Month: December 2017

Malnutrition is the condition in which individuals are unable to get enough nutrition from the food they eat. It usually results from consuming a diet in which nutrients are either not much or more than the required amounts that causes health problems. The two common terms that refers to malnutrition are;

• Under nutrition- include stunting, underweight, micronutrients deficiencies, anaemias
• Overweight, obesity resulting in metabolic disorders ( heart diseases, diabetes, hypertension etc).

Malnutrition is a common problem worldwide. According to WHO 1.9 billion people worldwide are overweight and 462 million are underweight. 29% of women of reproductive age are suffering from micronutrient deficiency anaemias. 41 million children under the age of 5 are overweight, whereas 159 million are stunted ( low height fir age)/and 50 million are wasted ( low weight for height).

Undernutrition

Undernutrition is the insufficient intake of energy and nutrients in order to meet body needs to maintain good health. It is the broad term which covers both protein energy malnutrition and micronutrients deficiencies. Sometimes the word malnutrition is used as a synonym of undernutrition. The most vulnerable group that are susceptible to undernutrition are older adults, women of childbearing age, and children under the age the 5.

Common signs and symptoms of undernutrition are

• Tiredness and fatigue
• Longer healing time for wounds
• Weight loss and loss of muscle, body fats and body tissues
• Shivering or feeling cold
• Hair loss
• Lack of concentration and difficulties in carrying out daily activities
• Body pain
• Breathlessness in extreme cases
• Delayed growth in children, lack of growth both physically and intellectually.

Causes of undernutrition

There are various reason which results in undernutrition ,some of them are environmental while other may occur as a results of medical or health problems. This includes

• Socio-economic problems which results in inability to buy foods and sometimes also results in inappropriate selection of foods.
• Poor maternal health and anaemia results in low birth weight infants.
• Little or no breastfeeding is the major cause of undernutrition specially in developing countries which lead to stunted growth.
• Isolation and inability to prepare and shop for meals is the primary cause of malnutrition amongst elderly in developed countries.
• Low intake as a result of mental or physical problems such as anorexia, schizophrenia, bulimia and dementia.
• Digestive disorders such as ulcers, crohn’s diseases, frequent onset of diarrhoea and vomiting results in poor absorption of nutrients.

Dietary management for the prevention of undernutrition

The treatment of malnutrition depends upon finding the underlying cause of malnourishment and then treating it accordingly. However both medical and nutrition therapy is extremely important for the prevention as well as treatment of malnutrition. There are different strategies for different age groups and health conditions, some of which are discussed below;

malnutrition in children

Malnutrition is the most common problem in infants and toddlers under the age of five. For the prevention malnutrition in young children it is always essential to follow some of the important points . Some of them are;

• Exclusive breast feeding to six months of age. Gradual introduction to solid foods along with breast feeding till two years of age.
• Regular height and weight check ups with health practitioners to rule out any signs of stunting and wasting.
• Frequent small meals and gradual introduction of protein rich foods after six months of age.
• Treatment of any underlying health problems and regular health checkups by health practitioners.

Malnutrition in pregnancy and lactation

Maternal malnutrition is the major reason for miscarriages and growth retardation in children . Caloric and nutrients supplementation is extremely important to reduce miscarriages and incidence of low birth weight. Below are some key points to keep in mind if your are trying to conceive, pregnant or lactating;

• Regular folic acid supplementation is required in first trimester to prevent neural tube defects.
• Iron supplementation after first trimester throughout pregnancy to prevent iron deficiency anaemia.
• Regular intake of milk and dairy products throughout pregnancy to prevent osteoporosis in later life.
• Regular checkups with doctors and health practitioners.

Malnutrition in elderly

Malnutrition is very common in old age which contributes to decline in health, reduced physical activities , weight loss and mortality. Some of the factors which helps to prevent malnutrition and increase the quality of living in later life are;

• Providing a healthy and friendly environment at meal times.
• Frequent small meals in order to prevent indigestion.
• High energy foods and drinks to undernourished elderly including egg nog, fish, fruits and vegetables.

Overweight and obesity

One of the most common and widely discussed form of malnutrition is overweight and obesity. The root cause of overweight and obesity is the consumption of high energy foods and lack of physical activities. Eating a healthy diet with regular exercise is important to maintain a normal weight and to prevent from diseases which occurs as a result of excess weight gain.

Low carbohydrates, high protein or high fat diet are getting popular these days for weight loss. Some examples of these diets include paleo, Atkins and ketogenic diets. But are these diets really healthy?

Common questions which comes in the mind of an ordinary man are;

• Are these diets really effective for losing weight?
• Are there any long term consequences of these diets regarding general health.
• Does the weight loss after these diets is long term or one gains weight soon after switching to routine diet.

To get the answer to all these questions we need to know the importance of each macro nutrients, their functions in body and their sources. The brief introduction to these macronutrients is illustrated in the table below;

According to USDA the general dietary requirements of carbohydrates for a normal healthy adult is 45-65% of the total calories. The requirements of proteins is 10-35% and of fat is 25-40% of the total calories.

Science behind these weight loss plans

All these diets , Paleo, Atkins and ketogenic focuses on limiting carbohydrates to less than 20 grams per day. According to these diets advocates, it initiates the process of ketosis . The carbohydrates after absorption is converted into glucose which is then transported via blood to all parts of the body as a source of energy required in different functions. The excess glucose is stored in the form of glycogen in liver. The remaining glucose is then converted in fats and is stored in adipose tissues. During fasting state when the body is not provided with sufficient glucose the body uses glycogen stores for energy. Once the glycogen stores are depleted, the fats stored in adipose tissues are used up by the body for energy.

The aim of these diets are to restrict calories from carbohydrates sources which would eventually results is burning of stored form of fats and thus results in weight loss. However the success of these diets vary among individuals.

Advantages and disadvantages of different diets

Atkins diet:

The Atkins diet was first promoted by Dr Robert Atkins in 1972. The diet promotes high proteins and saturated fats intake and limit carbohydrates consumption to less than 20 grams in a day. The main reason of weight loss is that the food low in carbohydrates are less palatable and one ends up in eating less calories. It encourages to eat fats and proteins like :

• Meat
• Poultry
• Seafood
• Butter
• Eggs
• Oils
• Cheese

It restrict foods such as

• Breads
• Rice
• Potatoes
• Chips
• Cookies
• Candies

Advantages:

• Promote rapid weight loss.
• Fancy diet which enables individuals to consume variety of meat products and fatty foods.

Disadvantages:

• Diet is very restrictive in nature.
• Diet is high in saturated fats and is not advisable for patients with positive family history of heart diseases.
• This diet can cause nervousness , bad breath ,nausea and headaches.
• High proteins diet place additional burden on kidneys and increases the risk of developing kidney diseases.
• Atkins diet offers less vitamins and minerals which eventually leads to nutritional deficiency.

Paleo diet

This diet was developed by Loren Cordain , a phd researcher in late seventies. This diet suggests eating all the foods available to people in prehistoric era . It includes meats,fish, nuts, leafy greens, vegetables and seeds. And restrict foods such as grains, dairy, processed and high sugar foods.

Advantages

• People tend to lose weight because of limited food choices.
• Improved satiety due to high fat and protein intake.
• Improved iron levels due to high intake of red meats.

Disadvantages

• The portion size of the food is not clearly specified, which end up in eating more than required proportions of foods.
• The diet is quite expensive.
• Not suitable for people who are vegetarian.
• This diet end up in developing calcium deficiency because of dairy restrictions.
• Not suitable for athletes and may result in hypoglycaemia.

ketogenic diet

For detailed review visit Ketogenic diet .

Practical recommendations to lose weight

• An overall caloric restriction along with exercise is the best way to lose weight. Restrict your calories to 1000 or 1200 calories.
• Avoid eating refined grains such as white bread, rice and pasta and eat whole grains. Increase fiber intake as it increases the feeling of fullness.
• Limit high fat, high sugar and processed foods.
• Drink plenty of water.
• Fill half of your plate with fruits and vegetables.

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by,

Aliya Waqas

At old age i.e above 65 years nutritional care is extremely important in order to promote healthy life style as well as for the prevention of various diseases. The risk of various age related diseases such as diabetes , hypertension, heart diseases , osteoporosis can be reduced by diet modification , also healthy diet helps in the treatment of these diseases along with medications.

Physiological changes

Aging is a normal process which involves decline in physiological functions. Organs change with age , however the rate of change differs among individuals. These changes effects the efficiency of organs and individuals to perform various functions. Factors which determines how aging progresses include genetics, socio_economics conditions and life style. Following are the physiological changes of ageing that directly effects eating behaviour of older adults and may occurs as a result of poor dietary habits.

• Sensory losses

Reduce senses of tase, smell, sight, hear and touch are common in old age and may lead to less food intake as a result of decreased appetite, feeding ability and food recognition. Studies reveal that lack of vitamin b12 in diet have been associated with increased ringing in the ears of older adults and low Vitamin D levels contributes to hearing loss.

• Oral health

The feeling of dry mouth , untreated dental caries and tooth loss are the common problems of old age and may cause difficulty in chewing and swallowing which eventually leads to decrease consumption of fresh fruits, meats and vegetables.

• Gastrointestinal functions

It is the most common factor that directly effects the food intake and health of old people .Gastric problems include

1. Constipation
2. Frequent onset of diarrhoea and constipation
3. Indigestion.

• Diabetes

Glucose intolerance or non insulin dependent diabetes become more common in later ages. These age related changes may become worse by obesity , lack of physical activity and certain drug. Treatment of glucose intolerance usually involves diet modification along with exercise and medications.

• cardiovascular diseases

Old age is associated with progressive decline of elasticity of blood vessels and total peripheral resistance which increases the risk of cardiovascular diseases. This include hypertension, atherosclerosis, angina and stroke.

Loss of immune function

Immune function decline with age. The term immunosenescence is used to describe the loss of immune function in older individuals over 65 years of age. Studies suggests that supplements of vitamin E enhance the immune functions in older adults.

Nutritional requirements of older adults

The nutritional requirements for older adults are similar to younger adults but in different amounts . Due to the decrease in physical activity and decline in metabolic rate , the caloric requirements at old age is usually lower than younger people. Average caloric intake for male above the age of 51 is 2300 kcal per day and for females is 1900 kcal. Health problems in elderly arise when the intake is less than 1500 kcal.

Proteins

As the people grow older the body composition changes which results in decrease in skeletal muscles and reduction in organ tissues, blood components and immune bodies. All of which contributes to impaired wound healing, inability to fight infections and loss of skin elasticity. All of which increases the need of exogenous protein from diet. For that reason the recommended dietary allowance of protein for older adults is 1 gram per kg of the body weight. However the amount of proteins needed for older adults suffering from kidney disorders is slightly less than the normal individuals.

The primary source of protein for elderly are animal proteins which is also a good source of iron, vitamin b12, folic acid, biotin and other nutrients. Eggs, fish, poultry and lean cuts of red meat should be given to older adults on regular basis.

Carbohydrates

The recommended dietary allowance for carbohydrates for older adults is 50-60% of the daily calories. Most of the carbohydrates should come from complex carbohydrate such as whole grains, vegetables, fruits and legumes. Fiber is important for older adults in order to prevent constipation and regulate bowel movement. Glucose tolerance usually declines with age and it is usually advisable to limit consumption of sugary foods such as desserts, cakes and soft drinks.

Fats and lipids

The recommended dietary allowance for fats is less than 30% of total calories. Emphasis should be given on limiting saturated fats, and trans fats and choosing monounsaturated and unsaturated fat sources .

Good source of fats for older adults like normal individuals are olive oil, nuts, soybean , canola and corn oil.

Minerals and vitamins

Calcium and vitamin D is necessary for bone health and for the prevention of osteoporosis. 10 mg of Vitamin D supplement is normally recommended daily for older adults. The risk of vitamin B12 deficiency in old age increases because of the low intake and lack of intrinsic factor which facilitates b12 absorption. The older adults with no history of renal impairment are recommended to eat more potassium as it helps to reduce blood pressure. Older adults should eat variety of fruits and vegetables along with fortified cereals in order to avoid micronutrient deficiency. Sometimes supplementation of vitamin and minerals become essential when the diet is failed to provide enough vitamins and minerals needed.

General guidelines for good nutrition in old age

• Balance your intake with physical activity. 30 minutes of light exercise in a day is essential to preserve independence in old age.
• Choose whole grains carbohydrates options such as whole wheat , brown rice and oatmeal for breakfast.
• Add fish in your diet at least twice a week.
• Don’t omit fat completely from diet instead change the quality of fat . Olive oil, flaxseeds and flaxseed oil, nuts , corn oil, are healthy options. Avoid saturated and trans fats.
• Opt for frequent small meals instead of three large meals.
• Take three servings of low fat dairy daily in order to keep bones healthy.
• Use less salt. Replace with low salt substitutes such as potassium chloride if not kidney patients.
• Limit high sugar, processed and fried foods.
• Consume at least five portion of fruits and vegetables daily as they are rich in antioxidants and nutrients which helps to keep you healthy and boost immune system.

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by,

Aliya Waqas