MALNUTRITION IN THE PHILIPPINES

Edgar M. Gerodias, R.N.,ECF,PCM, Hep. B Prec. CAP I, FMD
Joanna Ruth Palermo, R.N., ICF,PBL, AIDS Prec., TB Stage V, FMD

Common Malnutrition Problems in the Philippines
•Protein -Energy Malnutrition (PEM) - A lack of energy and protein which results in growth redardation. •Iron Deficiency Anemia (IDA) - A deficiency in iron wherein hemoglobin concentration is below the normal level which results in short attention span, reduced ability to learn and irritability.

Common Malnutrition Problems in the Philippines

Vitamin A Deficiency (VAD) - Lack of vitamin A that may result to xeropthalmia (dryness of the eye), nightblindness (inability to see in dim light) eyes sensitive to bright light, rough dry skin and membranes of nose and throat , low body resistance to disease, poor growth, and blindness in severe cases. Iodine deficiency Disorders (IDD) - Lack of iodine in the body which results in goiter, mental retardation, deaf-mutism, difficulty in standing or walking normally, and stunting of the limbs.

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low body resistance to disease. Iodine deficiency Disorders (IDD) . and stunting of the limbs. and blindness in severe cases. rough dry skin and membranes of nose and throat . difficulty in standing or walking normally.Lack of iodine in the body which results in goiter.Common Malnutrition Problems in the Philippines   Vitamin A Deficiency (VAD) . poor growth. mental retardation.Lack of vitamin A that may result to xeropthalmia (dryness of the eye). nightblindness (inability to see in dim light) eyes sensitive to bright light. . deaf-mutism.

.Simple Goiter – This condition is characterized by an enlargement of the entire gland. caused by a deficiency of iodine in the diet. or of one of its two lobes.

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to address the problem of micronutrient malnutrition This law is complimentary to RA 8172 or the ASIN Law (An Act Promoting Salt Iodization Nationwide).The Food Fortification Program RA 8976 Republic Act 8976 or the Food Fortification Act of 2000 was signed into law on November 7. 2004. 2000 for full implementation on November 7. passed in December 1995. . mandating the iodization of all salt sold in the country.

for human consumption in the Philippines. . 1 – The Philippine Food Fortification Program shall cover all imported or locally processed foods or food products for sale or distribution.Key Provisions of the Law: Rule IV: The Philippine Food Fortification Program Sec.

6 of RA 8976 and those that may be required by the National Nutrition Council. 2 – The Philippine Food Fortification Program shall consist of two systems: • Voluntary food fortification • Mandatory food fortification for specific food products enumerated in Sec. .Key Provisions of the Law: Sec.

traders. retailers. tollees. 3 – The Implementing Rules and Regulations shall apply to all manufacturers. as well as restaurants and food service establishments where such food products are encouraged to be served. 2 of Rule IV of the IRR.Key Provisions of the Law: Sec. or producers. . importers. repackers of food products covered by Sec.

The intake of these micronutrients through the Filipino diet is often inadequate and is responsible for the micronutrient malnutrition afflicting a majority of the population. and therefore must be provided through the diet. which cannot be synthesized by the human body.Sangkap Pinoy    a term used by the DOH for micronutrients added to food to enhance its nutritional quality These micronutrients are vitamin A. . iron and iodine.

SANGKAP PINOY SEAL Sangkap Pinoy Seal (SPS) is a mark of DOH recognition of a food product that is properly fortified with either vitamin A. iodine or iron or a combination of these micronutrients and that complies with regulations of the Bureau of Food & Drug (BFAD) of the DOH for quality. . labeling and addition of fortificants.

SANGKAP PINOY SEAL Approved Products .

Iron Chicken. Beef Goodah Instant Noodles Beef.NOODLES No. Iodine Chicken. Chicken Asado Vitamin A . Iron Vitamin A. Chicken Lucky Me Instant Mami Vitamin A. 1 2 3 4 PRODUCT Dolphin Plus Vermicelli Bihon Excellent Insant Mami FORTIFICANT Iron. Beef Pancit Canton. Pancit Canton with Kalamansi 5 MAGGI Rich Mami Noodles Vitamin A. Iron Vitamin A Beef. Chicken and egg. Chicken.

Hot & Spicy. and Pizza) Payless Instant Mami Chicken. Beef Wanton and Beef Brisket) Nooda Crunch Ready to Eat Noodle (Cheese. Cheezy Bacon 7 8 9 10 11 Saucy-Mi (Original. Toyomansi. Toyomansi. Beef Bulalo Vitamin A Vitamin A Vitamin A Vitamin A Vitamin A Vitamin A . Barbeque.NOODLES 6 Maggi Noodle Buddies Buttered Corn. and Instant Pancit Palabok Ho-Mi Canton (Classic. Pancit Canton with Chilimansi. Beef. Beef & Onion. Chili Anghang. and Pinoy Beefsteak) Ho-Mi Instant Mami (Chicken & Garlic.

SNACK FOODS 12 Granny Goose Tortillas Barbecue. Iron & Iodine Vitamin A. Iron & Iodine Vitamin A. Cheese. Ham and Cheese. Cheese Party flavored. Corn Snack Vitamin A. Barbecue. Cheese 15 16 17 Clover Chips Cheese flavor Oishi Prawn Crackers Oishi Kirei Yummy Flakes . Corn Snack 14 Granny Goose Kornets Natural. Sizzling Hot Cheese. Iron & Iodine Vitamin A Vitamin A Vitamin A 13 Granny Goose Nibbles Cheese. Chili.

SNACK FOODS 18 19 Oishi Boogyman Vegetable Crunch Oishi Cheese Barrel Vitamin A Vitamin A 20 21 22 23 24 25 26 Oishi Rinbee Cheese Sticks PeeWee Crunchy BBQ and Pizza flavored snack Cheez-it Tasty Snack Cracker Moby Caramel Puff Moby Chocolate flavored Snack Ri-Chee Crunchy Snacks Milk flavored Kenken Puffcorn Honey Caramel. Iron Vitamin A Vitamin A. Iron Vitamin A. Iron Vitamin A Iron 27 Regent Golden Sweet Corn Iron . Chocolate Vitamin A Vitamin A.

Cheese flavored snack Regent Ebisen Prawn Crackers Tomi Corn Chips Chicken.Vegetable Flavor Regent Cheese Ball . Iron 33 Humpy Dumpy Corn Chips Buttered Corn on a cob. Chili & Garlic Mexican Barbecue Royal Cheese Vitamin A.Cheese flavored snack Iron Iron 30 31 32 Regent Cheese Ring . Keso Iron Iron Vitamin A. Iron . Sweet Corn.SNACK FOODS 28 29 Regent Snack Rice Cracker.

Sweet Corn 36 37 38 Jack 'n Jill Chiz Curls Roller Coaster Potato Rings Cheese flavor Maggi No Cook Rice Porridge Guinataang Monggo. Iron Vitamin A . Iron Vitamin A. Champorado.SNACK FOODS 34 Fastsnax Corn Snacks Barbecue Fries Cheeseburger 35 Jack 'n Jill Mr. Arroz Caldo Vitamin A. Iron Vitamin A Vitamin A. Goto. Chips Nacho Cheese.

Raisin-Nuts. Mix fruit with soya. Chicken. Cream of Chicken with rice & milk. Monggo. Chicken Stew with vegetable and milk. Iron & Iodine 40 Gerber Infant Cereals Brown Rice. Choco-Cereal Vitamin A. Rice. Iron 41 Nutri-Pak Champorado. Wheat. Green mongo Vitamin A. Guinataan Vitamin A .SUPPLEMENTARY FOODS FOR INFANTS 39 Cerelac infant Cereals Rice-soya. Brown Rice with Soya. Cream of brown rice with milk. Beef. Wheat-Banana. Squash & Spinach.

BISCUITS 42 Goya Knick Knacks Coated Biscuit Chocolate. Peanut Butter. Milk Magic Flakes Crackers Sandwich Butter Cream. Iron 43 Vitamin A . Artificial Coconut Flavor Vitamin A. Chocolate. Orange.

pandesal. Wheat. Raisin. Vitamin A dinner rolls. Sandwich White Vitamin A. buns .BREADS 44 Arlee's Power Bread Loaf. Bun Sandwich Bread Egg and Milk. Iron 45 Vitamin A 46 Goldilocks Fresh Bake buns and rolls.

Mantekeso. Buttermilk 51 Minola Margarine Vitamin A . Iodine Vitamin A 50 Dari Crème Margarine Classic. Salad & Sandwich Spread. Vitamin A Ham and Bacon Spread 48 Miracle Whip All-Purpose Dressing Regular all-purpose Reduced Fat all-purpose dressing Vitamin A 49 Star Margarine Classic.SANDWICH SPREAD 47 Miracle Whip Spread Sandwich Spread. Sweet Blend & Garlic Vitamin A.

iodine Vitamin A 53 Kraft Cheddar-Cheese Spread Kraft Chiz Whiz Processed Cheese 54 Spread Cheezee Pasteurized Processed 55 Filled Cheese (in block form and jar) . Iodine Vitamin A.CHEESE PRODUCTS 52 Eden Pasteurized Filled Cheese Spread Vitamin A. Iodine Vitamin A.

Iron & Iodine . Iron 57 Lactum Powder Regular.MILK Alacta Grow Milk for older 56 kids Vitamin A. Chocolate Vitamin A.

CHOCOLATE DRINKS 58 Ovaltine Chocolate Beverage Vitamin A. Powder Iodine . Iron.

Orange. Pineapple. Pomelo. Pineapple Magnolia Ice Tea Drinks lemon Fruit C Orange Juice Drink Vitamin A 60 Vitamin A 61 Vitamin A 62 63 Vitamin A Vitamin A . Grape.FRUIT DRINKS 59 Eight O'Clock Orange Instant Drink Mix Tang Juice Drink Mangga (instant drink mix full sugar & instant drink mix hybrid) Orange. Mandarin-Orange. Soursop Magnolia Fruit Drinks Mango.

Hot Toyo Canned Sardines Vitamin A Vitamin A 66 67 68 69 70 Señorita Canned Sardines Mekeni Picnic Premium Hotdog Swift Mighty Meaty Hotdog Boomboom Hotdog Regular. Jumbo Purefoods Beefies Hotdog Vitamin A Vitamin A Vitamin A Vitamin A Vitamin A .MEAT AND FISH PRODUCTS 64 65 555 Sardines Regular.

CONDIMENTS 71 Papa Banana Catsup Vitamin A .

the Diamond Sangkap Pinoy Seal was introduced to be used solely for staple products mandated for fortification. rice. refined sugar and salt. Currently there are 71 products under the Diamond SPS . wheat flour.DIAMOND SANGKAP PINOY SEAL In 2004. namely cooking oil.

DIAMOND SANGKAP PINOY SEAL RICE Iron-Fortified Rice SALT First Choice Iodized Salt Fidel Iodized Salt SUGAR Azukal Pure Cane Sugar Vitamin A Iodine Iodine Iron .

GARANTISADONG PAMBATA   a campaign to support various health programs to reduce childhood illnesses and deaths by promoting positive child care behaviors A program of the Department of Health in partnership with the Local Government Units and other government and non-government organizations .

 .GARANTISADONG PAMBATA  GP is done twice a year one week in April and one week in October. Second week of October was designated as "Garantisadong Pambata" week.

GARANTISADONG PAMBATA SERVICES

Giving VIT A capsules (VAC) supplement to all 1259 months old children.

Catch up immmunizations (children who missed the routine immunizations like BCG, OPV, DPT, Measles)
Distribution of iron supplements to infants and pregnant women

GARANTISADONG PAMBATA SERVICES

Promotion of child positive caregiving behaviors like


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exclusive breastfeeding of infants from 0-6months old, feeding infant micronutrient rich complementary foods starting 6 months old, use of iodized salt daily, Buying and eating fortified foods, brushing of teeth properly and regularly, letting children play safe toys no smoking in front of preschooler

Marasmus speaks:
I am derived from a word meaning withering or wasting… Hence, my physical manifestations are related to my meaning…

I am the result of the misfortune in the family… .Kwashiorkor reacts: I come from the African language meaning “the sickness of the older child when the next baby is born. This corresponds to the “weaning time of the older child.” Therefore.

Etiology: Marasmus -due to a diet very low in calories (CHO. . fats and protein) -BALANCED STARVATION Kwashiorkor -a deficiency of PROTEIN with adequate or even excess of calories.

Scheduled b.Age Incidence: Marasmus -often the result of unsuccessful BF or insufficient BM supply with little or no other food given. BF may be given on: a. Per Demand .

thighs . muscle wasting best seen and felt at the buttocks. upper arms and scapular region (winged scapula) .Marasmus -failure to gain weight leads to loss of weight which leads to emaciation -the face becomes shrunken (old man’s face).

B complex. without high protein foods -it is highly probable that deficiencies of other nutrients such as Vit. other minerals and etc. are frequent contributing factors . A.Kwashiorkor -usually occurs in a breastfed child until he is weaned gradually into starchy diet.

penis.Clinical Features Diagnostic Edema-is a cardinal sign (meaning syndrome should not be diagnosed in its absence) -1st detected at the anklegeneralized but more marked on the subcutaneous tissues of the dependent parts such as legs. . and the lower face (moonface) 1. the lower back. scrotum. forearms.

-protruding abdomen is due to hypotonia of the abdominal muscles and the intestine and edema of the abdominal wall -muscle wasting can be demonstrated functionally by testing the infants ability to hold his head when gently pulled from a lying to a sitting position .

Psychomotor changes -looks miserable and does not smile -motor development is retarded Irritability-psychological trauma d/t maternal withdrawal assoc. with weaning from the breast plays an impt. role .

Mental changes -1st 3 years of life is very critical in brain development .

2. pale.pluckability records a prolonged period of deprivation . Common Signs -certain signs though not necessary for diagnosis are common and are usually present singly or in combination a. Hair changes-occasionally serve to indicate the duration of the deficiency: long scanty.

Anemia-nutritional anemia -the hemoglobin content of the blood is lower than the prescribed value for a given age group as a result of deficiency of folic acid or B12 like hookworm infestation .FLAG SIGN-alternate light and dark bands in the hair indicates alternating periods of protein adequacy and deprivation b. Depigmentation of the skin-there is general lightening of the color of the pigment of the skin due to interference in melanogenesis c.

Flaky Paint Rash or Enamel Dermatoses -seen in advanced cases. then purplish with macules and vesicleslater they become dry. Occasional Signs of Kwashiorkor a. if present it is pathognomonic of the disease -these are patches of skin turn reddish. leaving a raw.3. weeping areas like burns . peel off.

with Vit. A deficiency .-seen mostly in the hidden parts of the body like buttocks. groins and trunk. Grave Prognosis: Hepatomegaly-there is usually enlargement of the liver which has a smooth surface and edge Marasmus and Kwashiorkor are assoc.

Quiet Good Appetite Diarrhea Kwashiorkor Poor appetite Diarrhea Diffuse depigmentation Flaky-paint/enamel or dermatosis Moonface Hepatic Enlargement .Difference Between Marasmus and Kwashiorkor Marasmus Muscle Wasting Growth Retardation Apathetic.

Kwashiorkor Ching! .

Kwashiorkor Triple Treat! .

Mr. Marasmus 2007! Bongga! .

Non. .Infectious Diarrhea Infectious Diarrhea.Pathophysiology of Diarrhea in Malnutrition Types of Diarrhea: 1.PCM inflicts profound damage on the GIT particularly the stomach and duodenum. Infectious Diarrhea 2.

Infectious Diarrhea-damage further the intestinal pits which has already been weakened by malnutrition Vicious Cycle malnutrition malabsorption diarrhea .

Non-Infectious Diarrhea Malnutritionatrophy of the intestinal villi which contains the brush borderdissacharide: Lactose) enzyme lactase is secreted in the outermost layer of the brush borderin severe casessucrase and maltase TOTAL DISSACHARIDE INTOLERANCE or malabsorption .2.

Lactose Intolerance -80% of the malnourished child. abdominal cramps. . The intake of regular milk which contains lactose promote and perpetuate diarrhea Intake-1 hour after ingestion. vomiting.

How to confirm the dx. Of lactose intolerance: Aspirate watery-portion of the feces and test for -ph. reducing substance pH=<6 acidic Reducing substance= trace to +1 .

determine the presence of any medical emergency. Evaluate the Clinical Condition . make a clinical diagnosis and treat accordingly.TREATMENT OF PCM 1. .

Severe dehydration secondary to Infectious Diarrhea  Dehydration: REPLACEMENT 50 ml/kg BW 100ml/kg BW 150ml/kg BW Mild – 5% weight loss Moderate – 10% weight loss Severe – 15% weight loss  Treat with antibiotics .Ex.

enroll in teaching programs if necessary .make Nutritional diagnosis 3. Rehabilitate the malnourished child a.TREATMENT OF PCM 2.) home basis .institute medical and nutritional management b.) refer to malward if warranted . Assess the Nutritional Status .

family planning advice  food production information  Income. Institute follow-up measures such as:  Weighing  Medical and nutritional advice  Immunization.generating activities . deworming .TREATMENT OF PCM 4. sanitation advice.

.HOW TO RE-INTRODUCE MILK FEEDINGS Since early introduction of full-strength milk which contain lactose will provoke and perpetuate diarrhea. milk feedings should be resumed with extreme caution.

a very dilute mixture of milk preparation is given : S26 or Bona 1:2 dilution 1 part milk : 2 parts water 1:7 1:6 1:2 (1 – 2 days) By starting gradually.HOW TO RE-INTRODUCE MILK FEEDINGS After 2-3 days without milk. exacerbation of diarrhea due to lactose intolerance is AVOIDED .

Dextrimaltose Nursoy – soya .HOW TO RE-INTRODUCE MILK FEEDINGS To increase the caloric content of the dilute milk. For patients who are not tolerant to milk Re-feeding . one may add sugar (sucrose or pure glucose) provided there is no intolerance to them.Give NON LACTOSE FORMULA: Al 110 – glucose Isomil and Nutratigen – sucrose Sobee .

the essence of dietary management is to give the child HIGH CALORIC.DIETARY MANAGEMENT OF MALNOURISHED CHILD . HIGH PROTEIN DIET aiming at 100 – 200 cal/kg BW/ day   4-8 gm protein/kg BW/ day mode: feed frequently .

Starting them on a full diet will definitely cause a relapse of their diarrhea: NPO for 24 – 48 hours – IVF 50 – 75 cal/kg/day 2 gm/kg/day of protein No bouts of diarrhea .DIETARY MANAGEMENT OF MALNOURISHED CHILD .

DIETARY MANAGEMENT OF MALNOURISHED CHILD Increase 200 mg/day of calories Increase protein 8gm/day Until weight gain is OPTIMAL (2-4 weeks) Maintain CHO = 110 – 120 cal/kg/day PROTEIN = 4 – 8 gm/BW/day .

DIETARY MANAGEMENT OF MALNOURISHED CHILD PROGNOSIS: most of the clinical features and pathologic changes are REVERSIBLE but if SEVERE malnutrition occurs early in life. . when psychomotor and brain development is critical the changes noted maybe IRREVERSIBLE. specially before 6 months of age.

but should always be the product of a responsible gift of love of its parents to each other and to the Creator Himself” .“A child should never be the result of chance.

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