This document discusses several major nutritional disorders including kwashiorkor, marasmus, nutritional anemia, endemic goiter, and fluorosis. It defines each disorder, describes their signs and symptoms, and outlines corrective measures. Kwashiorkor is a protein deficiency disorder characterized by edema and easily pluckable hair. Marasmus is an energy deficiency disorder seen in underweight children. Nutritional anemia is caused by deficiencies in iron, vitamin B12, and other nutrients needed for hemoglobin formation. Endemic goiter is an iodine deficiency disorder causing thyroid enlargement. Fluorosis results from excessive fluoride intake, damaging teeth and bones. Prevention focuses on balanced nutrition and treatment involves slow refeeding,

1. Nutrional disorder its
causes & its corrective
measures
BABLU HRANGKHAWL
CAU/CPGS/B17/02
B.Sc.Agri 3RD Year
COA-KYRDEMKULAI CAU(I)

2. Malnutrition
The world health organisation (WHO)
defines malnutrition as “the cellular
imbalance between the supply of
nutrients and energy and the body’s
demand for them to ensure growth,
maintenance, and specific function”.

3. Major nutritional
disorders
1. Kwashiorkor
2. Marasmus
3. Xeropthalmia
4. Nutritional anemia
5. Endemic goiter
6. fluorosis

4. Protein energy malnutrition (PEM) is a
form of malnutrition that is defined as a
range of pathological conditions arising
from coincident lack of dietary protein
and/or energy(calories) in varying
proportion. It includes:
1. Kwashiorkor and
2. Marasmus

5. Kwashiorkor
• Kwarshiorkor is diagnosed based on laboratory
indices. In children kwashiorkor is often the
result of a low protein, starchy diet during stress
periods of growth. In a hospitalized patient under
stress and being supported by 50% dextrose
solution, kwashiorkor is often seen within as
short a period as two weeks. Fat reserves and
muscles mass tend to be normal giving a
deceptive appearance of adequate nutrition.

6. Signs which help in the diagnosis of kwashiorkor
are:
 Easily pluckable hair
 Edema
 Delayed wound healing
 Depression in cellular immune function
 Lymphopenia : an abnormally small number of
lymphocytes in the circulating blood

7. Corrective measures of kwashiorkor
 It can be prevented by eating a well-balanced diet
 Treatment
 Carbohydrates first, then protein
 Ingest protein rich foods : 3-4g of protein/kg body
weight/day
 Treatment can be monitored : using plasma albumin
concentration, disappearance of edema, gain in body
weight
 Calories are given first in the form of carbohydrates,
simple sugars, and fats. Proteins are started after other
sources of calories have already provided energy.
Vitamin and mineral supplements will be given.

8. • Food must be restarted slowly since the person has been without
much food for a long period of time. Suddenly eating high-calorie
foods can cause problems.
• Many malnourished children will develop intolerance to milk sugar
(lactose intolerance). They will need to be given supplements with the
enzyme lactase so that they can tolerate milk products.
Pic : Kwashiorkor on child

9. Marasmus
• Marasmus is a form of severe malnutrition
characterized by energy deficiency. It can occur in
anyone with severe malnutrition but usually occurs
in children.
• Body weight is reduced to less than 62% of the
normal body weight for the age. Maramus
occurrence increases prior to age 1, whereas
kwashiorkor occurrence increases after 18 months.
It can be distinguish from kwashiorkor is that
kwashiorkor is protein deficiency with adequate
energy intake whereas marasmus is inadequate
energy intake in all forms, including protein.

10. Symptoms of marasmus
 Shrunken, wasted appearance, loss of muscle mass and
subcutaneous fat mass
 Buttocks and upper limb muscle groups are usually more
affected then others
 Tachypnea (pneumonia, heart failure)
 Dry skin and brittle hair
 Children can also be short-tempered and irritable.

11. Corrective measures of Marasmus
 Initially, the child is fed dried skim milk that has been
mixed with boiled water. Once the child tolerates the milk,
a vegetable mix can be added including sesame, casein,
and sugar.
 Re-feeding must be done slowly to avoid re-feeding
syndrome.
 Once children start to recover, they should have more
balanced diets which meet their nutritional needs.
 Children with marasmus commonly develop infections
and are consequently treated with antibiotics or other
medications.
 Ultimately, marasmus can progress to the point of no
return when the body's ability for protein synthesis is
lost. At this point, attempts to correct the disorder by
giving food or protein are futile.

12. Pic : Children showing marasmus symptoms

13. Nutrional anemia
 Nutrional anemia refers to types of anemia that can be
directly attributed to nutrional disorders. Examples
include Iron deficiency anemia and pernicious anemia.
According to the WHO, a haemoglobin concentration
below 7.5 mmol/L and 8mmol/L for women and men,
respectively, is considered to be anemic. Thus anemia
can be diagnosed with blood test.
 Nutrional anemia is caused by a lack of iron/iron
deficiency, protein, B12 , and other vitamins and minerals
that needed for the formation of haemoglobin

14. Symptoms of anemia
 Fatigue and lack of energy
 Severe symptoms may be shortness of breath, rapid
pulse
 Paleness in hands, eyelids and fingernails
 Swelling of ankles, hair loss, constipation, depression
 Muscles twitching, burning and chest pain
 Cold hands and feet
 Dizziness
 Reduced immunity

15. Corrective measure of anemia
Many types of anemia can't be prevented. But you can avoid iron
deficiency anemia and vitamin deficiency anemia by eating a diet that
includes a variety of vitamins and minerals, including:
 Iron : Iron-rich foods include beef and other meats, beans, lentils,
iron-fortified cereals, dark green leafy vegetables, and dried fruit.
 Folate : This nutrient, and its synthetic form folic acid, can be found
in fruits and fruit juices, dark green leafy vegetables, green peas,
kidney beans, peanuts, and enriched grain products, such as bread,
cereal, pasta and rice.
 Vitamin B-12 : Foods rich in vitamin B-12 include meat, dairy
products, and fortified cereal and soy products.
 Vitamin C : Foods rich in vitamin C include citrus fruits and juices,
peppers, broccoli, tomatoes, melons and strawberries. These also
help increase iron absorption.

16. Endemic goiter
• Endemic is a type of goitre that is associated with iodine
deficiency. Some inland areas where soil and water lacks
in iodine compounds and consumption of marine foods is
low are known for higher incidence of goitre.
• In such areas goitre is said to be “endemic”. A goitre is
an abnormal enlargement of your thyroid gland.
• This type of goitre is preventable

17. Symptoms of goitre
 A swelling at the base of your neck that may be
particularly obvious when you shave or put makeup
 A tight feeling in your throat
 Coughing
 Hoarseness
 Difficulty in swallowing
 Difficulty in breathing
Pic : Goitre symptom

18. Corrective measures of goitre
 The use of iodized table salt
 Avoid goiter promoting foods such as cabbage, Brussels
sprouts, & soy
 Thyroid Replacement Therapy
 Thyroidectomy- surgery to remove part or all of the
thyroid.
 Treatment Options :
1. Symptom relief medications
2. Anti Thyroid Drugs – ATD : Methimazole, Carbimazole,
Propylthiouracil (PTU)
3. Radio Active Iodine treatment – RAI Rx

19. Fluorosis
• Fluorosis is a condition resulting due to ingestion of large
amounts of fluorine when the drinking water contains
fluorides in excess of 3-5 ppm.
• Fluorides are present in the environment
• Excessive systemic exposure to fluorides can lead to
disturbances of bone homeostasis (skeletal fluorosis)
and enamel development(dental/enamel fluorosis).
• Dental and skeletal fluorosis is known health hazards.
• Fluorides deficiency leads to dental caries

20. Symptoms of Fluorosis
Various symptoms are:
 Dental fluorosis: Clinical dental fluorosis is evident by
staining and pitting of the teeth.
 Skeletal fluorosis: The early symptoms of skeletal
fluorosis, include stiffness and pain in the joints.
 Gastrointestinal symptoms: Abdominal pain, excessive
saliva, nausea and vomiting are seen after acute high-
level exposure to fluoride.
 Neurological manifestation: Nervousness and
depression, tingling sensation in fingers and toes,
excessive thirst and tendency to urinate
 Muscular manifestations: Muscle weakness & stiffness,
pain in the muscle and loss of muscle power, inability to
carry out normal routine activities.

21. Corrective measures of fluorosis
Prevention: Fluorosis can be prevented by avoiding
excessive intake of fluoride by individuals / community.
 Using alternative water resources include surface water,
rainwater, and low fluoride ground water
 Defluoridation of water (removing excessive fluoride from
drinking water)
 Better nutrition: measures to improve nutritional status
(intake of calcium and vitamin C, iron,antioxidants) of
affected population particulary children are an effective
supplement to technical solutions mentioned above.
Mothers in affected areas should be encouraged to
breastfeed since breast milk is usually low in fluoride.

22. Pic : Fluorosis on teeth of adult

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