This document discusses various nutritional diseases and deficiencies. It begins by defining nutritional diseases as conditions caused by nutrient deficiencies or excesses. It then examines protein-energy malnutrition (PEM) in detail, describing marasmus and kwashiorkor. It explains biochemically how insulin and glucagon imbalances in PEM can lead to distended abdomens. The document also briefly discusses carbohydrate deficiency and ketosis, as well as omega-3 and omega-6 fatty acid deficiencies. It concludes by assigning students to create a note on vitamin deficiencies, explaining the diseases, signs/symptoms, and biochemical basis.

1. NUTRITIONAL BASIS OF
DISEASES
DR IBEZIM U.H.
BCH 311

2. INTRODUCTION
• Nutritional diseases are the nutrient-related conditions and diseases
that cause illness in human
• What are nutrients?
• They may include deficiencies or excesses of at least one nutrient in
the diet, obesity and eating disorder, and chronic diseases such as
hypertension, cardiovascular disease, cancer, and diabetes mellitus
• Also, nutritional diseases include hereditary metabolic disorders
which respond to dietary treatment, developmental abnormalities
that are preventable by diet, food allergies and intolerances, potential
hazards in the food supply, and the interaction of foods and nutrients
with drugs

4. PEM
• Chronic undernutrition manifests mostly as PEM, which is the most
commonly encountered form of malnutrition globally
• Also known as protein-calorie malnutrition, it is a continuum in which
individuals (often children) eat too little energy, protein, or both
• At one end of the continuum is marasmus, an absolute deprivation of food
with grossly limited amounts of both protein and energy, and at the other
end is kwashiorkor, characterized by severe protein deficiency
• Kwashiorkor is usually seen in a child weaned from high-protein breast milk
to a carbohydrate diet source with no sufficient protein. Children with
kwashiorkor, which is characterized by swollen belly due to fluid retention
(edema) (why?), are weak, grow poorly, wasted, and are more prone to
infectious diseases, which can result in lethal diarrhea(why?)

5. • Other symptoms of kwashiorkor are hair discoloration, apathy, and dry,
peeling skin with some sores that fail to heal (why). The weight loss may be
disguised due to the presence of edema, intestinal parasites, and enlarged
fatty liver
• Marasmus and kwashiorkor can also occur in hospitalized or
institutionalized patients receiving intravenous glucose for extended time,
for example when recovering from surgery or illness, or in those with
illness causing loss of appetite or nutrients malabsorption.
• Persons with eating disorders, AIDS, cancer, and other illnesses where
absorption of nutrients is hampered or appetite fails may lose muscle,
organ tissue, and fat stores
• Treatment is aimed at nutritional rehabilitation
• Question: biochemically explain why distended abdomen is seen in PEM?

6. glucagon insulin
up
down

7. • Increased glucagon, catecholamines and cortisol and reduced insulin
including glucose stimulated insulin secretion due to starvation
• Leads to a reduced uptake of glucose by peripheral insulin dependent cells
such as? And a shift towards utilization of fatty acids as energy source via?
• Glucose consumption continues by non-insulin dependent tissues (e.g.?)
and is sustained by gluconeogenesis from the liver. This is influenced by
glucagon
• There is ketogenesis and lipolysis to yield energy in the absence of glucose.
• The rate of lipolysis or ketogenesis relies on 3 enzymes
• Hormone sensitive lipase/triglyceride lipase
• Acetyl CoA carboxylase
• Mitochondrial 3-hydroxy-3methylglutaryl-CoA synthase

8. • On a good day, insulin inhibits ketogenesis by causing the
dephosphorylation of HSL and leads to lipogenesis by stimulating acetyl
CoA carboxylase
• In adipose tissues, dephosphorylation of HSL decreases the degradation of
TGs into FAs and glycerol which is the rate limiting step in the release of
FFAs from the adipocytes. This reduces the substrate needed for
ketogenesis
• Insulin also dephosphorylates the inhibitory sites of acetyl CoA
carboxylase which leads to enzyme activation and production of malonyl
CoA which inhibits β-oxidation of Fas thereby decreasing ketogenesis
• In hepatocytes, phosphorylation of acetyl CoA carboxylase by cAMP-
dependent protein kinase decreases the production of malonyl CoA. This is
done in the absence of insulin
• The activity of mHS is increased by starvation and a high fat diet and is
decreased by insulin

9. • Eventually, decreased gluconeogenesis occurs in PEM due to
prolonged starvation or fasting. There is deficiency of amino acids
necessary for gluconeogenesis.
• Quiz for the smart: glucagon concentrations have been found to be
lower in children with kwashiorkor compared with marasmus ……
why?
• PEM is frequently reported in Cri du chat syndrome (CDS), a genetic
disease…. For distinction students

10. CHO DEFICIENCY
• Under some circumstances, there is no total and complete dietary
requirement for carbohydrates
• Some cells, such as the brain cells, require glucose as fuel. If there is
insufficient dietary carbohydrate, glucose synthesis depends on breakdown
of amino acids derived from the body protein, dietary protein, and the
glycerol, which is derived from fat. The process is called gluconeogenesis,
and occurs mostly in the liver.
• Long-term carbohydrate insufficiency results in a condition known as
ketosis (increased production of some organic compounds called ketones),
which imparts a distinct sweet odor to the breath. Also known as?
• Question: what common metabolic disease condition can
ketosis/ketonemia/ketonuria be found? List the 3 ketone bodies you know
and which is present/common in the above named condition

11. FATTY ACIDS
• Omega-3 and omega-6 fatty acids also known as?
• The deficiencies of these two omega fatty acids have been detected in
hospitalized patients exclusively fed with intravenous fluids having no
fat for weeks, infants given low fat formulas, young children fed low-
fat diets or nonfat milk, and patients with medical conditions affecting
the absorption of fat such as?
• Symptoms of deficiency include hair loss, impaired wound healing,
and dry skin.

12. ASSIGNMENT
• CREATE A NOTE ON VITAMIN DEFICIENCIES
• AFTER THIS ASSIGNMENT YOU SHOULD KNOW:
• The different diseases caused by the different vitamin deficiencies
• The clinical signs and symptoms of these deficiencies
• The biochemical basis for such occurrences

13. I LOVE YOU GUYS
MEDICINE IS TOUGH BUT YOU ARE TOUGHER
NEVER FORGET THAT
NEVER EVER
#WINKS