Nutritional Disorders Under nutrition & Obesity

Dr. Mehzabin Ahmed

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.

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

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 pigmentation, reddish





bands (flag sign).


Shows pigmentation




Eating Disorders
They result from disturbances. psychiatric disorders and cause nutritional 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. 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 


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  Underweight  Normal  Overweight  Increased Obesity
  

BMI (kg/m2) Risk <18.5 18.5-24.9 25.0-29.9 Increased Normal

I II Extreme II

30.0-34.9 35.0-39.9 ≥40.0

High Very high 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.








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


Gallstones, pancreatitis, abdominal hernia, NAFLD (steatosis, steatohepatitis, and cirrhosis), and possibly GERD Metabolic syndrome, insulin resistance, impaired glucose tolerance, type II diabetes mellitus, dyslipidemia, polycystic ovary syndrome Hypertension, coronary artery disease, congestive heart failure, arrhythmias, pulmonary hypertension, ischemic stroke, venous stasis, deep vein thrombosis, pulmonary embolus Abnormal pulmonary function, obstructive sleep apnea, obesity hypoventilation syndrome Osteoarthritis, gout, low back pain Abnormal menses, infertility Urinary stress incontinence Cataracts Idiopathic intracranial hypertension (pseudotumor cerebri) Esophagus, colon, gallbladder, prostate, breast, uterus, cervix, kidney Atelectasis, pneumonia, deep vein thrombosis, pulmonary embolus










Postoperative events

3. Milder disorders the obese suffer from are breathing exertion, fungal infections in skin disorders on

creases, and a tendency to lower-leg

ulcers which and poorly.

heal slowly

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