Nutritional Deficiency Document PDF

**Nutritional Deficiency** (Nutrient) is the source of energy that is required to carry out all the processes of the human body. A good nutritional source is a fundamental right of every human being to maintain good health. The human body requires food that contains Vitamins, minerals, protein, car...

**Nutritional Deficiency** (Nutrient) is the source of energy that is required to carry out all the processes of the human body. A good nutritional source is a fundamental right of every human being to maintain good health. The human body requires food that contains Vitamins, minerals, protein, carbohydrates & fats. A balanced diet is a combination of both macro and micronutrients. Nutritional inadequacy involves an intake of nutrients that is lower than the estimated average requirements whereas nutritional deficiency consists of several reduced levels of one or more nutrients, making the body unable to perform its function normally and thus leading to an increased risk of several diseases like cancer, diabetes, & heart disease. Malnutrition could be caused by environmental factors and diseases like food scarcity conditions impaired digestion, intestinal malabsorption, swallowing inability, other chronic diseases, and persistent vomiting. Nutritional biomarkers like serum or plasma levels of nutrients such as Folate, Vitamin C, Vitamin B, Vitamin D, Selenium, copper, and zinc could be used for the evaluation of nutrient intake & dietary exposure Macronutrient deficiency could cause kwashiorkor, Marasmus, ketosis, growth retardation, wound healing problems, & increase infection. Susceptibility,  whereas micronutrients like Iron, Folate, zinc, iodine & vitamin - deficiency lead to poor growth prenatal, and intellectual impairment, a degenerative disease associated with aging & higher morbidity & mortality. Preventing macro & micro nutrient deficiency is crucial & this could be achieved through food-based approaches and supplementation. The causes of nutritional deficiency are multiple & are interrelated. The UNICEF nutrition strategies 2020-2030 are guided by UNICEF\'s conceptual framework on the determinants of maternal & Child nutrition, 2020. The 2020 framework builds on UNICEF\'s 1990 conceptual work, acknowledges the increasing triple burden of malnutrition- undernutrition, micronutrient deficiency, and Overweight & highlights the role of diet & cure as an immediate determinant of maternal & child nutrition. UNICEF Nepal 2019 reported that 32% of children under 5 years of age are stunting (short height per age) 12% are wasted. (Lower weight for height) only 40% of children aged 6 to 23 months are receiving diversified diets and 30% of them receiving a minimum acceptable diet. 53% of children under 5 age & 69% of children aged 6 to 23 months are suffering from anemia. Similarly, 44% of adolescent girls, 46% of pregnant women & 41% of reproductive age are suffering from anemia. Usually, Nepal's diet consists of cheap carbohydrates but not enough protein & other micronutrients. Not all Nepal's privileged has meat eggs milk legumes fruits vegetables, even if they have, they don't consume them regularly. Recurrent infections like acute, respiratory infection, gastroenteritis, and worm Infection further aggravate the problem. Nutritional deficiency can make an individual more susceptible to disease while disease contributes to nutritional deficiency. The underlying causes of nutritional deficiency diseases are insufficient access to food, inadequate health care & poor caring practices that inhibit growth & health In Nepal\'s inefficient health care system and poor caring practices in most part. **[Carbohydrates deficiency]** Carbohydrates are one of the three main macronutrients essential for human health along with proteins & fats. They serve as the primary source of energy for your body & play a crucial role in various physiological functions along with maintaining normal body function. Carbohydrates are commonly found in foods like cereals, grains, legumes, fruits, vegetables, etc. A deficiency of Carbohydrates leads to a range of health issues known as Carbohydrate deficiency diseases. Carbohydrate deficiency occurs when the body receives a insufficient amount of carbohydrates required to meet its requirements & other functions. Hypoglycemia, while carbohydrates are criticized for their association with weight gain, it is essential to recognize that they are a vital nutrient for our health. When we don\'t consume enough carbohydrates or our body cannot effectively use them, many health issues can arise. The symptoms of carbohydrate deficiency can be short or long-term based on the extent of deficiency. Since they are the major energy suppliers to the brain cells, a lack of them can result in a lack of concentration, & can affect memory and learning abilities. Since the brain cells work all the time they are in constant need of a steady glucose supply. Sever Carbohydrate deficiency can lead to serious problems like Seizures or paralysis. Here are some common carbohydrate Deficiency symptoms. 1. **Fatigue** 2. **Weakness** Muscle weakness & a general Sense of physical weakness can result from insufficient carbohydrate intake. This can affect daily activity & overall quality of life 3. **Headache** Many people who don\'t consume enough carbohydrates report expressing frequent headaches. This is likely due to a reduction of brain access to glucose, which is released for energy. 4. **Brain fog** Carbohydrates are essential for brain function and a lack of carbohydrates can lead to difficulty in contraction memory problems & mental confusion. 5. **Irritability** Low carbohydrate intake can contribute to mood swings & irritability. The brain\'s functions are closely tied to blood sugar levels which are regulated by carbohydrate consumption. 6. **Constipation** Fiber, a carbohydrate found in plant-based foods, is essential for digestive health. An inadequate amount of fiber leads to constipation & other digestive issues. 7. **Weight loss** While some people may aim to lose weight by reducing carbohydrate intake excessive carbohydrate restriction can lead to unhealthy and unintended weight loss. Other symptoms are:          Nausea          Muscles cramp & ache          Smelly breath          Lack of concentration & mental sharpness          Dehydration          Sodium deficiency.          Vitamin & mineral deficiency          Increase lipid level in blood. An adequate intake of carbohydrates is necessary for proper metabolism & optimal functioning of the human body. Ideally, 55% to 65% of daily calorie intake should be derived from carbohydrates. The body converts all carbohydrates into glucose, which acts as the basic fuel for the body and provides all the energy required for normal body functions. A lack of carbohydrates can lead to carbohydrate deficiency & can cause the following: **Problem** - **Hypoglycemia** It is very important to have a normal glucose level (70 mg per day to 110 mg per day for fasting level) when the glucose level in the blood drops below normal value. It is called low blood glucose or Hypoglycemia. Hypoglycemia is generally seen in diabetes patients but it can happen if adequate amounts of carbohydrates are not consumed because all Carbohydrates are converted into glucose. Hypoglycemia can cause a feeling of dizziness, lethargy, and confusion and trigger hunger. It can be corrected by eating a small amount of carbohydrate or glucose-rich food immediately & frequently. - **Ketosis**. When the body doesn\'t have an adequate supply of carbohydrates to produce energy, it starts breaking down the fats to meet the metabolic demands. Ketones are produced in the process of fat breakdown and an excess amount of ketones in blood is termed as ketosis. Mild ketosis can cause nausea, headache, smelly breath & mental fatigue. Server ketosis can seriously damage vital organs. According to the 2002 to 2025 guidelines for Americans, the minimum amount of carbohydrates required by the body is 130 grams per day. An intake of 225 to 325 grams of carbohydrates out of 2000 calories every day is recommended for ketosis. **Preventing & curing method** Carbohydrate deficiency can be easily sorted by increasing the number of Carbohydrates in a diet. When people eat food containing carbohydrates, the digestive system breaks down and the digestible ones into sugar and enter the blood. As Sugar levels rise, the pancreas produces insulin, (a hormone that prompts cells to absorb blood sugar for energy or storage). Simple carbohydrates such as fructose & glucose which have simple chemical structures are easily and quickly utilized by the body for energy because of their simple chemical structure, often leading to a faster rising blood sugar and insulin secretion from the pancreas-which can have negative health effects. Complex carbohydrates such as Oligosaccharides and polysaccharides have more chemical structure. Many carbohydrate foods contain fiber, vitamins & minerals, and they take longer to digest - which means they have less of an immediate impact on blood sugar, causing it to rise more slowly. Foods with a high glycemic, index like white bread, white rice, and potatoes are rapidly digested and cause substantial fluctuation in blood sugar. Food with a low glycemic index like green vegetables most fruits, raw carrots, and lentils are digested more slowly & prompting a more gradual rise in blood sugar. Eating too much hypoglycemic food, which causes powerful spikes in blood sugar, can lead to an increased risk for type 2 diabetes, disease, and overweight. Food with a low glycemic index has been shown to help control type 2 diabetes and improve weight loss, also that low glycemic index diet may offer anti-inflammatory benefits. Many factors can affect a food\'s glycemic index - **Processing** Grains that have been mealed and refined-removing the bran and germ have a higher glycemic index than minimally processed whole grains. - **Physical form** Finely ground grain is more rapidly digested than coarsely ground grains. This is why eating whole grains in their whole form like brown rice or oats can be healthier than eating highly processed whole grains. - **Fiber content ** A high-fiber food does not contain as many digestible carbohydrates, so it slows the rate of digestion and causes a more gradual and lower rise in blood sugar. - **Ripeness** Ripe fruits and vegetables tend to have a higher glycemic index than unripe fruits. Meals with higher fat or acid content are converted more slowly into sugar. The process of measuring the relationship between the amount of carbohydrates in a food and its impact on blood sugar levels is called the glycemic load. A food\'s glycemic load is determined by multiplying its glycemic index by the number of carbohydrates contained in food. In general, a glycemic load of 20 or more is high, 11 to 19 is medium, and 10 or under is low. High glycemic diets are associated with increased risks for type 2 diabetes risk & coronary heart disease So, those who consume lower glycemic load diets have a lower risk of developing type 2 diabetes than those who consume high glycemic load diets/ foods. **Low glycemic load (10 or under food sources)** - Bran, Cereals - Apple - Black beans - Skimmed milk (without fat) - Peanut - Orange - Kidney Seeds. - Lentils - Cashew **Medium glycemic load (21 to 19 food source)** - Oatmeal. - Rice cakes - Brown rice - Whole bread - Pasta **High glycemic load (20+ Food sources)** - Baked potatoes - French fries. - Refined breakfast cereals - Sweet & Beverage. - sugar - Candy bars  - White rice - White flour & pasta. **[Protein Deficiency (Hypoproteinemia)]** A protein deficiency (Hypoproteinemia) means someone is not getting enough protein to meet their body needs or requirements. A lack of protein in our country is a serious concern, especially in children. Protein Deficiency can lead to malnutrition such as Kwashiorkor & Marasmus, which can be life-threatening. Protein-energy malnutrition (PEM) is a term used to describe clinical disorders resulting from varying degrees of protein and energy deficiency. Protein deficiency can arise if a person has a health condition, including an eating disorder such as - Anorexia nervosa. - Certain genetic conditions - Advance the stages of cancer - Difficulty absorbing nutrients due to a health issue such as irritable bowel syndrome (IBS) or gastric bypass surgery. **Very low protein intake can lead to** - weak muscle tone, - edema, - swallowing due to fluid retention, - Thin brittle hair, - skin lesions, - and in adults a loss of muscle mass **In child ** - growth deficits,  - Hormonal imbalance - kwashiorkor When kwashiorkor was first described in 1935, it was noted that more than 90% of children affected by the condition had diets deficient in protein. Although the associated mortality is slightly lower now most children still die after the initiation of treatment. The name kwashiorkor comes from the language in Ghana & means rejected one.  The syndrome was named Ghana because it occurred most commonly in children who had recently been weaned from the breast, usually because another Child had just been born. Subsequently, the child was fed watery porridge, made from low-protein grains which account for protein intake. Kwashiorkor is characterized by swelling (edema) on the feet & abdomen, poor skin health, growth retardation, low muscle mass & liver malfunction. Recall that one of protein\'s functional roles in the body is fluid balance. A diet extremely low in protein does not provide enough amino acid for the albumin. One of the functions of albumin is to hold water in the blood vessels and into tissues causing swelling. The primary symptoms of kwashiorkor include not only swelling but also diarrhea, fatigue, peeling skin, and irritability. Kwashiorkor is a disease brought on by a severe dietary protein deficiency. Other symptoms include edema of the leg and feet light color, thinning hair anemia, and a pot belly. **Causes of Kwashiorkor** - A condition that interferes with protein absorption. - Dietary changes for management of milk allergies in infants and children - Diets that are low in protein. - Draught or Famine - Infection that interferes with protein absorption. - Limited food supply may occur during political unrest. - Parasites such as intestinal worms - Poor education about proper nutrition. **Marasmus** Marasmus is a severe form of protein energy malnutrition that results when a person doesn\'t consume enough protein and calories. Without vital nutrients, energy level becomes dangerously low and vital functions begin to deteriorate. Marasmus is a deficiency of all macronutrients carbohydrates, fat, and protein. Marasmus causes visible wasting of fat and muscles under the skin; it causes stunted growth in children. It can affect anyone who lacks overall nutrition, but it particularly affects children especially infants who require more calories to support their growing bodies. It is more common in developing countries with widespread poverty, and food scarcity and where parasites and infectious diseases may contribute to calorie depletion. Older adults who live alone and find it difficult to prepare food and care for them may be at risk. Sometimes Marasmus can affect older adults who have not eaten healthfully over some months or years. When the body is deprived of energy from food, it begins to feed on its tissue, at first adipose tissues, body fat, and then muscles. It also begins shutting down some of its functions to conserve energy. Cardiac activities slow down causing low heart rate, low blood pressure, and low body temperature. In some cases, this leads to heart failure. The immune system is also compromised, making it undernourished. People are more prone to infection and illness and slower to recover. Children with chronic Marasmus will not have the physical resources to grow and develop, as they should. They may be stunted in size and have developmental delays or intellectual disabilities. These effects can be lasting even in children who receive treatment. Parts of the digestive system also begin to weaken from the lack of use; this means that even when people do have food to eat they might not be able to absorb nutrition from their food effectively. **Symptoms and Causes** The main causes affect all age groups including poverty and food scarcity, wasting diseases such as aids, infections that cause chronic diarrhea, and Anorexia. - Additional causes affecting children: Inadequate breastfeeding or early weaning of infants and do not provide all nutrition in weaning food, child abuse, or neglect.  - Additional causes affecting elders Dementia, elder abuse, or neglect. **External sign of Marasmus** - Visible wasting of fat and muscle. - Prominent Skeleton - The head appears large for the body - The face may appear old. - Dry loose skin - Dry brittle hair or hair loss - Lethargy and weakness - Weight loss of more than 40% - BMI (body mass index) below 16% **Other Symptoms and Complications** - Dehydration - Electrolyte imbalance - Blood pressure low - Slow heart rate - Low body temperature - Gastro-intestinal / Mal absorption - Stunted growth - Developmental delay **Marasmic Kwashiorkor** Marasmic kwashiorkor is the third form of protein energy malnutrition that combines features and symptoms of both Marasmus and kwashiorkor. A Child suffering from Marasmic Kwashiorkor weighs less than 60% of the expected weight for his age and has Edema. Features of both Marasmus and Kwashiorkor are present in different degrees of severity. Children weighing less than 60% despite having Edema are in great danger of dying of various complications and need urgent attention and treatment. **Preventive and Curing Method ** People in treatment for Marasmus are at risk of refeeding syndrome a life-threatening complication that can result when the undernourished body tries to reboot too fast. Ideally, people with Marasmus should be treated in a hospital setting under close medical supervision. 1. **Rehydration and Stabilization** The first stage of treatment is focused on treating dehydration, electrolyte imbalance, and micro-nutrient deficiencies. To prepare the body for refeeding depending upon the individual, it may take several hours to days before they are considered stable enough to begin refeeding. Nutritional Rehabilitation Regarding begins slowly with a liquid formula that carefully balances carbohydrates, protein, and fat for the impatient. Healthcare providers prefer tube feeding because it allows for gradual but continuous nutrition. **Follow-up and Prevention                                                                    ** Since Marasmus can reoccur, a complete treatment protocol includes education and outgoing support for the patient and their caregiver before they are discharged. In the developing world, these may mean breastfeeding support, safe drinking water, food preparation guidelines, immunization, and education to prevent widespread diseases. The malnutrition universal Screening tool (MUST) can help identify people at risk.          A well-balanced diet is given once after the child\'s condition is stable and starts to recover slowly.          Diets rich in protein like skimmed milk, fish, eggs, nuts, pulses, legumes, and other energy-providing food supplements to increase the energy content.          Multivitamin supplements to improve appetite and nutrition deficiency. The WHO (World Health Organization) has outlined 10 steps to follow when treating severe undernutrition. 1. **Treat/prevent hypoglycemia**. The rehydration formula for malnourished people includes glucose to help restore balance 1. **Treat/ prevent hypothermia** Malnourished bodies have trouble regulating their own temperature so they must be kept warm. 1. **Treat/Prevent dehydration**. A special formula called RESOMAL (Rehydration Solution for Malnutrition) is given to treat dehydration in Kwashiorkor and Marasmus. It\'s designed to restore and maintain the body\'s fluid/Sodium balance. 1. **Correct electrolyte imbalance** Electrolyte imbalance can have serious and even life-threatening events, especially when a malnourished person begins refeeding. 1. **Treat/prevent infection**. With the diminished immune system that comes with Kwashiorkor and Marasmus. All infections are seriously treated to recovery infections are treated with antibodies. 1. **Correct micronutrient deficiency** Specific vitamin and mineral deficiencies can have serious effects if they are severe enough. 1. **Starts for cautious feeding** Undernourished bodies has changed metabolism. Refeeding will trigger their metabolism to change again but if this happens too fast in case, it can cause life-threatening complications (refeeding syndrome) swelling begins slowly under close observation. Protein in particular should the reintroduced gradually in kwashiorkor 1. **Achieve Catch-up-growth** Once the child has established and appears to be tolerating refeeding well their calories have increased up to 140% of recommended values for their age. The WHO provides ready-made liquid formulas that can be given orally or by tube feeding. This is the nutritional rehabilitation stage of treatment. It may last up & 6 weeks. 1. **Provides Sensory Stimulation and Emotional Support.** Children with Kwashiorkor and Marasmus may\'ve been in a state of apathy for some time. Their malnutrition may have stunted their intellectual, neurological, and social development. Stimulating their development to reboot is part of their treatment plan. 1. **Prepared for follow-up after Recovery** Before discharging the child from care, healthcare providers provide education and counseling to the mother regarding nutrition, breastfeeding food and water, hygiene, and disease prevention. They may provide immunizations as necessary. **[Fat deficiency]** Fat deficiency happens due to a lack of fat in your diet. It can lead to fat deficiency diseases such as EFA deficiency disease. Fat just like carbohydrates and protein are essential for growth and development and our body requires a suitable quantity of fat to function properly. PUFA and MUFA should be part of everyone\'s diet. These fats are present in nuts, seeds, olive oil, avocadoes, and fatty fish. **What are the symptoms of fat deficiency?** - Scaly/dry skin - Hormonal imbalance - Not able to lose weight - Constantly feeling cold - Always feels hungry - Acne joints pain - Brittle nails - Constipation - Increased chances of mental illness **Primary causes behind fat deficiency** - Eating disorder - Inflammatory bowel disorder - Pancreatic insufficiency - Excessive low-fat diet - Colectomy **Signs of fat deficiency** EFA is essential for the proper functioning of the human body. A deficiency of such fat can show up in your body in many ways such as: 1. **Skin Problems (dermatitis)** The organ skin is the most affected by lipid deficiency. Dermatitis often causes skin inflammation and swelling with dry and scaly rashes on the skin. 1. **Hair Loss** The human body produces prostaglandins of fatty chemicals that encourage hair growth. Insufficient fat may change your hair texture and increase the chances of hair loss. 1. **Hormonal Issues** The endocrine system produces hormones and for those hormones to function properly, one needs enough minerals, selenium, and vitamins. If you fail to get enough of such nutrients you probably have out-of-balance hormones. Fat deficiency affects the power of absorption of vitamins and minerals. 1. **Fatigue** Fat deficiency directly impacts the body\'s ability to absorb minerals, vitamins, and antioxidants, which can result in problems such as fatigue. Not having enough of these essential minerals and not feeling full due to fat deficiency can lead to tiredness both physically and mentally. 1. **Low Immunity** If you are prone to falling sick despite consuming vegetables, fruits, and sufficient amounts of carbohydrates, it might be a sign of fat deficiency. The immunity system may become weak because our body fails to absorb the nutrients we consume which happen when we are not getting enough fat. **Disease caused due to fat deficiency** 1. **Cardiovascular disease** Low levels of Omega-3 fatty acids in the blood are associated with cardiovascular diseases like coronary heart disease, hypertension, stroke, and cardiac rest. An Omega-3 index of less than 3% is a high risk for cardiovascular disease. 2. **Mental Disorders** Diets low in polyunsaturated fatty acids (PUFA) has been revealed to affect mental health. Individuals with autism spectrum disorder are found to have low levels of PUFA (Omega-3 fats). Post-partum depression in the mother could be due to poor dietary intake of fat (Omega-3 fatty acid). Deficiency may also pose a risk for Schizophrenia, characterized by cognitive decline, delusion, and social isolation. The deficiency of Docosahexaenoic acid (DHA) and Eicosapentaenoic acid (EPA) in the brain cells of people with Schizophrenia was observed. A decrease in plasma concentration of PUFAs may augment the risk for Alzheimer\'s disease. 3. **Cancers** Research Studies have found that there is an inverse relationship between relatively high adipose tissue levels of EPA and DHA and a decrease in the level of breast cancer risk. Similarly, Research studies have shown the inverse relationship between blood levels of EPA and DHA and the risk of prostate and colon cancer 4. **Auto Immunity Disorders and Chronic Inflammation** A Low level of Omega-3 fatty acid in the blood is associated with chronic inflammation like chronic obstructive pulmonary disease (COPD), Arthritis, Crohn\'s disease, Rheumatoid Arthritis, and Immunoglobulin (IGA) nephropathy. **Preventive and Curing Method** Adequate fat provision is the starting point to prevent essential fatty acid deficiency. At least 10% of total energy delivery should come from polyunsaturated fatty acids. 1. **Balanced Diet** The diet should include a variety of healthy fats such as olive oil, fatty fish, avocado, nuts, and seeds. 2. **Portion Control** Consume fats in moderation to maintain a balanced diet and prevent overconsumption. 3. **Avoid Transfats** Minimize intake of processed and fried foods that contain unhealthy transfat. 4. **Nutrient Rich foods** Eat a diverse range of nutrient-rich food to ensure to meet all dietary needs 5. **Dietary Supplement** In the severe case of fat deficiency, healthcare providers may recommend supplements containing essential fatty acids. E.g.: Omega-3 and Omega-6 fatty acid 6. **Medical Monitoring** Regular Checkups with healthcare professionals can help monitor your nutritional status and guide treatment as needed. **[Vitamin & Minerals]** **[Vitamin Deficiency ]** **Vitamin A Deficiency** Vitamin A is essential for good vision and the proper functioning of organs. A deficiency in Vitamin A occurs when the diet does not provide enough retinol (Vitamin A) or carotene (a substance the body converts into Vitamin A). This can happen if someone doesn\'t eat enough foods rich in these nutrients. **Cause of Vitamin A deficiency** - It is common in economically less privileged countries, especially in children, due to inadequate intake. This is aggravated by a low-protein diet which reduces the synthesis of retinol-binding protein. - Vitamin A deficiency is also known to occur in well-to-do families with plenty of food, where the children refuse to eat vegetables & fruits. - Deficient fat ingestion may impair carotene absorption intestinal malabsorption, fatty diarrhea & habitual intake of liquid paraffin causes vitamin A deficiency. - In advanced liver diseases such as cirrhosis of the liver biliary obstruction, there is Vitamin A deficiency. **Vitamin A deficiency diseases** - Xerophthalmia is the comprehensive term now used by WHO to denote all Vitamin A deficiency manifestations affecting the structure or function of eyes including conjunctive, Cornea, and retina. - Night blindness is the earliest symptom of deficiency, impaired vision in low light conditions. - Bitoto\'s foamy white patches on the conjunctiva in the eye indicate Vitamin A deficiency and impaired immune function. Vitamin A deficiency can weaken the immune system increasing susceptibility to infection particularly respiratory & diarrheal illness. - **Skines problems** Skines include dry, rough skin & increased susceptibility to infection and dermatitis. - **Growth retardation** Vitamin A deficiency can impair growth and development in children. - **Increased** **Mortality risk** Severe deficiency increases the risk of death, especially in young children & pregnant women. - **Impaired reproductive health** Inadequate levels of vitamin A can affect reproductive health leading to infertility and complications during pregnancy and increasing the risk of infant mortality. - **Impaired bone development** Vitamin A deficiency can interfere with bone remodeling, and growth, potentially leading to skeleton abnormality & increase susceptibilities to fracture. - **Impaired cognitive function** Some studies suggested that Vitamin A deficiency may contribute to cognitive impairment, particularly in children, affecting learning & development. - **Follicular hyperkeratosis** This condition is characterized by the accumulation of keratin around hair follicles leading to the formation of rough, raised bumps on the skin. - **Increase susceptibility to Infection**. Vitamin A deficiency compromises the integrity of mucosal barriers in various parts of the body, such as the respiratory, gastrointestinal, and urinary tracts making individuals more prone to infections such as pneumonia, measles, and diarrhea. **Preventive & Curative method** - Increase vitamin A intake by consuming yellow and orange fruits and vegetables. - Mothers should take vitamin A within 8 weeks after giving birth. - Children from six to 59 months should get vitamin A supplementation orally every six months. - Infants should be exclusively breastfed for six months, provide nutritious complementary food after 6 months, and continue to be breastfed for up to 24 months. - Health education to promote eating foods rich in vitamin A or carotene such as green leafy vegetables and yellow fruits and vegetables. - The liver and egg yolk are also good a source of vitamin A and fat is necessary for absorption of vitamin A. - Advising mothers and caretakers of children to mix healthy fats/fats and nutritious food for children that help prevent Vitamin A deficiency. **[Vitamin D deficiency ]** Deficiency of Vitamin D occurs with:          Inadequate exposure to sunlight          Inadequate intake          Drug intake that antagonizes vitamin D action.          Altered metabolism due to damaged liver or kidney.          This leads to diminished absorption of calcium and consequent low blood calcium, which may produce tetany          Vitamin D deficiency exacerbates osteoporosis and increases the risk of skeletal fractures. Vitamin D deficiency disease **Rickets** Rickets is due to a lack of deposition of calcium phosphate in the bone. Deformity of the weight-bearing bones gives rise to a deformed spine, bowing of the legs, and knocking knees. **Osteomalacia (defect in bone mineralization)** Osteomalacia (malacia-softening) is similar to rickets but occurs in older age groups. It results from:          Lack of dietary intake of Vitamin D or sunlight.          Malabsorption of vitamin D.          Secretion in milk during lactation.          Excessive demands as in pregnancy.          In Osteomalacia, bony mineral content decreases due to a lack of deposition of calcium phosphate.          There is also the reabsorption of bone minerals.          Vitamin D resistance in chronic renal disease: Chronic kidney diseases prevent vitamin D3 conversion to metabolically active calcitriol.          Increased urinary loss of protein-binding vitamin D-3.          Fanconi syndrome is a rare disease, with a congenital defect in the renal tubule resulting in excessive urinary excretion of phosphates, amino acids, and sugar.          The mineral disturbance results in defective bone formation. **Preventive and Curing Method **          As therapy for rackets and Osteomalacia, 50 to 120 mg cholecalciferol is given daily by mouth.          Natural vitamin D3 can also be given as codfish, halibut, or shark liver oil.          A total daily intake of 10mg of vitamin D, provided by 1 teaspoon of cod liver oil, is adequate protection against rackets.          Supplements with calcitriol (vitamin D3) 10 to 20mg and Calcium (about 1gm) reduce hip and other non-vertebral fractures among elderly women/people.          For post-menopausal women, walking a mile a day is highly beneficial for maintaining skeletal integrity.          Exposure to sunlight **Vitamin B1 (Thiamin)** Deficiency of Thiamin is frequently associated with low-calorie intake and deficiency of other factors of the Vitamin B complex. Deficiency of Thiamin can be caused by:          Low intake as with refined foods or polished rice.          Poor absorption with chronic diarrhea or other conditions           An Excessive demand as in pregnancy and lactation. Clinically, Thiamin deficiency can manifest itself in several ways.          Subclinical deficiency          Infertiat Beriberi Infantile Beriberi,          Dry Beriberi          Poly neuropathy associated with alcohol, Diabetes, and prolonged fever           wet Beriberi 1. **Subclinical deficiency** It is more common in women because the weight-reducing diet of the high-income group and the inadequate diet of the low-income group cannot cope with the large demands for thiamine during pregnancy and lactation. Typical symptoms include anorexia, weakness evening tiredness, and Constipation. 1. **Infantile Beriberi** It occurs in the first few months of life if the diet of the mother is deficient in thiamine. The heart is enlarged and the heart beats sound muffled.  Odema of the glottis manifests as a peculiar cry and later as a loss of voice. Ultimately, there may be heart failure twitching, coma, and death. 1. **Dry Beriberi** In Dry Beriberi, there is a peripheral polyneuropathy, first of the legs and later of the arms. Symptoms include tingling, numbness, and burning in the feet and hands. 1. **Poly neuropathy** Polyneuropathy is associated with alcohol diabetes and prolonged fever resembles dry beriberi and is probably due to Thiamine deficiency. In alcoholics, Thiamine intake is reduced and its absorption is also diminished. 1. **Wet Beriberi** Wet Beriberi manifests itself as peripheral Vessel dilatation (vasodilatation) high output failure and retention of sodium, excreting higher levels of sodium. Pathologically, there is an enlargement of the heart, the right side being more affected than the left. **Preventive & Curing method** - Those whose staple diet is refined cereals should be advised to eat whole grains; this will prevent many other B-group vitamin deficiencies as well. - Supplement of oral Thiamine of about 5mg/day is indicated in diabetes alcoholism, pregnancy, lactation, and prolonged fever.  - Educate the patient about a balanced/proper diet. - Therapy per dry or wet Beriberi consists of the daily injection of 10mg of Thiamin. **Niacin Deficiency (Nicotinic acid, Nicotinamide) ** Deficiency of Nicotinic acid is caused by:  - Deficient intake of Nicotinic acid as well as Tryptophan (in animal foods) - In defective digestion, as in diarrhea, lack of absorption can occur but once the food is digested, absorption is rapid. - Excessive demand during pregnancy, and rapid growth or increased metabolic rate (fever). - Subclinical Nicotinic acid deficiency manifests itself as weakness, irritability, burning tongue, and constipation. **Pellagra (3Ds)** Pellagra is classically characterized by 3Ds: Dermatitis, Diarrhea, and Dementia. **Dermatitis** Pellagra derives its name from its skin manifestations (Pelle-skin, agra-rough) changes are marked on the area exposed to the sun (back of hands, wrists, feet, ankle, neck, nose, cheeks) and to friction (elbow, knee, actional surfaces, perineal region). Erythema, thickening, and pigmentation are followed by exfoliation leaving a parchment-like skin. **Diarrhea** The tongue appears raw; the mucus membrane of the stomach is inflamed. Spiced and hot food can\'t be tolerated in Diarrhea.  **Dementia** There is irritability, depression, poor concentration, and loss of memory. Patients with Pellagra disease may be admitted to a lunatic asylum, the mental symptoms being interpreted as primary psychosis and the skin pigmentation being ascribed to poor hygiene. **Preventive and Curing Method** - Pellagra in humans is always associated with other nutritional deficiencies, thus a well-balanced diet is of utmost importance. - Milk, meat, and fresh meat are particularly needed. - Yeast tablets provide a cheap effective supplement.  - For the treatment of pellagra, 25-50 mg of Nicotinamide is administrated 4-6 times a day. **Folic Acid (Folate, Folacin) deficiency** **Causes** - **Deficient intake** Folic acid, being both labeled & water soluble is easily destroyed by repeated boiling of food or during cooking with excess water that is subsequently discarded. - **Increased demand ** Increased demand is created by rapidly proliferative tissue, pregnancy, infancy, hyperthyroidism, leukemia, and Carcinoma increasing Folate requirement.  - **Malabsorption** This is mainly due to a deficiency of the enzyme polyglutamate hydrolase following diseases of the Jejunum. Goat milk anemia occurs in infants fed on goat milk which contains only 10% as much Folate as human milk. Contraceptive pills are suspected to cause Folate deficiency. - **Inhibition of Folate metabolism** It is due to folic acid antagonists, alcoholism & liver disease. **Clinical manifestation** Clinically, Folate deficiency results in: - Megaloblastic anemia - Tropical sprue-like symptoms - Neurological disorder **Prevention & caring** - The expected mother should eat more vegetables, fruits & meat products than usual. - An oral supplement of 400 micrograms of folic acid may be given in pregnancy which may prevent neural tube defects. - Educate pregnant mother and their family about a balanced diet. - Consume fruits, vegetables, grains & meat products. **Deficiency of Vitamin C (Vitamin C is also known as ascorbic acid)** **Cause & Symptoms** Scurvy is the name for a vitamin C deficiency. It can lead to anemia, debility, exhaustion, spontaneous bleeding, pain in the limbs especially in the legs, swelling in some parts of the body, and sometimes ulceration of the gums or loss of teeth. Symptoms include swelling or edema, bleeding wound healing, and a reduced rate of healing for injuries. Scurvy can be treated with oral or intravenous vitamin C supplementation. It occurs when there is a lack of vitamin C in the diet, often due to a poor diet lacking in fresh fruits and vegetables, possibly due to low income or famine. Vitamin C is needed to make collagen, an important component in connective tissue. Connective tissues are essential for the structure and support of the body, including the structure of blood vessels. A lack of vitamin C will also affect the immune system, absorption of iron, metabolism of cholesterol, and other functions. Preventing and curing methods for Vitamin C deficiency: - Treatment involves administering vitamin C supplements orally or by injection in severe cases. In general cases, adding citrus fruits and vegetables to the diet helps prevent vitamin C deficiency. - Vitamin C-rich foods like kiwi, lemon, orange, guava, amla, and other vegetables can enhance iron absorption.  - Cereals and pulses soaked in water for about 48 hours and allowed to germinate form a good source of Vitamin C. **Iron deficiency:** Iron deficiency anemia (IDA) occurs when there is a low number of a red blood cell due to insufficient iron. Iron is a vital component of hemoglobin, which transports oxygen to various tissues of the body. Iron is indispensable; all living organisms require it as an essential element for growth and multiplication. The most common cause of ill health in women is iron deficiency anemia. This is likely the result of several factors such as poor intake and absorption, together with the loss of iron during menstruation, repeated pregnancy, prolonged lactation, and parasitic infestation. **Symptoms of iron deficiency:** The manifestations of iron deficiency include weakness, lethargy (particularly during the evening), and an absence of enthusiasm for work or play, and brittle nails. In more severe cases, there may be palpitations, breathlessness, and even congestive heart failure. Iron is also utilized by the brain, and iron uptake is at its maximum during rapid brain growth in the fetus. Iron-deficient infants may lag in mental and physical development. **Prevention and curing of iron deficiency:** Iron fortification is a crucial method. For example, salt, being one of the most commonly used processed food items, has been successfully fortified with iron to combat anemia. Consumption of cereals, beans, lentils, vegetables, vegetable leaves, pomegranates, radishes, spinach, cauliflower, egg yolks, meat, fish, and Vitamin C-rich foods aids in iron absorption. Using iron utensils for cooking can also contribute to iron intake. Nutrition education plays a significant role as a preventive measure against iron deficiency. Prevention of infections (e.g., malaria, womb infections) is also important, including the improvement of environmental health practices. For moderate iron deficiency anemia, a normal diet supplying over 10mg of iron, along with a daily oral iron supplement of 10 to 20mg, is adequate. **Calcium deficiency (Hypocalcaemia):** Low serum calcium levels are seen in the following situations: 1. Hypoparathyroidism 2. Vitamin D deficiency: - Due to poor diet, especially in regions where people do not expose themselves to sunlight. - Problems with absorption.                         Kidney deficiency disease where there is retention of phosphate or failure to acidify the urine, leading to systemic acidosis. **Calcium loss can occur due to various factors:** 1. A high-protein diet increases urinary calcium excretion. 2. Rheumatoid arthritis, where considerable calcium loss occurs early in the disease. **Clinical manifestations:** Since the absorption and metabolism of calcium are closely related to those of vitamin D, and because disease processes like Steatorrhea (fatty diarrhea) may prevent the absorption of both these factors, tetany can occur. Tetany syndrome is characterized by hypoexcitability of the nervous system, leading to muscle cramps. Tetany, a condition characterized by muscle spasms, occurs due to a decrease in ionizable serum calcium, resulting from various conditions including: 1. Lack of absorption of calcium from the gut due to inadequate intake of Vitamin D. 2. Late pregnancy and lactation increase the demand for calcium. 3. Hypoparathyroidism, either due to parathyroid gland dysfunction (such as in Paget\'s disease) or more commonly, accidental removal during thyroid surgery, especially in cases of hyperthyroidism. The manifestations of tetany depend not only on the decrease in ionizable calcium but also on the ratio of calcium to phosphorus. **Osteoporosis** Osteoporosis is characterized by significant loss of bone mineral density. It is a worldwide healthcare problem. It is 6 times more common in women than in men. Young women whose periods are stopped are at greater risk of developing osteoporosis. In men, osteoporosis primarily occurs with high alcohol consumption or cancer. Hyperparathyroidism is a common cause of osteoporosis in men. **Causes:** Osteoporosis is due to a combination of factors including low calcium intake and hormonal, physical, and circulatory factors. Deficiency of estrogen, removal of the ovaries, smoking, alcohol consumption, excess phosphorus intake, and sedentary habits contribute to its development. Women have smaller bone mass, and with repeated pregnancies, the demand for calcium increases, leading to a decrease in calcium storage. **Clinical manifestations:** Clinically, there is low back pain, weight loss, fractures of the vertebrae, neck of the femur, distal radius, and ulna, and loss of teeth due to lack of bone support. **Prevention and curing methods:** The most effective time to start prevention is in childhood when adequate calcium intake and exercise should be emphasized. It is necessary to achieve peak bone mass during adolescence as this reduces the chances of osteoporosis later in life. The diet should contain adequate calcium, with a focus on milk and milk products. Excess animal protein should be avoided as it increases urinary calcium excretion. Plant-based protein is preferable to animal protein. Cigarettes and alcohol should be stopped, as they are associated with an increased risk of bone fractures. Outdoor exercise, avoidance of immobilization, and adequate vitamin D intake can help reduce osteoporosis. **Zinc:**  Zinc is a trash mineral that is needed for the body. Its important function is its role in enzymatic action. It takes part in digestive and metabolic actions. Zinc also plays an essential role in the formation of DNA and RNA, and aids in the healing of burns and wounds. Sources of zinc include animal proteins, beans, and cereals. However, the zinc content of cereals is considerably reduced by milling. Refining significantly decreases all trace elements. **Causes of zinc deficiency:** - Zinc deficiency may occur with a decrease in protein intake, malnutrition, old age, and alcoholism. Increased requirements have been noted in childhood, adulthood, adolescence, pregnancy, and after surgery and burns.  - Decreased the absorption of Zinc - Zinc deficiency is also noted in malabsorption syndromes, hemodialysis, and during prolonged intravenous nutrition. **Symptoms:** Zinc deficiency results in poor appetite, loss of taste, mental lethargy, and delayed wound healing. **Diseases and syndromes attributed to zinc deficiency:** 1. **Hypogonadal dwarfism:**  This condition, characterized by decreased organ development, has been reported mainly in certain regions like Iran and Egypt. Symptoms include failure of growth, delayed sexual maturation in teenagers, impaired taste and smell, and impaired wound healing. 1. **Acrodermatitis enteropathica:** An inherited disorder characterized by diarrhea, dermatitis, and hair loss. 1. **Iron deficiency anemia:** Zinc deficiency has been noted to exacerbate iron deficiency anemia. 1. Impaired performance in school-going children and subsequent adult life can result from zinc deficiency. **Preventive and curing methods:**          Consumption of a variety of foods from different food groups, following dietary guidelines such as Five Food Group, My Plate, and maintaining a balanced diet. **[Just to know ]** [Sickle Cell anemia improves with zinc supplements. ] **Curing **          **Zinc supplementation:** Daily intake of zinc sulfate, around 35 mg, can result in rapid and complete clearance of skin lesions and improve malabsorption.