Malnutrition in India: Understanding Undernutrition and Overnutrition

This presentation explores the dual challenge of undernutrition and overnutrition, defining key terms such as stunting, wasting, marasmus, kwashiorkor, and obesity. It examines the causes and indicators of malnutrition, including poverty, illness, and nutrient deficiencies, and discusses the impact of these conditions on public health. The document also highlights national policies and programs in India that aim to address malnutrition and improve nutritional outcomes.

1. PRESENTED BY: SHRADDHA MAURYA
MASTERS IN PUBLIC HEALTH (| SEMESTER)

DY PATIL SCHOOL of PUBLIC HEALTH

3. Malnutrition

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5. INTRODUCTION
Definition
+ The World health Organisation

(WHO) defines malnutrition as

"the cellular imbalance between the supply of
nutrients and energy and the body demands for
them to ensure, growth, maintenance, and
specific function”.

6. Continue... HL

+ Malnutrition is failing health that result from not eatin
balance diet over a long period of time.

» Malnutrition refers to undernutrition resulting from
inadequate consumption or excessive loss of nutrients

> It can also refer to overnutrition resulting from overeating
or excessive intake of specific nutrients.

7. L) Definition

» Undernutrition is, defined as an imbalance between
andi) = = or delivery than that result in deficits of
energy , protein, or micronutrients that may negatively affects
growth and development

» In general malnutrition refers to undernutrition (esp. protein energy
malnutrition).

8. low height for age
Indicates chronic malnutrition
Prolonged food deprivation disease/illness
low weight for height
Indicates acute malnutrition
More recent food illness
Inderweight

low height for age
Combine acute and chronic malnutrition

9. +
es teme

» 1.9 billion adults are overweight or obese, while 462 million are underweight

» 52 million children under 5 year of age are wasted, 17 million are severely wasted and 155 million are stunted,
while 41 million are overweight or obese

» Around 45% of death among children under 5 year of age are linked to undernutrition

+ Poverty

+ Mliteracy

~ Ignorance

y Overcrowding
«Large family

10. et
Measure of
Weight
Height
mid arm circumference
Skin fold thickness
Waist and hip thickness
Result expressed as indices:
Weight for age
Height for age
Weight for height
MUAC for age
Waist hip ratio

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> Vitamin A: dry eye, night blindness, increase risk of infection

» Zinc: loss of appetite, stunted growth, delayed healing of
wounds, hair loss, diarrhea

» Iron: impaired brain function, issues with regulating body
temperature, anaemia

» lodine: enlarged thyroid gland (goiter) , decreased production
of thyroid hormones, growth and development issue

12. MALNUTRITION COMES IN MANY FORMS

13. A measure of current nutritional status

A child with low weight for height is thin, extreme thinness is called wasting

Wasting is typically divided in to two categories:

Moderate acute malnutrition (MAM), -3 to <- 2 z-score from the median weight for height.
Sever acute malnutrition (SAM), <-3 z-scores from the median weight-for-height

SAM + MAM = Global Acute Malnutrition (GAM)

SAM exist In two forms;

Kwashiorkor

marasmus

14. » It is a measure of long-term or chronic nutritional status in
children

» Such children grow poorly and have low hight for their age
i.e. they are short, termed as stunted

15. a

» Caused by protein deficiency.

» Due to poverty in developing nations. Families
cannot afford to feed their young children with
high protein food after the children have stopped
feeding on mother’s milk.

» It can be preventing by giving sufficient food
containing protein food to young children

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» Swelling of the legs

» Underweight

» "Moon face"

» Swollen abdomen

» Thin muscles but fat present
» Dry, Spares, Thin hairs

» Stunted growth

» Apathetic, Little interested in his surrounding

17. KWASHIORKOR

Malnutrition

Sparse hair > ~ “Flag sign” in the hair

Anemia

Moon face

Swelling of legs
(Edema)

18. +
+

» Cardiovascular problem

» Urinary tract infections

» Gastrointestinal problem

» An enlarged liver

» Loss of immune system function

» Impaired cellular function electrolyte imbalance

19. >

» Reduced total plasma protein (less than 4 gm/dl)
» reduced level of serum albumin (less than 2 gm/dl)

» Urea in blood urine is markedly reduced because deficient
intake of exogenous protein

» Low total body potassium due to potassium losses by
diarrhea

» Total body sodium is higher than normal

20. +
or

» To prevent kwashiorkor, children should be given nutritious food

» Proper education and awareness about : and weaning

» There should be a provision of 1111117 for all children in poor countries

> and lactating women should be given a sufficient amount of nutritious
food .

» Women should be encouraged to breast feed their infants

» Diet with enough ‚and can prevent kwashiorkor

21. O

» The term marasmus is derived from the Greek marasmus,
which mean

» It is a clinical syndrome and a form of under nutrition
characterized by failure to gain weight.
» Caused by deficiency of energy and protein foods in children.

» commonly in infants between the age of
(Infants atrophy)

22. » Under weight

» Old man face

» Thin muscle, thin fat

» Stunted growth

» Prominent ribs

» Absence of edema

» A decrease in physical activity

Poor growth»

23. » Growth problem in children

» Joint deformity and destruction
» Loss of strength

» Loss of vision and blindness

» Organ failure and dysfunction
» Unconsciousness and coma

24. » Plasma protein may be normal or
slightly lower

» Blood urea is low

» Blood glucose level is low

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Premature babies who.are weaning off breast milk
Deficient intake of calories and protein

Lack of nutritional knowledge

Poor sanitation and hygiene

Dilute milk and other starchy product

Lack of nutritional knowledge

Infection

Congenital defects

26. oe

+
» Treatment of marasmus involves -\.: and
to prevent and manage complication of malnutrition
» Diet rich in is recommended
» Complementary feeds should be given in addition to
» The treatment usually starts with introduction of rich foods
» Proper follow up of the
> and
» Should be spacingof - - ı between children

27. +.

» Southeast Asia
» Central America
» South Africa

» Uganda

» Congo

» Puerto Rico

28. KWASHIORKOR

Acute illness/ inflection prolonged starvation
Measles

Protein is principle nutrients:

Some weight loss

High mortality

Poor appetite

Enlarged fatty liver

Oedema present

Protruding abdomen and subcutaneous fat
reserved

Sparse hair
Fatty paint like skin

MARASMUS

Severe prolonged

‚Chronie/ recurring

Calories and protein principle nutrients
Sever weight loss

Low mortality

Voracious feeder

No fatty liver

Gedema not present

Shrunken abdomen and subcutaneous fat not
preserved

No hair changes noted
Dry and wrinkled skin

30. National policies for malnutrition

The program implemented are :
Direct nutritional health programmes:

Ministry of health and family welfare

1. National vitamin A prophylaxis programme

2 National Goiter control programme

3. National nutritional Anemia prophylaxis programme for mother and children

Ministry of human resources development
1. ICDS scheme

2. Special nutritional programme

3. Balwadi feeding programme

4. Mid day meal programme

31. Over nutrition

O Many tend to think malnutrition only in term of hunger, however overeating is also a
contributing factors.

+ The WHO define:
+ A BMI greater than or equal to 25 is overweight

+ A BMI greater than or equal to 30 is obesity

32. QI Real world example obesity :

v More than 1/3 of adult
are obese (34.9%)

v From 2011-2012, 17% of
children were obese

33. “ Health problems:

=] alt ads TO e
1, Obesity

2. Diabetes

3. Hypertension

4. Cardiovascular diseases

5. Renal diseases,

6. Disorder of liver and gall bladder

«* Solution

¥ Overnutrition can be fixed by balancing out meals and portion to a reasonable consumption rate.
Also by eating healthier foods as opposed to junk food.
¥ In addition daily exercise added to your life style will contributed to an over all better well-being.

35. "IF YOU CAN'T FEED
A HUNDRED PEOPLE