Malnutrition and GI Parasitology
in the Community

Jill Gallin, CPNP

Assistant Professor of Clinical Nursing

The Science of Nursing in the Community
N5290

Malnutrition

The ‘other end’ of malnutrition

An escalating global epidemic of overweight and obesity – “globesity” – is taking over many parts of the world. If immediate action is not taken, millions will suffer from an array of serious health disorders.

Obesity is one of today’s most blatantly visible – yet most neglected – public health problems. Paradoxically coexisting with undernutrition.

Protein Energy Malnutrition

“Protein-energy malnutrition (PEM) is by far the most lethal form of malnutrition. Children are its most visible victims. Malnutrition, “the silent emergency,” is an accomplice in at least half of the 10.4 million child deaths each year. These young lives are prematurely – and needlessly – lost “

Slide 5

Who is at Risk?
Protein Energy Malnutrition

People of impoverished countries

seen in the midst of drought or political turmoil.

However as many as 50% of elderly persons in nursing homes in the U.S. suffer from protein-calorie malnutrition.

Children

Pregnant women

Micronutrient Deficiency

Called “micronutrients” because they are needed in only miniscule amounts, these substances are the “magic wands” that enable the body to produce enzymes, hormones and other substances essential for proper growth and development.

As tiny as the amounts are, the consequences of their absence are severe. Their lack represents a major threat to the health and development of populations the world over, particularly to preschool children and pregnant women in low-income countries.

Global Health Macronutrient Deficiency

Iodine

Vitamin A

Iron

Vitamin A Deficiency

Vitamin A deficiency causes night blindness and is the single most important cause of childhood blindness in developing countries. Every year, about 500,000 children lose their sight as a result of vitamin A deficiency. The majority (about 70%) die within one year of losing their sight.

Vitamin A Deficiency

Vitamin A deficiency increases the risk of severe illness, and even death, from common childhood infections such as diarrheal diseases and measles. In developing countries 200–300 million children of preschool age are at risk of vitamin A deficiency.

Vitamin A Deficiency

Vitamin A deficiency may increase the risk of maternal mortality in pregnant women. Nearly 600,000 women die from childbirth-related causes each year, the vast majority of them from complications which could be reduced through better nutrition, such as vitamin A.

Iron Deficiency

"As many as 4–5 billion people, 66–80% of the world's population, may suffer from reduced learning ability and work capacity due to iron deficiency. More than 30% of the world's population, are anemic "
Battling iron deficiency anemia WHO 2002

Iron Deficiency

Iron deficiency impairs the cognitive development of children through to adolescence.

Iron Deficiency

Iron deficiency damages immune mechanisms, and is associated with increased morbidity rates.

Iron Deficiency

Iron deficiency impairs physical work capacity in men and women by up to 30%.

Iron Deficiency

Iron deficiency during pregnancy is associated with multiple adverse outcomes for both mother and infant, including increased risk of sepsis, maternal mortality, perinatal mortality, and low birth weight.

Iron Deficiency

Iron deficiency and anemia reduce learning ability and the work capacity of individuals and entire populations, bringing serious economic consequences and obstacles to national development.

Epidemiology of Iron Deficiency in the US

prevalence of iron deficiency was greatest

toddlers aged 1--2 years (7%)

adolescent and adult females aged 12--49 years (9%--16%)

The prevalence of iron deficiency was approximately two times higher among non-Hispanic black and Mexican-American females (19%--22%) than among non-Hispanic white females (10%).

Manifestations of Iron Deficiency

Pale skin (race)

Fatique

Irritability

Weakness

More . . .

Laboratory Findings in Iron Deficiency Anemia

Low Hgb/Hct

High RDW (microcytic cells)

Follow up with iron studies

Low serum ferritin

Low serum iron

High TIBC

"* Get a good history"

* Get a good history, rule out other cause for anemia ie. LEAD

Preventing Iron Deficiency

Iron is found in foods like red meat, egg yolks, and fortified flour, bread, and cereal

Breast feeding & iron fortified formula

Screening

Iodine Deficiency

Iodine deficiency is the number one cause of preventable brain damage, affecting millions of people worldwide.

Assessment of Iodine Deficiency Disorders and Monitoring their Elimination: A Guide for Programme Managers 2nd edition. WHO/UNICEF/ICCIDD 2001

Iodine Deficiency

The problem of iodine deficiency is especially serious for pregnant women and young children. During pregnancy, even a mild deficiency of iodine can reduce brain development of the fetus limiting the intellectual ability of an individual for life.

Iodine Deficiency

Iodine deficiency can cause severe mental and physical retardation, known as cretinism.

Iodine Deficiency

Iodine deficiency in chronic form, can cause goiter (a disorder characterized by swelling of the thyroid gland) in both adults and children.

Iodine Deficiency

Iodine deficiency most commonly, impedes fetal brain development. At the population level, the consequence of iodine deficiency is a 10–15% lower average intellectual quotient (IQ), which affects the social and economic development of both communities and nations.

Iodine Deficiency

The World Bank has estimated that, combined with vitamin A deficiency and iron deficiency, iodine deficiency may lower the economic wealth of a nation by as much as 5% every year.

"Case study:"

Case study:

Zacharia arrives in East Harlem

Manifestations of Iodine Deficiency

Goiter-enlarged thyroid cells and gland

Hypothyroidism: iodine is essential for the production of thyroid hormones and normal thyroid function

Cretinism: physical and mental retardation

Manifestations of Iodine Deficiency

Symptoms of hypothyroidism

Mental and physical sluggishness

Weakness

Fatigue

Cold intolerance

Weight gain

Depression

Many more . . .

Where is Iodine Deficiency?

Land locked areas without iodized salt: Asia, Central Africa

Endemic goiters occur within groups of people iving in geographical areas with iron depleted soil

Laboratory Findings

TSH high

Thyroid hormones low (T3 and T4)

Preventing Iodine Deficiency?

Iodized salt

Seafood: fish and kelp

Dairy products

Plants grown in iodine rich soil

Folic Acid Deficiency

An estimated 300,000 children are born each year with spina bifida and anencephaly, which are severe neural tube defects. Approximately 75%, 225,000, of these affected births could be prevented through increased consumption of synthetic folic acid by all women of reproductive age.

Gastrointestinal Parasites
(Often associated with malnutrition)

The Culprits

Ascaris lumbricoides (Round worm)

Trichurist (Whipworm)

Ancylostoma (Necator, Hookworm)

Strongyloides

Taenia (beef or port tapeworm)

Giardia lamblia (Giardia)

Entamoeba histolytica (Ameba)

Signs and Symptoms of
Intestinal Parasites

Varied organisms cause similar symptoms

Occasionally no symptoms

Symptoms may be caused by presence of multiple organisms

Malabsorption and diarrhea

Amebiasis

Ingested in fecally contaminated water

May be asymptomatic

Diarrhea alternating with constipation

Pain on defecation

Some blood in stool

Can cause liver abcess

Amebiasis Treatment

Metronidazole

Secnidazole

Giardia

Foul smelling diarrhea associated with flatulence, abdominal pain, distention and anorexia

Weight loss

FTT

Anemia

Giardia Treatment

Furazolidone

Metronidazole

Secnidazole

Ascaris (Roundworm)

Intermittent, no foul-smelling diarrhea

Abdominal protrusion

Pallor

Weight loss

Abdominal pain

Poor appetite, malnutrition

Ascaris (Roundworm)

Migratory

Large parasite load can cause intestinal obstruction with migration of worms into the mouth and nose.

Can cause persistent cough-”Loeffler’s Syndrome”

Ascaris Treatment

Albendazole

Mebendazole

Piperazine

Hookworm

Penetrates skin of hands and feet when touching contaminated earth or walking barefoot

Stinging, burning, papulovesicular rash 1-2 weeks

Abdominal pain

Diarrhea

Can cause rectal prolapse

Hookworm Treatment

Mebendazole

Albendazole

1 ounce ap of the higueron tree mixed with 1 ounce of milk and some honey

Tapeworm

Ingesting infected cow or pork

Abdominal pain

Hunger

Weight loss

Anemia

Passage of flat white worm segments

Tapeworm Treatment

Albendazole

Six year old boys

‘Full grown’ woman

Eleven year old boy

References

www.who.org

www.cdc.org

The Stanford Guide to Antimicrobial Therapy

AAP RedBook





	Jill Gallin, CPNP
	Assistant Professor of Clinical Nursing

	The Science of Nursing in the Community N5290


	An escalating global epidemic of overweight and obesity – “globesity” – is taking over many parts of the world. If immediate action is not taken, millions will suffer from an array of serious health disorders.
	Obesity is one of today’s most blatantly visible – yet most neglected – public health problems. Paradoxically coexisting with undernutrition.


	“Protein-energy malnutrition (PEM) is by far the most lethal form of malnutrition. Children are its most visible victims. Malnutrition, “the silent emergency,” is an accomplice in at least half of the 10.4 million child deaths each year. These young lives are prematurely – and needlessly – lost “


	People of impoverished countries
	seen in the midst of drought or political turmoil.
	However as many as 50% of elderly persons in nursing homes in the U.S. suffer from protein-calorie malnutrition.
	Children
	Pregnant women


	Called “micronutrients” because they are needed in only miniscule amounts, these substances are the “magic wands” that enable the body to produce enzymes, hormones and other substances essential for proper growth and development.
	As tiny as the amounts are, the consequences of their absence are severe. Their lack represents a major threat to the health and development of populations the world over, particularly to preschool children and pregnant women in low-income countries.


	Vitamin A deficiency causes night blindness and is the single most important cause of childhood blindness in developing countries. Every year, about 500,000 children lose their sight as a result of vitamin A deficiency. The majority (about 70%) die within one year of losing their sight.


	Vitamin A deficiency increases the risk of severe illness, and even death, from common childhood infections such as diarrheal diseases and measles. In developing countries 200–300 million children of preschool age are at risk of vitamin A deficiency.


	Vitamin A deficiency may increase the risk of maternal mortality in pregnant women. Nearly 600,000 women die from childbirth-related causes each year, the vast majority of them from complications which could be reduced through better nutrition, such as vitamin A.


	"As many as 4–5 billion people, 66–80% of the world's population, may suffer from reduced learning ability and work capacity due to iron deficiency. More than 30% of the world's population, are anemic " Battling iron deficiency anemia WHO 2002


	Iron deficiency impairs the cognitive development of children through to adolescence.


	Iron deficiency damages immune mechanisms, and is associated with increased morbidity rates.


	Iron deficiency impairs physical work capacity in men and women by up to 30%.


	Iron deficiency during pregnancy is associated with multiple adverse outcomes for both mother and infant, including increased risk of sepsis, maternal mortality, perinatal mortality, and low birth weight.


	Iron deficiency and anemia reduce learning ability and the work capacity of individuals and entire populations, bringing serious economic consequences and obstacles to national development.


	prevalence of iron deficiency was greatest
		toddlers aged 1--2 years (7%)
		adolescent and adult females aged 12--49 years (9%--16%)

	The prevalence of iron deficiency was approximately two times higher among non-Hispanic black and Mexican-American females (19%--22%) than among non-Hispanic white females (10%).


	Low Hgb/Hct
	High RDW (microcytic cells)
	Follow up with iron studies
		Low serum ferritin
		Low serum iron
		High TIBC


	* Get a good history, rule out other cause for anemia ie. LEAD


	Iron is found in foods like red meat, egg yolks, and fortified flour, bread, and cereal
	Breast feeding & iron fortified formula
	Screening


	Iodine deficiency is the number one cause of preventable brain damage, affecting millions of people worldwide.

	Assessment of Iodine Deficiency Disorders and Monitoring their Elimination: A Guide for Programme Managers 2nd edition. WHO/UNICEF/ICCIDD 2001


	The problem of iodine deficiency is especially serious for pregnant women and young children. During pregnancy, even a mild deficiency of iodine can reduce brain development of the fetus limiting the intellectual ability of an individual for life.


	Iodine deficiency can cause severe mental and physical retardation, known as cretinism.


	Iodine deficiency in chronic form, can cause goiter (a disorder characterized by swelling of the thyroid gland) in both adults and children.


	Iodine deficiency most commonly, impedes fetal brain development. At the population level, the consequence of iodine deficiency is a 10–15% lower average intellectual quotient (IQ), which affects the social and economic development of both communities and nations.


	The World Bank has estimated that, combined with vitamin A deficiency and iron deficiency, iodine deficiency may lower the economic wealth of a nation by as much as 5% every year.


	Goiter-enlarged thyroid cells and gland
	Hypothyroidism: iodine is essential for the production of thyroid hormones and normal thyroid function
	Cretinism: physical and mental retardation


	Symptoms of hypothyroidism
		Mental and physical sluggishness
		Weakness
		Fatigue
		Cold intolerance
		Weight gain
		Depression
		Many more . . .


	Land locked areas without iodized salt: Asia, Central Africa

	Endemic goiters occur within groups of people iving in geographical areas with iron depleted soil


	Iodized salt
	Seafood: fish and kelp
	Dairy products
	Plants grown in iodine rich soil


	An estimated 300,000 children are born each year with spina bifida and anencephaly, which are severe neural tube defects. Approximately 75%, 225,000, of these affected births could be prevented through increased consumption of synthetic folic acid by all women of reproductive age.


	Ascaris lumbricoides (Round worm)
	Trichurist (Whipworm)
	Ancylostoma (Necator, Hookworm)
	Strongyloides
	Taenia (beef or port tapeworm)
	Giardia lamblia (Giardia)
	Entamoeba histolytica (Ameba)