lecture 6

risk of artificial breast feeding

More diarrhoea and  respiratory infections Persistent diarrhoea Malnutrition Vitamin A deficiency More likely to die May become pregnant sooner Increased risk of anaemia, ovarian and breast cancer More allergy and  milk intolerance Increased risk of some chronic diseases Overweight Lower scores on intelligence tests

pellagra signs and symptoms

'Three Ds': diarrhea, dermatitis and dementia Reddish skin rash on the face, hands and feet which becomes rough and dark when exposed to sunlight (pellagrous dermatosis) acute: red, swollen with itching, cracking, burning, and exudate chronic: dry, rough, thickened and scaly with brown pigmentation Dementia, tremors, irritability, anxiety, confusion and depression

direct causes of malnutrition

...Primary undernutrition Due to inadequate food intake Secondary undernutrition Due to underlying diseases such as TB, HIV/AIDs

what is the suggested VIT a supplementation scheme for infants children 6-11 months of age

100,000 IE 30 mg RE of vitamin A once

what is the suggested VIT A supplementation scheme for 12-59 months of age

200,000 IE (60mg RE) vitamin A every 4-6 months

What percent of Children Death is due to Malnutrition?

55%

anemia assesment,

Blood can be tested for anemia using different methods which look at the color of the blood, the number of blood cells, or use a chemical which reacts with the haemoglobin. Hemoglobin (Hemocue) Hematocrit

what are obese youth more likely to have risk factors for

CV disease high cholesterol high BP pre-diabetes

kwashiorkor

Caused by inadequate dietary protein intake Ghanian tribal term "when a child is displaced from the breast" Characterized by marked muscle atrophy with normal or increased body fat and the presence of peripheral edema (anasarca). Edema is the defining characteristic for establishing the diagnosis Hepatomegaly Apathetic, listless affect Dry, dull hair and skin Normal or nearly normal weight for age

What is the clinical deficiency of VIT A defined by

Clinical deficiency is defined by: Night blindness Corneal xerosis and/ or ulcerations Bitot's spots Corneal scars caused by xerophthalmia VAD also has a role in a variety of clinical conditions not related to the eyes

what are common causes of anemia

Common causes of anemia Iron deficiency anemia (IDA) Infections (malaria, hookworm, HIV) Other vitamin deficiencies Hemoglobinopathies

Risk factors for VIT D deficiency

Critical for normal calcium absorption from diet Risk factors for deficiency: Inadequate diet Inadequate sunlight Adolescent lifestyle, including the above! Obesity Anticonvulsant therapy Malabsorption RDA = 600 IU (AAP recommendation = 400 IU)

vit d foods

D3 in fatty fishes and fish (cod) liver oils Fortified milk and juice has approx 100 IU/8 oz. Survey of vitamin D content of milk samples in U.S. found: approximately 15% had no detectable vitamin D and >50% had <80% of vitamin D content stated on label (Chen et al. NEJM 1993)

vit d deficiency

Deficiency of vitamin D, typically caused by dietary deficiency and inadequate exposure to sunlight Associated with hypocalcemia, hypophosphatemia, and rickets in children Softening of the bone and rickets due to defective mineralization of growing bone Rickets typically affects children <2 years old Osteomalacia in adults Needed for bone growth

beri beri

Develop within 12 weeks Dry Beriberi-->peripheral neuropathy Difficulty walking and paralysis of the legs Reduced knee jerk and other tendon reflexes, foot and wrist drop Progressive, severe weakness and wasting of muscles Wet Beriberi -->cardiopathy Edema of legs, trunk and face Congestive heart failure (cause of death)

anemia treatment

Dietary diversification Foods that are rich in iron include: Meat Fortified cereals Spinach Cashew nuts Lentils and beans Fortification Iron supplements Main target group for supplementation to prevent iron deficiency should be all women of childbearing age

dry beri beri

Dry Beriberi-->peripheral neuropathy Difficulty walking and paralysis of the legs Reduced knee jerk and other tendon reflexes, foot and wrist drop

zinc

Essential element for growth, proper immune function

niacin vitamin b3

Essential for healthy skin, tongue, digestive tract tissues, and RBC formation Processing of grains removes most of their niacin content so flour is enriched with the vitamin

signs and symptoms of zinc deficiency

Hair loss Skin lesions Diarrhea Poor growth Acrodermatitis enteropathica Death

vitamin c

Humans are among the few species that cannot synthesize vitamin C and must obtain it from food Manufacture of collagen Helps support and protect blood vessels, bones, joints, organs and muscles Protective barrier against infection and disease Promotes healing of wounds, fractures and bruises Sources Citrus fruits, strawberries, kiwifruit, blackcurrants, papaya, and vegetables

indirect causes of malnutrition

Indirect causes Poverty Unsanitary health conditions War and conflict

VIT A

Infants and children have increased vitamin A requirements Important and necessary for ocular health Inadequate intake can manifest as night blindness as the earliest sign Leading cause of preventable blindness in young children and contributor to increase in maternal mortality VAD is usually seen in clusters Reflects community dietary practices and shared risks of undernutrition and infection

who's recommenation for breast feeding

Initiate breastfeeding within one hour of birth. Breastfeed exclusively for the first six months of age (180 days). Thereafter give nutritionally adequate and safe complementary foods to all children. Continue breastfeeding for up to two years of age or beyond.

iodine deficiency

Iodine Essential for thyroid function Can lead to nervous system damage Hypothyroidism/goiters Risk from crops grown in iodine deficient soil May prevent this by iodizing common salt

micronutrient deficiency problems

Iron deficiency anemia Vit A deficiency Vitamin D Iodine deficiency zinc deficiency folate deficiency

iron deficiency

Iron deficiency is one of the most common micronutrient deficiencies in the world Iron is essential for the transport of oxygen and carrying out cellular respiration Common causes of anemia Iron deficiency anemia (IDA) Infections (malaria, hookworm, HIV) Other vitamin deficiencies Hemoglobinopathies Health impact Perinatal & maternal mortality Delayed child development

What are the risk factors of VIT A

Low availability of vitamin A-rich foods Dairy products, fish,liver and meat Leafy green vegetables, orange and yellow vegetables Lack of breastfeeding High rates of infection (measles, diarrhea) Malnutrition

iodine deficiency risk factors

Low iodine level in food Products grown on iodine-poor soil due to Erosion, floods, Mountainous areas, Distance from ocean (low fish intake) Non-availability of iodized food (salt)

iron deficiency anemia

Maternal iron deficiency during pregnancy increases the risk of iron deficiency in the infant. Low dietary intakes Diet poor in iron-rich foods/animal foods Insufficient iron absorption Infections (malaria, helminthes infection, schistosomiasis) Blood loss Menstruation Intenstinal parasites

what are micronutrients needed for

Micronutrients are needed for tissue growth, healing, and function

marasmus is caused by

Most common form of PEM and is caused by inadequate intake of all nutrients, but especially dietary energy sources (total calories). Marked by severe wasting that is grossly clinically evident Thin, dry skin Shrunken arms, thighs, and buttocks with redundant skin folds caused by loss of subcutaneous fat Absence of edema

micronutrient deficiencies

Nutritional deficiency is very rarely restricted to just one or two nutrients Many of the illnesses which precipitate protein-calorie malnutrition also provoke loss of nutrients Micronutrients are needed for tissue growth, healing, and function Highest risk groups Young children Pregnant Women Lactating women Need to recognize deficiency before the onset of clinical symptoms Difficult to recognize Symptomatic cases often represent tip of iceberg Laboratory assessment difficult & expensive Silent killers

prevention breastfeeding

One approach is preventing and treating malnutrition in pregnant women & infants Breastfeeding provides nutrient content of protein, minerals, micronutrients, and immunity is high Economically viable by requiring no purchase of powder or clean water

What are other factors that contribute to malnutrition

Poor physical resources, and overcrowded homes poor sanitation and water supply low income parents with little education minimal interaction/stimulation in the home poor governance and corruption

colostrum

Property Antibody-rich Many white cells Purgative Growth factors Vitamin-A rich Importance protects against infection and allergy protects against infection clears meconium; helps prevent jaundice helps intestine mature; prevents allergy, intolerance reduces severity of some infection (such as measles and diarrhea); prevents vitamin A-related eye diseases

protein energy malnutrition examples

Protein-energy malnutrition (PEM) or protein-calorie malnutrition refers to a form of malnutrition where there is inadequate calorie or protein intake Protein-energy malnutrition is currently the most widespread and serious health problem of children in the world. Three major forms of PEM Kwashiorkor Marasmus Marasmic kwashiokor

benefits of breastfeeding for the infant

Provides superior nutrition for optimum growth. Provides adequate water for hydration. Protects against infection and allergies. Promotes bonding and development.

zinc treatment deficiency

Regular zinc supplements can greatly reduce common infant morbidities in developing countries Adjunct treatment of diarrhea Pneumonia Stunting Zinc deficiency commonly coexists with other micronutrient deficiencies including iron, making single supplements inappropriate Dietary diversification Animal protein (oysters, red meat)

iodine deficiency disorders

Significant cause of preventable brain damage in children Health effects: Increased perinatal mortality Mental retardation cretinism Growth retardation Preventable by consumption of adequately iodized salt

scurvy

Small blood vessels fragile Gums reddened and bleed easily Teeth loose Joint pains Dry scaly skin lower wound-healing, increased susceptibility to infections, and defects in bone development in children

prevention/treatment of vitamin a

Supplementation Often given during immunization Highly effective in lowering mortality in infants and children in third world communities Breastfeeding Rich source of vitamin A Exclusive breastfeeding for 6 months recommended

anemia signs and symptoms

Tiredness and fatigue Headache and breathlessness Pallor: pale conjunctivae, palms, tongue, lips and skin

wet beri beri

Wet Beriberi -->cardiopathy Edema of legs, trunk and face Congestive heart failure (cause of death)

childhood nutritional needs

adding complementary foods during transition fortification of food items are essential in achieving a child's growth

Body mass index

adult with bmi>29.9 is obese obesity 1: 30-34.9 obesity 2: 35-49.9 morbid obesity: >40

maternal and child undernutrition

africa, india, asian countries

for children obesity bmi

at or above the 95th percentile of the same age and sex

adulthood nutritional needs

avoidance of obesity

thiamin deficiency leads to

beri beri

what are nutritional needs for neonatal

breast feeding up to 6 months and depends on health status of mother

what can over nutrition lead to

diabetes coronary artery disease strokes hypertension bad stuff dawwwwg

How do nutritional problems arise

due to lack of resources--> food, water, sanitation or illness

secondary

due to underlying disease: TB HIV/AIDS

what is the defining characerist for establishing diagnosis of kwashiorkor

edema

thiamine vit B1

energy production and carbohydrate and fatty acid metabolism vital for normal development, growth, reproduction, healthy skin and hair, blood production and immune function Deficiency due to diets of polished rice

where do we see undernutrition other than developing countries and humanitarian emergencies

food deserts in inner cities and disadvantaged neighborhoods 14% of ppl in us in isolated rural as well as disadvantaged urban areas are malnourished and undernourished undernutrition in the elderly

malnutrition

impaired development linked to both deficient and excessive nutrient intake

over nutrition largely affects populations

in a nutrition transition a process marked by a shift in diet away from norm and toward a more processed calorie rich diet with sugars, high fat, and low fiber couple with reduced physical activity

infection-malnutrition synergism

inadequate dietary intake-->weight loss, growth faltering, immunity lowered-->disease incidence, severity, duration-->appetite loss, nutrient loss, malabsorption, altered metabolism

primary undernutrition

inadequate food intake

undernutrition results from

insufficient food intake over an extended period of time (calories)

malnutrition rarely exists in

isolation and is multigenerational

protein energy malnutrition

kwashiorkor (low protein) marasmus (low calories)

urban issues

lack of access quality food, but cost can become an important barrier possible lack of clean water? overfed but still starving? sanitation?

rural issues

lack of : access variety of food fresh food (meat, fruits, veggies..) fresh water sanitation

where is overweight and obesity not on the rise

low and middle income countries

what is the most common protein energy malnutrition

marasmus

acute undernutrition

marasmus kwashiorkor marsmic kwashiorkor wasting

height for age

measure of stunting or chronic malnutrition

weight for age

measure of underweight or wasting and stunting combined

weight for height

measure of wasting or acute malnutrition

undernutrition

most common form of malnutrition in developing countries; energy, protein and micronutrients

what is the weight for age for kwashiorkor

normal or nearly normal weight for age

children and adolescents are likely to be ___ as an adult

obese; an increased risk of CV disease, diabetes and certain cancers

over nutrition

overweight/obesity seen in many developed country but growing in certain regions of the developing world chronic disease of imbalance and overabundance

niacin deficiency leads to

pellagra

hunger

physiological state when food not able to meet energy needs

adolescence nutritional needs

poorly nourished adolescent girls will grow poorly, including pelvis area- leading to increased perinatal complications

Indirect causes

poverty unsanitary causes war or conflict

causes of undernutrition

primary secondary indirect

causes of overnutrtion and obesity

real causes are uncertain but could be the cause of Real Causes of obesity are UNCERTAIN but may be a mix of the following factors: 1 Hereditary 2) Reduced Physical Activity -Reduced school based physical education -Sedentary life style 3) Excessive Energy Intake -Increased Portion Sizes - Increased availability of fast food - Increased use of high fructose corn syrup 4) Sleep Debt -Evidence shows that less sleep can cause increased body weight -Sleep restriction can increase hunger and appetite 5) The food environment: Increased number of fast food establishments in the U.S. and in urban areas in developing countries Lack of access to full service grocery stores selling affordable healthful foods Less healthy food & beverage advertising aimed at children Shift from traditional lifestyle to "modern" lifestyle

stunting- height for age

reflects pre and post natal linear growth shortness that is not genetic due to poor health or nutrition it is a good cumulative measure of well being for children populations because it is not affected by weight recovery

vit c deficiency leads to

scurvy

what is marasmus marked by

severe wasting

mild/moderate undernutrition

stunting wasting underweight- underweight encompasses both stunting and wasting

chronic undernutrition

stunting underweight

what is a good cumulative measure of well being

stunting-height for age

wasting-weight for height

thinness indicates in most cases a recent and severe process of weight loss consequence of starvation or severe disease can also be due to chronic conditions or a combination of both caused by illness and or sudden severe lack of food

weight for age is a measure of

underweight or wasting and stunting combined

Measurements of undernutrition by WHO

weight for height height for age weight for age

what are nutritional needs at pregnancy

will need 300 more calories and extra vitamins or minerals