This document discusses various nutritional problems including undernutrition and overnutrition. It describes different types of undernutrition such as protein-energy malnutrition, low birth weight, vitamin A and iodine deficiencies. Protein-energy malnutrition can manifest as kwashiorkor or marasmus. Overnutrition issues like obesity, skeletal and dental fluorosis are also covered. The prevention and treatment of these various nutritional deficiencies and disorders are outlined.

1. Nutritional
problems
Presented by : shivangi sharma

2. INTRODUCTION
• Nutrition is the selection
of foods and preparation of foods, and their
ingestion to be assimilated by the body. By
practicing a healthy diet, many of the
known health issues can be avoided.
The diet of an organism is what it eats,
which is largely determined by the
perceived palatability of foods.

3. NUTRITIONAL PROBLEMS
• A nutritional deficiency occurs when the
body doesn’t absorb or get from food the
necessary amount of a nutrient.
Deficiencies can lead to a variety of health
problems. These can include digestion
problems, skin disorders, stunted or
defective bone growth, and even dementia

4. TYPES OF NUTRITIONAL
PROBLEM
UNDER
NUTRITION
(MALNUTRITION)
OVERNUTRITION

5. UNDERNUTRITION
• Is defined as a pathological state resulting
from an absolute or relative deficiency of
one or more essential nutrients.
• It includes:
 Protein Energy Malnutrition
 Low birth weight
 Xerophthalmia
 Keratomalcia
 Nutritional anemia
 Lathyrism
 Endemic goiter (Iodine deficiency disorders)
 Endemic fluorosis

6. PROTEIN–ENERGY MALNUTRITION
• refers to a form of malnutrition
where there is
inadequate protein and calorie
intake
• It is considered as the primary
nutritional problem in India
• Causes childhood morbidity and
mortality
Conditions/Diseases
• Kwashiorkor
• Marasmus
• Marasmic - kwashiorkor

7. CAUSES/ CONTRIBUTORY FACTORS
• Inadequate intake of food
• Diarrhea
• Respiratory infections
• Measles
• Poor envt. Hygiene
• Large family size
• Poor maternal health
• Failure of lactation
• Premature termination of breast feeding
• Delayed supplementary feeding
• Use of over diluted cow’s milk

8. KWASHIORKOR
Kwashiorkor is the most
common and widespread
nutritional disorder in
developing countries. It is a
form of malnutrition caused by
not getting enough protein in
the diet.

9. MARASMUS
•Marasmus is a severe form of
malnutrition that consists of the
chronic wasting away of fat, muscle,
and other tissues in the body.
• Malnutrition occurs when the body
does not get enough protein and
calories.
•This lack of nutrition can range
from a shortage of certain vitamins to
complete starvation.

10. A COMPARATIVE CHART
KWASHIORKOR
• Acute illness/infections
prolonged starvation
• measles,trauma,sepsis
• Protein is principal
nutrient
• 18 months to 3 years
• Rapid, acute onset
• Some weight loss
• High mortality
MARASMUS
• Severe prolonged
• chronic/recurring
• calories and protein
principal nutrients
• 6months to 2 years
• chronic and slow
onset
• severe weight loss
• low mortality unless

11. COMPARISON OF CLINICAL FEATURES
KWASHIORKAR
• Edema, pot belly,
swollen legs
• Mild to moderate
growth retardation
• Weight masked by
edema
• Low subcutaneous fat
• Muscle atrophy
MARASMUS
• No
• Weight loss up to 40%
edema
• Severe growth failure
• Severe emaciation
• Severe loss of
subcutaneous fat
• Severe muscle atrophy

12. Assessment of PEM
Gomez Classification
• Weight for age (%) = Weight of child X 100
Wt. of normal child of same age
• Between 90 – 110% Normal Nutritional
Status
• Between 75 – 89% Mild malnutrition (1st
degree)
• Between 60 – 74% Moderate Malnutrition (2nd
degree)

13. PREVENTION
• Oral rehydration therapy helps to prevent
dehydration caused by diarrhea
• Exclusive breast feeding for 6 months thereafter
supplementary foods may be introduced along with
breast feeds
• Immunization for infants and children
• Nutritional supplements
• Early diagnosis and treatment
• Promotion and correction of feeding practices
• Family planning and spacing of birth

14. LOW BIRTH WEIGHT
• An LBW newborn is any newborn
with a birth weight of less than 2.5kg
(including 2.499kg) regardless of
gestational age.
CAUSES/RISK FACTORS
• Illness/infections
• Short maternal stature
• Very young age
• High parity
• Close birth intervals
• IUGR

15. PREVENTION
• Identification of mothers at risk – malnutrition,
heavy work load, infections, disease and high BP
• Increasing food intake of mother, supplementary
feeding, distribution of iron and folic acid tablets
• Avoidance if smoking
• Improved sanitation methods
• Improving health and nutrition of young girls
• Controlling infections – UTI, rubella, syphilis,
malaria

17. VITAMIN A DEFICIENCY
• Vitamin A deficiency (VAD) or hypovitaminosis A
is a lack of vitamin A in blood and tissues. It is
common in poorer countries but rarely seen in more
developed countries. Nyctalopia (night blindness) is
one of the first signs of VAD.
• Xerophthalmia i.e., dry eyes refers to all the ocular
manifestations of vitamin A deficiency
• It is the most widespread and serious nutritional
disorder

18. CLINICAL FEATURES
• Reduced vision in the night or dim light
• Dry eyes which could also lead to
Xerophthalmia
• corneal inflammation
• The child or adult may experience
susceptibility towards respiratory infection
and urinary infections.
• Growth can be halted in children
• Skin might also show signs of Vitamin A
deficiency. For example it may get rough
and/or dry

19. PREVENTION AND CONTROL
• Administering large doses of vitamin A
orally on a periodic basis
• Regular and adequate intake of vitamin A
• Fortification of certain food with vitamin A
– sugar, salt, tea and skimmed milk

24. VITAMIN B12 DEFICIENCY

26. NUTRITIONAL ANEMIA
• Nutritional anemia is a condition where the
hemoglobin content of blood is lower than
normal as a result of a deficiency of one or
more essential nutrients, regardless of the
cause of such deficiency.

27. CAUSES / RISK FACTORS
• Inadequate diet
• Insufficient intake of iron
• Iron malabsorption
• Pregnancy
• Excessive menstrual bleeding
• Hook worm infestation
• Malaria
• Close birth intervals
• GI bleed
• Infants and children
• Pregnant women
• Pre menopausal women

28. EFFECTS OF ANEMIA
Pregnancy
• Increases risk of
maternal and fetal
morbidity and
mortality
• Abortions,
premature births,
PPH, low birth
weight are
associated with
anemia during
pregnancy
Infection
• Anemia can be
aggravated by
parasitic infections
like malaria,
intestinal parasites
• Iron deficiency
may repair cellular
response and
immune functions
Work capacity
• More severe the
anemia, greater the
reduction in work
performance

29. PREVENTION
• Estimation of Hb to assess degree of anemia
• Blood transfusion in severe cases of anemia
(<8g/dL)
• Iron and folic acid supplements
• Food fortification with iron
• Changing dietary habits
• Control of parasites
• Nutritional education and awareness

30. IODINE DEFICIENCY DISORDERS
(IDD)
• IDD leads to a much wider spectrum of
disorders commencing with the intrauterine
life and extending through childhood to
adult life with serious health and social
implications

31. DISORDERS
• Goiter
• Hypothyroidism
• Subnormal intelligence
• Delayed motor milestones
• Mental deficiency
• Hearing defects
• Speech defects
• Mental retardation
• Neuromuscular weakness
• Endemic cretinism

32. EATING DISORDERS
Anorexia Nervosa Bulimia Nervosa

33. CLINICAL FEATURES
• Amenorrhea
• rapid, dramatic weight loss at least 15% under
normal body weight
• May engage in frequent, strenuous, or
compulsive exercise
• Perception of self as overweight despite being
told by others they are too thin
• Intolerance to cold and frequent complaints of
being cold. Body temperature may lower in an
effort to conserve energy
• Hypotension and/or orthostatic hypotension

34. Treatment modalities
Anorexia Nervosa
Pharmacother
apy
Psychological
therapies
Bulimia Nervosa
Bulimia Nervosa
Psychotherapy
TCA’s or SSRI’s

35. OVERNUTRITION
Is defined as a pathological state resulting from an
absolute or relative excess of one or more essential
nutrients.

36. SKELETAL FLUOROSIS
• Associated with life
time daily intake of
3-6mg/L or more
• Heavy deposition of
fluoride in skeleton
• Crippling occurs
leading to disability

37. DENTAL FLUOROSIS
• It occurs when excess
fluoride is ingested
during the years of
tooth calcification –
first 7 years of life
• Characterized by
molting of dental
enamel which has
been reported above
1.5mg/L intake
• Fluorosis seen on the
incisors of upper jaw

38. PREVENTION
• Changing the water sources
• Chemical defluorination
• Preventing use of fluoridated toothpaste
• Fluoride supplements not prescribed for
children consuming fluoridated water

39. OBESITY
• is an epidemic diseases, which consists of
body weight that is in excess of that
appropriate for a person’s height and age
standardized to account for differences,
leading to an increased risk to health
related problems

40. BODY MASS INDEX
• BMI = (Weight in Kilograms / (Height in
Meters x Height in Meters))
• A person with a BMI of 30 or more is
generally considered obese. A person with a
BMI equal to or more than 25 is considered
overweight.

41. Nursing management
• Nursing diagnosis:
• Imbalanced nutrition less than body requirement
• Muscle weakness
• Activity intolerance
• Impaired fluid and electrolyte balance
• Impaired skin integrity
• Fatigue
• Risk for infection
• Risk for injury

42. Summary

43. Conclusion