Nutrition
Epidemiology &
MALNUTRITION
A review of the different Types, Forms and
Causes
Epidemiology
• The term ‘epidemiology’ is coined from the Greek, implying
‘study among the population’.
• The study of the distribution and determinants of health-related
states or events in specified populations, and the application of
this study to control of health problems”.
Aims of Epidemiology
1. To identify the etiology or cause of a disease and the relevant risk
factors.
2. To determine the extent of disease found in the community.
3. To study the natural history and prognosis of disease.
4. To evaluate both existing and newly developed preventive and
therapeutic measures and modes.
5. To provide the foundation for developing public policy relating to
environmental problems, genetic issues, and other considerations
regarding disease prevention and health promotion.
Nutrition Epidemiology
• the application of epidemiological techniques to the
understanding of disease causation in populations
where exposure to one or more nutritional factors is
believed to be important.
Public Health / Nutrition
Public Health- the collective action taken by a society to
protect and promote the health of the entire populations;
it is the art and science of preventing disease, and
prolonging life through the organized efforts of the
society.
Public Health / Nutrition
Public Health Nutrition- an approach that focuses on the
promotion of good health through nutrition and the primary
prevention of nutrition related illness in the population.
• It is built on the foundation of basic and applied sciences,
operates in a public health context and uses the skills and
knowledge of epidemiology and health promotion.
MALNUTRITION
Which of the following is not malnourished?
MALNUTRITION
A state of disease caused by:
•
•
sustained deficiency
excess or imbalance of the supply of
calories, nutrients or both that are
available for use in the body.
FORMS OF MALNUTRITION
1.Undernutrition
2.Specific Deficiency
3.Overnutrition
4.Imbalance
5.Toxicity
FORMS OF MALNUTRITION
1.Undernutrition
•
pathological state resulting from the
consumption of inadequate quantity of food
over extended period of time.
• e.g.
• marasmus
• kwashiorkor
•
chronic energy deficiency (CED)
TYPES OF UNDERNUTRITION
A.Underweight
•
•
a condition when the child’s weight is
less than expected for their age
underweight-for-age
TYPES OF UNDERNUTRITION
B. Stunting
•
•
•
•
child’s height is less than expected for their age
child has not grown to his/her potential
chronic undernutrition or inadequate food to promote
growth for a long period of time, frequent illnesses or
long duration of illnesses at some point in the past
underheight-for-age
TYPES OF UNDERNUTRITION
C. Wasting
•
•
child’s weight is less than expected for their height
due to acute food deprivation or presence of illness
such as infection, or a combination of food shortage
and illness in the immediate past
TYPES OF UNDERNUTRITION
D. Kwashiorkor
•
•
•
results from a diet grossly deficient in protein
“sickness of the older child when the next baby is
born”
occurs after breastfeeding stops and child is
weaned into a starchy diet
TYPES OF UNDERNUTRITION
E. Marasmus
•
•
•
•
results from a diet severely lacking in
calories (low in CHO, CHON, Fats)
comes from a Greek word meaning
“wasting”
characterized by wizened of man’s face or
“monkey face”
due to inadequate breastfeeding or
improper (diluted) milk formula
TYPES OF UNDERNUTRITION
F. Chronic energy deficiency (CED)
•
•
•
long-standing intake of a diet that is inadequate in
energy to sustain optimal growth and physical activity
manifested in children by generalized undernutrition,
poor growth, stunting and underweight
usually used to describe adults - thinness and low
physical performance and work capacity
TYPES OF UNDERNUTRITION
G. Moderate acute malnutrition (MAM)
• weight of children under 5 years is between 70%
and 80% of the median weight-for-height or
between -3 and -2 z-scores of weight-for-height
TYPES OF UNDERNUTRITION
H. Severe acute malnutrition (SAM)
•
weight of children under 5 years is less than 70% of
the median weight-for-height or less than -3 zscores of weight-for-height
TYPES OF UNDERNUTRITION
I. Global acute malnutrition (GAM)
• Global Acute Malnutrition (GAM) is a measure of
acute malnutrition in children aged between 6 and 59
months.
• term used to include all malnourished children
whether they have moderate or severe wasting or
edema, or some combinations of these conditions
TYPES OF UNDERNUTRITION
I. Global acute malnutrition (GAM)
• weight-for-height rations that are less than -2 standard
deviation below the mean
• less than 80% of median weight-for-height
• presence of nutritional edema
FORMS OF MALNUTRITION
2. Specific Deficiency
•
pathological state resulting from a relative or
absolute lack of individual nutrients
• e.g.
• Vitamin A deficiency
• Iron Deficiency Anemia
FORMS OF MALNUTRITION
3. Overnutrition
•
pathological state resulting from the consumption of
excessive quantity of food and henace a caloric excess
over the extended period of time
• e.g.
• overweight
• obesity
FORMS OF MALNUTRITION
3. Overnutrition cont…
•
Common problems on the rise and dietary factor(s) implicated:
Obesity
total calories
Coronary Artery Disease (CAD)
total calories, especially saturated fat,
cholesterol
Hypertension
total calories, salt
Diabetes Mellitus
total calories
Some cancers (e.g. of the breast
in women, of the colon)
total calories, fat
FORMS OF MALNUTRITION
3. Overnutrition cont…
•
Other factors:
• Lifestyle factors: smoking, alcohol abuse
• increasing affluence of certain sectors which
facilitates the changes in lifestyle
• changes in demographic structure
• genetics
FORMS OF MALNUTRITION
4. Imbalance
•
pathological
state
resulting
from
disproportion among essential nutrients with
or without absolute deficiency of any nutrient
• e.g.
• amino acid imbalance
Six Essential Nutrients
1.
2.
3.
4.
5.
6.
Carbohydrates
Protein
Fat
Vitamins
Minerals
Water
FORMS OF MALNUTRITION
5. Toxicity
•
excessive intakes of certain nutrients which causes toxic effects
TYPES OF MALNUTRITION
1.
2.
3.
4.
Acute Malnutrition
Chronic Malnutrition
Primary Malnutrition
Secondary Malnutrition
TYPES OF MALNUTRITION
1. Acute Malnutrition
•
related to current state of nutrition manifested by:
• weight loss (underweight)
• low weight-for-height (wasting) although normal height-for-age
**usually caused by: decrease food consumption, increased energy expenditure,
illness
(Action Against Hunger, 2016)
TYPES OF MALNUTRITION
2. Chronic Malnutrition
•
related to past state of nutrition manifested by:
• stunting or nutritional dwarfism
• low weight-for-height (wasting) and low height-for-age (stunting)
**starts before birth caused by poor maternal nutrition, poor feeding
practices, poor food quality as well as frequent infection (UNICEF, 2016)
TYPES OF MALNUTRITION
TYPES OF MALNUTRITION
3. Primary Malnutrition
•
•
caused by inadequate food intake
“dietary malnutrition”
TYPES OF MALNUTRITION
4. Secondary Malnutrition
•
caused by certain conditioning factors other than food alone
•
includes all conditions within the body that reduce the
ultimate supply of nutrients to the cells
DOUBLE BURDEN OF
MALNUTRITION
DOUBLE BURDEN OF MALNUTRITION
•
co-existence of undernutrition, micronutrient deficiencies, overweight or
obesity and other nutrition-related chronic diseases in the same countries,
in the same communities and even in the same households
•
In the Philippines… exists as high levels of overweight/obesity and dietrelated non-communicable diseases among adults coexists with high
prevalence of child undernutrition
CAUSES OF MALNUTRITION
IN THE PHILIPPINES
According to the surveys conducted by the Food and Nutrition
Research Institute of the Department of Science and
Technology (FNRI-DOST), there are several causes of malnutrition
in the Philippines:
1. Direct or primary causes
2. Indirect or secondary causes
3. Basic causes
DIRECT OR PRIMARY CAUSES OF
MALNUTRITION IN THE PHILIPPINES
A. Inadequate and/or unbalanced food intake
B. Poor biological utilization of food
DIRECT OR PRIMARY CAUSES OF
MALNUTRITION IN THE PHILIPPINES
A.Inadequate
intake
•
•
and/or
unbalanced
food
<dietary per capita intake of calories of Filipinos
<intake of vegetables and fruits, milk and eggs,
dried beans, fats and oils
DIRECT OR PRIMARY CAUSES OF
MALNUTRITION IN THE PHILIPPINES
A.Inadequate
intake
•
•
and/or
unbalanced
food
<dietary per capita intake of calories of Filipinos
<intake of vegetables and fruits, milk and eggs,
dried beans, fats and oils
DIRECT OR PRIMARY CAUSES OF
MALNUTRITION IN THE PHILIPPINES
B. Poor Biological Utilization of Food
•
•
Malabsorption
Improper cooking/preservation of nutrients
DIRECT OR PRIMARY CAUSES OF
MALNUTRITION IN THE PHILIPPINES
B. Poor Biological Utilization of Food
•
•
Malabsorption
Improper cooking/preservation of nutrients
DIRECTOR
ORSECONDARY
PRIMARY CAUSES
OFOF
INDIRECT
CAUSES
MALNUTRITION
IN IN
THE
PHILIPPINES
MALNUTRITION
THE
PHILIPPINES
A.
B.
C.
D.
E.
Economic factors (poverty)
Socio-cultural factors
Demographic factors
Health factors
Environmental/ecological factors
DIRECTOR
ORSECONDARY
PRIMARY CAUSES
OFOF
INDIRECT
CAUSES
MALNUTRITION
IN IN
THE
PHILIPPINES
MALNUTRITION
THE
PHILIPPINES
A. Economic factors (poverty): PEM is more likely to
occur in households where:
•
•
•
•
<income
<expenditure for food
>food prices in the community
occupation of the household head is characterized by
unsteady or irregular income such as casual or farm
DIRECTOR
ORSECONDARY
PRIMARY CAUSES
OFOF
INDIRECT
CAUSES
MALNUTRITION
IN IN
THE
PHILIPPINES
MALNUTRITION
THE
PHILIPPINES
B. Socio-cultural factors: Malnutrition is more likely to
occur in households where:
• <parental education
<nutrition knowledge = faulty food habits,
beliefs and practices
• infant feeding practices are poor
•
DIRECTOR
ORSECONDARY
PRIMARY CAUSES
OFOF
INDIRECT
CAUSES
MALNUTRITION
IN IN
THE
PHILIPPINES
MALNUTRITION
THE
PHILIPPINES
C. Demographic factors
•
>large families = malnutrition
• children aged 1-3 years being the most vulnerable
•
mother’s age, gravid and fertility behavior = nutritional
status
• PEM = >teenage mothers
DIRECTOR
ORSECONDARY
PRIMARY CAUSES
OFOF
INDIRECT
CAUSES
MALNUTRITION
IN IN
THE
PHILIPPINES
MALNUTRITION
THE
PHILIPPINES
D. Health factors
•
•
•
mother’s nutritional status is poor
LBW
infectious diseases (diarrhea, upper respiratory
diseases, measles, primary complex and
parasitism co-exist with poor dietary intake)
DIRECTOR
ORSECONDARY
PRIMARY CAUSES
OFOF
INDIRECT
CAUSES
MALNUTRITION
IN IN
THE
PHILIPPINES
MALNUTRITION
THE
PHILIPPINES
E. Environmental/ ecological factors
exposure to drastic weather conditions
• geographic location and topography
= <access to basic services
• natural seasonal variations in availability of
food
•
BASIC CAUSES OF MALNUTRITION IN
THE PHILIPPINES
government policies
• land use
• political structure
• peace and order situation
•
CONSEQUENCES
OF MALNUTRITION
CONSEQUENCES OF MALNUTRITION
1. undernutrition in early years of life results to poor resistance to
infections leading to frequent illness and in some severe cases
even death
2. undernourished preschool children tend to be poor learners in
school
3. poor learning in school results to adults who are unskilled and
have low functional literacy, which limit their opportunities for
gainful employment
CONSEQUENCES OF MALNUTRITION
4. Unemployment and underemployment then results to low
productivity that brings up poverty, which in turn repeats the
cycle of undernutrition
5. Because individuals make up a community and a country,
then malnourished individuals also compromise the potentials
for socioeconomic development of a community and a country
CONSEQUENCES OF UNDERNUTRITION (NNC, 2005)
Early Death
Infection
Inability to
concentrate in
school
Weak Resistance
Malnourished
children
School dropout
Poverty
Lack skill/low literacy
Low Productivity
Under/unemployed
malnourished adults
WHY INVEST IN
NUTRITION?
UMBLERO - PHN v. 2016
Why invest in
NUTRITION?
WHY INVEST IN NUTRITION?
1. Only a healthy and well-nourished population has the
capability and capacity, bothy physically and
mentally to help develop its nation.
**Man is the most important resource of the
country
**Nutrition is a major determinant of whether an
individual will achieve his genetic size potential shortfalls in body size is associated with shortfall in
effective work performance
WHY INVEST IN NUTRITION?
2. Malnutrition is ethically unacceptable. The continued
prevalence of undernutrition violates the human rights.
**The right to food is a basic human right as well as a
basic human need.
WHY INVEST IN NUTRITION?
3. Malnutrition has unacceptable functional
consequences in health (morbidity and
mortality), education, productivity, and
economic development.
4. Thus, nutrition is not only a consequence but
also a cause of poverty and underdevelopment,
and therefore is an excellent investment for
development.