Role of Nutrition

Malnutrition weakens the immune system, making a child susceptible to disease, increasing severity of illness and
impeding recovery. A sick child, in turn, can quickly become malnourished. Age-appropriate breastfeeding and
nourishing complementary foods, along with adequate health care, can break this vicious cycle.

Maternal nutrition
A child’s nutritional future begins before conception with the mother’s nutritional status prior to pregnancy. A
chronically-undernourished mother is likely to give birth to an underweight baby, who may be stunted as a child and
in turn give birth to malnourished baby. A well-nourished woman over the age of 18 has a much greater chance of
surviving pregnancy and her child of growing up healthy.

Eliminating malnutrition in mothers can reduce disabilities in their infants by almost one third. It is also important that
expectant mothers eat a variety of foods, receive essential micronutrients and have adequate rest. During fetal
growth is when most of the child’s organs and tissues, blood, brain and bones are formed, and his or her potential is
shaped. Lack of maternal nutrition and nutritional stores can create irreversible harm.

First three years: Infant and young child feeding

The period from birth to the age of three is a time of rapid growth and represents a singular opportunity to provide a
child with a strong nutritional and immunological foundation. Intellectual and physical growth is the most rapid, with
doubling of brain size and quadrupling of body weight. If a child is malnourished during these early years, much of the
damage is irreversible – the answer lies in prevention.

If every baby immediately put skin-to-skin at the breast, hypothermia would be prevented, saving about 200,00 lives
annually, If every baby were exclusively breastfed for six months, an estimated 1.3 million additional lives would be
saved every year, and millions more would benefit in terms of health, intelligence and productivity. Breastmilk is the
perfect food – it contains all the nutrients and micronutrients an infant needs for normal growth during the first six
months of life.

Breastfeeding stimulates an infant’s immune system and response to vaccinations, and is continually changing to
meet the babies needs. Breastmilk contains hundreds of health-enhancing cells, proteins, fats, hormones, enzymes
and other factors found nowhere else but in mother's milk.

Breastfed babies have at least six times greater chance of survival in the first months because breastmilk has factors
that protect the mucous membranes of gastrointestinal and respiratory tracts, and cells and immune factors that
actively fight infections, shielding babies from diarrhoeal diseases and upper respiratory infections. (SOWC, 1998)
Exclusive breastfeeding increases the chance of survival many times more, and may also lower the chances of an
HIV-positive mother passing on the virus via breastfeeding.

After six months, the infant should continue her frequency of breastfeeding while begining responsive complementary
feeding with nutrient- and iron-dense foods that provide additional vitamins, minerals, proteins and carbohydrates to
meet her or his growing needs. Complementary feeding should start gradually, but the 6-8 month old child should
receive.

Essential micronutrients
Tiny doses of minerals, vitamins and trace elements can mean a difference between life and death for mothers and
children. Micronutrients – particularly iron, vitamin A, iodine and folate – play a vital role in the mother’s survival in
pregnancy and childbirth, and in the child’s development.

Vitamin A is essential for the functioning of the immune system. Vitamin A deficiency (VAD) causes blindness and
renders children susceptible to common childhood killers: measles, diarrhoea, malaria and pneumonia. Increasing the
vitamin A intake of populations with VAD can decrease childhood deaths from such illnesses by 25 per cent. Vitamin
A also helps prevent maternal mortality and may reduce mother-to-child transmission of HIV.

Iodine is a critical nutrient for the proper functioning of the thyroid gland which regulates growth and metabolism.
Iodine deficiency is the primary cause of preventable learning disabilities and brain damage, having the most
devastating impact on the brain of the developing foetus. One teaspoon of iodine – consumed in tiny amounts on a
regular basis over a lifetime – is sufficient to prevent the conditions known collectively as iodine deficiency disorders
(IDD).

The body needs iron to manufacture haemoglobin – the protein in red blood cells that carries oxygen around the
body – and several enzymes necessary for muscle, brain and the immune system. The body’s iron requirements
increase during menstruation, pregnancy, breastfeeding and high-growth periods. Iron-folate supplements during
pregnancy help prevent anaemia, which increases the risk of haemorrhage and sepsis (overwhelming bacterial
infection) during childbirth and is implicated in 20 per cent of maternal deaths. Folate, a B vitamin, is needed for the
formation of red blood cells and also the development of nerve cells in the embryo and feotus stages of development.

Forms and types of malnutrition

Types of malnutrition
Malnutrition is a group of conditions in children and adults generally related to poor quality or insufficient quantity of
nutrient intake, absorption, or utilization.

There are two major types of malnutrition:

 Protein-energy malnutrition - resulting from deficiencies in any or all nutrients

 Micronutrient deficiency diseases - resulting from a deficiency of specific micronutrients

Protein-energy malnutrition
The most basic kind is called protein energy malnutrition. It results from a diet lacking in energy and protein because
of a deficit in all major macronutrients, such as carbohydrates, fats and proteins. Marasmus is caused by a lack of
protein and energy with sufferers appearing skeletally thin. In extreme cases, it can lead to kwashiorkor, in which
malnutrition causes swelling including a so-called 'moon face'

There are three types of protein-energy malnutrition in children:

Type Appearance Cause

Acute malnutrition Wasting or thinness Acute inadequate nutrition leading to rapid weight loss or failure to
gain weight normally

Chronic malnutrition Stunting or shortness Inadequate nutrition over long period of time leading to failure of linear
growth

Acute and chronic Underweight A combination measure, therefore, it could occur as a result of
malnutrition wasting, stunting, or both

These forms of protein-energy malnutrition in children can be pictured like this:

Wasting and stunting are very different forms of malnutrition. Stunting is chronic and its causative factors are poorly
understood. Stunting usually does not pose an immediate threat to life and is relatively common in many populations
in less-developed countries. This is not to say that it is unimportant, just less important than wasting in humanitarian
emergencies. Wasting results from an acute shortage of food, is reversible with refeeding, and has a relatively high
mortality rate. For these reasons, wasting is the highest priority form of malnutrition in humanitarian emergencies.

Micronutrient deficiency diseases:

Deficiencies of iron, vitamin A and zinc are ranked among the World Health Organization's (WHO) top 10 leading
causes of death through disease in developing countries:

 Iron deficiency is the most prevalent form of malnutrition worldwide, affecting millions of people. Iron forms
the molecules that carry oxygen in the blood, so symptoms of a deficiency include tiredness and lethargy.
Lack of iron in large segments of the population severely damages a country's productivity. Iron deficiency
also impedes cognitive development, affecting 40-60 percent of children aged 6-24 months in developing
countries (source: Vitamin & Mineral Deficiency, a global damage assessment report, Unicef).

 Vitamin A deficiency weakens the immune systems of a large proportion of under-fives in poor countries,
increasing their vulnerability to disease. A deficiency in vitamin A, for example, increases the risk of dying
from diarrhoea, measles and malaria by 20-24 percent. Affecting 140 million preschool children in 118
countries and more than seven million pregnant women, it is also a leading cause of child blindness across
developing countries (source: UN Standing Committee on Nutrition's 5th Report on the World Nutrition
Situation, 2005).

 Iodine deficiency affects 780 million people worldwide. The clearest symptom is a swelling of the thyroid
gland called a goitre. But the most serious impact is on the brain, which cannot develop properly without
iodine. According to UN research, some 20 million children (source: Vitamin & Mineral Deficiency, a global
damage assessment report, Unicef) are born mentally impaired because their mothers did not consume
enough iodine. The worst-hit suffer cretinism, associated with severe mental retardation and physical
stunting.

 Zinc deficiency contributes to growth failure and weakened immunity in young children. It is linked to a
higher risk of diarrhoea and pneumonia, resulting in nearly 800,000 deaths per year.
 Importance of Nutrition
Eating a balanced diet is vital for good health and wellbeing. Food provides our bodies with the energy, protein,
essential fats, vitamins and minerals to live, grow and function properly. People need a wide variety of different foods
to provide the right amounts of nutrients for good health.

 develop, replace and repair cells and tissues;

 produce energy to keep warm, move and work;
 carry out chemical processes such as the digestion of food;
 protect against, resist and fight infection and recover from sickness

Nutrition Assessment:

A nutrition assessment is an in-depth evaluation of both objective and subjective data related to an
individual's food and nutrient intake, lifestyle, and medical history. Nutrition assessment is important in
clinical medicine because acute and chronic malnutrition are common clinical findings. Malnutrition is
defined as the sub-optimal supply of a nutrient that interferes with an individual’s growth, development or
maintenance of health. Over-nutrition is excessive intake of nutrients, mostly macronutrients and calories
which increase risk of many chronic diseases.

PURPOSE OF NUTRITION ASSESSMENT

• To accurately determine nutritional status

• To identify current and potential nutritional and medical problems
• To monitor changes in nutritional status during national policy changes,
fortification programs, nutrition intervention or the course of a chronic or acute illness

Nutritional screening is the process of identifying characteristics known to be associated with nutrition
problems. Its purpose is to identify populations, sub-groups or individuals who are malnourished or at
nutritional risk. Four different methods are used to collect data used in assessing nutritional status:

1. Anthropometric
2. Biochemical or Laboratory
3. Clinical (physical exam)
4. Dietary: Nutritional History Current Intake.

A. ANTHROPOMETRIC METHODS Anthropometric Measurement allows classification of a patient into

categories of nutritional status according to developed standards or reference data, usually based on
large numbers of healthy people from the U.S. population. These measurements may be performed as
part of the physical examination.
 WEIGHT OR CHANGE IN WEIGHT
 BMI (USING HEIGHT AND WEIGHT)
 WAIST CIRCUMFERENCE

In INFANTS AND CHILDREN, length or height, weight and head circumference should be plotted on:
• GROWTH CHARTS
B. DIETARY ASSESSMENT:
 1-7 Day Food Records
 24-Hour Recall
 “Usual” Daily Intake
 Food Frequency Questionnaire (FFQ)