – some season may have plenty of foods
while others may have no food produce
4. culture- beliefs and superstitions may prevent someone from
eating the right diet
5. Family size – large family size there is competition for food
6. Knowledge – concept of preparing quality food
7. Locality – homestead might be located near locally available
nutritious foods e.g those near the lakes get fish locally
10. FOOD CLASSIFICATION
Food is classified according to the nutrients it contains and functions it
performs. There are two types of nutrients according to the body
requirements; -
According to nutrients
Macronutrients –those that the body requires in large quantities measured in
grammes.
Micronutrients – those that the body requires in small quantities and a re
measured in milli- or micro grammes.
According to nutritional functions
Food is classified into 3 major groups according to nutritional functions.
Energy producing
Body building
Protective foods.
12. PROTEINS
They are the chief substances of the cells of the body. They are made up of simpler substances known as amino acids.
These amino acids are made of carbon, hydrogen, oxygen and nitrogen. They are categorized as essential and non
essential.
Essential
Those not synthesized by the body and must be included in the diet.
They include-histidine, methionine, tryphtophan, isoleucine, leucine,lysine, threonine, valine and
phenilanine
Non essential
Those that can be synthesized by the body and need not to be in the diet.
They include alanine, arginine, aspartic acid, asparagine, cysteine, cystine, glutamic acid, glutamine, glycine,
hydroxyproline, proline, serine, and tyrosine
The nutritional value of protein depends on the amino acids of which it is composed of.
Some foods are referred to as complete proteins because they contain all the essential amino acids in the proportions
required to maintain health. They are derived almost entirely from animal sources e.g. meat, fish, milk, eggs, soya beans,
and milk products excluding butter. They are also known as high quality proteins since they are easily digested.
13. CT..
Sources of proteins
1. Animal products
2. Plant products e.g. legumes cereals
3. Other sources like oil seeds
14. CT..
Functions of proteins
Amino acids are used for;-
1. Growth and repair of body cells ad tissues
2. Synthesis of enzymes, plasma proteins, immunoglobulin and
some hormones.
3. Provision of energy. When consumed in excess or there is
deficiency of carbohydrates in the diet and fat stores are depleted. 1
gram of protein produces 4.1 calories.
15. CARBOHYDRATES
They are the main sources of energy and are composed of carbon, hydrogen
and oxygen. 1 gram of carbohydrates yields 4.1 calories. Carbohydrates are
classified according to the complexity of the chemical substances from which
they are formed.
Monosaccharides – are the simplest forms and include glucose, fructose and
galactose. They are broken down into CO2 + H2O + energy after being
converted into glucose.
Disaccharides – These consist of 2 monosaccharide molecules chemically
combined. When the molecules are split into monosaccharides energy is
released for metabolic work. They include
Sucrose- glucose + fructose + water
Maltose- glucose + glucose + water
Lactose- galactose + glucose + water
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Polysaccharides- these are complex molecules made
up of a large number of monosaccharide molecules in
chemical combination e.g. starches, glycogen,
cellulose e.t.c
The polysaccharides are broken down during
digestion to give monosaccharides. Not all
polysaccharides can be digested by human e.g
cellulose, this is because the enzymes required to
digest them are not produced by the body. Thus pass
the alimentary canal untouched as roughage.
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Sources
1. Starch- cereals e.g. wheat rice, millet, maize.
2. Sugars
a.monosaccharides are found in fruits, honey, milk
b. Disaccharides like sucrose- sugar, lactose-milk,
maltose-starch.
3. Cellulose- fibrinous substance found in vegetables,
fruits and cereals.
18. CT..
Functions
1. Provision of rapidly available energy and heat. Glucose is the main fuel
molecule for energy production which is necessary for cellular activities.
2. It is essential for combustion of fats as fat is broken down using energy from
catabolism of carbohydrates.
3. Protein sparing- with adequate supply protein is not used for energy
4. Provision of energy for storage, when eaten in excess. In form of
a. Glycogen –as a short term energy store in the liver and muscles
b. Fat and deposited in the fat depots under the skin and other areas
Daily requirements
The optimum quantity is 50-70% of the total energy requirements.
19. FATS
These are lipids that are solid at room temperature. Lipids are
compounds that are insoluble in water but soluble in organic
solvents like ethanol or alcohol.
They are made up of carbon, hydrogen and oxygen. The hydrogen
and oxygen proportions are not the same as those of water and
thus differ with carbohydrates.
They are classified as saturated and non saturated fats.
20. CT..
Saturated –these are animal fats and contain saturated fatty
acids and glycerol. They are found in milk products, meat and
eggs. All animal protein sources contain saturated fats.
Cholesterol is a saturated fat of clinical importance and is
produced in the body but can be found in meat and egg yolk.
Unsaturated- this is vegetable fat containing unsaturated fatty
acids and glycerol and is found in margarine and vegetable oil.
There are three main poly unsaturated fats which are essential
in that they cannot be synthesized by the body. Thus must be
contained in the diet since they are necessary in the synthesis
of plasma membrane lipids, prostaglandins, leukotrines e.g
Linoleic acid and Arachidonic acids
21. CT..
Functions
1. Provision of most concentrated sources of chemical energy and heat.
2. Support of certain body organs e.g. kidneys, eyes
3. Transport and storage of fat soluble vitamins e.g. A, D, E, K.
4. Constituent of nerve sheaths and of sebum, the secretion of sebaceous glands in the skin.
5. Formulation of cholesterol and steroid hormones.
6. Insulation e.g. as a subcutaneous layer it reduces heat loss through the skin
7. Storage of energy in the adipose tissue
8. Satiety value- gastric emptying time is prolonged in chime containing fat thus prolonging the return of hunger
Sources
Animal sources for non essential fatty acids and marine fish oils like cod-liver oil for essential fats
Vegetable sources – all vegetable oils have essential fat acids except coconut oil.
22. WATER
It is the most important nutrient because the functions of the
cells occur in a fluid environment.
Water makes up about 60-70% of the body weight,
approximately 65 in men, 55 % in women and more in infants.
Lean people’s body contains more water than that of the obese.
Infants are the most vulnerable to water deprivation or loss but
everyone needs water for survival. Huge amounts of water are
lost everyday in form of urine, sweat and faeces.
This usually balanced in a normal individual by intake in food
and fluids to satisfy thirst. Dehydration with serious
consequences may occur if intake does not balance loss.
There also can be a positive balance in some clinical conditions
bringing about serious consequences.
23. FUNCTIONS
1. Provision of a moist internal environment required by all living cell in the body
2. Participation in all the chemical reactions that occur in the body.
3. Moistening of food as saliva.
4. Regulation of body temperature as sweat
5. Major constituent of blood and tissue fluid thus is involved in transport of
various substances in the body.
6. Dilution of waste products and poisonous substances in the body
7. Providing medium for secretion of waste products e.g. urine sweat.
24. MICRONUTRIENTS
VITAMINS
These are chemical compounds required in small quantities and
are essential for normal metabolism. Many are not produced in
the body thus have to be supplemented in the diet.
They are contained in many foods but are affected by processing,
storage and preparation of food.
Thus vitamin content is highest in fresh foods that are used
quickly with minimal exposure to heat, air and water.
25. CT..
Classification
They are grouped into water soluble and fat soluble
vitamins depending on there solubility.
Water soluble- vitamin B group and C
Fat soluble are vitamin A, D, E, K
Each vitamin has a specific function in the body. The
minimum intake of many has been determined but
optimum remains speculative.
26. WATER SOLUBLE
They cannot be stored in the body and must be provided in the daily intake.
Vitamin C
It is very soluble and easily destroyed by heat, aging, chopping, salting and drying.
Functions
1. Utilization of iron- it acts as an antioxidant thus important in the reduction of iron for its utilization
2. Forms cement that holds cells together known as collagen and thus strengthens blood vessels and promote wound
healing
3. It is important in the maturation of RBCs
4. It helps in arresting bleeding and is important in providing the first line of body defense
5. It is catalyst I the metabolism of amino acids.
Sources – citrus fruits, green vegetables liver and glandular tissues in animals.
Daily requirements-approximately 40mg daily that is
Adults-50mg
Pregnancy-50mg
Lactation – 50 + 30mg
Infants 30-50mg
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Deficiency
It becomes apparent within 2-3 months with
Scurvy (severe deficiency)
Poor wound healing
Easy bruising and minor hemorrhages
Lose teeth
Anemia
Excess
Results in –
kidney stones due to crystal formation
Urinary tract infection
Scurvy on withdrawal
28. CT..
Vitamin B1-thiamine
It is a relatively stable to heat in the dry form but other wise rapidly destroyed. The daily requirement is 0.8- 1 mg and the body
stores about 30mg thus the intake should be 5mg for a 1000 calories
Functions
1. Coenzyme in carbohydrate metabolism
2. Its important for the nervous system function and muscles because of the dependency of these tissues on glucose for fuel
3. Important in maintaining appetite and normal digestion
Sources- whole grains, unmilled cereal, milk, nuts, meat, lentils, green leafy vegetables
Deficiency results in beriberi where there is
1. Severe muscle wasting
2. Delayed growth in children
3. Polyneuritis – degeneration of nerves
4. Susceptibility to infections
Wernicke encephalopathy and Korsacoff syndromes in alcoholics whereby there is
irreversible memory loss, ataxia, visual disturbances (double vision) and cardiac
enlargement arrhythmias, calf tenderness and mental confusion. Rx is thiamine
29. CT..
Vitamin B2
It is also known as riboflavin. The daily requirement is 1.1-1.3 mg. Only small amounts are kept in the body and it’s
destroyed by light and alkalis.
Functions
1. Coenzyme in protein metabolism
2. Promotes healthy skin and eyes
3. Oxidation and reduction of fats
Sources- yeast, green, vegetables, milk, liver, fish, eggs, whole grain
Deficiency
Cracking of the skin especially around the mouth – angular stomatitis
Inflammation of the tongue – glossitis
Photophobia
Scrotal dermatitis
Greasy skin around the angle of the nose
Excess- elevated blood glucose and uric acid In blood
30. CT..
Folates
Occurs in 2 forms in food
1. Free folates
2. Bound folates e.g. folacin folic acid: It is synthesized by the bacteria in the large intestines. It is destroyed by heat and
moisture. Daily requirements are(Healthy adults-100 micro grams, Pregnancy- 300,Lactation-150,Children-100)
Only small amounts are stored in the body and deficiency is noted in a short time.
Sources – liver, kidney, fresh leafy green vegetables yeast and poultry
Functions
1. DNA synthesis – without it mitosis and cell division is impaired
2. Maturation of RBCs
3. Metabolism of amino acids ( synthesis of purine and pyrimidines)
Deficiency results in megaloblastic or macrocytic anima
Excess-masking of vitamin B12 deficiency, insomnia and diarrhea
31. CT..
Niacin- nicotinic acid Required for utilization of carbohydrate. Amino acid tryptophan is converted to niacin in the
body. Sources-meat, whole grain cereals, eggs and dairy products
Requirements -6.6mg/1000 calories/day
Functions
1. Coenzyme in energy production reactions
2. In fat metabolism it enables it inhibits production of cholesterol
3. Promotes healthy skin, gastrointestinal and nervous system functions
4. It helps in protein utilization
Deficiency-pellagra within 6-8 weeks of severe deficiency characterized by 3 Ds
1. Dementia
2. Dermatitis
3. Diarrhea- other gastrointestinal disturbances e.g. anorexia, nausea, dysphagia, inflammation of the oral mucosa.
NB isoniazid used in Rx of TB leads to deficiency of niacin
Excess- ulcer, liver dysfunction, increased blood glucose e.t.c.
32. CT..
Vitamin B6(Pyridoxine)
Functions
1. Important in protein metabolism especially synthesis of nonessential
amino acids and molecules like haem and nucleic acids.
2. Conversion of tryptophan to niacin
3. Proper functioning of the central nervous system
Daily requirements -1.2-1.4 mg and the dietary deficiency is rare but
affected by like alcohol and anti Tbs
Sources; meat, eggs yolk, peas, beans, yeast, liver e.t.c
Deficiency; chilosis, anaemia, skin lesions, CNS disturbances
33. CT..
Vitamin B12 (cobalamin) It contains cobalt. It is found in food of vegetable origin. It is
synthesized in the human colon but in bound form.
Daily requirement Adult -2 micrograms, Pregnancy- 2 micrograms, Lactation-2.5
micrograms
Functions
1. It is essential for DNA synthesis that is synthesis of purine
2. Formation and maintenance of myelin-fatty substance protecting the nerves
3. Red blood cell maturation
Sources – milk, cheese, foods of animal origin
Deficiency- usually due to absence or insufficiency of intrinsic factor in stomach to assist in its
absorption
Megaloblastic anaemia
Infertility
Peripheral neuropathy.
34. CT..
Pathothenic acid It is destroyed by heat and freezing
Function-
it is associated with amino acid metabolism
Cholesterol synthesis
Steroid hormones synthesis (activity of the adrenal cortex)
Sources- widely distributed in animal proteins
Daily requirements 3-7mg
Deficiency- no symptoms have been identified
Excess- increased need of thiamine, occasionally diarrhea and water
retention
35. CT..
Biotin
Function
synthesis of fatty acid
Utilization of glucose and vitamins B12, folate
Deficiency- not identified
Sources – synthesized in the gut microbes, liver, kidney, egg yolk
green vegetables
Daily requirement – 10-20 micrograms and is relatively stable
compound
36. FAT SOLUBLE VITAMINS
These vitamins can only be absorbed if fat absorption is normal.
Vitamin A
Sources-can be formed in the body from certain chemicals known as carotenes whose sources are fruits, carrots and
green vegetables but also found in milk egg yolk liver
Daily requirements 600-700 micrograms
Functions
Generation of the light sensitive pigment rhodopsin in the retina of the eye
Growth and differentiation especially fast-growing cells of the epithelium
Promotion of immunity and defense against infection
Promotion of growth through increas3 in the length of bones.
Deficiency
1. Xerophthalmia-drying and thickening of the conjunctiva leading to ulceration
2. Night blindness
3. Atrophy and keratinisation of other epithelial tissues leading to increase of infections like the ear and respiratory tract
infections
4. Immunity and bone development is compromised.
37. CT..
Vitamin D
Found mainly in animal fats e.g. butter, egg, cheese. Humans can
synthesise it by action of ultra violet rays of the sun on a form of
cholesterol found in the skin (7-hydrocholesterol)
Functions
Regulates calcium and phosphate metabolism by absorption in the
gut and stimulating their retention by the kidney. Thus calcification of
bones and teeth.
Deficiency – rickets in children and osteomalacia in adults
Daily requirements- 10 micro grams although it is also stored in the
muscles and fats thus deficiency may not be apparent for several years.
38. CT..
Vitamin E
Also referred to as tocopherol, recently been shown to protect against
coronary heart disease. Found in nuts, egg yolk, wheat germ,, whole cereal
and milk
Function- antioxidant – protects the body constituent’s e.g. membrane lipids
from being destroyed in oxidative reactions.
Deficiency is rare because of wide spread occurrence in foods but only seen in
preterm babies and conditions of impaired fat absorption e.g. cystic fibrosis.
Hemolytic anemia i.e. cell membrane rupture
Neurological abnormalities such as ataxia, visual disturbances
Daily intake -10mg –men, 8mg for women
39. CT..
Vitamin K
Synthesized in the large intestine by microbes and significant amounts are
absorbed. Absorption depends on the bile salts in small intestine.
Found in the liver, vegetable oils and leafy green vegetables.
Daily requirements 1 microgram / kg body weight
Functions- in the liver for production of prothrombin and factors VII, IX and X,
all essential for blood clotting.
Deficiency occurs in adults with malabsorption problems e.g. celiac disease and
liver problems in the form of coagulopathies.
Newborn infants may be given vitamin K because their intestines are sterile
and require several weeks to become colonized by the vitamin K producing
bacteria.
40. MINERAL SALTS
Necessary within the body for all body processes, usually in small amounts.
Calcium
Found in milk, eggs, fish, and green vegetables.
Functions
It is an essential structural component (bone) in the body.
It is important in coagulation of blood
Muscle contraction
Requirements are higher in children and pregnant women although can be adequate in a well balanced diet.
Phosphate
Sources- cheese, liver and kidney
Deficiency- if there is adequate calcium in the body there is no deficiency
Functions
Hardening of bone and teeth
Essential parts of nucleic acids (RNA, DNA)
Essential parts of energy storage molecules in cell ( ATP- adenosine triphosphate)
41. CT..
Potassium
Found in all foods especially fruits and vegetables and intake usually exceeds requirements. It is the most commonly
occurring intracellular cation and involved in many chemical activities in the cells including
Muscle contraction
Maintenance of electrolyte balance
Transmission of nerve impulse
Iron
It is a soluble compound found in the liver, the kidney, whole grain cereals and green vegetables. In adults about 1 mg
of iron is used by the body daily. The normal daily diet contains 9-15mg but only 5-15% of the intake is absorbed.
Functions
Formation of hemoglobin
Oxidation of carbohydrates
Synthesis of hormones and neurotransmitters.
Deficiency results in anaemia. Menstruating women, young people experiencing growth spurts and pregnant mothers
have increased iron requirements.
42. CT..
Iodine
Found in salt water fish and vegetables containing
iodine. In areas of the world where iodine is deficient
in the soil, small quantities are added to table salt.
Daily requirements depend upon the metabolic rate.
Functions- It is essential I the formation of thyroxine
and tri-idothyronine which are secreted by the thyroid
gland.
Deficiency results in goiter
43. VARIATIONS IN ENERGY AND NUTRIENT NEEDS
Children need more energy, protein and other nutrients per kilo body weight than adults. This
is because they are growing very fast and require playing
Women who menstruate need more iron than men.
Pregnant women need extra energy and protein and other nutrients especially iron.
Breast feeding mothers need extra energy and proteins.
Men need more energy than women even if they are of the same age and do the same
activities. This is because men’s bodies contain more muscle and less fat than women’s bodies.
Muscle uses more energy than fat.
Old people need less energy (if less active) than younger adults but similar amounts of
nutrients.
Women need less iron when they stop menstruating.
Big people need more energy, protein and some other nutrients than small ones. People who
are very active need more energy compared to those that are in active.
45. CT..
Nutritional Anthropometry - measurement of the variations of the
physical dimensions and the gross composition of the human body
at different age levels and degree of nutrition.
Advantages of Anthropometry
I. Procedures are simple, safe, noninvasive and are applicable to large
sample sizes
II. Inexpensive, portable and durable equipment
III. Relatively unskilled personnel can perform the procedures
IV. Information is generated on past long-term nutritional history which
cannot be obtained with equal confidence using other techniques
46. CT..
Disadvantages of Anthropometry
I. Cannot distinguish between specific nutrient deficiencies
II. Non nutritional factors can reduce specificity and sensitivity of
anthropometry
47. TWO GROUPS OF ANTHROPOMETRY
Growth -Measurements
I. Height (stature)
II. Weight
III. Age
Body composition
Body mass (fat free mass and body fat)
Skinfolds and circumferences
48. CT..
Age determination
Examine documented evidence priority
Reported by the mother
Local events calendar
RECORD THE AGE IN TERMS OF DATE OF BIRTH
Equipment
Weight measurements
Equipment – spring scale (Salter), Electronic weight scales, pediatric scale
Height (Length) Measurement
Equipment – height board, length board, microtoise or measuring tape with head board.
Mid Upper Arm Circumference –measuring Tape, Colored strip
Skinfolds – Skinfold calipers
49. ANTHROPOMETRY DATA COLLECTION
A. WEIGHT
Weight
B. HEIGHT /LENGTH
Height/length
Length is measured for children less than 24 months of age and is referred to as the recumbent length.
Height is measured for children older than 24 months of age
Mid Upper Arm Circumference
Appropriate in Children 6 to 59 months of age
Measurement taken on the left upper arm with a flexible non stretch tape made of fibreglass or steel.
Measurements taken with a sleeveless shirt at the midpoint between the shoulder and the tip of the elbow.
To locate the midpoint of the upper arm – should be bent at the elbow Identify the acromion and the olecranon
processes Measure the arm length and put a mark on the midpoint
51. CT..ADULTS
Nutritional status of adults can be determined with Body Mass Index
(BMI) which is the Weight (kg) divided by the square of height in meters:
BMI = WEIGHT (KG)/HEIGHT (M)2
Type of malnutrition BMI cut off
Obese 30.0+
Overweight 25.0 - 29.9
Normal 18.5 - 24.9
Mild under-nutrition 17.0 - 18.4
Moderate 16.0 - 16.9
Severe <16.0
52. CT..
Three indices are commonly used in assessing the
nutritional status of children:
3 indices of assessing nutritional status
1. Weight-for-length or Weight-for-height: Acute
Malnutrition (Wasting)
2. Length-for-age or Height-for-age: Chronic
malnutrition (stunting)
3. Weight-for-age: Any protein-energy malnutrition
(underweight)
54. FEEDING DIFFERENT GROUPS
Infant feeding
Breastfeeding is best for baby.
Babies must be breastfed exclusively for the first 6
months.
After 6 months wean the baby in 3 stages;
1. Most of the nutrients will come from breast milk then
start other foods.
2. From ten t0 18 months:
Continue with same amount of breast milk, increase the
amount of other foods.The food gradually changes to
regular family foods.
55. CT..
3. From 2 yrs he gradually takes less breast milk and
more family food, breastfeeding is only a snack and for
comfort.
Weaning food must be easy to eat and digest, and
well balanced.
Feed the child 4_5 times a day.
56. BREAST MILK
Colostrums-secretion from the breast in the first few
days after delivery.
Has high protein and antibodies from the mother,
confers immunity to infections during the first few
months.
57. ADVANTAGES OF BREASTFEEDING;
1. Meets full nutritional requirements for the first 6 months
in the right form and proportion.
2. Protects the baby against infections.
3. Psychological satisfaction for baby and mother.
4. Strengthens the bond between mother and baby.
5. It is hygienic, does not need preparation.
6. Proper emptying of the breasts prevents mastitis
7. Has contraceptive effect, prevents pregnancy
The baby should be fed on demand.
58. FOOD FOR TODDLERS 1-4YEARS
There is a marked decrease in appetite during the
second year, growth rate is slow.
Can share family food by the age of two.
Fruit are ideal snacks, as well as other nutritious
snacks 2-3 times a day.
They are active ,can get dehydrated, offer fluids 4-5
times a day.
59. CT..
Offer sweetened juices with meals to avoid tooth
decay by the acid.
Avoid tea and coffee, they prevent absorption of iron
from foods.
Avoid food that is not easily chewed to prevent
choking.
60. PRESCHOOL CHILDREN
They learn to imitate what adults do ,be a good
example.
Choose a diet that contains enough calcium and iron.
Cal. Requirement;500-800mg/day.
Iron requirements;10mg/day.
Give a variety of foods.
Balance the food with physical activity. Choose a diet
low in saturated fats.
61. FOOD FOR SCHOOL GOING
CHILDREN; 6-12
Food needs are increased in keeping with the child's
growth and activity.
He can eat food which needs biting and chewing.
Usually needs 4 meals a day with all the nutrients.
A good breakfast can have porridge milk and fruit.
62. FOOD FOR THE ADOLESCENT;
During this period boys need to eat a lot of rich food
to provide sufficient energy for rapid growth of bones
and muscles.
Girls need food rich in protein, iron and other
nutrients necessary for synthesis of iron for red blood
cells.i.e
Green leafy vegetables, eggs and liver.
For adolescents, it is necessary to gain wt. For their
height and build.Boys-42-60cal/kg,girls 38-40cal/day.
63. NUTRITION IN PREGNANCY AND
LACTATION;
The nutritional needs of the mother include;
1. Normal requirement of the mother
2. The developing foetus
3. Uterus and placenta
4. Mothers reserves in preparation for labour and lactation.
Good nutrition of the mother is an important determinant of labour
outcome and a healthy baby.
64. NUTRITION FOR THE AGED.
Physiological changes in the aged;
Malnutrition can occur owing to many physiological, sociological and
psychological problems of old age.
Loss of teeth interfere with chewing and reduce tolerance of certain
foods.
While hard foods are avoided, soft foods cause constipation.
65. PHYSIOLOGICAL CHANGES;
Digestive secretions of the stomach,pancrease and
intestines reduce with age.
Ability to digest and absorb food is reduced due to
changes in the intestinal mucosa.
Transportation of nutrients from intestinal tract is
reduced by changes in circulation and reduced
oxygen uptake.
Basal metabolism and total energy requirement goes
down.
66. AGED CONT.
They are unable to tolerate low blood sugar.
Have likes, dislikes and prejudices against some
foods.
Sense of smell and taste are less acute and they
interfere with appetite.
Have a sense of being isolated, rejected, and
unwanted, hence refuse to eat.
Serve healthy food in pleasant environment and show
that you care.
67. THE AGED CONT.
Give adequate amounts of protein to prevent
deficiency.
Keep fat intake to a minimum to prevent excess
cholesterol.
Loss of calcium may cause osteoporosis, offer food
rich in calcium,800mg/day.
Offer a diet rich in vitamins especially vit D for proper
absorption of calcium
68. CT..
Give adequate intake of CHO and vit in form of soft
vegetables and fruits.
Senile intestinal mucosa does not tolerate roughage
from mature vegetables.
Encourage mild physical activity, recreation and
entertainment to reduce stress and boredom and
maintain normal health.
69. SPECIAL DIETS
Diet in diabetes
Diabetes is failure of the pancreas to produce adequate
insulin necessary for converting glucose into
glycogen.
Advise patient to eat regular meals
Eat CHO which release their energy slowly e.g. Whole
meal bread and whole grain cereals.
Cut down on high sugar foods-the cause blood sugar
to rise quickly.
70. DIABETES CONT.
Reduce the amount of fat in the diet ie.3gm fat, eat
lean cuts of meat, chicken without skin.
Eat 5 portions of fruits and vegetables per day, they
reduce cholesterol and hypertension.
Cut down on salt intake i.e. Avoid adding salt to the
food, limit the amount used in the cooking, eat fresh
foods instead of tinned food.
71. DIABETES CONT.
Avoid alcohol, causes hypoglycaemia ,impairs
judgement.
Avoid the following foods;
Sweet drinks and carbonated drinks.
Caned foods and fruits.
Cakes, creams,sugar,potatoes.
72. DIABETES CONT.
Carbohydrates
Avoid drastic reduction, may cause excessive
metabolism of fat.
Calories; should be adequate for growing children
and under wt. persons.
Obese people require reduced calories. Encourage
green leafy vegetables and fibre.
73. DIABETES CONT.
Proteins; 1gm per kg body wt.
Cheese is good source of protein. Give potassium rich
foods-it helps transportation of glucose to the cells.
Add vit B12 to prevent diabetes neuritis.
74. DIET IN ACUTE
GLOMERULONEPHRITIS
A condition characterized by inflammation of the
kidney and the glomerular.
The condition can cause renal failure.
When the urine output is less than 400ml (oliguria)
restrict proteins, green vegetables and high sodium
foods.
When urine output is 500-800ml allow protein intake
of 0.5-0.75gm/kg body wt
75. G.NEPHRITIS CONT.
Allow normal protein when urine output is normal.
Fats
Allow 40-50gm,they do not affect the kidney function.
Give normal quantities of CHO and vit.
76. DIET IN NEPHROTIC SYNDROME
A form of nephritis in which there are albumin in the
urine, low plasma proteins and gross oedema
Restrict the following high sodium foods:
1. Salted butter
2. Salted biscuits
3. Preserved fish.
77. CONT.NEPHROTIC S
Give high protein diet 2-3 gm/kg body wt/day
because there is a lot of protein loss in the urine.
Give normal Carbohydrates
When oedema subsides Na restriction is not
necessary.
78. DIET IN RENAL FAILURE.
Restrict the following foods;
Sodium foods if there is hypertension, oedema and
oliguria.
Avoid butter, salted biscuits, meat table salt and milk.
Restrict potassium foods e.g. Avocado oranges
bananas and fish.
Give 40gm of protein but restrict it to 0.3-0.5gm/kg
when blood urea is high.CHO constitute the main
source of cal. give 2000-2500cal/day.
79. DIET IN HIV/AIDS
Malnutrition is a major complication
Causes
1. Reduced food intake
2. Inability to swallow due to sores in the mouth and
throat
3. Anorexia due to fatigue or depression
4. Side effects of medications
5. Reduced income due to illness resulting into
reduced quality and quantity of food.
80. CONT.
6. Infections which cause diarrhoea
7. Inability of the body to absorb nutrients
Good nutrition in early stages boosts immunity and
prevents opportunistic infections.
Contributes to wt. Gain
Give a well balanced diet rich in green leafy
vegetables and fruits to improve immunity. When the
mouth and throat are sore give soft non acidic foods
in small frequent meals.
81. DIET IN CONSTIPATION
Fats and oils act as lubricants to the bowel and
stimulate the bile flow for normal digestion.
Provide high fibre diet consisting of fruits and
vegetables and whole grain cereals.
They add volume and wt to the stool and speed the
movement of the undigested material through the
intestines.
Encourage 2-2.5li of fluid during the day and warm
milk at bed time, encourage exercises.
82. DIET IN PEPTIC ULCER
Foods to avoid;
Sour salty or spicy foods
Coarse foods e.g. Raw
vegetables, fruits with seeds and skin.
Very hot drink or food.
Smoking, alcoholic drinks
NSAIDs e.g ibuprofen, aspirin
Big servings of meat.
Meat soups, fried foods or any other food the patient
does not tolerate.
83. CONT.
Give adequate calories and vit C to help healing the ulcer.
Encourage the patient to eat a well balanced diet and to avoid the
foods which cause discomfort.
84. DIET IN ANAEMIA
Encourage the patient to take iron supplements as
prescribed.
Encourage the client to include iron rich foods in the
diet i.e.
Green leafy vegetables,liver,meats, eggs
85. DIET IN ISCHEMIC HEART DISEASE AND
HYPERTENSION AND CONGESTIVE
CARDIAC FAILURE.
The heart does not get adequate blood supply owing
to narrowing of the coronary arteries by lipids.
Proteins;1 gm/kg of body wt in a normal wt. Patient.
Fats; Avoid saturated fats e.g. Beef, pork, Fats from
dairy products such as; Cream, butter, ghee,
hydrogenated vegetable oils.
Encourage use of unsaturated oils e.g. sunflower oil
and olive oil.
Vit C is required for capillary stability,
86. ISCHEMIC HEART DISEASE CONT.
Nicotinic acid reduces lipids in the blood.
Adequate potassium and calcium are necessary to
prevent arrhythmias.
Salt restriction reduces hypertension of heart failure
Avoid smoking, it produces myocardial oxygen
deficiency and increases atherosclerosis and
hypertension
87. POST OPERATIVE DIET.
Bland diet
It is given to people who cannot handle a regular diet
but not serious enough for a liquid diet.
It is less likely to form gas than regular diets.
These are;
Lean meat fish poultry eggs milk,chese
Tender vegetables and fruits, refined cereals breads
butter or margarine jellies custards puddings' and ice
creams.
88. POST OP DIET CONT.
Clear liquid diet
Serves as a primary function of providing fluids and
electrolytes to prevent dehydration
It is the initial feeding after complete bowel rest.
It is also given as a bowel preparation for surgery or
tests.
The body digests clear liquids easily
89. LIQUID DIET
Contributes little or no residue in the GI tract.
Consists of fluids which are transparent to light and
are clear at room temperature e.g.
Water, clear broths, lemonade gelatine.
The client should not stat on this diet for more than a
day or two.
90. DIET IN BURNS
Give high protein diet to replace that lost through
breakdown of muscle tissue.
Increase foods such as meat fish chicken and dairy
products.
Give fruits and fruit juices to replace water loss and to
replace vit C for tissue healing.
91. DIET FOR A CANCER PATIENT
The cancer patient may have the following problems;
Loss of appetite
Fatigue
Nausea and vomiting
Sore throat and mouth
Diarrhoea Constipation, taste changes.
Address each problem accordingly i.e.
During anorexia period ,serve small portion at a time, eat in a
pleasant atmosphere with family and friends.
92. DIET IN CANCER CONT.
Encourage anti nausea medications and give
adequate fluids.
When the mouth is sore, provide soft foods which are
non acidic and not hot.
Avoid spiced foods
Sucking foods through a straw may be easier than
drinking from a cup.
Avoid raw fruits and vegetables, avoid foods with
seeds and nuts which can be trapped in the mouth
and cause discomfort.
95. CAUSES OF MALNUTRITION
1. Immediate Causes of Malnutrition:
Lack of food intake and disease are immediate cause of malnutrition
and create a vicious cycle in which disease and malnutrition exacerbate
each other. It is known as the Malnutrition- Infection Complex.
Thus, lack of food intake and disease must both be addressed to
support recovery from malnutrition
97. CT..
2. underlying causes of malnutrition include:
•Food: Inadequate household food security (limited access or
availability of food).
•Health: Limited acess to adequate health services and/or inadequate
environmental health conditions.
• Care: Inadequate social and care environment in the household and
local community, especially with regard to women and children.
98. CT..
3. Basic Causes of Malnutrition
The basic causes of malnutrition in a community originate at the
regional and national level, where strategies and policies that affect
the allocation of resources (human, economic, political and cultural)
influence what happens at community level. Geographical isolation
and lack of access to markets due to poor infrastructure can have a
huge negative impact on food security.
99. NUTRITION VULNERABLE GROUPS
Certain vulnerable groups in the population have special nutritional
needs.
1. Pregnant and lactating women
2. Infants and children
3. School age children
4. Refugees and displaced persons
5. The elderly
6. Immuno suppressed
100. FORMS OF MALNUTRITION;
Two main forms
Undernutrition- insufficient intake of food-energy and
nutrients
Overnutrition- excess intake of energy and nutrients
Micronutrient deficiency- hidden hunger
Categories of malnutrition
1. Chronic malnutrition: Determined by a patient’s degree of
stunting.
2. Acute malnutrition: Determined by the patient’s degree of
wasting.
Acute malnutrition is categorised into:
Moderate Acute Malnutrition (MAM) and
Severe Acute Malnutrition (SAM).
101. CT..
Severe Acute Malnutrition (SAM) is further
divided into:
1. Marasmus
2. Kwashiorkor
3. Marasmic kwashiorkor ( combination of 1 & 2)
103. DRY BERIBERI
Features
Severe weakness of the legs
Anorexia
Paralysis of the arms and the legs
Mental confusion and speech difficulties
Pain of the affected muscles
Strange eye movements(nystagmus)
Tingling sensation, vomiting
104. WET BERIBERI
Features
Awakening at night with shortness of breath.
Increased heart rate
Shortness of breath with activity
Swelling of the lower limbs
105. INVESTIGATIONS
A physical exam. May show signs of congestive heart
failure.
Difficult breathing with distended neck veins
Enlarged heart
Fluid in the lungs
Swelling of the lower limbs
Rapid heart rate
106. BERIBERI CONT
A person with late stage beriberi may be confused or
have memory loss and delusions.
The patient may be less able to sense vibrations.
A neurological exam may show signs of;
Changes in the walk
Co-ordination problems
Decreased reflexes an drooping of the eyelids.
107. Blood tests are done to measure the amount of
Thiamine in the blood.
Urine tests to see if Thiamine is passing through the
urine
108. TREATMENT
Replace Thiamine orally or by injection
Give other vit., they may be deficient.
Blood tests are done to assess the outcome of the
treatment
When treated early the condition is reversible
109. PREVENTION
Eating foods rich in Thiamine e.g. Whole grain cereals
especially breastfeeding mothers.
Cut down or quit alcohol_ it interferes with
absorption of vit B1
Giving fortified foods e.g. enriched cereals
Giving Thiamine supplements.
111. PELLAGRA
It is a condition caused by lack of Vit B3(Niacin) in the
diet.
It is common to people who eat mostly maize and
generally a poor diet.
112. CLINICAL FEATURES
High sensitivity to sunlight(Photophobia)
Aggression
Dermatitis,alopecia,edema
Smooth, beefy red glositis,Tongue becomes thick
Red skin lesions
Insomnia
Body weakness
113. PELLAGRA CONT
Mental confusion
Ataxia, paralysis of extremities, peripheral neuritis
Diarrhoea
Enlargement of the heart. Dementia
Abdominal pain and bloating
Variations in level of consciousness with involuntary
sucking and grasping motions(Enchephalopathic
syndrome)
114. Psycho sensory disturbances i.e. Annoying bright
lights, odours intolerance causing nausea and
vomiting,diziness after sudden movements
Psychomotor disturbances(restlessness, tense and
desire to quarrel, increased preparedness for motor
action)
Emotional disturbances .
115. CAUSES
Lack of Niacin
Deficiency of Tryptophan (Amino acid )found in
animal proteins which the body converts into Niacin
Diseases which interfere with absorption of Niacin e.g.
Diarrhea,alcoholism,cirrhosis of the liver.
Long term use of antituberculous drugs e.g. Isoniazid
116. TREATMENT
Supplement the diet with niacinamide by mouth or by
injection-dosage 300-500mg od po,or inj100-250mg
bd-tds
Give other B complex vitamins
Prevention
Give foods rich in Niacine.g. Meat
liver whole grains.
117. RICKETS
Vitamin D Deficiency
It is softening of the bones in children leading to
fractures and deformity
Clients at risk
Breastfed babies whose mothers are not exposed to
sunlight
Breastfed babies who are not exposed to sunlight
Individuals who do not consume milk-lactose
intolerant
118. RICKETS CONT
If a mother has low vit D levels during pregnancy, the
infant may have congenital rickets
Vit D is required for calcium absorption for calcium
absorption from the gut.
Deficiency of Vit D causes hypocalcaemia leading to
skeletal and dental deformities
119. SIGNS IN BABIES
Bones of the skull may be soft
The fontanelles take a long time to close
Swelling of the bones in wrists and ankles
Chest may be deformed, swelling at the ends of the
ribs
The baby may have repeated respiratory infections
Muscle weakness-the baby cannot support his legs to
stand when supported, he is floppy. There is increased
tendency to greenstick fractures
120. SIGNS IN CHILDREN
The skull may look enlarged and square shaped
The child may learn to walk late
Toddlers may get bowed legs
Older children may get knock knees
Adolescents may complain of pain in the back and
legs
Severe rickets in girls can cause pelvic deformities
which can result in difficult childbirth
121. OSTEOMALACIA
Occurs in women with Vit D deficiency
The body cannot absorb enough calcium from the
food, it uses calcium from the bones
The bones become soft and break easily
122. SYMPTOMS
Severe pain in the bones
Muscle weakness
Deformity of the pelvis leading to difficulties in
childbirth
Broken bones in people who are old and disabled
123. DIAGNOSIS
Serum calcium and phosphorus may show low levels
X-ray of the affected bones may show loss of calcium
from the bones or changes in the structure of the
bones
124. TREATMENT
Increase dietary intake of Vit D and phosphorus
Expose to ultraviolet B lights
Give fish oils and Alphacalcidol(Vit D3);Adults and
children over 20kg_1mcgm od, maintenance
dose0.25-1mcgm od.
Adjust the dose according to serum calcium levels to
prevent hypocalcaemia
(a lot of Ca may go to the cell depleting the serum of
calcium)
Neonates and preterm babies 50-100 nanogm/kg per
day. Children under 20kg-50ng/kg/day
125. PREVENTION
400IUof Vit D for infants and children. Dietary
supplementation with Vit D3 for cases at risk;
Adults age 50-200IUod,
50-70yrs-400IU od
Over 70yrs-600IUper od
Calcium supplements should be given as follows;
1-3yrs-500mg
4-8yrs-800mg
9-18yrs-1300mg
19-50yrs-1000mg ,over 50yrs-1200mg od
126. COMPLICATIONS OF RICKETS
Delays child's motor skills development
Failure to grow and develop normally
Skeletal deformities
Chronic growth problems which can result in short
stature
Seizures due to hypoglycaemia
Dental defects
127. SCURVY
It is caused by severe Vit C deficiency
It is common to people who have no access to fresh
foods
It is due to inadequate production of collagen, an
extracellular substance that binds the cells of the
teeth and bones and blood capillaries
It is essential for wound healing
Destruction of Vit C in foods by overexposure to air or
by overcooking, excessive ingestion of Vit C in
pregnancy which requires the newborn to acquire
large amounts of Vit C at birth
128. PEOPLE AT RISK OF SCURVY
Alcoholics
Refugees who cannot access fresh fruits and
vegetables
People who live in drought stricken areas where fruits
and vegetables are not available
Urban people who cannot access fresh fruits and
vegetables.
Old people and unmarried men who live alone and
do not eat enough fresh foods. Pregnant and
lactating women, sailors who are deprived of vit C for
a long time
129. CLINICAL FEATURES
Tiredness
Weakness
Irritability and depression
Aches and pains
Poor healing
Bleeding symptoms;
Weak capillaries
Bruising easily
130. FEATURES CONT;
Bleeding from old scars
Internal bleeding
Dental symptoms;
Swollen ,purple and spongy gums
Loose teeth
Limb and joint pains especially the knees
Children can have fever, diarrhoea vomiting tender
and painful swellings on the legs
131. DIAGNOSIS
Confirming diagnosis;
Serum Ascorbic Acid levels less than 30mg/dl
Dietary history revealing inadequate intake of Vit C
Capillary fragility test with a BP cuff;
It is positive if more than 10 petechiae form after 5
minutes of pressure
132. TREATMENT
Restore Vit C;
100-200mg of Vit C in mild cases
500mg of vit C/day in severe form
Symptoms subside in 2-3 days
Haemorrhages and bone disorders subside in 2-3
weeks
133. PREVENTION OF SCURVY
Clients unwilling to consume Vit C rich foods can take
daily supplements
Recommended daily allowance is 60mg/day
Educate clients on good dietary sources of Vit C
Educate against too much intake of Vit C,excess doses
may cause nausea,diarrhea and renal stones, can also
interfere with anticoagulant therapy
134. COMPLICATIONS OF SCURVY
Malabsorption of iron leading to iron deficiency
anaemia
Internal bleeding
Pathological fractures
135. IODINE DEFICIENCY
Iodine is required by the thyroid gland for normal
production of the thyroid hormones which are
necessary for;
Body metabolism
Development and functioning of the human brain
Other processes necessary for human life
136. SOURCES OF IODINE
Sea foods, fish vegetables milk, cereals
Causes of iodine deficiency
The body does not make its own iodine, it
must come from the food
Deficiency of iodine in the food reduces the amount
in the blood
Consumption of goitrogens-substances in the food
which reduce the amount of iodine that the thyroid
gland takes from the blood e.g.cassava roots and
leaves
137. IODINE DEF.CONT
The severity of iodine deficiency depends on ;
How much iodine is stored in the body
How much iodine the food contains
The presence of goitrogens in the food
For the unborn baby how much iodine is available in
the mothers blood
For the breastfeeding baby how much iodine is
available in the breast milk
138. IODINE CONT
The needs of iodine are higher;
During growth of infants, children and adolescents
when the growth rate is higher
During pregnancy and lactation
139. IODINE DEFICIENCY DISORDERS
Goitre
It is a swelling in the thyroid gland which causes a
swelling at the neck
It can be classified as follows;
I-Palpation Struma-in normal posture of the head it
cannot be seen
II-struma is palpable and can easily be seen
III-Struma is very big, it causes pressure symptoms
140.
141. OTHER CLASSIFICATIONS
Diffuse goitre-has spread through all the thyroid
gland
Toxic goitre-associated with high levels of the thyroid
hormone
Nontoxic(simple) goitre-associated with normal or
low thyroid hormone, this can further be classified as;
1. endemic 2. sporadic
142. IODINE CONT.
Non toxic goitres can start in childhood and gradually
enlarge during puberty
Can get bigger during puberty and lactation because
the body requires more thyroid hormone
In men it becomes smaller
143. MAIN SYMPTOMS
A swelling raging in size from a small nodule to a
massive lump in front of the neck below the Adams
apple.
A feeling of tightness in the throat area
Difficulty in breathing, coughing,sneezing,due to
compression of the larynx
Difficulty in swallowing due to compression of the
oesophagus, hoarseness, neck vein distension
144. TREATMENT OF GOITRE
Iodine can reduce the size in young people with
smaller goitres
In adults with large swelling for a long time, iodine
may not be effective,sugery may be the only option if
it causes difficulties in swallowing and breathing
145. CRETINISM
It is a congenital disease due to lack of thyroid
hormone. The child has;
Protruding tongue, thick lips, coarse brittle hair, flat
nose, dwarfism
It is classified into two;
1. neurological
2. hypothyroid
146. NEUROLOGICAL CRETIN
The baby has damage to the brain and the nervous
system
The effects may be mild to severe with physical
handicaps
Clinical features;
Deafness and mutism(cannot speak)
Squint-eyes are not straight
Weakness and stiffness of the legs, severe mental
handicap
147.
148.
149. CAUSES
Maternal deficiency of iodine in early pregnancy when
the baby's brain and the nervous system are
developing
There is no treatment ,the baby remains handicapped
for life and may die young
It can be prevented by giving the mother iodine
before conception
150. HYPOTHYROID CRETIN
Clinical features;
Anorexia, failure to gain wt
Constipation
Feels cold
Drowsiness thick dry skin
Hoarse cry
Slow mental development
151. CAUSE
The mother may be iodine deficient in later
pregnancy
Breastfeeding may protect the baby
After weaning the baby may get worse
Treat the child with iodine before 1 yr of age for the
treatment to be effective
152. INVESTIGATIONS FOR IODINE
DEFICIENCY
History and physical examination
24 hr urine collection will show low levels of iodine
Blood sample will show low levels of thyroid hormone
153. RECOMMENDED DIETARY INTAKE
OF IODINE
Adult women and men;100-200mcgm
Infants-40-50mcgm
Children 1-3yr-70mcgm
Children4-6yr-90 mcgm
Children 7-10-120mcgm
Children over 11yrs-150mcgm
Pregnant women-175mcgm
Lactating mothers-200mcgm
154. TREATMENT AND PREVENTION OF
IODINE DEFICIENCY;
Iodized salt is the best long term method to give
iodine
Giving iodized oil by moth in a capsule or 1 ml to
children or adults,0.2ml to nonbreastfeeding infants,
protects for 1-2 yrs
Giving iodine by inj. Prevents deficiency for 3-5 yrs
Adding iodine to drinking water.
155. EFFECTS OF IODINE DEFICIENCY IN
THE COMMUNITY;
Delays social and economic development in
the community;
1. There are more handicapped people who need care
from the community
2. Domestic animals are also iodine deficient, they grow
slowly and produce less
3. local people are mentally slower and less energetic
and more difficult to motivate
156. CONT.
4. Iodine deficient children are difficult to educate, are
less likely to get good jobs when they grow up
5. Children with cretinism die young, severe ones who
survive become a burden to their families and the
community
6. A large goitre may reduce a persons chances of
getting married
157. NUTRITIONAL ANAEMIA
Def; The blood does not have enough haemoglobin
It is a condition in which the circulating red blood cell
mass is insufficient to serve its function normally
The task of the red blood cells is to transport oxygen
bound Hb form the lungs to the tissues
158. WHO DEFINITION OF ANAEMIA
In man-Hb below 13mg/dl
Females-Hb below13
Children 6 months to 6yrs below 11gm/dl
Children 6 to 14yrs below 12gm/dl
159. CLINICAL PRESENTATION
Paleness of the tongue and mucous membranes
Breathlessness
Anorexia
Headaches
Brittle fingernails
Abdominal pains
Angular stomatitis
Loss of melanin from the skin pigmentation
160. CAUSES
2. Poor absorption of iron from foods due to;
Deficiency of Vit C which is also needed for
maturation of RBCs in he bone marrow
Copper deficiency
High content of phytates in cereals, legumes and
nuts, they bind with minerals e.g. Iron zinc, and
calcium and interfere with their absorption in the
body
161. CAUSES CONT
Tannin in soya ,coffee and tea
Calorie deficiency;13% of iron is absorbed at 1000
cal,28% at 2000 cal 40%at 3000 cal
Vit B12,folic acid, E and B6 deficiency,
2. Decreased nutrition due to;
Famine,illness,substituting traditional foods with fast
foods
3. Increased losses through bleeding
162. CAUSES
3. Increased needs e.g. Pregnancy
Persons at risk of anaemia
Preschool children
Adolescents during the growth spurt and
menstruating girls
Pregnant women
Women with many pregnancies closely spaced
People with chronic blood loss
163. CONSEQUENCES OF IRON
DEFICIENCY
Impaired motor development in infants and children
Poor language development and school
achievements
Poor psychological and behaviour effects e.g. poor
attention fatigue, insecurity
Decreased physical activity in adults
Reduced earning capacity
164. CONT
In pregnant women-increased maternal and infant
morbidity and mortality
Premature deliveries
Low birth wt infants
Heart failure in severe anaemia leading to death
165. INVESTIGATIONS
History and physical examination
Blood sample for Hb level and full blood count
Stool for ova and cyst of hookworm and other parasites
Blood test for malaria parasites
166. TREATMENT
Adults;
60mg iron per day for mild anaemia
120mg iron and Folic Acid 400mg for moderate
anaemia
Treatment should cont. Until Hb has reached normal
limits and has stopped to rise and another 4-6 weeks
to build the iron stores
167. TREATMENT CONT
Pregnant women; 400mg folic acid and 60mg iron
twice a day
Infants and children; liquid preparation at 5mg/kg/day
Indications for injectable iron
Oral treatment is not tolerated
Persistent non compliance
Severe iron deficiency anemia,late gestation of
pregnancy
Give treatment for intestinal worms and malaria as
required
168. PREVENTION OF ANAEMIA
There are 4 strategies;
1. Iron supplementation
2. Fortification of staple foods with iron
3. Measures to increase dietary intake of iron
4. Control of hookworm and other intestinal parasites
Iron suplementation;Give iron supplements to groups of people at risk
Recommendation_ combined tablet of iron 60mg and folic acid400mg twice a
day
Exclusive breastfeeding for 6 months
Supplement the preterm baby by 2 months of age-has no adequate stores of iron
Dosag;2mg/kg/day to a maximum of 15mg/kg/day until ready for weaning with
fortified cereals
Bottle-fed should receive formula containing iron12mg/l and vit E10IU/l
Children6-24 months;12.5mg iron and 50mg folic acid od
169. DIETARY MODIFICATION
Improve absorption of iron by increasing the
enhancers e.g.Vit C
Decrease iron absorption inhibitors e.g. Tannin and
phytic acid
Increase calorie intake to increase calorie absorption
by 30%
170. MALNUTRITION
Malnutrition means wrong or faulty nutrition
Protein calorie malnutrition(PCM) or protein energy
malnutrition(PEM) is deficiency of calories and
proteins in the body
It can be divided into 3 types;
Kwashiorkor
Marasmus
Marasmic kwashiorkor
171. IMMEDIATE CAUSES
Disease
Poor diet
Inadequate care of children and women
Poor health services
Family food shortages
Unhealthy environment
173. MARASMUS-STARVATION
The child has deficiency of proteins and CHO and
other nutrients
It is common to children who do not get enough
breast milk and are given inadequate foods during
weaning
174. CLINICAL FEATURES OF
MARASMUS
The wt is below 60% of the standard wt for age
Lack of subcutaneous fat, legs and arms are
thin
The skin is large and wrinkled and seems to be
too large for the body
The child looks anxious with face like an old
man
The child is usually hungry and eager to eat
Constipation and diarrhoea
175. CLINICAL FEATURES OF
KWASHIORKOR
Pitting oedema of the legs and
foot
The face is puffy(moonface)
The child is miserable and not
interested with the surroundings
178. KWASH CONT
The skin is light coloured,thin and
weak, it may peel off(flaky paint)
The skin has sores and cracks
The hair is thin and straight peels
easily
Diarrheal and anaemia
Subcutaneous fat is retained
Enlarged live due to fat deposits
179. DIFFERENCE BETWEEN MARASMUS AND
KWASHIORKOR
Feature Marasmus Kwashiorkor
Cause
Wasting
Muscle wasting
Loss of weight
Mental changes
Appetite
Skin changes
Hair changes
Hepatic
enlargement
Due to deficiency
of calories
Thin lean and
skinny
Severe
Severe
Usually absent
Usually good
None
Slight change in
texture
None
Protein deficiency
Less obvious, child
looks flabby. Moon
face
Sometimes less
Masked by oedema
Usually present
Poor
Depigmentation
Often sparse
pigmentation
greyish or reddish
Frequent
180. STEPS IN THE MANAGEMENT OF A
SEVERELY MALNOURISHED CHILD
Prevention of hypoglycenia,dehydration
and hypothermia
Correction of electrolyte imbalance
Treatment and prevention of infection
Correction of micronutrient deficiencies
Therapeutic feeds
181. STEPS CONT
Intensive feeding to rebuild
wasted tissues and increase
growth
Education of the parents on
nutrition to prevent
recurrence of malnutrition
182. MANAGEMENT OUTLINE
The child is admitted with the mother
in a well heated room to maintain
normal body temperature
Feed on special formulas with vit and
mineral supplements
Broad spectrum antibiotics to treat
infection
Psychological stimulation to make him
more active and cheerful
183. ADDITIONAL TREATMENT
Give 5mg of folic acid on day one and 1
mg od. For 2-3 months
Start Ferrous sulphate(iron) at 3mg/kg/day
for 3months after the child has gained
appetite and some wt.
Appropriate wt gain takes takes 4-6 weeks
Discharge the child when wt is gained,
appetite has improved and infection is
controlled
184. COMPLICATIONS OF P.E.M
Dehydration
Heart failure
Infections
Mental retardation
Blindness due to vit A deficiency
Retarded physical growth
Anaemia
185. OUTLINE CONT
Psychological stimulation to make
him more cheerful
Close monitoring of temperature,wt
and hydration status
Asses for complications
Involve the mother in the care of he
infant
186. MANAGEMENT
First 7 days;
Give WHO modified ORS over 4-10 hrs i.e.5-
10ml/kg every 30 min for 2 hrs then;
5-10 mls/kg every hr for4-10 hrs
The modified ORS has less sodium and more
potassium than the standard ORS
Always observe for signs of over hydration
When well hydrated commence phase 1 feeding
with F75 formula
187. PHASE 1 FEEDING
F.75 feed is made with;
25gm dried skimmed milk in 1 litre of
water with added 100gm sugar 3gm veg
oil electrolyte and mineral mixture 20ml
Give 130 mls /kg/day(or 100mls/kg/day if
there is oedema)
Divide the total vol into smaller feeds and
feed the child 2hrly through out the day
and night by nasal gastric tube
188. CONT.
If iv fluids are required;
Give Hartman's solution with 5%
Dextrose at 15ml/kg over 1 hr
then 10mls/kg/hr over 5 hrs
Give yogurt instead or milk if
there is lactose intolerance
189. PHASE 2 FEEDING
200mls/kg/day
The transition should take 3-4 days
Teach the mother to feed the baby by cup
and spoon or by syringe and encourage
her to participate in the care of her infant
190. MANAGE HYPOTHERMIA
Take rectal temperature with
a low reading thermometer
Cover the body including the
head and manage in a heated
room to keep warm
191. MANAGE HYPOGLYCAEMIA(BLOOD
SUGAR LESS THAN 3MMOL/LI)
Do a blood glucose test to confirm
If able to drink give 50mls of
10%dextrose or 1 tsp sugar in 3.5
tablespoons of water
Follow with the first feed of F75
If sugar remain low repeat the
glucose or sugared water.
192. HYPOGLYCAEMIA CONT
If the child is unconscious
give 10% Dextrose 5mls/kg iv
or 50mls of 10% dextrose by
NG tube if you cannot get iv
access.
193. TREAT INFECTION
For mildly sick children without infection
give;
Cotrimoxazole 1 tsp for 5 days
For children with infection;
Give inj. Ampicillin 50mg/kg 6hrly for
2-3 days then;
Oral Amoxillin 15mg/kg 8hrly od. for
7days +Gentamycin 7.5mg/kg od for 7
days
194. TREATMENT CONT
If the child has not responded within 48 hrs;
Give Chloramphenicol 25 mg/kg 4 times a day
for 5-10 days ( give ½ dose for very young
infants)
Consider treatment for TB and HIV. Consider
blood transfusion of 10ml/kg whole blood over
3 hrs + lasix 1mg/kg at the start of transfusion
if Hb is 4-6gm/dl
If heart failure is suspected, give 10mls of
packed cells of blood
195. GIVE ELECTROLYTES AND
MINERALS
1. Potassium chloride 6-8
mmol/kg/day for 1-2 weeks
Give Magnesium Chloride 2-3
mmol/kg/day
Give other mineral
supplements
196. OTHER TREATMENT
Give Vit A if it was not given in the last
month.;
Infants<6months-50,000 units
6-11 months-100,000 units
Children over 12 months 200,000 units
Administer antimalaria medications in
clinically endemic areas as required
198. REHABILITATION
Energy and proteins are
increased gradually until the
values of 150-220 cal/kg/day
and protein of 4-6gm/kg are
reached.
This is done by increasing the
veg oils and sugar to the milk
