1. Nutritional disorders Premed 2 Pathophysiology Dr. ROOPA

2. PROTEIN-CALORIE MALNUTRITION 1. Marasmus 1. Marasmus -deficiency of ALL nutrients -low proteins, vitamins, calories -less than 1 year old, not breastfed 2. Kwashiokor 2. Kwashiokor -deficiency of protein, calories OK -more than 1 year old -fatty liver, EDEMA, depigmented bands of hair and skin

3. MARASMUS

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

6. MARASMUS MARASMUS Poor growth Poor growth Loss of muscle Loss of muscle Loss of subcutaneous fat Loss of subcutaneous fat KWASHIORKOR KWASHIORKOR Poor growth Poor growth Loss of muscle Loss of muscle (+) subcutaneous fat (+) subcutaneous fat

8. Water soluble vitamins B1 – Thiamine B1 – Thiamine B2 – Riboflavin B2 – Riboflavin B3 – Niacin B3 – Niacin B6 – Pyridoxine B6 – Pyridoxine B12 – Cobalamin B12 – Cobalamin Folic acid Folic acid Vitamin C – Ascorbic acid Vitamin C – Ascorbic acid

9. Water soluble vitamins Regular intake is necessary Regular intake is necessary B12 – stored in liver in large amounts B12 – stored in liver in large amounts - deficiency takes years to develop - deficiency takes years to develop Toxicity rare Toxicity rare Excreted in the urine Excreted in the urine Sources: vegetables, cereals, grains, meat, dairy products, fruits Sources: vegetables, cereals, grains, meat, dairy products, fruits

10. Thiamine deficiency (B1) Common in Western countries: alcoholism, diets Common in Western countries: alcoholism, diets 1. Dry Beri-beri 1. Dry Beri-beri neuropathy of the peripheral limbs muscle atrophy 2. Wet beri-beri 2. Wet beri-beri dilated vessels, dilated heart High-output cardiac failure

11. Thiamine deficiency (B1) 3. Wernicke-Korsakoff deficiency 3. Wernicke-Korsakoff deficiency - alcholism -brain stem, diencephalon degenerates -hemorrhage in the brain -Wernicke’s triad: confusionataxiaophthalmoplegia -memory loss, confabulation

12. RIBOFLAVIN (B2) Rare deficiency Rare deficiency Always added to bread, cereal products Always added to bread, cereal products Deficiency: Deficiency: cheilosis (fissures at mouth angles) glossitis (inflammation of the tongue) increased blood vessels in the cornea seborrheic dermatitis

13. NIACIN(B3) Niacin, tryptophan deficiency Niacin, tryptophan deficiency Important part of nicotinamide adenine dinucleotides (NAD, NADP) Important part of nicotinamide adenine dinucleotides (NAD, NADP) PELLAGRA: PELLAGRA:dementiadermatitisdiarrhea

14. PYRIDOXINE (B6) May lead to deficiency of GABA May lead to deficiency of GABA Convulsions in kids Convulsions in kids Seen also in alcoholism, antiTB drug use Seen also in alcoholism, antiTB drug use Glutamate ( glutamic acid decarboxylase and pyridoxal phosphate as a cofactor)----GABA Glutamate ( glutamic acid decarboxylase and pyridoxal phosphate as a cofactor)----GABA

15. Cobalamin (B12) Reduced DNA replication Reduced DNA replication Reduced cell division Reduced cell division Found almost always in MALABSORPTION: Pernicious anemia Found almost always in MALABSORPTION: Pernicious anemia Crohn’s disease, Fish tapeworm infection (Diphyllobotrium latum, vegetarians Crohn’s disease, Fish tapeworm infection (Diphyllobotrium latum, vegetarians MEGALOBLASTIC ANEMIA + NEUROLOGIC ABNORMALITIES MEGALOBLASTIC ANEMIA + NEUROLOGIC ABNORMALITIES

16. FOLIC ACID May be due to malabsorption or due to increase demand May be due to malabsorption or due to increase demand Cancer therapy, alcoholic, dieters Cancer therapy, alcoholic, dieters MEGALOBLASTIC ANEMIA ONLY MEGALOBLASTIC ANEMIA ONLY

17. ASCORBIC ACID Serves as cofactor of the synthesis of proline and hydroxyproline ---- collagen synthesis Serves as cofactor of the synthesis of proline and hydroxyproline ---- collagen synthesis SCURVY SCURVY Poor wound healing Poor wound healing Abnormal bleeding Abnormal bleeding Bone changes Bone changes

18. FAT-SOLUBLE VITAMINS Vitamin A Vitamin A Vitamin D ( calciferol) Vitamin D ( calciferol) Vitamin E (alpha-tocopherol) Vitamin E (alpha-tocopherol) Vitamin K Vitamin K Toxicity common, hypervitaminosis Toxicity common, hypervitaminosis

19. Vitamin A Retinoids Retinoids A part of rhodopsin (visual pigment) A part of rhodopsin (visual pigment) Needed for good epithelium Needed for good epithelium Animal products, vegetables Animal products, vegetables

20. Vitamin A Vitamin A deficiency Vitamin A deficiency 1. Night blindness 1. Night blindness 2. Squamous metaplasia 2. Squamous metaplasia 3. Xeropthalmia (dry eyes) 3. Xeropthalmia (dry eyes) 4. Blindness 4. Blindness 5.Keratomalacia (soft cornea) 5.Keratomalacia (soft cornea) Vitamin A excess Vitamin A excess 1. alopecia (baldness) 1. alopecia (baldness) 2. liver damage 2. liver damage 3. bone changes 3. bone changes

21. Vitamin D Synthesized in the skin by exposure to sunlight Synthesized in the skin by exposure to sunlight Food sources: milk, butter, eggs Food sources: milk, butter, eggs Needed for calcium absorption in the intestines Needed for calcium absorption in the intestines

22. Vitamin D Vitamin D deficiency Vitamin D deficiency Rickets: children Rickets: children Osteomalacia: adults Osteomalacia: adults Vitamin D excess Vitamin D excess Poor growth Poor growth Excessive calcium Excessive calcium Hypercalciuria Hypercalciuria Nephrocalcinosis Nephrocalcinosis Renal calculi (stones) Renal calculi (stones)

23. Vitamin E Rare Rare Deficiency may cause neurologic abnormalities Deficiency may cause neurologic abnormalities

24. Vitamin K Needed in the synthesis of clotting factors II, VII, IX, X (2, 7, 9, 10) Needed in the synthesis of clotting factors II, VII, IX, X (2, 7, 9, 10) Synthesized by bacteria in our intestines Synthesized by bacteria in our intestines Food sources: vegetables, dairy products Food sources: vegetables, dairy products Malabsorption, antibiotic use Malabsorption, antibiotic use Hemorrhagic diasthesis Hemorrhagic diasthesis Hemorrhagic disease of the newborn Hemorrhagic disease of the newborn