MALNUTRITION

Gay Debonaire B. Tarala

MALNUTRITION
Malnutrition is a broad term which refers to both under nutrition (sub nutrition) and over nutrition. Individuals are malnourished, or suffer from under nutrition if their diet does not provide them with adequate calories and protein for maintenance and growth, or they cannot fully utilize the food they eat due to illness. People are also malnourished, or suffer from over nutrition if they consume too many calories.

 Malnutrition can also be defined as the insufficient, excessive or imbalanced consumption of nutrients. Several different nutrition disorders may develop, depending on which nutrients are lacking or consumed in excess. According to the World Health Organization (WHO), malnutrition is the gravest single threat to global public health. Sub nutrition occurs when an individual does not consume enough food. It may exist if the person has a poor diet that gives them the wrong balance of basic food groups

 Obese people, who consume more calories than they need, may suffer from the sub nutrition aspect of malnutrition if their diet lacks the nutrients their body needs for good health. Poor diet may lead to a vitamin or mineral deficiency, among other essential substances, sometimes resulting in scurvy - a condition where an individual has a vitamin C (ascorbic acid) deficiency. Though scurvy is a very rare disease, it still occurs in some patients - usually elderly people, alcoholics, or those that live on a diet devoid of fresh fruits and vegetables. Similarly, infants or children who are on special or poor diets for any number of economic or social reasons may be prone to scurvy.

Individuals who are socially isolated

People on low incomes (poor people) People with chronic eating disorders, such as bulimia or anorexia nervosa People convalescing after a serious illness or condition

Malnutrition is "Faulty nutrition resulting from mal-absorption, poor diet, or overeating." Under-nutrition is "A form of malnutrition resulting from a reduced supply of food or from inability to digest, assimilate, and use the necessary nutrients."

Signs and symptoms of malnutrition (sub-nutrition) include:

Loss of fat (adipose tissue)

Breathing difficulties, a higher risk of respiratory failure Depression Higher risk of complications after surgery Higher risk of hypothermia - abnormally low body temperature

 In more severe cases: Skin may become thin, dry, inelastic, pale, and cold Eventually, as fat in the face is lost, the cheeks look hollow and the eyes sunken Hair becomes dry and sparse, falling out easily Sometimes, severe malnutrition may lead to unresponsiveness (stupor) If calorie deficiency continues for long enough, there may be heart, liver and respiratory failure Total starvation is said to be fatal within 8 to 12 weeks (no calorie consumption at all)

 Children - children who are severely malnourished typically experience slow behavioral development, even mental retardation may occur. Even when treated, under-nutrition may have long-term effects in children, with impairments in mental function and digestive problems persisting; in some cases for the rest of their lives. Adults whose severe undernourishment started during adulthood, usually make a full recovery when treated

What are the causes of malnutrition?

Poor diet Mental health problems Mobility problems Digestive disorders and stomach conditions Alcoholism Food shortages Food prices and food distribution Lack of breastfeeding

What are the treatment options for malnutrition?

The care plan -aims for treatment will be set out, which should include the treatment for any underlying conditions/illnesses which are contributory factors to the malnutrition Diet - a good healthcare professional will discuss eating and drinking with the patient and provide advice regarding healthy food choices. The aim is to make sure the patient is receiving a healthy, nutritious diet

Preventing malnutrition Carbohydrates Fruit and vegetables Protein Dairy - vegans are able to find abundant nutrients from non-animal sources Fats The average human should drink at least 1.2 liters of fluid per day.

FOOD PYRAMID

NUTRITION

 The process of nourishing or being nourished, especially the process by which a living organism assimilates food and uses it for growth and for replacement of tissues. The science or study that deals with food and nourishment, especially in humans. A source of nourishment; food.

six major classes of nutrients

Carbohydrates

Fats Minerals Protiens Vitamins Water

FOOD PYRAMID

 Nutrition, nourishment, or aliment, is the supply of materials - food - required by organisms and cells to stay alive. In science and human medicine, nutrition is the science or practice of consuming and utilizing foods.

In hospitals, nutrition may refer to the food requirements of patients, including nutritional solutions delivered via an IV (intravenous) or IG (intragastric) tube.

 Nutritional science studies how the body breaks food down (catabolism) and repairs and creates cells and tissue (anabolism) - catabolism and anabolism = metabolism. Nutritional science also examines how the body responds to food. In other words, "nutritional science investigates the metabolic and physiological responses of the body to diet". As molecular biology, biochemistry and genetics advance, nutrition has become more focused on the steps of biochemical sequences through which substances inside us and other living organisms are transformed from one form to another - metabolism and metabolic pathways.

The human body requires seven major types of nutrients

A nutrient is a source of nourishment, an ingredient in a food, e.g. protein, carbohydrate, fat, vitamin, mineral, fiber and water. Macronutrients are nutrients we need in relatively large quantities. Micronutrients are nutrients we need in relatively small quantities. Energy macronutrients - these provide energy, which is measured either in kilocalories (kcal) or Joules. 1 kcal = 4185.8 joules.

 Molecules consist of carbon, hydrogen and oxygen atoms. Carbohydrates include monosaccharides (glucose, fructose, glactose), sisaccharides, and polysaccharides (starch). Nutritionally, polysaccharides are more favored for humans because they are more complex molecular sugar chains and take longer to break down - the more complex a sugar molecule is the longer it takes to break down and absorb into the bloodstream, and the less it spikes blood sugar levels. Spikes in blood sugar levels are linked to heart and vascular diseases.

1.Carbohydrates - 4 kcal per gram

2. Proteins - 4 kcal per gram

Molecules contain nitrogen, carbon, hydrogen and oxygen. Simple proteins, called monomers, are used to create complicated proteins, called polymers, which build and repair tissue. When used as a fuel the protein needs to break down, as it breaks down it gets rid of nitrogen, which has to be eliminated by the kidneys.

3.Fats - 9 kcal per gram

Molecules consist of carbon, hydrogen, and oxygen atoms. Fats are triglycerides - three molecules of fatty acid combined with a molecule of the alcohol glycerol. Fatty acids are simple compounds (monomers) while triglycerides are complex molecules (polymers)

4.FIBER
Fiber consists mostly of carbohydrates. However because of its limited absorption by the body, not much of the sugars and starches get into the blood stream. Fiber is a crucial part of essential human nutrition.

5.Water
About 70% of the non-fat mass of the human body is water. Nobody is completely sure how much water the human body needs - claims vary from between one to seven liters per day to avoid dehydration. We do know that water requirements are very closely linked to body size, age, environmental temperatures, physical activity, different states of health, and dietary habits. Somebody who consumes a lot of salt will require more water than another person of the same height, age and weight, exposed to the same levels of outside temperatures, and similar levels of physical exertion who consumes less salt. Most blanket claims that 'the more water you drink the healthier your are' are not backed with scientific evidence. The variables that influence water requirements are so vast that accurate advice on water intake would only be valid after evaluating each person individually.

6.Minerals
Dietary minerals are the other chemical elements our bodies need, apart from carbon, hydrogen, oxygen and nitrogen. The term "minerals" is misleading, and would be more relevant if called "ions" or "dietary ions" (it is a pity they are not called so). People whose intake of foods is varied and well thought out - those with a well balanced diet - will in most cases obtain all their minerals from what they eat. Minerals are often artificially added to some foods to make up for potential dietary shortages and subsequent health problems. The best example of this is iodized salt - iodine is added to prevent iodine deficiency, which even today affects about two billion people and causes mental retardation and thyroid gland problems. Iodine deficiency remains a serious public health problem in over half the planet

 Potassium What it does - a systemic (affects entire body) electrolyte, essential in co-regulating ATP (an important carrier of energy in cells in the body, also key in making RNA) with sodium. Deficiency - hypokalemia (can profoundly affect the nervous system and heart). Excess - hyperkalemia (can also profoundly affect the nervous system and heart).

 Chloride What it does - key for hydrochloric acid production in the stomach, also important for cellular pump functions. Deficiency - hypochleremia (low salt levels, which if severe can be very dangerous for health). Excess - hyperchloremia (usually no symptoms, linked to excessive fluid loss).

 Sodium What it does - a systemic electrolyte, and essential in regulating ATP with potassium. Deficiency - hyponatremia (cause cells to malfunction; extremely low sodium can be fatal). Excess - hypernatremia (can also cause cells to malfunction, extremely high levels can be fatal).

 Calcium What it does - important for muscle, heart and digestive health. Builds bone, assists in the synthesis and function of blood cells. Deficiency - hypocalcaemia (muscle cramps, abdominal cramps, spasms, and hyperactive deep tendon reflexes). Excess - hypercalcaemia (muscle weakness, constipation, undermined conduction of electrical impulses in the heart, calcium stones in urinary tract, impaired kidney function, and impaired absorption of iron leading to iron deficiency).

 Phosphorus What it does - component of bones and energy processing. Deficiency - hypophosphatemia, an example is rickets. Excess - hyperphosphatemia, often a result of kidney failure

 Magnesium What it does - processes ATP and required for good bones. Deficiency - hypomagnesemia (irritability of the nervous system with spasms of the hands and feet, muscular twitching and cramps, and larynx spasms). Excess - hypermagnesemia (nausea, vomiting, impaired breathing, low blood pressure). Very rare, and may occur if patient has renal problems.

 Zinc What it does - required by several enzymes. Deficiency - short stature,anemia increased pigmentation of skin, enlarged liver and spleen, impaired gonadal function, impaired wound healing, and immune deficiency. Excess - suppresses copper and iron absorption.

 Iron What it does - required for proteins and enzymes, especially hemoglobin. Deficiency - anemia. Excess - iron overload disorder; iron deposits can form in organs, particularly the heart

 Manganese What it does - a cofactor in enzyme functions. Deficiency - wobbliness, fainting, hearing loss, weak tendons and ligaments. Less commonly, can be cause of diabetes. Excess - interferes with the absorption of dietary iron.

 Copper What it does - component of many redox (reduction and oxidation) enzymes. Deficiency - anemia or pancytopenia (reduction in the number of red and white blood cells, as well as platelets) and a neurodegeneration. Excess - can interfere with body's formation of blood cellular components; in severe cases convulsions, palsy, and insensibility and eventually death (similar to arsenic poisoning.

 Iodine What it does - required for the biosynthesis of thyroxine (a form of thyroid hormone). Deficiency - developmental delays, among other problems. Excess - can affect functioning of thyroid gland.

 Selenium What it does - cofactor essential to activity of antioxidant enzymes. Deficiency - Keshan disease (myocardial necrosis leading to weakening of the heart), Kashing-Beck disease (atrophy degeneration and necrosis of cartilage tissue). Excess - garlic-smelling breath, gastrointestinal disorders, hair loss sloughing of nails, fatigue irritability, and neurological damage.

 Molybdenum vital part of three important enzyme systems, xanthine oxidase, aldehyde oxidase, and sulfite oxidase. It has a vital role in uric acid formation and iron utilization, in carbohydrate metabolism, and sulfite detoxification. Deficiency - may affect metabolism and blood counts, but as this deficiency is often alongside other mineral deficiencies, such as copper, it is hard to say which one was the cause of the health problem. Excess - there is very little data on toxicity, therefore excess is probably not an issue.

6. Vitamins
These are organic compounds we require in tiny amounts. An organic compound is any molecule that contains carbon. It is called a vitamin when our bodies cannot synthesize (produce) enough or any of it. So we have to obtain it from our food. Vitamins are classified by what they do biologically - their biological and chemical activity - and not their structure. Vitamins are classified as water soluble (they can dissolve in water) or fat soluble (they can dissolve in fat). For humans there are 4 fat-soluble (A, D, E, and K) and 9 watersoluble (8 B vitamins and vitamin C) vitamins - a total of 13.

 Water soluble vitamins need to be consumed more regularly because they are eliminated faster and are not readily stored. Urinary output is a good predictor of water soluble vitamin consumption. Several water-soluble vitamins are manufactured by bacteria.

 Fat soluble vitamins are absorbed through the intestines with the help of fats (lipids). They are more likely to accumulate in the body because they are harder to eliminate quickly. Excess levels of fat soluble vitamins are more likely than with water-soluble vitamins - this condition is called hypervitaminosis. Patients with cystic fibrosis need to have their levels of fat-soluble vitamins closely monitored.

 Vitamin A chemical names - retinol, retinoids and carotenoids. Solubility - fat. Deficiency disease - Night-blindness. Overdose disease - Keratomalacia (degeneration of the cornea)

 Vitamin B1 chemical name - thiamine. Solubility - water. Deficiency disease - beriberi, WernickeKorsakoff syndrome. Overdose disease - rare hypersensitive reactions resembling anaphylactic shock when overdose is due to injection. Drowsiness.

 Vitamin B2 chemical name - riboflavin Solubility - water Deficiency disease - ariboflanisosis (mouth lesions, seborrhea, and vascularization of the cornea). Overdose disease - no known complications. Excess is excreted in urine.

 Vitamin B3 chemical name - niacin. Solubility - water. Deficiency disease - pellagra. Overdose disease - liver damage, skin problems, and gastrointestinal complaints, plus other problems.

 Vitamin B5 chemical name -pantothenic acid. Solubility - water. Deficiency disease - paresthesia (tingling, pricking, or numbness of the skin with no apparent long-term physical effect). Overdose disease - none reported.

 Vitamin B6 chemical name - pyridoxamine, pyridoxal. Solubility - water. Deficiency disease - anemia, peripheral neuropathy. Overdose disease - nerve damage, proprioception is impaired (ability to sense stimuli within your own body is undermined).

 Vitamin B7 chemical name - biotin. Solubility - water. Deficiency disease - dermatitis, enteritis. Overdose disease - none reported

 Vitamin B9 chemical name - folinic acid. Solubility - water. Deficiency disease - birth defects during pregnancy, such as neural tube. Overdose disease - seizure threshold possibly diminished.

 Vitamin B12 chemical name - cyanocobalamin, hydroxycobalamin, methylcobalamin. Solubility - water. Deficiency disease - megaloblastic anemia (red blood cells without nucleus). Overdose disease - none reported.

 Vitamin C chemical name - ascorbic acid. Solubility - water. Deficiency disease scurvy, which can lead to a large number of complications. Overdose disease - vitamin C megadosage diarrhea, nausea, skin irritation, burning upon urination, depletion of the mineral copper, and higher risk of kidney stones.

 Vitamin D chemical name - ergocalciferol, cholecalciferol. Solubility - fat. Deficiency disease - rickets, osteomalacia (softening of bone), recent studies indicate higher risk of some cancers. Overdose disease - hypervitaminosis D (headache, weakness, disturbed digestion, increased blood pressure, and tissue calcification).

 Vitamin E chemical name - tocotrienols. Solubility - fat. Deficiency disease - very rare, may include hemolytic anemia in newborn babies. Overdose disease - one study reported higher risk of congestive heart failure.

 Vitamin K chemical name - phylloquinone, menaquinones. Solubility - fat. Deficiency disease - greater tendency to bleed. Overdose disease - may undermine effects of warfarin.