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Nutritional disorders.
Define nutritional disorder.
(suboptimal nutrition, marginal deficiencies, or malnutrition) = caused by a deficiency or excess of one or more nutrients that alters the structure and/or function of cells, tissues, and organs to cause disease
Most are chronic, not acute
Nutritional disorder risk factors
age
apathy/depression
disease (cancer, diabetes, cardiac, GI)
inability to buy, cook or consume food
inability to chew or swallow
limited mobility
Sensory loss
Treatment
Drug therapy
Failure to recognize malnutrition
Lack of nutritional screening or assessment
Lack of nutritional training
Confusion regarding nutritional responsibility
Failure to record height and weight
Failure to record patient intake
Lack of adequate intake
Lack of staff to assist with feeding
Importance of nutrition unrecognized
Iron Deficiency, disease and population
Anemia. Anyone, 30% of the population
Iodine deficiency. Disease and population
Goiter. On the rise in higher social economic countries, particularly women
Vitamin D. Disease and population?
Adults: Increased fractures, muscle weakness, bone loss (can contribute to osteoporosis, osteomalacia)
Children: growth delay, soft bones, rickets
About 42% of Americans deficient
3 out 4 older people may be deficient
Vitamina b12. Disease and population.
Megaloblastic anemia. Vegans, vegetarians, >20% of older adults (absorption decreases with age)
Calcium deficiency. Disease and population
Adults: osteoporosis, osteomalacia
Children: soft bones, rickets
60% of adult women
30% of adult men
Magnesium deficiency. Disease and population.
Low levels seen in type 2 diabetes, metabolic syndrome, heart disease, and osteoporosis
Main symptoms severe deficiency: abnormal heart rhythm, muscle cramps, restless leg syndrome, fatigue, and migraines
50% of Americans
Deficiency caused by disease, drugs, reduced digestive function, or inadequate intake
Vitamin C and scurvy. Symptoms?
Sailors’ disease
Bruising, swollen and/or bleeding gums, weakness, fatigue, rash, coiled hair, failure to thrive, irritability, muscle weakness, or weight loss
Pellagra and niacin.
Diet of mainly corn
4 Ds (dementia, diarrhea, dermatitis, and death)
Beriberi and Thiamine.
Seen in alcohol use disorder (AUD)
Wet form (heart)
Dry form (nervous system) leads to Wernicke encephalopathy and Korsakoff syndrome
Megaloblastic anemia
Pregnancy: congenital anomalies. Folate deficiency.
Specific foods now fortified with folate
Large red blood cells
Neural tube defects
Pregnancy: congenital anomalies
Night blindness. Vitamin A deficiency.
Retinol.
Excess amount – teratogen
Too little – night blindness
Kwashiorkor. Protein deficiency.
Children; AUD
Distended abdomen
Kwashiokor and Marasmus.
Kwashiorkor is a protein deficiency alone.
Marasmus is protein and calorie deficiency.
Kwashiorkor. Causes and symptoms.
Worldwide, seen in young children
After weaning from breastmilk onto starch-based diet
In U.S., seen in alcohol use disorder
Distended belly. Muscle wasting. Fatty liver. Depigmentation of skin.
Marasmus cause and symptoms.
Starvation
Eating disorder: clinical diagnosis of serious disturbance in eating with an excessive concern over body shape and/or body weight
—Anorexia nervosa
—Bulimia nervosa
Disordered eating: abnormal eating patterns that do not meet the diagnostic criteria for eating disorder
—Relative Energy Deficiency in Sports (RED-S)
—Female Athlete Triad
Loss of muscle mass and fat stores (wasting)
Growth failure in children
Eating disorder vs disordered eating.
Eating disorder: clinical diagnosis of serious disturbance in eating with an excessive concern over body shape and/or body weight
Anorexia nervosa
Bulimia nervosa
Disordered eating: abnormal eating patterns that do not meet the diagnostic criteria for eating disorder
Relative Energy Deficiency in Sports (RED-S)
Female Athlete Triad
How can obesity cause nutrient deficiencies?
Nutrient deficiencies associated with obesity:
Vitamin D, vitamin C, zinc, thiamine
Too many calories does not mean you are getting all the nutrients you need
How can bariatric surgery cause nutrient deficiency?
Restrictive: reduces amount of food (calories) taken in
Malabsorptive: bypass section of intestine; reduced nutrient absorption
Combined
Common nutrient deficiencies after bariatric surgery:
Iron, vitamin B12, folic acid, vitamin D, calcium
Nutritional disorder treatment and prevention.
Treatment
Usually consists of replacing missing nutrients or removing excess nutrients
Treating symptoms as needed
Treating any underlying medical condition
Prevention
Establish a regular, healthful eating pattern
Eat a well-balanced diet
Avoid nutrient-restricted/fad diets
Mediterranean diet. Dash diet. Flexitarian diet. Mind diet. Mayo clinic diet. Therapeutic lifestyle changes. Volumetrics diet. Weight watchers diet. Vegetarian diet. Nordic diet.
