2 - Nutritional Diseases

Malnutrition

• also referred to as protein energy malnutrition or PEM

• consequence of inadequate intake of proteins and calories, or deficiencies in the digestion or absorption of proteins, resulting in the loss of fat and muscle tissue, weight loss, lethargy, and generalized weakness.

• Millions of people in developing nations are malnourished and starving, or living on the cruel edge of starvation.

Severe PEM

• it is a serious

• often lethal disease affecting children

• common in low-income countries

• 25% of children may be affected

• major factor in the high death rates among children younger than 5 years

150, 000 & 650, 000

• in the west africa country of niger, which suffered a severe famine in 2005, united nations reports estimate that there were, respectively, ___________ and ___________ children with severe and moderate malnutrition

• in that country, malnutrition was a direct or indirect cause of mortality in 60% of children under age 5

• decreased food intake can also occur due to sharp increases in prices, as was seen in the first half of 2008

• in developed countries, PEM occurs in elderly and debilitated patients in nursing homes and hospitals

marasmus&kwashiorkor

• In malnourished children, PEM presents as a range of clinical syndromes, all characterized by a dietary intake of protein and calories inadequate to meet the body's needs.

• two ends of the spectrum of PEM syndromes:

  • ______________

somatic compartment

• there are two differentially regulated protein compartments in the body

• represented by proteins in skeletal muscles (marasmus)

visceral compartment

• there are two differentially regulated protein compartments in the body

• represented by protein stores in the visceral organs, primarily the liver (kwashiorkor)

Marasmus

• when weight falls to 60% of normal for sex, height, and age.

• growth retardation and loss of muscle

• anemia and manifestations of multiple vitamin deficiencies are present

• concurrent infections - immune deficiency, particularly T cell–mediated immunity

• characteristics:

  • normal hair

  • old man’s face

  • thin muscles/thin fat

  • no edema

concurrent infections

• marasmus

• immune deficiency, particularly T cell–mediated immunity

Kwashiorkor

• protein deprivation is relatively greater than the reduction in total calories

• most common form of PEM seen in African children who have been weaned too early and subsequently fed, almost exclusively, a carbohydrate diet

• high in impoverished countries of Southeast Asia.

Kwashiorkor

Less severe forms worldwide

• chronic diarrheal states in which protein is not absorbed

• chronic protein loss due to conditions such

• protein-losing enteropathies

• nephrotic syndrome

• extensive burns

• fad diets or replacement of milk by rice-based beverages have been reported in the United States.

Kwashiorkor

• edema

• loss of weight -masked by the increased fluid retention

• In relative sparing of subcutaneous fat and muscle mass

• characteristic skin lesions- alternating zones of hyperpigmentation, areas of desquamation, and hypopigmentation, giving a “flaky paint” appearance

• Hair changes include overall loss of color or alternating bands of pale and darker hair.

• fatty liver (resulting from reduced synthesis of the carrier protein component of lipoproteins)

• apathy, listlessness, and loss of appetite.

• vitamin deficiencies

• defects in immunity and secondary infections

• other characteristics:

  • changes in hair color or texture

  • loss of muscle mass

  • failure to gain weight and grow

  • increased and more severe infections

  • irritability

  • lethargy or apathy

  • large belly that sticks out

  • diarrhea

  • changes in skin pigment

  • edema

  • rash

Kwashiorkor (morphology)

• liver: enlarged

• small bowel: decrease in the mitotic index in the crypts of the glands, associated with mucosal atrophy and loss of villi and microvilli.

• bone marrow: hypoplastic

• brain: cerebral atrophy, a reduced number of neurons, and impaired myelinization of white matter

marasmus (morphology)

• liver: unenlarged

• small bowel: Similar with kwashiorkor but rare (decrease in the mitotic index in the crypts of the glands, associated with mucosal atrophy and loss of villi and microvilli.)

• bone marrow: hypoplastic

• brain: cerebral atrophy, a reduced number of neurons, and impaired myelinization of white matter

morphology of kwashiorkor and marasmus

(morphology of kwashiorkor and marasmus):

• other changes may be present, including:

  • (1) thymic and lymphoid atrophy (more marked in kwashiorkor than in marasmus)

  • (2) anatomic alterations induced by intercurrent infections, particularly with all manner of endemic worms and other parasites

  • (3) deficiencies of other required nutrients such as iodine and vitamins.

Thirteen

• ________ vitamins are necessary for health

• vitamins A, D, E, and K are fat-soluble

• all others are water-soluble

A, D, E, K

vitamins ___, ___, ___, and ___ are fat-soluble

Fat-soluble vitamins

______________ are more readily stored in the body, but they may be poorly absorbed in fat malabsorption disorders, caused by disturbances of digestive functions

vitamin A

• deficiency disease/disorder: loss of vision

• symptoms: Poor vision, loss of vision in darkness (night), sometimes complete loss of vision

• Xeropthalmia, keratomalacia

vitamin B1

• deficiency disease/disorder: beriberi

• symptoms: Weak muscles and very little energy to work

vitamin C

• deficiency disease/disorder: scurvy

• symptoms: Bleeding gums, wounds take longer time to heal

vitamin D

• deficiency disease/disorder: rickets

• symptoms: Bones become soft and bent

calcium

• deficiency disease/disorder: Bone and tooth decay

• symptoms: Weak bones, tooth decay

iodine

deficiency disease/disorder: goiter

symptoms: Glands in the neck appear swollen, mental disability in children

iron

deficiency disease/disorder: anemia

symptoms: Weakness

rickets

• bony necklace

• curved bones

• big joints

• bowed legs

sunlight

• ____________ is the best prevention and treatment of rickets

D

A deficiency of vitamin ___ or an inability to utilize vitamin ___ may lead to a condition called rickets, a weakening and softening of the bones brought on by extreme calcium loss

Thiamine

• B-Vitamins

• Vitamin B1

Riboflavin

• B-Vitamins

• Vitamin B2

Niacin

• B-Vitamins

• Vitamin B3

Pantothenic acid

• B-Vitamins

• Vitamin B5

Pyridoxine

• B-Vitamins

• Vitamin B6

Biotin

• B-Vitamins

• Vitamin B7

Folic Acid

• B-Vitamins

• Vitamin B9

Cobalomin/Cyanocobalomin

• B-Vitamins

• Vitamin B12

Vitamin B1

• Deficiency diseases

• Beriberi, Wernicke syndrome

Vitamin B2 

• Deficiency diseases

• Ariboflavinosis, Glossitis, Angular stomatitis

Vitamin B3

• Deficiency diseases

• Pellagra

Vitamin B5

• Deficiency diseases

• Paresthesia

Vitamin B6

• Deficiency diseases

• Anemia, peripheral neuropathy.

Vitamin B9 (folate)

• Deficiency diseases

• Megaloblastic anemia and Deficiency during pregnancy is associated with birth defects, such as neural tube defects

Vitamin B12

• Deficiency diseases

• Megaloblastic anemia

Vitamin C

• Deficiency diseases

• Scurvy

vitamin E

• tocopherols

• function:

  • antioxidant

  • free radical

  • scavenger

• deficiency state:

  • diet

  • malabsorption

  • neuromuscular deficits

vitamin K

• function:

  • clotting factors II, VII, IX, X

• deficiency state:

  • malabsorption

  • loss of gut flora

  • coumadin therapy

  • bleeding

II, VII, IX, X

vitamin K clotting factors

vitamin B1 (thiamine)

• TPP

• function:

  • enzyme co-factor

  • nerve conduction

• deficiency state:

  • diet

  • EtOH (ethyl alcohol)

  • polyneuropathy

  • cardiomyopathy

  • wernicke-korsakoff

vitamin B2 (riboflavin)

• FMN, FAD

• function:

  • enzyme co-factor

• deficiency state:

  • diet

  • EtOH (ethyl alcohol)

  • cheilosis

  • glossitis

  • dermatitis (atrophy)

vitamin B3 (niacin)

• NAD, NADP

• function:

  • enzyme co-factor

• deficiency state:

  • diet

  • EtOH (ethyl alcohol)

  • pellagra

  • dermitis

  • diarrhea

  • dementia

vitamin B6 (pyridoxine)

• NAD, NADP

• function:

  • enzyme co-factor

• deficiency state:

  • drugs (INH),

  • EtOH

  • similar to riboflavin and niacin deficiency

vitamin C

• NAD, NADP

• function:

  • hydroxylation of proteins

  • antioxidant

• deficiency state:

  • diet

  • EtOH

  • scurvy

  • weak connective tissue

  • bleeding

  • fractures

  • gingival swelling

  • peridontal disease

  • poor wound healing

vitamin K excess

Vitamin __ deficiency can develop due to improper functioning of the gastrointestinal tract and diseases that prevent the formation and excretion of bile.

K

Bleeding and hemorrhage are the only pronounced symptoms of vitamin ____ deficiency that occur due to blood clotting disorders.

vitamin D deficiency

• brain:

  • depression

  • schizophrenia

• circulatory:

  • high blood pressure

  • coronary heart disease

• muscle:

  • aches

  • weakness

• respiratory:

  • asthma

  • wheezing

• pancreas:

  • type 1 diabetes

• bone:

  • rickets

  • osteoporosis

• crohn’s disease, multiple sclerosis, rheumatoid arthritis

• cancer, influenza, tuberculosis

vitamin C deficiency

• bleeding gums

• petechiae & ecchymosis

• perifollicular haemorrhages

• splinter haemorrhages

• joint effusion

• anemia