medical

1. Module 3
Nutrient deficiencies

2. Protein Energy Malnutrition
Protein-energy malnutrition or PEM is the condition of lack of energy
due to the deficiency of all the macronutrients and many
micronutrients. It can occur suddenly or gradually. It can be graded as
mild, moderate or severe. In developing countries, it affects children
who are not provided with calories and proteins. In developed
countries, it affects the older generation.

3. Classification Of Protein Energy
Malnutrition
PEM can be classified into two types:
• Primary PEM
• Secondary PEM
Primary PEM
This type of protein-energy malnutrition is found in children. It is rarely found in the elders, the main cause being
depression. It can also be caused due to child or elder abuse. In children, PEM is primarily of two types:
• Kwashiorkor
• Marasmus
Kwashiorkor
• This occurs due to the abandonment of breastfeeding before the actual age due to the birth of a younger
sibling.
• Kwashiorkor may also be the outcome of acute illness such as gastroenteritis. It is confined only to a few parts
of the world such as rural regions of Africa, Pacific Islands, Caribbean. In these places, the food is low in
protein and high in carbohydrates.
• It causes leakage of the cell membrane, releasing the intravascular fluid and proteins. This results in oedema.
• It weakens the immunity of a person, making him susceptible to diseases.

4. Marasmus
• Weight Loss
• Fat and muscle depletion
• Most common in developing countries.
• More common than Kwashiorkor
• Prevalent in children younger than those affected by Kwashiorkor
• Cell-mediated immunity is impaired, making the children more susceptible
to infections.
Secondary PEM
• It is caused due to disorders in the gastrointestinal tract.
• It can be caused due to infections, hyperthyroidism, trauma, burns, and
other critical illnesses.
• It decreases appetite and impairs nutrient metabolism.

5. Symptoms of Protein Energy Malnutrition
• The patient becomes weak and inefficient.
• Impaired cognition and consciousness.
• Temporary lactose deficiency
• Diarrhea
• Gonadal tissues atrophy
• Causes amenorrhea in women
• Causes libido in both men and women
• Weight loss
• Shrinking of muscles
• Protrusion of bones
• The skin gets thin, pale, dry, inelastic and cold
• Hair fall
• Impaired wound healing
• Risk of hip fractures and ulcers increases in elderly patients
• Heart size and cardiac output decreases in severe cases
• A decrease in respiratory rate and vital capacity
• Liver, kidney or heart failure
• Acute PEM might also prove fatal

6. Diagnosis of Protein Energy Malnutrition
• PEM can be diagnosed by identifying the dietary history of the patient.
• The measurement of height and weight, fat distribution,
anthropometric measurements of lean body mass should be examined.
• The Body Mass Index or BMI is calculated to measure the severity of
PEM.
• Laboratory tests such as measurement of serum albumin, total
lymphocyte count, transferrin and response to skin antigens can help
to detect the severity of Protein Energy Malnutrition.
• The decreased level of hormones, lipids, fats, cholesterol, prealbumin,
insulin-like growth factor, fibronectin, calcium, magnesium, and
phosphate can also help to diagnose PEM.

7. Treatment of Protein Energy Malnutrition
Protein Energy Malnutrition can be treated in the following ways:
• Oral feeding
• Avoiding lactose
• Supportive care
• Reduction in poverty
• Improving nutritional education and public health measures
• Starvation can be treated by providing a balanced diet
• Multivitamin supplements
• Treat infections and fluid and electrolyte abnormalities, in severe
cases

8. Vitamin Deficiency Disease
“Deficiency diseases are diseases that are caused by the lack of certain
essential nutrients, especially vitamins and minerals, in one’s diet over a
prolonged period of time.”
A balanced diet is extremely important for the good health of a person. Any
imbalance in the diet might lead to excess or insufficient intake of certain
nutrients. Insufficient intake of a particular nutrient can lead to a deficiency
disease.
Vitamin is a micronutrient that is not prepared by the body in sufficient
amounts. This is the reason why it is necessary to take in from outside sources
for the normal functioning of the body. Inadequate intake of vitamins results in
vitamin deficiency diseases.

9. Types of Vitamins Deficiency Diseases
A (Retinol) Night blindness
B1 (Thiamine) Beri-beri
B2 (Riboflavin) Retarded growth, bad skin
B12 (Cyanocobalamin) Anaemia
C (Ascorbic acid) Scurvy
D (Calciferol) Rickets
K (Phylloquinone) Excessive bleeding due to
injury
Types of Minerals Deficiency Diseases
Calcium Brittle bones, excessive
bleeding
Phosphorus Bad teeth and bones
Iron Anaemia
Iodine Goitre, enlarged thyroid gland
Copper Low appetite, retarded
growth

10. Symptoms of Vitamin Deficiency
• Vitamin deficiency can cause a number of symptoms, including fatigue, dry skin and hair,
depression, poor wound healing, and more. While they can vary between deficiencies, many of
them overlap.
• Usually, noticeable effects don't begin to develop until you've had low levels for several months.
Fatigue and Weakness
• If you feel sleepy or sluggish all the time, you may be deficient in vitamin D, any of the B vitamins,
and/or vitamin C.
• Vitamin D helps with bone and muscle strength, so when you don't have enough, you may feel
weak and lack energy. Some research suggests that vitamin D deficiency is linked to fatigue and
that taking vitamin D supplements can improve this symptom.
• Vitamin C and all B vitamins except folate (B9) are involved in producing energy in your cells, so
being deficient in any of them can leave you feeling wiped out. It can also have a major impact on
your metabolism and overall health.
• Folate deficiency can lead to fatigue and weakness by causing anemia. In that condition, your
body doesn't have enough red blood cells, which carry oxygen to your tissues. That oxygen is
essential for proper function and energy.

11. Dry Skin and Hair
• Dry skin and hair are common symptoms of deficiencies in:
• Vitamin A
• B vitamins
• Vitamin C
• Vitamin D
• Some of these vitamins are commonly used in skincare and haircare
products. Ask your healthcare provider whether dietary sources,
supplements, or topical (on the skin) use is best for improving skin
and hair health.
• Use caution with vitamin A (retinol) products, however. High levels
can actually harm your skin.

12. Depression
• Vitamin deficiencies can sometimes be associated with clinical
depression. They include:
• Vitamins B1, 3, 6, 9, 12
• Vitamin C
• Vitamin D
• Supplements may help alleviate depression, but they're not a
replacement for antidepressants.

13. Easy Bruising or Bleeding
• Easy bruising and bleeding can happen due to problems with blood
clotting, poor healing, or collagen formation. (Collagen gives strength
to the walls of blood vessels.)
• Essential vitamin deficiencies that can contribute to easy bruising or
bleeding are:
• Vitamin C
• Vitamin K, especially in newborn babies
• Deficiencies of these vitamins are fairly uncommon, however. If you
start bruising or bleeding easily, don't just assume a deficiency is
causing it.

14. Poor Wound Healing
• Poor wound healing means that your sores take especially long to heal. A
lot of essential vitamins contribute to the healing process. Some aid in
collagen creation, others help with re-building different types of cells or
tissues, and others promote cellular health through antioxidant activity.
• Vitamin deficiencies that can contribute to poor wound healing include:
• Vitamin A
• B vitamins
• Vitamin C
• Vitamin D (when combined with zinc and arginine)
• Vitamin K

15. Bone Fractures
• Essential vitamins that keep your bones strong and healthy include vitamins A, B6, B9, B12,
C, D, and K.
• While research shows deficiencies in any of these vitamins can lower your bone density
and lead to fractures, it's not clear whether nutritional supplements lower the fracture
risk.
Skin Color Changes
• Skin color changes due to vitamin deficiency can manifest in a few different ways: loss of
pigmentation in spots, darker pigmentation in spots, or generally pale skin.
Loss of pigmentation and light-colored spots may result from deficiencies in:
• Vitamin D (in light-skinned people)
Darker pigmentation can be due to:
• Vitamin B12
• Vitamin D (in dark-skinned people)
Deficiencies that can cause generally pale skin include:
• Vitamin C
• Vitamin B6, 9, 12

16. Complications of Vitamin Deficiency
• Prolonged vitamin deficiency can cause more serious health issues that
may not improve, even with treatment. Severe vitamin deficiencies can
cause:
• Decreased sensation of the hands and feet
• Weakness of the toes and fingers
• Vision loss
• Memory loss
• Behavioral changes
• Shortness of breath
• Tachycardia (a rapid heart rate)

17. Causes of Vitamin Deficiency
• Often, vitamin deficiency is related to your diet. Vitamins are complex molecules present
in fruit, vegetables, grains, meat, poultry, and seafood. Each vitamin is found in more
than one type of food, and some foods are fortified with vitamins. For example, milk
naturally contains calcium (which is a mineral, not a vitamin) and it is fortified with
vitamin D. Pasta, rice, and cereal are often fortified with a variety of vitamins.
• In addition to dietary factors, medical conditions can affect your absorption of vitamins,
even if your dietary vitamin intake is adequate.
• Dietary Risk Factors
• Some diets can make you prone to vitamin deficiency. Vitamin B12 is found in meats—a
vegan or vegetarian diet can increase the risk of vitamin B12 and biotin deficiency. If you
are dairy-free, then you may be at risk of becoming deficient in vitamin D.
• A gluten-free diet is a diet low in grains, which are naturally rich in vitamins and are also
often fortified with vitamins. So a gluten-free diet can make you deficient in many
vitamins, including folate, and thiamine.
• A diet that is high in processed foods and low in fresh fruits and vegetables can result in
vitamin E and vitamin K deficiency.

18. Sunlight
• Vitamin D is found in foods such as seafood, eggs, and dairy products. But sunlight is also an important source of vitamin
D. And lack of sun exposure can result in vitamin D deficiency. In geographic regions that have a cold climate, this is fairly
common during the winter,
Medical Illness
• A number of medical problems make it hard to properly absorb and metabolize vitamins. This can lead to vitamin
deficiencies.
• Common medical causes of vitamin deficiency include:
• Alcoholic liver disease
• Liver failure
• Kidney disease
• Chronic diarrhea
• Malabsorption syndrome
• Gastric bypass
• Inflammatory bowel disease
• Crohn's disease
• Irritable bowel syndrome
• Pernicious anemia

19. Role and effect of sodium metals
• Sodium is a compound of many foodstuffs, for instance of common salt. It is
necessary for humans to maintain the balance of the physical fluids system.
Sodium is also required for nerve and muscle functioning. Too much sodium
can damage our kidneys and increases the chances of high blood pressure.
The amount of sodium a person consumes each day varies from individual
to individual and from culture to culture; some people get as little as 2
g/day, some as much as 20 grams. Sodium is essential, but controversely
surrounds the amount required.
• Contact of sodium with water, including perspiration causes the formation
of sodium hydroxide fumes, which are highly irritating to skin, eyes, nose
and throat. This may cause sneezing and coughing. Very severe exposures
may result in difficult breathing, coughing and chemical bronchitis. Contact
to the skin may cause itching, tingling, thermal and caustic burns and
permanent damage. Contact with eyes may result in permanent damage
and loss of sight.

20. Sodium Deficiency Disease (Hyponatremia)
• Hyponatremia occurs when the concentration of sodium in your
blood is abnormally low. Sodium is an electrolyte, and it helps
regulate the amount of water that's in and around your cells.

21. Symptoms
• Hyponatremia signs and symptoms may include:
• Nausea and vomiting
• Headache
• Confusion
• Loss of energy, drowsiness and fatigue
• Restlessness and irritability
• Muscle weakness, spasms or cramps
• Seizures
• Coma

22. Causes
• Sodium plays a key role in your body. It helps maintain normal blood pressure, supports the work of your nerves and
muscles, and regulates your body's fluid balance.
• A normal blood sodium level is between 135 and 145 milliequivalents per liter (mEq/L). Hyponatremia occurs when
the sodium in your blood falls below 135 mEq/L.
• Many possible conditions and lifestyle factors can lead to hyponatremia, including:
• Certain medications. Some medications, such as some water pills (diuretics), antidepressants and pain
medications, can interfere with the normal hormonal and kidney processes that keep sodium concentrations within
the healthy normal range.
• Heart, kidney and liver problems. Congestive heart failure and certain diseases affecting the kidneys or liver can
cause fluids to accumulate in your body, which dilutes the sodium in your body, lowering the overall level.
• Syndrome of inappropriate anti-diuretic hormone (SIADH). In this condition, high levels of the anti-diuretic
hormone (ADH) are produced, causing your body to retain water instead of excreting it normally in your urine.
• Chronic, severe vomiting or diarrhea and other causes of dehydration. This causes your body to lose
electrolytes, such as sodium, and also increases ADH levels.
• Drinking too much water. Drinking excessive amounts of water can cause low sodium by overwhelming the
kidneys' ability to excrete water. Because you lose sodium through sweat, drinking too much water during endurance
activities, such as marathons and triathlons, can also dilute the sodium content of your blood.
• Hormonal changes. Adrenal gland insufficiency (Addison's disease) affects your adrenal glands' ability to produce
hormones that help maintain your body's balance of sodium, potassium and water. Low levels of thyroid hormone
also can cause a low blood-sodium level.
• The recreational drug Ecstasy. This amphetamine increases the risk of severe and even fatal cases of
hyponatremia.

23. What is potassium?
• Potassium is a mineral that is essential for all of the body's
functions. It helps nerves, muscles and the heart to function
properly, as well as helping move nutrients and waste
around your cells.
What is potassium deficiency?
• Potassium deficiency is when a person has abnormally low
levels of potassium in their body. It is also called
hypokalaemia.

24. Role and effect of Potassium
• Potassium can be found in vegetables, fruit, potatoes, meat, bread,
milk and nuts. It plays an important role in the physical fluid system of
humans and it assists nerve functions. Potassium, as the ion K+,
concnetrate inside cells, and 95% of the body's potassium is so
located. When our kidneys are somehow malfunctioning an
accumulation of potassium will consist. This can lead to disturbing
heartbeats.
• Potassium can effect you when breathed in. Inhalation of dust or
mists can irritate the eyes, nose, throat, lungs with sneezing, coughing
and sore throat. Higher exposures may cause a build up of fluid in the
lungs, this can cause death. Skin and eye contact can cause severe
burns leading to permanent damage.

25. What are the symptoms of potassium deficiency?
• Some people with potassium deficiency don't experience any symptoms.
• If you do have symptoms, they may include:
• weakness and fatigue
• feeling tired
• muscle cramps
• an abnormal heart rhythm (arrhythmia) — skipped heartbeats or an irregular
heartbeat
What causes potassium deficiency?
• There are many possible causes of potassium deficiency.
• The amount of potassium in the body is affected by:
• the climate
• your level of physical activity
• using diuretic medicines ('water tablets')
• how much sodium you consume (as found in table salt)

26. Zinc
Zinc is an essential nutrient found in a variety of plant and animal foods, along with
supplements. It plays a key role in skin health, immune function, and cell growth and
may protect against acne, inflammation, and other conditions.
Zinc is a mineral essential for many of the body's normal functions and systems,
including:
• the immune system
• wound healing
• blood clotting
• thyroid function
• senses of taste and smell
Zinc also supports normal growth and development during pregnancy, childhood and
adolescence.
Zinc deficiency is when the body does not have enough of the mineral zinc for the
body's essential functions.

27. Role and effect of Zinc
Zinc is a vital mineral that your body uses in countless ways.
• In fact, zinc is the second-most abundant trace mineral in your body —
after iron — and is present in every cell.
• Zinc is necessary for the activity of over 300 enzymes that aid in metabolism,
digestion, nerve function, and many other processes.
• In addition, it’s critical for the development and function of immune cells.
• This mineral is also fundamental to skin health, DNA synthesis, and protein
production.
• What’s more, body growth and development relies on zinc because of its
role in cell growth and division.
• Zinc is also needed for your senses of taste and smell. Because one of the
enzymes crucial for proper taste and smell is dependent on this nutrient, a
zinc deficiency can reduce your ability to taste or smell.

28. What are the symptoms of zinc deficiency?
• Zinc deficiency can result in skin changes that look like eczema at first. There may
be cracks and a 'glazed' (smooth or glassy) appearance on the skin. These
changes may be noticed first around the mouth, nappy area and hands. The rash
doesn't get better with moisturisers, steroid creams or lotions.
• People with zinc deficiency may also have:
• hair loss
• skin and hair changes
• eye problems
• more infections than usual
• wounds that take a long time to heal
• loss of taste and smell
• diarrhea

29. What causes zinc deficiency?
• Zinc deficiency is uncommon, but it can occur if people have medical problems
that interfere with zinc absorption from their food, or if they don't have enough
zinc in their diet.
• Zinc deficiency can happen in people who have problems absorbing nutrients
from food, for example, older people and those who have some gastrointestinal
(gut) diseases. Some medicines can also increase the loss of zinc through urine.
• Zinc from animal-based foods is better absorbed than from plant-based foods.
This means that vegetarians and vegans, and people on other long-term
restricted diets, may be at a higher risk of zinc deficiency.
• Zinc is only found in low amounts in breastmilk, so babies who are exclusively
breastfed longer than 6 months may also experience zinc deficiency.
• Sometimes, newborn babies experience zinc deficiency if they are premature or
very sick, or if their mothers had a mild zinc deficiency. Some people are born
with zinc deficiency.

30. Iron
• Iron is an important mineral that helps maintain healthy blood. A lack
of iron is called iron-deficiency anemia, which affects about 4-5
million Americans yearly. It is the most common nutritional deficiency
worldwide, causing extreme fatigue and lightheadedness.
• Iron is a major component of hemoglobin, a type of protein in red
blood cells that carries oxygen from your lungs to all parts of the
body. Without enough iron, there aren’t enough red blood cells to
transport oxygen, which leads to fatigue. Iron is also part of
myoglobin, a protein that carries and stores oxygen specifically in
muscle tissues. Iron is important for healthy brain development and
growth in children, and for the normal production and function of
various cells and hormones.

31. Role and effect of Iron
• Iron performs many important functions in the body. It is primarily
involved in the transfer of oxygen from the lungs to tissues. However,
iron also plays a role in metabolism as a component of some proteins
and enzymes.
• Iron is toxic to the body in its free state. It is associated with proteins
either through ligand binding or by being incorporated into a
porphyrin group - a ring-shaped molecule. A complex of the ferrous
form of iron and protoporphyrin IX is known as heme. Heme iron is
found in proteins connected with oxygen transport, including
hemoglobin and myoglobin. Non-heme iron can be found in proteins
connected with oxidative phosphorylation and in iron storage
proteins like transferrin and ferritin.

32. Symptoms
• Initially, iron deficiency anemia can be so mild that it goes unnoticed. But as the
body becomes more deficient in iron and anemia worsens, the signs and
symptoms intensify.
• Iron deficiency anemia signs and symptoms may include:
• Extreme fatigue
• Weakness
• Pale skin
• Chest pain, fast heartbeat or shortness of breath
• Headache, dizziness or lightheadedness
• Cold hands and feet
• Inflammation or soreness of your tongue
• Brittle nails
• Unusual cravings for non-nutritive substances, such as ice, dirt or starch
• Poor appetite, especially in infants and children with iron deficiency anemia

33. Causes
• Iron deficiency anemia occurs when your body doesn't have enough iron to produce hemoglobin. Hemoglobin
is the part of red blood cells that gives blood its red color and enables the red blood cells to carry oxygenated
blood throughout your body.
• If you aren't consuming enough iron, or if you're losing too much iron, your body can't produce enough
hemoglobin, and iron deficiency anemia will eventually develop.
• Causes of iron deficiency anemia include:
• Blood loss. Blood contains iron within red blood cells. So if you lose blood, you lose some iron. Women with
heavy periods are at risk of iron deficiency anemia because they lose blood during menstruation. Slow, chronic
blood loss within the body — such as from a peptic ulcer, a hiatal hernia, a colon polyp or colorectal cancer —
can cause iron deficiency anemia. Gastrointestinal bleeding can result from regular use of some over-the-
counter pain relievers, especially aspirin.
• A lack of iron in your diet. Your body regularly gets iron from the foods you eat. If you consume too little iron,
over time your body can become iron deficient. Examples of iron-rich foods include meat, eggs, leafy green
vegetables and iron-fortified foods. For proper growth and development, infants and children need iron from
their diets, too.
• An inability to absorb iron. Iron from food is absorbed into your bloodstream in your small intestine. An
intestinal disorder, such as celiac disease, which affects your intestine's ability to absorb nutrients from digested
food, can lead to iron deficiency anemia. If part of your small intestine has been bypassed or removed
surgically, that may affect your ability to absorb iron and other nutrients.
• Pregnancy. Without iron supplementation, iron deficiency anemia occurs in many pregnant women because
their iron stores need to serve their own increased blood volume as well as be a source of hemoglobin for the
growing fetus.

34. Calcium
• Calcium is a mineral most often associated with healthy bones and
teeth, although it also plays an important role in blood clotting,
helping muscles to contract, and regulating normal heart rhythms and
nerve functions. About 99% of the body’s calcium is stored in bones,
and the remaining 1% is found in blood, muscle, and other tissues.

35. Role and effect of Calcium
• In order to perform these vital daily functions, the body works to keep a steady amount
of calcium in the blood and tissues. If calcium levels drop too low in the blood,
parathyroid hormone (PTH) will signal the bones to release calcium into the
bloodstream. This hormone may also activate vitamin D to improve the absorption of
calcium in the intestines. At the same time, PTH signals the kidneys to release less
calcium in the urine. When the body has enough calcium, a different hormone called
calcitonin works to do the opposite: it lowers calcium levels in the blood by stopping the
release of calcium from bones and signaling the kidneys to rid more of it in the urine.
• The body gets the calcium it needs in two ways. One is by eating foods or supplements
that contain calcium, and the other is by drawing from calcium in the body. If one does
not eat enough calcium-containing foods, the body will remove calcium from bones.
Ideally, the calcium that is “borrowed” from the bones will be replaced at a later point.
But this doesn’t always happen, and can’t always be accomplished just by eating more
calcium.

36. Causes
• When you have low levels of calcium in your bloodstream, especially for
prolonged periods, that means there's less available for your bones, Herries
noted. The body tries to maintain a steady balance by "not placing calcium
'into storage.'"
• The body sometimes takes, or reabsorbs, calcium from bones or teeth to
maintain adequate blood calcium levels, added Herries. "This may then
increase your risk of developing osteoporosis in the future," she said.
• Hypocalcemia, a severe form of deficiency in calcium, can result from not
getting enough vitamin D or magnesium. Other causes of hypocalcemia can
include not producing enough parathyroid hormone, critical illness, and
certain medications, such as drugs that prevent or slow bone loss (called
bisphosphonates), chemotherapy drugs, and proton pump inhibitors for acid
reflux.

37. Symptoms
• A deficiency in calcium may not have symptoms. Osteoporosis, for example, can be sneaky. You may not know you have it until
you break a bone. Similarly, the most severe form of a deficiency in calcium, hypocalcemia, may be symptomless.
But when it does cause symptoms, you might have:
• Burning or prickling feeling in the hands and feet
• Muscle cramps
• Excessive nervousness
• Headaches
• Muscle spasms in your hands, feet, arms, legs or face
• Numbness or tingling around the mouth, fingers and toes
• Dry, coarse skin
• Patchy hair loss, such as thinning eyebrows
• Fatigue
• General weakness
• An abnormal heart rhythm

38. Nutritional excess and imbalance
• Malnutrition is an imbalance between the nutrients our body needs to function
and the nutrients it gets. It can mean undernutrition or overnutrition. we can be
malnourished from an overall lack of calories, or we might have a protein, vitamin
or mineral deficiency.
• Our body needs a variety of nutrients, and in certain amounts, to maintain its
tissues and its many functions. Malnutrition happens when the nutrients it gets
don’t meet these needs. we can be malnourished from an overall lack of
nutrients, or we may have an abundance of some kinds of nutrients but lack
other kinds. Even the lack of a single vitamin or mineral can have serious health
consequences for our body. On the other hand, having an excess of nutrients can
also cause problems.
• Malnutrition is an imbalance in dietary intake. It occurs when a person has too
much or too little food or essential nutrients. A person with malnutrition may
lack vitamins, minerals, and other essential substances that their body needs to
function.

39. Overnutrition / Nutritional excess
• Overnutrition is another type of malnutrition. It occurs when a person takes in
more nutrients than they need. The result may be an accumulation of body fat
from the excess nutrients, resulting in overweight or obesity.
• Overnutrition has several health implications. People who have overweight
or obesity are at greater risk of:
• heart disease
• high blood pressure
• diabetes
• cancer
• high cholesterol
• The rate of overnutrition is growing worldwide. The World Health Organization
(WHO) reports that in 2020, 5.7% of children under 5 were overweight, an
increase from 5.4% in 2000.

40. Causes of Nutritional Excess / overnutrition
• Macronutrient overnutrition
• When our body has an excess of protein, carbohydrate and/or fat calories to
use, it stores them away as fat cells in our adipose tissue. But when our body
runs out of tissue for storage, the fat cells themselves have to grow. Enlarged
fat cells are associated with chronic inflammation and with a host of
metabolic disorders that follow. These can lead to NCDs such as diabetes
mellitus, coronary artery disease and stroke.
• Micronutrient overnutrition
• We can actually overdose on vitamin and mineral supplements. More
research is needed to explain how this happens and how much is too much
of a certain vitamin or mineral. In general, micronutrient overnutrition is
uncommon and doesn’t occur from diet alone. But if we take mega doses of
certain supplements, it can have toxic effects. It’s a good idea to check with
our healthcare provider first.

41. Populations more at risk of overnutrition include:
• Poor and low income. In developed countries, poorer communities
often have easier access to fast foods, which are high in calories but
low in nutritional value, than they have to nutritious whole foods.
This can lead to macronutrient overnutrition with micronutrient
undernutrition.
• Sedentary. Desk jobs, family obligations, health and social factors that
keep people sitting all day instead of out and moving about can lead
to significant weight gain.

42. Signs and symptoms of overnutrition
• Obesity.
• High blood pressure.
• Insulin resistance.
• Heart disease

43. What are the causes of overnutrition?
• Few nutritious food options.
• A sedentary lifestyle.
• A condition that slows down your metabolism, such as hypothyroidism.
• A hormone imbalance that interferes with your hunger and fullness signals.
• Chronic stress.
• Anxiety or depression.
• Binge eating disorder.
• Chronic overuse of dietary supplements.

44. Symptoms of malnutrition
• Some signs and symptoms of malnutrition include:
• weight loss
• a lack of appetite or interest in food or drink
• tiredness and irritability
• an inability to concentrate
• always feeling cold
• depression
• loss of fat, muscle mass, and body tissue
• a higher risk of getting sick and taking longer to heal
• longer healing time for wounds
• Dry, inelastic skin, rashes and lesions.

45. What are the causes of malnutrition?
• Undernutrition is usually caused by not eating enough nutrients. It can also be caused by
certain medical conditions that prevent your body from absorbing nutrients.
• You might have trouble getting enough nutrients if you have:
• Limited financial resources.
• Limited access to nutritious foods.
• Medical conditions that make eating difficult, such as nausea or difficulty swallowing.
• Medical conditions that deplete calories, such as chronic diarrhea or cancer.
• An extra need for calories, such as during pregnancy, breastfeeding or childhood.
• Mental health conditions that discourage eating, such as depression or dementia.
• Eating disorders such as anorexia and bulimia.
• Malabsorption disorders such as pancreatic insufficiency or inflammatory bowel disease.
• A condition that requires long-term intravenous feeding.
• A very restricted diet or an unappealing diet chosen by someone else.

46. How is malnutrition diagnosed?
• Physical observation and a history of your diet and health
conditions are often enough to diagnose protein-energy
undernutrition or overnutrition. Healthcare providers may
measure your BMI or measure a child’s arm circumference to
help understand the extent of the problem. If possible, they will
take a blood sample to test for specific micronutrient
imbalances. Micronutrient undernutrition often accompanies
macronutrient undernutrition, and it can accompany
macronutrient overnutrition too. A blood test will also diagnose
the rare case of micronutrient overnutrition if you have those
symptoms.