This document discusses malnutrition and its causes, signs, and consequences. It defines malnutrition as a state of relative or absolute deficiency or excess of one or more nutrients. The six essential nutrients - proteins, fats, carbohydrates, vitamins, minerals, and water - are described along with deficiency signs. Four main nutritional disorders are outlined: vitamin deficiencies, protein-calorie malnutrition, obesity, and mineral deficiencies. Specific vitamin deficiencies like Vitamins A, D, C, B1, B2, and niacin are then detailed in terms of functions, deficiency manifestations, and related diseases.

2. MALNUTRITION
“Pathological state- Due to Relative or
Absolute Deficiency or Excess of 1 or
more Nutrients”
• Undernutrition
• Overnutrition
• Specific Deficiency

3. Signs associated with malnutrition
 Hair
 Face
 Eyes
 Lips
 Tongue
 Teeth
 Gums
 Glands
 Skin
 Nails
 Muscular & Skeletal
systems
 Internal Systems
– Gastrointestinal
– Nervous
– Cardiac

4. 6 ESSENTIAL NUTRIENTS:
1. PROTEINS
2. FATS
3. CARBOHYDRATES
4. VITAMINS
5. MINERALS
6. WATER

5. PROTEINS
l 1 gm of protein= 4 kcal
l 8 essential AA- Isoleucine, Leucine,
Lysine, Methionine, Phenylalanine,
Theonine, Tryptophan, Valine.
l Needs to be supplied as body cannot
synthesize these.

6. FATS
• Fats and Fatty acids (Linolenic,
Linoleic, Arachidonic acid) =35% of
diet.
• 1 gm of fat= 9 kcal
• Increased ratio of polyunsaturated to
saturated fats minimizes the risk of
atherosclerosis.

7. CARBOHYDRATES
• Constitute major source of
dietary calories.
• 1 gm of carbohydrate= 4 kcal.

8. MINERALS
• IRON- Microcytic Hypochromic Anemia
• IODINE- Hypothyroidism, Goiter, Growth
retardation
• COPPER- Abnormal collagen linking,
Neuromuscular disorders
• ZINC- Infertility, Acrodermatitis
enteropathica, Growth retardation
• FLUORIDE- Dental carries
• SELENIUM- Myopathy, Cardiomyopathy.

9. 4 main Nutritional disorders
1. VITAMIN DEFFICIENCIES
2. PROTEIN CALORIE
MALNUTRITION (PEM)
3. OBESITY
4. MINERAL DEFFICIENCIES

10. PATHOGENESIS
1. PRIMARY DEFICIENCY: Due to either the lack
or decreased amount of essential nutrients in
diet.
2. SECONDARY DEFICIENCY: As a result of
various factors-
• Interference with ingestion
• Interference with Absorption
• Interference with Utilization
• Increased excretion
• Increased demand

11. VITAMINS
• “Vitamins are organic substances which
cannot be synthesized within the body
and are essential for maintenance of
normal structure and function of cells”.
1. FAT-SOLUBLE: Vit A,D,E,K.
2. WATER –SOLUBLE: Vit C and B
complex group.

12. VITAMIN A
• Retinol- transport form;
• Retinol ester- storage form;
• Retinal (aldehyde form)- visual pigment;
• Retinoic acid

13. Retinol (Vit A)
STORAGE & TRANSPORT FORM
RETINAL (all-trans form)
Visual pigment
Beta Carotene
(PROVITAMIN A)
Photo protective
Antioxidant
Redox rn
Intestinal
mucosa
RETINAL (cis form)
VISUAL PIGMENT
RETINOIC ACID
Growth regulation
Cell differentiation
isomerisation
Irreversible
oxidation

14. FUNCTIONS OF VIT A:
• Maintaining normal vision in reduced light.
(Rhodopsin in rods, iodopsins in cones).
• Differentiation of specialized epithelial cells,
mainly mucous secreting cells. Def. leads to
squamous metaplasia.
• Enhancing immunity to infections (measles)
• Anti-oxidant

15. VIT A DEFICIENCY:
• Night blindness: impaired vision in night
• Xerophthalmia: Dry eyes, dryness of
conjunctiva (xerosis).
• Bitot spots: Small opaque plaques with keratin
debris.
• Keratomalacia: Erosion of roughened corneal
surface with softening and destruction of cornea
and total blindness.

16. Vit A toxicity (Hypervitaminosis):
• Headache, vomiting, stupor, papilledema.
• Weight loss, nausea, dryness of mucosa
and lips; bone and joint pain;
• Hepatomegaly with parenchymal damage
and fibrosis.
• Synthetic retinoid- used in treatment of
acne increases risk of congenital
anomalies in fetus.

17. VIT ‘D’
• Major function of Vit D: maintenance of
normal plasma levels of Calcium and
Phosphorus.
• Def: Rickets in growing children
Osteomalacia in adults.
Hypocalcemic Tetany

18. NORMAL METABOLISM:
• 2 sources: Endogenous synthesis- in Skin- 80%
: Diet (deep sea fish, grains).
• Gut: Vit D absorbed as Ergosterol
• Skin: Synthesized from 7-dehydrocholestorol.
• Transported to liver by binding with globulin
• Conversion of 25(OH)D to 1, 25 (OH)2 D by
α1-hydroxylase in kidney; which is most active
form.

19. Vitamin-D Terminologies
• Vit-D2:: Available in Food or Fortified form.
• Vit-D3:: 7-Dehydrocholesterol in Skin
converted in the skin by UV light
Exposure.
• Vit D2 or Vit D3 must be made Biologically
active
• Activated in 2 process- Liver & Kidney.
• 1,25 (OH)2 Dehydrocholesterol is active.

21. PREDISPOSING FACTORS FOR
DEFICIENCY:
• Inadequate synthesis/ dietary deficiency:
-inadequate sun exposure, poor intake.
• Decreased absorption: Cholestatic liver ds,
Pancreatic insufficiency, Biliary tract
obstruction, Small bowel ds.
• Derangements in metabolism: diffuse liver
ds, Advanced renal ds.
• Phosphate depletion: Antacid abuse.

22. RICKETS AND OSTEOMALACIA:
• Excess of unmineralised matrix.
• Inadequate calcification of epiphyseal
cartilage deranging enchondral bone growth.
• Overgrowth of epiphyseal cartilage due to
inadequate calcification.
• Failure of cartilage cells to mature and
disintegrate.
• Distorted, irregular masses of cartilage
projecting into BM cavity.

23. • Inadequately mineralized cartilaginous
remnants.
• Disruption of orderly replacement of cartilage
by osteoid matrix, with enlargement and
lateral expansion of the osteochondral jn.
• Weak and poorly formed bones-
microfractures, stress fractures.
• Deformation of the skeleton due to loss of
structural integrity and rigidity of the
developing bones.

24. • HEAD: Craniotabes: softened occipital bones
become flattened with inward buckling of
parietal bones.
• Frontal bossing: Squared appearance of the
head.
• CHEST: ‘Rachitic rosary’-due to overgrowth
of cartilage at costochondral jn.
• Pigeon chest deformity: antr. Protrusion of the
sternum- weakened ribs subjected to pull by
respiratory muscles.
• Harrison's Groove: due to inward pull at the
margin of the diaphragm.

26. • Pelvis is deformed.
• Vertebrae: Lumbar Lardosis
• Bowing of legs: when child begins to walk.
• RICKETS=CHILDREN,
• OSTEOMALACIA= ADULTS: mc come with
microfractures and gross fractures.

29. VIT E
• Antioxidant property.
• Inhibits formation of atheromas by reducing
oxidation of LDL.
• Def: Neurological manifestations- absent
tendon reflexes, ataxia, loss of position and
vibration sense, loss of pain sensation,
spinocerebellar degenaration, muscle
weakness-ophthalmoplagia.
• Infertility.

30. Anti-Oxidants
• Enzymatic:: Super oxide Dismutase
Glutathione peroxidase
Catalase
• Non Enzymatic:: Vit-E, Vit- A, Vit-C,
Ferritin,
Ceruloplasmin.

31. VIT K:
• Required for clotting factor synthesis &
Post translational modification :F-II, VII, IX,
X: Protein C and S.
• Def: Bleeding diathesis, hemorrhagic ds of
newborn, hematomas, hematuria, melena,
ecchymosis, gum bleedings.
• Routine Prophylactic dose for newborns.

32. VITAMIN C (ASCORBIC ACID)
• SCURVY:
Hemorrhages: Gingival swelling, bacterial
periodontal infections, subperiosteal
hematomas, bleeding into joint spaces,
perifollicular, hyperkeratotic papular rash.
IMPAIRED WOUND HEALING: due to
deranged collagen synthesis.
Skeletal changes: soft bones, growth
retardation.

34. THIAMINE (VIT B1):
• Wet Beriberi: edema due to heart failure
• Dry Beriberi: CNS and PNS system
involved::::-----
a) Korsakoff syndrome: Psychosis with
confusion, loss of memory.
b) Wernicke’s encephalopathy: mental
confusion with ophthalmoplagia, nystagmus
and ataxia.

35. Thiamine Deficiency (B1) Beriberi
Dry beriberi – peripheral neuropathy, atrophy
Wet beriberi – dilated cardiomyopathy
Due to peripheral dilation of arterioles

36. RIBOFLAVIN ( VIT B2)
• Cheliosis:
• Glossitis: Magenta red tongue.
• Interstitial keratitis:
• Scaly dermatitis:
• Erythroid hyperplasia of BM:

37. Riboflavin (b2) deficiency
Cheilosis/Angular stomatitis
Glossitis

38. Magenta Tongue
B2 Deficiency

39. Angular Stomatitis plus Candidiasis

40. NIACIN:
• PELLEGRA: THREE D’s
1. Dermatitis
2. Diarrhea
3. Dementia

41. Pellagra (Niacin Deficiency) : Casals’ Necklace

42. Iodine Deficiency

43. Calcium Deficiency