Nutrition Deficiencies and Recommendations Quiz

Nutritional Disorders

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

Basic Principles of Nutrition

• Macronutrients:
  • Carbohydrates provide energy and support growth and repair.
  • Proteins are vital for growth and repair.
  • Fats are crucial for energy storage and cellular structure.
  • Imbalance leads to energy deficiencies (hypoglycemia) or excess (obesity).
• Micronutrients:
  • Include vitamins (e.g., A, C, D, and B complex).
  • Include minerals (e.g., calcium, iron, and magnesium).
  • Deficiencies cause diseases like scurvy (vitamin C deficiency), rickets (vitamin D deficiency), and anemia (iron deficiency).
• Water and Electrolyte Imbalance:
  • Dehydration and electrolyte disturbances can occur.

Malnutrition

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

Forms of Malnutrition

• Undernutrition: Marasmus
• Overnutrition: Obesity, Hypervitaminoses
• Specific Deficiency: Kwashiorkor, Hypovitaminoses, Mineral Deficiencies
• Imbalance: Electrolyte Imbalance

Etiology

• Primary Causes:
  • Low income and low purchasing power.
  • Ignorance and erroneous 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: Illustration of Pathogenesis

• Pathogenesis illustration shows the progression from tissue depletion to physical manifestations.
• Key stages include tissue depletion, blood changes, biochemical changes, urinary changes, and clinical manifestations.

Marasmus

• Common in the first year of life, related to a form of "balanced starvation".
• Conditions include insufficient breast milk, dilute milk mixtures, or lack of hygiene.
• Features include wasting, muscle wasting, growth retardation, mental changes, variable subnormal temperature, slow pulse rate, good appetite, often with diarrhea.
• Laboratory data shows serum albumin and urinary urea/gm cr levels are usually abnormal.

Kwashiorkor

• Occurs between 1–3 years of age.
• Characterized by a very low protein intake with some calories.
• Often occurs in areas where starchy foods are a main staple.
• Features include edema, muscle wasting, psychomotor changes, hair changes, possible flaky paint rash, Noma, hepatomegaly, and anemia, etc.

Treatment of PEM (Protein Energy Malnutrition)

• Severe PEM requires immediate hospitalization (1-3 months).
• Initial treatment focuses on addressing vitamin deficiencies, dehydration, and infections.
• In the acute phase, feeding is gradually restarted once rehydrated and edema resolved. Recovery takes 2-3 weeks.
• Rehabilitation involves high-energy feeds (150-200 kcal/kg/day) and usually takes 4-6 weeks.

Prognosis of PEM

• Severe PEM occurring early (especially before 6 months) can lead to permanent physical and mental growth impairment.
• The first 48 hours are critical, and mortality rates can exceed 50% without proper treatment.
• Even with treatment, mortality can still be as high as 10%.
• Factors contributing can include endocrine, cardiac or liver failure, electrolyte imbalances, hypoglycemia, and hypothermia.

Obesity

• Defined as a generalized, excessive accumulation of fat in subcutaneous and other tissues.
• Classification is based on desirable weight standards, with overweight being >10% and obese being >20%.
• The CDC recommends focusing on the 85th and 95th percentiles of BMI to identify "at risk" and "obese" levels, respectively.
• The American Obesity Association uses BMI 25 for overweight and 30 for obesity in adults.

Etiology of Obesity

• Excessive intake of food relative to energy utilization.
• Genetic factors.
• Psychiatric issues.
• Endocrine and metabolic disruptions (rare).
• Insufficient exercise or low activity level.

Clinical Manifestations of Obesity

• Fine facial features on a heavier, taller child.
• Larger upper arms and thighs.
• Common knock knees and slightly separated ankles (genu valgum).
• Relatively small hands and tapering fingers.
• Adiposity in mammary regions.
• Pendulous abdomen with striae.
• External genitalia often appear small (boys) and menarche usually is not delayed (girls).
• Psychological issues are common.
• Bone age may be advanced.

Treatment of Obesity

• Principle 1: Decrease Energy Intake:
  • Initial medical examination to rule out underlying conditions.
  • 3-day food recall to assess the diet.
  • Dietary planning that avoids sweets, fatty foods, and excessive milk intake. Dietary calorie restrictions and monitoring.
• Principle 2: Increase Energy Output:
  • Obtain a detailed activity history.
  • Increased physical activity.
  • Engaging in hobbies to prevent boredom and promote activity.

Complications of Obesity

• Pickwickian Syndrome: A rare complication of extreme exogenous obesity, presenting with severe cardiorespiratory distress, alveolar hypoventilation, polycythemia, hypoxemia, cyanosis, and congestive heart failure. Weight reduction is a crucial intervention.
• Other complications may include high blood pressure, high cholesterol, metabolic syndrome, type 2 diabetes, and sleep apnea.

Energy-Releasing Vitamins (Thiamine, Riboflavin, Niacin, Pyridoxine)

• These vitamins act as cofactors for enzymes involved in energy metabolism.
• Deficiency in these vitamins can result in tissue damage in growing tissues like epithelium.
• Deficiency symptoms often occur in nerve cells due to the high energy demands.

Thiamine (Vitamin B1) Deficiency

• Characterized by beriberi, which has various forms (wet, dry, and infantile).
• Biochemical effects include accumulation of pyruvic and lactic acid in body fluids leading to cardiac enlargement, edema, and fatty degeneration.
• Degeneration in myelin and axon cylinders result in peripheral neuropathy.
• Chronic deficiency may lead to Wernicke's encephalopathy (brain damage) and mental dysfunction.

Riboflavin (Vitamin B2) Deficiency

• Characteristic lesions are found in the lips, most commonly as angular stomatitis and cheilosis.
• Localized seborrheic dermatitis of the face may also occur.
• Other symptoms can include scrotal or vulvar dermatoses, along with ocular symptoms.

Niacin (Vitamin B3) Deficiency (Pellagra)

• This deficiency results from diets low in niacin and/or tryptophan.
• Clinical features include anorexia, weakness, irritability, sensory disturbances, and a classical triad of dermatitis; diarrhea; dementia.
• Dermatitis often appears as a symmetrical erythema, followed by dryness, scaling and pigmentation, with vesicles and bullae.
• Location is often on the back of hands, wrists, forearms, and legs (pellagrous glove).

Pyridoxine (Vitamin B6) Deficiency

• Loss from refining, processing, cooking, and storing food.
• Symptoms can include neuropathic conditions like irritability, depression, and somnolence.
• Other conditions can include pellagrous symptoms (due to insufficient niacin) and anemias.

Folic Acid (Vitamin B9) Deficiency

• A required component for DNA & RNA synthesis important for cell growth and multiplication.
• Newly discovered roles include protection from neural tube defects, heart disease, and colon cancer.
• Deficiency is often associated with poor dietary intake (especially in infants/children/pregnant women).
• Deficiency symptoms can include megaloblastic anemia, loss of appetite, failure to gain weight, chronic diarrhea, thrombocytopenic hemorrhages, and potential scurvy.

Cobalamin (Vitamin B12) Deficiency

• Needed in reactions for producing methyl groups, affecting DNA synthesis, protein synthesis, and cell growth.
• Deficiency causes pernicious anemia due to a lack of intrinsic factor secretion by the stomach.
• Features can also include megaloblastic anemia , neurological disorders (including ataxia, paresthesias, and coma), smooth red tongue, and excess of methylmalonic acid.

Ascorbic Acid (Vitamin C) Deficiency (Scurvy)

• Vitamin C is a necessary component for collagen synthesis and hydroxylation reactions/processes.

• Scurvy is characterized by symptoms like bleeding gums, corkscrew hairs, pinpoint hemorrhages (petechiae), and impaired wound healing.

• Other issues include osteoporosis, bone fragility, joint pain, and in severe cases, death.