Malnutrition
Supervision
Prof. Dr.Mervat Salah
By the end of this lecture,
students will be able to :
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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
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.)
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Malnutrition is not only insufficient intake
of nutrients. It can occur when an
individual is getting excessive nutrients as
well.
WHAT IS MALNUTRITION?
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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
WHAT CAUSES
MALNUTRITION?
Human beings need a
wide variety of nutrients
to supply essential
energy. Do you know
what nutrients we
need?
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protein
vitamins
minerals
If any one of these
nutrients is deficient in
a person's diet, he/she
may suffer from
malnutrition
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.
WHO IS AFFECTED BY
MALNUTRITION?
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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.
BUT DO YOU KNOW THE NUMBER
ONE FACTOR THAT CAUSES
MALNUTRITION?
POVERTY!
POVERTY…
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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.
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).
How Malnutrition Affects the
Body
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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.
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
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
Forms of malnutrition
1.
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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)
Kwashiokor/Marasmus
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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.
Kwashiorkor
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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 2.5-3.0 gm/kg/day
Marasmus
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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
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
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Nutrition supplements,
rehydration and
education all can all
serve to cure and prevent
these diseases.
Beriberi
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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.
Pellagra
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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.
Scurvy
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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.
Rickets
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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.
Assignment
Hadeer kamal abo bakr in deficiency of
iron
Nourhan Ashraf in deficiency of calcium
Soha Hesham Badr in deficiency of zinc
Recommended text book
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Manual dietetic book