various nutritional problem1

8/11/2019 Various Nutritional Problem1

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VARIOUS NUTRITIONAL PROBLEMSNutrition may be defined as a science of food and its relationsi! to ealt" It is

concerned !rimarily #it te !art !layed by nutrients in body $ro#t%

de&elo!ment and maintenance"

Te #ord nutrient or 'food factor( is used for s!ecific dietary constituents

suc as !roteins% &itamins and minerals" )ietetics is te !ractical

a!!lication of te !rinci!les of nutrition* it includes te !lannin$ of meals

for te #ell and te sic+" ,ood nutrition means -maintainin$ a nutrition

status tat enables us to $ro# #ell and en.oy $ood ealt/"

Nutrition !lays an im!ortant role in te !romotion and maintenance of ealt and

in te !re&ention of ealt and in te !re&ention of uman disease" Malnutrition

and undernutrition are te $reatest international ealt !roblems of te !resent

day" A sound +no#led$e of nutrition is terefore essential for a nurse"

In te $lobal cam!ai$n of ealt for all% !romotion of !ro!er nutrition is one of te

ei$t elements of !rimary ealt care" ,reater em!asis is no# !laced on

inte$ratin$ nutrition into !rimary ealt care systems #ene&er $oals to !romote

ealt and nutritional status of families and communities"

FOOD RELATION OF NUTRITION TO HEALTH

,ood relation of nutrition is a basic com!onent of ealt" Te relation of nutrition

to ealt may be seen from te follo#in$ &ie# !oints"• ,ood nutrition is essential for te attainment of normal $ro#t and

de&elo!ment not only for !ysical $ro#t and de&elo!ment% but also for te

intellectual de&elo!ment"

• Malnutrition is directly res!onsible for certain s!ecific nutritional deficiency

disease"

Te commonly re!orted ones in India are*

0" +#asior+or

1" marasmus"

2" blindness due to &itamin a deficiency

3" anemia

4" beri5beri

6" $oiter%etc

$ood nutrition terefore is essential for te !re&ention of s!ecific nutritional

deficiency diseases and !romotion to ealt"



• To $i&e resistance a$ainst infection"

Malnutrition !redis!oses to infection li+e tuberculosis" Infection in turn may

a$$ra&ate malnutrition by effectin$ te food inta+e% absor!tion and

metabolism"

• To reduce morbidity and mortality"

Indirect effects of mal malnutrition are7

0" 8i$ $eneral deat rate"

1" 8i$ infant mortality rate"

2" 8i$ sic+ness rate or morbidity rate"

3" Lo#er e9!ectation of life"

4" O&ernutrition #ic is anoter form of malnutrition" it is res!onsible

for7

Obesity"

)iabetes"

8y!ertension"

:ardio&ascular diseases"

Renal diseases"

)isorder of te li&er and $allbladder"

Nutrition deficiency disorders

Deficiency diseases are diseases in umans tat are directly or indirectlycaused by a lac+ of essential nutrients in te diet" )eficiency diseases are

commonly associated #it cronic malnutrition" Additionally% conditions suc as

obesity from o&ereatin$ can also cause% or contribute to% serious ealt

!roblems" E9cessi&e inta+e of some nutrients can cause acute !oisonin$"

Malnutrition

Tese results from te deficiency in te diet of ener$y% !rotein% &itamin% fibers or

all some of tem" Occasionally tese arise e&en tou$ te foods are not

deficient in nutrients" Tey are ten +no#n as -secondary malnutrition/" ;ollo#in$

are some of te causes of secondary malnutrition75

<a= Malabsor!tion from alcoolism% celiac diseases etc"

<b= Increased demand of foods as in !rotracted fe&ers"

<c= Increased e9cretion !roduced by diarreas and ancyclostomias"

<d= Inade>uate utili?ation of food on accounts of diabetes"

Following are the conseuences of !alnutrition"#

http://en.wikipedia.org/wiki/Disease

http://en.wikipedia.org/wiki/Essential_nutrient

http://en.wikipedia.org/wiki/Malnutrition

http://en.wikipedia.org/wiki/Obesity

http://en.wikipedia.org/wiki/Disease

http://en.wikipedia.org/wiki/Essential_nutrient

http://en.wikipedia.org/wiki/Malnutrition

http://en.wikipedia.org/wiki/Obesity



<a= Malnutrition !re&ents te affected cild from attainin$ full

$enetic !otential"

<b= It reduces bodily resistance to infection and !rolon$s reco&ery

follo#in$ illness"

<c= It im!airs mental ca!acity% co$niti&e ability and motor s+ills

<d= It reduces !ysical ca!acity and alertnessTHE $RO%LEM OF MALNUTRITION

Mal nutrition as been defined as -a !atolo$ical state resultin$ from a relati&e or

absolute deficiency or e9cess of one or more essential nutrients/" It com!rises

four forms75

• Undernutrition%

• O&ernutrition%

• Imbalance and

• S!ecific deficiency"

UNDERNUTRITION7 tis is te condition #ic results #en insufficient food is

eaten o&er an e9tended !eriod of time" In e9treme cases% it is called star&ation"

Undernutrition is a form of malnutrition" Undernutrition can result from inade>uate

in$estion of nutrients% malabsor!tion% im!aired metabolism% loss of nutrients due

to diarrea% or increased nutritional re>uirements <as occurs in cancer or

infection=" Undernutrition !ro$resses in sta$es* eac sta$e usually ta+es

considerable time to de&elo!" ;irst% nutrient le&els in blood and tissues can$e%

follo#ed by intracellular can$es in biocemical functions and structure"

Ultimately% sym!toms and si$ns a!!ear"

Ris& Factors

Undernutrition is associated #it many disorders and circumstances% includin$

!o&erty and social de!ri&ation" Ris+ is also $reater at certain times <ie% durin$

infancy% early cildood% adolescence% !re$nancy% breastfeedin$% and old a$e="

Problems $enerated due to undernutrition are75

• :arnitine )eficiency

• "Essential ;atty Acid )eficiency

• Protien ener$y malnutrition <PEM=

$ROTIEN ENER'( MALNUTRITION )$EM*"#

$EM is a $rou! of !atolo$ical conditions of &aryin$ de$ree of se&erity

arisin$ from a lac+% in &aryin$ !ro!ortions% of !roteins and calories" Tey are

!reci!itated by attac+s of infections"



Tey manifest as $ro#t failure% lo# body #ei$t and nutritional

y!o!rotinemia" It accounts for 4@ of deats in !rescool cildren" About 0@ of

cases are se&ere enou$ to need os!itali?ation" About 04@ of !ediatric beds% at

any one time% are occu!ied by cases of $EM+

,LA--IFI,ATION

Under nutrition in $eneral is classified as follo#s75'RADE .755C@ of reference #ei$t for a$e <RDA=% #ic is te 4 t centile

<median= #ei$t of 8ar&ard standards"

'RADE /75 656C@ of RDA"

'RADE 075 Less tan 6@ of RDA"

An additional $rade 4t is reco$ni?ed by te Indian academy of !ediatrics

and is defined as less tan 4@ RDA"

TREATMENT"##

)e!ends on te se&erity of PEM755

).*"# For !ild to !oderator cases1 the 2arents are ad3ised to do

as follows"#

• ,i&e te cild more of foods bein$ already $i&en"

• Increase te number of meals includin$ snac+s of 4 or 6"

• Include ,LVs in te diet"

• Enric te meals #it te addition of a little oil% an e$$ or e9tra mil+"

)/*"#Nutrition reha4ilitation75

Moderate cases of PEM and tose se&ere cases tat

do not re>uire os!itali?ation are treated at a -nutrition reabilitation centre/" Tis

is a sim!le% ut li+e structure #it a &e$etable and fruit $arden around it" In tis

centre cildren are treated for PEM and teir moters educated in te ri$t

metods of cildcare% feedin$% $ardenin$ and nutrition"

Te !ediatrician% a nurse% a !armacist% a ealt instructor% #ard boys%

el!ers and $ardeners staff te nutrition reabilitation centre" Te moter stays

eiter full time in te centre% or only durin$ te day% returnin$ ome for te li$t"

Te moters are $i&en education and so#n demonstration of te correct

coo+in$ metods #it te el! of te locally a&ailable foods" Te &essels% te

fuel% te sto&e% etc% in tese demonstration bear te local caracter of te &illa$e

#ere te centre is set u!" Te moters are encoura$ed to discuss te learnt

sub.ects amon$st temsel&es" Tey !artici!ate in loo+in$ after +itcen $arden



attaced to te centre" Te moters ta+e !art in te treatment of te cild and

note te im!ro&e tat e or se s!eedily ma+es"

<2= Se&ere cases of PEM are admitted to a !ediatric os!ital or #ard" Te

!rinci!les of teir mana$ement are $i&en belo#7

<a= Pro&ision of 1 +calF+$ of ener$y and 3 $F+$ of !rotein $radually in

te case of marasmus and a$$ressi&ely in tat of +#asior+or" <b= Treatment of accom!anyin$ nutritional deficiencies"

<c= Treatment of underlyin$ or accom!anyin$ infections% if any"

<d= Early detections of com!lications li+e deydration% y!otermia%

y!o$lycemia% etc"% by +ee!in$ a continuity &i$il and teir !rom!t treatment

sould tey de&elo!"

<e= Nutrition education of te !arents"

$RE5ENTION OF $EM

).* Educate about ome made i$ !rotein mi9ture" Moters are educated to

!re!are te follo#in$ i$5 !rotein mi9 at ome and use it in cild feedin$75 Ra$i

14,

Deat or rice 14,

,reen ,ram 14,

,roundnuts 0,

Til <sesame= 4,

Su$arFGa$$ery 2,

All te items e9ce!t su$ar or .a$$ery are se!arately fried" Ten tey are

mi9ed to$eter% su$ar or .a$$ery added% and #ole $round" Te resultin$ !o#der

is stored in a tin #it a ti$t lid" Si9ty , is mi9ed #it a little #ater to form

!orrid$e and fed to te cild t#o times a day" Alternati&ely te !o#der is mi9ed

#it a little $ee and made into ladoos" T#o of tem are $i&en to te cild e&ery

day"

)/* Education about breast feedin$" Moters are educated to start breast Hfeedin$ te baby #itin our of its birt and continue for t#o years" ;or te first

four monts tey are told not to $i&e anytin$ to te baby oter tan moter(s

mil+" All os!itals and maternity omes are ad&ised to !romote e9clusi&e breast5

feedin$ as abo&e"

)0* Early detection of PEM" Tis is !ossible trou$ $ro#t monitorin$" If PEM is

detected it is at once suitably treated"



)6* Nutrition su!!lementation #it te el! of mil+ !o#der% mid day etc"% is

carried out for te benefit of te &ulnerable $rou!s suc as te !re$nant and

lactatin$ #omen% !rescool etc"

)7* Te follo#in$ measures are underta+en to increase food !roduction%

im!ro&e food distribution and lo#er te food !rice7

Land reforms"

Im!ro&ed food tecnolo$y"

)istribution of certified im!ro&ed seeds to farmers"

)ri! irri$ation"

Subsidy for fertili?ers"

Subsidi?ed foods trou$ !ublic distribution system"

Post5 ar&est $odo#n <stora$e= facilities"

:reation of a buffer stoc+ of foods"

)8* All !ossible measures for te stabili?ation of te !o!ulation"

)9* Po&erty alle&iation measures" Tese are te follo#in$ 7 trainin$ of

yout in tecnical s+ills% easy loan facilities for settin$ u! business &entures*

community centers for andicraft* food for #or+* and #a$es for #or+"

):* :ontrol of endemic diseases trou$ immuni?ations% ORS tera!y%

!eriodic de#ormin$% cotrima9a?ole for ARIs% !rotected #ater su!!ly% sanitary

dis!osal of e9creta etc"

/" O3ernutrition" Tis is te !atolo$ical state resultin$ from te consum!tion

of e9cessi&e >uantity of food o&er an e9tended !eriod of time" Te i$ incidence

of obesity% ateroma and diabetes in #estern societies is attributed to

o&ernutrition"

O%E-IT(

Obesity is e9cess body fat* conse>uences de!end not only on te absolute

amount but also on te distribution of te fat" :om!lications includecardio&ascular disorders% diabetes mellitus% many cancers% colelitiasis% fatty

li&er and cirrosis% osteoartritis% re!roducti&e disorders in men and #omen%

!sycolo$ic disorders% and !remature deat" )ia$nosis is based on body mass

inde9 <BMIJcalculated from ei$t and #ei$t= and #aist circumference" BP%

fastin$ !lasma $lucose% and li!id le&els sould be measured" Treatment includes

!ysical acti&ity% dietary and bea&ioral modification% and sometimes dru$s or

sur$ery"

Etiology



Almost all cases of obesity result from a combination of $enetic !redis!osition

and a cronic imbalance bet#een ener$y inta+e% ener$y utili?ation for basic

metabolic !rocesses% and ener$y e9!enditure from !ysical acti&ity"

'enetic factors" 8eritability of BMI is about 66@" ,enetic factors may affect te

many si$nalin$ molecules and rece!tors used by !arts of te y!otalamus and

,I tract to re$ulate food inta+e" Rarely% obesity results from abnormal le&els of

!e!tides tat re$ulate food inta+e <e$% le!tin= or abnormalities in teir rece!tors

<e$% melanocortin53 rece!tor="

,enetic factors also re$ulate ener$y e9!enditure% includin$ BMR% diet5induced

termo$enesis% and non&oluntary acti&ityHassociated termo$enesis" ,enetic

factors may a&e a $reater effect on te distribution of body fat% !articularly

abdominal fat <see Obesity and te Metabolic Syndrome7 Metabolic Syndrome=%

tan on te amount of body fat"

En3iron!ental factors" Dei$t is $ained #en caloric inta+e e9ceeds ener$y

needs" Im!ortant determinants of ener$y inta+e include !ortion si?es and te

ener$y density of te food" 8i$5fat foods% !rocessed foods% and diets i$ in

refined carboydrates% soft drin+s% fruit .uices% and alcool !romote #ei$t $ain"

)iets i$ in fres fruit and &e$etables% fiber% and com!le9 carboydrates% #it

#ater as te main fluid consumed% minimi?e #ei$t $ain" A sedentary lifestyle

!romotes #ei$t $ain"

Regulatory factors" Prenatal maternal obesity% !renatal maternal smo+in$%

intrauterine $ro#t restriction% and insufficient slee! can disturb #ei$tre$ulation" About 04@ of #omen !ermanently $ain K 1 lb #it eac !re$nancy"

Obesity tat !ersists beyond early cildood ma+es #ei$t loss in later life more

difficult"

)ru$s% includin$ corticosteroids% litium% traditional antide!ressants <tricyclics%

tetracyclics% and monoamine o9idase inibitors MAOIs=% ben?odia?e!ines% and

anti!sycotic dru$s% often cause #ei$t $ain"

Uncommonly% #ei$t $ain is caused by one of te follo#in$ disorders7

• Brain dama$e caused by a tumor <es!ecially a cranio!aryn$ioma= or aninfection <!articularly tose affectin$ te y!otalamus=% #ic can stimulateconsum!tion of e9cess calories

• 8y!erinsulinism due to !ancreatic tumors

• 8y!ercortisolism due to :usin$s syndrome% #ic !roduces

!redominantly abdominal obesity

• 8y!otyroidism <rarely a cause of substantial #ei$t $ain=

http://www.merck.com/mmpe/sec01/ch006/ch006c.html

http://www.merck.com/mmpe/sec01/ch006/ch006c.html



Eating disorders" At least 1 !atolo$ic eatin$ !atterns may be associated #it

obesity7

• %inge eating disorder is consum!tion of lar$e amounts of food >uic+ly

#it a sub.ecti&e sense of loss of control durin$ te bin$e and distress after it"Tis disorder does not include com!ensatory bea&iors% suc as &omitin$"Pre&alence is 0 to 2@ amon$ bot se9es and 0 to 1@ amon$ !eo!le

enterin$ #ei$t reduction !ro$rams" Obesity is usually se&ere% lar$e amountsof #ei$t are fre>uently $ained or lost% and !ronounced !sycolo$icdisturbances are !resent"

Night#eating syndro!e consists of mornin$ anore9ia% e&enin$ y!er!a$ia% and

insomnia" At least 14 to 4@ of daily inta+e occurs after te e&enin$ meal" About

0@ of !eo!le see+in$ treatment for se&ere obesity may a&e tis disorder"

Rarely% a similar disorder is induced by use of a y!notic suc as ?ol!idem

,o!2lications

:om!lications of obesity include te follo#in$7

• Metabolic syndrome

• )iabetes mellitus

• :ardio&ascular disease

• Nonalcoolic steatoe!atitis <fatty li&er=

• ,allbladder disease

• ,astroeso!a$eal reflu9

• Obstructi&e slee! a!nea

• Re!roducti&e system disorders

• Many cancers

• Osteoartritis

• Social and !sycolo$ic !roblems

Diagnosis

• BMI

• Daist circumference

• Sometimes body com!osition analysis

Treat!ent

• Nutrition mana$ement• Pysical acti&ity

• Bea&ioral tera!y

)ru$s <e$% sibutramine% orlistat=

Nutrition" A normal eatin$ !attern is im!ortant" Peo!le #o miss brea+fast tend

to !assi&ely consume too many calories later in te day" Patients sould eat

small meals and a&oid or carefully coose snac+s" Lo#5fat <!articularly &ery lo#

saturated fat=% i$5fiber diets #it modest calorie restriction <by 6 +calFday=



and substitution of some !rotein for carboydrate a!!ear to a&e te best lon$5

term outcome" ;res fruits and &e$etables and salads sould be substituted for

refined carboydrates and !rocessed food% and #ater for soft drin+s or .uices"

Alcool consum!tion sould be limited to moderate le&els"

$hysical acti3ity" E9ercise increases ener$y e9!enditure% BMR% and diet5

induced termo$enesis" E9ercise also seems to re$ulate a!!etite to more closely

matc caloric needs" Oter benefits include

• Increased insulin sensiti&ity

• Im!ro&ed !lasma li!id !rofile

• Lo#er BP

• Better aerobic fitness

• Im!ro&ed !sycolo$ic #ell5bein$

Stren$tenin$ <resistance= e9ercises increase muscle mass" Because muscle

tissue burns more calories at rest tan does fat tissue% increasin$ muscle mass!roduces lastin$ increases in BMR" E9ercise tat is interestin$ and en.oyable is

more li+ely to be sustained" A combination of aerobic and resistance e9ercise is

better tan eiter alone"

%eha3ioral thera2y" Bea&ioral tera!y aims to im!ro&e eatin$ abits and

!ysical acti&ity le&el" Ri$id dietin$ is discoura$ed in fa&or of ealty eatin$"

:ommon5sense measures include te follo#in$7

• A&oidin$ i$5calorie snac+s

• :oosin$ ealtful foods #en dinin$ out

• Eatin$ slo#ly

• Substitutin$ a !ysically acti&e obby for a !assi&e one

Social su!!ort% co$niti&e tera!y% and stress mana$ement may el!% !articularly

durin$ te la!ses usually e9!erienced durin$ any lon$5term #ei$t loss !ro$ram"

Self5monitorin$ is useful% and maintenance of a diet diary is !articularly effecti&e"

Drugs" )ru$s may be used if BMI is 2 or if BMI is 1 and !atients a&e

com!lications <e$% y!ertension% insulin resistance=" Most #ei$t loss due to dru$

treatment is modest <4 to 0@= at best and occurs durin$ te first 6 mo* not all

!atients benefit" )ru$s are more useful for maintainin$ #ei$t loss but must be

continued indefinitely for #ei$t loss to be maintained" Premeno!ausal #omen

ta+in$ systemically actin$ dru$s for #ei$t control sould use contrace!tion"

Metabolic syndrome <syndrome % insulin resistance syndrome= is caracteri?ed

by a clusterin$ of ris+ factors for cardio&ascular disease and ty!e 1 diabetes

-urgery" Sur$ery is te most effecti&e treatment for e9tremely obese !atients

Metabolic Syndrome



mellitus" Tey commonly include e9cess intra5abdominal fat% insulin resistance%

and K 0 of te follo#in$7 ele&ated !lasma tri$lyceride le&els% decreased i$

density li!o!rotein <8)L= colesterol le&el% and y!ertension" :auses%

com!lications% dia$nosis% and treatment are similar to tose of obesity"

2+ I!4alance7 it is te !atolo$ical state resultin$ from a dis!ro!ortion amon$

essential nutrients #it or #itout te absolute deficiency of any nutrient"

Some of te common !roblems #ic lead to nutritional imbalance are discuss

belo# #it teir solutions"

• Decreased a22etite

• Heart4urn

• Nausea

• Diarrhoea

• ,onsti2ation

6+ -2ecific DeficiencyMenral deficiency and to;icity

Si9 macrominerals are re>uired by !eo!le in $ram amounts" ;our <Na% Q% :a%

and M$= are cations* t#o <:l and P= are accom!anyin$ anions" )aily

re>uirements ran$e from "2 to 1" $" Bone% muscle% eart% and brain function

de!end on tese minerals"

Nine trace minerals <microminerals= are re>uired by !eo!le in minute amounts7cromium% co!!er% iodine% iron% fluorine% man$anese% molybdenum% selenium%and ?inc"

TRACE ELEMENTSIRON

The iron is of great importance in human nutrition. The adult human body contains between 4 to 5 mg of iron, of which about 60-70 percent is present in blood as circulating

iron, and the rest as storage iron. Each gram haemoglobin contains about .4 mg of iron.EFFECTS OF IRON-DEFICIENCY

The end result of iron-deficiency is nutritional anaemia which is not a disease entity. !t israther a syndrome caused by malnutrition. besides anaemia there may be other functional

disturbance to infection, increased mobidity and mortality and diminished wor"

performance.

$re3ention of Iron Deficiency

It can el! to understand o# to !re&ent iron deficiency if you understand o#te body stores iron" Babies% unless tey are born !remature% are born #it all ofte iron tey need for te first 456 monts of life" After tat% unless tey are $i&enan iron su!!lement% tey can de&elo! iron deficiency% #ic means tat teydont a&e enou$ iron in teir body" If it continues% it #ill ten lead to irondeficiency anemia"



So to !re&ent iron deficiency% you sould breastfeed or $i&e your infant an ironfortified infant formula <a&oidin$ lo# iron formula= until tey are at least 01monts of a$e% and be$in an iron su!!lement by about 6 monts of a$e"

Startin$ an iron su!!lement doesnt necessarily mean startin$ tem on a &itamin#it iron tou$" Te usual su!!lement is sim!ly an iron fortified infant cereal$i&en once or t#ice a day" Remember tat !reemies or lo# birt #ei$t infantsdo usually also need a &itamin #it iron"

After you a&e introduced an iron fortified infant cereal% start one feedin$ a day of foods ric in &itamin : <e"$"% fruits% &e$etables% or .uice= to im!ro&e ironabsor!tion% !referably #it meals"

$re3ention of Iron Deficiency in Teens

To !re&ent iron deficiency in teens% tey sould be encoura$ed to eat iron5ricfoods and foods tat enance iron absor!tion" Tose #o are at ris+ of becomin$iron deficient sould be tested and $i&en an iron su!!lement if tey do a&e irondeficiency

,hro!iu!75Only 0 to 2@ of biolo$ically acti&e tri&alent cromium <:r= is

absorbed" Normal !lasma le&els are "4 to "4 $FL <0" to C"6 nmolFL="

:romium !otentiates insulin acti&ity and increases te $ro#t rate in

malnourised cildren" Su!!lements do not enance muscle si?e or stren$t in

men"

Deficiency" ;our !atients recei&in$ lon$5term TPN de&elo!ed !ossible

cromium deficiency% #it $lucose intolerance% #ei$t loss% ata9ia% and !eri!eral

neuro!aty" Sym!toms resol&ed in 2 #o #ere $i&en tri&alent cromium 04 to14 m$"

To;icity" 8i$ doses of tri&alent cromium $i&en !arenterally cause s+in

irritation% but lo#er doses $i&en orally are not to9ic" E9!osure to e9a&alent

cromium <:rO2= in te #or+!lace may irritate te s+in% lun$s% and ,I tract and

may cause !erforation of te nasal se!tum and lun$ carcinoma"

Fluorine

Most of te bodys fluorine <;= is contained in bones and teet" ;luoride <te ionic

form of fluorine= is #idely distributed in nature" Te main source of fluoride is

fluoridated drin+in$ #ater"

Deficiency" ;luorine deficiency can lead to dental caries and !ossibly

osteo!orosis" ;luoridation of #ater tat contains 0 !!m <te ideal= reduces te

incidence of dental caries" If a cilds drin+in$ #ater is not fluoridated% oral

fluoride su!!lements can be !rescribed"



To;icity" E9cess fluorine can accumulate in teet and bones% causin$ fluorosis"

)rin+in$ #ater containin$ 0 !!m is a common cause" Permanent teet tat

de&elo! durin$ i$ fluoride inta+e are most li+ely to be affected" E9!osure must

be muc $reater to affect deciduous teet"

Treatment in&ol&es reducin$ fluoride inta+e* e$% in areas #it i$ fluoride #ater

le&els% !atients sould not drin+ fluoridated #ater or ta+e fluoride su!!lements"

:ildren sould al#ays be told not to s#allo# fluoridated toot!astes

IODINE

In te body% iodine <I= is in&ol&ed !rimarily in te syntesis of 1 tyroid ormones%

tyro9ine <T3= and triiodotyronine <T2=" Iodine occurs in te en&ironment and in

te diet !rimarily as iodide" In adults% about @ of te iodide absorbed is

tra!!ed by te tyroid $land" Most en&ironmental iodine occurs in sea#ater as

iodide* a small amount enters te atmos!ere and% trou$ rain% enters $round

#ater and soil near te sea" Tus% !eo!le li&in$ far from te sea and at i$er

altitudes are at !articular ris+ of deficiency" ;ortifyin$ table salt #it iodide

<ty!ically $F$= el!s ensure ade>uate inta+e <04 $Fday=" Re>uirements are

i$er for !re$nant <11 $Fday= and lactatin$ <1C $Fday= #omen"

IODINE DEFI,IEN,(

)eficiency is rare in areas #ere iodi?ed salt is used but common #orld#ide"

Iodine deficiency de&elo!s #en iodide inta+e is 1 $Fday" In mild or moderate

deficiency% te tyroid $land% influenced by tyroid5stimulatin$ ormone <TS8=%

y!ertro!ies to concentrate iodide in itself% resultin$ in colloid $oiter" Usually%!atients remain eutyroid* o#e&er% se&ere iodine deficiency in adults may cause

y!otyroidism <endemic my9edema=" It can decrease fertility and increase ris+

of stillbirt% s!ontaneous abortion% and !renatal and infant mortality" Se&ere

maternal iodine deficiency retards fetal $ro#t and brain de&elo!ment%

sometimes resultin$ in birt defects% and% in infants% causes cretinism% #ic may

include mental retardation% deaf mutism% difficulty #al+in$% sort stature% and

sometimes y!otyroidism"

Treat!ent

• Iodide #it or #itout le&otyro9ine

Infants #it iodine deficiency are $i&en L5tyro9ine 2 $F+$ !o onceFday for a

#ee+ !lus iodide 4 to C $ !o onceFday for se&eral #ee+s to >uic+ly restore a

eutyroid state" :ildren are treated #it iodide C to 01 $ onceFday" Adults

are $i&en iodide 04 $ onceFday" Iodine deficiency can also be treated by $i&in$

le&otyro9ine

IODINE TO<I,IT(



:ronic to9icity may de&elo! #en inta+e is 0"0 m$Fday" Most !eo!le #o

in$est e9cess amounts of iodine remain eutyroid" Some !eo!le #o in$est

e9cess amounts of iodine% !articularly tose #o #ere !re&iously deficient%

de&elo! y!ertyroidism <God5Basedo# !enomenon=" Parado9ically% e9cess

u!ta+e of iodine by te tyroid may inibit tyroid ormone syntesis <called

Dolff5:ai+off effect=" Tus% iodine to9icity can e&entually cause iodide $oiter%

y!otyroidism% or my9edema" Very lar$e amounts of iodide may cause a brassytaste in te mout% increased sali&ation% ,I irritation% and acneiform s+in lesions"

Patients e9!osed to fre>uent lar$e amounts of radio$ra!ic contrast dyes or te

dru$ amiodarone

Manganese

Man$anese <Mn=% necessary for ealty bone structure% is a com!onent of

se&eral en?yme systems% includin$ man$anese5s!ecific $lycosyltransferases and

!os!oenol!yru&ate carbo9y+inase" Median inta+e is bet#een 0"6 and 1"2

m$Fday* absor!tion is 4 to 0@"

Deficiency as not been conclusi&ely documented% altou$ one e9!erimental

case in a &olunteer resulted in transient dermatitis% y!ocolesterolemia% and

increased al+aline !os!atase le&els"

To;icity is usually limited to !eo!le #o mine and refine ore* !rolon$ed

e9!osure causes neurolo$ic sym!toms resemblin$ tose of !ar+insonism or

Dilsons disease"

FI%RE DEFI,IEN,( DI-ORDER-"## ;oods tat are deficient in fiber <residue or rou$a$e= !redis!ose to consti!ation% iatus ernia% emorroids%

dee! &ein trombosis% &aricose &ein% inflammation of te a!!endi9 and cancer

of colon"

5ita!ins deficiency disorders"#

5ITAMIN A DEFI,IEN,(

Te si$ns of &itamin A deficiency are !redominantly ocular" Tey includes ni$t

blindness% con.uncti&al 9erosis% bitot(s s!ots% corneal 9erosis and +eratomalacia"

Te term -9ero!talmia/ <dry eye= com!rises all te te ocular manifestation of

&itamin A deficiency from ni$t blindness to +eratomalacia"

,i&en belo# is a sort descri!tion of te ocular manifestations"

NI'HT %LINDNE--



• Irre$ular and ill5 formed teet

• Side to side com!ression of te cest !roducin$ !i$eon cest

• Protuberance of abdomen !roducin$ !ot li+e .elly

• 8uncin$ of te &ertebral column

• ;lattenin$ of te feet

$RE5ENTION"##Pro!yla9is is acie&ed #it 4 m$ of &itamin )

administered to !rescool cildren at inter&als of 6 monts" If it is !ossible

ten increase &itamin ) consum!tion

%ERI%ERI"#

INTRO)U:TION755 BERIBERI of &itamin B0 deficiency arises from

consumin$ i$ly !olised rice or o&er refined #eat flour" Alcoolism

!redis!oses to it" Beriberi is no# rarely encountered"

RE,O'NITION"#A,UTE OR INFANTILE %ERI%ERI"# Tis occurs

in infants #ose moters are sufferin$ from sub clinical tiamine deficiency"

Te infant is !ale and a!atetic" Infant cannot old is ead erect" Vomitin$%

oarseness and ble!aro!tosis are !resent" Edema and eart failure occur" If

treatment is delayed te infant dies from con&ulsions and coma"

,HRONI, %ERI%ERI"# Tiamine deficiency ta+es one of te follo#in$

tree forms75

<a= Te !atient% usually a male adult en$a$ed in ea&y manual #or+%

com!lains of a!aty% anore9ia% #ea+ness% ata9ia% calf tenderness%

tin$lin$% numbness% and decreased attention s!an" On e9amination%

y!orefle9ia and foot or #rist dro! are found" 8e is sufferin$ from dry

beriberi"

<b= Te !atient com!lains of !al!itations% sortness of breat% andcest !ain" On e9amination% edema% increased systolic !ressure and

!ulmonary con$estion are found" Tis is a case of #et beriberi"

<c= Te !atient com!lains of double &ision% difficulty in readin$%

insomnia% loss of memory% ata9ia and deterioration in i$er mental

functions" 8e is a case of Dernic+e(s ence!alo!aty"



$RE5ENTION"# Peo!le are educated to consume !arboiled or ome H

!ounded rice" Tey are moti&ated not to #as rice re!eatedly% not to coo+ in

e9cess #ater% and not to discard $ruel"

Te !ossible a!!roaces to !re&ention are te

fortification of rice #it tiamine% su!!ly of tiamine tablets to !re$nant

#omen and culti&ation of ybrid rice containin$ a i$ !ercenta$e of tiamine"RI%OFLA5IN DEFI,IEN,("# Te indi&idual sufferin$ from ribofla&in

deficiency com!lains of #ea+ness% sore troat% burnin$ and itcin$ in te eye%

on e9amination% ceilosis% $lossitis% an$ular stomatitis% nasolabial seborroeic

dermatitis and corneal &asculari?ation are found" Educatin$ te !eo!le to

consume !lenty of colored &e$etables and fruits is effecti&e in !re&entin$ tis

disease"

$ELLA'RA"#

INTRODU,TION"# Pella$ra < )ry s+in = is a cronic disease of s+in%

intestinal canal and te ner&ous system caused by te deficiency of niacin or

its !recursor try!ti!an" It is !reci!itated by an imbalance bet#een leucine

and isoleucine" Unli+e most oter nutritional deficiency states tat are

common amon$ youn$ cildren% !ella$ra affects !redominantly adults a$ed

153C years" Te !atients are $enerally farmers and !easants #o #or+ for

ours in te ot sun and #ose sta!le diet is eiter .o#ar or mai?e" Pella$ra

is a disease of !o&erty < .o#ar and mai?e are cea! cereals =% lo# standard of

li&in$ and !oor en&ironmental sanitation"

Te !ella$ra !atients com!lains of diarrea% letar$y% #ea+ness in lo#er

limbs% confusion% &erti$o and occasionally loss of memory and decrease in

i$er mental functions"

Pella$ra dermatitis is se&ere in #inter tan in summer" It is seen on !arts

of s+in e9!osed in sun" dermatitis on foreead% nose% and cee+s form a

butterfly on a face" )ermatitis on nec+ and u!!er !art of te cest $i&es rise

to :asal(s nec+lace" )ermatitis of dorsum of ands and forearms u! to te rim

of slee&es !roduces !ella$ra $lo&es" And dermatitis of feet and le$s u! to te

ed$e of trousers !roduces !ella$ra soes" Tere is a clear demarcation

bet#een te effected and ealty s+in"



$RE5ENTION"# Peo!le are educated to !roduce and consume a &ariety of

cro!s instead of mai?e or .o#ar alone" A !ossible metod of !re&ention is te

fortification of mai?e or .o#ar #it niacin

-,UR5("#

INTRODU,TION"# Scur&y% &itamin : deficiency% !re&iously used to occur

amon$ sailors and te inmates of .ails% Military barrac+s and or!ana$es" It is

no# seen in !ersons #ose diet lac+s fres fruits and &e$etables and rarely

in infants and !e!tic ulcers !atients #o are subsistin$ on mil+ not

su!!lemented #it ascorbic acid"

RE,O'NITION"# -,UR5( IN ADULT-"# Deariness% letar$y% acin$

in limbs% de!ression% loss of moti&ation are te cief sym!toms of scur&y in

adults"

Te si$ns are bleedin$ from $ums and delayed #ound ealin$

-,UR5( IN INFANT-"## Te moter of an infant older tan 6 monts

see+s ad&ice for its irritability% e9cessi&e cryin$% anore9ia and inability to mo&e

its le$s"

$RE5ENTION"# Peo!le are educated to $ro# and consume fruits" Tey are

ad&ised to conser&e &itamin : by obser&in$ te follo#in$ rules"

• Eatin$ te fruits and &e$etables as soon after $aterin$ tem as

!ossible

• :uttin$ tem only #it a sar! +nife

• A&oidin$ e9!osure of te cut fruits and &e$etables #it te air and

li$t

• :oo+in$ &e$etables #it teir s+in on

• ;irst boilin$ #ater and ten addin$ te &e$etables into it rater tan

addin$ &e$etables to cold #ater and ten boilin$ it

• A&oidin$ te use of soda for coo+in$

FLUORO-I-"#

;luorosis results from% drin+in$ #ater containin$ more

tan 0"4 m$Fl of fluorides" It is common in tose #ose sta!le diet is sor$um"

It is a !ublic ealt !roblem in Andra Prades% Qarnata+a% and Tamil nadu%



Pun.ab% 8aryana% Ra.astan and Uttar Prades" E9cessi&e fluoride in$estion

$i&es rise to de!osition of calcium in bones% tendons and .oints" S!inal cord

and ner&e roots are affected secondarily on account of te in&ol&ement of te

&ertebral column"

RE:O,NITION75 Te !atients com!lains of tin$lin$ and numbness in te

limbs% abnormal breatin$ and inability to #al+ and loo+ side#ays" One9amination te bac+ is cur&ed% te .oints of te lo#er e9tremities are often

fi9ed and !ainful" On ins!ection of te oral ca&ity% te !ermanent teet are

seen to be cal+y #ite and riddled #it bro#n mottlin$

$RE5ENTION"## ;luorosis is !re&ented by te defluoridation of community

#ater su!!ly"

NUTRITIONAL DEFI,IEN,( ANAEMIA"#

;or Indians anemia is a condition in #ic emo$lobin is less tan

0$F0ml <D8O cutoff !oint is 02$Fdl" Anemia is te commonest N)) in

India"

;ollo#in$ are te im!ortant e!idemiolo$ical factors contributin$ to te

de&elo!ment of anemia

<a= :onsum!tion of a !redominantly cereal based diet% tou$ te iron

content of te diet is ade>uate% yet only 4@ of it is actually absorbed"

<b= :onsum!tion of diet lo# in calcium% co!!er and &itamin :% all of

#ic are necessary for te formation of emo$lobin"

<c= Ancylostomias and% to a lesser e9tent% tricuriasis" Te elmintes

res!onsible drin+ blood of te ost and cause loss of iron tat could be

as i$ as 1m$Fday"

RE,O'NITION "

Te anemic !atient com!lains of lac+ of concentration% ready fati$ability%

insomnia% !al!itation% eadace% tinnitus% consti!ation% e9ercise intolerance%

difficulty in s#allo#in$ solid foods% burnin$ sensation in ton$ue% bone !ains% loss

of libido and menstrual irre$ularity

On e9amination is s+in% ton$ue% oral mucosa and con.uncti&a are !ale"

In se&ere cases te !almer creases too !ale" Nails are !ale% brittle and so#

s!oon sa!ed conca&ity" ,lossitis is !resent" Tere is restin$ tacycardia"



TREATMENT"

Anemia is treated #it ferrous sulfate% 1m$ of elemental iron% !er day"

It is continued till te emo$lobin reaces normal &alue of 0$F0ml" in !re$nant

#omen 2 tablets of folifer% eac #it elemental iron of 6m$ and folate

4umFday are $i&en for 0 days

Te !atient is treated for oo+#orm infestation #it mebenda?ole0m$Fday for 2 days

IN5E-TI'ATION

Any cause for blood loss is in&esti$ated% for e9am!le stool for occult

blood

$RE5ENTATION"#durin$ !re$nancy 1 tablets of folic acid daily are $i&en for

0 days" Prescool cildren are $i&en folic acid !ediatrics tablets #it 1m$elemental iron and 0u$ folate% one tablet a day for 0 days" Peo!le are

educated and moti&ated to consume ra$i% .a$$ery% and $roundnuts and to a&oid

tea and antacids" Tey are ad&ised to use iron coo+#are" To a&oid oo+#orm

diseases tey are e9orted to use sanitary latrines and #ear foot #ares" A

!ossible metod of !re&ention is te fortification of salt% #eat flour or su$ar #it

iron and &itamin :"

,(ANO,O%ALAMIN DEFI,IEN,( ANEAMIA

Tis is not a !ublic ealt !roblem" It occurs in

infants #ose nursin$ moters are recei&in$ !oor su!!ly of cyanocobalamin in

teir diet" It is also seen in !ersons sufferin$ from )i!yllobotrium latum

infestation" Tis #orm absorbs all te &itamin B01 !resent in te diet" Lastly it is

seen in te $astrectomised !atient" In tem% te cause is te absence of te

'intrinsic factor( tat normally occur in te stomac" Tis factor is necessary for

te absor!tion of cynocobalamin" <Te anemia tat occurs from te con$enital

absence of intrinsic factor is called !ernicious anemia"="

RE,O'NITION"#

Te clinical !icture is similar to tat of folate deficiency anemia"

Additionally neurolo$ical sym!toms li+e sensory disturbance% motor #ea+ness%

!eri!eral neuro!aties and sub acute combined de$eneration of te s!inal cord

may be !resent"

TREATEMENT"#



Vitamin B01"

$RE5ENTION"#

Tem!orary cyanocobalamin su!!lementation is recommended

for te &e$etarian moters #o are nursin$ teir baby and !ermanent

re!lacement tera!y for !ersons #o a&e under$one $astrectomy"

OTHER NUTRITIONAL $RO%LEM-

• ;ood aller$y

• Eatin$ disorders

• Anore;ia ner3osa

• ;ailure to tri&e

Nutritional 2ro4le!s of children"#

• Obesity%

• )iabetes%

• 8eart )isease%

• Eatin$ )isorders%

• Malnutrition%

•

deficiency disorders etc"

Nutritional problems of adolesents#-

• $besity,%iabetes, &eart %isease.Eating %isorders.

High#Ris& 'rou2s

:ertain $rou!s of adolescents may be at ris+ for nutritional inade>uacies"

$regnant Teens+

Den a teena$er becomes !re$nant% se needs enou$ nutrients to su!!ort

bot er baby and er o#n continued $ro#t and !ysical de&elo!ment" If er

nutritional needs are not met% er baby may be born #it lo# birt #ei$t or oter

ealt !roblems" ;or te best outcome% !re$nant teens need to see+ !renatal

care and nutrition ad&ice early in teir !re$nancy"

Athletes+

http://www.faqs.org/nutrition/Met-Obe/Nutrients.html

http://www.faqs.org/nutrition/Met-Obe/Nutrients.html



Adolescents in&ol&ed in atletics may feel !ressure to be at a !articular #ei$t or

to !erform at a certain le&el" Some youn$ atletes may be tem!ted to ado!t

unealtful bea&iors suc as cras dietin$% ta+in$ su!!lements to im!ro&e

!erformance% or eatin$ unealtful foods to fulfill teir earty a!!etites" A

balanced nutritional outloo+ is im!ortant for $ood ealt and atletic

!erformance"

5egetarians+

A &e$etarian diet can be a &ery ealty o!tion" 8o#e&er% adolescents #o follo#

a &e$etarian diet% #eter for reli$ious or !ersonal reasons% need to carefully

!lan teir inta+e to $et te !rotein and !inerals tey need" Strict &e$etarians

<tose #o do not eat e$$s or dairy !roducts=% also +no#n as 3egans % may need

nutritional su!!lements to meet teir needs for calcium% &itamin B 01 % and iron"

Nutritional 2ro4le!s of elderly

Malnutrition is common in elderly !ersons li&in$ in institutions and in te

community" In many cases% te !roblem arises from a i$ly indi&idual

constellation of interactin$ !ysiolo$ic% economic% and !sycosocial causes tat

a&e te common effect of reducin$ nutrient inta+e" Protein5calorie and

micronutrient undernutrition added to te normal effects of a$in$ can undermine

functional inde!endence and diminis te >uality of life of te elderly" Te

s!ectrum of te elderly is e9tremely broad% and% conse>uently% nutritional

assessment and su!!ort must be i$ly indi&iduali?ed to be effecti&e" A

multidisci!linary a!!roac focusin$ on !rom!t identification and treatment of

correctable causes of undernutrition is most effecti&e" Tere is a #ide ran$e of

su!!ort modalities% from sim!le su!!lemental foods to total !arenteral nutrition%

any of #ic may be used successfully in an elderly !atient% !ro&ided tat te

necessary care is ta+en to define te $oals of tera!y and to !ro&ide !atient

assessment and monitorin$"

%I%LIO'RA$H(

• indrani TQ" Nursin$ manual of nutrition and tera!eutic diet" 0 st Ed" 'ew

%elhi# (aypee publishers# )p*++-04.

http://www.faqs.org/nutrition/Diab-Em/Diet.html

http://www.faqs.org/nutrition/Met-Obe/Minerals.html

http://www.faqs.org/nutrition/Diab-Em/Diet.html

http://www.faqs.org/nutrition/Met-Obe/Minerals.html



• .)ar" ". )reentie and social health medicine. Ed 7 th. 'ew %elhi (aypee

publishers# )p*+4-4+

• .%r./ 1. principles of community health nursing. Ed rd. 2!T/1 publishers

new %elhi# pp-5-3

• ###"comFdocF11C2Fcommunity nutrition

• ###"current community ealt nursin$"comFnutritions"tm

• D##"en"#i+i!edia"or$F#i+iF

• tt!7FFscolar"$oo$le"co"inFscolar

>W&ariousXnutritionalX!roblemsXofXelderlyYlWenYasZsdtWYasZ&isW0Yoi

Wscolart• tt!7FFnos"or$F210courseeFOPTIONALZA@1L51@1NUTRITIONAL

@1PROBLEMS@1IN@1IN)IA"!df

CLASSPRESENTATION

SUBJECT- ADVANCED NURSING PRACTICE

TOPIC- !ARIO"S N"TRITIONAL #RO$LEMS

SUBMITTED TO- Ms.JISA GEORGE.(LECTURER)

S.G.R.D.C.O.N, HOSHIARPUR.

http://www.com/doc/22983/community

http://www.current/

http://www.en.wikipedia.org/wiki/

http://scholar.google.co.in/scholar?q=various+nutritional+problems+of+elderly&hl=en&as_sdt=0&as_vis=1&oi=scholart



http://nos.org/321coursee/OPTIONAL_A%20L-28%20NUTRITIONAL%20PROBLEMS%20IN%20INDIA.pdf


http://www.com/doc/22983/community

http://www.current/

http://www.en.wikipedia.org/wiki/








SUBMITTED BY- RAMANDEEP KAUR ROLL NO- 10

M.Sc.(N) 1s !"#$

various nutritional problem1

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