Malnutrition preventive measures at family level

Malnutrition

1. Nutritional Problems In India Community Medicine - Seminar

2. What is Nutrition ? Nutrition is defined as Science of Food and it's Relation to Health Good Nutrition means Maintaining a Nutritional Status that enables us to grow well and enjoy Good Life!

3. What is the Need For Nutrition ? Need for Nutrition has led to Green Revolution and White Revolution in India and Increased Production of Food during 1st decades of Century!!

4. Dietary Goals Prudent Diet By WHO Fat < 15-30% of Total Dietary Intake Saturated Fats < 10% of Total Energy Intake Consumption of refined Carbohydrate should be Avoided Salt Intake < 5g/day Protein should be 10-15% of Total Energy Intake Junk food supplying Empty Calories - Cola , Ketchup should be Avoided

5. Balanced Diet A Diet that Contains Adequate Amount of all Necessary Nutrients required for Maintaining Health, Vitality and General Well being of an Individual 7 essential Nutrients are Proteins , Fats , Carbohydrates , Vitamins , Minerals , Water and Fibres

6. Recommended Dietary Allowance (RDA) The average daily dietary nutrient intake level sufficient to meet the nutrient requirement of nearly all (97-98%) healthy individuals in a particular life stage and gender group . RDA is derived from: a. individual variability b. nutrient bioavailability from the habitual diet

7. Factors Affecting RDA RDA of an individual depends mainly on many factors like: Age Sex Physical Work -sedentary -moderate - heavy Physiological stress Pregnancy Lactation

8. Rda for indian nationals ICMR has defined well nourished Indian adults who had satisfactory growth during childhood as Reference Men & Reference Women ICMR’s Reference Men: Between 20-39 years of age Weight 65 kg Height 1.77 meter BMI of 20.75 Free from disease & Physically fit for active work Engaged in 8 hours of occupation Spends 8 hours in bed , sitting of 4-6 hours , 2hrs of walking Active recreation or household duties

9. ICMR’s reference women Between 19-39 years of age Weight 55 kg Non pregnant non lactating {NPNL} Height 1.62 meter BMI of 20.95 Free from disease & Physically fit for active work Engaged in 8 hours of occupation Spends 8 hours in bed , sitting of 4-6 hours , 2hrs of walking Active recreation or household duties

10. Energy requirements The unit of energy which has ben in use in nutrition for long time is kilocalories [kcal]. Physical Activity Ratio (PAR) is expressed as the ratio of the energy cost of an individual activity per minute to the cost of the basal metabolic rate (BMR) per minute. Physical Activity Ratio = Energy cost of an activity per minute/Energy cost of basal metabolism per minute

11. Energy Requirement Table ICMR 2020

12. Major Nutritional Problems in India Malnutrition Micronutrient deficiency

13. Malnutri t ion

14. Understanding Severe Acute Malnutrition (SAM) Definition: Severe Acute Malnutrition (SAM) is a life-threatening condition, typically characterized by a very low weight-for-height (below -3 standard deviations of the median WHO growth standards), visible severe wasting, or the presence of nutritional edema. Key Indicators: Weight-for-height Z-score less than -3. Mid-Upper Arm Circumference (MUAC) less than 11.5 cm. Bilateral pitting edema (swelling on both sides of the body due to fluid retention). Causes: Inadequate dietary intake. Recurrent infections (diarrhea, respiratory infections, etc.). Poverty, food insecurity, lack of breastfeeding, or inadequate care practices. Global Prevalence: Over 45 million children under 5 years of age are affected globally, especially in low- and middle-income countries (Sub-Saharan Africa, South Asia).

15. Impact & Management of SAM I mpact on Children: Higher risk of mortality (9–12 times higher than well-nourished children). Developmental delays (cognitive and physical growth stunting). Increased susceptibility to infections and longer recovery times. Management of SAM: Outpatient Care : Ready-to-use therapeutic foods (RUTF), community-based management for children without medical complications. Inpatient Care : Therapeutic feeding centers for children with complications (dehydration, infection, etc.). Prevention : Promoting breastfeeding, improving dietary diversity, micronutrient supplementation, and addressing food insecurity. Key Interventions: Early identification, appropriate feeding practices, infection control, and long-term strategies to improve food systems and healthcare access.

16. Preventing Malnutrition During Pregnancy Importance of Maternal Nutrition: Adequate nutrition during pregnancy is critical for the health of both the mother and the developing fetus. Poor maternal nutrition can lead to low birth weight, preterm birth, and increased risk of child malnutrition. Key Nutritional Interventions: Balanced Diet : Ensure an intake of diverse food groups, including proteins, fruits, vegetables, grains, and healthy fats. Micronutrient Supplementation : Iron and Folic Acid : Prevent anemia and birth defects. Calcium : Supports bone development and reduces the risk of pregnancy-induced hypertension. Vitamin A and D : Essential for immune function and fetal growth. Adequate Caloric Intake : Meet increased energy needs during pregnancy (~300 extra calories/day during the second and third trimesters). Health and Lifestyle Practices: Regular Health Checkups : Monitor weight gain, blood pressure, and iron levels. Avoid Harmful Substances : Alcohol, tobacco, and excessive caffeine. Early Prenatal Care : Early diagnosis and management of pregnancy complications.

17. Preventing Malnutrition in Early Childhood Exclusive Breastfeeding (0-6 Months) : Optimal Nutrition : Breast milk provides all the necessary nutrients and antibodies for a baby’s growth and immunity. Reduces the risk of infections, diarrhea, and malnutrition. Complementary Feeding (6-24 Months) : Gradual introduction of diverse, nutrient-dense foods like fruits, vegetables, grains, legumes, and animal products while continuing breastfeeding. Ensure proper food hygiene to prevent infections that can lead to malnutrition. Micronutrient Supplementation : Vitamin A : Prevents blindness and boosts immunity. Zinc : Reduces the severity and duration of diarrheal episodes. Iron : Prevents anemia and supports brain development. Regular Growth Monitoring : Track weight and height to detect early signs of malnutrition and ensure timely interventions. Education and Support for Caregivers : Provide guidance on nutrition, food preparation, and feeding practices to parents and caregivers.

18. Programs Addressing severe acute malnutrition (SAMS) Integrated Management of Acute Malnutrition (IMAM) : A comprehensive approac h tha t includes: Community-Based Management : Identifies and treats SAM through outpatient care using Ready-to-Use Therapeutic Foods (RUTF). Inpatient Care : For children with medical complications, providing therapeutic feeding and medical treatment in health facilities. UNICEF’s Nutrition Program : Supports governments in scaling up SAM treatment programs by: Training healthcare workers. Providing therapeutic supplies like RUTF and equipment. Advocacy for SAM treatment policies. World Food Programme (WFP) – Nutrition Interventions : WFP works to address malnutrition through food assistance programs by: Supplying specialized nutritious foods to treat and prevent SAM. Supporting community-level health and nutrition education. WHO Essential Nutrition Actions : Provides global guidelines on managing SAM, emphasizing: Capacity building for health workers. Implementing national-level malnutrition screening.

19. Programs for Prevention of Malnutrition in Pregnancy and Childhood Maternal and Child Nutrition Program (USAID) : Focuses on improving the nutritional status of mothers, infants, and young children through: Micronutrient Supplementation : Providing iron, folic acid, and vitamin A to pregnant women and children. Promotion of Exclusive Breastfeeding for the first six months. Nutrition Education to promote diverse diets and safe feeding practices. The Baby-Friendly Hospital Initiative (BFHI) (WHO & UNICEF): Encourages hospitals to support breastfeeding by: Training healthcare staff on breastfeeding practices. Ensuring newborns are exclusively breastfed in the first hours of life. Scaling Up Nutrition (SUN) Movement : A multi-sectoral approac h supporting: Nutrition-Sensitive Interventions : Agriculture, water, and sanitation improvements to enhance food security and hygiene. Strengthening national policies to address malnutrition across the life cycle. The Global Alliance for Improved Nutrition (GAIN) : Works on food fortification programs, promoting: Fortification of Staple Foods with essential nutrients like iron, zinc, and folic acid to prevent malnutrition in women and children.

20. Understanding vitamins and minerals deficiencies and it’s prevention in general…

21. Vitamins :

22. Epecific deficienciemin has a specific function to perform and deficiency of any perticular vitamin may lead to Soecicifi

23. Deficiencies of vitamins : Vitamin A : ▶ Night blindness – inability to see in dim light ▶ Conjuncti val Xerosis – conjunctiva becomes dry and non wettable ▶ Bitot’s spot – pearly white spot on bulbar cunjunctiva ▶ Corneal xerosis – cornea becomes dry ▶ Keratomalacia – lequifaction of cornea

24. Vitamin D : (2)Osteomalacia : bones become weak and fragile

25. Vitamin E : Vitamin K :

26. Vitamin B1 ( Thiamine) : Beri beri Wernick’s encephalopathy Vitamin B2 ( Riboflavin)

27. Vitamin B3 ( Niacin ) Pellagra Diarrhea Dermatitis Demen Vitamin B5( Pantothenic acid ) :

28. Vitamin B6 ( Pyridoxine) : Vitamin B12 : Vitamin B9 ( Folate )

29. Vitamin C : Scurvy – bleeding and swollen gums Bleeding in skin or joints Anemia Weakness Delayed wound healing

30. Selenium Minerals are found in the human body, which are required for growth, repair and regulation of vital body functions

31. Prevention stratergies Guidance for speci f ic mineral de f iciencies

32. Symptoms and treatments