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Nutritional dissorders

The document discusses various nutritional disorders including obesity, starvation, kwashiorkor, marasmus, anorexia nervosa and bulimia nervosa. It defines key terms like calorie and essential nutrients. For each disorder, it describes the etiology, clinical manifestations, pathophysiology, nursing management and prevention. Specifically, it provides details on the signs and symptoms of kwashiorkor and marasmus, how they differ in morphology and nutritional content of foods to prevent protein deficiency. The nursing management of eating disorders focuses on helping clients develop normal eating behaviors and self-image.

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Guided by: Latha mam 02/11/14 NUTRITIONAL DISORDERS 1
What is calorie? CALORIE - is the amount of energy needed to raise the temperature of one gram of water by one degree Celsius         CALORIE = is represented by the letter C. 02/11/14 NUTRITIONAL DISORDERS 2
Essential nutrients Proteins Fats Carbohydrates Vitamins Minerals  water 02/11/14 NUTRITIONAL DISORDERS 3
Main nutritional disorders Obesity Starvation Kwashiorkor  Marasmus Anorexia nervosa Bulimia nervosa Vitamin deficiency Trace element deficiency 02/11/14 NUTRITIONAL DISORDERS 4
Obesity Obesity is defined as an excess of adipose tissue that imparts health risk. Etiology  genetic predisposition  diets largely derived from carbohydrates and fats than protein rich food. hypothyroidism, cushings syndrome, insulinoma, and hypothalamic disorders 02/11/14 NUTRITIONAL DISORDERS 5
Pathophysiology Obesity is associated with increased adipose stores in the subcutaneous tissue, skeletal muscles, internal organs such as the kidneys, heart, liver and fatty liver is also more common in obese individuals. There is increase in both sizes number of adipocytes and there is hypertrophy as well as hyperplasia. 02/11/14 NUTRITIONAL DISORDERS 6
Obesity 02/11/14 NUTRITIONAL DISORDERS 7
Metabolic changes Hyper insulinaemia Non- Insulin dependant diabetes Hypertension Hyper lipoproteinaemia: Atherosclerosis Coronary artery disease Cholelithiasis Cancer Osteoarthritis: 02/11/14 NUTRITIONAL DISORDERS 8
Serious health hazards of obesity Stroke Coronary artery diseases Hypertension Fatty liver Diabetes Atherosclerosis Hyperlipidaemia Osteoarthritis 02/11/14 NUTRITIONAL DISORDERS 9
02/11/14 NUTRITIONAL DISORDERS 10
Management of obesity Nutritional therapy Behavior modification Support groups MEDICAL MANAGEMENT Drug therapy {appetite suppressing drugs} Phentermine, diethylpropion etc. SURGICAL MANAGEMENT Vertical banded gastroplasty Adjustable gastric banding 02/11/14 NUTRITIONAL DISORDERS 11
Starvation Starvation is a state of overall deprivation of nutrients. Etiology    02/11/14 deliberate fasting famine conditions in a country or community. secondary under nutrition such as chronic wasting diseases, cancers etc. NUTRITIONAL DISORDERS 12
Signs and symptoms Dry and scaly skin  muscular weakness Anemia Increased susceptibility to infections Loss of appetite Wound healing may be delayed Brittle nails Loss of hair Depression Decreased B P ,pulse, slight cyanosis. 02/11/14 NUTRITIONAL DISORDERS 13
Starvation 02/11/14 NUTRITIONAL DISORDERS 14
Nursing management Health promotion Acute intervention Health education Try to maintain an optimal body weight TYPES OF SPECIALISED NUTRITIONAL THERAPY Oral feeding Tube feeding nasogastric and nasointestinal feeding gastrostomy and jejenostomy 02/11/14 NUTRITIONAL DISORDERS 15
Protein deficiency malnutrition Kwashiorkor- Which is related to protein deficiency through calorie intake may be sufficient. Marasmus- is starvation in infants occurring due to overall lack of calories. 02/11/14 NUTRITIONAL DISORDERS 16
KWASHIORKOR Clinical features Occurs in children between 6 months 3 years of age Growth failure Wasting muscles but preserved adipose tissue Edema , localized or generalized, present Enlarged fatty liver Serum proteins low Anemia present Alternate bands of light and dark hair 02/11/14 MARASMUS Clinical features Growth failure Wasting of all tissues including muscles and adipose tissue Edema present No hepatic enlargement Serum proteins low Anemia present Monkey-like face, protuberant abdomen, thin limbs NUTRITIONAL DISORDERS 17
02/11/14 NUTRITIONAL DISORDERS 18
02/11/14 NUTRITIONAL DISORDERS 19
Morphology KWASHIORKOR Morphology Enlarged fatty liver Atrophy of different tissues and organs but subcutaneous fat preserved 02/11/14 NUTRITIONAL DISORDERS MARASMUS Morphology No fatty liver Atrophy of different tissues and organs including subcutaneous fat 20
02/11/14 NUTRITIONAL DISORDERS 21
02/11/14 NUTRITIONAL DISORDERS 22
marasmus Diagnostic Evaluation Severe hypo chromic anemia is generally diagnosed. The plasma proteins level is usually lowered unless hemo concentration is present. 02/11/14 NUTRITIONAL DISORDERS 23
Pathophysiology marasmus When adequate calories are not ingested to fulfill the metabolic needs of the body, reserve food elements such as protein and fat in the tissues are used to sustain life. This process may be caused by An inadequate diet or faulty eating habits Congenital anomalies that present the infant taking an adequate diet Disease condition that interfere with the assimilation of food  Infections that produce anorexia and decrease the infants ability to digest food Loss of food intake through vomiting and diarrhea Food allergy that is not managed appropriate Emotional problems such as disturbed mother child relations. 02/11/14 NUTRITIONAL DISORDERS 24
Nursing Management of marasmus  Management consists of providing a nutritional intake that is rich in the essential nutrients to correct the dietary insufficiency and to promote normal growth and development. Parenteral fluid therapy may initially be necessary to correct the electrolyte imbalance and dehydration and to restore kidney if oral feedings are not tolerated, hyper alimentation is used. Additional vitamins and minerals and blood transfusion may be necessary. 02/11/14 NUTRITIONAL DISORDERS 25
In addition to assisting with administering parenteral fluids and giving oral feedings, the nurse is also responsible for maintaining the infant’s body temperature within a normal range, providing for periods of rest and appropriate activity and stimulation, recording intake and output, daily weighing turning and preventing infection. The nurse carefully observes affected infants for infection of mouth, skin and respiratory and genitourinary tracts. These infections are appropriately treated when they occur. The infant is protected from other patient and care givers who have infections because infants who have marasmus may also have emotional deprivation, their care is like that for those who have failure to thrive. 02/11/14 NUTRITIONAL DISORDERS 26
Prevention of marasmus The prevention of marasums consists of Parent education Prompt treatment congenital defects Prevention of emotional disturbance 02/11/14 NUTRITIONAL DISORDERS 27
KWASHIORKOR 02/11/14 NUTRITIONAL DISORDERS 28
Pathophysiology Kwashiorkor While growth is occurring, sufficient nitrogenous food must be consumed to maintain a positive nitrogen balance. When inadequate amounts of the essential aminoacids are not provided, not absorbed or abnormally lost, protein under nutrition results. The impaired absorption or loss of protein may occur in infants and children who have chronic diarrhea, nephrosis, hemorrhage, burns or infection. Nutritional edema, results when the body, lacking sufficient intake or sustaining a loss of high quality protein, burns its own tissues and destroys the plasma protein so that the level of plasma albumin becomes low. 02/11/14 NUTRITIONAL DISORDERS 29
kwashiorkor 02/11/14 NUTRITIONAL DISORDERS 30
PROTEIN CONTENT FOODS Eggs Cow’s milk Cheese Meat cooked Fish cooked Rice cooked Soy beans White potato wheat germ Nuts 02/11/14 NUTRITIONAL DISORDERS 31
02/11/14 NUTRITIONAL DISORDERS 32
Nursing Management The management of infants and children who have kwashiorkor includes replacement of the missing nutrients and treatment for any acute problems such as diarrhea, renal failure and shock. The dietary intake of protein and calorie in increased gradually, skin milk, synthetic amino acid mixtures or case in hydrolysates may be given to supplement the usual diet. Vitamins and minerals, especially vitamin 4, magnesium and potassium are added to the intake to correct any deficiencies. 02/11/14 NUTRITIONAL DISORDERS 33
The accompanying anemia can be corrected by administering iron and folic acid. In spite of this management the infant or child may initially loss weight because of the loss of edema fluid. However improvement can gradually be seen. Infections or infestations are treated appropriately. The long term management consists of feeding the child a diet with adequate calories, especially one high in protein of good biologic quality. 02/11/14 NUTRITIONAL DISORDERS 34
Prevention Prevention consists of providing a diet containing an adequate quality of protein of high biologic quality for all infants and children. In those areas where kwashiorkor is endemic parents should be taught the nutritional needs of all family members and adequate amounts of food should be provided to fulfill these needs. 02/11/14 NUTRITIONAL DISORDERS 35
Anorexia nervosa An eating disorder in which the person experiences hunger but refuses to eat because of a distorted body image, leading to a self perception of fatness. Anorexia nervosa is a condition of selfgenerated weight loss usually seen in adolescent girls and young women, but also in middle-aged women or men 02/11/14 NUTRITIONAL DISORDERS 36
Etiology of eating disorders Although the cause of eating disorders is not certain, several factors are likely to contribute to development of the disorders. Socio cultural and environmental factors including media and peer influences, family factors including parental discord, and biologic factors including genetics, neurotransmitter regulation, and hormonal functioning have been implicated. Negative affect, low selfesteem, and dieting behavior commonly predate the onset of an eating disorder. 02/11/14 NUTRITIONAL DISORDERS 37
Clinical manifestations of anorexia nervosa Clients with anorexia nervosa are usually first introduced to the health care system when the disordered eating behavior results in obvious weight loss. Clients may limit themselves to 200 to 500 kcal/day-only 60% to 70% of the amount needed for ideal body weight. Physical manifestations include dry skin, pallor, bradycardia, hypotension, intolerance to cold, constipation, and amenorrhea 02/11/14 NUTRITIONAL DISORDERS 38
Pathophysiology  The pathophysiologic changes associated with anorexia nervosa are similar to those seen in starvation. When caloric intake is severely limited, the body adapts by using the body's fat stores and sparing nitrogen stores. With prolonged starvation, significant shifts in fluid and electrolyte balance can occur and can be life-threatening. The hypothalamus responds to the lack of nutrient intake with changes in pituitary function, resulting in amenorrhea and infertility. The extent of malnutrition will determine the pathophysiologic changes observed. 02/11/14 NUTRITIONAL DISORDERS 39
02/11/14 NUTRITIONAL DISORDERS 40
Bulimia nervosa  An eating disorder characterized by uncontrollable binge eating alternating with vomiting or dieting. Bulimia nervosa is a less serious and entirely separate illness. Clients with bulimia nervosa tend to maintain a relatively normal weight, but go through periods of eating excessively (binging) and vomiting (purging) gastric contents to prevent weight gain. It has been suggested that bulimia nervosa is a form of depressive illness. 02/11/14 NUTRITIONAL DISORDERS 41
Clinical manifestations of bulimia nervosa  Clinical manifestations of bulimia nervosa include episodes of binge eating followed by self-induced vomiting. The eating and vomiting episodes occur most often in the late afternoon and evening and are done in secret. Some clients may abuse laxatives and diuretics as well. Personality characteristics typical of clients with bulimia are related to depression. Physical manifestations may not be as obvious, because the client with bulimia may be of normal weight without any depletion of fat stores. Less obvious clinical manifestations are erosion of tooth enamel from frequent vomiting and esophageal and throat irritation. 02/11/14 NUTRITIONAL DISORDERS 42
02/11/14 NUTRITIONAL DISORDERS 43
Nursing management of eating disorders  Outcomes  The client will be able to resume normal earning behaviors. In clients with severe nutritional depletion, the client will be able to regain weight at a safe rare (1 to 2 pounds/week).  Interventions: When caring for a client with anorexia nervosa, help the client select foods from the Food Guide Pyramid for a nutritionally balanced diet. The client is usually allowed to refuse a specific number of foods (such as two or three) so that some sense of control is felt. Observe the client during mealtimes. Be supportive during mealtimes and, if needed, stay with the client after he or she eats to prevent him or her from purging. Education related to nutrition must include the client's family, care-givers, or co-residents. An accurate calorie count and regular monitoring of weight are other important interven-tions. Parenteral or enteral nutrition may be needed forr refractory clients with extreme malnutrition. 02/11/14 NUTRITIONAL DISORDERS 44
Management cond……… Outcomes The client will lose 1 to 2 pounds per week until ideal body weight is achieved and maintain ideal body weight thereafter Interventions  Teach the client how to use the Food Guide Pyramid to select a healthy diet with portions of appropri-ate size. Encourage the client to eat slowly and develop a regular exercise pattern. Encourage the client to approach food, eating, and self-image in a new way. Provide emotional support and supervision for the client to overcome stressful periods and break the binge-and-purge cycle.  02/11/14 NUTRITIONAL DISORDERS 45
Management cond………  Outcomes The client will develop a more normal image of self, as evidenced by statements concerning increased self-esteem by the client's ability to overcome the eating disorder.  Interventions  Recognize that clients suffering from eating disorders typically have low self-esteem. These clients see the regulation of food and exercise of self-control in eating patterns and amounts as ways to prove themselves successful. It is important that the client's significant others help the client find other areas of self-regard. It is expected that the client will overcome the eating disorder with consistent and continued treatment and that weight will return to normal.    02/11/14 NUTRITIONAL DISORDERS 46
Vitamins Fat soluble vitamins vit A b) vit D c) vit E d) vit K  water soluble vitamins a) vit C b) vit B complex a) 02/11/14 NUTRITIONAL DISORDERS 47
Vitamin A [retinol] Physiologic functions of retinol Maintenance of normal vision in reduced light. This involves synthesis of rhodopsin, a light sensitive pigment in the rods and cones of retina, by oxidation of retinol. This pigment then transforms the radiant energy in to nerve impulses. Maintenance of structure and function of specialized epithelium Maintenance of normal cartilaginous and bone growth. 02/11/14 NUTRITIONAL DISORDERS 48
02/11/14 NUTRITIONAL DISORDERS 49
Deficiencies of vit A Night blindness Ocular lesions Cutaneous lesions Bitot spot Xerophthalmia 02/11/14 NUTRITIONAL DISORDERS 50
Bitot’s spot 02/11/14 NUTRITIONAL DISORDERS 51
Pathological changes: - Consequent to vitamin A deficiency following pathologic changes are seen. Ocular lesions: - Lesions in the eyes are most obvious. Night blindness is usually the first sign of vitamin A deficiency. As a result of replacement metaplasia of mucus secreting cells by squamous cells, there is dry and scaly sclera conjunctiva (xerophthalmia). The lacrimal duct also shows hyperkeratosis corneal ulcer may occur. Bitot's spots may appear which are focal triangular areas of opacities due to accumulation of keratinized epithelium. 02/11/14 NUTRITIONAL DISORDERS 52
contd If these occur on cornea, they impede transmission of light. Ultimately, infection, scarring and opacities lead to blindness. Cutaneous lesion:- The skin develops popular lesions giving toad like appearance (xeroderma). This is due to follicular hyper kurtosis and keratin plugging in the sebaceous gland. 02/11/14 NUTRITIONAL DISORDERS 53
Sources The major sources of retinol are liver, dairy products, eggs and carotenes are found in varying amounts in vegetables and fruits, especially in most of the dark green leafy and bright orange ones. Carotenes may also be present in the foods listed above that naturally contain retinol.  Recommended intake The 1980 RDA for Vitamin A is (5000 IU) for men and (4000 IU) for woman. 02/11/14 NUTRITIONAL DISORDERS 54
Management Mild to moderate cases of deficiency can be treated by daily oral dose of 10,000 IU of fat soluble vitamin A for 10 days. In severe cases larger dose (50,000 IU) is recommended for one week. A single massive dose of 50,000 IU of vitamin A every six months is prophylactic for children below six years of age. 02/11/14 NUTRITIONAL DISORDERS 55
Vitamin D[Calciferol] Functions Vitamin D is of almost importance in the regulation of calcium and phosphorous metabolism in the body. It serves to maintain proper blood levels of calcium and phosphorous by promoting their intestinal absorption and by mobilizing these minerals from the skeleton when needed. Mineralization of the skeleton and teeth requires an adequate supply of vitamin D. 02/11/14 NUTRITIONAL DISORDERS 56
02/11/14 NUTRITIONAL DISORDERS 57
Sources Exposure to straight, fortified foods, fish lives oil are good sources of vitamin D natural foods are poor sources at vitamin D although small amounts are present in egg yolk, liver, and fish such as herring, sardines, tuna and salmon. Recommended dietary allowances Vitamin D is now considered more as a pro hormone than a vitamin. Exposure to sunlight even for 5 minutes per day. A specific recommendation of a daily supplement of 400 IU is made. 02/11/14 NUTRITIONAL DISORDERS 58
Vitamin D deficiencies Tetani Rickets Osteomalacia 02/11/14 NUTRITIONAL DISORDERS 59
Tetani This is characterized by low serum calcium (less than 7.5 mg per 100ml) muscle twitching, cramps, and convulsions. It results from insufficient absorption of calcium or vitamin D, or from a disturbance of the parathyroid gland. 02/11/14 NUTRITIONAL DISORDERS 60
Osteomalacia Osteomalacia frequently called as adult rickets, occurs when there is lack of vitamin D and calcium. It may also occur when there is an interference with fat absorption and hence also vitamin D absorption.  02/11/14 NUTRITIONAL DISORDERS 61
Osteomalacia 02/11/14 NUTRITIONAL DISORDERS 62
Osteomalacia 02/11/14 NUTRITIONAL DISORDERS 63
Rickets Etiology Poor exposure to sunlight may also be related to the inactivity of the malnourished children. Disturbed metabolism and poor synthesis of vit D from the skin ,malabsorption state , diarrheal diseases and excessive phylate with low calcium and low phosphate content of the food may well be some causes of rickets in malnourished children. 02/11/14 NUTRITIONAL DISORDERS 64
Rickets 02/11/14 NUTRITIONAL DISORDERS 65
Rickets clinical features Head-Increased size and delayed closure of fontanels , craniotabes  Teeth-delayed dentition Thorax- rachitic rosary, pigeon chest Spine-scoliosis , kyphosis Limbs-widening of wrists, ankles and other epiphysis , genu valgum 02/11/14 NUTRITIONAL DISORDERS 66
rickets 02/11/14 NUTRITIONAL DISORDERS 67
Management In case of rickets recommended dose of vit D is 10000 to 50000units per day 02/11/14 NUTRITIONAL DISORDERS 68
Rickets heals promptly with 4,000 IU of oral vitamin D per day administered for approximately one month.. The bone abnormalities (visible by x ray) generally disappear gradually over a period of 3-9 months. Parents are instructed to take their infants outdoors for approximately 20 minutes per day with their faces exposed. Children should also be encouraged to play outside. Foods that are good sources of vitamin D include cod liver oil, egg yolks, butter, and oily fish. Some foods, including milk and breakfast cereals, are also fortified with synthetic vitamin D. 02/11/14 NUTRITIONAL DISORDERS 69
Rickets 02/11/14 NUTRITIONAL DISORDERS 70
Vitamin E[Tocopherol] Functions Vitamin E is needed for normal stability of red blood cells. In animals it has been shown to be essential for normal reproduction and for integrity and muscle and for nerves. There is no sound scientific basis for claims in the lay literature that vitamin E promotes fertility and sexual performance.. 02/11/14 NUTRITIONAL DISORDERS 71
02/11/14 NUTRITIONAL DISORDERS 72
Source The richest source of vitamin E are the vegetable oils that are risk in poly unsaturated wheat germ, nuts, whole grains, legumes and certain vegetables. Another sources Soybean oil, sunflower oil, mayonnaise walnut, lima beans, sweat potatoes, spinach, fish, liver, shell fish, eggs.   02/11/14 NUTRITIONAL DISORDERS 73
Recommended intake Although the 1980 RDA has been set at 10 mg tocopherol for men and 8 mg for woman this should be considered to be a recommendation for people consuming customary American diets. 02/11/14 NUTRITIONAL DISORDERS 74
Vitamin E deficiency Vitamin E deficiency is extremely rare in humans. It is limited to those individuals with fat malabsorption, or patients on total parenteral nutrition, or in formula fed premature infants. Changes occurring in severe deficiency include, increased hemolysis of red blood cells, creatinuria deposition of brandish ceroid pigments in smooth muscles and , in some cases, development of a form of muscular dystrophy  02/11/14 NUTRITIONAL DISORDERS 75
Management of Vitamin E disorders  Vitamin E has been used in daily doses of 400 to 800 mg for the treatment of diverse conditions such as habitual abortion, sterility muscular dystrophy diabetes ischemic heart disease, skin disorders and anemia in infants. Benefit has been reported in some of these cases but none has been established in clinical trails. Administration of 3 to 4 g of tocopherol daily over long periods has not produced any toxic effects in human beings. However several reports of adverse effects such as elevation of serum lipids, impaired blood coagulation and reduction of serum thyroid hormones suggest that indiscriminate ingestion of excessive amounts over long periods should be avoided. 02/11/14 NUTRITIONAL DISORDERS 76
Vitamin K Vitamin K is concerned with synthesis of coagulation factors 2,7,9,and 10 in the liver. Green leafy vegetables, soybeans and fish are it’s natural sources. Enough of these vitamin is produced by intestinal flora 02/11/14 NUTRITIONAL DISORDERS 77
02/11/14 NUTRITIONAL DISORDERS 78
Function Vitamin K is essential for the hepatic synthesis of prothrombin and certain others factors involved in blood clotting. For this reason it is sometimes called the antihemorrhagic it also appears to have a role in some metabolism. Sources Green leafy vegetables, cauliflower, broccoli and liver all the richest dietary sources of vitamin K. However, bacterial synthesis of vitamin K in the gut accounts for a large proportion of a persons daily supply initially a new born infant has a sterile gastro intestinal tract and thus cannot synthesize significant amounts of vitamin K for a few days since milk is low in vitamin K the vitamin is routinely administered to new borne. 02/11/14 NUTRITIONAL DISORDERS 79
DEFICIENCY DISORDERS Hemorrhagic disease of new born:- The new born infants are deficient in vitamin K because of minimal stores of vitamin K of birth, lack of established intestinal flora for endogenous synthesis and limited dietary intake since breast milk is a poor source of vitamin K. Biliary obstruction:- Bile is prevented from entering the bowel due to biliary obstruction so that this fat soluble vitamin cannot be absorbed. 02/11/14 NUTRITIONAL DISORDERS 80
Malabsorption syndrome:- Patients suffering from malabsorption of fat develops vitamin K deficiency e.g. coelic disease, sprue, pancreatic disease, hyper motility of bowel etc. Diffuse liver disease:- Patients with diffuse liver disease (e.g. cirrhosis, omyloidosis of liver hepatocellular carcinoma, hepatoblastoma) have hypoprothrombinaemia due to impaired synthesis of prothrombin administration of vitamin K to such patients is of no avail since liver, where prothrombin synthesis utilizing vitamin K takes place, is diseased. 02/11/14 NUTRITIONAL DISORDERS 81
Deficiency of vitamin K Deficiency of vitamin K causes defective blood coagulation Recommended dietary allowances Because of variation is the intestinal synthesis of vitamin K no special recommendation for allowance has been made. The food and nutrition board has established 1-2mg of vitamin K per kg body weight to be safe and adequate intake. 02/11/14 NUTRITIONAL DISORDERS 82
Thiamine Thiamine (vitamin B1), a water-soluble vitamin, is an essential coenzyme for metabolism of carbohydrates 02/11/14 NUTRITIONAL DISORDERS 83
02/11/14 NUTRITIONAL DISORDERS 84
sources  It is freely distributed in animal and vegetable products such as liver, egg, yolk, pork, legumes, yeast, pericarp and germ of cereals, autolysis yeast (marmite), and milk. Polishing the rice considerably destroys its thiamine content 02/11/14 NUTRITIONAL DISORDERS 85
Clinical Features Thiamine deficiency leads to the disease, beriberi. It occurs usually in infants (wet beriberi) though older infants and children may also suffer from its chronic form (dry beriberi). The earliest symptoms, occurring in early infancy (especially if the mother is providing thiamine-deficient breast milk), include restlessness, bouts of excessive crying (as if the infant is having an abdominal colic), vomiting, abdominal distention, flatulence, constipation/ and insomnia. 02/11/14 NUTRITIONAL DISORDERS 86
02/11/14 NUTRITIONAL DISORDERS 87
Treatment/management As soon as the diagnosis is convincingly made, the child must receive 10 mg of thiamine intravenously. In the subsequent three days, he should be given 10 mg of the vitamin intramuscularly twice daily. Over the next six weeks, 10 mg daily should be administered orally. The breastfeeding mother should receive thiamine therapy simultaneously. Prognosis is excellent provided reasonable intake of thiamine is ensured.  Prevention Ensuring that at least 0.4 mg of thiamine is provided in the daily diet (thrice the quantity in case of pregnant and lactating NUTRITIONAL DISORDERS women) prevents beriberi. 02/11/14 88 
Riboflavin  Riboflavin (vitamin B2), another water-soluble vitamin, is a constituent of flavoprotein enzymes vitally concerned with the intermediary metabolism of carbohydrates. It is found in both animal and vegetable foods such as liver, fish, egg, kidney, meat, beans, yeast, green leafy vegetables, cereals, legumes, groundnut and milk (5 times more in cow milk than in human milk). 02/11/14 NUTRITIONAL DISORDERS 89
02/11/14 NUTRITIONAL DISORDERS 90
Riboflavin deficiency Clinical Features Manifestations include angular stomatitis, cheilosis (fissuring of lips), nasolabial seborrhea and, occasionally magenta (purplish-red, smooth) tongue. There may occur corneal injection (vascularization) at the limbus, leading; to excessive lacrimation, photophobia, eye pain and later interstitial keratitis. 02/11/14 NUTRITIONAL DISORDERS 91
Treatment/management Therapy consists in administering riboflavin, 3 to 10 mg orally or 2 mg intramuscularly daily for a few days. This / should be followed by 10 mg orally daily for about three weeks. With this regimen, response is good. Complete recovery occurs provided that adequate intake of vitamin B2 is ensured in the weeks and months ahead. Prevention In order to prevent riboflavin deficiency, it should be ensured that the daily diet provides at least 0.6 mg riboflavin per 1,000 kcal. It is advisable to administer supplements of riboflavin (the whole B-complex may . be still better) to the infants and children belonging to vulnerable categories. 02/11/14 NUTRITIONAL DISORDERS 92
Nicotinic acid Nicotinic acid (niacin) is also involved in the carbohydrate metabolism and plays vital role in the functioning of the skin, gastrointestinal tract, central nervous system and hemopoietic system. This vitamin may be obtained either from the natural food sources or from the tryptophan endogenously. The natural food sources include milk, liver, pork, cheese, yeast, cereals, etc. 02/11/14 NUTRITIONAL DISORDERS 93
02/11/14 NUTRITIONAL DISORDERS 94
Clinical Features The disease caused by nicotinic acid deficiency is called pellagra. It usually occurs in children of schoolgoing age. The characteristic lesions are seen over the exposed areas of the skin, such as limbs, neck, ("Casal necklace") and cheeks. It is worth noting that the lesions are symmetrical, of desquamating pigmentary dermatitis type and are aggravated by sunlight. There is a widespread gastrointestinal inflammation, leading to red and sore tongue, dysphagia, nausea, vomiting and diarrhea. 02/11/14 NUTRITIONAL DISORDERS 95
Clinical Features Just like diarrhea, dementia is encountered much less childhood than in adults. Most children with pellagra are, no doubt, quite apathetic. Anemia as also other signs of malnutrition are usually present. 02/11/14 NUTRITIONAL DISORDERS 96
Pellagra 02/11/14 NUTRITIONAL DISORDERS 97
Pellagra 02/11/14 NUTRITIONAL DISORDERS 98
Pellagra 02/11/14 NUTRITIONAL DISORDERS 99
Treatment/management Nicotinamide, 50 to 300 mg daily in divided doses orally, given for two weeks followed by adequate supply of Bcomplex vitamins in diet brings about complete recovery. Prevention  The disease may be prevented by providing a balanced diet containing 5 to 10 mg daily supply of nicotinamide.  02/11/14 NUTRITIONAL DISORDERS 100
Pyridoxin  Pyridoxine (vitamin B6) plays a vital role in the metabolism of proteins and fatty acids. It is claimed to have a role in blood formation, in proper functioning of the nervous system and in conversion of tryptophan into nicotinic acid. Its natural sources include liver, egg yolk, meat, wheat] germ, soybeans, yeast, peas, pulses and cereals. It ii found in only small quantity in most vegetables am milk.  02/11/14 NUTRITIONAL DISORDERS 101
02/11/14 NUTRITIONAL DISORDERS 102
Clinical Features of deficiency of pyridoxin The manifestations include convulsions and microcytic, hypo chromic anemia refractory to iron therapy. Growth retardation and gastrointestinal symptoms like diarrhea may occur. Seborrheic dermatitis around nose and eyes, and sensory neuropathy occur only uncommonly in children. Cheilosis and glossitis are infrequent in childhood.  02/11/14 NUTRITIONAL DISORDERS 103
Growth retardation 02/11/14 NUTRITIONAL DISORDERS 104
Treatment/management Administration of 5 mg of pyridoxine intramuscularly followed by 0.5 mg daily orally for two weeks causes complete recovery. 02/11/14 NUTRITIONAL DISORDERS 105
Vitamin C[ascorbic acid] Ascorbic acid, which structurally resembles a monosaccharide sugar, is known to play important role in oxidation of tyrosine and phenylalanine, in formation of hydroxyproline, in preventing de polymerization of collagen and in hemopoiesis.  Deficiency of vitamin C, though quite common in its subclinical form, has virtually disappeared in its overt form from the affluent countries. But, its frank cases still continue to be seen from time to time in some parts of the developing regions.  02/11/14 NUTRITIONAL DISORDERS 106
02/11/14 NUTRITIONAL DISORDERS 107
sources Fruits and vegetables are the only significant sources of vitamin C. Recommended intake  For adults 60 mg daily. This level of intake is expected to maintain a body pool of 1500mg ascorbic acid. 02/11/14 NUTRITIONAL DISORDERS 108
Scurvy occurs usually in infants between the age of 6 months to 2 years. No age is a bar, however. Infantile scurvy is characterized by gross irritability, excessive crying and tenderness to touch, more so in the lower limbs. The infant adopts the so-called "frogposition”. The posture of the lower limbs gives an impression as though these are paralyzed  The palpable sub periosteal hemorrhage into the lower third of the femur may contribute to pain, thus preventing movements of the leg further and strengthening the impression that the limb may be paralyzed. 02/11/14 NUTRITIONAL DISORDERS 109
Hemorrhages may occur into the skin and mucous membranes. Hemorrhages into the gums may result in spongy, swollen, bluish purple gums, especially about the erupted teeth. Hemorrhages in the internal organs may cause hematuria, melena, proptosis and subdural swellings. Mild to moderate anemia is usual.  Scorbutic rosarymay result from posterior displacement of the sternum. Unlike rachitic rosary, it is tender,-sharp and angular and has a "step-shaped" configuration the sternum, being depressed. 02/11/14 NUTRITIONAL DISORDERS 110
scurvy 02/11/14 NUTRITIONAL DISORDERS 111
Treatment/management It consists in giving a dose of 500 mg of vitamin C followed by a daily dose of 100 to 300 mg for several weeks. Oral administration is good enough.  02/11/14 NUTRITIONAL DISORDERS 112
Folic Acid functions Folic Acid is needed for energy production, protein metabolism, the formation of red blood cells and it is vital for normal growth and development Sources Found in beans, beef, bran, barley, brown rice, cheese, chicken, dates, green leafy vegetables, lamb, lentils, liver, milk, oranges, organ meats (like liver), split peas, pork, root vegetables (like carrots), salmon, tuna, whole grains, whole wheat and yeast. 02/11/14 NUTRITIONAL DISORDERS 113
02/11/14 NUTRITIONAL DISORDERS 114
DEFICIENCY SYMPTOMS: A deficiency of Folic Acid may contribute to anemia, depression and anxiety,, and birth defects in pregnant women, sore tongue, and fatigue. 02/11/14 NUTRITIONAL DISORDERS 115
Vitamin B12:Vitamin B12 is a very large molecule and requires a special mechanism of absorption. Vitamin B12 functions in all the cells but especially those of the gastrointestinal tract and bone marrow and the nervous system. Sources : Found in beef, blue cheese, cheese, clams, crab, fish, eggs, herring, kidney, liver, mackerel, milk and milk products, pork, seafood and tofu. It is not found in vegetables - only in animal sources. BODY PARTS AFFECTED: liver, nerves, red blood cells, gastrointestinal tract. 02/11/14 NUTRITIONAL DISORDERS 116
02/11/14 NUTRITIONAL DISORDERS 117
DEFICIENCY SYMPTOMS: Appetite loss, diminished reflex responses, fatigue, irritability, memory impairment, mental depression and confusion, nervousness, pernicious anemia, unpleasant body odor, walking and speaking difficulties, weakness in arms and legs. A deficiency can cause problems with digestion, absorption of food, metabolism of carbohydrates and fats, nerves, fertility, growth and development. There can also be hallucinations, memory loss, eye disorders, and anemia. 02/11/14 NUTRITIONAL DISORDERS 118
Recommended dietary allowances About 1 mg of vitaminB12 is required to replace the daily obligatory losses. Treatment/management Vitamin B12 administered in doses 250-1000mg intramuscularly. 02/11/14 NUTRITIONAL DISORDERS 119
TRACE ELEMENTS DEFICIENCIES Several minerals in trace amounts are essential for health since they form components of enzymes and cofactors for metabolic function besides calcium and phosphorus required for vitamin D manufacture, others include iron, copper, iodine, zinc, selenium, manganese nickel chromium, molybdenum, fluorine 02/11/14 NUTRITIONAL DISORDERS 120
Iron Iron is best known for being an active part of hemoglobin in red blood cells but it is also a constituent of the muscle protein myoglobin and of a variety of protein that speed up chemical reactions within the body.  Sources Rating foods as sources of iron requires consideration of the bioavailability of the iron they contain in general flesh foods are the best sources because they contain heam iron. Some plant foods appear to be much better source of iron than they actually are. 02/11/14 NUTRITIONAL DISORDERS 121
Zinc Recognition of the importance of zinc as a nutrient is steadily increasing. growth ,sexual development , wound healing , ability to fight infections sense of taste, night vision, healthy epithelial tissue, and other vital functions depend upon an adequate supply of zinc. Sources  Flesh foods are the most reliable sources of zinc because they contain reasonably high amount of zinc. Red meats especially beef are higher in zinc. among plant foods sun flower seeds are good sources of zinc. Whole grains ,legumes and vegetables are richer in zinc. 02/11/14 NUTRITIONAL DISORDERS 122
Iodide A regular supply of iodide is needed for the production of the thyroid hormones, thyroxine and triidothyronine. Lack of iodine results in endemic goiter Sources Iodized salt 02/11/14 NUTRITIONAL DISORDERS 123
Copper Copper participates in many metabolic reactions that are necessary for normal development and maintenance of the skeleton, red blood cell production, normal skin and hair, and other functions. Sources Oysters are recognized as the leading source 02/11/14 NUTRITIONAL DISORDERS 124
Chromium  Chromium is essential for normal utilization of glucose. Chromium is active in the body only in the form of a complex molecule called glucose tolerance actor. Meat, cheese, and whole grains are also reported to be good sources. 02/11/14 NUTRITIONAL DISORDERS 125
Deficiency disorders of trace elements Iron:- Microcytic ,hypochronic anemia Copper:- Muscle weakness, neurologic defect Iodine:- Goiter and hyperthyroidism Zinc:- Growth retardation, infertility Selenium:- Myopathy, cardiomyopathy 02/11/14 NUTRITIONAL DISORDERS 126
GOITER 02/11/14 NUTRITIONAL DISORDERS 127
Goiter 02/11/14 NUTRITIONAL DISORDERS 128
Growth retardation 02/11/14 NUTRITIONAL DISORDERS 129
THANK YOU 02/11/14 NUTRITIONAL DISORDERS 130
02/11/14 NUTRITIONAL DISORDERS 131
02/11/14 NUTRITIONAL DISORDERS 132

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Nutritional dissorders

  • 1.
    Guided by: Lathamam 02/11/14 NUTRITIONAL DISORDERS 1
  • 2.
    What is calorie? CALORIE- is the amount of energy needed to raise the temperature of one gram of water by one degree Celsius         CALORIE = is represented by the letter C. 02/11/14 NUTRITIONAL DISORDERS 2
  • 3.
  • 4.
    Main nutritional disorders Obesity Starvation Kwashiorkor Marasmus Anorexia nervosa Bulimia nervosa Vitamin deficiency Trace element deficiency 02/11/14 NUTRITIONAL DISORDERS 4
  • 5.
    Obesity Obesity is definedas an excess of adipose tissue that imparts health risk. Etiology  genetic predisposition  diets largely derived from carbohydrates and fats than protein rich food. hypothyroidism, cushings syndrome, insulinoma, and hypothalamic disorders 02/11/14 NUTRITIONAL DISORDERS 5
  • 6.
    Pathophysiology Obesity is associatedwith increased adipose stores in the subcutaneous tissue, skeletal muscles, internal organs such as the kidneys, heart, liver and fatty liver is also more common in obese individuals. There is increase in both sizes number of adipocytes and there is hypertrophy as well as hyperplasia. 02/11/14 NUTRITIONAL DISORDERS 6
  • 7.
  • 8.
    Metabolic changes Hyper insulinaemia Non-Insulin dependant diabetes Hypertension Hyper lipoproteinaemia: Atherosclerosis Coronary artery disease Cholelithiasis Cancer Osteoarthritis: 02/11/14 NUTRITIONAL DISORDERS 8
  • 9.
    Serious health hazardsof obesity Stroke Coronary artery diseases Hypertension Fatty liver Diabetes Atherosclerosis Hyperlipidaemia Osteoarthritis 02/11/14 NUTRITIONAL DISORDERS 9
  • 10.
  • 11.
    Management of obesity Nutritionaltherapy Behavior modification Support groups MEDICAL MANAGEMENT Drug therapy {appetite suppressing drugs} Phentermine, diethylpropion etc. SURGICAL MANAGEMENT Vertical banded gastroplasty Adjustable gastric banding 02/11/14 NUTRITIONAL DISORDERS 11
  • 12.
    Starvation Starvation is astate of overall deprivation of nutrients. Etiology    02/11/14 deliberate fasting famine conditions in a country or community. secondary under nutrition such as chronic wasting diseases, cancers etc. NUTRITIONAL DISORDERS 12
  • 13.
    Signs and symptoms Dryand scaly skin  muscular weakness Anemia Increased susceptibility to infections Loss of appetite Wound healing may be delayed Brittle nails Loss of hair Depression Decreased B P ,pulse, slight cyanosis. 02/11/14 NUTRITIONAL DISORDERS 13
  • 14.
  • 15.
    Nursing management Health promotion Acuteintervention Health education Try to maintain an optimal body weight TYPES OF SPECIALISED NUTRITIONAL THERAPY Oral feeding Tube feeding nasogastric and nasointestinal feeding gastrostomy and jejenostomy 02/11/14 NUTRITIONAL DISORDERS 15
  • 16.
    Protein deficiency malnutrition Kwashiorkor- Whichis related to protein deficiency through calorie intake may be sufficient. Marasmus- is starvation in infants occurring due to overall lack of calories. 02/11/14 NUTRITIONAL DISORDERS 16
  • 17.
    KWASHIORKOR Clinical features Occurs inchildren between 6 months 3 years of age Growth failure Wasting muscles but preserved adipose tissue Edema , localized or generalized, present Enlarged fatty liver Serum proteins low Anemia present Alternate bands of light and dark hair 02/11/14 MARASMUS Clinical features Growth failure Wasting of all tissues including muscles and adipose tissue Edema present No hepatic enlargement Serum proteins low Anemia present Monkey-like face, protuberant abdomen, thin limbs NUTRITIONAL DISORDERS 17
  • 18.
  • 19.
  • 20.
    Morphology KWASHIORKOR Morphology Enlarged fatty liver Atrophyof different tissues and organs but subcutaneous fat preserved 02/11/14 NUTRITIONAL DISORDERS MARASMUS Morphology No fatty liver Atrophy of different tissues and organs including subcutaneous fat 20
  • 21.
  • 22.
  • 23.
    marasmus Diagnostic Evaluation Severe hypochromic anemia is generally diagnosed. The plasma proteins level is usually lowered unless hemo concentration is present. 02/11/14 NUTRITIONAL DISORDERS 23
  • 24.
    Pathophysiology marasmus When adequatecalories are not ingested to fulfill the metabolic needs of the body, reserve food elements such as protein and fat in the tissues are used to sustain life. This process may be caused by An inadequate diet or faulty eating habits Congenital anomalies that present the infant taking an adequate diet Disease condition that interfere with the assimilation of food  Infections that produce anorexia and decrease the infants ability to digest food Loss of food intake through vomiting and diarrhea Food allergy that is not managed appropriate Emotional problems such as disturbed mother child relations. 02/11/14 NUTRITIONAL DISORDERS 24
  • 25.
    Nursing Management of marasmus  Managementconsists of providing a nutritional intake that is rich in the essential nutrients to correct the dietary insufficiency and to promote normal growth and development. Parenteral fluid therapy may initially be necessary to correct the electrolyte imbalance and dehydration and to restore kidney if oral feedings are not tolerated, hyper alimentation is used. Additional vitamins and minerals and blood transfusion may be necessary. 02/11/14 NUTRITIONAL DISORDERS 25
  • 26.
    In addition toassisting with administering parenteral fluids and giving oral feedings, the nurse is also responsible for maintaining the infant’s body temperature within a normal range, providing for periods of rest and appropriate activity and stimulation, recording intake and output, daily weighing turning and preventing infection. The nurse carefully observes affected infants for infection of mouth, skin and respiratory and genitourinary tracts. These infections are appropriately treated when they occur. The infant is protected from other patient and care givers who have infections because infants who have marasmus may also have emotional deprivation, their care is like that for those who have failure to thrive. 02/11/14 NUTRITIONAL DISORDERS 26
  • 27.
    Prevention of marasmus Theprevention of marasums consists of Parent education Prompt treatment congenital defects Prevention of emotional disturbance 02/11/14 NUTRITIONAL DISORDERS 27
  • 28.
  • 29.
    Pathophysiology Kwashiorkor While growth isoccurring, sufficient nitrogenous food must be consumed to maintain a positive nitrogen balance. When inadequate amounts of the essential aminoacids are not provided, not absorbed or abnormally lost, protein under nutrition results. The impaired absorption or loss of protein may occur in infants and children who have chronic diarrhea, nephrosis, hemorrhage, burns or infection. Nutritional edema, results when the body, lacking sufficient intake or sustaining a loss of high quality protein, burns its own tissues and destroys the plasma protein so that the level of plasma albumin becomes low. 02/11/14 NUTRITIONAL DISORDERS 29
  • 30.
  • 31.
    PROTEIN CONTENT FOODS Eggs Cow’smilk Cheese Meat cooked Fish cooked Rice cooked Soy beans White potato wheat germ Nuts 02/11/14 NUTRITIONAL DISORDERS 31
  • 32.
  • 33.
    Nursing Management The managementof infants and children who have kwashiorkor includes replacement of the missing nutrients and treatment for any acute problems such as diarrhea, renal failure and shock. The dietary intake of protein and calorie in increased gradually, skin milk, synthetic amino acid mixtures or case in hydrolysates may be given to supplement the usual diet. Vitamins and minerals, especially vitamin 4, magnesium and potassium are added to the intake to correct any deficiencies. 02/11/14 NUTRITIONAL DISORDERS 33
  • 34.
    The accompanying anemiacan be corrected by administering iron and folic acid. In spite of this management the infant or child may initially loss weight because of the loss of edema fluid. However improvement can gradually be seen. Infections or infestations are treated appropriately. The long term management consists of feeding the child a diet with adequate calories, especially one high in protein of good biologic quality. 02/11/14 NUTRITIONAL DISORDERS 34
  • 35.
    Prevention Prevention consists ofproviding a diet containing an adequate quality of protein of high biologic quality for all infants and children. In those areas where kwashiorkor is endemic parents should be taught the nutritional needs of all family members and adequate amounts of food should be provided to fulfill these needs. 02/11/14 NUTRITIONAL DISORDERS 35
  • 36.
    Anorexia nervosa An eatingdisorder in which the person experiences hunger but refuses to eat because of a distorted body image, leading to a self perception of fatness. Anorexia nervosa is a condition of selfgenerated weight loss usually seen in adolescent girls and young women, but also in middle-aged women or men 02/11/14 NUTRITIONAL DISORDERS 36
  • 37.
    Etiology of eatingdisorders Although the cause of eating disorders is not certain, several factors are likely to contribute to development of the disorders. Socio cultural and environmental factors including media and peer influences, family factors including parental discord, and biologic factors including genetics, neurotransmitter regulation, and hormonal functioning have been implicated. Negative affect, low selfesteem, and dieting behavior commonly predate the onset of an eating disorder. 02/11/14 NUTRITIONAL DISORDERS 37
  • 38.
    Clinical manifestations of anorexianervosa Clients with anorexia nervosa are usually first introduced to the health care system when the disordered eating behavior results in obvious weight loss. Clients may limit themselves to 200 to 500 kcal/day-only 60% to 70% of the amount needed for ideal body weight. Physical manifestations include dry skin, pallor, bradycardia, hypotension, intolerance to cold, constipation, and amenorrhea 02/11/14 NUTRITIONAL DISORDERS 38
  • 39.
    Pathophysiology  The pathophysiologicchanges associated with anorexia nervosa are similar to those seen in starvation. When caloric intake is severely limited, the body adapts by using the body's fat stores and sparing nitrogen stores. With prolonged starvation, significant shifts in fluid and electrolyte balance can occur and can be life-threatening. The hypothalamus responds to the lack of nutrient intake with changes in pituitary function, resulting in amenorrhea and infertility. The extent of malnutrition will determine the pathophysiologic changes observed. 02/11/14 NUTRITIONAL DISORDERS 39
  • 40.
  • 41.
    Bulimia nervosa  Aneating disorder characterized by uncontrollable binge eating alternating with vomiting or dieting. Bulimia nervosa is a less serious and entirely separate illness. Clients with bulimia nervosa tend to maintain a relatively normal weight, but go through periods of eating excessively (binging) and vomiting (purging) gastric contents to prevent weight gain. It has been suggested that bulimia nervosa is a form of depressive illness. 02/11/14 NUTRITIONAL DISORDERS 41
  • 42.
    Clinical manifestations of bulimianervosa  Clinical manifestations of bulimia nervosa include episodes of binge eating followed by self-induced vomiting. The eating and vomiting episodes occur most often in the late afternoon and evening and are done in secret. Some clients may abuse laxatives and diuretics as well. Personality characteristics typical of clients with bulimia are related to depression. Physical manifestations may not be as obvious, because the client with bulimia may be of normal weight without any depletion of fat stores. Less obvious clinical manifestations are erosion of tooth enamel from frequent vomiting and esophageal and throat irritation. 02/11/14 NUTRITIONAL DISORDERS 42
  • 43.
  • 44.
    Nursing management of eatingdisorders  Outcomes  The client will be able to resume normal earning behaviors. In clients with severe nutritional depletion, the client will be able to regain weight at a safe rare (1 to 2 pounds/week).  Interventions: When caring for a client with anorexia nervosa, help the client select foods from the Food Guide Pyramid for a nutritionally balanced diet. The client is usually allowed to refuse a specific number of foods (such as two or three) so that some sense of control is felt. Observe the client during mealtimes. Be supportive during mealtimes and, if needed, stay with the client after he or she eats to prevent him or her from purging. Education related to nutrition must include the client's family, care-givers, or co-residents. An accurate calorie count and regular monitoring of weight are other important interven-tions. Parenteral or enteral nutrition may be needed forr refractory clients with extreme malnutrition. 02/11/14 NUTRITIONAL DISORDERS 44
  • 45.
    Management cond……… Outcomes The clientwill lose 1 to 2 pounds per week until ideal body weight is achieved and maintain ideal body weight thereafter Interventions  Teach the client how to use the Food Guide Pyramid to select a healthy diet with portions of appropri-ate size. Encourage the client to eat slowly and develop a regular exercise pattern. Encourage the client to approach food, eating, and self-image in a new way. Provide emotional support and supervision for the client to overcome stressful periods and break the binge-and-purge cycle.  02/11/14 NUTRITIONAL DISORDERS 45
  • 46.
    Management cond………  Outcomes Theclient will develop a more normal image of self, as evidenced by statements concerning increased self-esteem by the client's ability to overcome the eating disorder.  Interventions  Recognize that clients suffering from eating disorders typically have low self-esteem. These clients see the regulation of food and exercise of self-control in eating patterns and amounts as ways to prove themselves successful. It is important that the client's significant others help the client find other areas of self-regard. It is expected that the client will overcome the eating disorder with consistent and continued treatment and that weight will return to normal.    02/11/14 NUTRITIONAL DISORDERS 46
  • 47.
    Vitamins Fat soluble vitamins vitA b) vit D c) vit E d) vit K  water soluble vitamins a) vit C b) vit B complex a) 02/11/14 NUTRITIONAL DISORDERS 47
  • 48.
    Vitamin A [retinol] Physiologicfunctions of retinol Maintenance of normal vision in reduced light. This involves synthesis of rhodopsin, a light sensitive pigment in the rods and cones of retina, by oxidation of retinol. This pigment then transforms the radiant energy in to nerve impulses. Maintenance of structure and function of specialized epithelium Maintenance of normal cartilaginous and bone growth. 02/11/14 NUTRITIONAL DISORDERS 48
  • 49.
  • 50.
    Deficiencies of vitA Night blindness Ocular lesions Cutaneous lesions Bitot spot Xerophthalmia 02/11/14 NUTRITIONAL DISORDERS 50
  • 51.
  • 52.
    Pathological changes: -Consequent to vitamin A deficiency following pathologic changes are seen. Ocular lesions: - Lesions in the eyes are most obvious. Night blindness is usually the first sign of vitamin A deficiency. As a result of replacement metaplasia of mucus secreting cells by squamous cells, there is dry and scaly sclera conjunctiva (xerophthalmia). The lacrimal duct also shows hyperkeratosis corneal ulcer may occur. Bitot's spots may appear which are focal triangular areas of opacities due to accumulation of keratinized epithelium. 02/11/14 NUTRITIONAL DISORDERS 52
  • 53.
    contd If these occuron cornea, they impede transmission of light. Ultimately, infection, scarring and opacities lead to blindness. Cutaneous lesion:- The skin develops popular lesions giving toad like appearance (xeroderma). This is due to follicular hyper kurtosis and keratin plugging in the sebaceous gland. 02/11/14 NUTRITIONAL DISORDERS 53
  • 54.
    Sources The major sourcesof retinol are liver, dairy products, eggs and carotenes are found in varying amounts in vegetables and fruits, especially in most of the dark green leafy and bright orange ones. Carotenes may also be present in the foods listed above that naturally contain retinol.  Recommended intake The 1980 RDA for Vitamin A is (5000 IU) for men and (4000 IU) for woman. 02/11/14 NUTRITIONAL DISORDERS 54
  • 55.
    Management Mild to moderatecases of deficiency can be treated by daily oral dose of 10,000 IU of fat soluble vitamin A for 10 days. In severe cases larger dose (50,000 IU) is recommended for one week. A single massive dose of 50,000 IU of vitamin A every six months is prophylactic for children below six years of age. 02/11/14 NUTRITIONAL DISORDERS 55
  • 56.
    Vitamin D[Calciferol] Functions Vitamin Dis of almost importance in the regulation of calcium and phosphorous metabolism in the body. It serves to maintain proper blood levels of calcium and phosphorous by promoting their intestinal absorption and by mobilizing these minerals from the skeleton when needed. Mineralization of the skeleton and teeth requires an adequate supply of vitamin D. 02/11/14 NUTRITIONAL DISORDERS 56
  • 57.
  • 58.
    Sources Exposure to straight,fortified foods, fish lives oil are good sources of vitamin D natural foods are poor sources at vitamin D although small amounts are present in egg yolk, liver, and fish such as herring, sardines, tuna and salmon. Recommended dietary allowances Vitamin D is now considered more as a pro hormone than a vitamin. Exposure to sunlight even for 5 minutes per day. A specific recommendation of a daily supplement of 400 IU is made. 02/11/14 NUTRITIONAL DISORDERS 58
  • 59.
  • 60.
    Tetani This is characterizedby low serum calcium (less than 7.5 mg per 100ml) muscle twitching, cramps, and convulsions. It results from insufficient absorption of calcium or vitamin D, or from a disturbance of the parathyroid gland. 02/11/14 NUTRITIONAL DISORDERS 60
  • 61.
    Osteomalacia Osteomalacia frequently called asadult rickets, occurs when there is lack of vitamin D and calcium. It may also occur when there is an interference with fat absorption and hence also vitamin D absorption.  02/11/14 NUTRITIONAL DISORDERS 61
  • 62.
  • 63.
  • 64.
    Rickets Etiology Poor exposure tosunlight may also be related to the inactivity of the malnourished children. Disturbed metabolism and poor synthesis of vit D from the skin ,malabsorption state , diarrheal diseases and excessive phylate with low calcium and low phosphate content of the food may well be some causes of rickets in malnourished children. 02/11/14 NUTRITIONAL DISORDERS 64
  • 65.
  • 66.
    Rickets clinical features Head-Increasedsize and delayed closure of fontanels , craniotabes  Teeth-delayed dentition Thorax- rachitic rosary, pigeon chest Spine-scoliosis , kyphosis Limbs-widening of wrists, ankles and other epiphysis , genu valgum 02/11/14 NUTRITIONAL DISORDERS 66
  • 67.
  • 68.
    Management In case ofrickets recommended dose of vit D is 10000 to 50000units per day 02/11/14 NUTRITIONAL DISORDERS 68
  • 69.
    Rickets heals promptlywith 4,000 IU of oral vitamin D per day administered for approximately one month.. The bone abnormalities (visible by x ray) generally disappear gradually over a period of 3-9 months. Parents are instructed to take their infants outdoors for approximately 20 minutes per day with their faces exposed. Children should also be encouraged to play outside. Foods that are good sources of vitamin D include cod liver oil, egg yolks, butter, and oily fish. Some foods, including milk and breakfast cereals, are also fortified with synthetic vitamin D. 02/11/14 NUTRITIONAL DISORDERS 69
  • 70.
  • 71.
    Vitamin E[Tocopherol] Functions Vitamin Eis needed for normal stability of red blood cells. In animals it has been shown to be essential for normal reproduction and for integrity and muscle and for nerves. There is no sound scientific basis for claims in the lay literature that vitamin E promotes fertility and sexual performance.. 02/11/14 NUTRITIONAL DISORDERS 71
  • 72.
  • 73.
    Source The richest sourceof vitamin E are the vegetable oils that are risk in poly unsaturated wheat germ, nuts, whole grains, legumes and certain vegetables. Another sources Soybean oil, sunflower oil, mayonnaise walnut, lima beans, sweat potatoes, spinach, fish, liver, shell fish, eggs.   02/11/14 NUTRITIONAL DISORDERS 73
  • 74.
    Recommended intake Although the1980 RDA has been set at 10 mg tocopherol for men and 8 mg for woman this should be considered to be a recommendation for people consuming customary American diets. 02/11/14 NUTRITIONAL DISORDERS 74
  • 75.
    Vitamin E deficiency VitaminE deficiency is extremely rare in humans. It is limited to those individuals with fat malabsorption, or patients on total parenteral nutrition, or in formula fed premature infants. Changes occurring in severe deficiency include, increased hemolysis of red blood cells, creatinuria deposition of brandish ceroid pigments in smooth muscles and , in some cases, development of a form of muscular dystrophy  02/11/14 NUTRITIONAL DISORDERS 75
  • 76.
    Management of VitaminE disorders  Vitamin E has been used in daily doses of 400 to 800 mg for the treatment of diverse conditions such as habitual abortion, sterility muscular dystrophy diabetes ischemic heart disease, skin disorders and anemia in infants. Benefit has been reported in some of these cases but none has been established in clinical trails. Administration of 3 to 4 g of tocopherol daily over long periods has not produced any toxic effects in human beings. However several reports of adverse effects such as elevation of serum lipids, impaired blood coagulation and reduction of serum thyroid hormones suggest that indiscriminate ingestion of excessive amounts over long periods should be avoided. 02/11/14 NUTRITIONAL DISORDERS 76
  • 77.
    Vitamin K Vitamin Kis concerned with synthesis of coagulation factors 2,7,9,and 10 in the liver. Green leafy vegetables, soybeans and fish are it’s natural sources. Enough of these vitamin is produced by intestinal flora 02/11/14 NUTRITIONAL DISORDERS 77
  • 78.
  • 79.
    Function Vitamin K isessential for the hepatic synthesis of prothrombin and certain others factors involved in blood clotting. For this reason it is sometimes called the antihemorrhagic it also appears to have a role in some metabolism. Sources Green leafy vegetables, cauliflower, broccoli and liver all the richest dietary sources of vitamin K. However, bacterial synthesis of vitamin K in the gut accounts for a large proportion of a persons daily supply initially a new born infant has a sterile gastro intestinal tract and thus cannot synthesize significant amounts of vitamin K for a few days since milk is low in vitamin K the vitamin is routinely administered to new borne. 02/11/14 NUTRITIONAL DISORDERS 79
  • 80.
    DEFICIENCY DISORDERS Hemorrhagic diseaseof new born:- The new born infants are deficient in vitamin K because of minimal stores of vitamin K of birth, lack of established intestinal flora for endogenous synthesis and limited dietary intake since breast milk is a poor source of vitamin K. Biliary obstruction:- Bile is prevented from entering the bowel due to biliary obstruction so that this fat soluble vitamin cannot be absorbed. 02/11/14 NUTRITIONAL DISORDERS 80
  • 81.
    Malabsorption syndrome:- Patientssuffering from malabsorption of fat develops vitamin K deficiency e.g. coelic disease, sprue, pancreatic disease, hyper motility of bowel etc. Diffuse liver disease:- Patients with diffuse liver disease (e.g. cirrhosis, omyloidosis of liver hepatocellular carcinoma, hepatoblastoma) have hypoprothrombinaemia due to impaired synthesis of prothrombin administration of vitamin K to such patients is of no avail since liver, where prothrombin synthesis utilizing vitamin K takes place, is diseased. 02/11/14 NUTRITIONAL DISORDERS 81
  • 82.
    Deficiency of vitaminK Deficiency of vitamin K causes defective blood coagulation Recommended dietary allowances Because of variation is the intestinal synthesis of vitamin K no special recommendation for allowance has been made. The food and nutrition board has established 1-2mg of vitamin K per kg body weight to be safe and adequate intake. 02/11/14 NUTRITIONAL DISORDERS 82
  • 83.
    Thiamine Thiamine (vitamin B1),a water-soluble vitamin, is an essential coenzyme for metabolism of carbohydrates 02/11/14 NUTRITIONAL DISORDERS 83
  • 84.
  • 85.
    sources  It isfreely distributed in animal and vegetable products such as liver, egg, yolk, pork, legumes, yeast, pericarp and germ of cereals, autolysis yeast (marmite), and milk. Polishing the rice considerably destroys its thiamine content 02/11/14 NUTRITIONAL DISORDERS 85
  • 86.
    Clinical Features Thiamine deficiencyleads to the disease, beriberi. It occurs usually in infants (wet beriberi) though older infants and children may also suffer from its chronic form (dry beriberi). The earliest symptoms, occurring in early infancy (especially if the mother is providing thiamine-deficient breast milk), include restlessness, bouts of excessive crying (as if the infant is having an abdominal colic), vomiting, abdominal distention, flatulence, constipation/ and insomnia. 02/11/14 NUTRITIONAL DISORDERS 86
  • 87.
  • 88.
    Treatment/management As soon asthe diagnosis is convincingly made, the child must receive 10 mg of thiamine intravenously. In the subsequent three days, he should be given 10 mg of the vitamin intramuscularly twice daily. Over the next six weeks, 10 mg daily should be administered orally. The breastfeeding mother should receive thiamine therapy simultaneously. Prognosis is excellent provided reasonable intake of thiamine is ensured.  Prevention Ensuring that at least 0.4 mg of thiamine is provided in the daily diet (thrice the quantity in case of pregnant and lactating NUTRITIONAL DISORDERS women) prevents beriberi. 02/11/14 88 
  • 89.
    Riboflavin  Riboflavin (vitaminB2), another water-soluble vitamin, is a constituent of flavoprotein enzymes vitally concerned with the intermediary metabolism of carbohydrates. It is found in both animal and vegetable foods such as liver, fish, egg, kidney, meat, beans, yeast, green leafy vegetables, cereals, legumes, groundnut and milk (5 times more in cow milk than in human milk). 02/11/14 NUTRITIONAL DISORDERS 89
  • 90.
  • 91.
    Riboflavin deficiency Clinical Features Manifestationsinclude angular stomatitis, cheilosis (fissuring of lips), nasolabial seborrhea and, occasionally magenta (purplish-red, smooth) tongue. There may occur corneal injection (vascularization) at the limbus, leading; to excessive lacrimation, photophobia, eye pain and later interstitial keratitis. 02/11/14 NUTRITIONAL DISORDERS 91
  • 92.
    Treatment/management Therapy consists inadministering riboflavin, 3 to 10 mg orally or 2 mg intramuscularly daily for a few days. This / should be followed by 10 mg orally daily for about three weeks. With this regimen, response is good. Complete recovery occurs provided that adequate intake of vitamin B2 is ensured in the weeks and months ahead. Prevention In order to prevent riboflavin deficiency, it should be ensured that the daily diet provides at least 0.6 mg riboflavin per 1,000 kcal. It is advisable to administer supplements of riboflavin (the whole B-complex may . be still better) to the infants and children belonging to vulnerable categories. 02/11/14 NUTRITIONAL DISORDERS 92
  • 93.
    Nicotinic acid Nicotinic acid(niacin) is also involved in the carbohydrate metabolism and plays vital role in the functioning of the skin, gastrointestinal tract, central nervous system and hemopoietic system. This vitamin may be obtained either from the natural food sources or from the tryptophan endogenously. The natural food sources include milk, liver, pork, cheese, yeast, cereals, etc. 02/11/14 NUTRITIONAL DISORDERS 93
  • 94.
  • 95.
    Clinical Features The diseasecaused by nicotinic acid deficiency is called pellagra. It usually occurs in children of schoolgoing age. The characteristic lesions are seen over the exposed areas of the skin, such as limbs, neck, ("Casal necklace") and cheeks. It is worth noting that the lesions are symmetrical, of desquamating pigmentary dermatitis type and are aggravated by sunlight. There is a widespread gastrointestinal inflammation, leading to red and sore tongue, dysphagia, nausea, vomiting and diarrhea. 02/11/14 NUTRITIONAL DISORDERS 95
  • 96.
    Clinical Features Just likediarrhea, dementia is encountered much less childhood than in adults. Most children with pellagra are, no doubt, quite apathetic. Anemia as also other signs of malnutrition are usually present. 02/11/14 NUTRITIONAL DISORDERS 96
  • 97.
  • 98.
  • 99.
  • 100.
    Treatment/management Nicotinamide, 50 to300 mg daily in divided doses orally, given for two weeks followed by adequate supply of Bcomplex vitamins in diet brings about complete recovery. Prevention  The disease may be prevented by providing a balanced diet containing 5 to 10 mg daily supply of nicotinamide.  02/11/14 NUTRITIONAL DISORDERS 100
  • 101.
    Pyridoxin  Pyridoxine (vitaminB6) plays a vital role in the metabolism of proteins and fatty acids. It is claimed to have a role in blood formation, in proper functioning of the nervous system and in conversion of tryptophan into nicotinic acid. Its natural sources include liver, egg yolk, meat, wheat] germ, soybeans, yeast, peas, pulses and cereals. It ii found in only small quantity in most vegetables am milk.  02/11/14 NUTRITIONAL DISORDERS 101
  • 102.
  • 103.
    Clinical Features ofdeficiency of pyridoxin The manifestations include convulsions and microcytic, hypo chromic anemia refractory to iron therapy. Growth retardation and gastrointestinal symptoms like diarrhea may occur. Seborrheic dermatitis around nose and eyes, and sensory neuropathy occur only uncommonly in children. Cheilosis and glossitis are infrequent in childhood.  02/11/14 NUTRITIONAL DISORDERS 103
  • 104.
  • 105.
    Treatment/management Administration of 5mg of pyridoxine intramuscularly followed by 0.5 mg daily orally for two weeks causes complete recovery. 02/11/14 NUTRITIONAL DISORDERS 105
  • 106.
    Vitamin C[ascorbic acid] Ascorbicacid, which structurally resembles a monosaccharide sugar, is known to play important role in oxidation of tyrosine and phenylalanine, in formation of hydroxyproline, in preventing de polymerization of collagen and in hemopoiesis.  Deficiency of vitamin C, though quite common in its subclinical form, has virtually disappeared in its overt form from the affluent countries. But, its frank cases still continue to be seen from time to time in some parts of the developing regions.  02/11/14 NUTRITIONAL DISORDERS 106
  • 107.
  • 108.
    sources Fruits and vegetablesare the only significant sources of vitamin C. Recommended intake  For adults 60 mg daily. This level of intake is expected to maintain a body pool of 1500mg ascorbic acid. 02/11/14 NUTRITIONAL DISORDERS 108
  • 109.
    Scurvy occurs usuallyin infants between the age of 6 months to 2 years. No age is a bar, however. Infantile scurvy is characterized by gross irritability, excessive crying and tenderness to touch, more so in the lower limbs. The infant adopts the so-called "frogposition”. The posture of the lower limbs gives an impression as though these are paralyzed  The palpable sub periosteal hemorrhage into the lower third of the femur may contribute to pain, thus preventing movements of the leg further and strengthening the impression that the limb may be paralyzed. 02/11/14 NUTRITIONAL DISORDERS 109
  • 110.
    Hemorrhages may occurinto the skin and mucous membranes. Hemorrhages into the gums may result in spongy, swollen, bluish purple gums, especially about the erupted teeth. Hemorrhages in the internal organs may cause hematuria, melena, proptosis and subdural swellings. Mild to moderate anemia is usual.  Scorbutic rosarymay result from posterior displacement of the sternum. Unlike rachitic rosary, it is tender,-sharp and angular and has a "step-shaped" configuration the sternum, being depressed. 02/11/14 NUTRITIONAL DISORDERS 110
  • 111.
  • 112.
    Treatment/management It consists ingiving a dose of 500 mg of vitamin C followed by a daily dose of 100 to 300 mg for several weeks. Oral administration is good enough.  02/11/14 NUTRITIONAL DISORDERS 112
  • 113.
    Folic Acid functions Folic Acidis needed for energy production, protein metabolism, the formation of red blood cells and it is vital for normal growth and development Sources Found in beans, beef, bran, barley, brown rice, cheese, chicken, dates, green leafy vegetables, lamb, lentils, liver, milk, oranges, organ meats (like liver), split peas, pork, root vegetables (like carrots), salmon, tuna, whole grains, whole wheat and yeast. 02/11/14 NUTRITIONAL DISORDERS 113
  • 114.
  • 115.
    DEFICIENCY SYMPTOMS: A deficiencyof Folic Acid may contribute to anemia, depression and anxiety,, and birth defects in pregnant women, sore tongue, and fatigue. 02/11/14 NUTRITIONAL DISORDERS 115
  • 116.
    Vitamin B12:Vitamin B12is a very large molecule and requires a special mechanism of absorption. Vitamin B12 functions in all the cells but especially those of the gastrointestinal tract and bone marrow and the nervous system. Sources : Found in beef, blue cheese, cheese, clams, crab, fish, eggs, herring, kidney, liver, mackerel, milk and milk products, pork, seafood and tofu. It is not found in vegetables - only in animal sources. BODY PARTS AFFECTED: liver, nerves, red blood cells, gastrointestinal tract. 02/11/14 NUTRITIONAL DISORDERS 116
  • 117.
  • 118.
    DEFICIENCY SYMPTOMS: Appetite loss,diminished reflex responses, fatigue, irritability, memory impairment, mental depression and confusion, nervousness, pernicious anemia, unpleasant body odor, walking and speaking difficulties, weakness in arms and legs. A deficiency can cause problems with digestion, absorption of food, metabolism of carbohydrates and fats, nerves, fertility, growth and development. There can also be hallucinations, memory loss, eye disorders, and anemia. 02/11/14 NUTRITIONAL DISORDERS 118
  • 119.
    Recommended dietary allowances About1 mg of vitaminB12 is required to replace the daily obligatory losses. Treatment/management Vitamin B12 administered in doses 250-1000mg intramuscularly. 02/11/14 NUTRITIONAL DISORDERS 119
  • 120.
    TRACE ELEMENTS DEFICIENCIES Severalminerals in trace amounts are essential for health since they form components of enzymes and cofactors for metabolic function besides calcium and phosphorus required for vitamin D manufacture, others include iron, copper, iodine, zinc, selenium, manganese nickel chromium, molybdenum, fluorine 02/11/14 NUTRITIONAL DISORDERS 120
  • 121.
    Iron Iron is bestknown for being an active part of hemoglobin in red blood cells but it is also a constituent of the muscle protein myoglobin and of a variety of protein that speed up chemical reactions within the body.  Sources Rating foods as sources of iron requires consideration of the bioavailability of the iron they contain in general flesh foods are the best sources because they contain heam iron. Some plant foods appear to be much better source of iron than they actually are. 02/11/14 NUTRITIONAL DISORDERS 121
  • 122.
    Zinc Recognition of theimportance of zinc as a nutrient is steadily increasing. growth ,sexual development , wound healing , ability to fight infections sense of taste, night vision, healthy epithelial tissue, and other vital functions depend upon an adequate supply of zinc. Sources  Flesh foods are the most reliable sources of zinc because they contain reasonably high amount of zinc. Red meats especially beef are higher in zinc. among plant foods sun flower seeds are good sources of zinc. Whole grains ,legumes and vegetables are richer in zinc. 02/11/14 NUTRITIONAL DISORDERS 122
  • 123.
    Iodide A regular supplyof iodide is needed for the production of the thyroid hormones, thyroxine and triidothyronine. Lack of iodine results in endemic goiter Sources Iodized salt 02/11/14 NUTRITIONAL DISORDERS 123
  • 124.
    Copper Copper participates inmany metabolic reactions that are necessary for normal development and maintenance of the skeleton, red blood cell production, normal skin and hair, and other functions. Sources Oysters are recognized as the leading source 02/11/14 NUTRITIONAL DISORDERS 124
  • 125.
    Chromium  Chromium isessential for normal utilization of glucose. Chromium is active in the body only in the form of a complex molecule called glucose tolerance actor. Meat, cheese, and whole grains are also reported to be good sources. 02/11/14 NUTRITIONAL DISORDERS 125
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    Deficiency disorders of traceelements Iron:- Microcytic ,hypochronic anemia Copper:- Muscle weakness, neurologic defect Iodine:- Goiter and hyperthyroidism Zinc:- Growth retardation, infertility Selenium:- Myopathy, cardiomyopathy 02/11/14 NUTRITIONAL DISORDERS 126
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