Nutrition is the science of food and its interaction with living organisms. Good nutrition is important for health, development, resistance to disease, and physical and mental capabilities. Nutrition includes physiological processes of ingestion, digestion, absorption and utilization of nutrients from food. Main nutrients are carbohydrates, proteins, fats, vitamins and minerals. Carbohydrates provide energy, proteins build and repair tissues, and fats provide energy and carry fat-soluble vitamins. Good nutrition depends on adequate intake of essential nutrients and is influenced by religious, cultural and environmental factors.

1. UNIT 1
INTRODUCTION TO
NUTRITION
BY KARIMI R.G.

2. Objectives
1.Define various terms in relation to nutrition.
2. Explain the role of nutrition in health and disease.
3.Describe factors that affect nutrition.
4.Classify food.

3. What is Nutrition?
• It is a science that encompasses all the interactions
that occur between living organisms and food.
• These interactions include the physiological processes
by which an organism,
• Ingests
• Digests
• Absorbs
• Transports and utilize food.

4. • Nutrition includes the biological actions and interactions of
food with the body and their consequences for health and
disease.
• It also includes the psychological, social, cultural, economic,
and technological factors that influence which foods we eat.
• The biological importance of food is dictated by the nutrients
it contains.
• Other aspects of food such as taste, color, smell, texture,
presentation and packaging help determine its psychological,
cultural, social and personal value.

5. What is food?
• Food is material of plant or animal origin that
contains essential body nutrients and is ingested
and assimilated by an organism to produce
energy, stimulate growth and maintain life.

6. • Assimilation: The conversion of nutrients into
the fluid or solid substance of the body by
process of digestion and absorption.
• Digestion: The conversion of food in the
stomach and intestines into soluble and
diffusible products capable of being absorbed
by the body.

7. • Metabolism: The process of life by which
tissue cells are destroyed by combustion
(catabolism) and renewed from chemical
substances carried in the blood and derived
from digested food(anabolism).
• Enteral Nutrition: Administering nutrition with
liquefied foods into the gastrointestinal tract
via a tube.

8. • Malnutrition: Deficiency of the nutrients required
for development and maintenance of the human
body.
• Anorexia: Lack of appetite with no desire to eat.
• Nutrient: A source of nourishment, such as food
that can be metabolized by an organism to give
energy and build tissue.

9. Main Factors Affecting Nutrition:
• Religious
• Cultural
• Environmental

10. Importance of maintaining good nutrition
Good health depends upon the availability of
essential nutrients the body requires
throughout life.
A well nourished individual is mentally alert, is
at maximum of physical capability and has a
high resistance to disease.

11. Good nutrition is important for:
 The physical and mental development of
children
 Resistance to infection.
 Healthy pregnancies and deliveries
 The ability of the adults to work well.
 The prevention of deficiency diseases

12. Food can be classified into three main groups:
• Energy giving – Carbohydrates (CHO)
• Body building foods – Proteins
• Protective foods - Vitamins

13. Nutrients:
Carbohydrates; are the main sources of energy
• They are compounds which contain carbon,
hydrogen and oxygen (CHO).
• To produce energy they are metabolised ,in
the process they produce carbon dioxide and
water.

14.  Humans get most of their CHO in the form of
starches and sugars.
 CHO are classified according to to their
complexities as:
 1. Monosaccharide, i.e. simple sugars e.g.
glucose
 2. Disaccharides e.g. cane or beet
sugar(sucrose), milk(lactose)
 3. Polysaccharides e.g. starch, glycogen

15. 350gm of CHO is stored in the form of glycogen in
the muscles and liver.
Glucose is absorbed into the blood through the
walls of the intestines and finally carried to the
liver.
Glucose maintains glucose level in the blood.

16. • Excess CHO is converted into fat and stored.
• A minimum of 100gm of CHO needed daily in the
diet.

17. Dietary Fibre:
 Food that reaches the small intestines completely
undigested
 What happens to fibre in the body?
1.Food is broken up and mixed with saliva in the
mouth.
2. Passes through the oesophagus to reach the
stomach.
3. Mixes with digestive juices.

18. Dietary Fibre
• Pushed to the small intestine where fibre
remains unchanged.
• Fibre is non calorie diet containing bulk
requiring more chewing.
• Makes the stools large in volume, pale in
colour, soft in consistency.
• Softness of stools is due to emulsified gas
produced by the action of bacteria on fibre.

19. Effects of fibre on weight
Fibre requires more chewing , saliva fills the
stomach.
Fibre is bulk forming with very few calories.

20. • Fibre gives protection against heart attack by
decreasing the intake of lipid and simple CHO
which are low fibre diets and risk to the heart.
• Fibre binds cholesterol and reduces its
absorption from the intestinal tract.

21. How fibre prevents bowel cancer
• Diet rich in fibre increases the acidity of the stools
by fermentation.
• Fermentation reduces bacterial production of
carcinogens.

22. LIPIDS:
Lipids contain carbon, hydrogen and are composed of fatty acids.
Utilization in the body:
1.Padding around the organs to absorb the shock
2. Protection for the nerves.
3. Insulation of the body to avoid rapid change of temperature by excessive heat loss
from its surface.
4. Spares body proteins
5. Carriers of fat soluble vitamins A, D,E,K
6. Increases palatability and the satiety value of foods
7. Distinct flavours of different fruits and vegetables depend on the oils present in
them.
8. Fats are concentrated source of energy, each gram gives 9 calories.

23. Digestion of fats starts in the stomach by gastric lipase enzyme.
The bulk of the fats are digested in the small intestines by bile salts converted into fatty acids
and glycerol.
Fats are absorbed in the intestines and circulated through the lymph.
Some of the fats are used for supply of energy, the rest for storage i.e. In body organs ,
abdomen and the skin.
Fatty acids:
Grouped under two types:
1. Saturated fatty acids which are high in cholesterol found in animal products e.g. meats
and eggs. They are solid at room temp. And are the biggest dietary cause of high LDL ‘bad’
cholesterol levels and should be limited.
2. Unsaturated fatty acids low in cholesterol found in vegetable oils except palm oil.

24. Daily requirements of fats:30gm per day
Cholesterol content of foods mg per 100gm
Food Cholesterol Food Cholesterol
Butter 280 Egg white 0
Cheese 145 Egg yolk 1330
Cream 140 Chicken 40
Milk 11 Liver 250
Eggs 498-560mg Fish 50

25. .
• White portion of the egg is full of proteins
while yellow portion is full of cholesterol
• If you want to avoid fats, consume skimmed
milk, green vegetable and fruits.
 Deficiency of fats and CHO in the diet burns
reserve fat of the body to meet requirements
of the calories.

26. Proteins
• 1/6 of body weight consists of protein
• 1/3 in the muscles.
• 1/10 in the skin
• 1/5 in cartilage and bones
• Reminder in tissues and body fluids.
• Protein differs from carbohydrates and fats
because it contains 16% nitrogen and a larger
molecule.

27. Cont’d
• Proteins are made of 28 simpler substances
known as amino acids.
• Most of these are made in the body except 9
(essential) which must come from our diet.
• All amino acids in the diet are broken down
and the nitrogen compound released as urea.
• Excess proteins are converted into fats and
glycogen. No proteins are stored.

28. Essential amino acids
• 1. Isoleucine 2. phenylalanine
• 3.Leucin 3. Threonine
• 4. Lysine 5. Tryptophan
• 6. Methionine 7. Valine
8. Histidine 9. Arginine

29. Functions of proteins
• Provide material for growth, wear and tear of
tissues.
• Maintain acid base balance
• Provide energy and stimulate metabolism.
• Transformed into CHO which may be
synthesized to fat.
• Source of certain enzymes and ferments
concerned in digestion.
• Antibodies which are body defence against

30. Cont’d
Protein utilization
• Digestion starts in the stomach
• HCL of the stomach converts proteins into
peptides and amino acids
• 92% of dietary protein is digested.
• Proteins of plant origin are digested in less

31. .
Protein Requirements
• 1gm per kg body wt.
Extra proteins may be required to rebuild tissues
after the following situations:
1.During growing phase of infancy.
2. Donation of blood.
3. Excessive menstruation.
4. Haemorrhages

32. 5. In wasting diseases such as TB,HIV/AIDS
6. Pregnancy and lactation.

33. Essential amino acids
• 1. Isoleucine 2. Phenylalanine
• 3 Leucine 4 .Threonine
• 5.Lysine 6 .Tryptophan
• 7 Methionine 8.Valine.

34. Calories(Kilocalories)
• One kilocalorie is the amount of heat required
to raise the temperature of one kg of water
from 15 to 16 degrees Centigrade.
• The energy value of food is as follows;
• Carbohydrates -4 kcal per gm of edible
portion.
• Fats-9 kcal per gm of edible portion
• Proteins-4 kcal per gm of edible portion.

35. Energy is required by the body for:
• Basal body metabolism for internal body
processes e.g.respiration,digestion etc when
the body is at rest.
• Muscular activity.
• Utilisation of food.
• Growth and repair.

36. Basal body metabolism
• It requires 40 cal per hour per squire meter of
body surface in males ,37 cal in females.
• Calculation formula:
• Body surface area x 40 x24=cal per day.
i.e. Taking adult surface area of an adult as
1.75sq meters basic cal requirement will be;
40x1.75x24=1700cal.

37. .
• Extra energy is needed during stages of rapid
growth for building tissues such as;
Pregnancy.
Early childhood.
Adolescence.
Lactation

38. Vitamins
• Organic substances in food which are required
in small amounts to act as catalysts for
metabolism.
• All supplied from food
There are 12 vitamins each with a specific
function.

39. Types of vitamins
Water soluble;
• Vit C
• Vit B complex which includes;
• Thiamine (B1)
• Niacin
• Riboflavin
• Pyridoxine (B6)
• Biotin,B12,Folate

40. Fat soluble vitamins
• Vit. A
• Vit-D
• Vit-E
• Vit-K

41. Factors influencing the utilisation of
vitamins.
Availability-if the diet is deficient of dietary fat.
Provitamins-capable of conversion into vitamins.
E.g. Carotene for vit A
Bacteria in the gut:
• Normal bacteria flora in the gut can synthesize
vit K

42. .
• In most cases bacteria are more likely to
reduce absorption of vit.
Biosynthesis in the skin
Vit D can be synthesized from the skin regularly
exposed to the skin.
Requirement of vit E is increased when the
intake of polyunsaturated fat is high.
Diet high in CHO or alcohol requires more
thiamine for their metabolism.

43. Functions of vit A
• Essential for skeletal growth.
• Protects the body against infection, has
immunological effect
• Helps in normal vision

44. Daily requirements of vit A
• Adult daily requirement_750mcg.,lactating
and pregnant mothers_775mcg per day.
• Supplementation has been in MCH clinics .
• High doses Contraindicated in pregnancy, can
harm the foetus.
• The schedule for children is 100,000IU at 6
months of age and every 6 months till age 5.
• After 12 months the schedule for children is
200,000IU

45. Storage of vit A
• 90% is stored in the liver, may last for 6-9
months.
• 50% is lost during storage and cooking.
• Deficiency of vit A
• Insufficient intake leads to night blindness and
in severe cases causes total blindness

46. Other vitamins
• Vit D;
Functions;
1. Helps in metabolism of calcium and
phosphorus.
2. Promotes absorption of calcium from the
intestines, promotes bone mineralization

47. Sources of vitamin D
• Ultraviolent rays of the sun react to the skin
surface oils to produce vit D. In a strip off
status.
• Milk and milk products
• Eggs
• Cod liver oil
• Fish

48. Vitamin K
• Manufactured and stored in the liver, can be
produced by bacteria in the intestines in the
presence of unsaturated fatty acids.
• Functions;
• Helps in forming prothrombin, a constituent
of blood clotting
• It is given to newborns at childbirth –cannot
manufacture it and risk bleeding.
•

49. Sources of vit K
• Green leafy vegetables,eggyolk honey
tomatoes.
• Can be destroyed by freezing.

50. Daily requirement of vit C
• 50mg per day.
Smoking destroys vit C up to 25mg equiv of one
orange.
Any kind of stress e.g. argument extremes of
temperature fatigue illness depletes vit C.
It cannot be stored in the body.

51. Vit. C
Sources
• Citrus fruits
• Guavas, richest source
• Capsicum
• Amaranth
• Spinach, Tomato.
• Kales
• Other traditional green vegetables.

52. Functions of vit C
• Part of cementing material which hold the
body cells in place.
• Helps the body to build resistance to infection
• Helps in absorption of calcium and iron.

53. MINERALS
• SODIUM
• Sodium is Cation in extracellular fluid and the primary
regulator of its volume. It helps maintain acid base balance
and it is essential to nerve transmission for muscular
contraction
• Deficiency Toxicity
• Muscular cramps Oedema
• Mental apathy Acute hypertension
• Loss of appetite
• Food sources
• Table salt, soy sauce, processed foods, meats, milks,
vegetables

54. CALCIUM
• An average adult contains 1250grams of calcium in
the bones and teeth, blood and extra cellular fluids
and soft tissues.
• Functions
• Calcium is essential for skeleton development and
clotting of blood.
• It works together with vitamin D to build strong
bones and teeth.
• It is important for the functioning of the heart and
muscle functions, blood pressure and immune
defences.

55. IRON
Function
• Iron is a carrier of oxygen and carbon dioxide.
• Iron catalyses the conversion of beta-carotene (pro-
vitamin A precursor) to the active form of vitamin A.
• It is used in blood formation to make haemoglobin.
• It is used in antibody production and detoxification
of drugs in the liver.
• It eliminates old red blood cells and builds new cells.

56. • Sources
• Animal sources such as liver, egg yolk and other meats.
• Plant sources include: pulses, nuts, dried fruits, molasses,
dark green vegetables such as spinach, black night shade,
amaranthus, kale, stinging nettle.
• DEFICIENCY
• anaemia

57. ZINC
FUNCTIONS
 It is important in cell division.
 Sexual maturation and reproduction,
 Development of immune reactions
 It enhances the sense of taste.
 It mobilizes vitamin A from the liver stores to
maintain normal levels in the blood, and in the
utilization of vitamin A for vision.


58. POTASSIUM
• Functions
• Together with sodium, potassium regulates the water
balance and acid base equilibrium.
• It is used for muscle sensitivity and in the dispersion
of proteins.
• It is used in the metabolism of carbohydrates and
synthesis of proteins.
• It is an integral part of the cells and it is required for
growth.

59. IODINE
• Functions
• Iodine ensures the development and proper
functioning of the brain and the nervous system.
• As part of the thyroid hormone, thyroxin, iodine
plays a major role in regulating growth and
development.
• It is used in energy metabolism.
• It is essential for reproduction.
• It is used in the conversion of carotene into vitamin
A, the synthesis of protein, and the absorption of
carbohydrates.

60. UNIT 2 NUTRITION:
• OBJECTIVES
1. Describe the sources of various foods.
2. Describe dietary requirements of various
groups of people.
3. Outline various special diets.

61. Feeding different groups
 Infant feeding
 Breastfeeding is best for baby.
 Babies must be breastfed exclusively for 6 months
for the first 6 months.
 After 6 months wean the baby in 3 stages;
 1. Most of the nutrients will come from breast
milk start other foods.
 2. From ten to 18 months:
 Continue with same amount of breast milk,
increase the amount of other foods.
 The food gradually changes to regular family

62. .
• 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.

63. 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.

64. 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.

65. Breastfeeding;
• 6. Proper emptying of the breasts prevents
mastitis
• 7. Has contraceptive effect, prevents
pregnancy
• The baby should be fed on demand.

66. 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.

67. Toddlers;
• 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.

68. 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.

69. Preschooler
• Choose a diet moderate with sugar and salt.
• Use the food guide pyramid to include 5major
• food groups.
• Never use food as a bribe to reward a
behaviour.
• Do not force him to eat what others are
eating, offer an alternative.

70. 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.

71. 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.

72. Diet during17-21yrs.
• Growth is usually slow, the body tissues are
getting matured with good nutrition.
• Teach them about relationship between food
intake and body stored nutrients in
preparation for adulthood.

73. 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.

74. For pregnancy
• It recommended an increase of 300 calories
per day in the latter half of the pregnancy.
• Additional of 14g of protein daily during the
second half of pregnancy.
• Calcium and phosphorus increased for
formation of bones and teeth.
• Iron needed for synthesis of additional volume
of blood and other tissues for development of
the foetus.

75. Nursing mother
• Additional supply of 700 calories per day
above normal
• Additional intake of 20g of proteins per day
• Intake of high quality proteins helps in
improved secretion of milk
• The intake of minerals, calcium, iron, iodine
and vitamins should be increased as well

76. 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.

77. 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.

78. 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.

79. 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

80. .
• 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.

81. 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.

82. 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.

83. Diabetes cont.
• Avoid alcohol, causes hypoglycaemia ,impairs
judgement.
Avoid the following foods;
• Sweet drinks and carbonated drinks.
• Caned foods and fruits.
• Cakes, creams, sugar,

84. Diabetes cont.
CHO
Consume 250gm
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.

85. 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.

86. 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, fluids and high
sodium foods.
• The proteins included must be of H.B.V
• When urine output is 500-800ml allow protein
intake of 0.5-0.75gm/kg body wt

87. 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.
• Sodium intake is restricted in cases of oedema
• Iron supplements may be needed in cases of
anaemia due to poor nutrient reabsorption.

88. 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
4. Canned food

89. Cont.Nephrotic S
• Diet treatments must rectify oedema,
excessive protein loss and
malnutrition(anaemia etc)
• Give high protein diet 2-3 g/kg body wt/day
for children and 75-100g for adults because
there is a lot of protein loss in the urine.
• Give about 50-60calories/kg body weight
• Sodium restriction to about 500 mg to prevent
oedema
• Dietary fat and cholesterol may be limited to

90. 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.

91. 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.

92. 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.

93. • To improve the appetite of the patient:
• Offer soft food
• Serve frequent small meals
• Offer foods the patient tolerates
• Add sugar flavourings to improve acceptability
of liquid supplements
• Avoid extremely hot or cold foods, spicy or
acidic foods
• Give medicines after meals

94. 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 weight to the stool and
speed the movement of the undigested
material through the intestines.
• Increase 1-1.5litre of water above other fluid
intakes
• encourage fitness exercises.

95. 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 aspirin,
 Big servings of meat.
 Meat soups, fried foods or any other food the
patient does not tolerate.

96. 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.

97. Diet for ulcerative colitis
Inflammation and ulceration of the intestines
• Encourage the patient to take a lot of fluids
for hydration and prevention of constipation.
• Low residue diet to rest the bowels e.g. white
rice, pasta, noodles
• Avoid whole grains, raw and dried fruits
sukuma, cabbage, cauliflower, nuts,beans
• Give fruit and vegetable juices
• Well cooked potatoes with tender vegetables

98. Ulcerative colitis cont.
• Give well cooked tender meat, fish, eggs for
proteins.
• Eat frequent small meals
• Drink plenty of fluids mainly water but avoid
alcohol and carbonated drinks
• Have regular relaxation and breathing exercise
periods
• Avoid foods rich in fat e.g. Fried foods, butter,
margarine, cream sauces etc

99. 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
• Encourage the patient to take foods that
enhance iron absorption i.e. Foods rich in vit c
and calcium

100. 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;
Reduce the total amount of fats, mainly
saturated fats

101. Diet in isc.H ,CCF,hypertension cont.
Encourage use of unsaturated oils e.g. sunflower
oil and olive oil.
Decrease the intake of the amount of dietary
cholesterol
Moderate sodium intake 1000-1500mg/day
Abstaining from alcohol consumption

102. Cont.Ischaemic heart disease
• CHO
• They are responsible for synthesis of
cholesterol
• Reduce sugar intake to decrease serum
triglycerides.
• Calories;
• Reduce calories and reduce wt.
• Vit C is required for capillary stability,

103. 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

104. 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,cheese
• Tender vegetables and fruits, refined cereals
breads butter or margarine jellies custards

105. 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

106. 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 start on this diet for
more than a day or two.

107. Liquid diet cont.
• Full liquid diet.
• It is a second diet after clear fluids following
surgery for a client who is unable to swallow.
• They are nutritionally deficient in energy and
most nutrients
• These are;
• All clear fluids e.g. Ice creams, soups that are
strained, strained vegetable juices light
porridge.

108. Diet in burns
• Give high protein diet to replace that lost
through breakdown of muscle tissue.
• Increase foods such as egg, meat, fish, chicken
and dairy products.
• Give fruits and fruit juices to replace water
loss and to replace vit C for tissue healing.

109. 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

110. 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.

111. Diet in hepatic encephalopathy.
• The client has elevation of BUN which is a
product of protein metabolism
• Common in cirrhosis of the liver.
• The client requires a protein restricted diet.
• Provide enough protein to maintain
nutritional status but not that which will allow
the build up of waste products from protein
metabolism.

112. Encephalopathy cont.
• Give a small amount of high quality
protein,40-60gm of protein daily.
• Provide low protein products such as pasta
and bread,
• Give adequate amounts of CHO
• Add CHO in liquid form to provide additional
energy.

113. Food Guide Pyramid

114. Unit 3: Nutrition
Objectives
1. Classify deficiency disorders
2. Outline causes, features, and management of
deficiency disorders.

115. Beriberi
Predisposing factors:-
• People who eat refined starchy foods
• Taking high doses of diuretics
• Abuse of alcohol
There are two types of Beriberi:-
1. Wet
2. Dry.

116. 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

117. Wet Beriberi
Features
• Awakening at night with shortness of breath.
• Increased heart rate
• Shortness of breath with activity
• Swelling of the lower limbs

118. 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

119. 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.

120. • Blood tests are done to measure the amount
of Thiamine in the blood.
• Urine tests to see if Thiamine is passing
through the urine

121. 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

122. 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.

123. Complications
• Coma
• Congestive heart failure
• Psychosis
• Death

124. 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.

125. Clinical Features
• High sensitivity to sunlight(Photophobia)
• Aggression
• Dermatitis, alopecia, oedema
• Smooth, beefy red glossitis,Tongue becomes
thick
• Red skin lesions
• Insomnia
• Body weakness

126. 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)

127. .
• 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 .

128. 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

129. Treatment
• Supplement the diet with niacinamide by
mouth or by injection-dosage 300-500mg od
po, or inj100-250mg bd-tds
• In case of encephalopathic syndrome dosage is
1gm po or 100-250mg by inj.
• Give other B complex vitamins
Prevention
• Give foods rich in Niacine.g. Meat
• liver whole grains.

130. Rickets
• 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

131. 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 from the
gut. Deficiency of VitD causes hypocalcaemia
leading to skeletal and dental deformities

132. 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.

133. 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

134. 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

135. 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

136. 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

137. 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)

138. 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 50 yrs-1200mg od

139. 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

140. 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

141. 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

142. Clinical Features
• Tiredness
• Weakness
• Irritability and depression
• Aches and pains
• Poor healing
• Bleeding symptoms;
Weak capillaries
Bruising easily

143. 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

144. 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

145. 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

146. 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

147. Complications of Scurvy
Malabsorption of iron leading to iron
deficiency anaemia
Internal bleeding
Pathological fractures
1. References; Professional Guide To Diseases
8th edition-Online Textbook
2. Nutrition For Developing Countries by Savage
King and Burgess

148. 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

149. 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

150. 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

151. 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

152. 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

154. 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

155. 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

156. 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

157. 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

158. 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

159. 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

162. 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

163. Hypothyroid cretin
• Clinical features;
• Anorexia, failure to gain wt
• Constipation
• Feels cold
• Drowsiness thick dry skin
• Hoarse cry
• Slow mental development

164. 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

165. 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

166. 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

167. 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.

168. 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

169. 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

170. .
References:-
• Nutrition For Developing Countries, Savage
King and Burgess 2nd ed.
• Google Search

171. 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

172. 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

173. 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

174. 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

175. 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

176. 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

177. 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

178. 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

179. 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

180. 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

181. Treatment cont
Pregnant women; 400mg folic acid and 60mg
iron twice a day
Infants and children; liquid preparation
at5mg/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

182. 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

183. 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%

184. Malnutrition
• Malnutrition means wrong or faulty nutrition
• Protein calorie malnutrition is deficiency of
calories and proteins in the body
• It can be divided into 3 types;
Kwashiorkor
Marasmus
Marasmic kwashiorkor

185. Immediate causes
• Disease
• Poor diet
• Inadequate care of children and women
• Poor health services
• Family food shortages
• Unhealthy environment

186. Basic causes
• Social-e.g. Poverty
• Political factors
• Ideological factors
• Environmental factors

187. 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

188. 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

189. Clinical features of kwashiorkor
Wt for age is between60-80%of the
expected age
Wt loss and muscle wasting
Pitting oedema of the legs and foot
The face is puffy(moonface)
The child is miserable and not interested
with the surroundings

190. KWASHIORKOR

191. MARASMIC KWASHIORKOR

192. 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

193. 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

194. Steps cont
• Intensive feeding to rebuild wasted
tissues and increase growth
• Education of the parents on nutrition
to prevent recurrence of
malnutrition

195. 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

196. Management outline
The child is admitted with the
mother in a well heated room to
maintain normal body temperature
Feed on special formula's with vit
and mineral supplements
Broad spectrum antibiotics to treat
infection

197. 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

198. Complications of P.E.M
Dehydration
Heart failure
Infections
Mental retardation
 Blindness due to vit A deficiency
Retarded physical growth
Anaemia


199. 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

200. 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

201. 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

202. 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

203. 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

204. Phase 2 feeding
Increase the frequency of the feeds to 3-4hrly
over 1 week
Do a gradual change over from phase 1 to phase
2 with F100 instead of F75
Increase the feeds from 130ml/kg/day to
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

205. 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

206. 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.

207. 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.

208. 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

209. 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

210. 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

211. 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

212. Treat intestinal parasites
• Give mebedazole 500mg single dose or
100mg bd.for 3days.

213. 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

214. References;
• Tropical Diseases; Gordon and Alimuddin 2nd
Ed
• Nutrition For Developing Countries; Felicity
Savage and Ann Burges,2nd Ed.
• Child Health;AMREF
• Food And Nutrition; L C Gupta,Kusum Gupta,
6th Ed.