Nutrient deficiency - Micro nutrient deficiency

• Micronutrients, as opposed to macronutrients (protein, carbohydrates and fat), are comprised of vitamins and minerals which are required in small quantities to ensure normal metabolism, growth and physical well.

Vitamins

• Vitamins are organic compounds that are required in small amounts in our diet but their deficiency causes specific diseases.
• Most of the vitamins cannot be synthesized in our body but plants can synthesize almost all of them, so they are considered as essential food factors.
• However, the bacteria of the gut can produce some of the vitamins required by us.
• All the vitamins are generally available in our diet. Different vitamins belong to various chemical classes and it is difficult to define them on the basis of structure.
• They are generally regarded as organic compounds required in the diet in small amounts to perform specific biological functions for normal maintenance of optimum growth and health of the organism.
• Vitamins are designated by alphabets A, B, C, D, etc. Some of them are further named as sub-groups e.g. B1, B2, B6, B12, etc.
• Vitamin A keeps our skin and eyes healthy.
• Vitamin C helps body to fight against many diseases. Vitamin C gets easily destroyed by heat during cooking.
• Vitamin D helps our body to use calcium for bones and teeth.
• Excess of vitamins is also harmful and vitamin pills should not be taken without the advice of doctor.
• The term “Vitamine” was coined from the word vital + amine since the earlier identified compounds had amino groups.
• Later work showed that most of them did not contain amino groups, so the letter ‘e’ was dropped and the term vitamin is used these days.
• Vitamins are classified into two groups depending upon their solubility in water or fat.

Fat Soluble Vitamins

• Vitamins which are soluble in fat and oils but insoluble in water are kept in this group. These are vitamins A, D, E and K. They are stored in liver and adipose (fat storing) tissues.

Water Soluble Vitamins

• B group vitamins and vitamin C are soluble in water so they are grouped together.
• Water soluble vitamins must be supplied regularly in diet because they are readily excreted in urine and cannot be stored (except vitamin B12) in our body.

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Deficiency Diseases

• A person may be getting enough food to eat, but sometimes the food may not contain a particular nutrient. If this continues over a long period of time, the person may suffer from its deficiency.
• Deficiency of one or more nutrients can cause diseases or disorders in our body. Diseases that occur due to lack of nutrients over a long period are called deficiency diseases.

Minerals

Dietry Fibers

• Dietary fibres are also known as roughage. Roughage is mainly provided by plant products in our foods.
• Whole grains and pulses, potatoes, fresh fruits and vegetables are main sources of roughage.
• Roughage does not provide any nutrient to our body, but is an essential component of our food and adds to its bulk. This helps our body get rid of undigested food.

Protein Energy Malnutrition (PEM) or Protein Calorie Malnutrition (PCM)

• Dietary deficiencies of proteins and total food calories are widespread in many underdeveloped countries of South and South-east Asia, South America, and West and Central Africa.
• Protein-energy malnutrition (PEM) may affect large sections of the population during drought, famine and political turmoil.
• This happened in Bangladesh during the liberation war and in Ethiopia during the severe drought in mid-eighties.
• PEM affects infants and children to produce Marasmus and Kwashiorkar.

Classification of Protein Energy Malnutrition

👉🏻 PEM can be classified into two types:

1. Primary PEM
2. Secondary PEM

Primary PEM

👉🏻 This type of protein-energy malnutrition is found in children. It is rarely found in the elders, the main cause being depression. It can also be caused due to child or elder abuse. In children, PEM is primary of two types:

1. Kwashiorkor
2. Marasmus

Kwashiorkor

• Kwashiorkor is acute malnutrition that occurs mostly in children.
• This condition results from severe protein deficiencies.
• It is also known as “edematous malnutrition” because it is associated with oedema. The patients suffering from Kwashiorkor have an emaciated appearance all over the body. The ankles feet and belly swell with liquid.
• Kwashiorkar is produced by protein deficiency unaccompanied by calorie deficiency.
• It results from the replacement of mother’s milk by a high calorie-low protein diet in a child more than one year in age.
• Kwashiorkor shows wasting of muscles, thinning of limbs, failure of growth and brain development.
• It causes leakage of the cell membrane, releasing the intravascular fluid and proteins. This results in oedema.
• It weakens the immunity of a person making him susceptible to diseases.

Marasmus

• Marasmus is produced by a simultaneous deficiency of proteins and calories.
• It is found in infants less than a year in age, if mother’s milk is replaced too early by other foods which are poor in both proteins and caloric value.
• This often happens if the mother has second pregnancy or childbirth when the older infant is still too young.
• Infantile marasmus can occur even under one year of age when there is early weaning due to lactation failure or death of the mother.
• In Marasmus, protein deficiency impairs growth and replacement of tissue proteins; extreme emaciation of the body and thinning of limbs results, the skin becomes dry, thin and wrinkled.
• Growth rate and body weight decline considerably. Even growth and development of brain and mental faculties are impaired.
• Child looks very thin with shriveled body, wrinkled skin and bony prominences.

Secondary PEM

• It is caused due to disorders in the gastrointestinal tract.
• It can be caused due to infections, hyperthyroidism, trauma, burns, and other critical illnesses.
• It decreases appetite and impairs nutrient metabolism.

HRD in context of work capacity of women and children

National Nutrition Policy

• Widespread poverty resulting in chronic and persistent hunger is the single biggest scourge of the developing world today.
• The physical expression of this continuously re-enacted tragedy is the condition of under-nutrition which manifests itself among large sections of the poor, particularly amongst the women and children.
• Under nutrition is a condition resulting from inadequate intake of food or more essential nutrient(s) resulting in deterioration of physical growth and health. The inadequacy is relative to the food & nutrients needed to maintain good health, provide for growth and allow a choice of physical activity levels, including work levels that are socially necessary. This condition of under-nutrition, therefore, reduces work capacity and productivity amongst adults and enhances mortality and morbidity amongst children. Such reduced productivity translates into reduced earning capacity, leading to further poverty, and the vicious cycle goes on (figure 1 below)

National Family Health Survey 4

• The Fourth National Family Health Survey (NFHS-4) was carried out in 2014-2015.
• All States/UTs have Infant mortality rates (IMR) below 51 deaths per 1,000 live births.
• 38 percent of children under the age of 5 were stunted for their age, 21 percent were thin for their height, 36 percent were underweight and 2 percent were overweight.
• The proportion of women (aged 15-49) who received antenatal care rose from 80 per cent in 2005-06 to 84 percent in 2015-16. Deliveries at health facilities has increased from 39 per cent to 79 per cent.
• The total fertility rates range from 1.2 in Sikkim to 3.4 in Bihar. All states except Bihar, Madhya Pradesh and Meghalaya have either achieved or maintained replacement level of fertility.
• Full immunisation coverage in India has increased to 62% in 2015-16 compared to 44% in 2005-06.
• Though anaemia has declined, it still remains widespread. More than half of children and women are anaemic.
• Over two-thirds of households in every State/UT have access to an improved source of drinking water.
• More than 50% of households have access to improved sanitation facilities in all states/UTs except Bihar and Madhya Pradesh.

Nutrient deficiency - Micro nutrient deficiency

• Micronutrients, as opposed to macronutrients (protein, carbohydrates and fat), are comprised of vitamins and minerals which are required in small quantities to ensure normal metabolism, growth and physical well.

Vitamins

• Vitamins are organic compounds that are required in small amounts in our diet but their deficiency causes specific diseases.
• Most of the vitamins cannot be synthesized in our body but plants can synthesize almost all of them, so they are considered as essential food factors.
• However, the bacteria of the gut can produce some of the vitamins required by us.
• All the vitamins are generally available in our diet. Different vitamins belong to various chemical classes and it is difficult to define them on the basis of structure. …

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