NUTRITIONAL

DISEASES
JANDIE P. SAGAYNO, PTRP
 TOPIC OUTLINE
• Overview: Nutrition
• Differences between Primary and Secondary Nutritional diseases
• Type of Nutritional disorders
• Protein-energy malnutrition
• Eating disorders
• Vitamin deficiencies
• Medical and surgical interventions for each nutritional disorders
WHAT IS
NUTRITION?
Interaction of nutrients
and other substances in
food in relation to
maintenance, growth,
reproduction, health and
disease of the human
body
BODY MASS INDEX
 MAIN FOCUS: Nutrient deficiencies
NUTRIENT
DEFICIENCY

INADEQUATE INGESTION INADEQUATE UTILIZATION INCREASED REQUIREMENT

INADEQUATE ABSORPTION INCREASED EXCRETION

NUTRITIONAL EVALUATION of
a patient can be performed by:
• Taking a good dietary history
• Skin fold caliper
• Ordering the following tests
• Total proteins, prealbumin,
albumin and transferrin
• Total lymphocyte count
• Quantitation of the
immunoglobulins
PROTEIN-ENERGY
MALNUTRITION
 CASE NO. 1
An African mother brings her 18-month-old child to the clinic because -
she says - he was poisoned. Taking the history, it was noted that her
child was breast-fed till 1 year of age. Then another pregnancy started
and the mother baruptly weaned the child, who has since been fed
almost exclusively on sweet potatoes amd porridge. The child has been
presenting liquid stools for the last 2 weeks. According to his mother,
he refuses to eat. Physical examination reveals a sad, apathetic child.
His face is swollen. There is generalized edema, low weight, decreased
arm circumference and muscle wasting. His hair is pale, straight and
easily pulled off. His skin is pigmented, the liver and spleen are
palpable.
PROTEIN DEFICIENCY
• Affects the transport of nany
essential nutrients that normally
bound to protein carriers in the
plasma
• Imbalance between dietary
protein and energy intake
PROTEIN-ENERGY MALNUTRITION

MARASMUS KWASHIORKOR
PROTEIN-ENERGY MALNUTRITION
 An African mother brings her 18-month-old child to the clinic because - she says - he was poisoned.
Taking the history, it was noted that her child was breast-fed till 1 year of age. Then another
pregnancy started and the mother baruptly weaned the child, who has since been fed almost
exclusively on sweet potatoes amd porridge. The child has been presenting liquid stools for the last
2 weeks. According to his mother, he refuses to eat. Physical examination reveals a sad, apathetic
child. His face is swollen. There is generalized edema, low weight, decreased arm circumference
and muscle wasting. His hair is pale, straight and easily pulled off. His skin is pigmented, the liver
and spleen are palpable.

Which of the following statements is false?

A. This child presents the clinical picture of PEM of the marasmus type.
B. The etiology of the child's protein-energy malnutritrition is multifactorial.
C. The laboratory investigation of this child should include a thick smear, a microscopic
examination of the stools and a stool culture.
D. Nutritional therapy will aim at introducing foods rich in proteins to this child's diet
E. A good part of any successful outcome will reoly on dietary education of the mother.
EATING DISORDERS
ANOREXIA NERVOSA
• Weight loss secondary to a
distorted body image
• An eating disorder characterized
by markedly reduced appetite or
total aversion to food (<85% of
ideal body weight for age and
height)
• A serious psychological disorder
• May diet or exercise too much, or
use other methods to lose weight
ANOREXIA NERVOSA
HORMONAL IMBALANCES IN
ANOREXIA NERVOSA
• Reduced FSH and LH: secondary amenorrhea
• Decreased gonadotropins (decrease in estradiol levels): increased risk
of osteoporosis
• Elevated cortisol levels caused by increased stress release of ACTH
• Increased growth hormone levels from stress
BULIMIA NERVOSA
• Voluntary vomiting of the food in
order to lose weight, usually
after bingeing on massive
amounts of food
• Laxative and diuretic abuse is
frequently present
Serious complications of Bulimia
Nervosa
 FAT SOLUBLE
VITAMIN DISORDERS
FAT SOLUBLE
VITAMINS
VITAMIN A: RETINOL
• FUNCTIONS:
• maintains light sensitive pigment
rhodopsin in the rods for night
vision and iodopsin in the cones
for daytime vision
• prevents the keratinzation and
metaplasia of epithelial cells
• important in wound healing and
reverses the retardant effect of
corticosteriods on wounds
• beta-carotene
 VITAMIN A
DEFICIENCY
HYPERVITAMINOSIS A
VITAMIN D: CALCIFEROL
• Calciferol
• a steroid hormone that primarily acts
to increase transcription of Vitamin D
responsive genes primarily in the gut
• FUNCTIONS:
• maintains normal blood levels of
calcium and phosphorus by
mediating absorption
• protects bone mineralization,
maintains normal cellular growth
and functions and healthy immune
system
VITAMIN D DISORDERS
• ABNORMAL METABOLISM • MALABSORPTION OF VITAMIN D
• Vitamin D dependent RICKETS • Celiac sprue
• Increased metabolism of the • Chronic pancreatitis
Vitamin D in the liver • Bile salt deficiency
• Renal insufficiency
• Abnormalities in the PTH secretion
• Nephrotic syndrome (loss of
binding protein for Vitamin D in
the urine)
HYPERVITAMINOSES D
• Hypercalcemia and
Hyperphosphatemia
• Nephrolithiasis (calcium stone)
• Nephrocalcinosis (metastatic
calcification of the basement
membrane with polyuria and
loss of concentration leading to
chornic renal failure)
VITAMIN E: TOCOPHEROL
• VITAMIN E
• an anti-oxidant that neutralizes
free radicals
• deficiency of vitamin E is most
commonly due to malabsorption
• Clinical findings:
• peripheral neuropathy
• rarely causes hemolytic anemia
VITAMIN K: PHYTONADIONE
• VITAMIN K
• exists in a natural form (K1) and a
synthetic form (K2) derived from
bacteria in the GI tract
• activates the vitamin K dependent
coaugulation factors
• II, VII, IX, X
• protein C and S
• the liver synthesizes inactive
vitamin K dependent factors and
vitamin K1 gamma carboxylates
resulting in an active forms
VITAMIN K DEFICIENCY
• In newborns, it is normal during • In adults:
the 2nd to 5th day interval after • caused by malabsorption of fats
birth due to: andfat solube vitamins from bowel
disease (celiac disease)
• lack of intestinal abcterial • Pancreatic insufficiency
colonization for synthesis of K2
• Bacterial growth syndromes
• deficiency of vitamin K in milk • Common duct obstruction
• Cirrhosis
• Terminal ilieal disease
• Anti-biotic therapy (decreases
bacterial production of Vitamin K)
• coumadin (inhibits epoxide reductase)
WATER SOLUBLE
VITAMIN
DISORDERS
WATER SOLUBLE VITAMINS
• Vitamin C
• Thiamine
• Riboflavin
• Niacin
• Pyridoxine
VITAMIN C
• found in fruits and vegetables
(primarily on citrus and green
vegetables) and cannot be
synthesized in the body
• Functions:
• hydroxylates proline and lysine in
collagen synthesis
• Reducing agent that prevents the
oxidation of tetrahydrofolate and
maintains iron in the ferrous condition
for proper absorption in the duodenum
of the small intestine
• Key factor in absorption of iron
SCURVY
• Vitamin C deficiency
• Results in defective collagen
formation in the tissue and in
the osteoid bone (abnormal
osteiod but normal
mineralization)
• Defective osteoid growth affects
the epiphyseal growth in the
children
SCURVY
• Key findings:
• subperitoneal hemorrhages
• hemarthroses
• poor wound healing
• oral mucosal findings
• ecchymoses
• (+) scorbutic rosary
• anemia (iron deficiency)
• increased bleeding time
VITAMIN C TOXICITY
• predisposes to urinary stone
formation (uric acid and calcium
oxalate)
VITAMIN B1: THIAMINE
• THIAMINE
• A coenzyme that is important in
carbohydrate metabolism in the
pyruvate-dehydroxygenase
complex that converts the
pyruvate into the acetyl CoA for
the Kreb's cycle
• It is also involved in transketolase
reactions in the pentose
phosphate shunt in order to
provide intermediates for the
glycolytic cycle
THIAMINE DEFICIENCY
• Most often the result of poor diet or
alcoholism
• BERIBERI
• thiamine deficiency in beriberi (nervous
system: dry beriberi, cardiovascular
system: wet beriberi) findings:
• Wernicke's encephalopathy
• Korsakoff's psychosis
• Peripheral neuropathy
• Congestive cardiomyopathy
• dilated heart
• decrease ATP - decrease contractility
• heart failue
VITAMIN B2: RIBOFLAVIN
• RIBOFLAVIN
• An essential component of
oxidative phosphorylation in the
mitochondia for generation of ATP
• It is present in meats, dairy
products, and green leafy
vegetables
• It can also be synthesized by
bacteria in the bowel
• Deficiency is characterized by:
• Greasy, scaly facial rash - butterfly
pattern
• Cheilosis (cracking at angle of lips)
• Glossis - magenta tongue
VITAMIN B3: NIACIN
• NIACIN
• found in meats, fish, vegetables,
nuts and yeast
• can also be synthesized by
bacteria in the bowel and
endogenously from tryptophan
• Required for formation of NAD,
NADP which are involved in most
of the oxidation reduction
reactions in the body for
metabolism
PELLAGRA
• Niacin deficiency
• charcterized by 3 D's:
• diarrhea
• dermatitis (increased pigmentation
in sun exposed areas)
• dementia
• Cassal's necklace is a classic
findings (skin rash)
• Posterior colum disease (similar to
B12 deficiency)
VITAMIN B6: PYROXIDINE
• Abundant in most food,
inadequate diates are not the
usual case of deficiencies
• PYROXIDINE
• cofactor for the delta ALA in
hemosynthesis
• cofactor for the synthesis of GABA
and other neurotransmitters
• Pyridoxal phosphate - required by
the transaminases for
transamination reactions in amino
acid synthesis and excretion
VITAMIN B6 DEFICIENCY
• Related to drugs like isoniazid,
hydralazine and penicillamine
• Results in:
• angular stomatitis
• glossitis
• sideroblastic anemia
• peripheral neuropathy
VITAMIN B12: COBALAMINE
• Helps in formation of RBC and
maintenance of the CNS
• Sources:
• organ meats (beef, liver)
• shellfish (clams)
• meat, poultry, eggs, milk and
other dairy food
• Some breakfast cereals and
nutritional yeasts
• No vitamin B12 in plant foods
VITAMIN B12 DEFICIENCY
• Anemia and pernicious anemia
• loss of balance
• numbness or tingling in the arms
and legs
• weakness
 FOLATE
• Functions: • Deficiency:
• aids in protein metabolism • affects the cell growth and protein
• promoting blood cell formation pproduction - overall impaired
• lowering the risk for neural tube growth
defects • diarrhea and anemia
• also play a role in controlling • Mother with folate deficiency -
homocysteine levels - reduces the increased risk in developing neurla
risk for coronary heart diseases tube defects