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Nutritional Disorders

Under nutrition & Obesity

Dr. Mehzabin Ahmed


Malnutrition
It is a serious medical and socioeconomic
problem may be a consequence (result) or
cause of diseases.
Diseases associated with malnutrition:
 Anorexia nervosa
 Cancers of the stomach & esophagus
 Postoperative cases
 Dementia
Nutritional Deficiencies These include
 protein energy malnutrition
 vitamin deficiencies
 obesity
Protein energy
malnutrition
Protein energy malnutrition affects about 400 million children
in the world, making it a major health problem.
Young children tend to be most affected because they have
increased metabolic demands for nutrients during the rapid
early growth phase.
PEM refers to a range of clinical syndromes characterized by
an inadequate dietary intake of proteins and calories to meet
the body’s needs.
A child whose weight falls to less than 80% of normal is
considered as undernourished. When the level falls to 60% of
normal weight for sex and age, the child is considered to
have marasmus.
Marasmus
It is the compensated form of PEM.
It is characterized by the catabolism of the body’s
expendable tissues, adipose tissue and skeletal muscle.
The calories and amino acids derived from tissue catabolism
are used to maintain normal cellular metabolism.
The catabolism of adipose tissue and muscle leads to
extreme wasting, which is the hallmark of marasmus.
Normal serum albumin levels are maintained and there is no
edema.
Adequate synthesis of structural proteins and enzyme also
continues.
Anemia, multivitamin deficiency & immune deficiency is
Most common cause of
PEM in developing
countries is:

• Inadequacy of food

• Gastroenteritis &
other severe
infections

In developed countries:

• Malabsorption due to
intestinal disease

• Anorexia nervosa and


related psychological
disorders
Kwashiorkor
Represents the decompensated phase of PEM
The protein deprivation is greater than the deprivation in total
calories (carbohydrates still available). The child has 60-80%
of the normal weight.
1. Decreased synthesis of enzymes and structural protein
occurs. Deficient digestive enzyme production in the intestine
and atrophy of the small intestinal villi results in failure to
absorb ingested food.
2. Decreased serum albumin levels result in generalized
edema (due to a decrease in the colloidal osmotic pressure).
Ascites produces a protuberant abdomen.
3. Abnormal fat catabolism causes fatty liver with
hepatomegaly.
4. Changes also occur in the :

Hair-
 Becomes fine and brittle
 abnormal reddish
pigmentation,
 alternating light and dark
bands (flag sign).

Skin-
 Shows abnormal
pigmentation
 increased desquamation
Eating Disorders
They result from psychiatric disorders and cause nutritional
disturbances.
These disorders occur primarily in previously healthy young women
who have developed an obsession with thinness.
Anorexia nervosa
 self-induced starvation, resulting in marked weight loss.
 Patients with anorexia nervosa show abnormal hypothalamic
function that is an adaptive mechanism to chronic starvation.
 FSH & LH levels are decreased leading to failure of ovulation and
amenorrhea.
Bulimia
 a condition in which patient binges on food and then induces
vomiting.
 Patients with bulimia have
 electrolyte imbalance
 mucosal tears of the esophagus with bleeding,
 aspiration pneumonitis and

http://www.ag.uiuc.edu/~food-lab/resources/lectures/eatin
Obesity
Ideal weight are established on
the basis of height, sex, body
frame, obesity is usually defined
as a body weight 20% greater
than the ideal weight.
 An imbalance in the calorie intake () & its breakdown ()
tilting the balance towards storage of excess calories as fat
within adipocytes in the
subcutaneous adipose tissue,
omentum, mesentery,
perinephric tissue and
epicardial adipose tissue.
How does one measure fat accumulation?
There are several highly technical ways to approximate
the measurement, but for practical considerations, the
following ones are commonly used:

Some expression of weight in relation to height,

especially the measurement referred to as the body

mass index (BMI)

Skin fold measurements

Various body circumferences, particularly the ratio of


The BMI, expressed in kilograms per square meter

Obesity Class  BMI (kg/m2) Risk


Underweight  <18.5 Increased
Normal  18.5-24.9 Normal
Overweight  25.0-29.9
Increased
Obesity
 I 30.0-34.9 High
 II 35.0-39.9 Very high
 Extreme II ≥40.0 Extremely high
The etiology/causes of
obesity
Genetic: Genetic defect in the leptin gene can cause obesity.
Obesity is also known to be associated with some congenital
syndromes like
 Prader Willi syndrome,
 Laurence Moon Biedle syndrome,
 Cohen syndrome &
 Carpenter syndrome.

Environmental: Injury to the hypothalamus due to


trauma/surgery.
Drugs: Long term therapy with antidepressants, antiepileptics,
steroids, some antihypertensives can result in abnormal
weight gain
Clinical features
1. Hypoventilation syndrome: In extreme obesity increased fat in
chest wall causes decreased alveolar ventilation and
consequently carbon dioxide retention and apenic attacks.
2.  Diseases associated with obesity:
Hypertension
Diabetes mellitus type II
Hyperlipidemia & increased severity of Atherosclerosis
Myocardial infarction & Stroke
Osteoarthritis
Gallstones & obstructive biliary disease
Increased predisposition to leg vein thrombosis & pulmonary
embolus
Gastrointestinal
 Gallstones, pancreatitis, abdominal hernia, NAFLD (steatosis,
steatohepatitis, and cirrhosis), and possibly GERD
Endocrine/metabolic
 Metabolic syndrome, insulin resistance, impaired glucose tolerance, type II
diabetes mellitus, dyslipidemia, polycystic ovary syndrome
Cardiovascular
 Hypertension, coronary artery disease, congestive heart failure,
arrhythmias, pulmonary hypertension, ischemic stroke, venous stasis, deep
vein thrombosis, pulmonary embolus
Respiratory
 Abnormal pulmonary function, obstructive sleep apnea, obesity
hypoventilation syndrome
Musculoskeletal
 Osteoarthritis, gout, low back pain
Gynecologic
 Abnormal menses, infertility
Genitourinary
 Urinary stress incontinence
Ophthalmologic
 Cataracts
Neurologic
 Idiopathic intracranial hypertension (pseudotumor cerebri)
Cancer
 Esophagus, colon, gallbladder, prostate, breast, uterus, cervix, kidney
Postoperative events
 Atelectasis, pneumonia, deep vein thrombosis, pulmonary embolus
3. Milder disorders the obese

suffer from are

breathing disorders on

exertion,

fungal infections in skin

creases, and

a tendency to lower-leg

ulcers which heal slowly

and poorly.

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