Balanced Diet And Nutritional Disorders Important Notes
- Marasmus
- Marasmus is a common form of protein energy malnutrition
- Mostly occurs 6-12 months postnatally
- Clinical features
- Large head
- Distended abdomen
- Diarrhea
- Stick like limbs
- Reduced body weight
- Kwashiorkor
- It is a disease of protein energy malnutrition occurring in the second year of life
- Clinical features
- Generalized edema
- Change in color of hair
- Diarrhea
- Palpable liver
- Pigmentation of skin and ulceration
- Fat-Soluble Vitamins
- Vitamin A
- Vitamin D
- Vitamin E
- Vitamin K
- Water Soluble Vitamin
- Vitamin B complex
- Vitamin C
Balanced Diet And Nutritional Disorders Long Essays
Question 1. Describe the various manifestations of avitaminosis with particular reference to the oral cavity. How will you treat them?
Answer:
The Various Manifestations Of Avitaminosis With Particular Reference To The Oral Cavity
- Vitamins are essential for growth and normal body functions
- A deficiency of vitamins causes various clinical manifestations as follows
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Etiology, Clinical Features, Diagnosis, And Treatment Of Scurvy
Scurvy Etiology
- Vitamin C deficiency results in scurvy.
Scurvy Clinical Features
- Lesions and clinical manifestations of Vitamin C deficiency are seen more commonly in two extreme age groups i.e., early childhood and geriatric patients.
The following manifestations are seen in vitamin C deficiency.
- Hemorrhage diathesis – A marked tendency to bleed which is the characteristic of scurvy. There may be hemorrhages in the skin, mucous membranes, gums, muscles, joints, and underneath the periosteum.
- Skeletal lesions – There is a deranged formation of osteoid matrix but not deranged mineralization. Growing tubular bones as well as flat bones are affected.
- Delayed wound healing.
- Anaemia Normocytic normochromic type.
- Skin rash Hyperkeratotic and follicular rash may occur.
- Lesions in teeth and gums – Scurvy may interfere with the development of dentin.
- The gums are soft and swollen, may bleed easily, and get infected commonly.
Scurvy Diagnosis
- Through clinical features
Scurvy Treatment
- 250 mg of vitamin C orally three times a day
- Removal of the underlying cause
Etiology, Clinical Features, Diagnosis, And Treatment Of Thiamine Deficiency
Thiamine Deficiency
- Occurs due to vitamin B1
- It leads to beriberi
Thiamine Deficiency Types
- Wet beriberi
- Characterized by edema of legs, face, trunk, and serous cavities
- Dry beriberi
- Associated with neurological manifestations
- Infantile beriberi
- Seen in infants
Thiamine Deficiency Clinical Features
- Loss of appetite
- Weakness
- Constipation
- Nausea
- Mental depression
- Peripheral neuropathy
- Irritability
- Numbness in tire legs
Thiamine Deficiency Diagnosis
- Diagnosis is made from clinical manifestations
Thiamine Deficiency Treatment
- The initial dose of 50 mg intramuscularly is given for several days then 2.5-5 mg is given daily by mouth
Malnutrition
Answer:
Malnutrition
- Malnutrition occurs due to absolute or relative deficiency of energy and protein
Malnutrition Clinical Features
- Mild growth retardation
- Loss of weight
- Thirst
- Weakness
- Feeling cold
- Nocturia
- Amenorrhoea
- Pale and dry skin
- Thinning of hair
- Cold extremities
- Muscle wasting
- Oedema
- Subnormal body temperature
- Distended abdomen
- Diminished tendon jerks
- Apathy
- Depression
- Susceptibility to infections
Malnutrition Management
- Extra feeding
- Repletion of proteins, energy, vitamins, and micronutrients
Beriberi-Types And Clinical Features
Beriberi Types:
- Wet beriberi
- Characterized by edema of legs, face, trunk, and serous cavities
- Dry beriberi
- Associated with neurological manifestations
- Infantile beriberi
- Seen in infants
Beriberi Clinical Features
- Loss of appetite
- Weakness
- Constipation
- Nausea
- Mental depression
- Peripheral neuropathy
- Irritability
- Numbness in the legs
Lesions In Vitamin A deficiency
- Ocular lesions:
- Night blindness
- Xerophthalmia, dry and scaly sclera, conjunctiva
- Keratomalacia due to infections of corneal ulcers,
- Pilots spots are focal triangular areas of opacities due to the accumulation of keratinized epithelium.
- Blindness due to infection, scarring, and opacities.
- Cutaneous lesions: Xeroderma/toad-like appearance of skin because of papular lesions due to follicular hyperkeratosis and keratin plugging in the sebaceous glands.
- Other lesions:
- Squamous metaplasia of
- Respiratory epithelium,
- Pancreatic ductal epithelium,
- Urothelium
- Long-standing metaplasia may progress to anaplasia.
- Immune dysfunction,
- Pregnant women may have an increased risk of maternal infection, mortality, and impaired embryonic development.
Night Blindness
- Night blindness is a common symptom of vitamin A deficiency. It is a defective dark adaptation due to defective synthesis of rhodopsin in rods
- Night blindness is supported by low plasma retinol concentration
- If untreated the condition progresses with loss of the normal mucous cells from the cornea leading to xerophthalmia
Pellagra
- Niacin deficiency causes Pellagra i.e., rough skin
- The cardinal manifestations of pellagra are referred to as the three Ds ie, dermatitis, diarrhea, and dementia and if not treated may lead to 4th D i.e., death.
- Dermatitis: Sun-exposed areas of skin developed erythemia resembling sunburn which may progress to chrome type with blister formation.
- Diarrhoea This is seen along with stomatitis, glossitis, enteritis, nausea, and vomiting
- Dementia: Degeneration of neurons of the brain of the spinal tract results in neurological symptoms such as dementia, peripheral neuritis, ataxia, and visual and auditory disturbances.
- Oral findings include:
- Bald tongue of sandwich,
- Raw beefy tongue
- Mucosa becomes fiery red and painful
- Profuse salivation
- Chronic alcoholics are at high risk of developing pellagra because, in addition to dietary deficiency, niacin absorption is impaired in them.
Vitamin B12
- Vitamin B12 is cyanocobvilamine
Coenzyme Forms:
- 5 Deoxyadenosyl cobalamin
- Methylcobalamin
Coenzyme Functions
- Synthesis of methionine from homocysteine
- Vitamin B12 is used as methylcobalamin in this reaction
- Isomerization of methyl malonyl CoA to succinyl CoA
- It occurs m the presence of vitamin B12 coenzyme, deoxy adenosylcobalamin
Coenzyme Daily Requirements:
- Adults- 3 micrograms/day
- Children -0.5-1.5 micrograms/ day
- During pregnancy and lactation- 4 micrograms/day
Coenzyme Deficiency Manifestation:
- Cyanocobalamine or vitamin B12 deficiency leads to
- Pernicious anemia
- Characterized by low hemoglobin levels, decreased number of erythrocytes, and neurological manifestations
- Neuronal degeneration
- Demyelination of the nervous system
Riboflavin Deficiency
- Riboflavin deficiency symptoms include
- Cheilosis
- The presence of fissures at the corner of the mouth
- Glossitis
- The tongue appears smooth and purplish
- Dermatitis
Balanced Diet
- It is defined as a diet that contains different types of foods possessing the nutrients- carbohydrates, fats, proteins, vitamins, and minerals in a proportion to meet the requirements of the body
- It supplies a little more of each nutrient than the minimum requirement to keep the body in a state of good health and protect against leanness
- Its basic composition varies from country to country
- Indian balanced diet is composed of
- Cereals
- Pulses
- Roots and tubers
- Fruits
- Milk and milk products
- Fats and oils
- Sugar
- Groundnuts
- Meat, fish, and eggs in non-vegetarians
- Additional amounts of milk and pulses in vegetarians
Scurvy
Scurvy Etiology:
- Vitamin C deficiency results in scurvy.
Scurvy Clinical Features:
- Lesions and clinical manifestations of Vitamin C deficiency are seen more commonly in two extreme age groups i.e., early childhood and geriatric patients.
- The following manifestations are seen in vitamin C deficiency.
- Hemorrhage diathesis – A marked tendency to bleed which is characteristic of scurvy. There may be hemorrhages in the skin, mucous membranes, gums, muscles, joints, and underneath the periosteum.
- Skeletal lesions – There is a deranged formation of the osteoid matrix but not deranged mineralization. Growing tubular bones as well as flat bones are affected.
- Delayed wound healing.
- Anaemia Normocytic normochromic type.
- Skin rash Hyperkeratotic and follicular rash may occur.
- Lesions in teeth and gums Scurvy may interfere with the development of dentin.
- The gums are soft and swollen, may bleed easily, and get infected commonly.
Rickets
- Rickets is a clinical disorder seen in growing children from 6 months to 2 years of age due to a deficiency of Vitamin D.
Rickets Clinical Features:
- The gross skeletal changes depend on the severity of the rachitic process, its duration, and in particular the stresses to which individual bones are subjected.
- Craniotabes, are the earliest bony lesions due to small round unossified areas in the membranous bones of the skull.
- Harrisons sulcus occurs due to in drawing of soft ribs on inspiration.
- Pigeon chest deformity
- Bow legs occur In ambulatory children due to weak bones of lower logs.
- Knocked knees may occur due to enlarged ends of the femur, tibia, and fibula.
- Lower epiphyses of the radius may be enlarged.
- Lumbar lordosis due to involvement of the spine and pelvis.
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Niacin
- Niacin is vitamin M3
- Niacin is a pyridine derivative
Coenzyme Forms:
- Nicotinamide adenine dinucleotide, NAD+
- Nicotinamide adenine dinucleotide phosphate, NADP+
Niacin Functions:
- Involved in an oxidation-reduction reaction
- Participates in almost all the metabolism
Niacin Deficiency Manifestation:
- Pellagra
Vitamin D
- Vitamin D is a fat-soluble vitamin
- Vitamin D resembles sterols in structure
- Its best source is sunlight
- Its active form is calcitriol
- Vitamin D is involved in calcium metabolism
- Required in bone formation
- Its daily requirement is 400 IU
- Its deficiency leads to rickets in children and osteomalacia in adults
Vitamin C
- Vitamin C Is a water-soluble vitamin
- Vitamin C plays an important role in human health and disease
- Vitamin C is readily absorbed by the intestines and excreted in urine
- About 60-70 mg of vitamin C is required per day Citrus fruits are the main sources of vitamin C
- Vitamin C deficiency leads to scurvy
Vitamin E
- Vitamin E is a fat-soluble vitamin
Vitamin E Sources:
- Vegetable oils
- Meal
- Milk
- Butler
- Eggs
Vitamin E Requirements:
- Males-10 mg
- Females- 8
Vitamin E Deficiency Manifestations:
- Neurological dysfunction
Bitot’s Spots
- Bitot’s spot may appear as glistening white plaques of desquamated thickened conjunctival epithelium, usually triangular and firmly adherent to the underlying triangular and firmly adherent to the underlying conjunctival.
- Bitot’s spots occur due to vitamin A deficiency.
Bitot’s Spots Treatment:
- Oral administration of retinol 30 mg daily for 3 days
- In advanced cases, vitamin A is given in the dose of 50,000 IU parenterally for three days
Bitot’s Spots Prevention:
- Good nutrition
- Intake of fresh leafy green vegetables
- Intake of vitamin A
Vitamin B12
- Vitamin B12 is cyancvohalamine
Vitamin B12 Coenzyme Forms:
- 5-Deoxyadenosyl cobalamin
- Methylcobalamin
Vitamin B12 Functions:
- Synthesis of methionine from homocysteine
- Vitamin B12 is used as methylcobalamin in this reaction
- Isomerization of methyl malonyl CoA to succinyl CoA
- It occurs in the presence of vitamin B12 coenzyme, deoxy adenosylcobalamin
Vitamin B12 Daily Requirements:
- Adults- 3 micrograms/day
- Children -0.5-1.5 micrograms/day
- During pregnancy and lactation- 4 micrograms/day
Vitamin A deficiency
Vitamin A deficiency leads to
- Night blindness
- Xerophthalmia
- Keratomalacia
- Retarded growth
Vitamin K
Vitamin K is fat soluble vitamin
Vitamin K Sources:
- Animal sources
- Egg yolk, meat, liver, cheese, and dairy products
- Plant sources
- Cabbage, cauliflower, tomatoes, alfalfa, spinach
Vitamin K Functions:
- Helps in coagulation
- Daily Requirement- 70-140 micrograms/day
Vitamin K Deficiency Symptoms:
- Diminished blood clotting
- Increased prothrombin time
Vitamin B6
Vitamin B6 Sources:
- Milk
- Liver
- Meat
- Legumes
- Whole grains
- Cereals
- Nuts
- Vegetables
Vitamin B6 Functions:
- Acts as a cofactor for several enzymes involved in amino acid metabolism
- Involved in the metabolism of fat, carbohydrates, and several vitamins
- Involved in heme synthesis
Pyridoxine deficiency
Pyridoxine Deficiency Symptoms:
- Glossitis
- Cheilosis
- Weakness
- Peripheral neuropathy
- Depression
- Irritability
- Microcytic, hypochromic anemia
- Seizures
Pyridoxine Deficiency Treatment:
- Oral administration of vitamin B6 in the dosage of 10-20 mg/day
Cyanocobalamine Deficiency
Cyanocobalamine or vitamin B12 deficiency leads to
- Pernicious anemia
- Characterized by low hemoglobin levels, decreased number of erythrocytes, and neurological manifestations
- Neuronal degeneration
- Demyelination of the nervous system