This document discusses various nutritional disorders including malnutrition, undernutrition, micronutrient deficiencies, overweight, obesity, and metabolic syndrome. It defines each condition and provides details on signs, causes, and health effects. Malnutrition refers to deficiencies or imbalances in energy and nutrient intake and includes undernutrition, micronutrient deficiencies, overweight, and obesity. Undernutrition is insufficient food intake over time and includes wasting, stunting, and being underweight. Micronutrient deficiencies involve inadequate intake of vitamins and minerals. Overweight and obesity result from excessive calorie intake over time and not enough physical activity.

1. Nutritional disorders
DR. FARHANA ATIA
Assistant Professor (Biochemistry)
Nilphamari Medical College
Nilphamari, Bangladesh

2. Nutrition
Nutrition is a dynamic process of utilization of food by living
organisms concern with ingestion, digestion, absorption and
assimilation of food for nourishing the body.
Signs of good nutrition:
• Smooth shiny skin
• Glossy hair
• Well developed muscle, bone, teeth
• Strong build & energetic to look at

3. Malnutrition
• Malnutrition refers to deficiency, excess or imbalance in a
person’s intake of energy and/ or nutrients.
• Types
1. Under-nutrition
2. Micronutrient related malnutrition
3. Overweight & obesity
4. Diet related non-communicable disease

4. Under-nutrition
Insufficient food intake over an extended period of time.
Includes-
• Wasting: Low weight-for-height
Indicate recent, severe weight loss
• Stunting: Low height-for-age
In chronic & recurrent under-nutrition
• Underweight: Low weight-for-age
May be stunted, wasted or both

5. Micronutrient related malnutrition
Inadequacies or excesses in intake of vitamins & minerals.
Includes-
• Micronutrient deficiency:
• A lack of important vitamins & minerals.
• Iodine, vitamin A & iron deficiency is observed in
population worldwide
• Micronutrient excess:
• Hypervitaminosis

6. Overweight & obesity
• When a person is too heavy for his or her height
• Results in consumption of excessive quantity of food or
calorie over an extended period of time & engagement
in less physical activity.
Diet related non-communicable disease
• Cardiovascular disease (heart attack & stroke,
hypertension)
• Certain cancers
• Diabetes

7. Malnutrition in Bangladesh
• PEM [Protein energy malnutrition]
• Iron deficiency
• Vitamin A deficiency
• Iodine deficiency (Endemic goiter)
• Zinc deficiency
• Vit-B12 & Folic acid deficiency (combined deficiency
anemia)
• Diabetes & cardiovascular disease
• Malnutrition due to illiteracy & ignorance

8. Protein Energy Malnutrition
PEM is a spectrum of malnutrition occur
• due to deficiency of protein & or energy
• manifested by growth failure and
• associated with infection
• usually in children of low socioeconomic family
In developed country most commonly seen in
• patients with medical conditions that ↓ appetite or alter
how nutrients are digested/ absorbed
• in hospitalized patients (major trauma/ infection)

9. Classification of PEM
1. Kwashiorkor
• Protein deprivation is relatively greater than reduction in
total calories
• Commonly seen in children after weaning when their diet
consists predominantly of carbohydrates
2. Marasmus
• Calorie deprivation is relatively greater than the reduction
of protein
• Usually occurs in age <1 year when breast milk is
supplemented/ replaced with watery native cereal
3. Marasmic kwashiorkor- Has features of both forms

10. Traits Kwashiorkor Marasmus
Affected group Only children
(1 –3 years)
Both children & adult
Weight for age 60-80% <60%
Weight for height Normal/ ↓ Markedly ↓

11. Clinical features
Kwashiorkor Marasmus
Stunted growth Arrested growth
Skin lesions Extreme muscle wasting
Depigmented hair ↓ subcutaneous fat
Anorexia Weakness
Fatty liver Anemia
Bilateral pitting edema No edema
↓↓ serum albumin conc. Diarrhea
Muscle & fat loss may be masked by edema
Diarrhea

12. Edema in Kwashiorkor
Edema results from lack of adequate plasma protein to maintain
distribution of water between blood & tissues.
Kwashiorkor
↓
Hypoproteinemia
↓
↓plasma osmotic pressure
↓
↓Blood vol.
↓
↓cardiac output
↓
↓effective arterial blood vol.

13. Edema in Kwashiorkor
↓
↑ Renin secretion
↓
↑ Aldosterone
↓
↑ renal Na reabsorption
↓
↑ Renal water retention
↓
↑ Plasma volume
↓
↑ Transudation
↓
Edema

14. Muscle Wasting in Marasmus
• Prolong negative energy balance
• Body’s fat reserve exhausted
• Amino acids released from catabolism of tissue protein (not
only from muscle but also from heart, liver & kidneys)
• Amino acids are used as a source of metabolic fuel &
substrate for gluconeogenesis to maintain supply of glucose
for brain and RBC.

15. OBESITY
• Obesity is a disorder of body weight regulatory system
characterized by an accumulation of excess body fat.
• Now a days- obese > malnourished worldwide
• Alarming situation- obesity in children & adolescents
• Contributors of obesity epidemic
Sedentary lifestyle
Abundance & variety of palatable food
Industrialized society

16. Assessment of obesity: Amount of body fat
• Estimated indirectly by BMI (body mass index)
• Calculated by-
Wt in kg
-------------------------------------------------
Height in m²
• < 18.5 : Underweight
• 18.5-24.9 : Normal/ healthy
• 25-29.9 : Over wt.
• ≥30 : Obese
• > 40 : Morbid obesity

17. BMI chart

18. Assessment of obesity: Location of body fat
Abdomen, viscera
• Android/ apple shaped/ upper
body obesity
• ↑ risk of morbidity/ mortality
Hips, thighs
• Gynoid/ pear shaped/ lower
body obesity
• Nearly normal risk
•A waist/hip ratio >0.8 for women,
>1.0 for men
•A waist/hip ratio <0.8 for
women, <1.0 for men
A waist size ≥40 in men &
≥ 35 in women is
considered a risk factor

19. Biochemical differences in regional fat depots
• Lower body adipocytes are
larger, very efficient at fat deposition
tend to mobilize fatty acids slowly
FFA enter the general circulation & oxidized in muscle
• Visceral adipocytes
the most metabolically active
hormonally more responsive
FFA & cytokines released from this depot enter the portal vein and
have direct access to liver which may lead to insulin resistance &
increased TAG synthesis

20. Number & size of adipocytes
• Most obesity are thought to
involve an increase in both the
number & size of adipocytes
• Fat cells, once gained, are never
lost
• This observation emphasizes the
importance of preventing obesity
in the first place

21. Obesity results when energy intake
exceeds energy expenditure
Energy
expenditure
Energy (food)
intake
Genetic factor
Chemical factor
Environmental & behavioral
factor
Influenced by

22. Genetic contributions
• Influence both intake & expenditure
• Major role in determining body weight
• Biologic origin
70- 80 % chance of obesity if both parents are obese
The chance is 9% when both parents are lean
Identical twins have similar BMI
• Mutations
Single gene mutations can cause obesity (rare)

23. Chemical factors
• Leptin
• Serotonin
• Dopamine
• Ghrelin
• Cholecystokinin
• Norepinephrin
• Insulin

25. Environmental & Behavioral Factor
• Availability of food
• Palatable
• Energy dense
• Sedentary lifestyle (less physical activity)
• TV watching
• Automobiles
• Computer usage
• Energy sparing devices
• Eating behaviors
• Snacking
• Portion size
• Variety of food

26. Complications of Obesity
• DM Type II
• Coronary heart disease
• Hypertension
• Dyslipidemia
• Gall stone
• Cancer
• Arthritis
• Gout
• Sleep apnea
Ultimately risk of death is increased

27. Management outline of Obesity
Weight reduction process
Leads to ↓BP, ↓ serum TG, ↓ BGL, ↑HDL
• Diet
• Exercise
• Behavioral therapy
• Drugs
• To suppress appetite centrally
• Inhibit lipase in gut ↓ absorption of FA
• Surgery : Gastric banding
• When BMI > 40

28. Metabolic Syndrome/ Syndrome X
Abdominal obesity is associated with a cluster of metabolic
abnormalities that is referred to as the metabolic syndrome.
It includes
Hyperglycemia
Insulin resistance
Hyper-insulinemia
Dyslipidemia (↓ HDL, ↑ TG)
Hypertension
• Associated with increase risk of type II DM & heart disease

29. Dyslipidemia
Dyslipidemia is a disorder of rate of synthesis or clearance
of lipoprotein from the blood stream.
Features-
• ↑↑ TG
• ↑↑ Cholesterol
• ↑ LDL
• ↑ VLDL
• ↓ HDL

30. Causes of Dyslipidemia
• Drugs
• Corticosteroids
• Thiazide
• Beta blocker
• Some OCP
• Endocrine & metabolic disorder
• DM
• Hypopituitarism
• Hypothyroidism
• Pregnancy
• Storage disease
• Glycogen storage disease
• Renal
• CRF
• NS
• Hepatic
• Recurrent intrahepatic
cholestasis
• Acute & transient
• MI
• Others
• Anorexia nervosa
• Starvation