Malnutrition

• Malnutrition is the condition that develops when body does not get right amount
of vitamins, minerals and other nutrients it needs to maintain healthy tissue or
organ function.
• generally related to poor quality or insufficient quantity of nutrient intake,
absorption, or utilization
• Malnutrition occurs when people are over nourished or under undernourished.
• Malnutrition is the direct or indirect cause of 50% deaths in children.

• Under-malnutrition:
Undernutrition is a consequence of consuming too few essential
nutrients or using or excreting them more rapidly than they can be replaced.
• Overnutrition:
Overnutrition results from eating too much, eating too many of the wrong things,
not exercising enough, or taking too many vitamins or other dietary replacements.
Types of malnutrition:
• There are two major types of malnutriton;
1)Protein energy malnutrition (PEM): resulting from deficiencies in any or all
nutrients
2) Micronutrient deficiencies diseases: resulting from deficiency of specific
micronutrients
Protein energy Malnutrition:
• It is a group of body depletion disorder and includes marasmus, kwashiorkor and
intermediate stages.
• PEM is due to food gap between food intake and requirement.
• Causes: social and economic factors, biological factors, environmental factors,
role of free radicals and aflatoxins and age of host.
• PEM is silent killer in many children.
Marasmus (monkey
face)
• Simply represents starvation. The body adopts to a chronic
stage of insufficient of calorie intake.
• Derived from Greek word marasmus meaning withering or
wasting.
• Characterized by severe energy deficient and emaciation.
• Characterized by stunted growth and wasting of tissues and
muscles.
• Develops in the age between 6 months and 12 months in
children who have been weaned from breast feeding or
suffered from weaning diseases like chronic diarrhea.
Kwashiorkor (moon
face)
• Taken from Ga language of Ghana meaning the sickness of weaning.
• Refers to inadequate protein intake with enough calorie intake.
• Usually Appears at the age of 12 months when breast feeding is
discontinued or can be developed in children early formative stages.
• It caused fluid retention(edema) dry peeling skin, and hair
discoloration.
• Most recently, the causative agents are found to be micronutrient
and antioxidant deficiencies.
• victims fail to generate antibodies following the vaccination against
diphtheria and typhoid.
• Longterm effects on children physical and mental health and may
even lead to death.
Marasmic-Kwashiorkor
• A severely malnourished child with both the features of
marasmus and kwashiorkor.
Micro-Nutrient deficiency
• Regarded as subset of malnutrition.
• Resulted as a deficiency of vitamins and minerals.
• Deficiencies of fat-soluble vitamins, iron, and zinc are particularly common.
• Iron deficiency is the most prevalent nutrition problem in the world.
• Vitamin D deficiency can lead to osteoporosis and bone fractures and may
become life-threatening or leave an elderly person permanently
handicapped, thus reducing length and quality of life.
• Vitamin A deficiency is a public health problem in more than half of all
countries, especially in Africa and Southeast Asia, which causes
preventable blindness and increases the risk of disease and mortality
Cause of micronutrient deficiency malnutriton
1.Iron deficiency anemia
• results from low or depleted stores of iron, which is needed to produce red blood cells.
• Iron is an essential mineral.
• It’s a large component of red blood cells, in which it binds with hemoglobin and
transports oxygen to your cells.
• Iron deficiency is very common, especially among young women, children, and
vegetarians. It may cause anemia, fatigue, a weakened immune system, and impaired
brain function.
• Causes:
• excessive bleeding is the most common cause.
• People may be weak, short of breath, and pale.
• Blood tests can detect low levels of iron.
• Iron supplements are used to restore iron levels
2.Iodine deficiency disorder
• Iodine deficiency is the world’s most prevalent, yet easily preventable,
cause of brain damage.
• Iodine deficiency disorders (IDD), which can start before birth,
jeopardize children’s mental health and often their very survival.
• Serious iodine deficiency during pregnancy can result in stillbirth,
spontaneous abortion, and congenital abnormalities such as cretinism.
• Iodine is one of the most common nutrient deficiencies in the world. It
may cause enlargement of the thyroid gland. Severe iodine deficiency
can cause mental retardation and developmental abnormalities in
children.
3.Vitamin D deficiency: Symptoms include muscle weakness, bone loss,
an increased risk of fractures, and — in children — soft bones. It is very
difficult to get sufficient amounts from your diet alone.
4.Vitamin B12 deficiency: Vitamin B12, also known as cobalamin, is a
water-soluble vitamin.
• It is essential for blood formation, as well as brain and nerve function.
• The most common symptoms include blood disorders, impaired brain
function, and elevated homocysteine levels.
5.Calcium deficiency: Low calcium intake is very common, especially in
women of all ages and older adults. The main symptom of calcium
deficiency is an increased risk of osteoporosis later in life.
6.Vitamin A deficiency: Vitamin A deficiency is very common in many
developing countries. It may cause eye damage and blindness, as well
as suppress immune function and increase mortality among women
and children.
7.Magnesium deficiency: Magnesium is a key mineral in your body.
• Essential for bone and teeth structure, it’s also involved in more than
300 enzyme reactions
• Low intake and blood levels of magnesium are associated with several
conditions, including type 2 diabetes, metabolic syndrome, heart
disease, and osteoporosis
Situation of nutrition in Nepal
• Different types of malnutrition still exist in Nepal and includes:
I. Stunting
II. Wasting
III. Underweight
IV. Low body mass index
V. Micronutrient deficiency
VI. Overweight and
VII. obesity
 Chronic malnutrition

1. Stunting –(too short for age) an indicator of the long-term

cumulative effects of nutrition deficiency.
•Children <5 yrs particularly affected.
•Short term implications –growth faltering and weight loss with
associated micronutrient deficiencies.
•Increases susceptibility to disease & infection.
•Longer term effects –impaired physical & mental development.
•Consequences of stunting increase the demands on medical, public
health and food assistance in crisis situations
 Acute malnutrition
2. Wasting –(too thin for height) often an indicator of the current or recent
situation.

•Wasting results from an acute shortage of food, is reversible with re-feeding,

and has a relatively high mortality rate.

•Poses more severe health risks than chronic malnutrition leading to weight loss
and specific micronutrient deficiencies –resulting in impairment of bodily
functions esp. resistance to disease.

•Increased levels of acute malnutrition in a population result in increased illness

and death. These consequences often characterize nutrition emergencies and
famine situations
Chronic & Acute
3. Underweight

•A combination of wasting and stunting –difficult to determine

appropriate intervention.

•But is used as a measure of trends in general undernutrition e.g. is a

Millennium Development Goal (MDG) target:
–MDG 1 –Target -To reduce underweight by 50% by 2015
Body Mass Index
The concept of the « 1000 days »
• window of opportunity
• Undernutrition often starts in utero when mothers are malnourished
and /or stunted : intra-uterine growth retardation
• Undernutrition impairs physical growth and cognitive development
• After the age of 2 years damage is usually irreversible, Therefore it is
crucial to fight malnutrition during pregnancy and the first 2 years of
the child, i.e. the 1000 days between conception and the child’s second
birthday.
• Many preventive interventions target this period of time
Malnutrition & infectious disease
Malnutrition & Infectious Disease
• Malnutrition is particularly lethal in combination with infectious
diseases such as malaria, measles, diarrheal diseases -the major killer
diseases affecting children.
•Infection and micronutrient deficiencies can induce immunodeficiency
in otherwise healthy children, increasing susceptibility to diarrhea and
other infections.
•This can lead to a vicious cycle of repeated infections, reduced
immunity, and deteriorating nutritional status
•Malnutrition magnifies the effect of disease.
•A malnourished person has more severe disease episodes, more
complications, and spends more time ill for each episode.
Malnutrition/infection cycle
Undernutrition attributable deaths

• Among the primary causes of death in young children:

–Diarrhea 60.7%
–Measles 44.8%
–Pneumonia 52.3%
–Malaria 57.3%
Infectious diseases in Nepal
• Malaria
• Tuberculosis
• HIV/ AIDS
• Lymphatic filariasis (Culex quinquefasciatus ) (Parasite-Wuchereria bancrofti)
• Visceral leishmaniasis (Kala jaar) (sand fly, Phlebotomus argentipes)

• Dengue fever (Aedes aegipti)

• Japanese Encephalitis (Culex tritaeniorhyncus)
• Leprosy
• Epidemic prone diseases : cholera, gastroenteritis,
Health Effects of Toxic Chemicals

• TOXICITY:is the ability of a substance to produce an unwanted effect

when the chemical has reached a sufficient concentration at a certain
site in the body.
• The more toxic a material is, the smaller the amount of it necessary to
be absorbed before harmful effects are caused.
• The toxicity of a chemical is generally measured by experiments on
animals (quite often rats).
• If it is measured in terms of the amounts of material necessary to
cause death in 50% of the test animals. These values are called LD50
(lethal dose) or LC50 (lethal concentration) and are usually given in
weight of material per kg of body weight or airborne concentration of
material per set time period respectively.
Routes of Entry
• Ingestion:- This means taking a material into the body by mouth
(swallowing). Ingestion of toxic materials may occur as a result of
eating in a contaminated work area.
• Absorption- Substances that contact the eye and the skin may be
either absorbed into the body or cause local effects. For the majority
of organic compounds, the contribution from skin absorption to the
total exposure should not be neglected.
• Inhalation- This means taking a material into the body by breathing it
in. In the lungs, very tiny blood vessels are in constant contact with
the air we breath in. As a result, airborne contaminants can be easily
absorbed through this tissue. In the occupational environment, this is
generally the most important route of entry.
Health Effects - Chronic vs Acute
• Once a toxic substance has contacted the body it may have either acute (immediate) or chronic
(long term) effects.
• Example: Spilling acid on your hand will cause immediate harm, i.e. a burn to the skin.
• Exposure to asbestos or tobacco smoke may result in lung cancer after as much as twenty years
(this is a long term effect).
• Exposure - Chronic vs Acute
• Exposure can be classified as chronic or acute. In chronic exposures, the dose is delivered at some
frequency (daily or weekly usually) over a period of time.
• In acute exposures, the dose is delivered in a single event and absorption is rapid. Usually, a
chronic exposure occurs at low concentration and acute exposure at high concentration.
• Some materials may only cause harm if given acutely, not having any effect in the long term.
Other materials may not exhibit an effect in the short term but may cause problems after
prolonged exposure.
Physiological Classification of
Materials
• This classification identifies toxic materials on the basis of biologic action.
• Irritants - refers to some sort of aggravation of whatever tissue the material comes in contact
with. e.g. ammonia, nitrogen dioxide.
• Asphyxiants - exert their effects through a depletion of oxygen to the tissues
e.g. - simple asphyxiants - carbon dioxide, nitrogen, methane, hydrogen
chemical asphyxiants - carbon monoxide, hydrogen cyanide, hydrogen sulphide.
• Narcotics or Anaesthetics - the main toxic action is the depressant effect upon the Central
Nervous System. e.g. - many organics, chloroform, xylene.
• Systemic Poisons - the main toxic action includes the production of internal damage
e.g. Hepatotoxic agents - toxic effects produce liver damage. eg. carbon tetrachloride.
• e.g. Nephrotoxic agents - toxic effects produce kidney damage eg. some halogenated
hydrocarbons
• Carcinogens - agents/compounds that will induce cancer in humans. e.g. benzene, arsenic,
inorganic salts of chromium, nickel, beryllium.
• Mutagens - agents that affect the cells of the exposed people in such a way that it may cause
cancer in the exposed individual or an undesirable mutation to occur in some later generation.
e.g. radiation, variety of chemical agents that alter the genetic message.
• Teratogens - Agents or compounds that a pregnant woman takes into her body that generate
defects in the fetus e.g. Thalidomide, possibly steroids
• Sensitizers- Agents that may cause allergic or allergic-like responses to occur. After an initial
exposure to a substance an individual may become sensitized to that substance. Subsequent
exposures to the same substance, often at a much lower concentration than before, produce an
allergic response. This response may be a skin rash (dermatitis) or an asthmatic-like attack,
depending on the route of exposure. e.g. cutting oils, isocyanates in polyurethane foam
operations and paint spraying operations, some laboratory solvents.
Long term health
effects of Toxic
Chemicals
• RESPIRATORY SYSTEM
• supply oxygen to the body and remove carbon dioxide.
• It includes the nasal passages, pharynx, trachea, bronchi, and lungs.
• Possible health effects of the respiratory system include asbestosis(cancer of the
pleura), lung cancer, chronic bronchitis, fibrosis, emphysema, and decreased oxygen
supply in blood.
• Possible Contaminants Where do you find these?
• Asbestos Old insulation
• Radon The ground
• Cadmium Old batteries
• Benzene Degreasers
• Carbon monoxide Car exhaust, unvented or faulty furnaces
• Soot Furnaces, wood burning stoves
RENAL SYSTEM
• to rid the body of waste, to regulate the amount of body fluids, and to regulate
the amount of salts in the body.
• It includes the kidneys, the urethra, the bladder, and the ureter.
• Possible health effects of the renal system include decreased formation of urine,
decreased blood flow to kidney, decreased ability to filter the blood, prevented
urine flow, kidney tissue damage, and kidney cancer.
• Cadmium Old batteries, cigarette smoke
• Lead Old paint, outdated plumbing
• Mercury Thermostats, thermometers, some fish
• Uranium Food & water, proximity to nuclear testing sites
• Chlorinated hydrocarbon solvents Degreasers, paint removers, dry cleaning
solutions.
CARDIOVASCULAR SYSTEM
• Move nutrients, gases, and wastes to and from the body, to help stabilize body temperature, and
to fight diseases and infections by transporting white blood cells to important areas.
• It includes the heart, blood, arteries, veins, and capillaries.
• Possible health effects include heart failure and the inability of blood to carry the necessary
oxygen to the body.
• Carbon monoxide Car exhaust, unvented or faulty furnaces
• Carbon disulfide Industrial production
• Nitrates Fertilizers
• Methylene chloride Auto part cleaners, paint removers
REPRODUCTIVE SYSTEM
• Produce egg and sperm cells, to nurture a developing fetus, and to produce hormones.
• For males it includes the testicles, seminal vesicles, prostate gland, and the penis.
• For females it includes the uterus, bladder, vagina, Fallopian tubes, ovaries, and the cervix.
• Possible health effects of the reproductive system include decreased ability to have a baby,
increased baby deaths, increased birth defects, and infertility (the inability to have children).
• Methyl mercury Some fish, coal-burning power
• Carbon monoxide Car exhaust, unvented or faulty furnaces
• Lead Old paint, outdated plumbing
NERVOUS SYSTEM
• Transmit messages from one part of the body to another.
• It includes the central nervous system (the brain and spinal cord) and the peripheral nervous
system.
• Possible health effects of the nervous system include inability to move, loss of feeling, confusion,
and decreased speech, sight, memory, muscle strength, or coordination.
• Arsenic Pressure treated wood
• Cadmium Discarded batteries
• Carbon monoxide Car exhaust, unvented or faulty furnaces
• Cyanide Rat poison
IMMUNE SYSTEM
• Protect the body from tumor cells, environmental substances, and invading viruses or bacteria.
• It includes the lymph system, bone marrow, white blood cells, and the spleen.
• Possible health effects of the immune system include overreaction to environmental substances
(allergy), immune system slow down or failure, and autoimmunity (autoimmunity causes the body
to attack itself – which makes it more likely to have an over-reaction or infection).
• Mercury Thermostats, thermometers, some fish
• Lead Old paint, outdated plumbing
• Pesticides Unwashed fruits and vegetables
• Polychlorinated biphenyls (PCBs) Industrial waste, fish from contaminated water
• Polycyclic aromatic hydrocarbons (PAHs) Cigarette smoke, vehicle exhaust, asphalt roads
SKIN
• Barrier to germs and other substances, prevents dehydration, and regulates body temperature.
• Possible health effects of the skin include irritation, rash, redness or discoloration, dermatitis, and
health effect related to other systems and organs due to contamination through the skin.
• Nickel Cement
• Mercury Thermostats, thermometers, some fish
• Arsenic Pressure treated wood
• Chromium Paints, industrial production
• Polychlorinated biphenyls (PCBs) Industrial waste, fish from contaminated water
• VOC (volatile organic compounds) Fumes from gasoline, paint, adhesives,
building supplies
HEPATIC SYSTEM
• Break down food and store nutrients, to make proteins which are essential for
blood to clot, and to purify the body of drugs, contaminants, or chemicals.
• It includes the liver and its veins.
• Possible health effects of the hepatic system include liver damage, tumors,
accumulation of fat (steatosis), and death of liver cells.
• Carbon tetrachloride Adhesives
• Methylene chloride Auto part cleaners, paint removers
• Vinyl chloride Pipe sealer
Infectious diseases
• Caused by pathogenic microorganisms: bacteria, virus, fungi and parasites.
• This disease can spread directly or indirectly from one body to another.
• Zoonotic diseases or zoonoses are infectious diseases that can disease when transmitted to
human.
• An infection occurs when a foreign organism enter a person's body and cause harm.
• The organism that uses that person's body to sustain itself, reproduce and colonize.
• These infectious organisms are known as pathogens. They can multiply and adopt quickly.
• Some infections are mild and barely noticeable, but others are serious and life threatening,
and some are resistant to treatment .
• Infections can be transmitted in a variety of ways; skin contact, bodily fluid, contact with
feces, airborne particles and touching an object that an infected person has also touched.
• The immune system is an effective barrier against infectious diseases, but colonies of
pathogens may grow too large for immune system to fight. At this stage, infections become
harmful. Many pathogens give off toxins that triggers negative responses from the body.
Types of immunoglobin
Fast facts about infections
• Infections is the effect of a foreign organisms in the body.
• Type of infections includes bacterial fungal viral protozoan parasites
and prion diseases.
• They are classified by the organisms causing the infections.
• Infections can range from mild inflammation in one person to
epidemic.
Types of infection
• Viral infection: caused by virus
• Millions of virus are thought to exist, but only 5000 types have been
identified.
• Contains a small genetic code which are protected by a coat of protein.
• Virus can enter a body, releases genetic materials, forces the cell to multiply
and the virus multiply.
• When the cell dies it releases new virus and these go to infect new cells.
• Not all virus destroy the host cell. Some of them change the function of the
host cell. In this way, virus such as Human papillomavirus or Epstein Barr
virus can lead to cause cancer by forcing cells to replicate in an uncontrolled
way.
Examples of viruses
Examples of viral infections
Diseases Causative agents
Common cold Rhinovirus, corona virus, adenovirus
Encephalitis/ meningitis Enterovirus and the herpes virus
Warts and skin infection HPV and herpes simple's virus (HSV)
Gastroenteritis nova virus

Other viral conditions includes:

Zika virus, HIV, Hepatitis, EBOLA, polio, Influenza, Dengue fever
Antibiotics are not effective against viruses. Using antibiotics against a virus will not stop the virus and it
increases the risk of antibiotic resistance.
Bacterial infection
• Bacteria are single celled microorganisms known as prokaryotes.
• Estimated to be at least 1nonllion (10^30) bacteria on earth. Much of
the earth's biomass is made up of bacteria.
• Some bacterial infections are fatal.
• Some examples of bacterial diseases are:
• Cholera Vibrio cholerae
• Tuberculosis Mycobacterium tuberculosis
• Diphtheria Corynebacterium diphtheriae
• Typhoid Salmonella paratyphi
• Dysentery Shigella bacillus
• Bubonic plague Yersinia pestis
• Pneumonia Streptococcus pneumoniae
Types of bacterial shape
• Bacterial infections can be treated with antibiotics, but some strains become resistant and can
survive treatment.
Antibiotic resistance bacteria
• Antibiotic resistance is a serious public health problem.
• Some bacteria that can cause serious disease are becoming resistant to most
commonly available antibiotics.
• Antibiotic resistant bacteria can spread from person to person in the
community or from patient to patient in hospital.
• Careful infection control procedures can minimize spread of these bacteria in
hospitals.
• Good personal hygiene can minimize spread of these bacteria in the
community.
• Careful prescribing of antibiotics will minimize the development of more
antibiotic resistant strains of bacteria.
• The most serious concern with antibiotic resistance is that some
bacteria have become resistant to almost all of the easily available
antibiotics.
• These bacteria are able to cause serious disease, and this is a major
public health problem. Important examples are:
• methicillin-resistant Staphylococcus aureus (MRSA)
• vancomycin-resistant Enterococcus (VRE)
• multi-drug-resistant Mycobacterium tuberculosis (MDR-TB)
• carbapenem-resistant Enterobacteriaceae (CRE) gut bacteria
Fungal infection
• Caused by fungus
• Approximately 51 million species of fungus are dominating earth
• Many fungal infections will appear on the upper surface of skin and some progress to the
deeper layers.
• Inhaled fungal spores can lead to systemic fungal infections, such as thrush or
candidiasis. Systemic diseases affect the whole body.
• Enough good bacteria keep balance of microflora on the body; however the balance is
destroyed eg, using antibiotics and fungi can grow and cause health problem for the
host.
• Those with a higher risk of developing fungal infections includes people who :
• Use strong antibiotic for a long time
• Have weakened immune system due to HIV, diabetes, chemotherapy or who has gone organ
transplant
Examples of fungal infections
• Volley fever/coccidioidomycosis (caused by. inhaling the spores
(“seeds”) of either Coccidioides)
• Athletes foot
• Ring worm
• Some eye infections
Prion disease (misfolded proteins which characterize several fatal neurodegenerative
disease in animals and humans. The word prion is derived from proteinaceous infectious particles)

• A prion is a protein that contains no genetic materials.

• It is normally harmless, but if it folds into an abnormal shape, it can become agent and affects the
structure of brain or other part of the nervous system.
• Prions do not replicate or feed on host but trigger abnormal behavior in the body's cell and
proteins.
• Prion disease are rare but they progressing rapidly, and all are currently fatal.
• Prions cause degenerative brain disease such as
• Bovine spongiform encephalopathy (BSE) also known as mad cow disease
• Creutzfeldt Jakob disease (CJD)
Researchers have linked some case of Alzheimer's disease to prion infection.
Other infections include
• Protozoans amoebic dysentery
• Helminths flatworms, round worms
• Ectoparasites mites, ticks, lice, fleas can cause infections by
attaching or burrowing into the skin.