UNIT –V
NON
COMMUNINICABLE
DISEASES
Upendra Parashar
Assistant Professor,
SNC, Jaipur
[Link]'s Degree College for Women
[Link]
DEFINITIONS
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.“
Malnutrition is the condition that develops when
the body does not get the right amount of the vitamins,
minerals, and other nutrients it needs to maintain
healthy tissues and organ function.
Malnutrition consists four forms, which
are followings:-
1. Undernutrition
2. Overnutrition
3. Imbalance
4. Specific deficiency
1. Undernutrition:- this is condition which
resulting when insufficient food eaten over
extended period of time. It is also called
starvation.
2. Overnutrition:- This is condition resulting
when consumption of excessive food over an
extended period of time.
3. Imbalance:- This is condition resulting from a
disproportion among essential nutrients with
or without the absolute deficiency of any
nutrients.
4. Specific deficiency:- This is condition
resulting from a relative or absolute lack of an
individual nutrients.
Malnutrition is a man made disease. It is a
diseases of human societies. The effects of
malnutrition on the community both direct or
indirect.
The direct effects are nutrition
deficiencies such Kwashiorkor, Marasmus,
vitamin and mineral diseases.
The indirect effects are high mortality and
morbidity among young children( 50% of total
deaths in developing countries), retarded
physical and mental growth and development.
It also associated with MMR, LBW and
other many communicable & systematic
diseases.
Overnutrition is encountered much
more than undernutrition. The health hazards
due to overnutrition are obesity,
hypertension, diabetes , cardiovascular and
renal diseases.
Protein Energy malnutrition (PEM)
Protein Energy Malnutrition(PEM) is
identified as a major health and nutrition
problem in India. It occurs particularly in
weakling and children in the first year of life.
It is not only an important cause of childhood
morbidity and mortality, but also to
permanent impairment of physical and
mental growth and development.
PEM is also referred to as protein-calorie
malnutrition.
It is considered as the primary nutritional
problem in India. Also called the 1 st National
Nutritional Disorder.
The term protein-energy malnutrition (PEM)
applies to a group of related disorders that
include marasmus, kwashiorkor, and
intermediate states of marasmus-kwashiorkor.
PEM is due to “food gap” between the intake
and requirement.
KWASHIORKOR
It is the body’s response to insufficient
protein intake.
MARASMUS
Represents simple starvation. The body
adapts to a chronic state of insufficient
caloric intake
Protein-Energy Malnutrition
ETIOLOGY
ETIOLOGY:
Different combinations of many etiological
factors can lead to PEM in children. They are:
1. Social and Economic Factors
2. Biological factors
3. Environmental factors
4. Age of the Host
1-3. Amongst the Social, Economic, Biological and
Environmental Factors the common causes are:
Lack of breast feeding
Improper complementary feeding
Over crowding in family
Ignorance
Illiteracy
Lack of health education
Poverty
Infection
Familial disharmony
4. Age Of Host :
Frequent in Infants & young children whose
rapid growth increases nutritional requirement.
PEM in pregnant and lactating women can
affect the growth, nutritional status & survival
rates of their fetuses, new born and infants.
Elderly can also suffer from PEM due to
alteration of GI System
CLINICAL FEATURES
The clinical presentation depends upon
the type , severity and duration of the dietary
deficiencies. The three forms of PEM are :
1. Kwashiorkor
2. Marasmus
3. kwashiorkor- Marasmus
KWASHIORKOR
The term kwashiorkor is taken from the Ga language
of Ghana and means "the sickness of the weaning”.
Williams first used the term in 1933, and it refers to an
inadequate protein intake with reasonable caloric (energy)
intake.
Kwashiorkor, also called wet protein-energy
malnutrition, is a form of PEM characterized primarily by
protein deficiency.
This condition usually appears at the
age of about 12 months when breastfeeding is
discontinued, but it can develop at any time
during a child's formative years.
It causes fluid retention (edema); dry,
skin; and hair discoloration.
SYMPTOMS
1.
Changes in skin pigment.
2. Decreased muscle mass
3. Diarrhea
4. Failure to gain weight and grow
5. Fatigue
6. Hair changes (change in color or texture)
7. Increased and more severe infections due to
damaged immune system
8. Irritability
9. Lethargy or apathy
10. Rash (dermatitis)
11. Shock (late stage)
12. Swelling (edema)
[Link]'s Degree College for Wome
n
MARASMUS
is derived from the Greek
The term marasmus
word marasmos, which means withering or wasting.
Marasmus is a form of severe protein-energy
malnutrition characterized by energy deficiency.
Primarily caused by energy deficiency, marasmus is
characterized by stunted growth and wasting of muscle
and tissue.
Marasmus usually develops between the ages of
six months and one year in children who have been
weaned from breast milk or who suffer from weakening
conditions like chronic diarrhea.
SYMPTOMS
1.
Severe growth retardation
2. Loss of subcutaneous fat
3. Severe muscle wasting
4. The child looks appallingly thin and limbs appear as
skin and bone
5. Wrinkled skin
6. Irritability, and apathy
7. Frequent watery diarrhoea
8. Dehydration
9. Edema and fatty infiltration are absent
DIFFERENCE IN CLINICAL
FEATURES BETWEEN
MARASMUS &
KWASHIORKOR
CLINICAL KWASHIORKOR MARASMUS
FEATURES
[Link] Sometimes Obvious
hidden by edema
WASTING and fat
[Link] Fat often retained but Severe loss of
WASTING not confirm subcutaneous fat
[Link] Present in lower legs, None
and usually in face
and lower arms
[Link] FOR May be masked by Very low
HEIGHT edema
[Link] Irritable, moaning, Sometimes quite
CHANGES apathetic and apathetic
[Link] Poor Good
[Link]
[Link] Diffuse Usually none
CHANGES pigmentation,
dermatitis’
3. MARASMIC-KWASHIORKOR
A severely malnourished child with features
of both marasmus and Kwashiorkor.
The features of Kwashiorkor are severe
edema of feet and legs and also hands, lower
arms, abdomen and face. Also there is pale skin
and hair, and the child is unhappy.
There are also signs of marasmus,
wasting of the muscles of the upper arms,
shoulders and chest so that you can see the ribs.
UNDERWEIGHT CHILD
TREATMENT
Treatment strategy can be divided into three stages.
1. Hospital Treatment
2. Dietary Management
3. Rehabilitation
1. Hospital Treatment
The following conditions should be corrected.
hypothermia, hypoglycemia, infection, dehydration,
electrolyte imbalance, anemia and other vitamin
and mineral deficiencies.
2. Dietary Management
The diet should be from locally available
staple foods - inexpensive, easily digestible,
evenly distributed throughout the day and
increased number of feedings to increase the
quantity of food.
3. Rehabilitation
The concept of nutritional rehabilitation is
based on practical nutritional training for mothers
in which they learn by feeding their children back
to health under supervision and using local foods.
PREVENTION
1. Promotion of breast feeding
2. Development of low cost weaning
3. Nutrition education and promotion of
correct feeding practices
4. Family planning and spacing of births
5. Immunization
6. Food fortification
7. Early diagnosis and treatment
THE END
THANK YOU
