Child Nutrition and Obesity Quiz
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Questions and Answers

What is the primary principle for treating obesity in children?

  • Increasing energy intake
  • Decreasing energy intake (correct)
  • Eliminating all unhealthy foods
  • Increasing energy output
  • Which of the following is NOT a clinical manifestation of obesity in children?

  • Genu valgum
  • Fine facial features on a heavy-looking taller child
  • Relatively large hands and fingers tapering (correct)
  • Larger upper arms and thighs
  • Which of these is NOT a clinical manifestation of Marasmus?

  • Muscle wasting
  • Growth retardation
  • Mental changes
  • Edema (correct)
  • In Marasmus, what is the likely cause of the low serum cholesterol levels?

    <p>Increased cholesterol catabolism due to energy needs (D)</p> Signup and view all the answers

    What is the recommended calorie intake for a 10-14 year old child on a diet for several months?

    <p>1,100-1,300 calories (A)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of Pickwickian Syndrome?

    <p>Increased red blood cell count (B)</p> Signup and view all the answers

    Which of the following laboratory findings is NOT typically associated with Marasmus?

    <p>Elevated serum essential amino acid index (C)</p> Signup and view all the answers

    Which of the following is NOT a common sign of Kwashiorkor?

    <p>Hypoglycemia (C)</p> Signup and view all the answers

    Why is anemia relatively uncommon in Marasmus?

    <p>The body prioritizes iron for essential functions, not red blood cell production (B)</p> Signup and view all the answers

    What is the primary role of thiamine, riboflavin, and niacin in the body?

    <p>Facilitating energy metabolism (A)</p> Signup and view all the answers

    What is the most significant period for treatment of Kwashiorkor, in terms of mortality rate?

    <p>The first 48 hours (B)</p> Signup and view all the answers

    Kwashiorkor primarily affects children in which age range?

    <p>Between 1-3 years old (D)</p> Signup and view all the answers

    Which of the following is NOT a recommended strategy for increasing energy expenditure in children with obesity?

    <p>Prescribing weight loss medication (D)</p> Signup and view all the answers

    Which of the following statements about the etiology of Marasmus is TRUE?

    <p>Marasmus results from a general lack of calories and essential nutrients (A)</p> Signup and view all the answers

    Which of the following is the most common cause of obesity in children?

    <p>Excessive food intake compared to energy expenditure (C)</p> Signup and view all the answers

    Which of the following factors distinguishes Kwashiorkor from other types of malnutrition?

    <p>A deficiency in protein but with adequate calories (C)</p> Signup and view all the answers

    What is the significance of the finding that Glucose tolerance curves are diabetic-type in Marasmus?

    <p>It reflects impaired insulin secretion in Marasmus (A)</p> Signup and view all the answers

    What is the significance of a "flaky-paint rash" in Kwashiorkor?

    <p>It is an occasional, but not diagnostic, sign of Kwashiorkor (D)</p> Signup and view all the answers

    In the context of treating obesity, what does "R/O" stand for?

    <p>Rule out (D)</p> Signup and view all the answers

    Which of these would be the MOST likely explanation for the low serum cholesterol levels found in Marasmus?

    <p>Increased catabolism of cholesterol for energy production (C)</p> Signup and view all the answers

    What is the recommended calorie intake for rehabilitation of a patient with Kwashiorkor?

    <p>150-200 kcal/kg/day (D)</p> Signup and view all the answers

    Which of these is the MOST likely explanation for the low urinary hydroxyproline/gm crea levels found in Marasmus?

    <p>Increased breakdown of collagen for energy production (A)</p> Signup and view all the answers

    Which of the following is NOT a potential cause of mortality in patients with Kwashiorkor?

    <p>Iron deficiency (C)</p> Signup and view all the answers

    What is the most significant consequence of severe Kwashiorkor occurring early in childhood?

    <p>Permanent impairment of physical and mental growth (B)</p> Signup and view all the answers

    Which of the following is NOT a typical symptom of Beriberi?

    <p>Hepatitis (B)</p> Signup and view all the answers

    What is the underlying biochemical cause of the symptoms associated with Beriberi?

    <p>Accumulation of pyruvic and lactic acid in body fluids (C)</p> Signup and view all the answers

    In the context of Beriberi, what is the primary effect of thiamine deficiency on the nervous system?

    <p>Degeneration of myelin and axon cylinders (B)</p> Signup and view all the answers

    What is the key difference between 'wet beriberi' and 'dry beriberi'?

    <p>Wet beriberi is characterized by generalized edema while dry beriberi is not (C)</p> Signup and view all the answers

    Which of the following is a characteristic of infantile beriberi?

    <p>It can be diagnosed through clinical manifestations and therapeutic tests (C)</p> Signup and view all the answers

    Which of the following is a valid preventive measure for Beriberi?

    <p>Improved milling of rice to conserve thiamine content (A)</p> Signup and view all the answers

    What is the most effective way to diagnose Beriberi?

    <p>Using a therapeutic test with parenteral thiamine (C)</p> Signup and view all the answers

    Which of the following best describes the pathogenesis of Wernicke's encephalopathy?

    <p>It arises due to vascular dilatation and brain hemorrhages in chronic thiamine deficiency (A)</p> Signup and view all the answers

    Which of the following is NOT a clinical manifestation of riboflavin (Vitamin B2) deficiency?

    <p>Scleral icterus (C)</p> Signup and view all the answers

    A patient presents with anorexia, weakness, irritability, and dermatitis that first appeared as symmetrical erythema, followed by drying, scaling, and pigmentation with vesicles and bullae at times. The dermatitis is predominantly affecting the back of the hands, wrists, forearms, neck, and lower legs. What is the most likely diagnosis?

    <p>Niacin deficiency (Pellagra) (A)</p> Signup and view all the answers

    What is the recommended daily intake of thiamine for nursing mothers?

    <p>1.5 mg (C)</p> Signup and view all the answers

    Which of the following is NOT a common cause of impaired absorption of riboflavin?

    <p>Hyperthyroidism (A)</p> Signup and view all the answers

    Which of the following best describes the role of riboflavin in the body?

    <p>Acts as a coenzyme involved in energy production and cell growth. (D)</p> Signup and view all the answers

    A patient presents with angular stomatitis, cheilosis, and seborrheic dermatitis of the face. What dietary recommendations would you make to prevent further development of these symptoms?

    <p>Increase intake of eggs, liver, meat, fish, and dairy products. (A)</p> Signup and view all the answers

    Which of the following is NOT a gastrointestinal symptom associated with niacin deficiency (pellagra)?

    <p>Constipation (D)</p> Signup and view all the answers

    What is the recommended daily intake of niacin for adults?

    <p>The RDA for niacin is not specified in the provided text. (D)</p> Signup and view all the answers

    Flashcards

    Nutritional Pathology

    The study of how poor nutrition affects health and causes disease.

    Macronutrients

    Nutrients needed in large amounts: carbohydrates, proteins, and fats.

    Micronutrients

    Essential vitamins and minerals required in smaller amounts.

    Malnutrition

    A disorder caused by inadequate or excessive intake of nutrients.

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    Marasmus

    A form of undernutrition resulting in severe wasting and growth retardation.

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    Clinical Manifestations of Marasmus

    Signs include muscle wasting, growth retardation, and no edema.

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    Specific Nutritional Deficiency

    Insufficient intake of one specific nutrient, e.g., Vitamins or minerals.

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    Electrolyte Imbalance

    Disruption in the balance of electrolytes in the body, can lead to dehydration.

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    Thiamine Deficiency

    A deficiency of Vitamin B1 leading to Beriberi and various neurological symptoms.

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    Beriberi

    A disease caused by thiamine deficiency characterized by cardiac and neurological symptoms.

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    Wet Beriberi

    A form of Beriberi with generalized edema and acute cardiac symptoms.

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    Dry Beriberi

    A form of Beriberi without edema, similar to peripheral neuritis.

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    Infantile Beriberi

    Thiamine deficiency in infants leading to cardiac issues and other symptoms.

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    Neurological Symptoms of Thiamine Deficiency

    Includes peripheral neuropathy, depression, mental confusion, and lack of coordination.

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    Diagnosis of Thiamine Deficiency

    Includes clinical tests, parenteral thiamine tests, and monitoring lactic acid levels.

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    Prevention of Thiamine Deficiency

    Ensure a diet rich in meat, whole grains, and legumes.

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    Kwashiorkor

    A form of malnutrition caused by very low protein intake despite caloric adequacy.

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    Clinical Manifestations of Kwashiorkor

    Signs include edema, muscle wasting, and psychomotor changes.

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    Flaky-paint rash

    A skin manifestation often seen in Kwashiorkor.

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    Treatment of PEM

    Includes hospitalization, treating deficiencies, and gradual feeding.

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    Prognosis of PEM

    Severe cases can lead to permanent growth impairment and high mortality.

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    Obesity Definition

    Excessive accumulation of fat in the body.

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    Obesity Classification

    Classified as 'overweight' >10% and 'obese' >20% of desirable weight.

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    CDC Overweight Percentiles

    85th percentile BMI indicates 'at risk'; 95th percentile indicates severe obesity.

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    85th percentile BMI

    Used to define overweight in children, corresponds to a BMI of ~25.

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    95th percentile BMI

    Defines obesity in children, corresponds to a BMI of ~30.

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    Etiology of obesity

    Factors leading to obesity include excessive food intake and insufficient exercise.

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    Clinical manifestations of obesity

    Observable features in obese children, like fine facial features and pendulous abdomen.

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    First principle of obesity treatment

    Decrease energy intake by modifying diet and involving family.

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    Second principle of obesity treatment

    Increase energy output through physical activity and hobbies.

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    Pickwickian Syndrome

    Rare severe obesity complication causing respiratory distress.

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    Energy-Releasing Vitamins

    Thiamine, Riboflavin, Niacin, Pyridoxine help in energy metabolism.

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    Riboflavin Function

    Essential for amino acid, fatty acid, and carbohydrate metabolism.

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    Riboflavin Deficiency Symptoms

    Includes angular stomatitis, cheilosis, and seborrheic dermatitis.

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    RDA for Riboflavin

    Recommended dietary allowance varies by age: Infants 1.4-2mg, Adults 0.025mg/gm protein.

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    Niacin Deficiency Etiology

    Caused by low niacin or tryptophan diets, malabsorption, or excessive corn consumption.

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    Pellagra Symptoms

    Classical symptoms include dermatitis, diarrhea, and dementia.

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    Riboflavin Sources

    Foods high in riboflavin include eggs, liver, meat, fish, and dairy.

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    Riboflavin Treatment

    Treatment involves 2-5mg daily of riboflavin supplements or parenteral administration.

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    Study Notes

    Nutritional Disorders

    • Nutritional pathology is a branch of pathology that investigates how inadequate or excessive nutrition affects health, leading to disease. It combines biochemistry, physiology, and clinical medicine.
    • Chronic diseases like obesity, heart disease, and diabetes are significantly influenced by diet.
    • Nutritional deficiencies lead to conditions like anemia, rickets, and scurvy.

    Basic Principles of Nutrition

    • Macronutrients:
      • Carbohydrates provide energy for growth and repair.
      • Proteins are essential for growth and repair.
      • Fats are crucial for energy storage and cellular structures.
      • Imbalance in macronutrients leads to energy deficiencies (hypoglycemia) or excess (obesity).
    • Micronutrients:
      • Include vitamins (e.g., A, C, D, and B complex) and minerals (e.g., calcium, iron, and magnesium).
      • Deficiencies cause diseases such as scurvy (vitamin C deficiency), rickets (vitamin D deficiency), and anemia (iron deficiency).

    Malnutrition

    • Malnutrition is a pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients. It is often detected only through biochemical, anthropometric, or physiological tests..

    Forms of Malnutrition

    • Under-nutrition (e.g., marasmus)
    • Over-nutrition (e.g., obesity, hypervitaminoses)
    • Specific deficiencies (e.g., kwashiorkor, hypovitaminoses, mineral deficiencies)
    • Imbalances (e.g., electrolyte imbalances).

    Etiology of Malnutrition

    • Primary Causes:
      • Poverty and low purchasing power
      • Ignorance and poor food habits
      • Scarcity of food supply
      • Overpopulation
    • Secondary Causes:
      • Obesity, insulin resistance, and diabetes
      • Hepatobiliary disorders
      • Metabolic and renal diseases
      • Diarrhea and intestinal malabsorption
      • Infections (especially respiratory infections)

    Nutritional Deficiency - Pathogenesis Illustration

    • Nutrient deficiency leads to tissue depletion.
    • Physiological changes result in weight loss and anthropometric measurements changes.
    • Biochemical changes in blood, urine, and other bodily fluids happen.
    • Clinical and subjective symptoms follow.
    • Anatomical abnormalities in organs and tissues appear.

    Marasmus

    • Prevalence: Common in the first year of life
    • Etiology: "Balanced starvation," insufficient breast milk, or diluted milk mixtures.
    • Symptoms:
      • Wasting and muscle wasting
      • Growth retardation
      • Mental changes
      • No edema (unlike a different nutritional deficiency, Kwashiorkor)
    • Laboratory Data: Low serum albumin, abnormal urinary urea/creatinine ratios, low hydroxyproline, infrequent anemia

    Kwashiorkor

    • Prevalence: Between 1-3 years old
    • Etiology: Very low protein intake, but sufficient calories from carbohydrates. Occurs in areas where starchy foods are the main staple. Not an exclusively dietary deficiency.
    • Symptoms:
      • Edema
      • Muscle wasting
      • Psychomotor changes
      • Hair changes
      • Diffuse depigmentation of skin
      • Moonface

    Treatment of PEM (Protein-Energy Malnutrition)

    • Severe PEM requires immediate hospitalization (1-3 months).
    • Treat underlying vitamin deficiencies, dehydration, and infections.
    • Start feeding as soon as hydration and edema resolved using complete strength nutrition.
    • Rehabilitation with high-energy feeds (150–200 kcal/kg/day) to recovery in 4-6 weeks.

    Prognosis of PEM

    • Severe PEM in infancy can lead to permanent physical and mental growth impairment.
    • Early treatment improves prognosis greatly but some mortality rates still occur (up to 50% in first 48hrs depending on patient).
    • Causes for mortality could include endocrine, cardiac, or liver failure; electrolyte imbalance, hypoglycaemia and hypothermia.

    Obesity

    • Definition: Excessive accumulation of fat in subcutaneous and other tissues throughout the body.
    • Classification: Overweight (>10% above desirable weight), obese (>20% above desirable weight or BMI of >30, more severe level)
    • Classification Standard: Centers for Disease Control (CDC): avoids the use of the term obesity to describe certain categories but instead uses 85th percentile BMI for "at risk" levels and 95th percentile BMI as more severe.
    • American Obesity Association: 85th percentile BMI for overweight and 95th percentile BMI for obesity
    • Etiology: Excessive food intake compared to expenditure, genetic factors, or psychological or endocrine disorders. Insufficient exercise or lack of physical activity is another significant factor.
    • Clinical Manifestations:
      • Fine facial features in a taller, seemingly heavy child
      • Larger upper arms and thighs
      • Genu valgum (knock knees)
      • Relatively small hands and fingers
      • Adiposity in mammary regions
      • Pendulous abdomen with striae
      • External genitalia appear smaller in boys, average in girls

    Treatment of Obesity

    • First principle: Decrease energy intake.
      • Medical evaluation to rule out underlying issues
      • Food diary to assess current diet.
      • Plan a tailored diet.
      • Restriction on sweets, fried foods, and fats.
      • Milk intake limit ( < 2 glasses /day)
    • Second principle: Increase energy output.
      • Obtain activity history.
      • Increase physical activity.
      • Involve in hobbies to reduce boredom

    Complications of Obesity

    • Pickwickian Syndrome: A rare complication of extreme exogenous obesity, characterized by severe cardiorespiratory distress and alveolar hypoventilation. Symptoms include polycythemia, hypoxemia, cyanosis, and congestive heart failure (CHF)

    Energy-Releasing Vitamins

    • Thiamine, riboflavin, niacin, and pyridoxine are cofactors for enzymes in energy metabolism. Tissues such as epithelium show rapid growth.

    Thiamine (Vitamin B1) Deficiency (Beriberi)

    • Pathology: Pyruvic and lactic acid accumulation in the body. This leads to cardiac failure, edema of interstitial tissue, and fatty degeneration of the myocardium.
    • Types of Beriberi:
      • Wet beriberi: generalized edema and acute cardiac symptoms
      • Dry beriberi: similar to peripheral neuritis, no edema
      • Infant beriberi: various types: acute cardiac, aphoic, and pseudomeningeal.
    • Diagnosis: Clinical manifestations, therapeutic test, blood lactic and pyruvic acid test, decreased red blood cell transketolase.
    • Prevention: Rich sources of thiamine include meat, whole grains, and enriched cereals.

    Riboflavin (Vitamin B2) Deficiency

    • Functions: Riboflavin acts as a coenzyme for flavoprotein in CHO metabolism and cellular respiration. Essential to retinal eye pigments for light adaptation
    • Clinical Manifestations: Common lesions include (angular) stomatitis, cheilosis, stomatitis, nasolabial seborrhea or dyssebacia, angular palpebritis, scrotal/vulvar dermatosis, and ocular symptoms (photophobia, blurred vision, itching, and corneal vascularization).
    • Diagnosis: Urinary riboflavin determination, RBC riboflavin load test.
    • Prevention: Food sources rich in riboflavin include eggs, liver, meat, fish, milk, and green leafy vegetables.
    • Treatment: Riboflavin 2-5mg daily and increase B-complex, parenteral if necessary

    Niacin (Vitamin B3) Deficiency (Pellagra)

    • Etiology: Low niacin and/or tryptophan intake.
    • Clinical Manifestations:
      • Beginning symptoms of anorexia, weakness, irritability, and numbness, often followed by dermatitis, diarrhea, and dementia.
      • Dermatitis often appears initially symmetrical erythema, followed by drying, scaling, pigmentation, and sometimes vesicles.
      • Predilection for the back of the hands, wrists, forearms (“pellagra glove”.
    • Diagnosis: Diet history, look for clinical manifestations indicative of poor niacin or tryptophan diet plus clinical symptoms.
    • Prevention: Eat food sources rich in niacin and tryptophan, limit corn intake.
    • Treatment: Niacin (50–300mg daily for long time if needed), soothing lotions for skin lesions.

    Pyridoxine (Vitamin B6) Deficiency

    • Functions: Vitamin B6 is involved in various metabolic processes, including amino acid metabolism, neurotransmitter synthesis, and niacin synthesis.
    • Etiology: Losses from food processing/cooking, malabsorptive diseases (e.g., celiac disease), or drug interactions (e.g., INH therapy).
    • Clinical Manifestations:
      • Various clinical presentations including neuropathic (irritability, depression, somnolence), pellagrous (seborrheic dermatitis, angular stomatitis, glossitis), and anemic types
    • Diagnosis: Tryptophan load test, blood tests.
    • Prevention: Consume foods rich in pyridoxine (e.g., meat, whole wheat, corn, egg yolks, liver)
    • Treatment: Pyridoxine supplementation.

    Hematopoietic Vitamins

    • Necessary to produce blood, especially red blood cells.

    Folic Acid (Vitamin B9) Deficiency

    • Functions: Crucial for DNA synthesis, cell formation, esp. red blood cells, needed for new cell formation(e.g., in GI cells)
    • Etiology: Low intake of folate, malabsorption, medications, chronic inflammation, increased requirements during pregnancy and rapid growth, or alcohol use.
    • Clinical Manifestations:
      • Megaloblastic anemia, irritability, failure to gain weight, diarrhea (chronic)
      • Thrombocytopenic hemorrhages
      • Scurvy (symptoms) may be present
      • Anemia, macrocytic
    • Diagnosis: Low folic acid level (<3ng/ml), abnormal blood cell morphology on lab analysis , increased homocysteine in the blood.
    • Prevention: Rich dietary intake
    • Treatment: Folic acid supplementation (parenteral if needed).

    Cobalamine (Vitamin B12) Deficiency

    • Absorption: Cobalamin requires intrinsic factor (IF) from the stomach to be absorbed.
    • Etiology: Congenital deficiency (e.g., lack of intrinsic factor), inadequate intake (e.g., strict vegetarian diet), malabsorption, or disease that damages the absorption sites in the stomach or small intestine (e.g., pernicious anemia, celiac disease).
    • Clinical Manifestations:
      • Neurological issues like ataxia, paresthesias, hyporeflexia, Babinski responses, clonus, coma.
      • Macrocytic anemia (large blood cells).
      • Smooth, red, and often painful tongue
      • Elevated methylmalonic acid levels in the urine (a diagnositc test for deficiency).
    • Diagnosis: Low serum vitamin B12 levels, elevated serum homocysteine or methylmalonic acid
    • Prevention: Eat foods rich in vitamin B12 (e.g., meat, eggs, dairy).
    • Treatment: Cyanocobalamin injections or high oral maintenance dose, or both if needed to correct and/or maintain cobalamin levels.

    Ascorbic Acid (Vitamin C) Deficiency (Scurvy)

    • Functions: Collagen formation, synthesis of steroids, iron absorption, and maintenance of normal B vitamins and folate.
    • Etiology: Dietary deficiencies, improper cooking practices, faulty dietary habits, or malabsorption.
    • Clinical Manifestations:
      • Easy bruising (petechiae) and ecchymosis
      • Easy bleeding
      • Swollen and bleeding gums (often painful)
      • Poor wound healing, weak collagen , delayed bone growth and deformities
      • Corkscrew hairs
      • Painful and immobile legs
      • Swelling (oedema)
    • Diagnosis: History, clinical picture, abnormal X-rays (pencil-thin cortex, dumbell/club shaped bones,) lab values (zero or low vitamin C), and/or therapeutic test.
    • Prevention: Eat fruits and vegetables rich in vitamin C.
    • Treatment: Ascorbic acid supplementation

    Overall note:

    • These notes cover the key aspects of nutritional disorders, from their causes and symptoms to their treatment and prevention
    • Several nutritional deficiencies focus on infants and early development and symptoms often appear as generalized and/or delayed development or growth
    • Several disorders correlate with symptoms or conditions that require specialist diagnosis and treatment.

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    Nutritional Disorders PDF

    Description

    Test your knowledge on child nutrition and obesity-related conditions such as Marasmus and Kwashiorkor. This quiz covers clinical manifestations, dietary recommendations, and the roles of various nutrients. A must-take for anyone interested in pediatric health and nutrition.

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