Micronutrients Deficiency

Dr. Shreedhar Paudel6th April, 2009

Vitamin A• Deficiency:-

– blindness-- ↑ childhood and maternal mortality

• Sources:---cod liver oil--shark liver oil--liver--butter, ghee--egg, yolk--carrots, green leafy veg, yellow red veg and

fruits

Vitamin A

• Fat soluble vitamin

• Cooking, especially frying in oil improves the absorption of carotenes

• Stored in liver

• Zinc is required to mobilise from liver

Vitamin A • Functions:-

--essential for normal maintenance and function of body tissues for

-vision-cellular integrity-immune competence-growth

--anti-infective vitamin--anti-oxidant property—reduces

incidences of cancer

C/F of Vitamin A deficiency

• Subclinical deficiency:- increased severity of infections

• Early features:- defective dark adaptation → night blindness

• Xerophthalmia:- on prolonged deficiency presents with a syndrome of xerophthalmia

C/F of Vitamin A deficiency

Primary signs Secondary signsX1 A Conjunctival xerosis XN Night blindnessX1 B Bitot’s spots XF Fundal changesX2 Corneal xerosis XS Corneal scarringX3 A Corneal ulceration (<1/3 of cornea)X3 B Corneal ulceration (>1/3 of cornea)

C/F of Vitamin A deficiency

C/F of Vitamin A deficiency

• Skin– scaly and toad like ( phrynoderma)

• More prone to respiratory infections

• Alteration in mucosa of renal pelvis and urinary bladder predispose to formation of renal and vesical calculi

Treatment of Vit A deficiency

• Immediately on diagnosis– oral vit A --50,000 International units→ < 6 mo of age--1 lakh → 6-12 months of age--2 lakh → more than 1 yr

-same dose repeated next day and 4 weeks later

Treatment of Vit A deficiency….

• Local treatment:--antibiotics drops or ointment—3 times

a day to prevent secondary infection in corneal ulcer

-padding eye—prevents dehydration, enhances healing, reduces pain and photophobia

Prevention of Vit A deficiency

• Infants who are not breastfed– 50,000 IU supplement of vit A by two months of age

• Every infant– one dose of 1 lakh units of vit A along with measles vaccine at 9 months

• Encourage consumption of vit A rich food ( locally available and cheap too—green leafy veg, yellow and orange veg and fruits)

Vitamin D

• Sources:--fish, liver, oils, yolk of eggs, butter

• Fat soluble vitamin• Function:-

-absorption of calcium from gut-absorption or deposition of calcium

from or to the bone depending on level of calcium in blood

Vitamin D deficiency• Rickets:-

-craniotabes — ping pong ball like skull bones

-large anterior fontanelle

-bossing of frontal bones

-rachitic rosary—prominent costochondral junction

-pigeon breast—sternum projecting forward

Vitamin D deficiency• Rickets:-

-Harrison’s groove—horizontal depression on lower border of chest (corresponding to insertion of diaphragm)

-delayed eruption of primary teeth

-deformation of long bones when child start bearing body wt

-protuberant abdomen—pot belly

Vit D deficiency

Vitamin D deficiency….• Rickets diagnosis:-

-clinical manifestations

-x-ray changes in lower ends of radius and ulna → cup shaped depression

-larger gap between epiphyses and metaphyses

Vitamin D deficiency….• Management of rickets:-

-supplementation of vit D (oral or IM)-deformities of bone → orthopedic

measures

• If vit D deficiency is present along with PEM:- once the child starts gaining weight, vitamin D will be required to support growth (400 IU/day)

Iron deficiency

• Iron deficiency anaemia is responsible for a fifth of early neonatal mortality

• Also affects growth and development• Limits the learning capacity• Reduces cognitive development• Reduces work capacity of the affected

Iron deficiency• Maternal anemia is associated with intrauterine growth

retardation, premature delivery, increased fetal loss

• Prevented by antenatal supplementation of iron capsules

• Iron rich diet—child, mother

• If deficiency is present along with PEM iron in the form of ferrous sulphate can be given but only after 7 days of admission when the child is on the way to recovery

Iodine Deficiency Disorders• Iodine deficiency in pregnancy → cretinism

and possible fetal wastage• Wide spectrum of effects on growth and

development--endemic goitre--endemic cretinism--impaired mental function--increased stillbirths and perinatal and infant mortality

Iodine deficiency disorders

• Seafoods and vegetables grown on iodine rich soil are good sources

• Goitrogens– maize, bamboo shoots, sweet potatoes, cauliflower, cabbage

Iodine deficiency disorders• Clinical features:-

--abortion and still birth--congenital anomalies--neurological and myxedematous

cretinism--psychomotor defects in newborn--juvenile hypothyroidism--impaired mental function--retardation of physical and sexual growth

Iodine deficiency disorders

• Clinical features:---Neurological cretinism → deaf-mutism,

rigid extremities, gait disturbances

--Myxedematous cretinism → retarded psychomotor development, short stature, coarse facial features but without deaf mutism

Iodine deficiency disorders• Management:-

--prevention- iodinated salt, iodized oil

--treatment with iodine or thyroxine—eliminate signs of hypothyroidism but neuromotor and intellectual deficiency are irreversible

--so prevention is the best management

ZINC

• Zinc is present in all organs, tissues, fluids and secretions of body

• Necessary for RNA, DNA and ribosome stabilization

• Critical for functioning of biomembranes• Supplementation results in improved growth

in children, lower rates of diarrhoea, malaria and pneumonia

Zinc• Sources:-red meat, pork, cheese, whole wheat,

nuts, legumes

• Deficiency states:- – Growth retardation– Hypogonadism– Anorexia– Alopecia– Acral dermatitis– Enteropathica– Behavioural changes– Increased susceptibility to infections

Zinc

• Deficiency states in pregnant women:---premature delivery--intrauterine growth retardation--neural tube defects

• Management:- Zinc fortification of diets