Nutritional disordersNutritional disorders

Premed 2Premed 2

PathophysiologyPathophysiology

Dr. ROOPADr. ROOPA

PROTEIN-CALORIE PROTEIN-CALORIE MALNUTRITIONMALNUTRITION

1. Marasmus1. Marasmus-deficiency of ALL nutrients-deficiency of ALL nutrients-low proteins, vitamins, calories-low proteins, vitamins, calories-less than 1 year old, not breastfed-less than 1 year old, not breastfed

2. Kwashiokor2. Kwashiokor-deficiency of protein, calories OK-deficiency of protein, calories OK-more than 1 year old-more than 1 year old-fatty liver , EDEMA, depigmented bands of -fatty liver , EDEMA, depigmented bands of

hair hair and skinand skin

MARASMUSMARASMUS

KwashiorkorKwashiorkor

Kwashiorkor sufferers show signs of thinning Kwashiorkor sufferers show signs of thinning hair, hair, edema, inadequate growth, and weight , inadequate growth, and weight loss. loss.

MARASMUSMARASMUS Poor growthPoor growth Loss of muscleLoss of muscle Loss of subcutaneous Loss of subcutaneous

fatfat

KWASHIORKORKWASHIORKOR Poor growthPoor growth Loss of muscleLoss of muscle (+) subcutaneous fat(+) subcutaneous fat

Water soluble vitaminsWater soluble vitamins

B1 – ThiamineB1 – Thiamine B2 – RiboflavinB2 – Riboflavin B3 – NiacinB3 – Niacin B6 – PyridoxineB6 – Pyridoxine B12 – CobalaminB12 – Cobalamin Folic acidFolic acid Vitamin C – Ascorbic acidVitamin C – Ascorbic acid

Water soluble vitaminsWater soluble vitamins

Regular intake is necessaryRegular intake is necessary B12 – stored in liver in large amountsB12 – stored in liver in large amounts

- deficiency takes years to develop- deficiency takes years to develop Toxicity rareToxicity rare Excreted in the urineExcreted in the urine Sources: vegetables, cereals, grains, meat, Sources: vegetables, cereals, grains, meat,

dairy products, fruitsdairy products, fruits

Thiamine deficiency (B1)Thiamine deficiency (B1)

Common in Western countries: alcoholism, Common in Western countries: alcoholism, dietsdiets

1. Dry Beri-beri1. Dry Beri-berineuropathy of the peripheral limbsneuropathy of the peripheral limbsmuscle atrophymuscle atrophy

2. Wet beri-beri2. Wet beri-beridilated vessels, dilated heartdilated vessels, dilated heartHigh-output cardiac failureHigh-output cardiac failure

Thiamine deficiency (B1)Thiamine deficiency (B1)

3. Wernicke-Korsakoff deficiency3. Wernicke-Korsakoff deficiency- alcholism- alcholism-brain stem, diencephalon degenerates-brain stem, diencephalon degenerates-hemorrhage in the brain-hemorrhage in the brain-Wernicke’s triad:-Wernicke’s triad:

confusionconfusionataxiaataxiaophthalmoplegiaophthalmoplegia

-memory loss, confabulation-memory loss, confabulation

RIBOFLAVIN (B2)RIBOFLAVIN (B2)

Rare deficiencyRare deficiency Always added to bread, cereal productsAlways added to bread, cereal products Deficiency: Deficiency:

cheilosis (fissures at mouth angles)cheilosis (fissures at mouth angles)

glossitis (inflammation of the tongue)glossitis (inflammation of the tongue)

increased blood vessels in the corneaincreased blood vessels in the cornea

seborrheic dermatitisseborrheic dermatitis

NIACIN(B3)NIACIN(B3)

Niacin, tryptophan deficiencyNiacin, tryptophan deficiency Important part of nicotinamide adenine Important part of nicotinamide adenine

dinucleotides (NAD, NADP)dinucleotides (NAD, NADP) PELLAGRA:PELLAGRA:

dementiadementia

dermatitisdermatitis

diarrheadiarrhea

PYRIDOXINE (B6)PYRIDOXINE (B6)

May lead to deficiency of GABAMay lead to deficiency of GABA Convulsions in kidsConvulsions in kids Seen also in alcoholism, antiTB drug useSeen also in alcoholism, antiTB drug use Glutamate ( glutamic acid decarboxylase and Glutamate ( glutamic acid decarboxylase and

pyridoxal phosphate as a cofactor)----GABApyridoxal phosphate as a cofactor)----GABA

Cobalamin (B12)Cobalamin (B12)

Reduced DNA replicationReduced DNA replication Reduced cell divisionReduced cell division Found almost always in MALABSORPTION: Found almost always in MALABSORPTION:

Pernicious anemia Pernicious anemia Crohn’s disease, Fish tapeworm infection Crohn’s disease, Fish tapeworm infection

(Diphyllobotrium latum, vegetarians(Diphyllobotrium latum, vegetarians MEGALOBLASTIC ANEMIA + MEGALOBLASTIC ANEMIA +

NEUROLOGIC ABNORMALITIESNEUROLOGIC ABNORMALITIES

FOLIC ACID FOLIC ACID

May be due to malabsorption or due to May be due to malabsorption or due to increase demandincrease demand

Cancer therapy, alcoholic, dietersCancer therapy, alcoholic, dieters MEGALOBLASTIC ANEMIA ONLYMEGALOBLASTIC ANEMIA ONLY

ASCORBIC ACIDASCORBIC ACID

Serves as cofactor of the synthesis of proline Serves as cofactor of the synthesis of proline and hydroxyproline ---- collagen synthesisand hydroxyproline ---- collagen synthesis

SCURVYSCURVY Poor wound healingPoor wound healing Abnormal bleedingAbnormal bleeding Bone changes Bone changes

FAT-SOLUBLE VITAMINSFAT-SOLUBLE VITAMINS

Vitamin AVitamin A Vitamin D ( calciferol)Vitamin D ( calciferol) Vitamin E (alpha-tocopherol)Vitamin E (alpha-tocopherol) Vitamin KVitamin K Toxicity common, hypervitaminosisToxicity common, hypervitaminosis

Vitamin AVitamin A

RetinoidsRetinoids A part of rhodopsin (visual pigment)A part of rhodopsin (visual pigment) Needed for good epitheliumNeeded for good epithelium Animal products, vegetablesAnimal products, vegetables

Vitamin AVitamin A

Vitamin A deficiencyVitamin A deficiency 1. Night blindness1. Night blindness 2. Squamous metaplasia2. Squamous metaplasia 3. Xeropthalmia (dry 3. Xeropthalmia (dry

eyes)eyes) 4. Blindness4. Blindness 5.Keratomalacia (soft 5.Keratomalacia (soft

cornea)cornea)

Vitamin A excessVitamin A excess 1. alopecia (baldness)1. alopecia (baldness) 2. liver damage2. liver damage 3. bone changes3. bone changes

Vitamin DVitamin D

Synthesized in the skin by exposure to sunlightSynthesized in the skin by exposure to sunlight Food sources: milk, butter, eggsFood sources: milk, butter, eggs Needed for calcium absorption in the intestinesNeeded for calcium absorption in the intestines

Vitamin DVitamin D

Vitamin D deficiencyVitamin D deficiency Rickets: childrenRickets: children Osteomalacia: adultsOsteomalacia: adults

Vitamin D excessVitamin D excess Poor growthPoor growth Excessive calciumExcessive calcium HypercalciuriaHypercalciuria NephrocalcinosisNephrocalcinosis Renal calculi (stones)Renal calculi (stones)

Vitamin EVitamin E

RareRare Deficiency may cause neurologic Deficiency may cause neurologic

abnormalitiesabnormalities

Vitamin K Vitamin K

Needed in the synthesis of clotting factors II, Needed in the synthesis of clotting factors II, VII, IX, X (2, 7, 9, 10)VII, IX, X (2, 7, 9, 10)

Synthesized by bacteria in our intestinesSynthesized by bacteria in our intestines Food sources: vegetables, dairy productsFood sources: vegetables, dairy products Malabsorption, antibiotic useMalabsorption, antibiotic use Hemorrhagic diasthesisHemorrhagic diasthesis Hemorrhagic disease of the newbornHemorrhagic disease of the newborn