Co-authorsCo-authors::Drs. K.A. Parvathy, C.V.Harinarayan, B. Vengamma, Bindu Menon,Drs. K.A. Parvathy, C.V.Harinarayan, B. Vengamma, Bindu Menon,

U.V. Prasad,G. Hima BinduU.V. Prasad,G. Hima Bindu

NUTRITIONAL STATUS IN NUTRITIONAL STATUS IN ADOLESCENTS WITH EPILEPSYADOLESCENTS WITH EPILEPSY

PresentedPresentedbyby

V.SWAPNAV.SWAPNA

AIMAIM

To evaluate To evaluate The anthropometric measurementsThe anthropometric measurements

Dietary parameters and Dietary parameters and

Biochemical markers of Bone Mineral Biochemical markers of Bone Mineral MetabolismMetabolism

NEED FOR THE STUDYNEED FOR THE STUDY

Adolescence, a period of transition, occupies Adolescence, a period of transition, occupies a crucial position in the life of human beings.a crucial position in the life of human beings.

Under-nutrition reduces growth rate, learning Under-nutrition reduces growth rate, learning and working capacity amongst adolescents. and working capacity amongst adolescents.

Epilepsy is the most serious common Epilepsy is the most serious common neurological disorder.neurological disorder.

Epilepsy treatment leads to nutritional Epilepsy treatment leads to nutritional deficiencies, especially vitamin Ddeficiencies, especially vitamin D33 Metabolism.Metabolism.

AED INTERFER WITH 25 OHase AT THE LIVER AND LOWERS THE FORAMTION OF1,25(OH)2 D3.

Low 25(OH)D levels leads to low 1,25(OHD)D levels.

Hence the absorption of calcium from the gut is retarded.

n= 64n= 64 Anthropometry -Anthropometry -

Ht, Wt, BMI, Arm span, U.S, L.SHt, Wt, BMI, Arm span, U.S, L.S Skin fold thickness –Skin fold thickness –

Triceps, Biceps, S.Scapular, Suprailliac.Triceps, Biceps, S.Scapular, Suprailliac. Dietary Intake – Dietary Intake –

Calories, protein, fat, Ca, Phos, Phy/Ca ratio Calories, protein, fat, Ca, Phos, Phy/Ca ratio Biochemical parameters – Biochemical parameters –

Serum Albumin, Ca, Phos, SAP, Creatinine, Serum Albumin, Ca, Phos, SAP, Creatinine, 25(OH)D, 25(OH)D, ntactntact PTH. PTH.

MATERIALS AND METHODSMATERIALS AND METHODS

STATISTICALSTATISTICAL ANALYSISANALYSIS

The results presented as Mean ± SDThe results presented as Mean ± SD

Correlation co-efficient (Pearson's) - Value Correlation co-efficient (Pearson's) - Value P<0.05 taken as significant.P<0.05 taken as significant.

Statistical package used SPSS software Statistical package used SPSS software (version 10.0).(version 10.0).

NUTRIENTSNUTRIENTS MEAN ± SDMEAN ± SDEnergy(K.cal)Energy(K.cal) 2059±1502059±150

D.Calcium(mg)D.Calcium(mg) 297±33297±33

D.Phosphorous(mg)D.Phosphorous(mg) 574±84574±84

D.Protein(gm)D.Protein(gm) 36±736±7

D.Fat(gm)D.Fat(gm) 18±218±2

Phy/CalPhy/Cal 0.6±0.080.6±0.08

DIETARY INTAKE PER DAYDIETARY INTAKE PER DAY

PARAMETERSPARAMETERS MEAN ± SDMEAN ± SD

S.Albumin (3.0-5.5gm/dl)S.Albumin (3.0-5.5gm/dl) 4±0.344±0.34

S.Calcium (8-10.5mg/dl)S.Calcium (8-10.5mg/dl) 10±0.10±0.

S.Phoshorous(2.7-4.5 mg/dl)S.Phoshorous(2.7-4.5 mg/dl) 4±0.84±0.8

SAP (140 SAP (140 IU/l)IU/l) 95±5995±59

S.Creatinine (<1.6 S.Creatinine (<1.6 mg/dl)mg/dl) 0.79±0.190.79±0.19

25(OH)D (>20 25(OH)D (>20 ng/ml)ng/ml) 16.59±10.416.59±10.4

PTH (13-54PTH (13-54pg/ml)pg/ml) 21.57±11.321.57±11.3

BIOCHEMICALBIOCHEMICAL VALUESVALUES

Distribution of Vit D levels in the Study Sample

35%

45%

20%<10ng/ml

10-20ng/ml

>20ng/ml

Duration of Drugs used by study samples

57%36%

7%

<5y

5-10y

>10y

Percent of sample using each Drug

50%43%

64%

0%

10%

20%

30%

40%

50%

60%

70%

Phy CBZ PB% of Pop

*SINCE TREATMENT INCLUDES MORE THAN ONE DRUG, THE *SINCE TREATMENT INCLUDES MORE THAN ONE DRUG, THE PERCENTAGE WILL EXCEED HUNDRED.PERCENTAGE WILL EXCEED HUNDRED.

DISCUSSIONDISCUSSION

AED’s can lower the uptake of calcium, AED’s can lower the uptake of calcium, worsening the bone health.worsening the bone health.

Inadequate intake of calcium can lead to a Inadequate intake of calcium can lead to a decreased amount of bone calcium decreased amount of bone calcium reserves.reserves.

Adolescent epileptic girls in the rural areas Adolescent epileptic girls in the rural areas could be greater risk of nutritional stress.could be greater risk of nutritional stress.

The socio-economic aspects have not The socio-economic aspects have not been dealt Micro studybeen dealt Micro study

The data was collected from only SVIMS, The data was collected from only SVIMS, Tirupati. Tirupati.

Data from other hospitals and clinics were Data from other hospitals and clinics were not collected.not collected.

The epilepsy patients approaching SVIMS The epilepsy patients approaching SVIMS for treatment mostly belong to lower socio-for treatment mostly belong to lower socio-economic strata.economic strata.

LIMITATIONS OF THE STUDY LIMITATIONS OF THE STUDY

StrategiesStrategies

AwarenessAwareness Dietary IntakeDietary Intake SupplementsSupplements Life Skills EducationLife Skills Education Primary CarePrimary Care Social StigmaSocial Stigma

CONCLUSIONCONCLUSION Hypo Vitaminosis-D and low dietary calcium Hypo Vitaminosis-D and low dietary calcium

intake adversely affect the bone mineral intake adversely affect the bone mineral homeostasis in adolescents with epilepsy.homeostasis in adolescents with epilepsy.

There is a need to treat epilepsy through There is a need to treat epilepsy through proper diet & nutrition and reducing the proper diet & nutrition and reducing the intake of medicines over a period of timeintake of medicines over a period of time

CONCLUSIONCONCLUSION Epileptic adolescents to be supplemented Epileptic adolescents to be supplemented

with dietary calcium and vitamin-Dwith dietary calcium and vitamin-D

Health educators have to be trained to deal Health educators have to be trained to deal with adolescent girls with epilepsy as they with adolescent girls with epilepsy as they are vulnerable for social evils like early are vulnerable for social evils like early marriage marriage

Than QThan Q