Nutritional problems

Introduction:-
The human body needs nourishment in a balanced manner to carry out all its biological
processes optimally. The micro and macronutrients which one needs are not synthesized
naturally inside the human body. Hence, our diet plays a significant role in this scenario. The
nutritional problems in India mainly arise when there is a lack of essential nutrients within the
human body.

Nutrition is one of the most important aspects of staying healthy. Eating a balanced diet
containing the right nutrition can keep us healthy and away from diseases. Also, for our body to
perform optimally, various nutrients are required that we take from the food and the atmosphere
around us. Although most nutrients can be found in the food we consume, people in the country
do not eat the right amount of nutrients, resulting in many types of disorders like night blindness,
osteoporosis, etc.

There are many causes of nutritional problems in India. The major cause is unhealthy food and
not eating the right amount of nutrients.

A balanced diet is essential for a healthy body. We need macro and micronutrients in adequate
qualities to perform biological functions. But if there is a deficiency or over- consumption of
nutrients, it can hamper overall health and also lead to nutritional problems in India. Most of the
nutrients our body requires are present in the food we intake. However, many people do not eat
the right amount of nutrients causing health challenges. If we consume healthy and balanced
diet, we can prevent deficiencies of vital nutrients and reduce the number of nutritional
problems and associated health issues.

What is balanced diet?

A balanced diet contains an adequate amount of all nutrients required by the body to grow,
remain healthy and be disease-free. In addition, a healthy, balanced diet provides the necessary
energy requirement, protects against vitamin, mineral, and other nutritional deficiencies, and
builds up immunity.

7 essential components of a Balanced Diet:

MACRONUTRIENTS:

Nutrients that are needed in large amounts are called macronutrients. These are three classes
of macronutrients: carbohydrates, lipids and proteins. These can be metabolically processed
into cellular energy. The energy from macronutrients comes from their chemical bonds. This
chemical energy is converted into cellular energy used to perform work, allowing our bodies to
conduct their basic functions. A unit of measurement of food energy is the calorie. In nutrition
food labels, a Kilocalorie (calorie) is the amount of heat generated by a particular macronutrient
that raises the temperature of 1 kilogram of water 1 degree Celsius. On the nutrition facts panel,
the calories within a particular food are expressed as kilocalories, which is commonly denotes
as”calorie” with a capital “C” (1Kcal=1 Calorie), Water is also a macronutrient in the sense that
we require a large amount of it, but unlike the other macronutrient, it does not provide calorie.

1. Carbohydrates – Carbohydrates are molecules composed of carbon, hydrogen, and

oxygen. The major food sources of carbohydrates are grains, milk, fruits, and starchy
vegetables, like potatoes. Non – starchy vegetables also contain carbohydrates but in
lesser quantities. Carbohydrates are broadly classified into two forms based on their
chemical structure; simple carbohydrates, simple sugar, and complex carbohydrates.

Simple carbohydrates consist of one or two basic units. Examples of simple sugar
include sucrose, the type of sugar we would have in a bowl on the breakfast table, and
glucose, the type of sugar that circulates in our blood.

Complex carbohydrates are long chains of simple sugars that can be branched. During
digestion, the body breaks down digestible complex carbohydrates into simple sugar
mostly Glucose. Glucose is then transported to all our cells, stored, used to make
energy, or used to build macromolecules. Fiber is also a complex carbohydrate, but
digestive enzymes cannot break it down in the human intestine. As a result, it passes
through the digestive tract undigested unless the bacteria that inhibit the colon or large
intestine break it down.

One gram of digestible carbohydrates yields four kilocalorie of energy for the
body’s cell to perform work. Besides providing energy and serving as building blocks for
bigger macromolecules. Carbohydrates are essential for the Nervous system’s proper
functioning, heart and kidneys. As mentioned, glucose can be stored in the body for
future use. In human, the storage molecule of carbohydrates is called Glycogen, and it’s
a complex carbohydrates.It should constitute 50-6-% of our diet.

Sources of healthy carbs are:-

 Whole grains like oats, quinoa
 Whole wheat, Dahlia
 Legumes
 Millets like ragi, bajra, barley
 Vegetables
2. Protein – Protein are macromolecules composed of chains of subunits called amino
acids. Amino acids are simple subunits composed of carbon, oxygen, hydrogen, and
nitrogen. The word protein comes from a Greek word meaning “of primary importance”,
which is a description of these macronutrients; they are also colloquially as the
‘workhorses’ of life. Proteins provide 4 kilocalorie of energy per gram; however,
providing energy is not protein’s most important function. Proteins provide structure to
bones, muscles, and skin and play a role in conducting most of the chemical reactions
that take place in the body. Scientists estimate that greater than one-hundred thousand
different proteins exist within the human body. The genetic codes in DNA are basically
protein recipes that determine the order in which 20 different amino acids are bound
together to make thousands of specific proteins. It should constitute 10-12% of our diet.
 Sources of proteins are:
 Legumes and beans, soybean
 Dairy products
 Poultry chicken
 Seafood – fish, crab, prawn
 Eggs
 Meat
 Nuts and seeds
 Yoghurts
3. Lipids – Lipids are also a family of molecules composed of carbon, hydrogen, and
oxygen, but they are insoluble in water, unlike carbohydrates. The three main types of
lipids are triglycerides (triacyglycerols), phospholipids and sterols. The main job of lipids
is to provide or store energy. Lipids provide more energy per gram than carbohydrates
(nine kilocalories per gram of lipids). In addition to energy storage, lipids serve as major
components of cell membranes, surround and protect organs (in fat storing tissues),
provide insulation to aid in temperature regulation, and regulate many other body
functions.

It is a misconception that fats are bad for our health. It would be best if we choose
healthy fats as fats help us in maintain our body temperature and help to absorbs fat-
soluble vitamins A, D, E & K.
Sources of healthy fat are:-
 Nuts
 Butter
 Meat
 Dairy products
 Seeds
 Avocados
 Olive oil
 Fish
4. Water- There is one other nutrient that we must have in large quantities : water. Water
does not contain carbon but is composed of two hydrogen, and one oxygen per
molecule of water. More than 60% of our total body weight is water. Without it, nothing
could be transported in or out of the body, chemical reactions would not occur, organs
would not be cushioned, and body temperature would fluctuate widely. On average, an
adult consumes just over two liters of water per day from food and drink combined.
Since water is so critical for life’s basic processes, the amount of water input and output
is significant.
 MICRONUTRIENTS:

Micronutrients are nutrients require by the body in lesser amounts but are still essential
for carrying out the bodily functions. Micronutrient includes all the essential minerals and
vitamins. There are sixteen essential minerals and thirteen vitamins. In contrast to
carbohydrates, lipids, and proteins, micronutrients are not sources of energy (calories),
but they assist in the process as cofactors or components of enzymes (i.e. coenzymes).
Enzymes are proteins that catalyze chemical reactions in the body and are involved in all
aspects of body functions, from producing energy to digesting nutrients to building
macromolecules. Micronutrients play many essential roles in the body.

5. Vitamins- The thirteen vitamins are categorized as either water-soluble or fat-soluble.

The water-soluble vitamins are vitamin C and all the B vitamins, including thiamine,
riboflavin, niacin, pantothenic acid, pyridoxine, biotin, folate, and cobalamine. The fat-
soluble vitamins are A, D,E, and K. vitamins are required to perform many functions in
the body, such as making red blood cells, synthesizing bone tissue, playing a normal
vision, nervous system function, and immune system function.
Sources of vitamins are:
 Fruits
 Vegetables
 Poultry
 Seeds
 Nuts

S.N VITAMINS MAJOR FUNCTIONS

O
WATER-SOLUBLE
THIAMINE (B1) Coenzyme, energy metabolism assistance
RIBOFLAVIN(B2) Coenzyme, energy metabolism assistance
NIACIN (B3) Coenzyme, energy metabolism assistance
PANTOTHENIC Coenzyme, energy metabolism assistance
ACID (B5)
PYRIDOXINE (B6) Coenzyme, amino acid synthesis assistance
BIOTIN (B7) Coenzyme, amino acid and fatty acid metabolism
FOLATE(B9) Coenzyme, essential for growth
COBALAMIN(B12) Coenzyme, red blood cells synthesis
Vitamin C Collagen synthesis, antioxidant
(ASCORBIC ACID)
FAT-SOLUBLE
VIT-A Vision, reproduction, immune system function
VIT-D Bone and teeth maintenance, immune system
function
VIT-E Antioxidant, cell membrane protection
VIT-K Bone and teeth health maintenance, blood clotting.

6. Mineral- Minerals are solid inorganic substances that form crystals and are classified
depending on how much of them we need. Trace minerals, such as molybdenum,
 selenium, zinc, iron, and iodine are only required in a few milligrams or less. Macro
mineral, such as calcium, magnesium, potassium, sodium, and phosphorus are required
in hundreds of milligrams. Many minerals are critical for enzymes function. Other are
used to maintain fluid balance, build bone tissue, synthesize hormones, transmit nerve
impulses, contract and relax muscles, and protect against harmful free radicals in the
body that can cause health problems such as cancer.
Sources of minerals are:
 Fish
 Meat
 Beans
 Cereals
 Nuts and seeds
 Iodized salt

S.NO MINERALS MAJOR FUNCTIONS

MACRO
1. SODIUM Fluid balance, nerve transmission, muscle contraction
2. CHLORIDE Fluid balance, stomach acid production.
3 POTASSIUM Fluid balance, nerve transmission, muscle contraction
4 CALCIUM Bone and teeth health maintenance, nerve
transmission, muscle contraction, blood clotting
5 PHOSPHORUS Bone and teeth health maintenance, acid base
balance.
6 MAGNESIUM Protein production, nerve transmission, muscle
contraction.
7. SULFUR Protein production

TRACE
8. IRON Carries oxygen, assists in energy production.
9 ZINC Protein and DNA production, wound healing, growth,
immune system function.
10. IODINE Thyroid hormone production, growth, metabolism
11. SELENIUM Antioxidant
12 COPPER Coenzyme, iron metabolism
13. MAGANESE Coenzyme
14 FLUORIDE Bone and teeth maintenance, tooth decay prevention
15 CHROMIUM Assists insulin in glucose metabolism
16 MOLYBDENUM Coenzyme

7. Fiber- Fiber helps in digestion and also helps in lowering cholesterol levels and
controlling sugar levels.
Sources of fiber are:
 Oats and dahlia, brown rice
 Beans
 Whole grains
 Nuts and seeds
 Green leafy vegetables
.

Definition:
 A nutritional problem or deficiency occurs when a person’s body does not have a
sufficient amount of essential nutrients or a particular nutrient.
 A nutritional problem or deficiency refers to a condition when an individual’s body
experiences a shortage of essential nutrients or some specific nutrient. Such problems
can give rise to several health issues such as anemia, osteoporosis, Iodine deficiency
disorder, anemia etc.
 Nutritional problem or disease, any of the nutrient-related diseases and conditions that
causes illness in humans. They may include deficiencies or excesses in the diet, obesity
and eating disorders, and chronic diseases such as cardiovascular disease,
hypertension, cancer and diabetes mellitus.

Causes of Nutritional Problems:

 Poverty (limited financial resources)is recognized as one of the primary causes of

nutritional deficiency in India. Some people cannot afford a balanced meal, which
results in a lack of nutrition and several health challenges.
 In recent years, the problem has emerged even in urban wealthy families. In such
cases, people can buy enough food, but their food choices are unhealthy, making
them prone to common nutrition problems.
 Another cause becoming prevalent is the influence of the western diet. It has led to
people consuming higher quantities of fats, carbohydrates, and refined sugar, which
lead to a high-calorie count without adequate nutritional value.
 Limited access to nutritious foods
 Medical conditions that make eating difficult, such as nausea, or difficulty swallowing
 Medical conditions that depletes calories, such as chronic diarrhea or cancer
 An extra need for calories, such as pregnancy, breastfeeding or childhood
 Mental health conditions that discourage eating such as depression or dementia
 Eating disorder such as anorexia and bulimia
 Mal-absorption disorders such as pancreatic insufficiency or inflammatory bowel
disease
 A condition that requires long-term intravenous feeding.
 A very restricted diet or an unappealing diet chosen by someone else.
 A sedentary lifestyle
 A condition that slows down metabolism such as hypothyroidism
 A hormone imbalance that interfere with hunger and fullness signals
 Chronic stress
 Anxiety or depression
 Binge eating disorder
 Chronic overuse of dietary supplements.
 Other causes :
ꟷ Food insecurity
ꟷ Poor access to health services
 ꟷ Lack of education and information
ꟷ Poor sanitation
ꟷ Lack of availability of fresh drinking water
ꟷ Poor breastfeeding

Types of Nutritional problems:-

Nutritional problems can have an impact in the short and long term. If we want to find a cure, we
must know which type of nutritional problems we have:

 Primary Nutritional Problem:

A person consuming a balance diet is unlikely to suffer from a nutrient deficiency. The
primary type of deficiency results from improper food intake or an imbalanced diet. If we
want to eliminate the deficiencies, we need to consume a balanced diet, take vitamins,
and eat nutritious food.
 Secondary Nutritional Problem:
This type of nutritional problem arises due to underlying health issues. For instance, if
we have allergies to certain food items, our body is likely to fall short of such nutrients.
Other medical conditions causing nutrient deficiencies include lactose intolerance, cystic
fibrosis, pernicious anemia, pancreatic insufficiency, and celiac disease. We must intake
nutrient supplements and treat the underlying health problem.
 Malnutrition: - Our body needs a variety of nutrients, and in certain amounts, to
maintain its tissues and its many function. Malnutrition happens when the nutrients it
gets don’t meet these needs. We can be malnourished from an overall lack of nutrients,
or we may have an abundance of some kind of nutrients but lack other kinds. Even the
lack of a single vitamin or mineral can have serious health consequences for our body.
On the other hand, having an excess of nutrients can also cause problems.

Malnutrition can be under nutrition or over nutrition. It can also mean an imbalance of
macronutrients (protein, carbohydrates, fats) or micronutrients (vitamins and minerals).

Under nutrition:- (insufficient intake of energy and nutrients)

Under nutrition manifest in four broad forms wasting, stunting, underweight, and
micronutrient deficiencies.
Under nutrition is what most people think of when they think of malnutrition. Under
nutrition is a deficiency of nutrients. We may be under nourished if we don’t have an
adequate diet, or if our body our body has trouble absorbing enough nutrients from our
food. Under nutrition can cause visible wasting of fat and muscle, but it can also be
invisible. We can be overweight and undernourished.
ꟷ Macronutrient under nutrition:- also called protein-energy under nutrition,
this is a deficiency of macronutrient. Proteins, carbohydrates, and fats.
Macronutrients are the main building blocks of our diet, the nutrient that body
relies on to produce energy to maintain itself. Without them- or even just one of
them – our body soon begins to fall apart, breaking down tissues and shunting
down nonessential functions to conserve its low energy.
 ꟷ Micronutrient under nutrition:- Micronutrients are vitamins and minerals. Our
body needs these in smaller amounts, but it does need them, for all types of
functions. Many people are mildly not notice a certain vitamin and minerals from
a lack of variety in our diet, we might not notice a mild vitamin deficiency
affecting us, but as micronutrient under nutrition becomes more severe, it can
begins to have serious and lasting effects.
Over nutrition: - over nutrition is a form of malnutrition (imbalanced nutrition) arising
from excessive intake of nutrients, leading to accumulation of body fat that impairs
health (i.e. overweight/obesity).
The world health organization added over nutrition to its definition of malnutrition to
recognize the detrimental health effects that can be caused by excessive consumption of
nutrients. This includes the effects of overweight and obesity, which are strongly
associated with a list of non- communicable diseases (NCDs). It also includes the
toxicity that can result from overdosing specific micronutrients.
ꟷ Macronutrient over nutrition: - When our body has an excess of protein,
carbohydrate and fat calorie to use, it stores them away as fat cells in adipose
tissues. But when body runs out of tissue for storage, the fat cells themselves
have to grow. Enlarged fat cells are associated with chronic inflammation and
with a host of metabolic disorders that follow. These can lead to NCDs such as
diabetes mellitus, coronary artery disease and stroke.
ꟷ Micronutrient over nutrition: - An overdose on vitamin and mineral
supplements. It is uncommon and doesn’t occur from diet alone. But if you take
mega doses of certain supplements, it can have toxic effects.

Signs and symptoms of malnutrition:-

Under nutrition may look like:

ꟷ Low body weight, prominent bones, depleted fat and muscle.

ꟷ Thin arms and legs with edema in belly and face.
ꟷ Stunted growth and intellectual development in children.
ꟷ Weakness, faintness and fatigue
ꟷ Irritability, apathy or inattention
ꟷ Dry, inelastic skin and lesions
ꟷ Brittle hair, hair loss and hair pigment loss
ꟷ Frequent and severe infections
ꟷ Low body temperature, unable to get warm
ꟷ Low heart rate and blood pressure.

Over nutrition may look like:-

ꟷ Obesity
ꟷ High blood pressure
ꟷ Insulin resistance
ꟷ Heart disease
ꟷ Stroke
Determinants of malnutrition:-

 Maternal malnutrition
 Low birth weight
 Faulty child feeding practices
 Dietary inadequacy
 Frequent infections
 Large families
 High female illiteracy
 Taboos and superstitions

Factors affecting nutritional status:-

High risk group:-

 Pregnant women
 Lactating women
 Infants
 Preschool children
 Adolescent girls
 Elderly
 Socially deprived

NURTITIONAL PROBLEM IN INDIA:-

  Protein energy malnutrition
 Low birth weight
 Xeropthalmia
 Nutritional anemia
 Iodine deficiency disorders
 Flurosis
 Lathyrism
 Obesity
 Cardiovascular diseases
 Diabetes mellitus
 Cancer

PROTEIN ENERGY MALNUTRITION:-

 PEM refers to the deficiency of energy and protein in the body.

 Occurs due to inadequate intake of food in both quantity and quality or as result of
infections-measles, intestinal worms, diarrhea, respiratory infections etc.
 Commonly in developing countries
 Incidence- 2% in preschool children

Contributing factors to PEM:-

 Poor environmental conditions

 Large family size
 Poor maternal health
 Failure of lactation
 Premature termination of breast feeding
 Adverse cultural practices related to child rearing and weaning
 Delayed supplementary feeding

Clinical forms of PEM:-

 MARASMUS
 KWASHIORKOR

MARASMUS:-

 Common type of PEM observed among children below 1 year of age

 Caused by severe deficiency of nearly all nutrients especially protein and calorie
 Conditions are characterized by extreme wasting of the muscles and a daunt
expression.
 Extensive tissue and muscle wasting
 Dry skin
 Loose skin folds hanging over glutei and axilla
 Fat wasting
 Small for age
  Sparse hair that is dull brown or reddish yellow
 Mental retardation
 Behavioral retardation
 Low body temperature (hypothermia)
 Slow pulse and breathing rates
 Absence of edema

Fig: MARASMUS,sciencedirect.com/topics/medicine-and-dentistry/marasmus

KWASHIORKOR:-

 Kwashiorkor occurs in children between 2-3 years of age

 Acute form of PEM due to deficiency of protein in the diet (both in quantity and quality)
 Deficiency of micronutrients (iron, folic acid, iodine, selenium, and vitamin c)
 Deficiency of antioxidant (albumin, vitamin E, PUFA, Gluthathione)
 Kwashiorkor is identified as swelling of the extremities and belly, which is deceiving to their
actual nutritional status.
 Kwashiorkor child with pedal edemas
 Growth failure
 Moon face
 Distended abdomen
 Ascitis (abnormal accumulation of fluid)
 Enlarged liver with fatty infiltrates
 Thinning of hair
 Loss of teeth
 Skin depigmentation
 Dermatitis
 Irritability
 Anorexia
 Assessment of PEM:-
GOMEZ Classification
 Weight for age = weight of the child Ꭓ 100
Weight of normal child of the same age

Between 90-110% Normal Nutritional status

Between 75-89% Mild Malnutrition (1st degree)
Between 60-74% Moderate Malnutrition (2nd degree)
Under 60% Severe Malnutrition

Preventive measures of PEM:-

 Health promotion measure
 Promotion of breast feeding, low cost weaning food, nutrition education, family planning
and birth spacing
 Protein energy rich food (milk, egg, fresh fruits)
 Immunization, food fortification
 Early diagnosis
 Rehabilitation
 Vitamin and mineral supplements
 Oral rehydration
 Control of infections and infestation

Low birth weight:-

Low birth weight (LBW) is defined as a birth weight of less than 2500 g (up to and including
2499 g) as per the world health organization (WHO).

< 2.5 Kg Low birth weight (LBW)

2.5-1.5 Kg Moderately low birth weight (MLBW)
1.5-1 Kg Very low birth weight (VLBW)
<1 Kg Extremely low birth weight (ELBW)
Prevalence -18% in India and 15% in world

LBW babies include:

 Preterm babies: - A birth that occurs before the 37th week of pregnancy.
 Small for dates babies:- (SGA)Small for gestational age is defined as a birth weight of
less than 10th percentile for gestational age.

Causative factors:-

 Maternal malnutrition and anemia

 Illness and infection during pregnancy
 High parity
 Close birth intervals
 Most common cause of LBW – Prematurity
 Leading cause of death in LBW babies- Pneumonia, Atelectasis, Pulmonary
hemorrhage, Intra cranial bleeding

Factors modifying prevalence of LBW:-

 More institutional deliveries

 Improving No. of ANCs (minimum > 5)
 Improving quality of ANC
 Includes no. of ANCs, TT, Weight, BP examination of blood, examination of urine.

Xeropthalmia (Dry Eye):-

 Disease due to deficiency of Vitamin –A (VAD)

 Also called Xeroma
 Absence of tears
 Xeropthalmia is most common in children aged 1-3 years (often related to weaning)
 Cornea and conjunctiva become dry and necrosed
 Ocular manifestations –
ꟷ loss of vision to green light (earliest manifestation)
ꟷ night blindness :-Night blindness is the symptoms of vitamin-A deficiency,
under situations, the child cannot see properly in sunlight particularly after the
sunset. In hindi, it is called as “Rathanundi”
ꟷ conjuctival xerosis:- conjunctiva in normal childrenis bright white, smooth and
glistering. Conjuctival xerosis is characterized by dryness of the conjunctiva,
after exposure to air for 10-15 seconds by keeping eyelids drawn back, which
becomes thick, rough and wrinkled. The changes associated with conjunctiva
include: dryness, unwettability, loss of transparency, wrinkling and pigmentation.
ꟷ bitot’s spots:- As the deficiency progress, dirty white, foamy and raised spots
are formed on the surface of the conjunctiva, generally on the outer side of the
cornea. These spots are accumulation of denuded conjuctival epithelial cells.
They stain black in the eyes when applied ‘kajal’
 ꟷ corneal xerosis:- this is a sign of severe vitamin A deficiency, in which the
cornea lossed its normal smooth and glistering appearance and becomes dry
and rough. The child tends to keep the eyes closed, particularly in bright light
due to photophobia (inability to see in bright sun) and hence, the condition may
be missed during the clinical examination, if not observant.
ꟷ Keratomalacia:- this condition of rapid destruction and liquefaction of full
thickness of cornea, leading to prolapsed to iris, resulting in permanent
blindness. Usually keratomalacia consists of characteristics softening of the
entire thickness of a part, or more often the whole of the cornea leading to
deformation or destruction of the eyeball. It is painless but the corneal structure
just melts into a cloudy gelatinous mass, dead-white or dirty yellow in colour.
Extrusion of the lens and loss of the vitreous may occur. In infective conditions,
the eye will be red and swollen.
ꟷ Corneal ulcer:- corneal xerosis, if not treated promptly, leads to ulceration of the
cornea. Initially, the ulcer may be shallow, and if it becomes deep, it may lead to
perforation resulting in prolapsed of contents of the eyeball. These lesions are
more common in the lower central cornea.
ꟷ Corneal scar:- the corneal ulcer, on healing a white scar, which may vary in size
depending upon the size of the ulcer. When the scar is big or positioned centrally
blocking the papillary region, normal vision is affected
 Extra ocular manifestation-
ꟷ Follicular hyperkeratosis (Toad-skin):- A skin condition characterized by
excessive development of keratin in hair follicles, resulting in rough, cone
shaped, elevated papules resulting from closure of hair follicles with a white plug
of sebum.
ꟷ Anorexia
ꟷ Growth retardation

WHO classification for assessment of vitamin-A deficiency

Classification primary sign

XI A Conjunctival xerosis

XI B Bitot’s spots

X2 Corneal Xerosis

X 3A Corneal ulceration

X 3B Keratomalacia

Secondary signs

XN Night blindness

XF Fundal changes

XS Corneal scaring
Fig: a- conjuctival xerosis fig:b- Bitot’s Spot

Fig:c Corneal ulcer fig: d Corneal xerosis

Fig: e Keratomalacia

Risk factors
  Ignorance
 Faulty feeding practices
 Infections
 Diarrhea
 Use of skimmed milk (totally devoid of vitamin-A)

Prevention:-

 Short term action- oral administration of large dose of Vitamin-A (retinol palmite)
 Medium term action- food fortification with vitamin- A
 Long term action- promotes breastfeeding, consumption of green leafy vegetables, and
immunization to infections.

Nutritional Anemia:-

 Hemoglobin content of blood is lower than normal as a result of deficiency of one or

more essential nutrients.
 Most frequent cause of Nutritional Anemia is iron deficiency and less frequently folate
and vitamin B12 deficiency.

 Problem statement of iron deficiency anemia:

ꟷ Women of reproductive age group (15-49 years) and children (6- 35 months) are
at high risk
ꟷ Prevalence is high in adolescent girls as many of them get married at younger
age
 Causes of Iron Deficiency Anemia:-
ꟷ Poor bioavailability
ꟷ Inadequate intake of iron
ꟷ Women loses considerable amount of iron during menstruation
ꟷ Malaria and hookworm infestation
 Detrimental effect of Anemia:-
ꟷ Pregnancy- abortion, premature birth, PPH, LBW
ꟷ Infections- anemia aggravated by parasitic disease e.g. malaria, intestinal
parasite
ꟷ Work capacity- significant decrease in work capacity
 Manifestations of Iron Deficiency Anemia:-
ꟷ Paleness of conjunctiva
ꟷ Paleness of tongue
 ꟷ Paleness of mucosa of soft palate
ꟷ Low hemoglobin
ꟷ Swelling of feet in severe anemia
ꟷ Koilonychias
 WHO Hemoglobin cut-off criteria:

Group Cut-off for hemoglobin (g/100ml)

Children < 6 years 11
Children > 6 years Adolescents Non 12
pregnant and Non lactating women
Pregnant women 11
Lactating women 12
Adult male 13

 Consequences of Iron Deficiency Anemia:-

ꟷ Maternal and perinatal mortality
ꟷ Low birth weight and prematurity
ꟷ Reduced physical work capacity
ꟷ Poor cognitive performance in children

 Interventions :-
ꟷ Iron folic acid supplementations
ꟷ Nutritional anemia prophylaxis programmer (daily fe and folic acid
supplementation to pregnant women and lactating women)
ꟷ Iron fortification
ꟷ Control of parasites and nutritional education

Iodine Deficiency Disorder (IDD):-

 IDD refers to a spectrum of disabling conditions arising from an inadequate dietary

intake of iodine.
 Prevalence of iodine deficiency in India – 3-10%
 IDD affects the health of humans from fetal stage to adulthood.
 Spectrum of Iodine Deficiency Disorder:-
ꟷ Goiter
ꟷ Hypothyroidism
ꟷ Delayed milestones (delayed development)
ꟷ Mental deficiency
ꟷ Hearing defects (deafness)
ꟷ Speech defects
ꟷ Strabismus (squint)-unilateral/bilateral
ꟷ Nystagmus
ꟷ Neuromuscular weakness- spastic Diplegia/ spastic quadrupled\gia
ꟷ Endemic cretinism- hypothyroid cretinism/ neurological cretinism
 Causes of IDD:-
ꟷ Deficient iodine intake- consuming foods with low iodine content, crops grown in
iodine depleted soil.
ꟷ Increased demand for iodine in the body- demand of iodine is increased during
the stage of rapid growth (infancy, puberty, pregnancy, lactation). Demand
exceeds supply results in deficiency.
ꟷ Presence of Goitrogens – goiter producing substances naturally present in some
foods (cabbage, cauliflower etc) interfere with iodine utilization.
 Manifestations of IDD:-
ꟷ Goiter
ꟷ Abortion, congenital abnormalities
ꟷ Increased perinatal mortality
ꟷ Cretinism

GRADE 0 No goiter (neither palpable nor visible, palpable but size is

 Iodine deficiency disorders
less than the :-
distal phalange)
GRADE ‘I’ Not visible when neck is in normal position, but palpable
(the size of the enlargement of the land should be more
than the size of the distal phalange of the thumb of the
subject)
GRADE ‘II’ Visible from the minimum distance
ꟷ Endemic goiter:-
→ also called Derbyshire neck
→ enlargement of thyroid gland causing swelling in front part of the neck
→ due to lack of iodine in the diet
→ goiter belt- Himalayan region
→ common among girls than boys

Fig: Endemic goiter

ꟷ Cretinism :-
→ Severe form if IDD
→ Occurs during fetal stage
→ Interfere with brain development causing brain damage and death
→ Result in growth failure, mental retardation, speech and hearing defects.
  Prevention and control:-
ꟷ Iodized salt
ꟷ Iodized oil injections
ꟷ Double fortified salt
ꟷ Mass communication

Endemic flurosis:-

 Occurs due to consumption of excessive amount of fluorine through drinking water.

 Observed in parts where- fluorine in drinking water is 5mg/L
 Important health problem in – Nagaland, Andhra Pradesh, Tamil Naidu, Karnataka and
Kerala
 Toxic manifestations:-
→ Dental fluorosis:-
ꟷ Reported at fluoride level > 1.5 mg /L of drinking water
ꟷ Occurs when excess of fluoride is ingested during first 7 years of life.
ꟷ Seen in children 5-7 years of age
ꟷ Teeth lose their shiny appearance and chalk white patches develop on
them
ꟷ Changes are called mottling of enamel
ꟷ In severe cases loss of enamel gives teeth a corroded appearance
ꟷ Dental flurosis is confined to permanent teeth and develops only during
the period of formation.

→ Skeletal fluorosis:-
 ꟷ Associated with daily intake of 3-6 mg/L
ꟷ Heavy fluoride deposition in the skeletal
ꟷ Seen in older adlts
ꟷ Heavy fluoride deposition on skeleton
ꟷ Manifested as pain numbness and tingling sensation of the extremities
ꟷ Stiffness of neck

→ Genu valgum:-

ꟷ Observed among those people whose staple is sorghum (jowar)

ꟷ Genu valgum and osteoporosis of lower limb.
ꟷ A form of skeletal deformity associated with flurosis
ꟷ The lower limb look knock kneed due to osteoporosis

Prevention of flurosis:-
 Exclusive breast feed
  Check primary source of drinking water
 Regulate toothpaste use: - by far, one of the most common causes of fluorosis is
regularly swallowing toothpaste. For this reason, it is extremely important to
regulate how much toothpaste child uses and to supervise them while brushing
their teeth.
 Avoid mouthwash: - while mouthwash can have benefits, it is not recommended
for children under the age of 6. This is because young children under the age of
6 haven’t fully developed the swallowing reflex and are more likely to swallow
large amounts of mouthwash.
 Schedule regular dental visits:- starting at six months of age, your child should
visit their dentist every six months. This allows your child’s dentist to closely
monitor their oral health and detect possible signs of fluorosis early on. Child’s
dentist can also provide you with additional information on how to prevent
fluorosis.
 Try to limit drinking soda because its generally made with fluoridated water.
 Fluoride may be used as a preservative in many products.

Lathyrism :-

 Paralyzing disease
 Referred as neurolathyrism
 Occurring mostly in adults (15-45 years)
 Pulse – lathyrus sativus commonly known as khesari dal (teora dal/ lak dal/ batra/
gharas/ matra)
 It contains a toxin called Beta oxalyl amino (BOAA)
 It is relatively cheaper

Intervention:-

Removal of toxin:-

 Steeping method :-
ꟷ Soaking the pulse in hot water for about 2 hours and the soaked water is
drained off completely.
 Genetic approach:-
ꟷ Development of low toxin varieties of lathyrus
 Banning the crop:-
ꟷ The prevention of food adulteration act in India has banned lathyrus in all
forms.

Obesity: -

 Most prevalent form of malnutrition

 Abnormal growth of adipose tissue due to enlargement of fat cell (Hypertrophic),
increase in no. of fat cells (hyperplasic) or combination of both.
 Obesity: - when the body weight is 20% more than the desirable weight.
  Overweight: - when the body weight is between 10-20% more than the desirable
weight

Factors contributing to obesity:-

 Age
 Sex
 Genetic factors
 Physical inactivity
 Socio economic staus
 Eating habits
 Psycho-social factors
 Alcohol
The direct cause of overweight in India is
 Lack of physical activity due to sedentary life style
 Loss of traditional diet
 Faulty diet
 High stress
 High rate of economic growth
BMI- WEIGHT IN KG
(HEIGHT IN METER)2
20-25 IDEAL
26-30 OVERWEIGHT
31-40 OBESE
40+ VERY OBESE

Control of obesity:-

 Eat food according to body’s requirement

 At least 3-4 hrs interval between meals
 Avoid in between snacks
 Eat more leafy vegetables which contain high fiber
 Avoid intake of fatty and fried foods
 Regular physical exercise.

Cardiovascular diseases:-

 Classified as one of the food habit related illness

 Change in food habits and lifestyle has increased the risk of CVD in Indian population
mostly in middle class and upper middle class groups.

Cancer: -

80% of cancer due to environmental factors

 Dietary fat- positive correlation with colon cancer, breast cancer

 Dietary fiber- risk of colon cancer is inversely related
 Micro nutrients- lack of vitamin C and vitamin A arise the risk of stomach cancer and
lung cancer.
 Food additives- saccharin, cyclamate, coffee, aflatoxin associated with bladder cancer.
 Alcohol-liver cancer, rectal cancer