NUTRITIONAL DISORDERS OF PUBLIC HEALTH IMPORTANCE

Malimu EZ

KIU

DEFINITIONS

• Nutrition• Scientific understanding of how food works in

the body

Importance of food (nutrients)

• Food and health– Necessary for body function– Source of energy: carbohydrates and fats– Body building and repair: proteins– Regulation: vitamins– Pleasure

• Food and infections– Prevention– Healing

• Food and environment– 10-20 metric tones per person

Group of nutrients

• Macronutrients (needed in large amounts)– Carbohydrates– Fats– Proteins

• Micronutrients (trace amounts)– Vitamins – Minerals

Classification of nutritional disorders

• Macronutrient deficiencies– Under-nutrition (inadequate, malabsorption,

abnormal systemic loss of nutrients due to diarrhea, hemorrhage, renal failure, excessive sweating, infection, drug addiction)

– PEM• Kwashiorkor• Marasmus• Marasmus-kwashiorkor

– Over-nutrition (over-eating, insufficient exercise, over-prescription of therapeutic diets)

• Macronutrient deficiencies– Vitamin A def (VAD)– Iodine deficiency disorder (IDD)– Iron Deficiency Anaemia

• Other minor deficiencies– Niacin, vitamin B1, C, D, zinc excess of flourine

(flourosis)

Nutritional disorders of PH importance

• PEM (def of carbohydrates, fats and proteins)• Vitamin A deficiency• Iodine Deficiency Disorder• Nutritional anaemia

Why PH importance?

• They have a wide spread prevalence• They have an enormous burden of disability• Have a staggering cost to the society• Affect vulnerable groups or population

segments

PEM

• Commonest nutritional problem in developing countries

• Results from consumption of inadequate food and frequently aggravated by infections

• Possible etiological factors in Africa:– Shortage of calories and protein– Inadequate breast feeding– Ignorance– Superstition– Cultural taboos

PEM contd…

• Underfives mostly affected– Increases their risk of morbidity and mortality– Related to impaired mental development

• Known risk factors:– Non-exclusive breast feeding for the first 6

months of life– HIV/AIDS, diarrheal diseases and food diversity

and availability

Micronutrient deficiencies

• Insufficient intake- vitamin A, iron and iodine• Mild/moderate forms-not always recognized• Often referred to as “hidden hunger”• Most commonly reported deficiencies in both

adults and children are:– Iron– Vitamin– Iodine deficiency

• All three are highly prevalent in Tanzania• Affect the health and survival of more than 2

billion people world wide• Most at risk- women and children

Vitamin A deficiency

• Vitamin A (retinol) is fat soluble• Found mainly in fish, liver oils, liver egg yolks,

butter, green leafy and yellow vegetables• Most are stored in the liver if they are in

excess

• VAD is a major PH problem:– Main cause of preventable childhood blindness– Increases risk of mortality and morbidity

• Contributing factors– Low intake of Vitamin A intake– Vitamin A deficient mothers-low Vitamin A in

breast milk– High demand during infection– High losses during diarrhea

• WHO classifies VAD in Tanzania as a clinical health problem– Country wide an estimated 10,000 children are

likely to suffer from VAD– Common in areas with little access to Vitamin A

rich foods

Strategies to combat VAD (WHO/UNICEF)

• Food fortification• Supplementation• Dietary diversification

Public health measures

All approaches are complementary and should not be used in isolation

Complementary PH measures

• IMCI- Intergrated Management of Childhood lllinesses

• Immunization (EPI)• Safe motherhood initiative• Improve malnutrition and other micronutrient

deficiencies- (iron, iodine)• Promotion of breast feeding• Improve water and sanitation• Poverty alleviation programmes

Iodine deficiency

• Iodine is present in minute amounts in the body• Essential for synthesis of thyroid hormone• Deficiency causes a spectrum of disorders-IDDs-

are a world wide PH problem• Affects 7% of the worlds population• Children and pregnant women- most susceptible• Impairs brain development- low IQ– 1st preventable brain damage problem

Effect of ID

• Goitre- most common visible effect• Severe ID- cretinism which is manifested by

irreversible mental retardation– Can only be prevented by adequate intake of

iodine during pregnancy

Prevention and control of IDDs

• Supplementation with iodized oil• Food fortification– SALT-recommend food vehicle for iodization (others-

bread, milk, water)– Consumed by everyone – Production is generally centralized– Iodization is easy to implement-reasonable cost– Color, taste and odour of salt are not affected– Salt quality can be easily monitored at production,

retail and household level (using field tests)

• Recommended level of iodine in salt is 20-40 mg/iodine/kg salt assuming:– 20% loss-production point household– 20% loss during cooking

• For programme to be sustainable- salt intake of 10 g/person/day

Iron Deficiency Anaemia

• The most common form of anaemia• Affects about 20% of children, 50% of

pregnant women and 3% of men• A prevalent public health problem• The most widespread nutritional disorder in

Tanzania• Increases the risk of poor pregnancy outcome

prematurity, LBW and maternal mortality

Control of IDA

• Food diversification:– Nutrition education, cultivation of iron-rich foods

and vegetables

• Food fortification:– Cereal flour-wheat and maize

• Supplementation:– FeFo to pregnant mothers

• Public health measures:– De-worm school children