NUTRITIONAL DISEASES

1. NUTRITIONAL DISEASES

2. An adequate diet :total proteins, sufficient total calories, essential amino acids, essential fatty acids, vitamins, and minerals. A deficiency of any of these dietary factors leads todisordered cellular metabolism and cellular injurywith recognizable symptoms and signs of nutritional deficiency.

3. MALNUTRITION

4. NUTRITIONAL DEFICIENCY Primary Nutritional Deficiency inadequate food intake in developing nations, poor individuals, elderly, mentally retarded individuals, alcoholics.

5. Secondary Nutritional Deficiency Malnutrition occurring in the presence of adequate food consumption Failure of Intestinal Absorption failure of vitamin B12 absorption in pernicious anemia Increased Metabolic Demand the increased folic acid requirement in pregnancy Antagonists folic acid antagonists such as methotrexate used in cancer chemotherapy.

6. PROTEINS & CALORIES

7. PROTEIN - ENERGY MALNUTRITION Marasmus Kwashiorkor

8. Kwashiorkor the more extreme disorder. Marasmus: pure caloric deficiency Kwashiorkor: pure protein deficiency. In most cases, elements of both conditions are present, leading to an increasing preference for the termProtein-energy malnutrition (PEM). Protein-energy malnutrition affects about 400 million children in the world.

9. Developmental Effects of Protein & Energy Malnutrition 1. Growth retardation 2. Intellectual impairment malnutrition in the first 2 years of life does cause permanent deficits 3. Immunologic deficiency defects in both humoral and cellular immunity.

10. Marasmus The compensated phase of protein-energy malnutrition The hallmark of marasmus: Caloric deficiencies are compensated for by catabolism of the body's expendable tissues, adipose tissue and skeletal muscle.

11. The catabolism of adipose tissue and muscle leads to extreme wasting Marasmic child: only skin and bone in the extremities, wasting of facial muscles and fat,

12. Gastrointestinal tract digestive enzymes are secreted in the normal way, Any food that is eaten is digested and absorbed normally, Marasmus is therefore relatively easy to treat-simply providing food while ensuring adequate fluid and electrolyte balance is sufficient.

14. Kwashiorkor The name is derived from the Ga language of coastal Ghana, translated as "the sickness the baby gets when the new baby comes", and reflecting the development of the condition in an older child who has been weaned from the breast when a younger sibling comes. Breast milk contains proteins and amino acids vital to a child's growth. In at-risk populations, kwashiorkor may develop after a mother weans her child from breast milk, replacing it with a diet high in carbohydrates, especially starches, but deficient in protein.

15. Decompensated phase of protein-energy malnutrition While total caloric intake may be adequate, protein intake is not, Catabolism of endogenous protein cannot compensate. Decreased synthesis of enzymesand structural proteins (serum albumin levels fall). Failure of cellular metabolism occurs and is manifested in the brain, where it causes lethargy and somnolence.

16. Difficult to feed and treat Deficient digestive enzyme production in the intestine Atrophy of small intestinal villi failure to absorb ingested food. Decreased serum albumin levels Generalized edema Ascites (the protuberant abdomen that is characteristic of kwashiorkor).

17. Abnormal fat metabolism fatty liver with hepatomegaly (reversible). Hair fine and brittle, pigmentation-reddish in color, alternating light bands (flag sign). Skin abnormal pigmentation increased desquamation Nutritional anemia deficient intake of iron and folic acid deficient erythropoietin production.

18. VITAMINS

19. Vitamins are complex organic substances required as coenzymes for many metabolic processes necessary to sustain life. With few exceptions, vitamins are not synthesized in the body and must be provided in the diet. Vitamins are classified as (1) fat-soluble: A, D, E, and K; (2) water-soluble: B vitamins and vitamin C. The B group of vitamins includes thiamin, riboflavin, nicotinamide, pyridoxine, folic acid, and cyanocobalamin.

20. VITAMIN A Visual impairment failure of night vision (nyctalopia). Abnormal maturation of epithelium Squamous epithelium undergoes thickening owing to hyperplasia and excessive keratinization xerophthalmia (dry conjunctiva) keratomalacia (cornea; blindness) follicular hyperkeratosis (squamous metaplasia). Vitamin A Deficiency (Hypovitaminosis A)

21. Vitamin A Toxicity (Hypervitaminosis A) Cerebral dysfunction Raised intracranial pressure Liver enlargement Bone changes Teratogen in pregnancy Chronic toxicity (simulate psychiatric diseases).

22. Vitamin D Deficiency Primary deficiency: minimal exposure to sunlight Secondary deficiency: intestinal malabsorption, chronic renal disease liver failure. Vitamin D

23. Hypovitaminosis D results in a negative calcium balance with failure of normal calcification of osteoid in bone. Deficient mineralization of bone causes rickets (in children with growing bones) osteomalacia (in adults after epiphysial closure)

24. Vitamin D DeficiencyRickets Children Failure of mineralization of osteoid in bone with abnormalities of bone growth. The plasma level of either calcium or phosphate is decreased over a prolonged period.

25. Findings Widening of the epiphyses of bones of the wrists and knees; Masses of osteoid that develop at the costochondral junctions -small bumps on either side of the sternum (rachitic rosary). bones of rickets are much softer than normal bones, bowing of the tibias and abnormal curvatures in vertebrae and the pelvis. Protuberances appear on bones at points of muscle action, and the pull of the contracting diaphragm produces a transverse line across the lower rib cage (Harrison's sulcus). The inward pulling of ribs by the intercostal muscles and forward protrusion of the sternum (pigeon breast) Softening of the cranial bones (craniotabes).

26. Vitamin D DeficiencyOsteomalacia Failure of bone mineralization in adults. Dietary deficiency or abnormal metabolism of vitamin D. Growth retardation does not occur. Wide areas of uncalcified osteoid on histologic sections. Bone pain.

27. Vitamin D Toxicity(Hypervitaminosis D) Only with extreme overdose. Increased calcium absorption and bone resorption cause hypercalcemia: metastatic calcification, nephrocalcinosis, chronic renal failure.

28. VITAMIN K Vitamin K Deficiency Dietary deficiency is rare. Common causes of vitamin K deficiency: intestinal malabsorption of fat a lack of intestinal bacterial flora, prolonged broad-spectrum antibiotic therapy; presence of vitamin K antagonists, eg, coumarin derivatives (anticoagulant effect because they antagonize vitamin K).

29. Vitamin K deficiency is characterized by : decreased plasma levels of blood coagulation factors II (hypoprothrombinemia), VII, IX, and X. Bleeding tendency bruises in the skin, gastrointestinal tract hemorrhage (melena), hematuria. Increased prothrombin time.

30. VITAMIN E Antioxidant in cells protecting organelles from the noxious action of free radicals and peroxides produced in the cell. Low serum vitamin E levels occur in patients with severe chronic fat malabsorption. Deficiency diseases: Brain and skeletal muscle dysfunction, Sterility (in male rat), Hemolytic anemia Acute hemolytic anemia in vitamin E-deficient premature infants. Neuromuscular degeneration.

31. VITAMIN C Vitamin C is an antioxidant! Vitamin C Deficiency Scurvy Fragile capillaries (hemorrhage in gingivae, skin, joints, nailbed) Impaired wound healing Gingival infections Abnormalities in bone formation

33. Vitamin C Toxicity Predisposition to arsenic toxicity (converting inactive organic arsenicals in food to toxic arsenic compounds) Urinary calculi.

34. THIAMIN (Vitamin B1) Thiamin Deficiency Cheilosis and angular cheilitis (inflammation and fissuring of the lips) Glossitis (with atrophy) Corneal opacities (vascularization, ulceration, and blindness) Rash (face and genitalia).

35. NIACIN (Nicotinic Acid; Nicotinamide) Niacin deficiency Pellagra (dermatitis, diarrhea, and dementia- the three Ds). Niacin Toxicity IV Administration of large doses intravenously causes vasodilation (burning sensation in the face and head).

37. PYRIDOXINE (Vitamin B6) Pyridoxine Deficiency Skin (seborrheic dermatitis) Eyes (blepharitis) Mouth (cheilitis, glossitis) Neurologic manifestations (convulsions in infants and peripheral neuropathy in adults) Anemia (hypochromic and sideroblastic)

38. FOLIC ACID & VITAMIN B12 Folic acid and vitamin B12 deficiencies Mostcommon vitamin deficiencies Megaloblastic anemia (prominent clinical manifestation of folate and vitamin B12 deficiency)

39. MINERALS

40. IRON The most common deficiency Iron deficiency inadequate intake, impaired absorption, blood loss.

42. Iron deficiency Hypochromic anemia (decrease of Hb) Atrophy of mucosae (mouth, pharynx,stomach) Formation of mucosal webs (esophagus) Iron excess Hemochromatosis (increased storage of iron in the body).

43. TRACE ELEMENTS

44. Iodine Iodine deficiency Decrease in thyroid hormone output stimulating pituitary thyroid-stimulating hormone (TSH) production  thyroid hyperplasia and enlargement  goiter.

45. Fluoride Fluoride deficiency Dental caries. Fluoride toxicity Mottling of tooth enamel.

46. Calcium & Phosphate Abnormalities of calcium and phosphate metabolism(parathyroid disease or vitamin D-related disease) rickets, osteomalacia. Excessive intake of calcium(milk-alkali syndrome, due to chronic ingestion of milk and antacids) hypercalcemia, acute neurologic dysfunction. Hypocalcemia (malabsorption syndromes).

47. Magnesium Magnesium deficiency (in malabsorption syndromes, kwashiorkor, diuretic therapy, magnesium-deficient parenteral nutrition products) Tetany.

48. Zinc Zinc deficiency anemia growth retardation diarrhea gonadal atrophy skin rashes impaired wound healing.

49. Copper Deficiency of copper Anemia Neutropenia Decreased bone production (osteoporosis), Neurologic abnormalities (demyelination and faulty synthesis of neurotransmitters. Elevated levels of copper Hepatolenticular degeneration (Wilson's disease).

50. Selenium Selenium deficiency Congestive cardiomyopathy (in China, Keshan disease) Selenium is an antioxidant!