By:

DR. ANTOINETTE T. LEUTERIO

FORMS

> UNDERNUTRITION
> OVERNUTRITION
> NUTRITIONAL DEFICIENCY
> NUTRITIONAL EXCESS
MAJOR FACTORS

> LOW INCOME

> IGNORANCE
> SCARCITY OF FOOD SUPPLY
> OVERPOPULATION
PRIMARY /SECONDARY
MALNUTRITION (dec intake, malabsorption,
increased requirements, special categories)
PATHOGENESIS

> TISSUE DEPLETION

> BIOCHEMICAL CHANGES
FUNCTIONAL CHANGES
SUBJECTIVE SYMPTOMS
CLASSICAL SYMPTOMS
ANATOMIC LESIONS
UNDERNUTRITION

> PROTEIN CALORIE MALNUTRITION

MARASMUS
KWASHIORKOR

> EATING DISORDERS

ANOREXIA NERVOSA
BULIMIA
TABLE 1
PRINCIPAL FEATURES OF CHON-CAL DEF
MARASMUS/ KWASHIORKOR

Usual age : M- 0 -2 K- 1- 3 yo
Edema: M- none K- lower legs (dec albumin)
Muscle wasting: M- loss of fat “all skin & bone” K- sometimes
Growth retardation: M- obvious K- sometimes hidden
Mental changes: M- apathetic K - irritable
Appetite: M- good K - bad
Diarrhea: M & K often
Skin changes: M- seldom K- flaky paint dermatsis
Hair changes: M- seldom K- sparse w/ dyspigmentation
Moonface: M-seldom K- often
Hepatic enlargement: M- seldom K- always
Serum albumin: M- normal K- low
Urinary urea per g creatinine: M- normal K- always
Serum essential amino acid index: M-normal K- low
Anemia: M- uncommon K- common( iron def)
Liver biopsy: M- normal K- fatty change ( abnormal lipid)
TABLE 2
EATING DISORDERS
ANOREXIA NERVOSA/ BULIMIA

Predominant sex: Both- FEMALE (yong women)

Method of weight control: A- restriction B- vomiting
Binge eating: A- uncommon B- common ( Mallory- Weiss Syn )
Weight at diagnosis: A- decreased B- near normal
Ritualized exercise: A- A- usual B- rare
Amenorrhea: A- 100% B- 50%
Antisocial behavior: A- rare B- frequent
Cardovascular changes(bradycardia):A-commonB-uncommon
Skin changes (hirsutism,dryness): A- usual B- rare
Hypothermia: A- usual B- rare
Edema- : both A & B - + /-
Medical complication: both HYPOKALEMIA
OVERNUTRITION- OBESITY

DEFINITION
BMI > 30 kg/m2 ( obese)
normal BMI 25 kg/m2
overwt BMI bet 25 to 29.9kg/m2

ETIOLOGY
heredity, environmental, psychosocial

ASSOCIATED DISODERS
HYPOVENTILATION SYNDROME / PICKWIKIAN SYN
 TABLE 3
DISEASES ASSOCIATED WITH
OBESITY

Adult- onset diabetes mellitus

M- due to increased resistance to insulin action
C- atherosclerosis
Hypertension
M – due increased adrenal glucocorticoids
C- stroke
Hyperlipidemia
M- increased lipoprotein synthesis
C- hypercholesterolemia
Atherosclerotic arterial disease
Cholelithiasis: M- inc cholesterol in bile C- cholecystitis
Osteoarthrosis: M- cartilage degeneration in wt bearing joints
C- hips
VITAMINS AND MINERALS

FAT-SOLUBLE VITS
A, D, E, K

WATER-SOLUBLE VITS
VIT C & B
 TABLE 4
VITAMINS
FX / DEF/ EXCESS/ SOURCES

FAT SOLUBLE VITS

VIT A (retinol): D- nyctalopia E- carotenemia S- leafy vege
VIT D (steroid alcohols): D- rickets E- hypercalcemia S- liver oil
VIT E (tocopherol): D- sterility E- unknown S- eggyolk
VIT K ( naphthoquinones):D- bleeding E-hemolytic A. S-tomato
WATER SOLUBLE VITS
VIT C ( ascorbic acid):D-scurvy E- oxaluria S- citrus fruit
VIT B COMPLEX
Thiamine( B1): D-beri-beri (Korsakoff’s / Wernikes ) E- none
S- whole grain
Riboflavin ( B2):D- glossitis E- none S- milk products
Niacin ( Nicotinic acid):D-pellagra E- flushing S- peanut
Pyridoxine (B6): D-convulsions E- unknown S- legumes
Cobalamine (B12): D-pernicious A E- unknown S-meat
Folate (folic acid):D-megaloblastic A E- unknownS- green v
MINERALS
❂ Functions
• Sodium, potassium, chloride, magnesium
– Neuromuscular excitation
• Calcium & phosphorous
– Bone metabolism
• Zinc
– Cofactor for certain enzymes
• Manganese
– Involved in protein metablism
• Copper
– Involved in electron transport
• Iron
– Production of normal red cells
 TABLE 5
MINERALS
FX / DEF/ EXCESS/ SOURCES

Def ici enc y

SODIUM- muscle cramps
POTASSSIUM- muscle weakness
CHLORIDE- with sodium
MAGNESIUM- with CA
CALCIUM- with Vit D
PHOSPHOROUS- w/ CA & VIT D
ZINC- delayed wound healing
MANGANESE
COPPER- Wilson’s dses
IRON- hypochromic macrocytic anemia
IODINE- goiter, cretinism
FLOURINE- dental caries
SELENIUM
MINERALS
❂ EXCE SS
• Calcium - mi lk a lkali sy bdro me
• Iro n – h emoc hrom ato si s
• Coppe r – Wi lso ns di sea se