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MALNUTRITION
Malnutrition
DEFINITION:
Malnutrition is the condition or state in which a body do not get proper nutrition or get
over nutrition ( imbalanced nutrition ) and as the result a deficiency or excess or
imbalanced of energy.
Malnutrition is an acute or chronic condition where a deficiency or imbalance of energy,
protein and other nutrients cause measurable and adverse effects on body composition,
function and clinical outcomes.
nutrients cause measurable and adverse effects on body composition, function and
clinical outcomes.
Lack of essential nutrients
Malnutrition is a broad term commonly used as an alternative to under nutrition but
technically it also refers to over nutrition .
The World Health Organization (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 functions."
Signs and symptoms of malnutrition (subnutrition) include:
Loss of fat (adipose tissue)
Breathingdifficulties,ahigherriskof respiratoryfailure
Depression
Higherriskof complicationsaftersurgery
Higherriskof hypothermia - abnormallylowbodytemperature
The total numberof some typesof white bloodcellsfalls;consequently,the immunesystemis
weakened,increasingthe riskof infections.
Highersusceptibilitytofeelingcold
Longerhealingtimesforwounds
Longerrecovertimesfrominfections
Longerrecoveryfromillnesses
Lowersex drive
Problemswithfertility
Reducedmuscle mass
Reducedtissue mass
Tiredness,fatigue,orapathy
Irritability.
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In more severe cases:
Skinmay become thin,dry,inelastic, pale,andcold
Eventually,asfatinthe face islost,the cheekslookhollow andthe eyessunken
Hair becomesdryand sparse,fallingouteasily
Sometimes,severe malnutritionmayleadtounresponsiveness(stupor)
If calorie deficiencycontinuesforlong enough,there maybe heart,liverandrespiratoryfailure
Total starvationissaidto be fatal within8 to 12 weeks(nocalorie consumptionatall).
Types of malnutrition
Two typesof Malnutrition
1. OVER NUTRITION
2. UNDER NUTRITION
( 1) OVERNUTRITION
• Overnutrition is a form of malnutrition in which the intake of nutrients is oversupplied.
The amount of nutrients exceeds the amount required for normal growth, development,
and metabolism.
• Overnutrition can develop into obesity, which increases the risk of serious health
conditions, including cardiovascular disease, hypertension, cancer, and type-2 diabetes.
Overnutrition is frequent or habitual overconsumption of nutrients by eating too much food to
the point that it becomes dangerous to health. Nutrients are all compounds necessary for
bodily function, including minerals, vitamins, fats, carbohydrates and proteins. Although most
nutrients can be harmful in excess, the danger of overnutrition relates mostly to carbohydrates
and fats. Overeating differs conceptually from overnutrition, although they are essentially the
same thing in action;
whereas overeating is a compulsion considered a psychological disorder, overnutrition is
volitionally choosing to eat more food than you need, even if you don't realize it.
Alsocalled Protein-energy malnutrition( PEM )
Protein–energy malnutrition (PEM) or protein–calorie malnutrition refers to a form of malnutrition where
there is inadequate calorie or protein intake.
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( 2 ) UNDERNUTRITION
What happens when you are undernutrition?
Undernutrition is the opposite of overnutrition, meaning that it is a nutrient deficiency from not
eating enough food or not getting rich nourished food or getting poor food and as the result
the body became weak and suffering from differents diseases.
A person who is undernutrition , he or she will not work properly and will affects on their
physiological and mental status . Undernutrition usually affects the balance of all the nutrients
in our body. Nonetheless, problems relating to a deficiency in carbohydrates and fats will
manifest first and most acutely. Initially, the body starts using its glycogen -- or sugar --
reserves, stored water and body protein. Then, your body consumes stored fatty acids and lean
muscle. Short-term undernutrition is possible if you inexplicably lose at least 10 percent of your
body weight over three to six months.
TYPES OF NUTRIENTS
There are twomaintypesof nutrientswhichare veryimportantforthe personwhois
undernourishment.
1) Macronutrients
2) Micronutrients
(1) Macronutrients
Nutrients are environmental substances used for energy, growth, and bodily functions by
organisms. Depending on the nutrient, these substances are needed in small amounts or larger
amounts. Those that are needed in large amounts are called macronutrients.
There are three macronutrients required by humans:
For example:
• In carbohydrates, there are 4 calories per gram
• In proteins, there are 4 calories per gram
• And in lipids, there are 9 calories per gram
(2) Micronutrient
Micronutrients are the materials which are needed to our body in small amounts.
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For example : Calcium , copper , zinc , iodine , vitamins , iron etc. Deficiency of these nutrients
created a big problem in the body. As a result , cause different types of diseases in the body.
The diseases caused by micronutrients deficiency is called Micronutrient malnutrition .More
than 2 billion people in the world today may be affected by Micronutrient malnutrition.
Types of malnutrition diseases
Calcium. Osteoporosis. Rickets. Tetany.
Iodine deficiency. Goiter.
Selenium deficiency. Keshan disease.
Iron deficiency. Iron deficiency anemia.
Zinc. Growth retardation.
Thiamine (Vitamin B1) Beriberi.
Niacin (Vitamin B3) Pellagra.
Vitamin C. Scurvy.
Causes OF Malnutrition
There are many types of malnutrition, and they have different causes. Some causes include:
Poor diet
Starvation due to food not being available
Eating disorders
Mobilityproblems
Alcoholism
Lack of breastfeeding
Problems with digesting food or absorbing nutrients from food
Certain medical conditions that make a person unable to eat
Sometimes malnutrition is very mild and causes no symptoms. Other times it can be so severe
that the damage it does to the body is permanent, even though you survive.
Poverty, natural disasters, political problems, and war can all contribute to malnutrition and
starvation, and not just in developing countries.
Kwashiorkor And Marasmus
Kwashiorkor (proteinmalnutrition predominant)
It isa clinical syndrome andaform of malnutritioncharacterizedbyslow rate of growthdue to
deficientof proteinintake,highCHOdietandvitamins&mineralsdeficiency(adequate supply of
calories).
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Complication of kwashiorkor
Secondaryinfection,fungal andbacterial infection
Hemorrhagictendency,purpura
Gastroenteritis
Hypoglycemia
Hypothermia
Heart failure due toanemiaandinfection.
Marasmus (deficiencyin calorie intake)
Marasmic Kwashiorkor (marked protein deficiency and marked calorie insufficiency signs
present, sometimes referred to as the most severe form of malnutrition)
Note that PEM may be secondary to other conditions such as chronic renal disease or cancer
cachexia in which protein energy wasting may occur.
Complications of Marasmus
Intercurrentinfection:Bronchopneumonia.isthe cause of death
Gastro enteritis
Hemorrhagictendency,purpura
Hypothermia
Hypoglycemia
Edema(marasmickwashiorkor)
Diagnosis of malnutrition
Body mass index (BMI)
Thisis calculatedbythe weightinkilogramsdividedbythe heightinmetressquared.A healthyBMIfor
adultsusuallyliesbetween18.5and 24.9. Those witha BMI between17and 18.5 couldbe mildly
malnourished,those withBMIsbetween16and 18 couldbe moderatelymalnourishedandthose witha
BMI lessthan16 couldbe severelymalnourished.
Those witha historyof unintentionallylosingweightoverthe lastfew months,those whoare unable to
feedthemselvesorthose withahealth conditionthatcausedlackof adequate nutritionorcaused
increaseddemandsof nutrientsthatwasnot metbyregulardietare at riskof malnutrition.
These individualsneedtobe evaluatedcarefully.Those whohave eatenlittle ornothingforthe lastfive
daysor are likelytoeatlittle ornothingforfive daysorlonger,those whocannotabsorbnutrientsfrom
foodwell like those withulcerative colitisorCrohn’sdisease,maybe atrisk.
In general all withaBMI lessthan18.5 ina course of few monthsneedtobe evaluated.Pregnant
women,elderlylivingincare homesandchildrenare atgreaterrisk.
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Routine blood tests
Thisis done toassessanemiaandothervitaminandmineral deficiencies.There maybe dehydration,
lowbloodsugarand signsof severe infectionasisevidentbyraisedwhile bloodcell counts.
Diagnosis of malnutrition in children
In childrenweightandheightismeasuredandcomparedwiththe chartsshowingthe expectedaverage
heightandweightfora childof that age.Some childrenare persistentlysmallerforage and may be
geneticallyso.
What shouldalarmparentsandcaregiversisa suddenor significantdropbelow the expectedlevel fora
childas itmay indicate malnutrition.Childrenwhoshow aslowergrowthmayalsobe malnourished.
Mid-upper arm diameter
Mid upperarm diametermaybe usedinchildren.Anupperarmcircumference of lessthan110 mm is
alsousedto define severe malnutritioninchildren.Inchildrenthicknessof skinfoldsisalsomeasured.
Withmalnutritionthere islossof the fatbeneaththe skincalledthe subcutaneousfat.Thisleadstothin
skinfolds.
Blood tests in children
Routine bloodtestsinchildrenincludethose forbloodglucose,bloodcounts,urineforroutine
examination,stool forparasitesandworminfestations(asthese mayleadtomalnutritioninchildren),
bloodproteinoralbuminlevels,HIV testandtestsforotherinfections.
Levelsof ironinblood,folicacidandvitaminB12 are also recommended.Forproteinestimationother
testsinclude Pre-albumin,transferrin,retinol-bindingprotein.
Other tests for malnutrition
Othertestsinclude:
thyroidfunctiontests
estimationof the intestine forCrohn’sdisease orCoeliacdisease
levelsof Calcium, Phosphate,Zincandvitamins
low levelsof cholesterolandalbumin(especiallyinelderly)
Treatments for malnutrition
Treatment of malnutrition at home
This issuitable forpatientswhoare able toeatand digestfoodnormally.Treatmentathome involves:
The dietplannerandadvisordiscussthe dietwiththe patientandmakesrecommendationsand
dietplanstoimprove nutrientintake.
In mostpatientswithmalnutritionthe intakeof protein,carbohydrates,water,mineralsand
vitaminsneedtobe graduallyincreased.
Supplementsof vitaminsandmineralsare oftenadvised.
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Those withproteinenergymalnutritionmayneedtotake proteinbarsor supplementsfor
correctionof the deficiency.
The Body Mass Index isregularlymonitoredtocheckforimprovementorresponsivenessto
dietaryinterventions.
Occupational therapistsandateamof physiciansof different specialties maybe necessaryfor
people withdisabilitywhocannotcookorshop forthemselvesorthose whohave mental
disorders,dementiaorlongtermillnesses.
Those whohave difficultyinswallowing,chewingoreatingmayneedtobe givenverysoftor
pureedfoodforeasyeating.
Treatment of malnutrition at the hospital
The team of physiciansandhealthcare providerswhomanage malnutritionpatientsincludesa
gastroenterologistwhospecializesintreatingdigestive conditions,adietician,anutritionnurse,a
psychologistandasocial worker.
Nasogastrictube feeding,PEGfeedingandintravenousinfusionorparenteral nutritionmaybe done in
the hospital formoderate toseverely malnourishedpatientswhoare unable totake foodviathe mouth.
Parenteral feeding - asterile liquidisfeddirectlyintothe bloodstream(intravenously).Some patients
may notbe able totake nourishmentdirectlyintotheirstomachorsmall intestine.
Names of the countries which are under the risk of Undernutrition
Country Name Number of Undernourished(million)
India 217.05
China 154.0
Bangladesh 43.45
Pakistan 35.2
Ethiopia 31.5
Tanzania 16.1
Philippines 15.2
Brazil 14.4
Indonesia 13.8
Thailand 13.4
Nigeria 11.5
Kenya 9.7
Sudan 8.8
North Korea 7.9
Yemen 7.1
Zimbabwe 5.7
Zambia 5.1
