Macro Nutrients for health students (1).pdf

Macro Nutrients for health students (1).pdf

3. Objective

After Completing this chapter the students is able to
= Recognize essential nutrients for life function

= Describe the characteristics, types, physiological functions,

and food sources of essential nutrients

= Explain recommended intakes and the adverse effects of

both inadequate and excessive intake of nutrients

4. Introduction

= Nutrients are substances found in food that gives us

nourishment. We take them from the foods we consume

or the different types of liquid we drink.

= There are six classes of nutrients found in the food.

1.

ARNO

Carbohydrate

Lipids (Fats and Oils)

Protein

Vitamins

Minerals

Water 4

5. Introduction...

= Nutrients can be assigned to three functional categories.

Nutrient classes that Promote growth, Regulate body
provide energy development, and processes

maintenance

v Most Y” Protein Y” Protein
carbohydrates Y” Lipids Y Some lipids
Y” Proteins Y” Some vitamins Y” Some vitamins
Y” Most lipids Y” Some minerals Y Some minerals

Y Water Y Water

6. Types of Nutrients

= Based on the amount needed each day

1. Macro Nutrients

2. Micro Nutrients

= Based on the ability of the body to synthesize
1. Essential Nutrients

2. Non-Essential Nutrients

7. Macro and Micro Nutrients

1. Macro Nutrients
= Nutrients required in large amount.
Ÿ i.e. Carbohydrates, Proteins, Lipids, and Waters.
= Mainly include calorie nutrients.
= Requirements daily given in a gram/day
= Micro Nutrients
= Nutrients required in small amount.
y i.e. Vitamins and Minerals.

= Requirements daily given in a milligram or microgram/day. ,

8. Essential and Non-Essential Nutrients

Essential nutrients

A mio Y The nutrients that can be
normal body functioning synthesized by the body
AAA SIESTA may also be absorbed from
by the body. foods.

MARIE Y Examples: Vitamin D,
acid (a-linolenic, linolenic) Cholesterol, most fatty

Most vitamins...etc. acids...etc.

10. Carbohydrates

“It is an organic class of compounds found in nature

abundantly.
= Contain the elements C, H and O.

" The term “Carbohydrate” came from fact that these

compounds could be written as “hydrates of carbon” .
= The name derived from the general formula (CH,O),

"Chemically can exists in food as simple sugar and

complex carbohydrates. 10

11. Classification of Carbohydrates

= Monosaccharides - simple sugar units that serve as the

basic unit of all carbohydrate structure.
= Disaccharides - 2 monosaccharides covalently linked.

= Polysaccharides - polymers consisting of chains of

monosaccharide or disaccharide units.

12. Monosaccharides

= Glucose, also known as dextrose
Y Major monosaccharide found in the body
v It is the end product of other CHO

Y It is oxidized to produce energy, heat and carbon
dioxide, which is exhaled in breathing.

= Fructose also called Fruit sugar
v Is the sweetest sugar

V Convert to glucose in the liver
Galactose

= Not found freely in food, but it is found
combined together with Lactose.

= Convert to glucose in the liver

13. Disaccharides

= Sucrose also known as Table sugar
y Composition of glucose + fructose

Y Least expensive & most common
sweetener

= Lactose also knownas Milk sugar
Ÿ Composition of galactose + glucose

Y Used for food processing, milk & milk
production, and pharmaceutical Industries

= Maltose also known as Malt sugar
v Not found freely in food
Y” As an intermediate in digestion of Starch

Y” Produce in the process of malting

Sucrose

Glucose

glycosidic bond >»
HOH,C _o.
Hi
A (CH,OH
A

ou
Fructose

Lactose CH,OH
hoy

H
CH,OH Ne
mojo. 0 OH

HOH
nea
Hon \B-glycosidic bond

Galactose

Glucose

Maltose

HOH HOH
H On) IH 00H
H

HH OHH
ue OH

H OH H OH

Glucose Glucose

a-glycosidic bond

14. Polysaccharides

= Composed of many glucose molecule may contain 1000
or more glucose units are chiefly found in grains,

vegetables and fruits.
= Contains more than 10 monosaccharide units

= Few (oligosaccharides) or many (polysaccharides) glucose
units bound/linked together in straight or branched chains.

v Examples: Starch, glycogen

15. Polysaccharides...

Starch

“Major storage carbohydrate in

plants. They store in two forms

1. Amylose — long straight glucose

chains

2. Amylopectin — branched every

24-30 glucose residues

‘Starch (amylose)

Starch (amylopectin)

16. Polysaccharides...

Fiber

= A structural part of the plant composed of many sugar units.

1.

Insoluble fibers are non viscous and are not digested by

intestinal bacteria.

Y These fibers are found in grains

Y Act as natural laxative

Soluble fibers are viscous and can be digested by intestinal

bacteria.

V These fibers are found in fruits and vegetables.
V Soluble Fibers have lower serum cholesterol level & reduce BGL in
Diabetics patient

17. Polysaccharides...

Glycogen

=" The only form of CHO that animals
&human stored

= In most foods of animal origin it is a
negligible source of dietary carbohydrate.

= The glycogen in the liver used as a
reserve fuel and it serves between

meals and over night.

18. Carbohydrate Concept Map

Simple Carbohydrates

Monosaccharides

Fructose | Galactose

Combine to form

Disaccharides

table sugar breakdown of starch

Sucrose Maltose
glucose + fructose glucose + glucose || glucose + galactose

Complex Carbohydrates

Polysaccharides

plants indigestible by humans animals

Glycogen
straight chain branched soluble insoluble

7 7 7 7 oon Stored in
Amylose Amylopectin Pectins, ec! Cellulose, etc. se sralıver

19. Food Sources of Carbohydrates

= Free sugars are found from: fruits, juices, Soft drinks, , milk, sugar,
sugar cane, honey and yogurt, Cereal grains, Legumes & dried fruits,
vegetables, processed foods (pasta), pastries, breads, candies fruits like

banana, and sweet potato

= Starch is found from: starchy foods (like cereals and legumes and

potatoes), Other foods like fruits, vegetables, beans, nuts, seeds

= Oligosaccharides are found from : Garlic, onion, Whole grain cereals

and legumes (beans and peas)

= Non starch polysaccharides are found from: Fruits, vegetables,

Whole grain cereals and legumes 19

20. Food Sources of Carbohydrates...

Top 10 foods with the highest
percentage of carbohydrate

Table sugar 99.9%

Hard candies & gummies 98-99%
Sugary cereals 90-93%

21. Brain storming

Is juicing
healthier than
eating whole
fruit or

vegetables?

22. Carbohydrate Digestion

= Eating food doesn’t simply supply nutrients to body cells.

Digestion and absorption must occur.

= The enzymatic digestion of carbohydrates begins in the
mouth by Salivary amylase (Ptyalin) produced by the

salivary glands.

= No carbohydrate digestion takes place in the stomach.

OOO: ED ED ED ED BD

‘amylase breaks the bonds between glucose molecules in starch 5

23. Carbohydrate Digestion...

= Digestion occurs mainly in the small intestine through the

action of pancreatic and intestinal juices containing the

enzymes amylase, lactase, sucrase, and maltase.

= Maltose Maltase Two glucose molecule.

= Sucrose Sucrase Glucose + Fructose
Lactas

= Lactose actase Glucose + Galactose

= Carbohydrates that can be digested and absorbed in the

human small intestine are referred to as ‘glycemic

carbohydrates.

24. Carbohydrate Digestion...

= Some plant polysaccharides in foods are resistant to
hydrolysis by human digestive enzymes and are referred

to as ‘dietary fiber’.

= These polysaccharides and the group of oligosaccharides
which are also not digested and absorbed in the small

intestine are described as ‘non-glycemic’ carbohydrates.

25. ‘Stomach
‘Stomach acid inactivates

‘enzymes. halting
starch digestion.

mattose
Then enzymes
‘on the surface of the small
intestinal cells hydrolyze the.
disaccharides into
monosaccharides:
Glucose
Mattose —Maltase 7 4
Glucose
Fructose
Sucrose Sue. 5
Glucose
Galactose
Lactose —bactase 5
Glucose

‘Stomach
Fiber is not digested. and it
delays gastric emptying.

26. Carbohydrate Absorption

= Carbohydrate mainly absorbed in Small intestine.
" Glucose & galactose- active transport

= Fructose — absorbed somewhat more slowly-by facilitated
diffusion The single sugar in absorptive cells are then

transferred to portal circulation > to liver.

= The liver then metabolize those sugars by transforming

monosaccharides galactose and fructose into glucose.

27. Reading assignment

? LACTOSE MALDIGESTION
AND INTOLERANCE

28. Glycemic index

= Not all complex carbohydrates are digested at the same rate;
Some carbohydrate sources lead to immediate rise in blood
Glucose levels after ingestion whereas others slowly raise

blood Glucose levels over an extended period after ingestion.

= Glycemic index of a food is an indication of how rapidly

blood Glucose levels rise after consumption

= The glycemic response to ingested foods depends: not only on
the glycemic index of the foods, but also on:

y The fiber content of the food. 28

29. Carbohydrate metabolism

= Carbohydrate metabolism denotes the various biochemical
processes responsible for the formation, breakdown and
interconversion of carbohydrates in living organisms.

= Glucose is the most important carbohydrate as it is
metabolized by nearly all organisms.

= There are three ways in which the tissues dispose blood

glucose:

V It may be utilized directly as a source of energy
v It may be stored in the form of glycogen

Y” If there is surplus of glucose, it will be converted into fats and
deposited as fats in the body.

30. Carbohydrate metabolism...

"= The two hormones which control the metabolisms of

carbohydrates in the human body are insulin and glucagon.

= Insulin is secreted by the beta cells of the islets of
Langerhans. Its secretion is stimulated by hyperglycemia

and parasympathetic nervous activity.

= Functions of insulin include:

v To facilitate glucose transport to the liver and muscle cells
v To facilitate formation of glycogen in the liver and muscle

cells
30

31. Carbohydrate metabolism...

= Glucagon is secreted by the alpha cells of the islet of
Langerhans and the secretion is stimulated by

hypoglycemia and sympathetic nervous activity

= Its function is to facilitate the breakdown of glycogen in

the liver and muscle cells into glucose.

32. Carbohydrate metabolism...

33. Functions of Carbohydrates

= Provide energy (4kcal/g)

= Prevent ketosis

= Sparing protein

= Supply carbon for synthesize of other compounds

= Promote growth of certain desirable bacteria in the intestine
= Needed for the regulation of body processes

= Insoluble fiber makes elimination of waste much easier

= Soluble fiber can reduce blood cholesterol and glucose level,

34. How much carbohydrate do we need?

Age Recommended minimum Carbohydrate as percent of
carbohydrate intake grams/day daily calorie intake

0-6 months 60g

7-12 months 959

1-8 years 130g 45-65
9-18 yrs 130 9 45-65
19+ years 130 9 45-65
Pregnancy 1759 45-65
Lactation 2109 45-65

35. How much fiber do we need?

Life stage group

Adequate intake (g/day)

Male Female

1-3 years 19 19
4-8 years 25 25
9-13 years 31 26
14-18 years 38 26
19-30 years 38 25
31-50 years 38 25
51-70 years 30 21
Over 70 years 30 21
Pregnancy 28
Lactation 29

36. Functions of Dietary fibers

"Increasing bulk of intestinal contents > by absorbing

water

= Stimulates peristaltic movements;
Y To reduce stool transit time and prevents constipation
= Bind & dilute bile acids

= Lower blood glucose and cholesterol

38. Brainstorming

Many People regard fats
and oils as foods which
should be avoided. Do
you agree? Why?

39. Lipids
= Lipids are a group of organic chemical compounds that are

insoluble in water but soluble in organic solvents.

= The class of nutrients known as lipids includes triglycerides

(fats and oils), phospholipids, and sterols.

= The most obvious lipids are fats and oils

40. Classification of Lipids

" Lipids are classified into three on the basis of their chemical

structure.

1. Simple lipids > Fats and oils (Triglycerides)
v 95% of dietary lipids (fats & oils)

2. Compound lipids > Phospho-lipids, Lipoproteins and
Glycolipids.

3. Derived lipids > Fatty acids and sterols

41. Fats and oils (Triglycerides)

= Triglycerides are lipids with
three fatty acids attached to a
glycerol.

" They are primary form of lipid.

=" Fatty acids are found in the

Triglycerides.

Glycerol

» A "free". Fatty Acid
HE 0H o

IONS
non
|

A

Triglyceride

i] ©.
ini SSA
TWA
2 nn

o

42. Fatty acids

= Fatty acids are the simplest form of

lipids found in the Triglycerides. .

" They are long chains of carbons

Acid
end

bonded together and flanked by Methyl

hydrogens. and

= At one end of the molecule ( alpha end)
is an acidic group and at other end

(the omega end) is a methyl group.

43

43. Classification of Fatty Acids

= Based on number of carbon atom

y Short chain (2-4C),
Y Medium chain (6-10C) &
y Long chain(12~26C) fatty acid

= According to whether it contains double bond or not

V Saturated — No carbon to carbon double bond
V Unsaturated fatty acid - Carbon to carbon double bond

= According to weather the body synthesize or not

v Essential

v Non- Essential

44. Saturated fatty acid

= All short/medium chain fatty acids

= Long Chain FA are either saturated or

0
unsaturated nnd
"The major Saturated FA in diet - Palmiic acd, 160
palmitic & stearic acids ‘ 9
PAIPA

= Mostly obtained from animal sources
Stearic acid, 18:0
such as butter, dairy product and meat. ‘

= Coconut oil & palm oil — are the only

plant sources of saturated fatty acids. 45

45. Unsaturated fatty acid

= Either they are Monounsaturated:

containing only one double & Q

HH

11
polyunsaturated: containing two HO en an ee
or more double bond. DER
Oleic Acid: Monounsaturated Fatty Acid

0

| IT

= Most common MUFA in the diet is H-0-C-t-(-(- cai anual
oleic acid HH AHH

Linoleic Acid- Polyunsaturated Falty Acid

= Most from plant origin

= Human breast milk rich in PUFA

acids ld

46. Essential Fatty Acids

= Cannot be synthesized by body

so, we must obtain from the
Hp Hp H oH m Hp Hp Hp

: ON A NET QUE SER SUR GE P
Omega 6 or n-6 fatty acid
= i i = H HH
Currently Linoleic (Omega-6 MEET
. . . H, H H H, H H; H; H;
fatty acid) and a-Linolenic AS

(Omega-3 fatty acid ) acids

are classified as essential acids.

47. Essential Fatty Acids...

Functions of FA
= Are needed for the normal functioning of all tissues
= Form a part of the structure of each cell membrane.

= Help transport nutrients and metabolites across the cell

membrane
= Are also involved in brain development
= Are important for immune function and vision

= Are needed for the synthesis of prostaglandin 48

48. Phospholipid

= Phospholipids contain glycerol, two
fatty acids and a phosphate group
with a molecule of choline.

= A well-known phospholipid is lecithin
which is made by liver.

= Food sources of lecithin include eggs,
liver, soybeans, wheat germ and
peanuts

"Roles of Phospholipids- enable
transport of lipids across cell
membranes, emulsifiers.

CHy—0—C—R

CH—O—C—R'

CHy—0—P—0

PA Norns

49. Sterols

= A class of lipid with a characteristic

of multi ringed structure.
= A well-known sterol is cholesterol

= Cholesterol serves the precursor of

Vitamin D, bile salt and steroid

hormones also its structural

cholesterol

component of cell membranes

50. LIPIDS CONCEPT MAP

‘main form of fat in food and body

in lipid bilayer in
‘cell membranes -
de

ee
en a

ak and inplont aids fat
de Ef en

tropical oils

high in olive oil y

high in fish oil high in plant oils

51. Functions of Lipids

= Are the form of stored energy in animals

" Have high energy value 9 kcal/gm of fat

= Actas carriers for fat soluble vitamins

= Are palatable giving good taste and satiety
= Structural support for cells

= Production of steroid hormones, vitamin D

= EFA important for functions of nervous system

52. Food Sources Fats

High Risk for CHD

Y Saturated fat (found in foods like meat, butter, and cream) and
(found in baked goods, snack foods, fried foods, and margarines)

Low Risk for CHD

V Unsaturated Fat (PUFAS & MUFAS) (found in foods like
olive oil, avocados, nuts, and canola oil, vegetable oils, fish)

=" Replacing saturated and trans fat in your diet with
unsaturated fat has been shown decrease the risk of

developing heart disease.

53. Digestion of Lipids

= The first phase of fat digestion begin in mouth and
stomach by the action of salivary and gastric lipase

respectively.
= The main route for digestion of Fats involves:
Y” Hydrolysis to fatty acids & 2-Monoacylglycerols in
the lumen of the intestine by Pancreatic lipase.
Y Globules of fat need to be emulsified before

digestion can take place by bile.

54. Absorption, and Transport of Lipids

= Glycerol and short- and medium-chain fatty acids diffuse

and are absorbed directly into the bloodstream.

= Monoglycerides and long-chain fatty acids form micelles,
are absorbed, and are reformed into new triglycerides. With

protein they are transported by chylomicrons.

= Lipid transport is made possible by a group of vehicles

known as lipoproteins.

55. Lipoproteins

= These are compound lipids that contain both protein and

various types and amounts of lipids.
= They are 25-30 % proteins and the remaining as lipids.

= They are made mostly in the liver and are used to transport

water-insoluble lipids throughout the body.

56. Lipoproteins...

Lipoprotein Primary component

Ch Triglyceride Carries dietary fat from the small
intestine to cells

Triglyceride Carries lipids made and taken by
up by the liver to cells
Cholesterol Carries cholesterol made by the
liver and from other sources to the
cell
Protein Contribute to cholesterol removal

from cells and in turn excretion of
it from the body

57

57. Lipoproteins...

Health Implications

" High LDL is associated with higher risk of heart attack

and is known as “bad” cholesterol.

= High HDL seems to have a protective effect and is known

as “good” cholesterol.

58. Fat Digestion and Absorptior

Stomach: Only minor digestion of fat
fakes place in the stomach through the
action of lipase enzymes.

Liver: The liver produces bile, stored in
e gallbladder and released through
duct into the small intestine.
Is in fat digestion and
sorption by emulsifying lipids in the
digestive juices.

Pancreas: The pancreas secretes a
W)imixture of enzymes, including lipase,
into the small intestine.

Stomach

he small intestine

te for digestion and
‘absorption of lipids. Once absorbed,
long-chain fatty acids are packaged
for transport through the lymph and
bloodstream. (Shorter-chain fatty acids
are absorbed directly into portal
circulation.)

(a Small

fimtestime,

Large intestine: Less than 5% o!

of
ingested fat is normally excreted in the
feces.
y

59. Chapter 5: Lipi
Bile acide
espe ©;
Gallbladder
Lipase

!

Most bile acids
eventually return
to the liver

GED chetestorci

Phospholipids
a Protein

a . Chylomieron
sel

60. Recommended Intakes of Fat

Life stage Linoleic acid Linolenic acid
"The DRI and the 2005 arp lg) aida)
Infants
. . . 006 44 0.5
Dietary Guidelines 6t 12m 46 05
Children
1-3y 7 0.7
recommend fat at 20-35% of aay 10 09
9-13 y 12 12
energy intake (400-700 kcal 1930 > 7 18
31-50 y 17 16
à 51-70 y 14 1.6
of a 2,000-kcal diet). >70 y 14 16
Females
9-13 y 10 1.0
. . 14-18 y i 1.1
= Essential fatty acids Adequate 19-30 y 12 1
31-50 y 12 1.1
51-70 y il 1.1
intake (Table) Hat il El
Pregnancy
14-18 y 13 14
19-30 y 13 14
31-50 y 13 14
Lactation
14-18 y 13 13
19-30 y 13 hae
31-50 y 13 13

61. Fat Abnormalities

= The consumption of excess amount of fat will exposed for:-
Y Atherosclerosis
Y” Obesity and

Y” Metabolic syndrome

63. Protein

= Proteins are the main functional and structural building

blocks of every cell in our body.

= Each protein itself is made up of a variety of smaller

components called amino acids.

= Proteins contains C, H, N, O in the form of amino acids, are

essential to cell functions.

= Amino acids -organic acids containing an amino group and

a carboxyl group subunits of proteins

64. Protein...

= Proteins are made from 20 different
amino acids, 9 of which are essential.

= Each amino acid has an amino group,
an acid group, a hydrogen atom, and
a side group.

"It is the side group that makes each
amino acid unique.

= The sequence of amino acids in each
protein determines its unique shape

and function.

67

65. Protein...

= There are over 20 amino acids in dietary protein.

= Nine are “essential” amino acids that our bodies cannot
make; we must get these from our diet.

v Dietary proteins from animal sources such as meat, fish and
milk products contain all nine essential amino acids and are

considered complete proteins.

68

66. Protein...

= Eleven amino acids are called “non-essential” because our
bodies are able to make them..

Y Most plant sources of protein such as Cereals, nuts and
grains tend to have poor amounts of one or more essential
amino acids and are considered as incomplete proteins.

"A good quality or a complete protein is the one that
supplies all the essential amino acids in sufficient quantities

and in proper ratio for normal growth and maintenance.

67. Essential and Non-Essential Amino Acids

| Histidine | Alanine |

Isoleucine* Arginine**

Leucine* Asparagine

Lysine Aspartic acid
I | selenocysteinet* |
po Serine
po Tarim |
po Tyrosine |

"Branched-choin amino acid
**Conditionally essential amino acid

70

68. Functions of Protein

Y” Enzymes- they act as the catalyst

Y Provide materials for cell growth and mitosis

Y” Maintain fluid balance in vasculature (albumins and globulins)
Y Maintain blood pH

y Form hormones

Y Contribute to immune function

Y” Provide energy - 4 kcal/gram

Y To make other compounds

Y” Transporters

y Other Roles
Y Blood clotting
v Vision by eye

69. Protein Food Sources

= Milk and milk products such as cheese, ice cream all

derive their protein from milk.
= Meat, poultry, and fish are all forms of animal tissues

= Eggs are in a class by themselves a protein food of high

nutritive value.
= Vegetables are poor source of protein.
= Legumes provide more than 4 or 6 percent: they provide

one of the better quality plant proteins. 5

70. Protein Food Sources...

= Legumes listed as meat alternates in the four-food group
charts because they provide one of the better quality plant

proteins.

= Bread and cereals make an important contribution to the
protein of the diet, the protein of uncooked grain ranges 7 to

14 percent.

71. PROTEIN CONCEPT MAP

Provide

a

In blood

In blood

Bind to

Catalyze Internal foreign proteins

Incell chemical body
membranes reactions messengers

calorie
restriction

72. Protein Digestion

= The enzymatic digestion of protein begins in the stomach.

= Proteins are first denatured by stomach acid. Then the major
stomach enzyme pepsin breaks polypeptide into shorter

chain of amino acids.

= The partially digested protein move from stomach to into
small intestine along the rest of nutrients and substance in

chyme.

73. Protein Digestion...

= Once in Small Intestine, CCK is released which causes
secretion of trypsin, chymotrypsin, carboxypeptidase and

elastase from pancreas.
= These enzymes break up partially digested protein into
polypeptides, dipeptides & amino acid

= Amino-peptidase & di-peptidase secreted by the glands in
the intestinal wall completes the break down of protein into

Amino acid (final products).

74. Activation of Peptidases

enteropeptidase

Trypsinogen —— ——— Trypsin

Chymotrypsinogen _ ran, Chymotrypsin

Proelastase "+ yen Elastase

75. Protein Absorption

= In the small intestine short chain amino amino-acids and
individual amino-acids are taken by active transport into

absorptive cells lining small intestine.
= Then amino-acids travel to the liver via portal vein.

"In the liver individual amino-acids can undergo several

modification depending on various body tissues.
= May combined into protein needed by specific cell
= Broken down for energy needs
= Converted into non essential amino acids, glucose or fat.

76. LS

intestine’

Protein Digestion
and Absorption

>

Partial protein digestion
by the enzyme pepsin
and stomach acid.

77. Recommended Intakes of Protein

= The recommendations for protein are expressed as grams of

protein per kilogram of body weight per day (g/kg/day).
= Adult Women and Men need 0.8 g/kg/day

= Pregnant and lactating women need 1.1 and 1.3 g/kg/day,
respectively.

v Example: for a 70 kg person: 70 kg x 0.8 g/kg = 56 grams of protein
per day

78. Protein-energy-malnutrition (PEM)

= PEM is today the most serious nutritional problem in

Ethiopia and other developing countries.
= Its two clinical forms are Kwashiorkor and Marasmus.

= The diseases occur mostly in children between one and

three years of age, after they have been taken of the breast.

79. Marasmus

= Marasmus: Severe form of acute malnutrition that is
characterized by wasting of body tissues.

Y Marasmic children are extremely thin.

= Kwashiorkor: Severe form of acute malnutrition characterized
by bilateral edema and weight-for-height of greater or equal

to -2 SD.

= Marasmic-Kwashiorkor: Severe form of acute malnutrition
characterized by bilateral edema and weight-for-height of

less than -2 SD. 83

80. KWASHIORKOR VS MARASMUS

In preschool children (1-
5 years of age)

+ Due to low protein intake

Mild growth retardation

Mild reduction in body
weight

+ Protruding abdomen and
subcutaneous fat
reserved

+ Ribs not very prominent

Poor appetite

+ Enlarged fatty liver

+ Oedema present

+ Moonfacies

© Sparse hair

« Flaky paint-like skin

+ Lethargic

+ Requires adequate
amount of protein

« In weakened infants(<1
year old)

+ Due to low calorie intake

+ Severe growth retardation

+ Severe reduction in body
weight

+ Shrunken abdomen and
subcutaneous fat not
preserved

« Prominent ribs

+ Voracious feeder

+ No fatty liver

« Oedema not present

+ An old man like face

+ No hair changes noted

« Dry and wrinkled skin

+ Alert but irritable

+ Requires adequate
amount of protein, fat and

arasmus

84