The Causes and Consequences of Malnutrition in Children

MALNUTRITION IN CHILDREN
Malnutrition  basically  means  ‘bad  nutrition’  and  is  a  condition  in  which  there  is  a  disparity  between  the  amount  of  food  and  other nutrients that the body needs for proper growth and health and the amount that it receives or takes in (absorbs). This imbalance is most frequently associated with undernutrition, but it may also be due to over nutrition.
Consequences of malnutrition include:
• increased risk of illness and infection
• slower wound healing
• increased risk of falls
• low mood
• reduced energy levels
• reduced muscle strength
• reduced quality of life
• reduced independence and ability to carry out daily activities.
Blood test What it is Why is it tested ? What it means Nutritional intervention
Albumin Protein made by the liver. It is an indicator of malnutrition, although Albumin and prealbumin are affected more significantly by factors other than nutritional intake. Malnutrition effects hepatic function. Factors that alter serum albumin and prealbumin may include the following :  the acute-phrase response;  hydration (intravascular volume) status;  disease state;  and  severe zinc deficiency.
Amino acid profile Comprehensive amino acid testing. Asseses the amount of different amino acids present in the body. Individual amino acids can be focused upon. Depending upon amino acid deficiency. If multiple amino acid deficiency is present, include proteins of good quality.
CBC Complete blood count Easy and very common test that screens for certain disorders that can affect your health. It tests the health of the three basic types of blood cells:
•     RBC
•     WBC
•     Platelets
Low RBC - Increase iron rich foods and Vitamin C. Check for pernicious anaemia.
High WBC indicates infection and inflammation. Get to the cause of infection.
Low platelets- increase proteins, Vitamin K, folate, Vitamin B &  C.
Creatinine Creatinine is a breakdown product of creatine phosphate in muscle Low levels indicate breakdown of muscle and inadequate amounts of protein consumption.   Increase intake of proteins.
Iron Mineral It is involved in transporting oxygen to all cells of the body. Iron deficiency is very common in India and it leads to anaemia and depleting iron stores in the body. Iron rich foods along with Vitamin C rich foods. Focus on Heme iron if possible.
Check if iron absorption is poor.
Malnutrition, high intake of phytates, polyphenols also cause iron deficiency.
In children parasitic infections ( hook worm, tape worm) may also cause iron deficiency.
Elucidate what kind of anaemia it is and treat accordingly.
Hemoglob in Protein Present in the RBC and it transports oxygen to all parts of the body. Iron deficiency is very common in India and it leads to anaemia and depleting iron stores in the body. Iron rich foods along with Vitamin C rich foods. Focus on Heme iron if possible.
Check if iron absorption is poor.
Malnutrition, high intake of phytates, polyphenols also cause iron deficiency.
In children parasitic infections ( hook worm, tape worm) may also cause iron deficiency.
Elucidate what kind of anaemia it is and treat accordingly.
Ferritin Protein Ferritin is a blood cell protein that contains iron Ferritin levels tells how well your body is storing iron.  
Transferri n Protein Main protein in the blood that binds to iron and transports it throughout     the     body.     A transferrin       test       directly measures   the   level   in   the blood Transferrin  is  used  to  evaluate protein      and      iron      status. Inflammation      leads      to      a decrease    in    transferrin;    iron deficiency  causes  it  to  increase.
3      In      patients      with      iron deficiency,   transferrin’s   use   is limited.    Like    other    negative acute-phase     reactants,     many underlying  factors  affect  serum transferrin   levels,   putting   its sensitivity   as   an   indicator   of nutrition         depletion         and response      to      depletion      in question.
Transferin  takes up iron derived from dietary absorption and from macrophage recycling and delivers it to utilizing cells.
•     Find the root cause of iron deficiency and treat it accordingly.
RBP Retinol binding protein   Some     medical     professionals consider      RBP      a      sensitive indicator       of       changes       in nutritional    status.RBP    in    the blood        is        decreased        in uncomplicated     protein-calorie malnutrition.       Although        a negative    acute-phase    reactant protein,   RBP   seems   relatively unaffected by inflammation. •     Biomarker of Vitamin A status.
•     Zinc concentrations have a correlation between not only plasma retinal levels but also liver RBP concentrations.
•     RBP is transported through chylomicrons- ensure adequate fat levels.
•     Treatment for subclinical VAD (Vitamin a deficiency) includes the consumption of vitamin A–rich foods, such as liver, beef, chicken, eggs, fortified milk, carrots, mangoes, sweet potatoes, and leafy green vegetables.
Lipid profile It measures cholesterol and triglyceride levels. Childhood obesity is on the rise and with this comes dyslipidemia.   1.    Reducing cholesterol levels :
•     Limit total fat and saturated fat
•     Reduce visceral fat
•     Increase consumption of soluble fibres
•     Decrease alcohol consumption
•     Increase consumption of Omega 3
•     Foods rich in plant sterols and stanols which block cholesterol absorption into the cells eg whole grain, beans, nuts etc
2. Reducing Triglycerides
•     Maintain ideal weight
•     Avoid trans fats
•     Increase consumption of mono and polyunsaturated fats
•     Cut down on smoking
•     Consume soluble fibre
•     Reduce consumption of refined food
Leptin Hormone which is predominately responsible for fat gain. Increased levels of leptin is associated with obesity. There is a strong co relation between serum leptin levels and BMI . •    High leptin level is linked to high body-fat mass. Maintain healthy weight.
•    Foods containing pectin such as apples improve leptin sensitivity.
Vitamin B Vitamin Vitamin B is responsible for energy release, brain function and metabolism. Deficiency causes lethargy, tiredness and delayed growth and brain development. •     Check for gastritis, pernicious anaemia, GI diseases like Chron’s, celiac or lupus. This effects Vitamin B levels severely.
•     Having a healthy gut with good gut micro biome helps to breakdown Vitamin B from food.
•     Anti biotics and anti seizure drugs decrease Vitamin B levels
Vitamin D Vitamin Vitamin   D   is   an   emerging factor      influencing      female fertility and IVF outcome Vitamin     D     helps     regulate calcium  and  phosphate  in  the body, nutrients that are essential for   healthy   bones,   teeth   and muscles. A lack of vitamin D can lead    to    bone    deformities    in children such as rickets.
Vitamin     D     also     helps     to regulating  thyroid  hormones  - which  in  turn  regulate  growth
and weight management.
•     In most cases Vitamin D supplementation is needed.
•     Ensure that a source of fat is taken with the Vitamin D supplement.
•     Vitamin D in large quantities can be toxic. Monitor blood levels frequently.
Folate Vitamin B9 Most children ingest less than the daily amounts required to maintain body stores. Folate deficiency along with Vitamin B12 deficiency can lead to sever acute malnutrition .
Signs of folate deficiency can include fatigue, lethargy, weakness, shortness of breath etc.
Folate rich foods are green leafy vegetables, peas, eggs etc
Zinc Mineral •     DNA        and         protein synthesis,        and        cell division   are   all   related to zinc levels in the body.
•     Adequate    zinc    ensures good  sense  of  smell  and taste  and  thus  regulates appetite.
Zinc    deficiency    is    associated with growth retardation (height and weight), delayed sexual and bone      maturation,      impaired immune     function,     recurrent infections, dermatitis, diarrhoea, alopecia,   anorexia   and   mental disturbances.
The   gastrointestinal   tract   may be  one  of  the  first  target  areas where zinc insufficiency may be manifested.   This   may   lead   to diarrhoea         and         lowered immunity.
•     Zinc deficiency is also associated with decreased sense of taste and smell. Check for other nutritional deficiencies.
•     Although  the  cause  in  some  cases  may  be  inadequate dietary  intake  of  zinc,  inhibitors  of  zinc  absorption  are most likely the most common causative factor.
•     Phytate,  which  is  present  in  staple  foods  like  cereals, corn   and   rice,   has   a   strong   negative   effect   on   zinc absorption from composite meals.
•     The amount of protein in a meal has a positive effect on zinc    absorption,    but    individual    proteins    may    act differently; e.g., casein has a modest inhibitory effect of zinc absorption compared with other protein sources.
•     Zinc      and      iron      interact      competitively      during intestinal absorption.
Vitamin E Vitamin Vitamin E can lead to: Muscle weakness:     Vitamin     E     is essential      to      the      central nervous  system.  It  is  among the body's main antioxidants, and   a   deficiency   results   in oxidative stress. Vitamin  E  is  another  powerful antioxidant.Vitamin        E        is important       in       maintaining normal   neurological   structure and function. •     Nuts, seeds, vegetable oils and green leafy vegetables are a good sources of Vitamin E.
•     High doses of vitamin E may increase the body's vitamin K requirement.
•     Increased intake of omega-6 fatty acids may increase vitamin E requirements.
Vitamin C Vitamins While   symptoms   of   severe vitamin C deficiency can take months  to  develop,  there  are some  subtle  signs  to  watch out  for  such  as  rough  skin and  hair,  easy  bruising,  slow heal thing etc Vitamin C deficiency is rare and is linked to malnutrition.
Scurvy   caused   by   vitamin   C deficiency. It can lead to anemia, d e b i l i t y,          e x h a u s t i o n , spontaneous  bleeding,  pain  in the   limbs,   and   especially   the legs,  swelling  in  some  parts  of the      body,      and      sometimes ulceration of the gums and loss of teeth.
•     Vitamin C is heat sensitive and is best taken in the raw form.
Cortisol Hormone Hormone which regulates metabolism, immune response, sleep- wake cycle, control sugar level etc High cortisol levels can lead to symptoms such as weight gain, hypertension, high blood sugar, osteoporosis and fragile skin while low levels may cause weight loss, weakening of muscles, fatigue, low blood pressure, vomiting and diarrhea and loss of consciousness. To reduce Cortisol levels:
•      Anti inflammatory diet: whole grains, no processed, nuts , fish, turmeric, ginger, cinnamon
•      DHEA promoting foods: wild yams, soya, flax seeds, salmon, olive oil
•      Vitamin B complex
•      Adaptogens
To increase cortisol levels:
•      Dark chocolate, pro & pre bionics, green tea, banana , pears helps increase cortisol levels.
•      Avoid caffeine,  alcohol, processed food, & refined sugar.
Mercury Metal M      e      r      c      u      r      y poisoning  symptoms  include speech,   walking,   or   hearing impairment;         emotional c h a n g e s ;          i n s o m n i a ; headaches;  and  a  decline  in cognitive function.
High    mercury    levels    can disrupt   metabolic   processes. Mercury exposure can lead to oxidative  stress  and  decrease detoxification.
Mercury    in    any    form    is poisonous,      with      mercury toxicity      most      commonly affecting      the      neurologic, gastrointestinal (GI) and renal organ systems.
Hair or blood toxicity test is done. •     Higher seafood consumption is associated with elevated blood mercury concentrations.
•     Fish eat contaminated vegetation, and the mercury becomes biomagnified in the fish. Fish protein binds more than 90% of the consumed methylmercury so tightly that even the most vigorous cooking methods (eg, deep-frying, boiling, baking, pan-frying) cannot remove it.
•     Adequate zinc is needed for mercury elimination.
Fluoride Mineral Fluoride is the most common toxin in water. High levels of fluoride exposure may adversely
affect neurodevelopment in children.
Children may experience gastrointestinal distress upon consumption of flavoured toothpaste.
Toxic levels of fluoride have been associated with a weakening of bones and an increase in hip and wrist fractures.
•   Ground water that is abnormally fluoride-rich
•   Children may be swallowing toothpaste regularly