Pathophysiology Exam 4.28.

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.