Manlutrition05 14 02
Manlutrition05 14 02
Manlutrition05 14 02
Physiology of
Malnutrition
Lia Fernald, Ph.D., M.B.A.
Protein (g) 36 – 46 44 – 60
Inadequate Disease
Diet
Reduced
Inadequate mental
Higher
food, health capacity
maternal
& care
mortality
Correlate: Unsafe Water
Source for photos: Overseas Aid: www.nat.uca.org.au, Statistics, UNICEF State of the World’s Children 2000
Correlate: Inadequate Sanitation
21% urban
and 75% rural
households do
not have
access to
adequate
sanitation
Source for photos: Overseas Aid: www.nat.uca.org.au, Statistics, UNICEF State of the World’s Children 2000
Correlate: Poor Education
Source for photos: Overseas Aid: www.nat.uca.org.au, Statistics, UNICEF State of the World’s Children 2000
Correlate: Poor Stimulation
39% of females
and 21% of males
over the age of 15
cannot read or
write
Source for photos: Overseas Aid: www.nat.uca.org.au, Statistics, UNICEF State of the World’s Children 2000
Correlate: Poor Public Health
About 30% of 1-
year olds are not
fully immunized
for TB, DPT
(Diptheria,
Pertussis, and
Tetanus), polio
and measles
Source for photos: Overseas Aid: www.nat.uca.org.au, Statistics, UNICEF State of the World’s Children 2000
Correlate: No Breastfeeding
Babies are twins (boy and
girl)
Length/
Height
Weight
Age
Summary: Measurement
• There are several types of malnutrition,
micro- and macro-malnutrition;
• Measurement of severe malnutrition (>3
S.D.) and micro-nutrient deficiency usually
occurs due to presence of critical signs (to
be discussed);
• Measurement of mild/moderate malnutrition
(>2 S.D.) occurs with growth charts.
Today’s Class
• Overview of Nutritional Requirements
• Definition of Malnutrition
• Correlates of Malnutrition
• Measurement and Types of Malnutrition
• Severe Malnutrition
• Mild/Moderate Malnutrition (Underweight
and Stunting)
• Specific Nutritional Deficiencies (Iodine and
Iron)
Severe malnutrition % <5 y.o.
20%
18% South Asia
16%
14% Sub-Saharan Africa
12%
10% Middle East and
8% North Africa
6% CEE/CIS & Baltic
4% States
2% Latin America &
0% Caribbean
%
Infection Sparse
hair
Swollen
belly
Decreased
muscle
mass
Pellagra
Apathy
Kwashiorkor (low protein)
• Decreased muscle mass (failure to gain weight and of
linear growth)
• Swollen belly (edema and lipid build-up around the liver)
• Changes in skin pigment (pellagra); may lose pigment
where the skin has peeled away (desquamated) and the
skin may darken where it has been irritated or traumatized
• Hair lightens and thins, or becomes reddish and brittle.
• Increased infections and increased severity of normally
mild infection, diarrhea
• Apathy, lethargy, irritability
Ravenously
hungry
Gross
weight
loss &
no fat
Marasmus
• Deficit in calories – “marasmus” comes
from Greek origin of word “to waste”
• Gross weight loss
• Hyper-alert and ravenously hungry
• Children have no subcutaneous fat or
muscle
50% Sub-Saharan
Africa
40%
0%
CEE/CIS &
Baltic States
Developing Countries 39%
Least Developed Countries 47%
(India 52%, Bangladesh 55%, Cambodia 56%)
Data for 1992-98, UNICEF State of the World’s Children 2000
Stunting: Real Numbers
India where 52% of all children under 5 (total <5 is
115,615,000) are stunted
60M children in India are stunted (as many people
live in the MidWest)
alterations in
development
of CNS
poor mental
poor emotional
reactivity, development &
nutrition impaired behavior
stress response
“functional
isolation”
Summary: Mild/moderate maln.
• Stunting refers to growth retardation (>2
S.D.) secondary to malnutrition;
• Almost 40% (223M) of children <5 in the
developing world are stunted;
• Children are most at risk for stunting in the
first 2-3 years of life;
• Stunting is associated with poor mental
development and altered behavior.
Today’s Class
• Overview of Nutritional Requirements
• Definition of Malnutrition
• Correlates of Malnutrition
• Measurement and Types of Malnutrition
• Severe Malnutrition
• Mild/Moderate Malnutrition (Underweight
and Stunting)
• Specific Nutritional Deficiencies (Iodine,
Iron, Vitamin A, Vitamin D)
Specific Nutritional Deficiencies
• Iodine Deficiency
• Iron Deficiency
• Vitamin A
• Vitamin D
Iodine deficiency - thyroid
http://www.spoilheap.co.uk/rickets.htm
Summary: Micronutrient
deficiency
• Iodine is critical for thyroid function –
deficiency results in cretinism & goiter
• Iron is critical for blood and muscles –
deficiency results in anemia
• Vitamin A is critical for visual development
– deficiency results in blindness
• Vitamin D is critical for bone development –
deficiency results in rickets
Where do we go from here?
Poverty
reduction Economic growth
Increased
productivity Improved child Social sector
nutrition investments
Enhanced human
capital
From UNICEF, State of the World’s Children: Adapted from Stuart Gillespie, John
Mason and Reynaldo Martorell, How nutrition improves, ACC/SCN, Geneva 1996.