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Components of the Philippine Nutrition Program

The Philippine
Nutrition Program

Components of the Philippine Nutrition Program

Components of the Philippine Nutrition Program Components of the Philippine Nutrition Program

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Components of the Philippine Nutrition Program
Conditions associated with malnutrition
 Infections: diarrhea, vomiting & fever
+ 1°C in body temp. = +17% in basal
metabolic needs
 Intestinal parasitism
Anthropometry
1. Weight for age: ABW/EBW (age)
 under-5, Operation Timbang
 Do not use when client has edema
 Used in detection of
Chronic undernutrition = stunting
Acute (current) malnutrition
Overweight  obesity
Underweight  wasting
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Components of the Philippine Nutrition Program
Nutritional assessment methods
1. Anthropometry – major tool in dx of protein-
energy malnutrition (PEM)
2. Biochemical examination – more expensive
than the other methods: Hgb det, Serum
CHON, BUN, serum creatinine
3. Clinical examination – examination of the
patient for the symptoms; dx of micronutrient
deficiencies
4. Dietary history
5. Health history – to determine secondary
factors of malnutrition, such as diarrhea
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Gomez classification of nutritional status

Actual body weight

% of EBW = X 100
Expected body weight

>110% = overweight
91-110% = normal
76-90% = 1° undernutrition (mild)
61-75% = 2° undernutrition (moderate)
 60% = 3° undernutrition (severe)

3. Mid upper arm circumference

 1-4 year old
2. Height for age: Actual height/expected height  Rapid screening for malnutrition
(age)  Procedure:
 under-5 a. Determine midpoint between acromion &
 detection of chronic undernutrition  stunting olecranon.
 Heredity? b. Measure circumference at midpoint.
c. Interpretation:
 13 cm. = normal nutritional status
< 13 cm. = acute undernutrition (wasting)
< 11 cm. = severe (3rd degree) undernutrition

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4. Weight for height (body mass index) - for  Interpretation:

detection of acute malnutrition in adults
< 18.5 – underweight
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 Formula: weight in kg./height in m.
18.6 - 22.9 – normal

Weight = 50 kg 23 – overweight
Height = 1.52 m. (5 feet) 23 - 24.9 – at risk of obesity
25 – 29.9 – obesity I
50 50 = 21.64 (normal)
= ≥ 30 – obesity II
1.52 X 1.52 2.31

5. Skin fold thickness

 Thickness of subcutaneous tissue in
Triceps
Femoral
Abdominal
Scapular
 Adults; to detect acute malnutrition
 Caliper – ex. Harpenden

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6. Waist circumference – central obesity

 Men: < 90 cm (35 inches)
 Women: < 80 cm (31.5 inches)
7. Waist to hip ratio (WHR) – central obesity
 Waist circumference / hip circumference
Men: < 1
Women: < 0.85

Pt. of diff. Kwashiorkor Marasmus Pt. of diff. Kwashiorkor Marasmus

Etymology Afr. “the sickness of Gr. “wasting” Wasting Present, but may not Present and is very
the older child when be obvious obvious
the next baby is born”
Major Edema: ascites, pedal Wasting = skin and
Definition Condition that results Condition that results feature bones appearance
from severe protein from severe energy
deficiency deficiency Weight May be normal Abnormal = 2nd or 3rd
degree malnutrition
Age group Weaning age: Various age groups,
affected toddler even infants Old man’s facies
Facial Moon facies
Health Improper weaning Starvation (famine, appearance
history Diarrhea extreme poverty,
child abuse)

Pt. of diff. Kwashiorkor Marasmus

Mental Irritable Apathetic
outlook

Appetite for Poor Very good

food

Hair Sparse Absent

changes
Depigmentation
“Flag sign”

Skin Flaky paint Absent

changes dermatosis

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Management of PEM
 1st & 2nd degree malnutrition: home
management; nutrition education
 3rd degree malnutrition: referral to a hospital;
nutrition education
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Micronutrient – a substance found in very small
amounts in the body (< .005% of body
weight)
Major micronutrient deficiency conditions in the
Philippines
1. Vitamin A deficiency (VAD)
2. Iron-deficiency anemia (IDA)
3. Iodine deficiency disorders (IDD’s)
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Signs of VAD (Xerophthalmia)

Vitamin A Deficiency (VAD/Xerophthalmia)
1. Night blindness – earliest sign; due
 Susceptible population: 1-4 year; usually
occurs together with PEM
to lack of rhodopsin (visual purple) in
rods
 Foods rich in vitamin A
Richest: liver, egg yolk & milk; 2. Photophobia
contain retinol
3. Conjunctival xerosis – dryness of the
Best (considering socio-economic status of conjunctiva 2° to inadequate tears
family): dark green leafy
vegetables, yellow fruits &
vegetables; contain carotene

Signs of VAD (Xerophthalmia)

1. Night blindness – earliest sign; due
to lack of rhodopsin (visual purple) in
rods
2. Photophobia
3. Conjunctival xerosis – dryness of the
conjunctiva 2° to inadequate tears
4. Bitot’s spot – foamy, silvery spot on
sclera

Signs of Vitamin A Deficiency

(Xerophthalmia)
5. Corneal opacity

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Signs of Vitamin A Deficiency

(Xerophthalmia)
5. Corneal opacity
6. Keratomalacia – softening of cornea;
 corneal rupture  eye evisceration
 irreversible blindness

Iron Deficiency Anemia (IDA)

 Susceptible pop: pregnant women & infants
 Foods rich in iron
Egg yolk
Liver & other internal organs
Dark green leafy vegetables
 Major sign of IDA: palmar pallor

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Iodine Deficiency Disorders

 Foods rich in I: seafoods
 Susceptible pop: pregnant women
Goitrogens - substances that interfere w/ I
 Most serious effect: mental retardation with
use; found in cabbage, carrots, radish,
growth stunting (cretinism) of the baby if the
turnips, mustard, red skin of peanuts,
mother does not have enough supply of I
cauliflower, broccoli, brussels sprouts,
during pregnancy.
cassava.

Strategies in prev & mgt of micronutrient

deficiencies
1. Supplementation – administration of a
concentrated source of a nutrient
 VAD prevention: Retinol capsule (VAC)
Infants (6-11 months): 100,000 IU
Preschoolers (12-83 months): 200,000 IU
q 6 mos

 VAD treatment: days 1 & 2, after 2 wks

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Strategies in prev & mgt of micronutrient

deficiencies
 Pregnant women: VAC 10,000 IU
twice a week from 4th month onwards
 Pregnant women with night blindness:
10,000 IU OD for 4 wks upon diagnosis
 Postpartum: 200,000 IU w/in 1 mo after
delivery of each child

 Iron supplement (prev):

Infants (6-11 mos): 0.6 ml elemental iron  Iodine (potassium iodate) capsule: 1 cap
drops OD for 3 mos. (15 mg/0.6 ml) 200mg once a year
Preschoolers (12-59 mos): 1 tsp elemental Children in endemic areas (0-59 mos)
iron syrup OD for 3 mos. (30 mg/5 ml)
Pregnant women
Pregnant: 60 mg elemental iron + 400 ug
Adult males
folic acid OD for 6 mos or 180 days
Postpartum: 60 mg elemental iron + 400 ug
folic acid OD for 3 mos or 90 days

2. Fortification – addition of a nutrient to food

during processing
R.A. 8172: “Asin” Law; sale of iodized salt
R.A. 8976: Food Fortification Law (rice,
wheat flour, cooking oil, sugar)
E. O. 382: November 7 declared as National
Food Fortification Day
Sangkap Pinoy seal – placed on label of
fortified foods

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