NUTRITIONAL ASSESSMENT

AND
MALNUTRITION
(Under 5 and above 5 years of age)

By:
Dr Gulzar Usman
MBBS, DFHC, MPH, PhD
dr.gulzar79@gmail.com
Learning Objectives:
1- To understand about various methods of
Nutritional Assessment

2- To be able to conduct the Nutritional Assessment

3- To know the concept and Types of Malnutrition

4- To be familiar with Treatment and Prevention of

Malnutrition
Nutritional Assessment:
Finding out the overall Nutritional status
of the community, which will help out in
decreasing disease burden through;
Identifying at risk/vulnerable population
Identifying those who need nutritional
counselling
Nutritional intervention and conducting
Research
Nutritional Assessment of a single
individual:
Quantity and Quality of Food taken
Overall general health status of that individual

Nutritional Assessment of a Community:

Sum of individuals’ nutritional status
Socio-demographic fabric of the community
 Comprehensive
Nutritional Survey:
Getting Information
Identifying at-risk population
Policy making and Programming
Monitoring of Program
Evaluation of Program
Methods of Nutritional Assessment
Anthropometry
Biochemical Assessment
Clinical Examination
Dietary Intake Assessment

Vital and Health Statistics

Ecological Factors assessment
Anthropometric measures:
Height, Weight, BMI

Circumferences:
Head, Hip/waist
Mid Upper-Arm Circumference (MUAC)

Skin Fold thickness

Methods….
Biochemical Assessment
Haemoglobin estimation
RBC Count , Hematocrit levels
Urinary levels of iodine
Stool DR for chronic amebic dysentary
Serum levels of retinol
Clinical/Physical Examination
Angular stomatitis
(Fungal)

Bitot’s spots (Vitamin A

deficiency)

Enlargement of thyroid
gland (Iodine deficiency)
Other methods…
 DIETARY SURVEY
ASSESMENT OF DIETARY INTAKE

 24- HOUR DIET RECALL FORM

(Food consumption record)

 VITAL & HEALTH STATISTICS (Records, Registries)

 ECOLOGICAL FACTORS
(Awareness, Socio-economics, availability of Food etc)
 MALNUTRITION

Malnutrition comprises both:

1. Under nutrition
2. Over nutrition
MALNUTRITION
(Bad Nourishment)

Relative OR Absolute

Deficiency

A Pathological state OR
resulting from
Excess of
Excess of One OR
One OR More
More Essential Nutrients
Essential Nutrients
The World Health Organization (WHO) defines
malnutrition as
the cellular imbalance between

supply of nutrients and the body's

& energy demand

to ensure
growth, Primary: inadequate food intake
maintenance, and
Secondary: result of disease
specific functions
Mixed
 TYPES OF UNDERNUTRITION Affects all age
groups; vulnerable
UNDERNUTRITION groups are young
children , pregnant
women, & lactating
women .

ACUTE CHRONIC
UNDERNUTRITION UNDERNUTRITION

• Marasmus • Stunting
• kwashiorkor • Underweight
• Marasmic- kwashiorkor
• Wasting

There were 925 million undernourished people in the world in 2010, an increase of
80 million since 1990.

Nearly 17% of people in the developing world are undernourished.

 MANIFESTATIONS OF OVERNUTRITION

In the more developed countries of the world, over nutrition is

encountered much more frequently than under nutrition.

The health hazards from over

nutrition are:
1. Obesity,
2. Diabetes,
3. Hypertension,
4. CVD,
5. Renal diseases,
6. Disorders of liver &
gall bladder.

19
(protein defici:
Edema lower
legs)

(Energy defic:
Extreme thinness)

(Show both Signs)

(Very Thin)

(Too short for their Age)

(Short / Thin or Both)

Marasmus: (6m – 15m)
(Energy deficiency )
Extreme thinness

Kwashiorkor (Displaced Child) 1-3 Ys

(Protein deficiency)
Edema lower legs

Marasmic-Kwashiorkor
 (Show both Signs)
Age group affected
Usually b/w 6 months & 3 years
Marasmus = 6 months to 15 months
Kwashiorkor = 1 to 3 years
PEM (45%) = 1 to 2 years
PEM (69%) = 1 to 3 years
Factors related to Malnutrition

Social and Economic

Poverty
Ignorance
Inadequate weaning practices

Cultural & social practices

Vegetarian

Low fat diets

Biologic factors

Maternal malnutrition, prematurity

Start life with poor stores
Infectious disease
Diarrhea, TB, measles, Malaria, AIDS
Environmental
Unsanitary living, poor quality water
Droughts, floods, wars, forced migrations
TYPES OF MALNUTRITION

Anemia or Iron Deficiency

Vitamin A Deficiency
Iodine Deficiency
Lack of vitamin D – Rickets
Lack of Vitamin C- Scurvy
Lack of Niacin (vit: B3) – Pellagra
Lack of Thiamin (Vit: B1) – Beri-Beri
Malnutrition due to a lack of energy and protein foods
• How maternal & child nutrition are linked…???
Anthropometric Measures
Children:
Weight-for-age (underweight)
Reflects chronic or acute malnutrition or both

Height-for-age (stunting)
Reflect chronic (prolonged, cumulative) malnutrition

Weight-for-height (wasting)
Reflects acute and recent malnutrition
Anthropometric Measurements
Adults:
Body Mass Index (BMI)
Low weight-for-height ( kg/m2) reflects chronic &/or
acute

Mid-upper arm circumference (MUAC)

Thin reflects chronic &/or acute
 Treatment of Malnutrition
Follow WHO Guidelines

1. Treat/prevent hypoglycaemia

2. Treat/prevent hypothermia
3. Treat/prevent dehydration
4. Correct electrolyte imbalance
5. Treat/prevent infection
6. Correct micronutrient deficiencies
7. Initiate refeeding
8. Facilitate catch-up growth
9. Provide sensory stimulation & emotional support
10. Prepare for follow-up after recovery
 Prevention of Malnutrition
Primary Prevention
 Health Education to mothers about good nutrition and food
hygiene through Lady Health Workers
 Immunization of children.
 Growth monitoring on Growth Charts specially of all children
under 3 years of age

Secondary Prevention
 Mass Screening of high risk populations, using simple tools like
(Weight for age) or MUAC.

Tertiary Prevention
 Good Nutritional Care, supplementary feedings and
rehabilitation,
 counseling of mothers.
Interventions Proven to Reduce Malnutrition When Linked
with Health Services
(Essential Nutrition Actions)
Complementary Mother’s
Breastfeeding feeding nutrition

Vitamin A Sick/severe Iodized salt

and iron cases
THANX