Mal

MALNUTRITION

Definition of Malnutrition

  • 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."

Broad Understanding of Malnutrition

  • Malnutrition is commonly used interchangeably with undernutrition; however, it technically also refers to overnutrition.

  • Individuals are considered malnourished if:

    • Their diet fails to provide adequate calories and protein necessary for growth and maintenance or if they cannot fully utilize the food due to illness (undernutrition).

    • They consume excessive calories (overnutrition).

  • Types of Malnutrition:

    • Deficiency (nutrient insufficiency)

    • Excess (overconsumption of nutrients)

    • Imbalance (inadequate nutrient distribution)

Types of Malnutrition

1. Under Nutrition

  • Characteristics:

    • Growth failure

    • Micronutrient malnutrition

    • Chronic underweight

    • Acute malnutrition (wasting or nutritional edema)

  • Consequences:

    • Reduced overall growth and cognitive development.

2. Over Nutrition

  • Characteristics:

    • Excess calorie intake leading to major health issues including obesity.

    • Public Health Concern: Overnutrition can lead to diseases like type 2 diabetes and heart disease.

Examples of Deficiency Conditions

  • Type I Nutrient Deficiencies:

    • Anemia (Iron deficiency)

    • Beri-Beri (Thiamin deficiency)

    • Pellagra (Niacin deficiency)

    • Xerophthalmia (Vitamin A deficiency)

  • Type II Nutrient Deficiencies:

    • Include deficiencies in nitrogen, sulfur, essential amino acids, potassium, sodium, magnesium, zinc, phosphorus.

WHO Classification of Malnutrition

Classification System

  • Moderate Malnutrition:

    • Symmetrical edema with weight for height and height for age:

    • -3 ≤ SD score < 2 (70-80%)

    • -3 SD score < 2 (80-85%)

  • Severe Malnutrition:

    • Symmetrical edema indicating severe malnutrition where:

    • SD score < -3 (< 70%) for severe wasting

    • SD score < -3(< 85%) for severe stunting.

Criteria for Growth Failure

Classifications by Age Group

  • Birth - 3 months: No weight gain or loss of weight within 2 weeks, should gain 100 grams.

  • 4 - 6 months: No weight gain or loss of weight within 1 month, should gain 250 grams.

  • 7 - 12 months: No weight gain or loss of weight within 6 weeks, should gain 500 grams.

  • 13 - 24 months: No weight gain or loss of weight within 3 months, should gain 1 kg.

Clinical Forms of Acute Malnutrition

Types of Acute Malnutrition

  • Marasmus:

    • Severe weight loss or wasting.

    • Common in nutritional emergencies; untreated severe cases can quickly lead to death.

    • Characterized by severe wasting of fat and muscle.

  • Kwashiorkor:

    • Characterized by bilateral pitting edema due to water retention.

    • Color loss in hair, apathy, irritability, and distinct dermatosis styles.

  • Marasmic-Kwashiorkor:

    • Combination of features from both Marasmus and Kwashiorkor.

Clinical Signs of Kwashiorkor

  • Edema Classifications:

    • Mild: Edema present in both feet.

    • Moderate: Edema present in both feet and lower legs, hands/lower arms.

    • Severe: Generalized edema affecting the whole body.

  • Visual Signs:

    • Loss of appetite, color changes in hair, skin patches (dermatosis).

Conceptual Framework for Causes of Malnutrition in Society

Causality Levels

  1. Immediate Causes:

    • Inadequate dietary intake due to low food access or infection.

  2. Underlying Causes:

    • Food insecurity, inadequate care, public health issues.

  3. Basic Causes:

    • Political, legal, and cultural factors affecting nutrition.

Identifying Vulnerability to Malnutrition

  • Groups at increased risk include:

    • Children, pregnant and lactating women.

    • Geographical and political vulnerabilities due to displacement or minority status.

    • Elderly individuals, those with disabilities, chronic illnesses, and individuals with HIV/AIDS.

Global Prevalence and Projections

  • WHO Projections for 2015:

    • Global prevalence of malnutrition expected to decrease to 17.6%.

    • Significant numbers of children affected by low weight for age in developing countries.

  • Regional Breakdown of Malnutrition:

    • 70% of malnourished children projected to live in Asia, particularly south-central regions, with an additional 26% in Africa.

  • Additional Statistics:

    • 165 million children stunted due to poor nutrition; prevalence of protein energy malnutrition in sub-Saharan Africa remains high.

Clinical and Economic Consequences of Malnutrition

  • Mortality Rates:

    • 45% of under-five mortality linked to undernutrition.

    • Over 300,000 deaths reported annually in developing countries connect to undernutrition significantly impacting child mortality.

  • Economics:

    • Improved growth in children under 2 years boosts educational attainment and GDP significantly.

    • Countries lose various percentages of their GDP due to nutrition-related issues.

Assessment and Monitoring of Malnutrition

Methodologies

  • Anthropometric Measurements:

    • Assessing growth through physical measures like weight and height.

  • Biochemical Tests:

    • Analysis of blood and urine samples for nutrient components.

  • Dietary Intake Assessment:

    • Evaluation of diet over specific periods to ensure sufficiency.

Nutritional Indices

  • Key Indices Used:

    • Weight-for-height (WFH): Indicator for acute malnutrition.

    • MUAC (Mid-Upper Arm Circumference): Specific for acute malnutrition.

    • Height-for-age (HFA): Measures stunting.

    • Weight-for-age (WFA): Measures underweight.

Nutritional Interventions

Food Response Interventions

  • General food ration distribution should include fortified items for effective nutritional addressing.

  • Supplementary Feeding:

    • Targeting moderate acute malnutrition for prevention and treatment.

Non-Food Response Interventions

  • Support for livelihoods through cash grants, micro-finance, food vouchers.

  • Essential health services provision, including sanitation and immunization.

Objectives and Targets for Nutrition Improvement

Non-communicable Diseases and Capacity Building

  • Reduction targets for obesity in children, adolescent, adult demographics.

  • Enhancing nutrition monitoring and evaluation systems globally, aiming for specific reductions in stunting, low birth weight, and mortality rates.

Global Targets for 2025

  1. Reduction Targets for Under-5 Children:

    • 40% reduction in stunting prevalence.

  2. Anemia in Women:

    • 50% reduction expected.

  3. Low Birth Weight:

    • Targeting a 30% reduction.

  4. Childhood Overweight:

    • Aiming for no increase in rates.

Other Health Targets

  • Increase exclusive breastfeeding rates in the first 6 months.

  • Goals defined to manage and prepare for nutrition emergencies effectively.

Sarcopenia

  • Definition: Sarcopenia is characterized by progressive loss of muscle mass and strength, especially in aging populations. Linked to lifestyle factors: inactivity and insufficient nutrition. Regular exercise and protein-rich diets are recommended for prevention.

Thank You

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