SCHOOL OF NURSING SCIENCE AND RESEARCH

(SHARDA UNIVERSITY)

ASSIGNMENT
ON
NUTRITIONAL PROBLEMS IN COMMUNITY

SUBMITTED ON: 14th MAY 2020

SUBMITTED TO:- SUBMITTED BY:-

Mrs. Bhavna Sharma Ms. Samjhana Neupane
Assistant Professor Msc. Nursing 1st year
Community Health Nursing Department SNSR
NUTRITIONAL PROBLEMS IN COMMUNITY
Introduction:
India is the second most populous country in the World next to China. Among its population
majority of the people belongs to rural community and they are from low socio economic status,
illiteracy and lack of basic human needs. From the nutritional point of view majority are
undernourished and only a small group are well-fed. The high income groups are suffering from
the diseases of over nourishment.
Under nutrition is widely recognized as a major health problem in the developing countries of
the world ,food is a major concern of the mankind beginning from the time of conception &
extending through the entire life span of the individual.

Food supply the energy for physical activity & other metabolic for maintaining growth of the
individual & for repair of the ageing tissues.
Definition Of nutrition:
Nutrition is the selection of foods and preparation of foods, and their ingestion to be assimilated
by the body. By practicing a healthy diet, many of the known health issues can be avoided. The
diet of an organism is what it eats, which is largely determined by the perceived palatability of
foods.

NUTRITIONAL PROBLEMS :
  A nutritional deficiency occurs when the body doesn’t absorb or get from food the
necessary amount of a nutrient. Deficiencies can lead to a variety of health problems.
These can include digestion problems, skin disorders, stunted or defective bone growth,
and even dementia.
 Nutritional problem or malnutrition is the condition of improper or inadequate food
intake or inadequate absorption of food. And it manifests in so many diseases. It
comprises four forms under nutrition, over nutrition, imbalance and the specific
deficiency.
Some terminologies :
HEALTH – It is the state of complete physical, mental and emotional well being and not merely
the absence of disease or infirmity.
NUTRIENTS – These are the components of food that help to nourish the body. The basic
nutrients are CHO, proteins, vitamins, lipids (fats), minerals and water.
NUTRITIONAL STATUS – It is the condition of the body as it relates to consumption and
utilization of food.
TYPES OF NUTRITIONAL PROBLEM:
1. Under nutrition (malnutrition)
2. Overnutrition

1. Under nutrition (malnutrition):

WHO defines Malnutrition as "the cellular imbalance between the supply of nutrients and
energy and the bodys demand for them to ensure growth, maintenance, and specific
functions.“ Malnutrition is the condition that develops when the body does not get the right
amount of the vitamins, minerals, and other nutrients it needs to maintain healthy tissues and
organ function.
Is defined as a pathological state resulting from an absolute or relative deficiency of one or
more essential nutrients. • It includes:
 Protein Energy Malnutrition
 Low birth weight
 Xerophthalmia
 Keratomalcia
 Nutritional anemia
 Lathyrism
 Endemic goiter (Iodine deficiency disorders)
 Endemic fluorosis
a) PROTEIN–ENERGY MALNUTRITION:
It refers to a form of malnutrition where there is inadequate protein and calorie intake .It is
considered as the primary nutritional problem in India. PEM is due to the “food gap” between the
intake and requirement • Causes childhood morbidity and mortality.
PEM is also referred to as protein-calorie malnutrition. It develops in children and adults whose
consumption of protein and energy is insufficient to satisfy the body's nutritional needs. While
pure protein deficiency can occur when a person's diet provides enough energy but lacks the
protein minimum. PEM may also occur in persons who are unable to absorb vital nutrients or
convert them to energy essential for healthy tissue formation and organ function.
EPIDEMIOLOGY
Global burden- more prevalent in developing countries. “Often starts in the womb and ends in
the tomb” . PEM affects every 4th child world-wide .
More than 50% of deaths in 0-4 years are associated with malnutrition. Median case fatality rate
is-23.5% in severe malnutrition reaching 50% in edematous malnutrition
INDIAN SCENARIO
 Childhood malnutrition underlying cause of death in 35% of all deaths under 5.
 During 1st 6 months, when most babies are breastfed, 20-30% are already malnourished.
 By 18-23 months, during weaning, 30% are severely stunted, 1/5th are underweight.
INDICATORS
Indicator Interpretation Interpretation
Stunting Low for height for age Chronic malnutrition
Prolonged food
deprival/disease
Wasting Low weight for height Acute malnutrition
Recent food deficit/illness
Underweight Low weight for age Combined indicator to reflect
both acute on chronic
malnutrition.

CLASSIFICATION
 WEIGHT-FOR-AGE
 HEIGHT-FOR-AGE
 WEIGHT-FOR-HEIGHT
WEIGHT-FOR-AGE
GOMEZ CLASSIFICATION
 Only wt for age taken into account
 No comment about height
  All cases of edema in 3rd degree ireespective of wt for age
Nutritiona Status Wt for Age(% of expected)
Normal >90
1st degree PEM 75-90
2nd degree PEM 60-75
3rd degree PEM <60

WHO recommended three terms: stunting, under weight and wasting for assessing the
magnitude of malnutrition in under five children.
The classification is based on deficit in body weight for age and presence or absence of edema.
Children weighing b/w 60-80% percent of their expected weight for age with edema are
classified as kwashiorkor.

Kwashiorkor

Protein Energy
Marasmus
Malnutrition

Marasmus
Kwahiorkor
CAUSES AND RISK FACTORS:
 Inadequate intake of food
 Diarrhea
 Respiratory infections
 Measles
 Intestinal worms
 Infants and pre schoolers
CONTRIBUTORY FACTORS:
  Poor enviromental Hygiene
 Large family size
 Poor maternal health
 Failure of lactation
 Premature termination of breast feeding
 Delayed supplementary feeding
 Use of over diluted cow’s milk
KWASHIORKOR:
Kwashiorkor is the most common and widespread nutritional disorder in developing countries. It
is a form of malnutrition caused by not getting enough protein in the diet.
It is a clinical syndrome that results from a severe deficiency of protein and an inadequate caloric
intake characterized by edema, irritability, anorexia, and an enlarged liver with fatty infiltrates.
Either from lack of intake or from excessive losses of or increases in metabolic rate caused by
chronic infections secondary vitamin and mineral deficiency may contribute to sign and
syndrome.
It is most serious and prevalent form of malnutrition in the world today. Especially in the
industrially underdeveloped countries.
The term "kwashiorkor" comes from a word used in Ghana that means a "disease of a baby
deposed from the breast when the next one is born." Kwashiorkor usually happens when a baby
is weaned from protein-rich breast milk (for any reason) and switched to protein-poor foods. In
impoverished countries, protein-rich foods are difficult to acquire.
MARASMUS :
It is a severe form of malnutrition that consists of the chronic wasting away of fat, muscle, and
other tissues in the body. Malnutrition occurs when the body does not get enough protein and
calories.This lack of nutrition can range from a shortage of certain vitamins to complete
starvation.
Comparision Between Kwashiorkor and Marasmus
Kwashiorkor Marasmus
Acute illness/infections prolonged Severe prolonged
starvation
measles,trauma,sepsis calories and protein principal nutrients
Protein is principal nutrient 6months to 2 years
18 months to 3 years severe weight loss
Rapid, acute onset low mortality unless
Some weight loss chronic/recurring
High Mortality chronic and slow onset
Edema, pot belly, swollen legs No edema, pot belly, swollen legs
Mild to moderate growth retardation Weight loss up to 40% edema
 Weight masked by edema Severe growth failure
Low subcutaneous fat Severe emaciation and Severe loss of
subcutaneous fat
Muscle atrophy Severe muscle atrophy

MARASMIC-KWASHIORKORA
It severely malnourished child with features of both marasmus and Kwashiorkor. The features of
Kwashiorkor are severe oedema of feet and legs and also hands, lower arms, abdomen and face.
Also there is pale skin and hair, and the child is unhappy.There are also signs of marasmus,
wasting of the muscles of the upper arms, shoulders and chest
Assessment of PEM
Gomez Classification
 Weight for age (%) = Weight of child X 100 Wt. of normal child of same age
 Between 90 – 110% Normal Nutritional Status
 Between 75 – 89% Mild malnutrition (1st degree)
 Between 60 – 74% Moderate Malnutrition (2nd degree)
MUAC TAPE AND ITS INTERPRETATION:

MUAC less than 110mm (11.0cm), RED COLOUR, indicates Severe Acute Malnutrition
(SAM). The child should be immediately referred for treatment.

MUAC of between 110mm (11.0cm) and 125mm (12.5cm), RED COLOUR (3-colour Tape) or
ORANGE COLOUR (4-colour Tape), indicates Moderate Acute Malnutrition (MAM). The child
should be immediately referred for supplementation.

MUAC of between 125mm (12.5cm) and 135mm (13.5cm), YELLOW COLOUR, indicates
that the child is at risk for acute malnutrition and should be counselled and followed-up for
Growth Promotion and Monitoring (GPM).

MUAC over 135mm (13.5cm), GREEN COLOUR, indicates that the child is well nourished.
PREVENTION :
 Oral rehydration therapy helps to prevent dehydration caused by diarrhea
 Exclusive breast feeding for 6 months thereafter supplementary foods may be introduced
along with breast feeds
 Immunization for infants and children
 Nutritional supplements
 Early diagnosis and treatment
 Promotion and correction of feeding practices
 Family planning and spacing of birth
2) LOW BIRTH WEIGHT:
An LBW newborn is any newborn with a birth weight of less than 2.5kg (including 2.499kg)
regardless of gestational age.
CAUSES/RISK FACTORS :
 Illness/infections
 Short maternal stature
 Very young age
 High parity
 Close birth intervals
 IUGR
PREVENTION :
 Identification of mothers at risk – malnutrition, heavy work load, infections, disease and
high BP
 Increasing food intake of mother, supplementary feeding, distribution of iron and folic
acid tablets
 Avoidance if smoking
 Improved sanitation methods
 Improving health and nutrition of young girls
 Controlling infections – UTI, rubella, syphilis, malaria
VITAMIN A DEFICIENCY :
Vitamin A deficiency (VAD) or hypovitaminosis: A is a lack of vitamin A in blood and
tissues. It is common in poorer countries but rarely seen in more developed countries. Nyctalopia
(night blindness) is one of the first signs of VAD.
Xerophthalmia i.e., dry eyes refers to all the ocular manifestations of vitamin A deficiency • It
is the most widespread and serious nutritional disorder.
CLINICAL FEATURES :
  Reduced vision in the night or dim light
 Dry eyes which could also lead to Xerophthalmia
 corneal inflammation
 The child or adult may experience susceptibility towards respiratory infection and urinary
infections.
 Growth can be halted in children •
 Skin might also show signs of Vitamin A deficiency. For example it may get rough
and/or dry
PREVENTION AND CONTROL :
 Administering large doses of vitamin A orally on a periodic basis
 Regular and adequate intake of vitamin A
 Fortification of certain food with vitamin A – sugar, salt, tea and skimmed milk
NUTRITIONAL ANEMIA:
Nutritional anemia is a condition where the hemoglobin content of blood is lower than normal as
a result of a deficiency of one or more essential nutrients, regardless of the cause of such
deficiency.
CAUSES / RISK FACTORS
 Inadequate diet
 Insufficient intake of iron
 Iron malabsorption
 Pregnancy
 Excessive menstrual bleeding
 Hook worm infestation
 Malaria
 Close birth intervals
 GI bleed
 Infants and children
 Pregnant women
 Pre menopausal women
EFFECTS OF ANEMIA
Pregnancy :
 Increases risk of maternal and fetal morbidity and mortality
 Abortions, premature births, PPH, low birth weight are associated with anemia during
pregnancy
Infection
 Anemia can be aggravated by parasitic infections like malaria, intestinal parasites
  Iron deficiency may repair cellular response and immune functions
Work capacity
 More severe the anemia, greater the reduction in work performance
PREVENTION
 Estimation of Hb to assess degree of anemia
 Blood transfusion in severe cases of anemia (<8g/dL)
 Iron and folic acid supplements
 Food fortification with iron
 Changing dietary habits
 Control of parasites
 Nutritional education and awareness
IODINE DEFICIENCY DISORDERS (IDD)
IDD leads to a much wider spectrum of disorders commencing with the intrauterine life and
extending through childhood to adult life with serious health and social implications
DISORDERS DUE TO LACK OF IODINE:
 Goiter
 Hypothyroidism
 Subnormal intelligence
 Delayed motor milestones
 Mental deficiency
 Hearing defects
 Speech defects
 Mental retardation
 Neuromuscular weakness
 Endemic cretinism
OVERNUTRITION
Is defined as a pathological state resulting from an absolute or relative excess of one or more
essential nutrients. Some of the overnutrition conditions are as follows:
a) FLUROSIS
Fluorosis is a disease caused by deposition of fluorides in the hard and soft tissues of the
body. It is not merely caused by excess intake of fluoride but there are many other
attributes and variables which determine the onset of fluorosis in human population. It is
usually characterised by discoloration of teeth and crippling disorders.
Causes
i) Excessive intake of fluorides from multiple sources such as in food, water and
excessive use of fluoridated toothpaste.
 ii)Tobacco chewing, cigarette smoking.
iii) fluoride rich food such tea, ocean fish, fluoridated salt
Symptoms
i)Dental fluorosis:
 staining and pitting of the teeth.
 In more severe cases all enamel may be damaged.
ii)Skeletal fluorosis:
The early symptoms of skeletal fluorosis, include stiffness and pain in the joints.
In severe cases, the bone structure may change and ligaments may calcify, with
resulting impairment of muscles and pain.

2.Non Skeletal Flurosis/ Effects of Fluorosis on soft tissues/Systems:

i)Gastrointestinal symptoms:
Abdominal pain,
excessive saliva,
nausea and vomiting are seen after acute high level exposure to fluoride.
PREVENTION
 Changing the water sources
 Chemical defluorination
 Preventing use of fluoridated toothpaste
 Fluoride supplements not prescribed for children consuming fluoridated water
OBESITY
Definition:
 Obesity may be defined as an abnormal growth of the adipose tissue due to an
enlargement of fat cell size (hypertrophic obesity) or an increase in fat cell number
(hyperplasic obesity)or a combination of both.
 The most prevalent form of malnutrition.
 Expressed in terms of body mass index (BMI).
 weight gain affects the risk associated with obesity, and the kind of disease that results.
 As a chronic disease, prevalent in both developed and developing countries, and affecting
children(10- 20%) as well as adults(20-40%).
Causes of obesity:
- Age
- Sex
- Genetic Factor
- Physical Inactivity
- Socio-economic Status
- Eating Habits
- Psychological Factors
- Familial Tendency
- Alcohol & Smoking - Education - Drugs

ASSESSMENT OF OBESITY
The most widely used criteria are :
1. BODY WEIGHT
2. SKIN FOLD THICKNESS
3. WAIST HIP RATIO
BMI to Classify Obesity
 Body mass index (BMI) is a simple index of weight- for-height that is commonly used to
classify underweight, over weight and obesity in adults.
 It is defined as the weight in Kilograms divided by the square of the height in metres
(kg/m²).
  example, an adult who weighs 75 kg and whose height is 1.75 mtr will have a BMI of
22.9 BMI= 70 (kg)/1.75²(m²) =22.9

Skin Fold Thickness-:

 It is a rapid and "non-invasive” method for assessing body fat. Several varieties of
callipers (e.g., Harpenden skin callipers)
 The measurement may be taken at all the four sites - mid-triceps, biceps, sub scapular and
suprailiac regions.
 The sum of the measurements should be less than 40 mm in boys and 50 mm in girls
Waist-Hip Ratio-:
 There is an increased risk of metabolic complications
 for men with a waist circumference > 102 cm, and
 women with a waist circumference > 88 cm
 Over the past 10 years or so, it has become accepted that a high WHR (> 1.0 in men and
> 0.85 in women) indicates abdominal fat accumulation.
HAZARDS OF OBESITY
 Increased Morbidity
 Increased Mortality
PREVENTION AND CONTROL
 Dietary Changes
 Increased Physical Activity
 Health education has an important role to play in teaching how to reduce overweight
and prevent obesity.
Conclusion:
India is the second most populous country in the World next to China. Among its population
majority of the people belongs to rural community and they are from low socio economic status,
illiteracy and lack of basic human needs. Under nutrition is widely recognized as a major health
problem in the developing countries of the world ,food is a major concern of the mankind
beginning from the time of conception & extending through the entire life span of the individual.
Nutrition is the selection of foods and preparation of foods, and their ingestion to be assimilated
by the body. By practicing a healthy diet, many of the known health issues can be avoided. The
diet of an organism is what it eats, which is largely determined by the perceived palatability of
foods. A nutritional deficiency occurs when the body doesn’t absorb or get from food the
necessary amount of a nutrient. Deficiencies can lead to a variety of health problems. These can
include digestion problems, skin disorders, stunted or defective bone growth, and even
dementia.It is of 2 type undernutrition and overnutrition. Most commonly children are suffered
from Protein energy Malnutrition but nowadays problem of overnutrition like obesity is seen in
City area.
REFERENCES:
 Gulani K.K.( 2009).Community Health Nursing. New Delhi: kumar publishing
house.Page no: 100-116
 Park,K. (2019).Preventive And Social Medicine.25th edi. New Delhi:banarsidas bhanot.
Page no: 287-290
 Rao.S.B,(2010). Principles of community medicine. 5th edition.AITBS Publishers, India.
Page no: 524-531
 https://www.ncbi.nlm.nih.gov/pubmed/114962
 https://dhsprogram.com/pubs/pdf/OD56/OD56.pdf
 https://en.wikipedia.org/wiki/Malnutrition_in_India