Nutritional Diseases Lecture Notes PDF

PATHOLOGY | TRANS 02 LE Nutritional Diseases EVETTE LILYBELLE A. DEMAISIP, M.D., FPSP | Lecture Date (09/14/20...

PATHOLOGY | TRANS 02 LE Nutritional Diseases EVETTE LILYBELLE A. DEMAISIP, M.D., FPSP | Lecture Date (09/14/2024) | Version 1 02 Malnutrition is a public health problem globally. In 2021, OUTLINE 149 million children under 5 years old were stunted, 45 I. Dietary Insufficiency V. Obesity A. Epidemiology VI. Conclusion million were wasted, and almost 40 million were B. Appropriate Diet VII. Review Questions overweight. II. Severe Acute Malnutrition VIII. References In the philippines: A. Marasmus IX. Formative Quiz → ¼ of children under 2 years old are stunted B. Kwashiorkor → ⅕ of women are nutritionally at risk III. Anorexia Nervosa and → Almost 40% of adults are overweight Bulimia Nervosa → ¼ of the general population are deficient in zinc, which A. Anorexia Nervosa is an important element for immune system and B. Bulimia Nervosa IV. Vitamin Deficiencies metabolism function While there have been reductions in the number of people Must Lecturer Book Previous Youtube affected by stunting since 2000, overweight children under ❗️ Know 💬 📖 📋 Trans 🔺 Video 5 years old have increased over time. SUMMARY OF ABBREVIATIONS B. APPROPRIATE DIET SAM Severe Acute Malnutrition An appropriate or balanced diet provides all the essential LEARNING OBJECTIVES nutrients our body needs to function optimally. Each should By the end of this lecture, students should be able to: contain the following: ✔ Identify Key Nutritional Disorders: Describe the major → Fruits and vegetables types of nutritional disorders, including severe acute ▪ Rich in vitamins, minerals, fibers, and antioxidants malnutrition (protein-energy malnutrition), vitamin − Coenzymes, hormones, structural components deficiencies, and disorders related to dietary excess, ▪ This should make up a significant portion of our diet such as obesity. → Carbohydrates, fats, and proteins ✔ Understand Pathophysiological Mechanisms: Explain ▪ Energy sources the pathophysiological mechanisms underlying nutritional ▪ Carbohydrates are the primary energy source mainly disorders coming from whole grain like rice, wheat, and whole ✔ Recognize Clinical Features: Identify the clinical signs wheat bread and symptoms associated with common nutritional → Amino acids and Fatty acids deficiencies and excesses. (e.g. obesity and its ▪ Building blocks of proteins and lipids complications). ▪ Derived from animal sources like meat, poultry, fish, ✔ Correlate Diet with Disease: Correlate specific dietary eggs, and dairy products, and plant sources like imbalances with the development of systemic diseases, beans and nuts such as cardiovascular disease, type 2 diabetes, and If there is an imbalance among these nutrients then there certain cancers, emphasizing the role of nutrition in is malnutrition disease prevention. ✔ Learning Objectives for Obesity: Explain the MALNUTRITION pathophysiology of obesity; Explore the associated health risks of obesity; Examine the role of genetics, environment, and lifestyle in the development and progression of obesity; Discuss clinical implications for prevention, diagnosis, and management. I. DIETARY INSUFFICIENCY A. EPIDEMIOLOGY Figure 2. Appropriate Diet[Lecturer’s PPT] A consequence of inadequate intake of either: → Proteins and calories called PRIMARY MALNUTRITION → Deficiencies in digestion, absorption, utilization, storage, excess loss or increase need, called SECONDARY MALNUTRITION There are several conditions that may lead to primary or Figure 1. Epidemiology[Lecturer’s PPT] secondary malnutrition. These are the common causes: LE 2 TG 1 | Acharon, Acuña, Aguinaldo, Agustin A., TE | Acuña AVPAA | Calpito PAGE 1 of 16 TRANS 2 Agustin L. VPAA | Cambas PATHOLOGY | LE 2 Nutritional Diseases | EVETTE LILYBELLE A. DEMAISIP, M.D., FPSP → Poverty resulting in decrease in serum albumin causing → Acute and chronic illness generalized or dependent edema. → Chronic alcoholism The weight of children with severe kwashiorkor is typically → Ignorance and failure of diet supplementation 60-80% of normal, but this is masked by the increased → Self-imposed dietary restriction fluid retention or edema. → Other causes: GI diseases, malabsorption, etc. They have a distended abdomen often referred to as pot WHO Definition belly, hepatomegaly, or enlarged liver due to fatty liver → Weight for height ratio: 3SD < Normal Range infiltration. → Imbalance of nutrients, either deficiency or excess The small bowel shows mucosal atrophy and loss of villi and microvilli, resulting in loss of small intestinal enzymes, so absorption is affected and the infants with kwashiorkor II. SEVERE ACUTE MALNUTRITION (SAM) A.K.A initially may not respond well to milk-based diets. PROTEIN-ENERGY MALNUTRITION (PEM) There is a characteristic dermatosis described as flaky paint-like skin lesions, darkening and peeling. Hair becomes thin, brittle, and may lose its color Children have stunted growth and weight loss There is cerebral atrophy and impairment of the white myelinization, and so the affected children may experience apathy, lethargy and irritability. Like in marasmus, there is also muscle wasting and despite the presence of edema, there is significant muscle loss. Children are also prone to infection due to immune suppression. Figure 3. Marasmus and Kwashiorkor[Lecturer’s PPT] III. ANOREXIA NERVOSA AND BULIMIA NERVOSA Manifests as a spectrum of clinical syndromes resulting from a dietary intake of protein and calories that is inadequate to meet the body’s needs At two ends of SAM are Marasmus and Kwashiorkor A. MARASMUS Develops when there is severe caloric deficiency and weight falls to 60% of what is normal for sex, height, and age. Growth retardation and loss of muscle mass due to catabolism Depletion of the somatic protein component as the body adapts to provide amino acids as a source of energy. Due to these losses of muscle and subcutaneous fat, the Figure 4. Anorexia and Bulimia Nervosa[Lecturer’s PPT] extremities are emaciated and the head appears too large Eating disorders are serious mental illnesses marked by for the body. dysfunctional eating behaviors and distorted body image. Anemia and manifestations of multivitamin deficiencies There are several types but the two well known and most There is also presence of immunodeficiency, particularly of frequent worldwide are Anorexia Nervosa and Bulimia T-cell mediated immunity and so, infections are usually Nervosa. present. Most people affected by these eating disorders are young Visceral protein is minimally depleted, so serum albumin women in the western countries, estimated to occur in levels are either normal or only slightly reduced. 1-2% of women and few among men, about 0.1%. Other features: sunken eyes, thin and bony face, ribs Average onset: 20 years old clearly visible through skin These disorders occur primarily in previously healthy young women who had developed an obsession with body B. KWASHIORKOR image and thinness Severe form of malnutrition, primarily caused by Anorexia nervosa has the highest death rate of any deficiency in dietary protein psychiatric disorder Typically affects children in developing countries, Bulimia nervosa is more common than anorexia nervosa, particularly during periods of famine or in areas where and generally has a better prognosis. diets are predominantly composed of carbohydrates with The neurobiologic explanation that might have something minimal protein. to do with the altered serotonin metabolism This is the most common form of severe acute malnutrition seen in African children who have been weaned too early and are subsequently fed almost exclusively a carbohydrate diet. Unlike in marasmus, there is marked protein deprivation due to severe loss of the visceral protein component *Space intentionally left blank* PATHOLOGY Nutritional Diseases PAGE 2 of 16 PATHOLOGY | LE 2 Nutritional Diseases | EVETTE LILYBELLE A. DEMAISIP, M.D., FPSP A. ANOREXIA NERVOSA Famous American singer in the 1970s, best known as part of the musical duo, the Carpenters. Her struggle with anorexia nervosa, which ultimately led to her death at 32 years old, is one of the most well documented cases in the public eye. She began dieting in the early 1970s, primarily due to industry pressure and desire to maintain a certain image. Her dieting escalated to anorexia nervosa, characterized by severe restriction of food intake, and significant weight loss. Overtime, her weight loss dropped to dangerously low levels. In 1983, she died of heart failure caused by emetine toxicity, a drug she was taking to induce vomiting. Figure 5. Anorexia Nervosa[Lecturer’s PPT] B. BULIMIA NERVOSA Self-induced starvation resulting in marked weight loss, similar to severe acute malnutrition. Also prominent in diagnostics are endocrine hormonal abnormalities such as: → Amenorrhea, due to decreased secretion of GnRH, subsequently decreasing LH and FSH → Decreased thyroid hormone release causes cold intolerance, slow heart rate (bradycardia), constipation, changes in the skin and hair, dehydration, and electrolyte imbalance Figure 7. Bulimia Nervosa[Lecturer’s PPT] Recurrent binge eating or ingesting large amounts of food, principally carbohydrates, followed by compensatory behavior to avoid weight gain like induced vomiting. Menstrual irregularities are common but amenorrhea is not as common as in Anorexia Nervosa, because weight and gonadotropin levels can be normal. → Amenorrhea in