Nutrition: Malnutrition and its Prevention

Study Notes

Malnutrition: bad nourishment, not enough or too much food, wrong types of food, or inability to use nutrients properly
Classified into two types: undernutrition and overnutrition

Undernutrition: depletion of energy (calories) from insufficient food intake over time
Types:
- Starvation: extreme undernutrition
- Famine: severe food shortage in a community
- Specific nutrient deficiency: e.g., vitamin A deficiency, iodine deficiency

Definition: deficiency of hemoglobin concentration in blood below the healthy range according to sex and age
Prevalence:
- Children: 11-12%
- Adults: Men 14-18 gm/dl, Women 12-16 gm/dl, Pregnant women 11 gm/dl
Types:
- Iron deficiency anemia
- Vitamin B12 and folate deficiency anemia

Causes:
- Dietary deficiency
- Increased loss
- Malabsorption
- Increased expenditure
Factors influencing iron absorption:
- Heme iron: efficiently absorbed from animal food sources (25%)
- Nonheme iron: present in plant-based foods, absorbed with a mean of 17%
- Enhancing factors: vitamin C, animal muscle tissue
- Inhibiting factors: phytates, tannins, calcium, polyphenols, soybean proteins

Risk factors:
- Deficient dietary intake
- Malabsorption, hypoparathyroidism, malabsorptive bowel disease
Manifestations:
- Decreased bone mass and osteoporotic fracture in adults
- Rickets in children
- Increased risk of kidney stones and colon cancer

Definition: defective calcification of osteoid and epiphyseal cartilage of growing bones
Affects children between 6-24 months
Causes: deficiency of vitamin D and/or calcium
Manifestations:
- Skeletal: enlarged metaphyseal ends of long bones, deformities, rachitic rosary, softening of skull bones
- Non-skeletal: hypotonia, tetany, convulsions, chest infections

Osteomalacia: bone disease of rarefaction and softening of bones due to calcium deficiency
Osteoporosis: bone mineral density of 2.5 standard deviation or more below the mean peak bone mass
Manifestations:
- Osteomalacia: bone aches, tender bony prominences, uneven gait
- Osteoporosis: fragility fractures, increased risk of osteopenia and osteoporosis

DRIs for calcium:
- Children aged 1-3 years: 700 mg/d
- Children aged 4-8 years: 1000 mg/d
- Adolescents: 1300 mg/d
- Younger adults: 1000 mg/d
- Women over 51 years: 1200 mg/d
- Men and women over 70 years: 1200 mg/d
Natural food sources: dairy foods, fortified foods (calcium-fortified soymilk, calcium-fortified orange juice)

Fortified foods: calcium-fortified soymilk, calcium-fortified orange juice
Plant-based milk alternative beverages: fortified soy milk, others not evaluated for calcium bioavailability

Definition: pathological state resulting from the consumption of excessive quantity of food over an extended period
Health hazards associated with overnutrition:
- Excess energy intake: obesity
- Excess sugar intake: dental caries, hypertriglyceridemia, diabetes
- Excess fat and cholesterol intake: atherosclerosis, coronary heart diseases
- Excess protein intake: gout, kidney diseases
- Excess fat-soluble vitamins: toxicity, liver disease
- Excess minerals (fluoride): dental fluorosis
- Excess sodium intake: water retention, hypertension

Definition: disease with genetic, environmental, and behavioral determinants that confers increased morbidity and mortality
Aetiology:
- Dietary factors: excess intake, reduced expenditure (sedentary life)
- Non-dietary factors: genetic and hormonal defects, metabolic disorders, hypothalamus disorder
Complications:
- Metabolic diseases (dislipidemia, prediabetes, type 2 diabetes, metabolic syndrome)
- Osteoarthritis
- Sleep apnea and breathing problems
- Many types of cancer
- Low quality of life
- Mental illness (clinical depression, anxiety)
- Body pain and difficulty with physical functioning