nutritional disorders. nutritional diseases an adequate diet should provide: –energy in the form...
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NUTRITIONAL DISORDERS
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Nutritional Diseases
• An adequate diet should provide:– Energy in the form of carbohydrates, fats and
proteins.– Essential ( as well as non essential) amino acids and
fatty acids to be utilized as building blocks for synthesis of structural and functional proteins and lipids.
– Vitamins and minerals, which function as co-enzymes or hormones in vital metabolic pathways or, as for the case of Ca &P, as important structural components.
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MAIN CATEGORIES OF NUTRITIONAL DISORDERS
• Vitamin deficiencies• Protein-calorie malnutrition • Obesity
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SIGNS OF VITAMIN A DEFICIENCY
• Eye changes: xerophthalmia, Bitot’s spots, keratomalacia, night blindness.
• Squamous metaplasia in respiratory and urinary tract predisposing to infection.
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SIGNS OF VITAMIN D DEFICIENCY
• Rickets (children)* Leg deformities – bow legs.* Thoracic changes – pigeon breast
deformity, rachitic rosary, Harrison groove.
* Head – craniotabes and frontal bossing.
* Vertebrae – lumbar lordosis.• Osteomalacia (adults)
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SIGNS OF VITAMIN K DEFICIENCY
• Bleeding tendency.
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SIGNS OF RIBOFLAVIN DEFICIENCY
• Cheilosis and glossitis.• Angular stomatitis.
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SIGNS OF NIACIN DEFICIENCY
• Niacin deficiency causes pellagra (3 Ds):* Dermatitis* Diarrhea* Dementia
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SIGNS OF PYRIDOXINE (B6) DEFICIENCY
• Deficiency is rare in humans and usually subclinical. It cannot be distinguished from other avitaminoses, particularly niacin deficiency.
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SIGNS OF THIAMINE DEFICIENCY
Deficiency causes • wet beriberi, characterized by edema due to
heart failure ( Cardiomyopathy).• dry beriberi, characterized by neurologic
disturbances: CNS and peripheral nerve changes- Korsakoff syndrome – psychosis with confusion, confabulation and loss of memory.- Wernicke encephalopathy – mental
confusion with ophthalmoplegia, nystagumus and ataxia.
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Vit B1 ( Thiamine) deficiency
wet beriberi, characterized by edema due to heart failure
dry beriberi: Korsakoff syndrome – psychosis with confusion, confabulation and loss of memory.- Wernicke encephalopathy: – mental confusion with ophthalmoplegia, nystagumus and ataxia.
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SIGNS OF VITAMIN C DEFICIENCY
• Vitamin C deficiency causes scurvy, which presents with:* Vascular pattern – gingival bleeding, petechiae and echymoses* Skeletal changes – soft bones, growth retardation* Delayed wound healing
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Malnutrition
• Primary: related to diet.
• Secondary: related to:– Nutrient malabsorption.– Impaired nutrient utilization or storage.– Excess nutrient losses.– Increased need for nutrients.
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Malnutrition
• Under nutrition in affluent societies may be due to:– Ignorance and poverty.– Chronic alcoholism.– Acute and chronic illnesses.– Self-imposed dietary restrictions.– Other less common causes: malabsorption
syndromes, genetic diseases, specific drug therapies, and total parenteral nutrition.
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Protein-energy Malnutrition
• Inadequate intake of protein and calories.
• Two main clinical syndromes:– Marasmus.– Kwashiorkor.
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WHAT IS MARASMUS?
• Marasmus is a consequence of protein energy deficiency characterized by:– wasting of muscles and fat tissue (“skin and
bone”). – Serum protein levels are normal, and there
is no edema.– It can occur at any age and can be easily
compensated by normalizing nutritional supply of proteins and other nutrients.
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Protein-energy MalnutritionMarasmus:
• Weight is less than 60% of normal.
• Loss of muscle mass and subcutaneous fat leading to emaciation.
• Usually there is associated anemia, multivitamin deficiencies, and immune deficiency (T-cell mediated immunity).
• Serum albumin levels are normal or slightly reduced.
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WHAT IS KWASHIOKOR?
• Kwashiokor is a childhood protein energy deficiency associated with:– hypoalbuminemia and generalized edema. – Typically it occurs in children who have been weaned
of the mother’s breast when the second child was born.
– It presents with:• edema• desquamation of skin, • discoloration of hair,• anemia • fatty liver.
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Protein-energy Malnutrition
Kwashiorkor: • Occurs when protein deprivation is relatively
greater than the reduction in total calories.• Weight is between 60% -80% of normal.• Loss of visceral protein compartment leading
to hypoalbuminemia, which results in significant edema.
• Usually there is sparing of muscle and subcutaneous fat.
• Associated skin lesions, hair changes, anemia, large fatty liver, atrophy and loss of small intestinal villi, apathy and listlessness, other vitamin deficiencies, and defects in immunity.
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Kwashiorkor:
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LIST OF DEFICIENCES OF ESSENTIAL MINERALS
• Iron – hypochromic microcystic anemia.• Iodine –hypothyroidism, goiter, growth retardation.• Copper – abnormal collagen linking, neuromuscular
disorders.• Zinc – infertility, acrodermatitis enteropathica,
growth retardation.• Fluoride – dental caries.
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Anorexia Nervosa and Bulimia• Anorexia nervosa:
– A self-induced starvation.
– Clinically presents as severe PEM and effects on endocrine system: amenorrhea, hypothyroidism, decreased bone density, anemia, lymphopenia, hypoalbuminemia, and increased susceptibility to cardiac arrhythmia.
• Bulimia: – Eating large amount of food followed by induced vomiting.
– Lead to amenorrhea (50%), hypokalemia (--> cardiac arrhythmia), aspiration pneumonia, esophageal and cardiac rupture.
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Obesity
• How to measure fat accumulation:– Expression of in relation to height, body mass index
(BMI: kg/m2). Increased BMI is associated with increased health risk, and mortality rate.
– Skin fold measurements.– Various body circumferences particularly the ratio of
the waist-to-hip circumference.
• Distribution of fat has also an effect: central or visceral obesity is associated with more risk than excess accumulation of fat in subcutaneous tissue.
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OBESITY• Two basic types of obesity:
* Lifelong obesity.
Also called hyperplastic obesity. Begins in childhood and is characterized by an increased number of adipocytes on peripheral parts of the body.
* Adult onset obesity. Also called hypertrophic obesity. It is characterized by an increased size of fat cells and central adiposity. Fat accumulates on the trunk.
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HOW DOES THE BODY PREVENT THE DEVELOPMENT OF OBESITY?
• Balance between calorie intake and expenditure.
• The critical role in this regulation is played by Leptin. Leptin binds to leptin receptors in the hypothalamus, thus suppressing food intake and increasing expenditure of calories.
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Obesity: Causes
• Role of the leptin hormone.
• Genetic factors (identical twins).
• Environmental factors (type of diet ~ emigrant Asians).
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ADVERSE CONSEQUENCES OF OBESITY
• Hypertension
• Diabetes
• Osteoarthritis
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Obesity: Associated Risks• Hyperglyceremia.
• Low HDL cholesterol.
• Atherosclerosis, coronary artery disease and myocardial infarction .
• Cholelithiasis
• hypoventilation syndrome (pickwickian syndrome)
• ? stroke
• ? cancer (breast, endometrial carcinoma).