COMMON NUTRITIONAL DISORDERS IN THE PHILIPPINES

• Malnutrition – pathological state due to relative or absolute deficiency or excess of one or more essential nutrients
• Forms
o Undernutrition – inadequate food intake over an extended period of time
o Specific Deficiency – relative or absolute lack of an individual nutrient
o Overnutrition – excess food intake, caloric excess over an extended period of time
o Imbalance – disproportion among essential nutrients
• Etiology
o Primary – low income, low purchasing power, ignorance, erroneous food habits, food scarcity, overpopulation
o Secondary – infectious diseases, febrile diseases (increases nutrient demands), hepatic and metabolic disorders

Protein-Calorie Malnutrition
• Deficiency of calories and/or proteins in their diet
• Mild-moderate – first and second degree underweight for age-weight (61-90% of standard)
• Severe – third level underweight (<60%), includes marasmus and kwashiorkor

Marasmus Kwashiorkor
diet low in protein and calories (balanced
Nutritional imbalance in early childhood, low protein but has
Etiology undernutrition), unsuccessful breast-feeding,
calories (carbs)
insufficient breast milk, dilute milk
Diagnostic Signs – edema (cardinal sign), muscle wasting with
Failure to gain weight, emaciation, skin and
some subcutaneous tissue, psychomotor changes, miserable,
bones, oldman facies, distended
retarded motor development
Clinical abdomen, muscle wasting, potbelly,
Common Signs – hair changes (flag sign), diffuse skin
manifestations winged scapulae, apathetic, quit,
depigmentation, moonface (beyond nasolabial fold), anemia
subnormal temperature, slow pulse rate,
Occasional Signs (Pathognomonic) – flaky paint rash,
↓ BMR, sparse brown hair
enamel dermatosis, hepatomegaly
Serum Albumin Normal to low Low
Urea excretion /
Normal to low Low
g creatinine
Serum essential
Laboratory findings

Low Low
AA index
Anemia Uncommon Common (megaloblastic)
Glucose
Diabetic Diabetic
tolerance curve
K+ deficiency Almost always present Almost always present
Serum
Low Low
cholesterol
GI enzymes Diminished Diminished
Bone growth Delayed
Liver biopsy Normal or atrophic Fatty change
Preventable, adequate feeding at all ages, early diagnosis and correction, prevent and control infections,
Prevention
good hygiene, health measures
Avoid delay (always an emergency), high calorie, high protein diet (150-200 cal/kgBW/day, 2.5g
Treatment
protein/kgBW/day), food selection guide, frequent feeding (4-6 per day)

Overnutrition / Obesity
• Generalized excessive accumulation of fatty subcutaneous tissue
• Overweight = ABW >10-19% above DBW
• Obese = ABW >20% above DBW
o 20% adolescents, 30% adults, morbid if ABW = 2 x DBW
• Assessment of Body Fat
1. Body Mass Index
• BMI = weight in kg / height in m2
• Correlates closely with total body fat, adjustable for age, but does not indicate fat distribution
• BMI Nomogram (WHO)
o Underweight – <18.5
o Healthy – 18.5-24.9
o Overweight – 25-29.9
o Obese I, II, III - >30, 30-34.9, 35-39.9, >40
2. Waist to Hip Ratio
• Waist = smallest circumference between lowest rib and iliac crest; Hip = greater trochanter
• Acceptable gauge of fat distribution, reflects intraperitoneal / visceral fat
• Upper body obesity if >1.0 (males) or >0.85 (females)
3. Waist Circumference
• Accurate measure of visceral fat
• Thresholds – 102 cm (males), 88 cm (females)

• Etiology: excess food intake vs utilization, genetic constitution, psychic disturbances, lack of activity, endocrine / metabolic
disturbances
• Clinical Manifestation: small nose and mouth, double chin, fat in mammary regions, pendulous abdomen, disproportionately
smallmale genitalia, fat in upper arms and thighs
• Diseases: coronary artery disease, hypertension, NIDDM, cancer, gallstones, joint disease, respiratory problems
• Prevention: avoid energy-rich foods, avoid fatty foods, limit rice, eliminate sweets, liberal veggies
• Treatment: decrease daily caloric intake, increase physical activity, diet not longer than 16 weeks, behavioral modification, lower
activity level when computing for TER

Vitamin A Deficiency
• Etiology: poor storage, maternal malnutrition, no VitA in diet, malabsorption
• Clinical Manifestations
o Eye
 Early – nyctalopia (night blindness), photophobia, later becomes pain insensitive
 Xerosis conjunctivae – first clinical sign, dryness of conjunctiva, Bitot spots – well-demarcated dry chalk like plaques
lateral to cornea
 Corneal Xerosis or xerophthalmia – hazy cornea, cellular infiltration
 Corneal ulcers – erosions, may perforate
 Keratomalacia – soft and gelatinous cornea, metaplasia and degen of corneal epithelium, blindness
o Skin
 Xerosis – generalized dryness, desquamation, scaling
 Phrynoderma / Follicular hyperkeratosis – horny papules, hyperplastic metaplasia, plugging of hair follicles
o Infections
 Substitution of stratified keratinizing epithelium in respi, GI, GUT, eyes and paraocular glands
 ↓ T lymphocyte activity
o Others – apathy, mental retardation, faulty epiphyseal bone formation, defective enamel
• Diagnosis
o Routine eye exam
o Biophysical exam – dark adaptation test (normally in seconds only)
o Biochemical test – low plasma carotene, abnormal Vit A absorption
• Prevention – preventable, follow RNI, ↑ intake for 3rd trimester, prophylaxis
• Treatment – oral or IM retinol palmitate / acetate

Iron Deficiency Anemia

• Etiology – inadequate Fe due to intake, impaired absorption (diarrhea), excessive demands, blood loss
• Clinical Manifestation – irritability, listlessness, no appetite, ↓ work capacity, easy fatigability, dizziness, loss of consciousness and
sleep, pallor, tachycardia, systolic murmur, cardiomegaly
• Laboratory Findings – hypochromic microcytic RBC, ↓ Hgb, Hct, RBC count; ↓ RBC indices, ↓ serum iron, ↑ latent and TIBC,
transferrin saturation <15%, erythroid hyperplasia in bone marrow
• Prevention – iron supplementation, weaning foods with iron @ 4-6mo
• Treatment – treatment of causative factor, oral administration as ferrous sulfate, parenteral iron, blood transfusion

Iodine Deficiency
• Incidence – pregnant, lactating mothers, ↑ mountainous regions (far from bodies of water)
• Etiology – insufficient iodine intake, high demand, goitrogens (↓ iodine utilization for thyroid hormones; cabbage, spinach, nuts)
• Clinical Manifestation – goiter, Iodine Deficiency Disorders
• Treatment – encourage iodine-rich food intake, food supplementation, iodination of salt