CHAPTER ONE
1.0
INTRODUCTION
1.1 NUTRITIONAL DISORDER
Nutritional
disorder is a pathological state due to a relative or absolute deficiency or
excess of one or more essential nutrients; clinically manifested or detected
only by biochemical, anthropometric or physiological tests. Nutritional
disorder which is also known as malnutrition is a condition that results from eating a diet in which nutrients are either not enough or are too much such
that the diet causes health problems (Young, 2012). It may involve calories, protein, carbohydrates, vitamins or minerals. Not enough nutrients is called undernutrition or undernourishment while too much is
called overnutrition (Young, 2012). Malnutrition is often used specifically to refer to
undernutrition where there is not enough calories, protein, or micronutrients. If undernutrition occurs during pregnancy, or before two years of age, it may result
in permanent problems with physical and mental development in a child. When a
child is exposed toextreme undernourishment, known as starvation, this may have symptoms that include: a
short height, thin body, very poor energy levels, and swollen legs and abdomen in child. Children also often get infections
and are frequently cold. Undernutrition is an important determinant of maternal and
child health, accounting for more than a third of child deaths and more than 10
percent of the total global disease
burden according
to previous studies (Black et al., 2008) The World Health Organization
estimates that malnutrition accounts for 54 percent of child mortality
worldwide, (Walker et al., 2008) about 1 million children (Jean,
2008). Another estimate also by WHO states that childhood underweight is the
cause for about 35% of all deaths of children under the age of five years
worldwide (FAO, 2008). As underweight children are more vulnerable
to almost all infectious diseases, the indirect disease burden of
malnutrition is estimated to be an order of magnitude higher than the disease
burden of the direct effects of malnutrition (FAO, 2008). The combination of
direct and indirect deaths from malnutrition caused by unsafe water, sanitation
and hygiene (WASH) practices is estimated to lead to 860,000 deaths per year
in children under five years of age.
The symptoms of micronutrient deficiencies depend on the micronutrient that is lacking.
Some
of the well-known classification of nutritional disorders in children are: Under-nutrition
(Marasmus), Over-nutrition (Obesity, Hypervitaminoses), Protein-energy
malnutrition (PEM) (Kwashiorkor, Hypovitaminoses), Mineral
Deficiencies, Imbalance (Electrolyte Imbalance).
1.1.1 Malnutrition (Undernutrition and Overnutrition)
Malnutrition is most often
due to not enough high-quality food being available to eat. This is often
related to high food prices and poverty. A
lack of breast
feeding may contribute, as may a number of infectious
diseases such as: gastroenteritis, pneumonia, malaria,
and measles,
which increase nutrient requirements (WHO, 2005). There
are two main types of undernutrition: protein-energy
malnutrition and dietary deficiencies. Protein-energy
malnutrition has two severe forms: marasmus (a
lack of protein and calories) and kwashiorkor (a
lack of just protein). Common micronutrient deficiencies include: a lack of iron, iodine,
and vitamin
A. During pregnancy,
due to the body’s increased need, deficiencies may become more common. In some developing
countries, overnutrition in the form of obesity is
beginning to present within the same communities as undernutrition. Other
causes of malnutrition include anorexia nervosa and
bariatric
surgery(WHO,
2005).
Nutritional disorder is caused by eating a
diet in which nutrients
are not enough or are too much such that it causes health
problems. It is a category of diseases that includes undernutrition and overnutrition.
Overnutrition can result in obesity
and being overweight (Murray, 2012). In some developing
countries, overnutrition in the form of obesity is
beginning to present within the same communities as undernutrition. However,
malnutrition is commonly used to refer to undernutrition only. Undernutrition
encompasses stunted
growth (stunting), wasting, and deficiencies of essential
vitamins and minerals (collectively referred to as micronutrients). The term hunger,
which describes a feeling of discomfort from not eating, has been used to
describe undernutrition, especially in reference to food insecurity (Lim et al, 2012).
1.1.2 Protein-energy
malnutrition (PEM)
Undernutrition is sometimes used as a synonym
of protein–energy
malnutrition (PEM). While other include both micronutrient
deficiencies and protein energy malnutrition in its
definition. It differs from calorie
restriction in that calorie restriction may not result
in negative health effects (Black et al., 2008). The term hypoalimentation
means underfeeding. Severe malnutrition or Severe undernutrition is often used
to refer specifically to PEM.
PEM is often associated with micronutrient deficiency. Two forms of PEM are kwashiorkor
and marasmus,
and they commonly coexist (Stevenson
and Conaway, 2011). Chronic
undernutrition manifests primarily as protein-energy malnutrition (PEM), which is the most
common form of malnutrition worldwide. Also known as protein-calorie
malnutrition, PEM is a continuum in which people—all too often children—consume
too little protein, energy, or both (WHO, 2005). At one end of the continuum is kwashiorkor, characterized by a severe protein deficiency,
and at the other is marasmus, an absolute food deprivation with grossly
inadequate amounts of both energy and protein. Treatment of PEM
has three components. (1) Life-threatening conditions—such as fluid and
electrolyte imbalances and infections—must be resolved. (2) Nutritional status
should be restored as quickly and safely as possible; rapid weight gain can
occur in a starving child within one or two weeks. (3) The focus of treatment then
shifts to ensuring long term nutritional rehabilitation of the child. The speed
and ultimate success of recovery depend upon the severity of malnutrition, the
timeliness of treatment, and the adequacy of ongoing support (WHO, 2005).