Josie Grace C. Castillo, M.D.

Transcription

1 Josie Grace C. Castillo, M.D. 2 types of nutrients Macronutrients Carbohydrate Fats Protein Micronutrients Vitamins Minerals 1

2 Occur when the quantity or quality of food is not sufficient to meet a persons needs Not having enough food to eat Presence of infections Infections increase nutrient requirements and may reduce appetite Nutritional deficiencies lead to MALNUTRITION Malnutrition Immediate cause Inadequate dietary intake Infection Underlying cause Inadequate household food security Inadequate maternal and child care Inadequate access to water, sanitation and health facilities 2

3 Protein Energy Malnutrition (PEM) Wasting Acute thinness Stunting Long term reduction in growth Caused by deficiency in both macro and micronutrients Micronutrient Malnutrition Not wasted or stunted but with deficiency in 1 or more specific micronutrients Affects about 2B people worldwide Occur when people do not have access to micronutrient-rich foods Increase the general risk of infectious illness and dying from diarrhea, measles and pneumonia 3

4 Most common deficiency affecting mainly older infants and young children Causes: Increased iron requirement related to rapid growth during the 1 st 2 yrs of life Relatively low iron content in most infant diets Iron deficiency Condition resulting from inadequate iron in the body Iron deficiency anemia Severe depletion of iron stores resulting in a low Hgb concentration Anemia RBC s do not carry enough oxygen to the tissues 4

5 Causes Low dietary intake Poor iron absorption Increased needs Chronic blood loss Malaria and parasitism Iron deficiency IDA Anemia Consequences Growth retardation Impaired motor dev t & coordination Poor mental dev t (low IQ) Impaired language dev t Poor psychosocial & behavioral activity Fatigue USAID-A22 Micronutrient and Child Blindness Project, ACCESS Program and Food and Nutrition Technical Assistance (FANTA) Project Report 5

6 Clinical signs and symptoms Palmar pallor Pale conjunctiva Pale nailbeds Pale buccal mucosa Laboratory tests Hemoglobin level determination most common test Other laboratory tests Serum ferritin Transferrin saturation Erythrocyte protoporphyrin 6

7 Heme iron From animal food sources Absorption not significantly affected by diet e.g. Liver, kidney, spleen, heart, blood, meat, chicken, fish/shellfish Non-heme Iron From plant sources Absorption is affected by some components of diet e.g. Dark green leafy vegetables, legumes, cereals 7

8 Iron inhibitors Decrease non-heme iron absorption Foods that contain tannin tea, coffee, and phytates whole grains, legumes, seeds Iron enhancers Increase iron absorption Meat, fish, poultry, organ meats Vitamin C-rich fruits and vegetables Improve dietary intake of iron-rich foods Consume iron-fortified foods Take iron supplements Increase consumption of Vitamin C-rich foods Take deworming tablets Improve personal hygiene Proper health and environmental sanitation 8

9 Fat-soluble vitamin Not synthesized by the body and should be obtained from food Crucial for child survival Decreases : risk from mortality by 23 34% * Deaths due to measles by about 50% Deaths due to diarrhea by about 40% *Acceleration of Progress in combating Vit A def. UNICEF 1997 Functions: Promotes and maintains good vision Important in cell division Essential for normal functioning of the immune system Promotes bone growth 9

10 Preformed vitamin A From animal sources In form of retinol Readily absorbed and can be used by the body immediately e.g. Breast milk, liver, egg yolk, whole milk Provitamin A Comes from plants In form of carotenoid Must be converted to retinol before it can be utilized e.g. Dark orange fruits, orange and yellow vegetables, dark-green leafy vegetables, root crops 10

11 Results from prolonged inadequate intake of Vitamin A 11

12 Xerophthalmia principal clinical sign of VAD Clinical classifications of Xerophthalmia Night blindness Bitot s spot foamy, soapy, whitish patches on the eye Corneal xerosis - cloudy, dry cornea with orangepeel appearance Corneal ulcer Keratomalacia soft, bulging cornea Corneal scar 12

13 Serum retinol level To assess Vitamin A status Classification Deficient Low Acceptable Serum Retinol Level <10µg/dl (<0.35mmol/l) 10-19µg/dl ( mmol/l) µg/dl (>1.05mmol/l) WHO/UNICEF/ IVACC 1982 Causes Inadequate intake of Vitamin A-rich foods Non-breastfeeding Frequent illness and malnutrition Consequences Low resistance to acute respiratory infections 40% increased risk of death from diarrhea 50% increased risk of severe measles 23-43% increase in overall mortality Physical growth retardation (bone, brain) Blindness 13

14 Exclusive breastfeeding for the 1 st 6 mos of life Increased intake of Vitamin A-rich foods with adequate intake of dietary fat, protein, zinc Consumption of Vitamin A-fortified foods Vitamin A supplementation 6 mos- 11 mos: 100,000IU > 1yr: 200,000IU Essential mineral found in almost every cell in the body Stimulates activity of many enzymes and controls many major biochemical reactions in the body Functions Used in the management of diarrhea to decrease duration, frequency and severity of diarrhea, in addition to ORS Supports normal growth and development during pregnancy, childhood and adolescence Supports a healthy immune system to prevent diseases and infections Supports healthy respiratory and intestinal tracts 14

15 Sources: Beef, pork, poultry Shellfish, crabs, oysters Milk and cheeese Wholegrain cereals, peanuts and beans, oats Potatoes, brown rice Absorption affected by: Dietary fiber, phytic acid decreases absorption Vitamins C, E, B6, magnesium increases absorption 1. Add nutrient rich food or increase the size of the general ration Ensure the best use of the available food Educate on the importance of different nutrients, which foods contain them and how to prepare the foods to preserve, as far as possible, the nutritional value 15

16 2. Provide fresh food items Buy locally available and in-season foods 3. Promote production of fruits and vegetables 4. Provide fortified foods Vitamin A - oil, Iodine salt Calcium, thiamine, iron, niacin - cereals Salt Food Vehicle Wheat and corn flour, bread, pasta, rice Milk, margarine, yoghurts, soft cheeses Infant formulas, cookies Soy milk, orange juice Juices and substitute drinks Ready-to-eat breakfast cereals Diet beverages Enteral and parenteral solutions Sugar, tea Iodine, Iron Fortifying agent Vitamin B complex, iron, folic acid Vitamins A and D Iron, Vitamins B1 and B2, niacin, Vitamin K, folic acid, zinc Calcium Vitamin C Vitamins and minerals Vitamins and minerals Vitamins and minerals Vitamin A 16

17 5. Distribute nutrient supplements Vitamin A supplements Iron and folate Multivitamins to severely malnourished individuals in therapeutic feeding programs 6. Non-food public health interventions Vaccination against measles Water, sanitation and hygiene promotion to control diarrhea Deworming to control anemia due to intestinal parasites Malaria control Health and nutrition promotion activities e.g. sun exposure as protective factor against rickets 17

18 7. Promote exclusive breastfeeding and appropriate complementary infant feeding practices Exclusive breastfeeding until 6 mos of age followed by introduction of complementary foods with continued breastfeeding Complementary foods rich in energy and nutrients to meet the requirements for normal growth and development THANK YOU! 18

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