NTA Level 4 • Semester 1 • PST04102

Specialised Food Therapy

Disease Control and Prevention • Source Session/Topic 44

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Session 44: Specialised Food Therapy

Total Session Time: 120 minutes + 2 hours Assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Define Specialised Food Therapy

• Explain Nutrients Required for Different Groups

• Explain Entry and Exist Criteria for Specialised Food Products

• Describe Different Types of Specialised Food Products

• Describe the Importance of Nutritional Therapy for Acute Malnourished

Clients

Resources Needed

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Computer and LCD projector

• Handout 44.1

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Common Nutritional Deficiency Diseases (50 minutes)

|Activity: Buzzing (10 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the common nutritional deficiency diseases? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Malnutrition

• Can occur at any time in the life cycle.

• When it occurs early in life, irreversible damages can be done to the

body and brain

• Affects a significant proportion of populations, presenting as macro

and or micronutrient deficiency disorders.

• Nutrition disorder means any kind of disorder caused by eating too

little or too much of one or more different nutrients.

Classification of Malnutrition

• Can be classified in different ways but most commonly as under

nutrition or over nutrition.

o Under Nutrition occurs when nutrients intake does not meet nutrients

needs.

o Many nutrients are in high demand due to the constant state of cell

lose and later regeneration in the body.

o Over nutrition is prolonged consumption of more nutrients than the

body needs

Protein Energy Malnutrition (PEM)

• A deficiency of energy and protein which results in body wasting,

• Occurs more frequently in infants and young children but is also

observed in adolescents and adults

• Severe forms of PEM are Kwashiorkor and Marasmus

Kwashiorkor

• Caused by failure to provide an adequate dietary sources of protein

to substitute for the protein

• Signs and symptoms includes:

o failure of growth but the child is not severely wasted,

o swollen abdomen,

o hair changes (hair becomes brown, straight and soft)

o skin rashes,

o child becomes inactive, apathetic, irritable and is difficult to feed,

o oedema of lower limbs

Marasmus

• Causes: severe loss or chronic waste of fat, muscles and other tissues of

the body. The disease occurs due to shortage of basic nutrition, proteins,

vitamins and calories to the body. It is inadequate energy intake in all

forms, including protein.

• Signs and Symptoms of Marasmus: remarkable failure of growth, severe

muscle wasting with flaccid, wrinkled skin and bony prominence, the child

looks awake and hungry and displays what is referred to as ‘old person’s

face and Oedema is absent

Prevention of PEM

• The different strategies may include:

• Incorporating nutrition objectives into development of policies and

programmes

• Improving household food security

• Protection and promotion of good health

• Improving the quality and safety of foods

• Protect and promote breastfeeding and complementary feeding

• Early treatment of common diseases

• Immunization

• Growth monitoring

• Promoting appropriate diets and healthy lifestyles

Vitamins and Minerals Nutritional Deficiencies

Vitamin A Deficiency

• It plays important roles in the body including vision, maintenance of

epithelial tissue, and synthesis of mucous secretion, growth,

reproduction and immunity.

• The organ that is most readily affected is the eye.

Symptoms and Signs:

• Night blindness (Reduced ability to see in dim light)

• Conjunctival xerosis/ drying

• Corneal xerosis/drying,

• Xerophthalmic fundus (retina has white dots)

• Keratomalacia: Perforation of the cornea prolapsed of the iris, loss of

ocular contents and perhaps destruction of the eye

o All of these may lead to complete blindness

Vitamin B1 Deficiency (Beriberi):

• It occurs when people consume highly milled polished rice or maize, and

starchy roots such as cassava, which are deprived of thiamine content.

• Signs and Symptoms:

o Heart palpitation, chest pain.

o Dyspnoea (breathlessness), a rapid, sometimes irregular pulse and

distended neck veins with visible pulsations

o The heart is found to be enlarged

o Cyanosis

o Increased oedema

o Severe dyspnoea

o Acute circulatory failure and death

o The patient is thin with weak, wasted muscles Anaesthesia and ‘pins-

and-needles’ feelings in the feet and arms may increase, eventually

causing difficulty in walking

o Foot drop and wrist drop commonly occur

Vitamin B2 (Riboflavin) Deficiency (Beriberi)

Sign and symptoms:

• Angular stomatitis

• Glossitis

• Skin changes

• Seborrheic dermatitis

• Vascularization of the cornea

Vitamin B3 (Niacin) Deficiency (Pellagra):

• It is generally associated with maize diet.

• Early Symptoms of Pellagra: A person appears poorly malnourished, often

weak and underweight. A person may also have diminished sensitivity to

gentle touch and sometimes some muscular weakness and tremor. Untreated

cases of pellagra may die of the disease

• The disease is later characterized by the three ‘Ds’:

o Dermatitis: deepening of the pigmentation, dry skin, scaly and

eventual cracked, desquamation, occasionally the skin may blister, the

tongue and other parts of the mouth are often sore, red, smooth and

raw-looking

o Diarrhoea: a patient with pellagra may frequently have bouts of

abdominal pain, diarrhoea and other digestive upsets. The upsets

include nausea, excessive salivation, and a burning sensation in the

epigastrium.

o Dementia: this involves the effect of pellagra in nervous system which

brings about Irritability, loss of memory, anxiety and insomnia

Vitamin C Deficiency (Scurvy):

• Ascorbic acid is essential for the formation of intercellular collagen

and hence for the development of cartilage, bone and teeth and for the

healing of fractures and wounds.

Symptoms and Signs:

• The walls of blood vessels lack solidity and become fragile and bleeding

or haemorrhage from various sites results. Other haemorrhages include

nosebleeds, blood in the urine or faeces

• Moderate deficiency of vitamin C may result in poor healing of wounds.

People who do not eat enough vitamin C may not absorb enough iron and may

develop iron deficiency anaemia especially in pregnancy

• Tiredness and weakness

• Swollen gums which bleed easily at the base of the teeth

• In the skin – follicular hyperkeratosis, skin bruising haemorrhages and

broken coiled hair

• Swollen painful joints particularly of the knees, hip and elbow also pain

in all muscles

• Loss of secretion of lachrymal and salivary glands, loss of hair, dryness

of the skin and loss of dental fillings.

• Beading of the ribs

Vitamin D Deficiency (Rickets and Osteomalacia)

• The main feature of both rickets and osteomalacia is lack of calcium in

the bones.

• Rickets occurs in children whose bones are still growing. Often children

are plump and appear well fed

• Osteomalacia occurs in adults who have formed bones. Both conditions are

caused mainly by a deficiency of vitamin D, and not by a dietary lack of

calcium.

Symptoms and Signs of Rickets:

• Child tends to be miserable

• Flabby (toneless state of muscles that causes a pot-belly),

• Impairment of normal development

• Gastro-intestinal upset and excessive sweating of the head.

• The main signs of the disease are bone deformation.

Vitamin E Deficiency

• It is not common among human beings as it is widely distributed in foods.

Signs and symptoms:

• Muscular dystrophy

• Paralysis

• Impaired fat absorption

• Haemolytic anaemia in babies after delivery

• Liver necrosis, erythrocyte haemolysis and anaemia in adults

Vitamin K Deficiency (haemorrhagic disease)

• Dietary deficiency is not common. Deficiency occurs due to deficient

production of it by the gut, with prolonged antibiotic therapy, due to

poor absorption of vitamin K, in malabsorption of fat and due to low

prothrombin synthesis in liver disease.

Signs and symptoms:

• Tendency to bleed from skin and mucous membranes

Anaemia

• Anaemia is a pathological condition arising as a result of low level of

haemoglobin which impairs oxygen transport to the tissues. There are

various types of Anaemia such Haemorrhagic, haemolytic and nutritional

Anaemia.

• Nutritional anaemia is due to deficiency of nutrients that are needed for

the synthesis of red blood cells: iron, folic acid and vitamin B12.

• Thus nutritional anaemia includes: Iron deficiency anaemia, Folic acid

deficiency anaemia and Vitamin B12 deficiency anaemia.

Iron Deficiency Anaemia (IDA)

Symptoms and Signs Iron Deficiency Anaemia (IDA)

• Tiredness and fatigue

• Dizziness and/or headaches

• Palpitations

• Difficulty in breathing on exertion

• Inadequate temperature regulations

• Mild degree of splenomegaly

• Brittle finger nail

Folate and vitamin B12 (Megaloblastic anaemia) Deficiency

Symptoms and Signs:

• Glossitis, sometimes stomatitis, hyper pigmentation of skin and mucosa,

peripheral neuropathy and dementia

o In children, severe Vitamin B12 deficiency may produce mental

regression, convulsions, coma and ultimate death

Note: The symptoms are quite variable, and they can be caused by other

conditions. The only sign you can look for is paleness, which is not very

reliable. So to know whether a person is anaemic or not, you need to

measure the amount of haemoglobin in the blood.

Iodine Deficiency

• Deficiency of iodine in the body leads to conditions termed iodine

deficiency disorders (IDD).

• Iodine is found in the soil and is picked up by different foods

(plants, animals, water) obtainable in the area.

• The major cause of iodine deficiency is its loss from the soil through

leaching. Iodine deficiency manifests as goitre as well as a variety

of conditions termed hypothyroidism.

• Symptoms and Signs of Iodine Deficiency Disorders:

Goitre

• A person who is hypothyroid: Feels cold easily, moves slowly and lacks

energy, think slowly and appear unconcerned, may be sleepy, has a dry

skin and may be constipated

• A child who is hypothyroid: Also grows slowly, may be very short and may

not do well in school

• Women who are hypothyroid during pregnancy may also have; Miscarriage or

still birth, Low birth weight babies, Babies with congenital deformities

and Babies with cretinism

[pic]

STEP 3: Management of Nutritional Deficiency Diseases (40 minutes)

|Activity: Small Group Discussion ( 10 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

|How are nutritional deficiency diseases managed? |

| |

|ALLOW students to discuss for 10 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

Vitamin A

• Promotion of horticultural foods (fruits and vegetables such as carrots,

cabbage and sweet potatoes)

• Promotion of production and use of red palm oil and other cooking oils

• Improvement of appropriate child feeding: Breastfeeding and Improved

complementary foods

• Use of milk and milk products

• Early treatment of diseases (measles, respiratory tract infections,

diarrhea)

• Promotion of immunization coverage

• Vitamin A supplementation (to children, lactating women)

• Fortification of foods with Vitamin A

Vitamin B1 (Thiamine)

• Consumption of diet containing adequate quantities of vitamin B

• If highly milled white rice is the staple food, diet should be

supplemented with foods rich in thiamine: nuts, beans, peas and other

pulses, whole grain cereals and yeast based products

• Nutrition education to stress cause of diseases, foods that should be

consumed, and ways to minimize vitamin loss

Vitamin B2 (Riboflavin)

• Consumption of diet containing adequate quantities of vitamin B2 such as

eggs, milk and milk products, meat, fish, whole cereals, oil seeds, nuts

and leafy vegetables

Vitamin B3 (Niacin)

• Diversity in the diet

• Production and consumption of food known to prevent pellagra i.e. those

rich in niacin such us nuts and tryptophan such as eggs, milk, lean meat

and fish should be increased

• Enrich milled maize meal with niacin

• Niacin tablets are administered as prophylaxis in prisons, refugee camps

and institutions in areas where pellagra is endemic.

• Nutrition education

Vitamin C

• Increased production and consumption of vitamin C rich foods: fruits and

vegetables. Encourage the use of wild edible fruits and vegetables

• Provision of vegetable fruits and fruits juices to all community members

(including children beginning at six months)

• Nutrition education in consumption of vitamin C rich foods, minimizing

vitamin C loss in cooking and food preparation

Vitamin D

• All children get adequate amount of sunlight

• Children, pregnant women and lactating women should have adequate calcium

and vitamin D in their diet

• Attend clinic regularly

• Fish- liver oils, egg yolk, milk, butter, cheese and ghee

• Establish allowing supplementation of cod-liver oil or other vitamin D

supplements

• Nutrition education (including child spacing)

Vitamin E

• It is widely distributed in nature that it is difficulty to prepare a

diet deficient in vitamin E

• Human milk is enough for the infants

• Cereal especially wheat germ oils are the richest source. Vegetable fats

from corn, soya bean, peanuts and coconut or cotton seeds are good

sources followed by cereals, eggs and meat and green leaves such as

spinach.

Vitamin K

• Bacteria in the intestine normally produce it in adequate amount

• Fresh dark green vegetables especially spinach, kale and cauliflower

• Plant oils, rice bran oil and wheat germ oil, soya bean and cotton seed

oils are best sources

Iodine

• Various medicinal preparations are administered, such as:

o Injectable iodized oil

o Iodinated oil capsules

o Salt iodation: emphasis should be on salt iodation only because

currently other strategies are less commonly usedControl of Iodine

Deficiency

Iron

• Promotion of consumption of iron- and vitamin-rich foods

• Prevention and treatment of anemia-related diseases (malaria, worm

infestation)

• Iron and folic acid supplementation to the most at risk groups (children,

pregnant women, sickle cell disease patients)

• Fortification of foods with relevant nutrients (iron, folic acid)

• Prevention and treatment of anaemia-related diseases (malaria, worm

infestation)

[pic][pic] Handout 43.1: Nutrition Supplements and Associated Nutrient

Disorders

[pic][pic]Handout 41.2: Nutrition Supplements and Associated Nutrient

Disorders

[pic][pic]Handout 41.3: Nutrition Supplements

STEP 4: Key points (5 minutes)

• Common nutritional deficiency diseases are Protein Energy Malnutrition

and Vitamins and Minerals Nutritional Deficiencies

• Management of nutritional deficiency diseases depends much on handling

their signs and symptoms

STEP 5: Evaluation (10 minutes)

• What are the common nutritional deficiency diseases?

• How are nutritional deficiency diseases managed?

STEP 6: Assignment (10 minutes)

|Activity: Take Home Assignment (10 minutes) |

| |

|DIVIDE students in groups or individuals |

| |

|ASK the students to work on the following Assignment |

|Prepare a presentation about different types of Anaemia and how they |

|can be managed |

|ALLOCATE time for students to do the assignments and submit |

| |

|REFER students to recommended references |

References

Beaton G.H. & Bengoa J.M. (1976).Nutrition in Preventive Medicine. Geneva:

WHO

King, S. F & Burgess, A. (2000). Nutrition for Developing Countries.

(2nded.). New York: Felicity Oxford University Press

Kumar P. & Clark, M. (2006).Clinical Medicine. (6thed.) New York: Elsevier

Limited

Latham M. C (1997). Human Nutrition in the Developing World.David Lubin

Memorial Library

McLaren.S. (1992).A Colour Atlas and Text of Diet-Related Disorders.

(2nded.) BPCC Hazells Ltd, Aylesbury, England

Raheena Begum.(2006). A textbook of Foods, Nutrition and Dietetics.(2nd

Rev.ed.). New Delhi: Sterling Publishers Private Ltd

Tanzania Food and Nutrition Centre.(2009). National Guidelines for

Nutrition Care and Support for People Living with HIV. (2nded.) Dar es

Salaam: TFNC

Wardlaw G.M. (2003). Contemporary Nutrition: Issues and Insights. (4thed.)

Phidalephia: Mc GrawHill,

|[pic] |Handout 43.1: Nutrition Supplements and Associated Nutrient |

| |Disorders |

[pic]

|[pic] |Handout 43.2: Nutrition Supplements and Associated Nutrient |

| |Disorders |

[pic]

|[pic] |Handout 43.3: Nutrition Supplements |

[pic]

Hand Out 44.1: Specialised Food Products Used in Tanzania

a) F 75 and F 100

|2 |Protein |10% de |5% de |

|3 |Lipids |45% de |31% de |

|4 |Vit.A |800 ug |0.9 mg |

|5 |Vit.D |15 ug |18 ug |

|6 |Vit.E |20 mg |20 mg |

|7 |Vit.C |50 mg |59 mg |

|8 |Vit.B1 |0.5mg |0.5 mg |

|9 |Vit.B2 |1.6 mg |1.2 mg |

|10 |Niacin |5 mg |5 mg |

|11 |Vit.B6 |0.6 mg |0.6 mg |

|12 |Folic acid |200 ug |200 ug |

|13 |Vit.B12 |1.6 ug |1.6 ug |

|14 |Biotin |60 ug |60 ug |

|15 |Pantothenic acid |3 mg |3 mg |

|16 |Vit.K |16 ug |24 ug |

|17 |Sodium |<290 mg |<87 mg |

|18 |Calcium |300 mg |560 mg |

|19 |Phosphorus |300 mg |330 mg |

|20 |Magnesium |80 mg |50 mg |

|21 |Zinc |11 mg |12.2 ug |

|22 |Iodine |70 ug |100 ug |

|23 |Potasium |1100 mg |775 mg |

|24 |Copper |1.4 mg |1.7 mg |

|25 |Selenium |20 ug |30 ug |

|26 |Iron |<0.2 mg |<0.3 mg |

b) READY TO USE THERAPETIC FOOD ‘Plumpy'Nut.

[pic]

It is a paste of groundnut composed of vegetable fat, peanut butter,

skimmed milk powder, lactoserum, maltodextrin, sugar, mineral and vitamin

complex

|Nutrient |Per sachet of 92 |Nutrient |Per sachet of 92 g |

| |g | | |

|Energy |500 kcal |Vitamin A |840 mcg |

|Proteins |12.5 g |Vitamin D |15 mcg |

|Lipids |32.86 g |Vitamin E |18.4 mg |

|Calcium |276 mg |Vitamin C |49 mg |

|Phosphorus |276 mg |Vitamin B1 |0.55 mg |

|Potassium |1 022 mg |Vitamin B2 |1.66 mg |

|Magnesium |84.6 mg |Vitamin B6 |0.55 mg |

|Zinc |12.9 mg |Vitamin B12 |1.7 mcg |

|Copper |1.6 mg |Vitamin K |19.3 mcg |

|Iron |10.6 mg |Biotin B5 |60 mcg |

|Iodine |92 mcg |Folic acid |193 mcg |

|Selenium |27.6 mcg |Pantothenic acid|2.85 mg |

|Sodium |< 267 mg |Niacin B3 |4.88 mg |

c) FORTIFIED BLENDED FOOD (FBF)

High Energy Pre-cooked Porridge Flour, Fortified with Vitamins & Minerals

| |

|Composition Table of Fortified Blended Flour (Fbf) |

|Foundation Plus+- (Corn Soy Blend ) Frominsta Health |

|Builder |

| |

| |Maize |64.4%, |

| |Soybeans |25% |

| |Sugar |5%, |

| |Palm Olein Oil |5%, |

| |Vitamins & Minerals |0.6% |

[pic][pic]

———————–

PST 04102Disease Control and Prevention

NTA Level 4 Semester 1

December 2016

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