CLINICAL ASSESSMENT OF NUTRIENTS

A. Clinical Assessment of Energy and Protein Deficiency

Deficiency Definition Major Functions Clinical Symptoms of Physical Signs of

Deficiency Deficiency

Marasmus ● severe ● Carbohydrates ● Anemia ● Visible wasting of

energy and - the source of ● Slow heart rate fat and muscle
protein energy ● Osteomalacia ● Prominent
deficiency ● Proteins - ● Electrolyte skeleton
building blocks imbalances ● Head appears
for tissue growth ● Low blood pressure large for the body
and repair ● Diarrhea ● Face may appear
● Lower immunity old and wizened
● Stomach infection ● Dry, loose skin
● Lactose intolerance (skin atrophy)
● Respiratory infection ● Dry, brittle hair or
● Gastrointestinal hair loss.
malabsorption ● Sunken
● Intellectual disability fontanelles in
● Fatigue infants
● Muscle Atrophy

Kwashiorkor ● Protein Proteins help in ● Psychomotor ● Edema

deficiency 1. Movement changes ● Muscle Mass
2. Transport ● Lethargic movement Loss (wasting)
3. Hormone ● Irritable ● Moon face
synthesis ● Diarrhea ● Bloated stomach
4. Protection ● Muscle tone and ● Patches of red,
5. Storage strength diminish irritated skin
6. Structural ● Prone to infection ● Hair change
support ● Difficulty to
7. Enzymatic increase height
catalysis ● Nails with ridges
8. Generation and cracks
and
transmission Functional Tests:
of nerve 1. Skeletal
impulses Muscle
Function
2. Hand Grip
Method
3. Lymphocyte
count
4. Lymphocyte
proliferation
assays
5. Delayed
cutaneous
Hypersensitivit
y
B. Clinical Assessment of Vitamin Deficiency

Deficiency Definition Major Functions Clinical Symptoms of Physical Signs of

Deficiency Deficiency

Vitamin A ● A fat-soluble ● Retinoic acid - ● Xeropthalmia - ● Xeropthalmia

Deficiency vitamin involved in gene drying and wrinkling ○ Conjunctival
● Retinoids: expression of the outer layer of xerosis
1. Retinol ● Retinal - the eye - ○ Bitot’s spots
2. Retinal involved in vision conjunctiva; and ○ Corneal
3. Retinoic ● Retinol - night blindness xerosis
Acid circulate in the ● Follicular ○ Corneal
4. Retinyl blood involved in Hyperkeratosis ulceration
esters vision; involved ○ Phrynoderma; (X3A) w/o
5. Retinoids in skin cell itchiness on the secondary
production affected area, infection
drying, scaling ○ Corneal
and patching of ulceration
the skin. (X3A) w/
○ Darier disease; secondary
itchy and sore, infection
unpleasant odor ○ Keratomalacia
on the skin, (Grade X3B)
moisture on the ○ Corneal scar
affected areas. (Grade XS)
○ Lichen ● Follicular
spinulosus; Hyperkeratosis
feeling of ○ Phryynoderma
brushing your ○ Darier Disease
fingers over a ○ Lichen
nutmeg grater, spinulosus
and itchiness.

Functional Tests 1. Night Blindness Test

2. Dark Adaptation Test
3. Immune Response
4. Growth Retardation Test

Vitamin D ● A fat-soluble ● Assists the body ● Fatigue ● Recurrent

Deficiency vitamin that to absorb ● Not sleeping well Fractures
is mostly calcium and ● Bone pain ● Bone Deformity
found in liver phosphorus ● Depression or ● Rickets
and fish oils. ● Essential for feelings of sadness ● Rachitic Rosary
controlling renal ● Hair loss ● Pigeon Chest
functioning and ● Muscle weakness ● Frontal Bossing
safeguarding the ● Loss of appetite ● Craniotabes
kidney against ● Getting more easily ● Osteomalacia
infection ● Pale skin
● Crucial for ● Bone tenderness
cellular
development,
maintenance,
and metabolism
● Vitamin D
synthesis and
activation

Functional Tests 1. Serum Parathyroid (PTH) Levels

2. Hand Grip Strength
3. Bone density Test
Vitamin E ● Fat-soluble ● Fat-soluble ● Muscle weakness ● Essential Tremors
Deficiency compounds antioxidant ● Coordination and ● Peripheral
that include ● Protects all walking difficulties Neuropathy
both membranes ● Numbness and ● Sipinocerebellar
tocopherol ● Defend cells tingling Ataxia
and from damage by ● Vision deterioration ● Pigmented
tocotrienol. heavy metals ● Weakened immune Retinopathy
● Important for system
immune function ● Easily tired For infants
and to inhibit ● Apathetic ● Shiny skin
platelet ● Puffy eyes
aggregation ● Firm legs
● Low birth
weight

Functional Tests 1. Physical Examination

2. Blood Tests

Vitamin C ● A ● Repair and ● Brittle Bones ● Petechiae

Deficiency water-soluble maintain ● Slow Wound Healing ● Purpurae
e-vitamin that cartilages ● Disfigured nails and ● Ecchymoses
is essential in ● Improve immune hair ● Splinter
collagen system ● Impaired immune hemorrhages
formation ● Iron absorption system ● Hyperkeratotic
and ● Anti-oxidant ● Inflammation hair follicles
synthesizing ● Collagen ● Fatigue/Easily Tired ● Gingivities
wound Formation ● Unexplained Wight ● Sublingual
healing. Gain hemorrhages
● Edema
● Anemia
● Spoon shaped
nails

Functional Tests 1. Plasma vitamin C concentration

2. Leukocyte vitamin C concentrations
3. Iron levels in the blood
4. Capillary Fragility Test/Hess Test

Thiamin ● Water-solubl ● Antioxidant ● Weight loss ● Dry beri–beri;

Deficiency e vitamin ● Increase ● Confusion polyneurities/
needed for immunity ● Dizziness peripheral neuritis
CNS ● Maintain the ● Anxiety ● Wet Beri-beri;
proper operation ● Dimentia heart
of our nervous ● Muscular Atrophy enlargement, and
system ● Myalgia edema
● Adis in the ● Emotional instability ● Wernicke-Korsako
production of ● Backache ff Syndrome
HCL ● Paresthesia ● For babies:
● Skin renewal ● Palpitation Infantile BeriBeri;
and delaying the ● Malaise opisphotonus,
appearance of ● Fatigue aphonia, dyspnea,
wrinkles, spots, ● Vomiting oliguria, & edema.
dark circles, etc.

Functional Tests —-

Riboflavin ● A precursor ● Energy ● Photophobia ● Glossitis

Deficiency of the metabolism ● Fatigue ● Angular stomatitis
 formation of ● Cell Respiration ● Swollen throat ● Seborrhic
FMN and ● Production of ● Blurred vision stomatitis
FAD. antibodies ● Depression ● Dermatitis
● Growth and ● Hyperemia ● Cheilosis
Development ● Liver degeneration ● Corneal
● Reproductive vasculirization
problems ● Itchy and red eyes
● Nervous system ● Edema of the
degeneration mouth and throat
● Hair loss

Functional Test 1. EGR activity coefficient

2. Urinary Excretion

Niacin ● B-vitamin ● Synthesis of ● Thick, scaly, ● Cassal’s Necklace

Deficiency that play a coenzyme NAD pigmented rash on ● Glossitis
role in and NADP skin ● Angular Stomatitis
metabolism ● Improves ● Diarrhea ● Mental Change
circulation and ● Headache ● Delirium
keeps nervous ● Apathy ● Neurological
system and skin ● Fatigue Disturbances
healthy ● Depression ● Diarrhea,
● Synthesis of sex ● Disorientation Dermatitis,
and ● Memory Loss Dementia & Death
stress-related ● Weakness
hormones ● Lassitude
● Irritability
● Depressive
psychosis

Folate ● B-vitamin ● Purine & ● Reduced sense of ● Jaundice

Deficiency that is pyramidine taste ● Glossitis
commonly synthesis (DNA ● Fatigue ● Mouth Ulcers
found in & RNA) ● Depression ● Angular stomatitis
green leafy ● Rapid cell ● Headaches ● Neuropathy
vegetables division and ● Irritability ● Dementia
growth ● Difficulty ● Neural Tube
● Hematopoiesis concentrating Defects (for
● Shortness of breath babies)
● Loss of appetite and ●
weight loss
● Diarrhea
● Numbness and
tingling in the feet
and hands
● Muscle weakness

Functional Assessment 1. Plasma total homocystein (tHcy)

2. Radioisotope
3. Competetive binding
4. Chemiluminescence assay

Vitamin ● Coenzyme ● Coenzyme for ● Depression ● Dermatitis

B6 that helps in the ● Migraines ● Cheilosis
Deficiency amino acid transamnation ● Tingling and (Cracked and sore
and protein reactions for numbness of the lips)
metabolism protein extremities ● Glossitis
catabolism ● Seizures ● Pale Skin
 ● Synthesis of ● Loss of balance and
essential amino coordination
acid cysteins ● Stabbing pains
from methionine ● Muscle spasms
and to
synthesize
hemoglobin
● Necessary for
the metabolism
of glycogen,
production of
lipids that make
up the myelin
sheath
● Cellular vitality

Vitamin ● B-vitamin ● Blood formation ● Fatigue ● Pale or Yellow

B12 that contains ● DNA synthesis ● Headaches Skin
Deficiency cobalt in their ● Nerve Functions ● Depressive ● Sore and Red
structure and Symptoms Tongue
plays an ● Mouth Ulcers
crucial part in
nerve health,
reeneratin
nerve fibers
and repairing
nerve
damage.

Functional Assessment 1. Serum cobalamin assay

2. Analysis of plasma total homocysteine (tHcy)

C. Clinical Assessment of Mineral Deficiency

Deficiency Definition Major Functions Clinical Symptoms of Physical Signs of

Deficiency Deficiency

Iron ● Plays a role ● Production of ● Weakness ● Koilonychia

Deficiency in the blood ● Fatigue (brittle nails)
movement ● Carrier and ● Dizziness ● Pallor
of oxygen transported of ● Irritability ● Conjunctival
in the oxygen ● Palpitations Pallor
blood and ● Vertigo ● Atrophic Glossitis
is essential ● Shortness of breath ● Apthous Ulcers
for its ● Chest Pain ● Angular chelitis
production ● Low body
temperature
●

Zinc ● A mineral ● Synthesis of ● Emotional disorder ● Alopecia (hair

Deficiency that is DNA ● Fatigue loss)
essential ● Growth of cells ● Irritability ● Bullous-pustular
fro growth ● Building proteins ● Brittle hair dermatitis
and ● Healing ● Dizziness ● Hypogonadism
developme damaged tissue ● Loss of Appetite ● Diarrhea
 nt ● Support immune ● Lack of taste and ● Infections
system smell

Functional Assessment 1. Blood Plasma or Serum Zinc concentration

2. Dietary Zinc Intake
3. Stunting Prevalence

Iodine ● A mineral ● Synthesis of T3 ● Fatigue & Weakness ● Goiter

Deficiency that is and T4 ● Cold Intolerance ○ Nontoxic
essential HORMONES for ● Learning and goiter:
for TH ○ Protein memory difficulties Normal
synthesis synthesis ● Trouble Focusing ○ Toxic goiter:
○ Increase and confusion increased
blood ● Trouble breathing thyroid
glucose ● Difficulty Swallowing hormone
levels production
○ Utilization of ○ Hypothyroid
fat goiter:
○ Water & decreased
Electrolyte thyroid
balance hormone
○ Temperatur production
e ● Deaf Mutism
Regulation ● Spastic Diplegia
● Squint
● Cretenism

Functional Assessments 1. Thyroglobulin

2. Thyroid-stimulating hormone
3. Thyroid SIze