This document discusses nutritional deficiency disorders, including the principles and management of various deficiencies. It begins by defining primary and secondary nutritional deficiencies. It then covers protein-energy malnutrition and classifications like marasmus and kwashiorkor. The document also discusses various vitamin deficiency disorders like Vitamins A, D, and their signs, symptoms, management and prevention. It concludes by covering mineral deficiency diseases. Overall, the document provides a comprehensive overview of different types of nutritional deficiencies, their causes and treatment approaches.

1. PRINCIPLES AND MANAGEMENT OF
NUTRITIONAL DEFICIENCY DISORDERS
BY
DR. SUMIT GAIKWAD
BAMS GRADUATE
SVAMC ,SHRIGONDA

2. • NUTRITIONAL DEFICIENCIES OCCUR WHEN A PERSON’S NUTRIENT INTAKE CONSISTENTLY
FALLS BELOW THE RECOMMENDED REQUIREMENT. NUTRITIONAL DEFICIENCIES CAN LEAD
TO A VARIETY OF HEALTH PROBLEMS BUT IT CAN BE PREVENTED BY EATING A BALANCED
DIET OR EATING A PARTICULAR NUTRIENT RICH DIET WHICH THE BODY NEEDS MORE.
THERE ARE TWO TYPES OF NUTRITIONAL DEFICIENCIES-PRIMARY AND SECONDARY.
• PRIMARY NUTRITIONAL DEFICIENCY – IT MAINLY OCCURS BECAUSE A PERSON DOESN’T
GET ENOUGH OF CERTAIN VITAL NUTRIENTS AND IT CAN BE RESOLVED BY EATING FOODS
OR TAKING SUPPLEMENTS TO PROVIDE THE MISSING NUTRIENTS.
• SECONDARY NUTRITIONAL DEFICIENCY – IT OCCURS WHEN THE BODY’S ABILITY TO
ABSORB NUTRIENTS IS LIMITED BY A MEDICAL CONDITION OR ILLNESS LIKE CELIAC
DISEASE, CYSTIC FIBROSIS, LACTOSE INTOLERANCE, PANCREATIC INSUFFICIENCY AND
PERNICIOUS ANEMIA. MALNUTRITION DUE TO SECONDARY NUTRITIONAL DEFICIENCY
CAN BE MORE CHALLENGING TO TREAT THAN PRIMARY NUTRITIONAL DEFICIENCY.

3. TYPES OF NUTRITIONAL DEFICIENCIES -
PROTEIN – ENERGY MALNUTRITION
VITAMIN DEFICIENCY DISORDERS
MINERAL DEFICIENCY DISEASES

4. PROTEIN ENERGY MALNUTRITION
MALNUTRITION
IT IS A CONDITION THAT OCCURS DUE
TO DEFICIENCY OR EXCESS OF ONE OR
MORE ESSENTIAL NUTRIENTS.

5. PROTEIN ENERGY MALNUTRITION :
PROTEIN–ENERGY MALNUTRITION (PEM), SOMETIMES CALLED PROTEINENERGY
UNDERNUTRITION (PEU), IS A FORM OF MALNUTRITION THAT IS DEFINED AS A
RANGE OF PATHOLOGICAL CONDITIONS ARISING FROM LACK OF DIETARY
PROTEIN AND/OR ENERGY (CALORIES) IN VARYING PROPORTIONS.

6. CLASSIFICATION OF PEM
SYNDROMAL CLASSIFICATION
• KWASHIORKOR
• NUTRITIONAL MARASMUS
• PRE KWASHIORKOR
• NUTRITIONAL DWARFING

7. CLASSIFICATION BY INDIAN ACADEMY OF
PEDIATRICS :
• GRADE I- BETWEEN 71 AND 80 PERCENT OF EXPECTED WEIGHT FOR THE AGE
• GRADE II- BETWEEN 61 AND 70 PERCENT OF EXPECTED WEIGHT FOR THE AGE
• GRADE III- BETWEEN 51 AND 60 PERCENT OF EXPECTED WEIGHT FOR THE AGE
• GRADE IV- 50 PERCENT OR LESS OF EXPECTED WEIGHT FOR THE AGE
*IF EDEMA IS PRESENT IN THE CHILD THE LETTER K IS PLACED IN FRONT OF THE
GRADE OF MALNUTRITION.

8. GOMEZ CLASSIFICATION :
• GRADE I- WEIGHT BETWEEN 75 AND 90 PERCENT OF EXPECTED WEIGHT FOR
THE AGE
• GRADE II- WEIGHT BETWEEN 61 AND 75 PERCENT OF EXPECTED WEIGHT FOR
THE AGE
• GRADE III- WEIGHT LESS THAN OR EQUAL TO 60 PERCENT OF EXPECTED WEIGHT
FOR THE AGE

9. WHO CLASSIFICATION :
• STUNTING- CHILD BELOW 2 STANDARD DEVIATION (SD) SCORE FROM MEDIAN
HEIGHT FOR AGE
• UNDERWEIGHT- CHILD BELOW 2 STANDARD DEVIATION (SD) SCORE FROM
MEDIAN WEIGHT FOR AGE
• WASTING- CHILD BELOW 2 STANDARD DEVIATION (SD) SCORE FROM MEDIAN
WEIGHT FOR HEIGHT

10. CLINICAL FEATURES OF PEM
• KWASHIORKOR: - INSUFFICIENT PROTEIN CONSUMPTION
CHILD WEANED: MOTHER’S MILK TO STARCHY VEGETABLES
• MARASMUS - ENERGY DEFICIENCY
• MARASMIC-KWASHIORKOR - DEFICIENCY OF BOTH CALORIES AND PROTEIN

11. KWASHIORKOR
• WEIGHT LOSS: -ARMS AND LEGS
-DECREASE OF MUSCLE MASS
•SWOLLEN ABDOMEN
-ASCITES: INCREASE OF CAPILLARY PERMEABILITY
-ENLARGED LIVER: FATTY LIVER
•PERIPHERAL OEDEMA: DECREASE OF ONCOTIC PRESSURE
•ANEMIA: LETHARGY
•HAIR AND SKIN CHANGES

12. MARASMUS
• WEIGHT LOSS: “SKIN AND BONES”
• PROMINENT OF RIBS
• DRASTIC LOSS OF ADIPOSE TISSUE
• GROWTH RETARDATION
• CHRONIC DIARRHEA
• MUSCLE ATROPHY
• SKIN FOLDS
• “OLD MAN” FACE

13. MANAGEMENT OF PEM
• PEM IS MANAGED ACCORDING TO THE DEGREE OF SEVERITY
• IT COULD BE EITHER MANAGED AT HOME, NUTRITIONAL REHABILITATION
CENTRES OR IN THE HOSPITAL
• MAINLY IT IS MANAGED THROUGH NUTRITIONAL REHABILITATION

14. DOMICILIARY MANAGEMENT :
WHO CAN BE MANAGED AT HOME-
• MILD TO MODERATE MALNUTRITION
• NO INFECTIONS OR COMPLICATIONS PRESENT
• AVAILABILITY OF SUITABLE CARE TAKER AT HOME
HOW-
• EDUCATE THE PARENTS ABOUT THE NEEDS OF THE CHILD
• NUTRITIONAL COUNSELLING SHOULD BE PROVIDED
• TEACH THE RECOMMENDED DIET AND AVAILABILITY OF LOCALLY AVAILABLE RICH
SOURCES
OF PROTEINS AND CALORIES
• REGULAR HOME VISITS BY ANGANWADI WORKER
• FOLLOW UP FOR MEDICAL SUPERVISION AND EVALUATION

15. NUTRITIONAL REHABILITATION CENTRE
• WHO-
• MILD TO MODERATE MALNUTRITION
• DOMICILIARY MANAGEMENT NOT ENSURED ADEQUATELY
HOW-
• GOVERNMENT INSTITUTIONS OR NGOS PROVIDE REHABILITATION SERVICE
• CORRECTION OF WATER AND ELECTROLYTE BALANCE
• DIETARY SUPPORT - 3-4G PROTEIN AND 200 CAL/ KG BODY WEIGHT/DAY
• VITAMINS AND MINERALS
• COUNSEL PARENTS AND PLAN FUTURE INCLUDING IMMUNIZATION AND DIET
SUPPLEMENTS

16. MANAGEMENT :
WHO-
• ADVANCED CASES WITH INFECTIONS
• OTHER COMPLICATION MAY BE PRESENT
HOW-
• TREATMENT OF COMPLICATIONS
• START INTENSIVE FEEDING (IF ORAL NOT POSSIBLE THEN NG FEEDS MAY BE GIVEN)
• INITIALLY MILK BASED SMALL FEEDS AS PER CHILD’S TOLERANCE
• GRADUALLY MOVED TO SEMISOLID FOOD, HIGH IN PROTEINS AND CALORIE
• 80-100 KCAL/KG/DAY FOR MAINTENANCE, GRADUALLY INCREASED TO 150
KCAL/KG/DAY OF ENERGY AND 2-3G/KG/DAY OF PROTEINS

17. • FLUID INTAKE SHOULD BE WITHIN 100-125 ML/KG/DAY
• FAT SHOULD ALSO BE SUPPLEMENTED
• MINERALS AND TRACE ELEMENTS ARE ALSO ADDED
• IRON AND VITAMIN B COMPLEX ARE NOT USEFUL IN INITIAL THERAPY
• EMOTIONAL AND PHYSICAL STIMULATION IS ALSO REQUIRED
• MOTHER SHOULD ALSO BE TRAINED FOR HOME CARE (CONTINUATION OF
NUTRITIONAL SUPPORT, NECESSARY HYGIENE MEASURES, IMMUNIZATION,
ROUTINE CARE, REGULAR FOLLOW UP, PREVENTION OF RELAPSE)

18. VITAMIN DEFICIENCY DISORDERS

19. VITAMIN DEFICIENCY DISORDERS
1. FAT SOLUBLE VITAMINS- VITAMIN A, D, E, K
2. WATER SOLUBLE VITAMINS- VITAMINS B COMPLEX AND VITAMIN C

20. VIT A :
SOURCES-
ANIMAL SOURCES- LIVER, EGG YOLK, BUTTER, CHEESE, GHEE, WHOLE MILK,
CHEESE, FISH, VITAMIN- A (RETINOL AND BETA CAROTENE)
MEAT AND FISH LIVER OIL
PLANT SOURCES- GREEN LEAFY VEGETABLES, CEREALS AND PULSES, GREEN AND
YELLOW FRUITS AND VEGETABLES
DEFICIENCY LEADS TO-
MAJOR EFFECT ON EYES, MALNUTRITION, DIARRHOEA, MALABSORPTION
SYNDROME, CYSTIC FIBROSIS, HEPATIC INSUFFICIENCY , MEASLES AND
PREMATURITY.

21. OCULAR MANIFESTATION :
CONJUNCTIVAL XEROSIS (WRINKLED CONJUNCTIVA)
• BITOT’S SPOT(PEARLY WHITE SPOT ON CONJUNCTIVA ON EITHER SIDE OF
CORNEA)
• CORNEAL XEROSIS AND ULCERATION
• INEFFICIENT FORMATION OF RHODOPSIN
• NIGHT BLINDNESS
• KERATOMALACIA
• BLINDNESS

23. EXTRAOCULAR MANIFESTATION
• PHRYNODERMA (TOAD SKIN)
• HYPERKERATOSIS
• DRY SCALY SKIN
• HYPERTROPHY OF TONGUE
• GROWTH RETARDATION
• SUSCEPTIBLE TO INFECTIONS
• RENAL STONE
• INTERFERENCE TO REPRODUCTIVE FUNCTIONS

24. TREATMENT OF VAD
• ORAL VITAMIN- A ADMINISTRATION (ADULT -700 MCG PER DAY )
• PARENTERAL WATER SOLUBLE VIT A MAY BE ADMINISTERED IN CASE OF
IMPAIRED ORAL INTAKE, PERSISTENT VOMITING AND MALABSORPTION
1,00,000 UNITS PER DAY IM INJ. FOR 3 DAYS
FOLLOWED BY 50,000 UNITS PER DAY FOR 2 WEEKS FOLLOWED WITH ORAL
THERAPY.

25. BLOOD INVESTIGATIONS :
NORMAL VALUE :20-60MCG/DL

26. EXCESS OF VITAMIN A
• TOXIC EFFECTS LIKE VOMITING, DIZZINESS, INCREASED ICP, TENSION AND
PAPILLEDEMA.
• CHRONIC INTOXICATION CAN CAUSE ANOREXIA, DRY ITCHY SKIN, SLEEP
DISORDERS, PAINFUL EXTREMITIES, SPARSE HAIR, ENLARGEMENT OF LIVER AND
SPLEEN, HYPOPLASTIC ANAEMIA, TERATOGENICITY ETC.

27. PREVENTION OF VAD
• VITAMIN A ORAL SUPPLEMENTATION- ONE DOSE OF 1 LAKH IU AT 9 MONTHS
WITH MEASLES VACCINATION FOLLOWED BY EIGHT MORE DOSES OF 2 LAKH IU
EVERY 6 MONTHS INTERVAL (18, 24, 30, 36, 42, 48, 54 AND 60 MONTHS)
UPTO 5 YEARS OF AGE
• INTAKE OF FOOD ITEMS RICH IN VITAMIN A
• REDUCTION, EARLY DETECTION AND MANAGEMENT OF CHILDHOOD ILLNESSES
LIKE PEM, ARI, DIARRHOEA, MEASLES, WORM INFESTATION ETC.
• EARLY DETECTION OF ANY DEFICIENCY AND PROMPT MANAGEMENT
• CREATING PUBLIC AWARENESS REGARDING PREVENTIVE MEASURES

28. VITAMIN D (CALCIFEROL AND
CHOLECALCIFEROL)
FUNCTIONS-
• REGULATES MINERALIZATION OF BONES AND TEETH
• PROMOTES INTESTINAL ABSORPTION OF CALCIUM AND PHOSPHORUS
• HELPS IN NORMAL GROWTH AND DEVELOPMENT OF CHILDREN
SOURCES-
SUNLIGHT AND ANIMAL FOOD (LIVER, EGG YOLK, BUTTER, CHEESE, FISH, MILK)
RDA-
5 MICROGRAMS (200 IU) FOR INFANTS AND 5-10 MICROGRAMS (200-400 IU) FOR
CHILDREN

29. SIGNS AND SYMPTOMS OF VIT D DEFICIENCY :
• FREQUENT INFECTIONS OR ILLNESSES
• FATIGUE AND MUSCLE WEAKNESS
• BONE AND JOINT PAIN
• FRACTURES
• SLOW WOUND HEALING
SYMPTOMS OF A VITAMIN D DEFICIENCY IN CHILDREN INCLUDE:
• IRRITABILITY
• LETHARGY
• BONE PAIN OR FRACTURES

31. DEFICIENCY OF VIT. D
• RICKETS BONE DEFORMITY
• GROWTH RETARDATION
• MUSCULAR HYPOTONIA
• OSTEOMALACIA IN ADULT WOMAN

33. • ACCORDING TO THE INSTITUTE OF MEDICINE (IOM), THE FOLLOWING VALUES
DETERMINE YOUR VITAMIN D STATUS (19):
• DEFICIENT: LEVELS LESS THAN 12 NG/ML (30 NMOL/L).
• INSUFFICIENT: LEVELS BETWEEN 12–20 NG/ML (30–50 NMOL/L).
• SUFFICIENT: LEVELS BETWEEN 20–50 NG/ML (50–125 NMOL/L).
• HIGH: LEVELS GREATER THAN 50 NG/ML (125 NMOL/L).

34. • SOURCES OF VITAMIN D
• GETTING PLENTY OF SUNLIGHT IS THE BEST WAY TO INCREASE YOUR BLOOD VITAMIN D
LEVELS.
• THAT’S BECAUSE YOUR BODY MAKES DIETARY VITAMIN D3 OUT OF THE CHOLESTEROL IN
THE SKIN WHEN IT IS EXPOSED TO THE SUN’S UV RAYS (1TRUSTED SOURCE).
• HOWEVER, PEOPLE WHO DON’T LIVE IN SUNNY COUNTRIES NEED TO CONSUME MORE
VITAMIN D THROUGH FOODS AND SUPPLEMENTS.
• GENERALLY SPEAKING, VERY FEW FOODS ARE GREAT SOURCES OF VITAMIN D.
HOWEVER, THE FOLLOWING FOODS ARE EXCEPTIONS…
• SUMMARY: SUNLIGHT IS THE BEST
SOURCE OF VITAMIN D, BUT MANY PEOPLE CAN’T GET ENOUGH FOR VARIOUS REASONS.
FOODS AND SUPPLEMENTS THAT ARE HIGH IN VITAMIN D CAN HELP AND INCLUDE COD
LIVER
OIL, FATTY FISH, EGG YOLKS AND MUSHROOMS.

35. SOME PEOPLE NEED MORE VITAMIN D
THERE ARE CERTAIN GROUPS OF PEOPLE WHO NEED MORE DIETARY VITAMIN D THAN
OTHERS.
THESE INCLUDE
1 OLDER PEOPLE,
2 THOSE WITH DARKER SKIN,
3 PEOPLE WHO LIVE FAR FROM THE EQUATOR AND
4 THOSE WITH CERTAIN MEDICAL CONDITIONS.(THESE INCLUDE INFLAMMATORY
BOWEL DISEASE (CROHN’S DISEASE AND ULCERATIVE COLITIS), LIVER DISEASE AND
ALSO PEOPLE WHO HAVE HAD BARIATRIC SURGERY )

36. RICKETS
• USUALLY SEEN IN CHILDREN BETWEEN 6 MONTHS TO 2 YEARS OF AGE
• INITIALLY THE SYMPTOMS WILL BE VAGUE WITH IRRITABILITY, RESTLESSNESS AND
SWEATING
OVER THE HEAD ESPECIALLY DURING SLEEP
• EARLY SIGN- CRANIOTABES (DELAYED FUSION OF FONTANELS AND SOFT AND THIN SKULL
BONES
WHICH FEEL LIKE PING PONG BALL)
• LARGE SIZE OF HEAD
• FRONTAL BOSSING AND BOX SHAPE HEAD
• PROMINENT COSTOCHONDRAL JUNCTION ( RACHITIC ROSARY)
• PIGEON CHEST DEFORMITY
• HORIZONTAL DEPRESSION OF LOWER BORDER OF CHEST (HARRISON’S GROVE)
• VIOLIN SHAPES DEFORMITY OF CHEST (PECTUS EXCAVATUM)
• SPINAL DEFORMITIES (SCOLIOSIS, KYPHOSIS OR LORDOSIS)
• KNOCK KNEES (GENU VALGUM), BOW LEGS (GENU VARUM)
• BROADENING OF WRIST AND ANKLES

37. MANAGEMENT
• ADMINISTRATION OF SINGLE MASSIVE DOSE OF VITAMIN D ORALLY OR
INTRAMUSCULARLY
• GROSS ORTHOPEDIC DEFORMITY CORRECTED SURGICALLY
• ANIMAL FOOD SOURCES OF VIT. D SHOULD BE ADDED IN FOOD
• CHILD SHOULD BE ENCOURAGED TO PLAY OUTSIDE FOR LONGER PERIOD FOR
EXPOSURE TO SUNLIGHT
• OVERDOSE OF VIT. D MAY LEAD TO TOXIC SYMPTOMS (NAUSEA, ABDOMINAL
CRAMPS, DIARRHOEA, IRRITABILITY, PALLOR, POLYDIPSIA, FAILURE TO THRIVE,
CALCIURIA, CALCIFICATION OF SOFT TISSUE, CARDIAC ARRHYTHMIAS AND RENAL
FAILURE)

38. VITAMIN E (TOCOPHEROL) :
• FUNCTIONS-
• HELPS IN CELL MATURATION AND MAINTENANCE OF STABILITY OF BIOLOGICAL MEMBRANES
• IT HAS ANTIOXIDANT AND ANTINEOPLASTIC EFFECTS
• SOURCES-
• VEGETABLE OIL, SUNFLOWER OIL, SOYA BEAN, WHEAT, GERMS, LEAFY VEGETABLES, EGG
YOLK, NUTS, SEEDS ETC.
• DEFICIENCY-
• PREMATURITY, HAEMOLYTIC ANAEMIA, SKIN CHANGES, JAUNDICE, EDEMA, ROP,
INTRAVENTRICULAR HAEMORRHAGE, BRONCHOPULMONARY DYSPLASIA, MUSCULAR
DYSTROPHY AND GROWTH FAILURE.
• PREVENTION-
• DIETARY IMPROVEMENT OF MOTHER AND CHILD
• CREATING AWARENESS REGARDING FUNCTIONS, SOURCES AND DEFICIENCY

39. • VITAMIN K
• • FUNCTIONS-
• • STIMULATE THE PRODUCTION AND RELEASE OF CERTAIN COAGULATION FACTORS IN THE LIVER
• • SOURCES-
• • GREEN LEAFY VEGETABLES, SOYA BEAN, TOMATO, FRUITS, LIVER, EGG YOLK AND MILK.
• • DEFICIENCY-
• • PROLONGED BLOOD CLOTTING TIME DUE TO DECREASED PROTHROMBIN LEVEL
• • MANIFESTED IN NEWBORNS AS BLEEDING FROM GIT, IC HAEMORRHAGE, BLEEDING FROM
• UMBLICAL STUMP
• • IN INFANTS VIT. K DEF. MAY BE RELATED TO CHRONIC DIARRHOEA, MALABSORPTION
• SYNDROME, WORM INFESTATION, PROLONGED USE OF ORAL ANTIBIOTICS
• • PREVENTION-
• • INJ. VIT K (1 MG) IM GIVEN TO THE NEWBORNS

40. • VITAMIN B COMPLEX
• • VITAMIN B COMPLEX GROUP INCLUDES
• • VITAMIN B1 - THIAMINE
• • VITAMIN B2 - RIBOFLAVIN
• • VITAMIN B5 - NIACIN/ NICOTINIC ACID
• • VITAMIN B6 - PYRIDOXINE
• • VITAMIN B12 - CYANOCOBALAMIN
• • FOLIC ACID/ FOLATE/ FOLACIN

41. • VITAMIN B1 (THIAMINE)
• • FUNCTIONS-
• • ESSENTIAL FOR METABOLISM OF CARBOHYDRATES AND PROTEINS
• • ESSENTIAL FOR SYNTHESIS OF ACETYLCHOLINE WHICH HELPS IN NERVE CONDUCTION
• • VITAL ROLE IN THE NUTRITION OF HEART AND PERIPHERAL NERVES
• • SOURCES-
• • ALL NATURAL FOODS I.E. WHOLE GRAIN CEREALS, WHEAT, GRAM, PULSES, OILSEEDS AND
• NUTS. MEAT, FISH, EGGS, VEGETABLES AND FRUITS CONTAIN LESS THIAMINE.
• • DEFICIENCY-
• • BERI BERI
• • WERNICKE- KORSAKOFF SYNDROME
• • SUBACUTE NECROTISING ENCEPHALOPATHY

42. • BERIBERI
• • DRY BERIBERI
• • CHRONIC NEUROLOGIC INVOLVEMENT CHARACTERISED BY ANOREXIA, INDIGESTION, WEIGHT
• LOSS, WEAKNESS, DIARRHOEA, CONSTIPATION, EDEMA, APATHY, ATAXIA, PERIPHERAL
• NEURITIS, HOARSENESS, VOCAL CORD PARALYSIS AND DIMINISHED DEEP TENDON
• REFLEXES
• • WET BERIBERI
• • ACUTE CARDIAC INVOLVEMENT CHARACTERISED BY CONGESTIVE CARDIAC FAILURE WITH
• DYSPNEA, CYANOSIS, TACHYCARDIA, EDEMA AND HEPATOMEGALY
• • INFANTILE BERIBERI
• • FOUND BETWEEN 2-4 MONTHS OF AGE OF BREAST FED BABY OF A THIAMINE DEFICIT
• MOTHER WITH PERIPHERAL NEUROPATHY
• • MENINGITIS WITH BERIBERI IS MANIFESTED WITH CONVULSIONS, DIALITED

43. • PREVENTION OF THIAMINE DEFICIENCY
• • HEALTH EDUCATION ON BALANCED DIET AND THIAMINE RICH FOOD (PARBOILED
• AND UNDERMILLED RICE)
• • ADEQUATE ANTENATAL DIET
• • TREATMENT OF PROLONGED ILLNESSES
• • IMPROVEMENT OF SOCIOECONOMIC STATUS
• • PROPHYLACTIC USE OF THIAMINE TO THE CHILDREN WITH PERSISTENT VOMITING
• OR PROLONGED GASTRIC ASPIRATION AND FOR THOSE WHO GO ON LONG FASTS,
• PREVENTS THE DEFICIENCY STATE

44. • VITAMIN B2 (RIBOFLAVIN)
• • FUNCTIONS-
• • ESSENTIAL FOR METABOLISM OF CARBOHYDRATES, FATTY ACIDS AND PROTEINS
• • HELPS IN CELLULAR OXIDATION
• • SOURCES-
• • MILK, EGG, LIVER, GREEN LEAFY VEGETABLES ETC. CEREALS AND PULSES ARE POOR
• SOURCES BUT GERMINATION INCREASES THEIR RIBOFLAVIN CONTENT
• • DEFICIENCY-
• • ANGULAR STOMATITIS, CHEILOSIS, MAGENTA TONGUE, GLOSSITIS, NASOLABIAL
SEBORRHEIC
• DERMATITIS, DYSQUAMINATION, KERATITIS, WATERING OF EYES,
PHOTOPHOBIA,BLURRING
• OF VISION, PERIPHERAL NEUROPATHY AND GROWTH FAILURE
• • PREVENTION-
• • PROMOTING INTAKE OF RIBOFLAVIN CONTAINING FOOD AND PREVENT FAULTY
ABSORPTION

45. • VITAMIN B5 (NIACIN)
• • FUNCTIONS-
• • ESSENTIAL FOR METABOLISM OF CARBOHYDRATES, FAT AND PROTEINS
• • HELPS IN NORMAL FUNCTIONING OF SKIN, GIT, NERVOUS AND HEMOPOIETIC SYSTEM
• • SOURCES-
• • NATURAL FOOD LIKE MILK, LIVER, CHEESE, CEREALS, PULSES, GROUNDNUT AND FISH ETC.
• • DEFICIENCY-
• • PELLAGRA (3 DS- DIARRHOEA, DERMATITIS AND DEMENTIA), GLOSSITIS, STOMATITIS,
DYSPHAGIA,
• NAUSEA, VOMITING, LOSS OF APPETITE, ANEMIA, MENTAL CHANGES
• • DERMATITIS IS FOUND IN EXPOSED SKIN AS PIGMENTED SCALY CRACKED AREA ON NECK,
BACK OF
• HAND, LOWER LEGS AND FACE
• • MAINLY SEEN IN JAWAR AND MAIZE EATERS
• • PREVENTION-
• • PROMOTING INTAKE WELL BALANCED DIET INCLUDING LEGUMINOUS FOOD AND ANIMAL
PROTEIN

46. • VITAMIN B6 (PYRIDOXINE)
• • FUNCTIONS-
• • HELPS IN METABOLISM OF CARBOHYDRATES, FATTY ACIDS AND PROTEINS
• • ESSENTIAL FOR NORMAL FUNCTIONING OF BRAIN AND NERVOUS SYSTEM
• • ROLE IN BLOOD FORMATION AND MATURATION OF POLYMORPHONUCLEAR CELLS
• • SOURCES-
• • NATURAL FOOD LIKE LIVER, EGG, MEAT, WHEAT GERM, SOYABEAN, PEAS, PULSES,
CEREALS
• ETC.
• • DEFICIENCY-
• • CONVULSIONS, PERIPHERAL NEURITIS, IRRITABILITY, HYPOCHROMIC ANAEMIA (NOT
• RESPONDING TO IRON THERAPY) AND SEBORRHEIC DERMATITIS AROUND NOSE AND
EYES,
• GI UPSET, LOSS OF APPETITE, ABDOMINAL DISCOMFORT AND DIARRHOEA
• • PREVENTION-
• • PROMOTING WELL BALANCED DIET

47. • VITAMIN B 12 (CYANOCOBALAMIN)
• • FUNCTIONS-
• • SYNTHESIS OF DNA ALONG WITH FOLATE
• • SYNTHESIS OF FATTY ACID IN MYELIN
• • GROWTH OF LACTOBACILLI IN INTESTINE AND MATURATION OF RBC
• • SOURCES-
• • ONLY THE ANIMAL FOOD AS LIVER, MEAT, EGG, MILK, CHEESE ETC.
• • IT IS SYNTHESISED IN THE COLON BY BACTERIA
• • DEFICIENCY-
• • JUVENILE PERNICIOUS ANAEMIA AND MEGALOBLASTIC ANAEMIA DUE TO LACK OF INTRINSIC
• FACTORS IN STOMACH
• • IT IS FOUND IN STRICT VEGETARIANS
• • MAY LEAD TO DEMYELINATING LESIONS OF SPINAL CORD WITH NUMBNESS AND TINGLING
• SENSATION OF FINGERS AND TOES
• • PREVENTION-

48. • FOLIC ACID
• • FUNCTIONS-
• • NORMAL DEVELOPMENT OF BLEED CELLS IN THE BONE MARROW
• • SYNTHESIS OF DNA
• • SOURCES-
• • LEAFY VEGETABLES, CEREALS, FRUITS, MILK, EGG, LIVER, MEAT AND DIARY PRODUCTS
• • OVERCOOKING AND HEAT DESTROY FOLIC ACID IN FOOD
• • DEFICIENCY-
• • MEGALOBLASTIC ANAEMIA, WEAKNESS, ANOREXIA, GLOSSITIS, CHEILOSIS, GI UPSET
• • PREVENTION-
• • BALANCED DIET WITH PROPER COOKING METHODS
• • ADEQUATE TREATMENT OF LIVER DISEASES, MALABSORPTION SYNDROME, RECURRENT DIARRHOEA
• AND WORM INFESTATION
• • TREATMENT-
• • 1-2 MG FOLIC ACID ORALLY

49. • VITAMIN C (ASCORBIC ACID)
• • FUNCTIONS-
• • FORMATION OF COLLAGEN AND INTRACELLULAR MATRIX IN TEETH, BONES AND CAPILLARIES.
• • HELPS IN TISSUE OXIDATION, MATURATION OF RBSS, ABSORPTION OF IRON
• • PROTECTION AGAINST INFECTION AND ENHANCES IN WOUND HEALING
• • SOURCES-
• • AMLA, GUAVA AND OTHER FRESH FRUITS LIKE TOMATO, ORANGE AND LEMON
• • ALSO AVAILABLE IN GREEN LEAFY VEGETABLES, PEAS, BEANS ETC.
• • MOST SENSITIVE TO HEAT
• • DEFICIENCY-
• • SCURVY WITH FEATURES OF SWOLLEN AND BLEEDING GUMS, SUBCUTANEOUS BRUISING, BLEEDING UNDER
• THE SKIN OR IN JOINTS, DELAYED WOUND HEALING AND ANAEMIS.
• • MAY ALSO LEAD TO WEAKNESS, IRRITABILITY, APPREHENSIVE LOOK, TENDERNESS AND PAIN OVER
• EXTREMITIES WITH FROG LIKE POSITION
• • PREVENTION-
• • TAKING ADEQUATE FRESH FOOD ITEMS CONTAINING VITAMIN C
• • ADEQUATE TREATMENT OF GASTROINTESTINAL DISTURBANCES
• • TREATMENT-

50. • MINERALS AND THEIR DEFICIENCY DISORDERS
• • MINERALS ARE NUTRITIONALLY SIGNIFICANT
• • THEY ARE ESSENTIAL FOR GROWTH, REPAIR AND REGULATION OF BODY FUNCTIONS
• • MAJOR ESSENTIAL MINERALS ARE-
• • CALCIUM, PHOSPHORUS, SODIUM, POTASSIUM AND MAGNESIUM
• • TRACE ELEMENTS REQUIRED FOR THE BODY ARE-
• • IRON, IODINE, FLUORINE, ZINC. COPPER, COBALT, CHROMIUM, MAGANESE, NICKEL, TIN,
• SILICON ETC.
• • TRACE ELEMENTS WITH NO KNOWN FUNCTIONS-
• • LEAD, MERCURY, BORON, ALUMINIUM ETC.

51. • CALCIUM
• • FUNCTIONS-
• • FORMATION OF BONES AND TEETH
• • BLOOD COAGULATION, CARDIAC FUNCTIONS, NERVE CONDUCTION, MUSCLE CONTRACTION AND
• METABOLISM OF ENZYMES AND HORMONES
• • SOURCES-
• • MILK AND MILK PRODUCTS, EGG, FISH
• • OTHER SOURCES- LEAFY VEGETABLES, CEREALS AND MILLETS.
• • CALCIUM ABSORPTION IS AIDED BY VITAMIN D, VITAMIN C AND LACTOSE AND HINDERED BY
• OXALIC ACID, PHYTIC ACID, FATS, FIBRES AND PHOSPHATE
• • DEFICIENCY-
• • RICKETS AND HYPOCALCEMIC TETANY WITH MUSCLE CRAMPS, NUMBNESS, TINGLING SENSATION
• OF LIMBS ETC.
• • MAY ALSO CAUSE GROWTH RETARDATION, OSTEOMALASIA, SKIN PROBLEMS, JOINT PAIN AND
• PALPITATION
• • PREVENTION-
• • INCREASED DIETARY INTAKE OF CALCIUM CONTAINING FOOD, PROMOTING CALCIUM ABSORPTION
• HYPOCALCEMIA IS MORE COMMON AMONG
• LBW BABIES, BABIES WITH PEM, ARTIFICIALLY
• FED BABIES, INFANTS OF DIABETIC MOTHER

53. PHOSPHORUS :
• ESSENTIAL IN METABOLISM OF PROTEINS, FATS AND CARBOHYDRATES
• ESSENTIAL FOR FORMATION OF BONES AND TEETH
• HELPS IN REGULATION OF ACID BASE EQUILIBRIUM
• SOURCES ARE- MILK, MEAT, FISH, EGG YOLK, CEREALS AND PULSES
• DEFICIENCY OCCURS RARELY
• DEFICIENCY MAY LEAD TO RICKETS IN CHILDREN
• HYPERPHOSPHATEMIA RESULTS IN RENAL FAILURE

54. SODIUM :
SODIUM
• IMPORTANT ELECTROLYTE, PRESENT IN ALL BODY FLUIDS
• ESSENTIAL FOR MAINTAINING OSMOTIC PRESSURE
• AVAILABLE IN COMMON SALT, DRINKING WATER, VEGETABLES, MILK EGG, MEAT
ETC.
• DEFICIENCY MAY LEAD TO DEHYDRATION, WEAKNESS, LASSITUDE, DIZZINESS,
NAUSEA, ANOREXIA, HYPOTENSION, SYNCOPE AND CONVULSIONS
• HYPERNATREMIA RESULTS IN EDEMA AND CNS SYMPTOMS LIKE DULLNESS,
CONVULSIONS AND COMA

55. POTASSIUM
• HELPS IN MUSCULAR CONTRACTION, CONDUCTION OF NERVE IMPULSES AND CELL
MEMBRANE PERMEABILITY AND ENZYME ACTION
• ESSENTIAL FOR MAINTENANCE OF OSMOTIC PRESSURE, FLUID ELECTROLYTE BALANCE
AND INTEGRITY OF CARDIAC MUSCLE EXCITABILITY, CONDUCTION AND RHYTHM
• ALL FOOD CONTAIN POTASSIUM. MAINLY- MEAT, MILK, CEREALS, DRY FRUITS AND FRUIT
JUICES
• DEFICIENCY DOES NOT OCCUR NORMALLY. HYPOKALEMIA DEVELOPS IN STARVATION,
MALNUTRITION, GASTROENTERITIS, STEROIDS AND DIURETIC THERAPY, MANIFESTED
BYTACHYCARDIA,
ECG CHANGES, MARKED MUSCLE WEAKNESS, HYPOTONIA, ABDOMINAL
DISTENSION AND DROWSINESS
• HYPERKALEMIA MAY OCCUR DUE TO RENAL FAILURE AND EXCESS POTASSIUM THERAPY
MANIFESTED BY ABDOMINAL DISTENSION, RESTLESSNESS, DIARRHOEA, ABNORMAL
CARDIAC RHYTHM, CARDIAC ARREST AND VENTRICULAR FIBRILLATION

56. • IRON
• • FUNCTIONS-
• • HELPS IN FORMATION OF HAEMOGLOBIN AND MYOGLOBIN
• • HELPS IN DEVELOPMENT AND FUNCTION OF BRAIN, REGULATION OF BODY TEMPERATURE, MUSCLE
ACTIVITY
• • MAIN FUNCTION IS OXYGEN TRANSPORT AND CELL RESPIRATION
• • SOURCES-
• • HEME IRON SOURCES- LIVER, EGG, MEAT, FISH
• • NON HEME IRON- GREEN LEAFY VEGETABLES, LEGUMES, NUTS, CEREALS, OILSEED, JIGGERY, DRY FRUITS
ETC.
• • MILK, EGG, TEA AND EXCESS FIBRES HINDER IRON ABSORPTION
• • VITAMIN C CONTAINING FOOD PROMOTE IRON ABSORPTION
• • DEFICIENCY-
• • MICROCYTIC HYPOCHROMIC ANEMIA
• • EXCESS OF IRON MAY LEAD TO DEPOSITION OF ABNORMAL IRON PIGMENT (HEMOSIDERIN)
• • PREVENTION-
• • IRON RICH DIETARY INTAKE BY CHILD AND MOTHER

58. THANK YOU