Principles of Nutrition-
NUTR 001
Spring 2016-2017
Malnutrition
Malnutrition
• Indicates an excess, deficit, or imbalance of one or more of the
essential nutrients
• Used to describe an excess or deficit in calories.
• Poverty, illness, and ignorance main causes of malnutrition
• Malnutrition affects the most vulnerable groups of the population
children and women in their productive years, however, it can affect
any age.
• Take a variety of forms that often appear in combination and
contribute to each other
Causes of Malnutrition
• Multifactorial
1. Reduced intake.
2. Increased needs.
3. Impaired absorption.
MICRONUTRIENT DEFICIENCIES
Anemia: A Global Health Concern
• One of the most frequent causes of anemia is nutritional
deficiency.
• According to WHO, anemia affects nearly 2000 million people
worldwide, or about a third of the world’s population, the
majority is due to iron deficiency.
• Overall, 39 % of preschool children and 52 % of pregnant women
are anemic, more than 90 % live in developing countries.
MICRONUTRIENT DEFICIENCIES
Anemia: A Global Health Concern
Definition
The condition that results from the inability to maintain a normal
hemoglobin concentration, on account of an inadequate supply of
one or more of essential nutrients [iron, folic acid, vitamin B12,
protein, vitamin C, copper, cobalt, and zinc].
MICRONUTRIENT DEFICIENCIES
Anemia: A Global Health Concern
Iron Deficiency Anemia [IDA]
• Most common form of malnutrition, affecting both industrialized
and developing countries.
• In industrialized countries, iron deficiency is the main cause of
anemia.
• In developing countries, the risk of anemia is worsened by the
fact that iron deficiency is associated with other micronutrient
deficiencies (folic acid, vitamin A and vitamin B12), parasitic
infestation such as malaria and hookworm, and chronic infections
such as HIV.
MICRONUTRIENT DEFICIENCIES
Anemia: A Global Health Concern
Groups at greatest risk of IDA
• Young children [6-24 months].
• Women of reproductive age.
• Older children and adolescents.
• Elderly.
Adults may be also at risk especially when there is inadequate food
intake or frequent parasitic infections.
MICRONUTRIENT DEFICIENCIES
Anemia: A Global Health Concern
Causes of IDA
The most frequent cause of iron deficiency is nutritional; an imbalance
between amount of iron absorbed and the amount of iron lost or required
for physiological conditions (increased needs).
1. Reduced absorption of iron can be the result of either low levels of
dietary iron (reduced intake) or a poor absorption of dietary iron or both.
2. Increased iron requirements due to physiological needs such as during
periods of rapid growth (young child, adolescent), and in the reproductive
years of females as a result of pregnancy.
3. Increased blood losses due to pathological causes such as excessive
blood loss in menstruation, parasitic infestations, tumors in
gastrointestinal tract or uterus, or bleeding from gastrointestinal ulcers,
hemorrhoides.
MICRONUTRIENT DEFICIENCIES
Anemia: A Global Health Concern
Consequences of ID and IDA
Iron deficiency and iron deficiency anemia have profound negative
effects on human health and development.
In infants, children and adolescents:
• Impaired motor development and coordination.
• Impaired language development and scholastic achievement.
• Psychological and behavioural effects (fatigue, insecurity,..).
• Decreased physical activity.
• Decreased resistance to infection and impaired immune system.
• Increased risk to heavy metal poisoning due to increased
absorption of iron during iron deficiency, which enhance
absorption of other metals as lead and cadmium.
MICRONUTRIENT DEFICIENCIES
Anemia: A Global Health Concern
Consequences of ID and IDA
In adults of both gender:
• Decreased physical work and earning capacity.
• Decreased resistance to fatigue.
In pregnant women:
• Increased maternal morbidity and mortality.
• Increased fetal morbidity and mortality.
• Increased risk of low birth weight.
MICRONUTRIENT DEFICIENCIES
Anemia: A Global Health Concern
Treatment of IDA
The chief treatment for IDA consists of oral administration of iron.
Dietary changes alone cannot correct IDA especially when severe.
Blood transfusion is only given to severe cases
MICRONUTRIENT DEFICIENCIES
Anemia: A Global Health Concern
Prevention of IDA
Four basic approaches:
1. Supplementation with medicinal iron: Applied to high risk groups
such as pregnant women, infants and preschool children, and school
children.
2. Dietary modification and nutrition education: Aiming at
enhancing the absorption of iron ingested by promoting the intake
of iron absorption enhancers and reducing the ingestion of
inhibitors.
MICRONUTRIENT DEFICIENCIES
Anemia: A Global Health Concern
Prevention of IDA
The following recommendations can be made:
• Improve food choices to increase amount of total dietary iron
• Include a source of vitamin C every meal.
• Include MFP (meat, fish, and poultry) every day if possible.
• Avoid drinking large amounts of tea and coffee with meals.
MICRONUTRIENT DEFICIENCIES
Anemia: A Global Health Concern
Prevention of IDA
3. Food fortification: Fortification of suitable staple food such as
wheat flour or sugar with absorbable forms of iron.
4. Control of viral, bacterial, and parasitic infections: This can help
to improve iron status.
Other measures such as:
Reproductive and obstetric interventions such as family planning,
preventing adolescent pregnancy, and improving obstetric practices.
Overweight and Obesity
Overweight and Obesity: An Emergency Epidemic
• Overweight and obesity are now considered an emergency
epidemic globally.
• Both developed and developing countries are seriously affected.
• The problem appears to increase rapidly in children as well as in
adults the true health consequences may only become fully
apparent later
Overweight and Obesity
Overweight and Obesity: An Emergency Epidemic
Definition
Obesity is defined as a condition of abnormal or an excessive
fat accumulation in adipose tissue, to the extent that health
may be impaired.
Overweight and Obesity
Overweight and Obesity: An Emergency Epidemic
Epidemiology
Obesity and overweight occur in all ages, and in both gender.
However, obesity is more common among women especially
housewives, while overweight is more common among men. Obesity
is more prevalent in urban than rural population.
Overweight and Obesity
Overweight and Obesity: An Emergency Epidemic
Causes
1. Dietary and activity patterns:
Obesity and overweight result from a chronic energy imbalance such
that the rate of energy intake exceeds the rate of energy
expenditure. The energy imbalance can result from excessive energy
intake and/ or reduced energy expenditure, and the underlying
disease. Thus, obesity is a behavioural problem in which the dietary
and activity patterns are the primary causes of weight problem.
Overweight and Obesity
Overweight and Obesity: An Emergency Epidemic
Causes
2. Genetic and family environmental influences:
Recent studies suggest that genes provide the susceptibility for
obesity but are not the actual causes. This means that although
genes appear to increase the vulnerability to obesity, other
determinants must be present for obesity to occur, and the major
factor is the environment.
Overweight and Obesity
Overweight and Obesity: An Emergency Epidemic
Classification of Overweight and Obesity
Body mass index (BMI) is a simple index of weight-for-height that
commonly used to classify overweight and obesity in adults.
BMI = Weight (kg)
Height (m2)
According to WHO, the classification of overweight and obesity using BMI is as follows:
Overweight and Obesity
Overweight and Obesity: An Emergency Epidemic
Classification of Overweight and Obesity
Classification BMI (kg/ m2)
Underweight <18.5
Normal range 18.5-24.9
Overweight ≥ 25.0
Pre-obese 25.0-29.9
Obese class I 30.0-34.9
Obese class II 35.0-39.9
Obese class III ≥ 40.0
Overweight and Obesity
Overweight and Obesity: An Emergency Epidemic
Classification of Overweight and Obesity
Waist circumference measurement is an index of intra-abdominal fat mass and total fat.
It is used to identify overweight patients at increased risk of obesity-associated illness.
Values that consider at increased risk are: ≥ 94.0 cm in men, and ≥ 80.0 cm in women
Overweight and Obesity
Overweight and Obesity: An Emergency Epidemic
Consequences and Complications of Obesity
Morbidity and mortality: There is an increased risk of morbidity and
mortality among obese individuals.
Psychological: Obesity creates emotional problems and disturbance
of body image.
Mechanical disability: In form of flat feet; abdominal herinas and
varicose veins due to infiltration of abdominal muscles with fat; and
bronchitis due to interference with respiration.
Metabolic: Such as diabetes, hyperlipidemias
Overweight and Obesity
Overweight and Obesity: An Emergency Epidemic
Consequences and Complications of Obesity
Cardiovascular: High blood pressure; atherosclerosis; and coronary
heart diseases.
Respiratory: Obstructive sleep apnea; hypoventilation; and
increased anaesthetic risk.
Cancer: Increased risk of endometrial, breast and colorectal cancer
among obese.
Accidents: Can cause fractures.
Obese individuals with excess fat in the intra-abdominal depots are
at particular risk of the negative health consequences of obesity.
Overweight and Obesity
Overweight and Obesity: An Emergency Epidemic
Management of Obesity
There are several lines in the management of obesity that should be
integrated for weight loss:
1. Dietary modification,
2. Exercise.
3. Behavioural modification
When the above approaches fail to bring the desired weight
reduction,
4. Pharmaceutical (medication) management is applied.
5. Surgical intervention is applied in morbid obesity.
