1. Malnutrition
Supervision
Prof. Dr.Mervat Salah

2. By the end of this lecture, students will be able to :
Define malnutrition and identify its forms
Understand the physical findings of malnutrition
Understand how malnutrition affects the body
Identify some tips for managing an individual with malnutrition
Develop awareness of refeeding syndrome
Identify some of the complications associated with malnutrition

3. WHAT IS MALNUTRITION? Malnutrition is:
poor nutrition due to an insufficient, poorly balanced diet, faulty digestion or poor utilization of foods. (This can result in the inability to absorb foods.)
Malnutrition is not only insufficient intake of nutrients. It can occur when an individual is getting excessive nutrients as well.

4. WHAT IS MALNUTRITION?
Malnutrition is caused by an inadequate availability of nutrients, because of either poor intake or deficiency as a result of disease.
It results from inadequate consumption, poor absorption, or excessive loss of nutrients

5. WHAT CAUSES MALNUTRITION?
Human beings need a wide variety of nutrients to supply essential energy. Do you know what nutrients we need?
protein
vitamins
minerals
If any one of these nutrients is deficient in a person's diet, he/she may suffer from malnutrition

6. WHAT CAUSES MALNUTRITION? (continued)
Malnutrition also occurs when there is an imbalance of energy and protein in an individual’s diet. The body may become unable to absorb the nutrients it requires to function properly.
*For example, if a child is suffering from energy and protein malnutrition, they will most likely have deficiencies in iron, calcium, and other vitamins and minerals.

7. WHO IS AFFECTED BY MALNUTRITION?
Individuals who are dependent on others for their nourishment. (infants, children, the elderly, prisoners)
Mentally disabled or ill because they are not aware of what to eat.
People who are suffering from tuberculosis, eating disorders, HIV/AIDS, cancer, or who have undergone surgical procedures are susceptible to interferences with appetite or food uptake which can lead to malnutrition.

8. BUT DO YOU KNOW THE NUMBER ONE FACTOR THAT CAUSES MALNUTRITION?
POVERTY!

10. POVERTY…
Nearly 3 billion people in the world are living on less than $1 a day. They have little access to their basic needs, including adequate nutrition to help their bodies stay in balance. Poverty may also prevent individuals from accessing education, which can lead to misinformation about adequate nutrition.

11. Effects of malnutrition
Nutritional deficiencies can contribute to various diseases which can be found everywhere, but most often go without cures/treatment in Less Developed Countries (LDCs).

12. How Malnutrition Affects the Body
Digestive system: Decreased production of HCL,and frequent diarrhea that could be fatal.
Cardiovascular system: Reduced heart size, reduced amount of blood pumped, bradycardia, and heart failure.
Respiratory system: Slow breathing, reduced lung capacity, and, ultimately, respiratory failure.
Reproductive system: Reduced size of ovaries and testes, loss of libido, cessation of menstruation.

13. Nervous system: Apathy and irritability, mental retardation in children sometimes, mental dysfunction in older people.
Muscles: Reduced muscle mass and strength and reduced ability to exercise or work.
Blood: Anaemia
Metabolism: Hypothermia, fluid accumulation in arms, legs, and abdomen, and disappearance of subcutaneous fat.
Skin and hair: As in slide 8
Immune system: Impaired ability to fight infections and repair wounds

14. Physical Findings ofMalnutrition
Hair that is dull, brittle, dry, or falls out easily
Swollen glands of the neck and cheeks
Dry, rough, or spotty skin
Poor or delayed wound healing or sores
Thin appearance with lack of subcutaneous fat
Muscle wasting (decreased size and strength)
Edema of lower extremities
Weakened hand grasp
Depressed mood
Abnormal heart rhythm, or BP
Enlarged liver or spleen
Loss of balance and coordination

15. Forms of malnutrition
Macronutrient malnutrition protein-calorie malnutrition (PCM)
Kwashiorkor, marasmus, and mixed marasmus-kwashiorkor.
2. micronutrient malnutrition
particularly vitamin A deficiency (VAD), iron deficiency anemia (IDA), and iodine deficiency disorders (IDD)

16. Kwashiokor/Marasmus
Kwashiokor, which means “disease of the displaced child” in the Ga language of Ghana is a protein deficiency which results is characterized by inability to gain weight, diarrhea, lethargy and a swollen belly. Kwashiokor can lead to comatose as well as death.
Similarly, Marasmus is a disease resulting from protein deficiency which affects children early in life (typically in the 1st year) slowing growth, decreasing weight and hindering proper development.
Nutrition supplements, rehydration and education all can all serve to cure and prevent these diseases.

17. Kwashiorkor
Kwashiorkor results from inadequate protein intake or may be precipitated by an illness, such as measles.
Patients appear well nourished or over nourished because of edema.
Treatment is mainly to correct protein deficiency by giving gm/kg/day

18. Marasmus
Marasmus results from chronic deprivation or impaired absorption of energy, protein, vitamins, and minerals. For example, patients with cancer may experience gradual wasting.
Patients with marasmus present with severe weight loss and wasting of both muscle and adipose tissue.
Initial treatment of marasmus may consist of IV or oral glucose followed by liquids. Multivitamins and mineral supplements may be indicated

19. Mixed Marasmus-Kwashiorkor
This condition develops in chronically starved patients who experience stress (surgery, trauma).
Patients may have edema that masks wasted appearance.
Anthropometric measurements and proteins are depleted

20. Nutrition supplements, rehydration and education all can all serve to cure and prevent these diseases.

22. Beriberi
Beriberi is a thiamine (vitamin B1) deficiency which is common in South East Asia where many diets consist solely of white rice.
Beriberi affects the proper functioning of the nervous system as well as the circulatory system and heart.
Pregnancy, breast feeding mothers and those who are ill with fever may have a heightened dependency on thiamine and may develop a deficiency.
Thiamine is best acquired through foods such as pork, beef and whole grain (unrefined) breads and grains.

24. Pellagra
Pellagra ”rough skin” is a niacin (or Tryptophan) deficiency which often results in the “3 Ds”; diarrhea, dementia and dermatitis.
The large scale consumption of corn has resulted in many cases of pellagra because corn is poorly absorbed in the body. The best sources of Niacin are broccoli, eggs, dates, beef, salmon, seeds and peanuts.

26. Scurvy
Scurvy is a disease which is born of Vitamin C deficiency. It is characterized by bleeding around hair follicles, anemia and gingivitis.
Scurvy may occur in those who consume large amounts of junk foods, smokers (as smoking depletes Vitamin C) and those who don’t have proper access to sources of vitamin C. Namely, the poor.

28. Rickets
Vitamin D deficiencies may result in “Rickets” which is a lack of proper calcium characterized by poorly developed and deformed bones.
Vitamin D can be best found in beef products (especially cows milk) but is very low in breast milk. Thus, women in developing countries are contributing to this disease if their babies sole source of nourishment is breast milk.

30. Assignment Hadeer kamal abo bakr in deficiency of iron
Nourhan Ashraf in deficiency of calcium
Soha Hesham Badr in deficiency of zinc

31. Recommended text book
Manual dietetic book