Diet in Nutritional Anemia.pptx

Nutritional anemia

1. Diet in Nutritional Anemia

2. Outline Introduction Global anemia prevalence Types of nutritional anemia Iron deficiency anemia Megaloblastic anemia Pernicious anemia Others Dietary modifications Sample diet plan

3. Nutritional Anemia Deficiency in size or number of red blood cells or amount of hemoglobin they contain, due to a poor diet, which is deficient in Iron, copper & folate vitamin B12 ,B6 & E Protein & essential fatty acids Not a disease but a symptom of conditions including extensive blood loss, excessive blood cell destruction, or decreased blood cell formation

4. Global anemia prevalence and number of individuals affected Globally, anemia affects 1.62 billion people which corresponds to 24.8% of the population The highest prevalence is in preschool-age children 47.4% and the lowest prevalence is in men 12.7% However, the population group with the greatest number of individuals affected is non-pregnant women (468.4 million) Source: Worldwide prevalence of anemia 1993-2005. World Health Organization, 2008.

5. Population group Prevalence of anemia Population affected Percent Number  (millions) Preschool-age children 47.4 293 School-age children 25.4 305 Pregnant women 41.8 56 Non-pregnant women 30.2 468 Men 12.7 260 Elderly 23.9 164 Total population 24.8 1620

6. Iron Deficiency Anemia Characterized by the production of small (microcytic) erythrocytes and diminished level of circulating hemoglobin Koilonchia—A Sign of Iron Deficiency Inadequate ingestion & absorption Defects in release from stores Increased requirement (From Callen JP, Greer KE, Hood AF, Paller AS, Swinyer LJ. Color Atlas of Dermatology. Philadelphia: W.B. Saunders, 1993.)

7. Megaloblastic Anemia A form of anemia characterized by the presence of large, immature, abnormal red blood cell progenitors in the bone marrow 95% of cases are attributable to folic acid or vitamin B 12 deficiency

8. Pernicious Anemia A macrocytic, Megaloblastic anemia caused by a deficiency of vitamin B 12. Usually secondary to lack of intrinsic factor (IF) May be caused by strict vegan diet Also can be caused by ↓gastric acid secretion, gastric atrophy, H-pylori, gastrectomy , disorders of the small intestine D rugs that inhibit B12 absorption including neomycin, alcohol, colchicine, metformin, pancreatic disease

9. Other Nutritional Anemia's Copper deficiency anemia Anemia of protein-energy malnutrition Sideroblastic (pyridoxine-responsive) anemia Vitamin E–responsive (hemolytic) anemia

10. Copper Deficiency Copper is required for mobilization of iron from storage sites In copper deficient state, result is low serum iron and hemoglobin, even when iron stores are normal Copper is widespread in foods and needed in tiny amounts Sometimes occurs in infants fed deficient formula or cow’s milk, adults and children with malabsorption or on TPN without copper Diagnosis is important, since more iron won’t help and may interfere with copper absorption

11. Sideroblastic Anemia Pyridoxine-responsive anemia, distinguished from anemia caused by pyridoxine deficiency Buildup of immature sideroblasts —hence the name B 6 is essential—must replace 25 to 100 times the RDA; may need lifelong replacement Oxidative damage to cells— lysis occurs Vitamin E is an antioxidant that seems to be protective. This anemia can occur in newborns, especially preemies. Hemolytic Anemia

12. Diet for nutritional anemia Diet must be provide the sufficient amount of all these nutrients Iron, copper & folate vitamin B12 ,B6 & E Protein & essential fatty acids Specially Iron , folate and vitamin b12

13. Dietary modification for Iron-Deficiency Anemia Increase iron rich foods Increase absorbable iron in the diet Include vitamin C at every meal Include meat, fish or poultry at every meal Decrease iron inhibitors consumption

14. Iron rich foods Red meat Egg yolks Dark, leafy greens (spinach, collards) Dried fruit (prunes, raisins) Iron-enriched cereals and grains Beans, lentils, chick peas and soybeans Liver

15. Absorbable iron haem vs non haem Haem iron Haem iron is provided by animal-origin foods (i.e. red meat and meat products, liver, kidneys, egg yolk, fish, chicken, etc.). derived from hemoglobin and myoglobin, which is highly absorbed. Absorption can range 8 to 40 % Non haem Non- haem iron, which is inorganic iron, very abundant in vegetable foods and in fortified foods (i.e. dried fruits and vegetables, wholegrain cereals, legumes). The bioavailability of non- haem iron is much lower than haem iron absorbed by 0.5–6%

16. Vitamins & iron absorption Vitamins like vitamin A and C enhance iron availability, thus counteracting the action of polyphenols and phytic acid Vitamin c by citrus fruits etc vitamin A are provided by both animal foods (cow's milk, eggs, cheese, yogurt, fish chicken) and plant foods (fruits and vegetables e.g. carrot & sweat potato)

17. Iron inhibitors iron absorption is inhibited by the presence of Phytic acid phenolic compounds Tannins Calcium Phytic acid found in whole grains, legumes , nuts & oil seed. Consuming 5-10 mg of phytic acid can reduce iron absorption by 50% phenolic compounds found in spices and herbs (i.e. chilli , garlic, pepper, shallot and turmeric) are potent inhibitors of iron availability, reducing iron availability from 20 to 90% in a dose-dependent manner Calcium more than 40mg Calcium seems to have a direct effect on haem iron absorption, counteracting the enhancing effect of meat. Up to 300mg calcium inhibit iron absorption 100%

18. Diet for vitamin b12 deficiency Animal source foods are rich in b12 specially sea food then meat and dairy products The dietary management of B12 deficiency includes a high-protein diet (1.5 g/kg body weight), a higher consumption of green leafy vegetables and food items rich in B12, i.e. meat, eggs and dairy products.

19. Diet for Folate deficiency Natural dietary sources of folate include citrus and other fruits, dark green leafy vegetables, and legumes & all flour and uncooked cereal grains. Folate is sensitive to high temperatures and cooking can destroy 50–95% of folate in the foods. Therefore, patients should be consume fresh fruit and vegetables.

20. Sample diet plan Breakfast : 250 milk, 7 almonds,2 bread slice 1 egg Mid morning snack : pomegranate juice 250 ml , 200g beef slice cooked with lemon ,125g mix vegetable salad Lunch : 2 fermented breads , 125g cooked liver (meat) with lemon, 1 raw tomato , 1 cucumber Snack : 250ml orang juice , 100g lentils bean Dinner : 200g boiled white rice , 200g chicken with lemon ,