Malnutrition- Undernutrition and Overnutrition

1. SHRADDHA MAURYA
DY PATIL SCHOOL of PUBLIC HEALTH
MASTERS IN PUBLIC HEALTH (I SEMESTER)
PRESENTED BY:

2. TOPIC

3. Malnutrition
Under Nutrition Over Nutrition
Wasting Stunting
SAM
MAM
Obesity
Marasmus
Kwashiorkor

5. INTRODUCTION
Definition
The World health Organisation
(WHO) defines malnutrition as
“the cellular imbalance between the supply of
nutrients and energy and the body demands for
them to ensure, growth, maintenance, and
specific function”.

6. Continue...
Malnutrition is failing health that result from not eating
balance diet over a long period of time.
Malnutrition refers to undernutrition resulting from
inadequate consumption or excessive loss of nutrients
It can also refer to overnutrition resulting from overeating
or excessive intake of specific nutrients.

7. UNDERNUTRITION
Definition
 Undernutrition is, defined as an imbalance between nutrient
requirement and intake or delivery than that result in deficits of
energy , protein, or micronutrients that may negatively affects
growth and development
 In general malnutrition refers to undernutrition (esp. protein energy
malnutrition).

8. Indicators of Undernutrition:
• Stunting:
o low height for age
o Indicates chronic malnutrition
o Prolonged food deprivation disease/illness
• Wasting:
o low weight for height
o Indicates acute malnutrition
o More recent food illness
• Underweight:
o low height for age
o Combine acute and chronic malnutrition

9. Problem statement :
 1.9 billion adults are overweight or obese, while 462 million are underweight
 52 million children under 5 year of age are wasted, 17 million are severely wasted and 155 million are stunted,
while 41 million are overweight or obese
 Around 45% of death among children under 5 year of age are linked to under-nutrition
Factors leading to undernutrition :
 Poverty
 Illiteracy
 Ignorance
 Overcrowding
 Large family

10. Assessment of undernutrition :
 Measure of
 Weight
 Height
 mid arm circumference
 Skin fold thickness
 Waist and hip thickness
 Result expressed as indices :
 Weight for age
 Height for age
 Weight for height
 MUAC for age
 Waist hip ratio

11.  Vitamin A: dry eye, night blindness, increase risk of infection
 Zinc: loss of appetite, stunted growth, delayed healing of
wounds, hair loss, diarrhea
 Iron: impaired brain function, issues with regulating body
temperature, anaemia
 Iodine: enlarged thyroid gland (goiter) , decreased production
of thyroid hormones, growth and development issue
 Consequences of specific micronutrients deficiencies:

13. Wasting
 A measure of current nutritional status
 A child with low weight for height is thin , extreme thinness is called wasting
 Wasting is typically divided in to two categories:
 Moderate acute malnutrition (MAM), -3 to <- 2 z-score from the median weight for height.
 Sever acute malnutrition (SAM), <-3 z-scores from the median weight-for-height
 SAM + MAM = Global Acute Malnutrition (GAM)
• SAM exist In two forms;
 Kwashiorkor
 marasmus

14. Stunting
 It is a measure of long-term or chronic nutritional status in
children
 Such children grow poorly and have low hight for their age
i.e. they are short, termed as stunted

15. Some Effects of Malnutrition
 Kwashiorkor:
 Caused by protein deficiency.
 Due to poverty in developing nations. Families
cannot afford to feed their young children with
high protein food after the children have stopped
feeding on mother’s milk.
 It can be preventing by giving sufficient food
containing protein food to young children

16.  Symptoms of kwashiorkor are:
 Swelling of the legs
 Underweight
 “Moon face”
 Swollen abdomen
 Thin muscles but fat present
 Dry, Spares, Thin hairs
 Stunted growth
 Apathetic, Little interested in his surrounding

18. Complication of Kwashiorkor are
 Cardiovascular problem
 Urinary tract infections
 Gastrointestinal problem
 An enlarged liver
 Loss of immune system function
 Impaired cellular function electrolyte imbalance

19. Laboratory Finding :
 Reduced total plasma protein (less than 4 gm/dl)
 reduced level of serum albumin (less than 2 gm/dl)
 Urea in blood urine is markedly reduced because deficient
intake of exogenous protein
 Low total body potassium due to potassium losses by
diarrhea
 Total body sodium is higher than normal

20.  TREATMENT AND PREVENTATION
 To prevent kwashiorkor, children should be given nutritious food
 Proper education and awareness about breastfeeding and weaning
 There should be a provision of immunization for all children in poor countries
 Pregnant and lactating women should be given a sufficient amount of nutritious
food
 Women should be encouraged to breast feed their infants
 Diet with enough carbohydrates, fat and protein can prevent kwashiorkor

21.  Marasmus :
 The term marasmus is derived from the Greek marasmus,
which mean wasting.
 It is a clinical syndrome and a form of under nutrition
characterized by failure to gain weight.
 Caused by deficiency of energy and protein foods in children.
 commonly in infants between the age of 6 month-2years
(Infants atrophy)

22. Symptoms of Marasmus are :
 Under weight
 Old man face
 Thin muscle, thin fat
 Stunted growth
 Prominent ribs
 Absence of edema
 A decrease in physical activity

23. Complication of Marasmus are :
 Growth problem in children
 Joint deformity and destruction
 Loss of strength
 Loss of vision and blindness
 Organ failure and dysfunction
 Unconsciousness and coma

24. Laboratory Finding:
 Plasma protein may be normal or
slightly lower
 Blood urea is low
 Blood glucose level is low

25. Causes of Marasmus :
 Premature babies who are weaning off breast milk
 Deficient intake of calories and protein
 Lack of nutritional knowledge
 Poor sanitation and hygiene
 Dilute milk and other starchy product
 Lack of nutritional knowledge
 Infection
 Congenital defects

26. TREATMENT AND PREVENTATION :
 Treatment of marasmus involves proper feeding, rehydration and close medical
observation to prevent and manage complication of malnutrition
 Diet rich in vitamin E is recommended
 Complementary feeds should be given in addition to breastfeeding
 The treatment usually starts with introduction of carbohydrates rich foods
 Proper follow up of the growth rate
 Good sanitation and hygiene
 Should be spacing of three to four years between children

27. Most common :
 Southeast Asia
 Central America
 South Africa
 Uganda
 Congo
 Puerto Rico

28. A COMPARATIVE CHART
KWASHIORKOR
 Acute illness/ inflection prolonged starvation
 Measles
 Protein is principle nutrients
 Some weight loss
 High mortality
 Poor appetite
 Enlarged fatty liver
 Oedema present
 Protruding abdomen and subcutaneous fat
reserved
 Sparse hair
 Fatty paint like skin
MARASMUS
 Severe prolonged
 Chronic/ recurring
 Calories and protein principle nutrients
 Sever weight loss
 Low mortality
 Voracious feeder
 No fatty liver
 Oedema not present
 Shrunken abdomen and subcutaneous fat not
preserved
 No hair changes noted
 Dry and wrinkled skin

30. National policies for malnutrition
The program implemented are ::
Direct nutritional health programmes:
Ministry of health and family welfare
1. National vitamin A prophylaxis programme
2. National Goiter control programme
3. National nutritional Anemia prophylaxis programme for mother and children
Ministry of human resources development
1. ICDS scheme
2. Special nutritional programme
3. Balwadi feeding programme
4. Mid day meal programme

31. Over nutrition
 Many tend to think malnutrition only in term of hunger, however overeating is also a
contributing factors.
“over nutrition is the pathological state resulting from the consumption of excessive quantity
of food over an extended period of time” .
 Over weight and obesity are very common condition in developed countries
 The most common over nutrition problem is obesity with too much energy being
consumed , or high level of inactivity
 The WHO define:
• A BMI greater than or equal to 25 is overweight
• A BMI greater than or equal to 30 is obesity

32.  More than 1/3 of adult
are obese (34.9%)
 From 2011-2012, 17% of
children were obese
Real world example obesity :

33. The health hazards from overnutrition are:
1. Obesity
2. Diabetes
3. Hypertension
4. Cardiovascular diseases
5. Renal diseases,
6. Disorder of liver and gall bladder
Health problems:
Solution
 Overnutrition can be fixed by balancing out meals and portion to a reasonable consumption rate.
Also by eating healthier foods as opposed to junk food.
 In addition daily exercise added to your life style will contributed to an over all better well-being.

34. CORONARY HEART DISEASES
Coronary heart disease is caused by the
build up of fat due to over nutrition
90% of people living with type 2
diabetes are overweight or have
obesity caused by overnutrition

35. “IF YOU CAN’T FEED
A HUNDRED PEOPLE
THEN FEED JUST ONE”