4% 55%
HIV/AIDS
5% 18% Acute
Measles Respiratory
10%
Infection
15%
Malaria
Diarrhea
3
Malnutrition is sometimes referred to as
protein-energy malnutrition (PEM).
Clinical picture
The clinical picture of this disease represents
manifestations from both diseases as:
loss of subcutaneous fat as in marasmus
Edema, hair and skin changes as in KWO.
Micronutrient deficiencies
Risk Factors:
Food Forms
o As pre-formed vitamin A in foods from animals
Liver, fish
o As pro-vitamin A in some plant foods
Red palm oil, carrots, yellow maize
Fortified blended foods
Definition: Its is a systemic metabolic disease due to
deficiency of vitamin D, results in inadequate deposition of
calcium in developing cartilage and bone leading to bone
deformities, hypotonia and some times affecting CNS.
Vitamin D: Reabsorption of ca and phosphours by kidneys
Two types:-
D2 called as Calciferol and D3 called as Chole calciferol
Biologically, D2 and D3 which are present (in-active) form
and transformed to active form in the liver as (Calcitriol)
Dietary deficiency of vitamin D and Calcium
Lack of exposure to sun rays
Malabsorption of Vit. D as in obstructive jaundice
Taking of anti-convulsive drugs
Poor utilization of Vit. D by the tissues as in :-
hyper parathyroidism, renal disorders
hypo phosphatemia
recurrent attacks of diarrhea
High proportion of phosphorous in some cows milk
leads to impaired absorption of calcium.
1. Age --- common in infants (6 months - 2years)
2. Preterm babies and twins
3. Season --- more in winter than in summer
4. Diet --- Inadequate intake of vitamin D and calcium and
vitamin C in diet.
5. The disease is more common in artificial feed babies than
breast feed infants
6. Heredity factor
7. Atmospheric condition --- More common in big cities and
heavy crowded areas
8. Race ---- more common in dark races
1. Delayed motor development specially walking
2. Delayed dentition
3. Deformities of the bones
4. Bone fractures, limbs deformities
5. Tetany due to hypocalcaemia
6. Anemia
7. G.I.T disturbances as: Gastro Entities, Constipation.
8. Respiratory complications as pneumonia, broncho
pneumonia
9. Low resistance, liability to infection as urinary tract
infections
A - Early manifestations:
RDA:
Infants 0.4 mg, Older children 0.6-1.2 mg, Nursing mothers 1.5 mg,
Adults 1-1.3mg
Treatment:
1. Children: 10 mg daily for several weeks
2. Adults 50 mg
Functions:
1. Important in amino acid, fatty acid, carbohydrate metabolism
& cellular respiration
2. Needed also by retinal eye pigments for light adaptation
Clinical Manifestations:
1. Characteristic lesions of the lips, stomatitis and cheilosis
2. Localized dermatitis of the face
3. Ocular photophobia, blurred vision, itching of the eyes,
lacrimation & corneal vascularization
Diagnosis:
1. Urinary riboflavin determination
2. RBC riboflavin load test
RDA: Infants & children <10yrs 0.6-1.4mg
Children >10yrs 1.4-2mg depending on food intake
Adults 0.025mg/gm dietary protein
Prevention:
1. Best sources: eggs, liver, meat, fish, milk, whole or enriched
ground cereals, legumes, green leafy vegetables
2. Also present in beer
3. Impaired absorption in achlorhydria (less HCl in stomach),
diarrhea & vomiting
Treatment:
1. Riboflavin 2-5mg daily and increase B complex
2. Parenteral administration if relief not obtained
Causes:
1. Diets low in niacin &/or tryptophan
2. Amino acid imbalance or as a result of malabsorption
3. Excessive corn consumption
Clinical Manifestations:
1. Weakness, irritability, numbness & dizziness
2. Classical dermatitis, diarrhea & dementia
3. Erythema, drying, scaling & pigmentation, vesicles
4. Predilection for back of hands, wrists, forearms (pellagrous
glove), neck (Casals necklace) & lower legs (pellagrous boot)
5. GIT - diarrhea, stomatitis or glossitis; feces pale, foul milky,
soapy
6. Mental changes include depression, irritability, disorientation,
insomnia & delirium
Diagnosis:
1. History & manifestations of diet poor in niacin or tryptophan
2. In niacin deficiency, urinary levels of N-methyl-nicotinamide low or
absent
Prevention:
1. Rich sources include meat, peanuts and legumes, whole grain and
enriched breads and cereals
2. Avoid too large proportion of corn
Treatment:
1. Niacin 50-300mg daily which may be taken for a long time
2. Skin lesions may be covered with soothing lotions
Functions:
1. Vitamin B6 is involved in the synthesis of amino
acids, neurotransmitters and niacin
2. Plays important role in clinical conditions such as
anemia, cardiac decompensation, radiation effects,
skin grafting, dermatitis
Causes:
1. Losses from refining, processing, cooking & storing
2. Malabsorptive diseases such as celiac disease
(difficult in digestion)
Clinical Manifestations:
Prevention:
1. Firm requirement not established but usually recommended:
Infant 0.1-0.5mg, Child 0.5-1.5mg & Adult 1.5-2mg
2. Rich sources include yeast, whole wheat, corn, egg yolk, liver
and lean meat
Treatment:
1. Pyridoxine 100mg IM injection for seizures due to deficiency
2. Children should be given 2-10mg IM injection or 10-100mg
oral vitamin B6
Functions:
Treatment:
1. Injection or infusion: Folic acid 2-5mg/24 hrs, for 3-4 wks
2. Satisfactory response - lower the dose to 50 mcg/24 hrs
Causes:
Congenital Pernicious Anemia: Lack of secretion of intrinsic
factor by stomach
Breast-fed infants whose mothers had deficient diets or
pernicious anemia
Vitamin B12 malabsorption from disease of intestine
Clinical Manifestations:
1. Megaloblastic anemia that becomes severe
2. Neurological includes ataxia, paresthesias, clonus & coma
3. Tongue smooth, red & painful
RDA: Infants 0.5 mcg/day
Older children & adults 3 mcg/day
Laboratory Findings:
Blood - Anemia, Serum vitamin B12 <100 pg/ml
Urinary - Excess of methylmalonic acid
Treatment:
1. Injection vitamin B-12 1-5mcg/24hrs
2. If there is neurological involvement 1mg IM daily for at
least 2wks
3. Pernicious Anemia: Monthly vitamin B12 1mg IM necessary
throughout patients life
Functions:
1. Collagen, steroids and epinephrine synthesis process
2. Ascorbic acid also aids iron absorption
Clinical Manifestations:
1. Weakened collagen fibrils
2. Severe deficiency results in decreased wound healing,
osteoporosis, hemorrhaging, bleeding into the skin and friable
bleeding gums with loosened teeth
4. Presenting feature in infant with painful, immobile legs
(pseudoparalysis)
5. Low grade fever & anemia usually present
6. Impairment of growth & development
Diagnosis:
Bleeding, swollen gums: Chronic gingivitis & pyorrhea with pus
X-ray findings of the bones (Knee atrophy, pencil-point thinness)
Tenderness of limbs: age >2 yrs (Arthritis & osteomyelitis)
Prevention :
1. A minimum daily intake of 30 mg is recommended by WHO for
all age levels.
2. Every infant should receive supplement starting 2 nd week of life.
3. Lactating mothers should have at least 50mg vitamin C daily.
4. Guava & papaya richer in vitamin C than citrus fruits, also in most
green leafy vegetables, tomatoes & fresh tubers
Treatment:
Ascorbic acid 200-500 mg daily or 100-150 ml of fruit juice.
Most common global nutrition problem
Common causes of anemia
o Iron deficiency anemia (IDA)
o Infections (malaria, hookworm, HIV)
o Other vitamin deficiencies
o High intake of inhibitors (Tea)
o Hemoglobinopathies
o Blood loss
Health impact
o Perinatal & maternal mortality
o Delayed child development
o Reduced work capacity
Signs and Symptoms
Tiredness and fatigue
Headache and breathlessness
Pallor: pale eye, palms, tongue, lips and skin
Diagnosis:
Blood test for anaemia (Hemoglogin / Hematocrit)
Defined by WHO as:
o Hb <11.0 g/dL children
o Hb <12.0 g/dL Adults
Prevention:
Meat, Spinach, Fortified cereals, Cashew nuts,
Lentils and beans
Treatment: Iron supplement
Thyroid hormone imbalance
Significant cause of preventable brain damage in children
Health effects:
o Increased perinatal mortality
o Mental retardation
o Growth retardation
Preventable by consumption of adequately iodized salt
Iodine Deficiency Affects the Brain
Cretinism
Goitre
Reduced
intellectual
performance
Causes:
Low iodine level in food
o products grown on iodine-poor soil (Erosion, floods,
draught, mountainous areas)
o distance from sea (low fish intake)
Non-availability of iodized food (salt)
Diagnosis:
Measure urinary iodine excretion (UIE)
Measure levels of thyroid hormones in blood
Measure degree of goitre
Grade 0 No Goitre
Grade 1 Palpable Goitre
Grade 2 Visible Goitre