Lecture 30 Nutritional Disorders 2022 McGriff.pdf

Nutritional Disorders WIL MCGRIFF, MPH, OD CHRISTOPHER REEVE, OD, FAAO ASSISTANT PROFESSOR ASSISTANT PROFESSOR [email protected] [email protected] Lecture Objectives u Identify major causes of malabsorption and their systemic and ocular effects u Recall most common vitamin deficiencies and t...

Nutritional Disorders WIL MCGRIFF, MPH, OD CHRISTOPHER REEVE, OD, FAAO ASSISTANT PROFESSOR ASSISTANT PROFESSOR [email protected] [email protected] Lecture Objectives u Identify major causes of malabsorption and their systemic and ocular effects u Recall most common vitamin deficiencies and their systemic and ocular effects u Differentiate between the most common forms of eating disorders and their impact on systemic and ocular health NBEO Outline u S. Nutrition u 1. Epidemiology u 2. Symptoms and signs of nutritional abnormalities u a. Malabsorption u b. Alcoholism u c. Vitamin deficiencies and toxicities u d. Trace minerals u e. Eating disorders u 3. Diagnostic testing and imaging u 4. Pathophysiology and diagnosis Vitamin and Mineral Deficiencies Symptom Malabsorbed Nutrient Anemia (hypochromic, microcytic) Anemia (macrocytic) Bleeding, bruising, petechiae Carpopedal spasm Edema Glossitis Night blindness Pain in limbs, bones, pathologic fractures Iron Vitamin B12, folate Vitamins K and C Ca, Mg Protein Vitamins B2 and B12, folate, niacin, iron Vitamin A K, Mg, Ca, vitamin D Peripheral neuropathy Vitamins B1, B6, B12 http://www.merckmanuals.com/professional/gastrointestinal-disorders/malabsorption-syndromes/overview-of-malabsorption Malabsorption u Impaired digestion and absorption u Range in specificity u Various causes u u Infectious (Giardiasis) u Congenital (Lactose intolerance) u Autoimmune (Crohn’s, Celiac) u Surgical (Colon cancer, gastric bypass) Common symptoms u Diarrhea* u Weight loss Alcoholic Malnutrition u Chronic alcoholics u Substitute alcohol for essential nutrients u Directly impairs digestion and absorption u Display signs of malnutrition Nutritional Optic Neuropathies u Alcohol & tobacco abuse u u B-12, B-1, and B-complex deficiencies Papillomacular bundle damage u Central scotoma u Reduced color vision u Treat w/ diet and supplements u Reduce tobacco and ETOH use Vitamin A Deficiency u Photoreceptors, epithelial tissues u Obtained through diet u u Stored in liver Symptoms of deficiency u Impaired immunity u Night blindness u Keratinization of mucous membranes u u Bitot’s spot Xerophthalmia Treat w/ supplements or injections Keratomalacia Vitamin Toxicities u Fat-soluble vitamins are higher risk u Vitamin A u u Teratogenic during pregnancy u Carotenemia through food u Dangerous as a supplement Vitamin B-6 u u Vitamin E u u Neurotoxic at chronically high doses Coagulopathy Iron* u Corrosive effect on GI mucosa Trace Minerals Nutrient Chromium Principal Sources Liver, processed meats, whole-grain cereals, nuts Copper Organ meats, shellfish, nuts, dried legumes, dried fruits, whole-grain cereals, peas, cocoa, mushrooms, tomato products Fluorine Seafood, tea, fluoridated water (sodium fluoride 1.0–2.0 ppm) Iodine Seafood, iodized salt, eggs, cheese, drinking water (content varies) Iron Many foods (except dairy products)—soybean flour, beef, kidney, liver, fish, poultry, beans, clams, molasses, enriched grains and cereals (bioavailability variable in plant sources) Manganese Whole-grain cereals, pineapple, nuts, tea, beans, tomato paste Molybdenum Milk, legumes, whole-grain breads and cereals, dark green vegetables Selenium Meats, seafood, nuts, plant-based foods (selenium content varying with soil concentration) Zinc Meat, liver, oysters, seafood, fortified cereals, peanuts, whole grains (bioavailability variable in plant sources) Functions Promotion of glucose tolerance Enzyme component, hematopoiesis, bone formation Bone and tooth formation Thyroxine (T4) and triiodothyronine (T3) synthesis, development of fetus Hemoglobin and myoglobin formation, cytochrome enzymes, iron-sulfur proteins Healthy bone structure, Enzyme component Coenzyme component Enzyme component Enzyme component, skin integrity, wound healing, growth Trace Minerals Nutrient Effects of Deficiency and Toxicity Chromium Deficiency: Possibly impaired glucose tolerance Copper Deficiency: Anemia in undernourished children, Menkes (kinky-hair) syndrome Toxicity: Wilson disease, copper poisoning Fluorine Deficiency: Predisposition to dental caries, possibly osteoporosis Toxicity: Fluorosis, mottling and pitting of permanent teeth, exostoses of spine Iodine Deficiency: Simple (colloid, endemic) goiter, cretinism, deaf-mutism, impaired fetal growth and brain development Toxicity: Hyperthyroidism or hypothyroidism Iron Deficiency: Anemia, pica, glossitis, angular cheilosis Toxicity: Hemochromatosis, cirrhosis, diabetes mellitus, skin pigmentation Manganese Deficiency: Questionable Toxicity: Neurologic symptoms resembling those of parkinsonism or Wilson disease Molybdenum Deficiency: Tachycardia, headache, nausea, obtundation (sulfite toxicity) Selenium Deficiency: Keshan disease (viral cardiomyopathy), muscle weakness Toxicity: Hair loss, abnormal nails, nausea, dermatitis, peripheral neuropathy Zinc Deficiency: Impaired growth and delayed sexual maturation, hypogonadism, hypogeusia Toxicity: RBC microcytosis, neutropenia, impaired immunity http://www.merckmanuals.com/professional/nutritional-disorders/mineral-deficiency-and-toxicity/overview-of-minerals Eating Disorders u Lifetime incidence: 20M women / 10M men u 50-80% have family history of eating disorders u u Family history increases risk (7-12X) Related to Mood Disorders u Comorbid w/ anxiety, depression, social phobia u Excessive concern about diet, calories, and exercise u Racial and gender differences u Higher risk groups: athletes (gymnasts, dancers, runners, cyclists, wrestlers), Type A, LGBTQ+, people who have been bullied Binge Eating Disorder u u u u u 3-5% of women / 2% of men affected u Comorbid w/ anxiety, depression, substance abuse u More common in people who are overweight Recurrent episodes (1x/week for 3 months) 3 or more of the following u Eating alone due to shame over amount u Eating rapidly u Eating excessively w/o hunger u Eating to discomfort u Feeling of guilt or depression Outcomes similar to obesity Tx: CBT / Medication Anorexia and Bulimia u Anorexia Nervosa u 1% of women/0.3% of men affected u u u 5-20% mortality u Highly restrictive diet / excess exercise u Dramatic weight loss (<85% ideal weight) u Bradycardia / hypotension / organ failure Bulimia Nervosa u 1-2% of women / 0.5% of men affected u Laxatives and/or self-induced vomiting u Stained teeth, esophageal inflammation Tx: Family Therapy, CBT Ocular Manifestations of Eating Disorders u Subconjunctival hemorrhage u Dry eye disease u Macular thinning u Retinal detachment Lecture Objectives u Identify major causes of malabsorption and their systemic and ocular effects u Recall most common vitamin deficiencies and their systemic and ocular effects u Differentiate between the most common forms of eating disorders and their impact on systemic and ocular health Nutritional Disorders WIL MCGRIFF, MPH, OD CHRISTOPHER REEVE, OD, FAAO ASSISTANT PROFESSOR ASSISTANT PROFESSOR [email protected] [email protected]