Malnutrition

1. Malnutrition • Malnutrition results from imbalance between the body's needs and the intake of nutrients, which can lead to syndromes of deficiency. Condition related to malnutrition • Overnutrition : Consumption of excessive food or nutrient, as occurs in obesity, megadoses of vitamins leading to toxicity. • Undernutrition : inadequate ingestion of nutrients as in PEM (Protein Energy Malnutrition), Vit. Deficiencies

2. Malnutrition • Malnutrition may be caused by endogenous factors, such as faulty metabolism, or exogenous factors, such as inadequate dietary intake • it may be classified as primary resulting from inadequate or excessive intake of one or more essential nutrients “or secondary” resulting from altered body functions such as malabsorption syndrome.

3. Risk factors associated with malnutrition • Low education • Poverty • Mental/physical disabilities • Old age • Alcoholism • Drug addiction • Food fadism (no food) • Institutionalization “prisons”

4. Secondary malnutrition.Risk factors predisposing to S. M. • 1- Failure to meet the excess nutritional need during, fast growing period, lactation, pregnancy and physical stress • 2- Problem involving ingestion, digestion, absorption and metabolism, pathological conditions as in • Anorexia loss of appetite, nausea and vomiting,fever, poor dentition. • Gastrectomy, cholicystitis (inflammation of gallbladder) or pancreatic insufficiency • Achlorhydria (low gastric acid production), liver and gall bladder diseases, diarrhea, colitis (inflammation of the colon), malabsorption.

5. Excessive loss of nutrients via execration as an high sweating or polyuria (large production of urine). • Excessive loss of nutrients via hemorrhage (blood loss), diarrhea and parasites • Abnormal metabolism as in DM, liver failure, alcoholism and in some leukemia’s • prolonged usage of antibiotics which destroys the natural flora causing vits. Deficiency (B and K)

6. Prevention • 1- Adequate and well-balanced diet emphasizing the deficient nutrient(s) • 2- Alleviating the patho. cause and provide supplement if necessary.

7. Dietary Recommendations • All dietary recommendations should be considered within the framework of a nutritionally balanced diet. The goal for each and every patient is healthy eating primarily achieved by consumption of a combination of low fat, high fiber foods, and exercise .

8. Monounsaturated fat 10-15% Saturated fat<10% Protein15% Carbohydrate 50-60% Polyunsaturated fat <10%

9. PROTEIN • RDA: for a healthy adult is 0.8-1.0 gm/kg IBW/d. • Children require 1-2 gm/kg/d

10. Protein • Excess • High ptn. Intake is wasteful “economically” • High ptn. Intake is a burden for diseased liver or kidney. • High Ca loss in urine • Sources of animal ptn. Are sources of saturated fat too, which will lead to undesirable levels of fat intake if ptn. Intake is high.

11. GOUT

12. Purines-rich foods predispose to gout. • Gout is a condition of abnormal purine metabolism in which individuals has reduced ability to execrate uric acid and may also produce it in excessive amounts. It builds up in the blood and eventually is deposited in the joints.

16. Causes • The cause of gout is an inflammation in your joint resulting from an accumulation of urate crystals. Uric acid is a waste product formed from the breakdown of purines. • These are substances found naturally in your body as well as in certain foods, especially organ meats — such as liver, brains, kidney and sweetbreads — and anchovies, herring, asparagus and mushrooms.

17. Prevention & Self-care • Maintain a healthy weight • Avoid excessive amounts of animal protein • Avoid alcohol • Drink plenty of liquids

18. Protein deficiency • Occur when individual dose not eat enough ptn. foods of low biological value, or obtain insufficient calories

19. Protein energy malnutrition • Kwashiorkor, and marasmus, are major health problems for infants and young children in Africa, or after the infant is weaned • Kwashiorkor: Lack of protein in diet over period of time (first-second child), affects older children • Marasmus: Severe Nutritional def in general, and affect infants and very young children

20. Prevention of kwashiorkor, and marasmus • 1- Provide adequate nourishment of vulnerable group • 2-provide ptn-rich foods or supplementation • 3- Control problems associated with K and M • 4- Nutrition education for care-givers

21. Deficiency 1. Kwashiorkor • Loss of pigmentation of the hair • The children have dry scaling, pale skin • A protuberant abdomen • Fail to grow normally • Swelling ( edema )

22. 2. Marasmus • caused by an inadequate intake of both protein and calories.

23. FAT A- Excess: lead to • Obesity and related problem • Excess intake of fat-soluble vitamins B- Deficiency: lead to • 1- Lack of essential fatty acids and fat-soluble vitamins • 2- Weight loss • 3-Inefficient utilization of Protein and CHO

24. Monounsaturated Fatty Acids • Appear to lower LDL (“bad”) cholesterol and help raise levels of HDL (“good”) cholesterol. • Food sources: olives, olive oil, avocados, peanuts oil and canola oil.

25. SOURCES of MONO-UNSATURATED FATS Canola oil Olive oil

26. Polyunsaturated Fatty Acids • Fats that seem to lower total cholesterol levels. • Food sources: many vegetable oils, such as corn oil, soybean oil and safflower oil, sunflower oil.

27. VEGETABLE SOURCES OF POLYUNSATURATED FATTY ACIDS Corn oil Safflower oil Sunflower oil

28. Polyunsaturated Fatty Acids (ESSENTIAL FA) Linoleic sunflower, soybean Linolenic fatty fish, shell fish

29. High fat diets are linked to… • Heart Disease • Obesity • Cardiovascular Related Problems

30. Lowering Fat and Cholesterol in the Diet • Exercise • Replace saturated fats with unsaturated fats in the diet • Choose lean cuts of meat • Steam, boil or bake foods instead of cooking them in oil or fat • (See the last page of your handout for more tips)

31. CARBOHYDRATES A- Excess: lead to • Obesity and related problem B- Deficiency : lead to 1- Abnormal energy metabolism 2- Weight loss 3-Inefficient utilization of Protein and Fat