MARA JUNIOR SCIENCE COLLEGE LANGKAWI

NAME : MUHAMMAD AMIR IZZAT BIN ABU ZULKARNAINCLASS : 104 URANIUMCOLLEGE : 13434NUMBERTITLE : THE EFFECTS OF NUTRITIONAL DEFECIENCIES TEACHER’S : NAME

WHAT IS NUTRITIONAL DEFICIENCIES?

Nutritional deficiencies are diseases in humans that are directly or indirectly caused by a

lack of essential nutrients in the diet. Nutritional deficiencies are commonly associated with chronic malnutrition. Additionally, conditions such as obesity from overeating can also cause, or contribute to, serious health problems. Excessive intake of some nutrients can also cause acute poisoning.

WHAT IS NUTRIENTS?

A nutrient is a chemical that an organism needs to live and grow or a substance used in an organism's metabolism which must be taken in from its environment.[1] They are used to build and repair tissues, regulate body processes and are converted to and used as energy. Methods

for nutrient intake vary, with animals and protists consuming foods that are digested by an internal digestive system, but most plants ingest nutrients directly from the soil through their roots or from the atmosphere.

Organic nutrients include carbohydrates, fats, proteins (or their building blocks, amino acids), and vitamins. Inorganic chemical compounds such as dietary minerals, water, and oxygen may also be considered nutrients.[2] A nutrient is said to be "essential" if it must be obtained from an external source, either because the organism cannot synthesize it or produces insufficient quantities. Nutrients needed in very small amounts are micronutrients and those that are needed in larger quantities are called macronutrients. The effects of nutrients are dose-dependent and shortages are called deficiencies.[3]

THE IMPORTANCE OF NUTRIENTS

Nutrients are important to us as i

There are 7 major classes of nutrients which are:

Carbohydrate

Fats

Minerals

Protein

Vitamins

Water

Fibre

These nutrients are very important in our life. But, if we lack or over intake some nutrients, it will become danger to us.

WHAT IS THE CAUSE OF NUTRITIONAL DEFICIENCIES?

1. Poverty The person that in poor condition. They

might have some problem on buying foods.

2. Lack of food resources

They could run out of food resources because of the catastrophe that usually happens.

THE DISEASE CAUSE BY NUTRITIONAL DEFICIENCIES

Proteins/fats/carbohydrates

Protein-energy malnutrition

Kwashiorkor

Marasmus

Mental retardation [2]

Dietary vitamins and minerals

Calcium

Osteoporosis

Rickets

Tetany

Iodine deficiency

Goiter

Selenium deficiency

Keshan disease

Iron deficiency

Iron deficiency anaemia

Zinc

Growth retardation

Thiamine (Vitamin B1)

Beriberi

Niacin (Vitamin B3)

Pellagra

Vitamin C

Scurvy

Vitamin D

Osteoporosis

Rickets

KwashiorkorThe disease is usually infected by a child who no longer breastfed at the age of 5 years and will often eat foods that contain either grain, potatoes or starchy.

MarasmusSevere malnutrition in children caused by a diet lacking in calories as well as protein. Marasmus may also be caused by disease and parasitic infection

Mental retardationMental retardation is a developmental disability that first

appears in children under the age of 18. It is defined as an intellectual functioning level (as measured by standard tests for intelligence quotient) that is well below average and significant limitations in daily living skills (adaptive functioning).

OsteoporosisThe word osteoporosis literally means "porous bones." It occurs when bones lose an excessive amount of their protein and mineral content, particularly calcium. Over time, bone mass, and therefore bone strength, is decreased. As a result, bones become fragile and break easily. Even a sneeze or a sudden movement may be enough to break a bone in someone with severe osteoporosis.

RicketsRickets is a childhood condition caused by serious vitamin D deficiency. This lacking in vitamin D results in weak, soft bones, along with slowed growth and skeletal development. Rickets is, by definition, a disorder which

begins in childhood. If this problem occurs only later in life it is known as osteomalacia.

TetanyA disorder of the nervous system characterized by muscle cramps, spasms of the arms and legs, and numbness of the extremities.

Goiter

Goiter refers to any visible enlargement of the thyroid gland.

Keshan diseaseCardiomyopathy due to the deficiency of selenium found in women and children in Keshan, China.

Iron deficiency anaemia

Anaemia can be caused by iron deficiency, folate deficiency, vitamin B12 deficiency, and other causes. The term iron deficiency anaemia means anaemia that is due to iron deficiency. Iron deficiency anaemia is characterized by the production of small red blood cells. When examined under a microscope, the red blood cells also appear pale or light colored. For this reason, the anaemia that occurs with iron deficiency is also called hypo chronic microcytic anaemia.

Growth retardationFailure of an individual to develop at a normal rate of height and weight for his or her age.

BeriberiBeriberi is a disease caused by a deficiency of thiamine (vitamin B1) that affects many systems of the body, including the muscles, heart, nerves, and digestive system. Beriberi literally means "I can't, I can't" in Singhalese, which reflects the crippling effect it has on its victims. It is common in parts of southeast Asia, where white rice is the main food. In the United States, beriberi is primarily seen in people with ch ronic alcoholism.

PellagraPellagra is a disorder brought on by a deficiency of the

nutrient called niacin or nicotinic acid, one of the B-complex vitamins.

ScurvyScurvy is a condition caused by a lack of vitamin C (ascorbic acid) in the diet. Signs of scurvy include tiredness, muscle weakness, joint and muscle aches, a rash on the legs, and bleeding gums. In the past, scurvy was common among sailors and other people deprived of fresh fruits and vegetables for long periods of time.

THE EFFECTS OF NUTRITIONAL DEFICIENCIES

Iron Deficiency

In general, iron deficiency presents as microcytic anaemia in a well-nourished infant who is

otherwise healthy and asymptomatic. Less common presentations include pallor, lethargy, irritability, poor feeding, and cardiomegaly. Although iron deficiency is often caused by deficient iron in the diet, it can also be caused by intestinal blood loss (e.g. due to early introduction of cow’s milk), celiac disease, Helicobacter pylori infections, and anaemia of chronic disease. Risk factors for iron deficiency include children in poverty, premature and low-birth-weight infants, toddlers of African or Hispanic ancestry, infants who are exclusively fed with non-iron fortified formulae; obese children aged 1-3, and immigrant children.

Infants and children can be screened for dietary iron deficiency by haemoglobin levels, but this is generally not very sensitive or specific. The most important screening tool is a careful dietary history. Iron deficiency can be suspected in children who consume less than five servings of meat, grains, and fruits and vegetables per week, drink more than 480 mL of milk or soda per day,

or have a daily intake of snacks high in fat or sugar. Iron deficiency can be diagnosed by low haemoglobin levels with low ferritin levels. A more complete iron workup could also be indicated. Once nutritional iron deficiency has been diagnosed, the condition can be treated with supplemental oral iron. Close follow-up of the patient is indicated.

Vitamin D Deficiency

Vitamin D is essential for the absorption of calcium in the gastrointestinal tract. Deficiencies in vitamin D can lead to hypocalcaemia and hypophosphatemia, leading to rickets in children. Paediatric patients with vitamin D deficiency are generally asymptomatic, but can present with secondary hyperparathyroidism and changes in growth plates. Risk factors for vitamin D deficiency include prolonged breast-feeding without vitamin D supplementation, breast-feeding mothers who are dark-skinned, breast-feeding mothers who are vitamin D deficient, and low sun exposure.

Additionally, there has been evidence that suggests that vitamin D deficiency has a role in immune function independent from the calcium metabolism pathway. This implies that vitamin D deficiency could be involved in the development of allergies and atopic diseases, tuberculosis and other respiratory infections, and autoimmune diseases such as type I diabetes mellitus, asthma, and multiple sclerosis.

The characteristic laboratory finding of rickets due to vitamin D deficiency is elevated serum parathyroid hormone concentrations. There can also be radiologic findings in severe rickets. Treatment involves daily vitamin D supplementation at doses ranging from 1000-5000 IU depending on the age of the child. Once there is radiographic evidence of bone healing, this dose of vitamin D can be reduced to 400 IU. Calcium supplementation should be concomitant at 1000 mg per day. Patients can be followed-up with a test for urinary calcium, which should become detectable after three months of

treatment. Other tests used to follow-up these patients include serum calcium, phosphorus, alkaline phosphatase, and urinary calcium/creatinine ratio.

Calcium Deficiency

Rickets secondary to nutritional causes can be due to either vitamin D deficiency, calcium deficiency, or both. Particularly in regions of the world where there is ample sunlight, rickets may be due to calcium deficiency rather than vitamin D deficiency. In these cases, it would be best to treat with supplemental calcium with vitamin D rather than with supplemental vitamin D alone.

Deficiencies of Cobalamin and Folate

Deficiencies of cobalamin (vitamin B12) and folate can cause megaloblastic anaemia, which is diagnosed by red blood cell histology. Macrocytosis with hypersegmentation of neutrophils is pathognomonic for megaloblastic anaemia. There may also be other hematologic abnormalities, such as decreased reticulocyte

count, increased serum iron, thrombocytopenia, and neutropenia.

In infants, cobalamin deficiency is usually due to cobalamin deficiencies of breast-feeding mothers who follow strict vegan or moderate vegetarian diets. Other causes include breast-feeding mothers who have had gastric bypass, malabsorptive syndromes, and pernicious anaemia. Infants often present with growth, movement, developmental, and hematologic problems, but if identified and treated early with supplementation, children can avoid long term consequences of this nutritional deficiency.

Folate deficiency is usually caused by dietary folate deficiency. Medications such as pyrimethamine, methotrexate, and phenytoin can also cause folate deficiency.

Deficiencies of Other Water-Soluble Vitamins

Thiamine (vitamin B1) deficiency is associated with beriberi, Wernicke-Korsakoff syndrome, and Leigh syndrome. Foods with more thiamine include yeast, legumes, pork, rice, and cereals; milk

products, fruits, and vegetables are not good sources of thiamine. Beriberi in infants can present as cardiomegaly, tachycardia, a loud piercing cry, cyanosis, dyspnea, and vomiting, all culminating in fulminant cardiac syndrome. These patients can also develop aseptic meningitis.

Riboflavin (vitamin B2) deficiency presents with relatively non-specific signs, such as sore throat, hyperemia and edema of mucous membrane, cheilitis, stomatitis, glossitis, normocytic anemia, and seborrheic dermatitis. Foods rich in niacin include meats, fish, eggs, milk, green vegetables, and yeast.

Niacin (vitamin B3) deficiency presents with hyperpigmentation in sun-exposed areas, a red tongue, diarrhoea, vomiting, and neurologic symptoms, such as insomnia, anxiety, delusions, and dementia. Dietary niacin deficiency is known as pellagra.

Pyridoxine (vitamin B6) deficiency is not commonly encountered as an isolated nutritional deficiency. If encountered, it is often associated

with isoniazid treatment or in infants older than six months who are exclusively breast-fed.

Biotin deficiency in children is generally due to a genetic disorder known as biotinidase deficiency, which causes hypotonia, ataxia, hearing loss, optic atrophy, skin rash, and alopecia. Supplementation with biotin resolves these symptoms.

Rates of vitamin C deficiency are quite low, but when patients’ diets are deficient in this vitamin, they present with symptoms such as bleeding gums, ecchymoses, petechiae, coiled hairs, hyperkeratosis, arthralgias, and impaired wound healing. This is because vitamin C is involved in collagen synthesis. Supplementation with vitamin C resolves these symptoms.

Deficiencies of Other Fat-Soluble Vitamins

Vitamin A deficiency typically presents as drying of the conjunctiva, presence of Bitot spots (keratin debris on the conjunctiva), drying of the cornea, and night blindness. This can eventually progress to permanent blindness. Vitamin A deficiency is often subclinical and renders the

pediatric patient susceptible to infection. Physical growth is also reduced.

Vitamin E deficiency is not common, but can be due to patients who have difficulty absorbing fat, as well as in patients with disorders such as abetalipoproteinemia and cystic fibrosis. Clinical presentation of vitamin E deficiency includes myopathy, ataxia, pigmented retinopathy, and vision loss.

Vitamin K deficiency causes hypocoagulation and can be diagnosed with an elevated prothrombin time and international normalized ratio. Vitamin K deficiency in infants can be due to mothers taking medications that inhibit vitamin K (e.g. warfarin), insufficient nutrition, and exclusive breast-feeding up to six months of age. Administration of vitamin K within 24 hours of delivery can prevent vitamin K deficiency at birth.

Other Mineral Deficiencies

Zinc deficiency can cause growth failure, primary hypogonadism, and impaired immune system functioning. This could be due to diets high in

phytates, which bind and inhibit the absorption of zinc.

Iodine deficiency causes deficiencies in thyroid hormones, which can lead to goiter, hypothyroidism, mental retardation, and cretinism, although iodine deficiency in children may be subclinical.

Selenium deficiency can present in infants and children with diet restrictions or in those who are on long term parenteral nutrition.

Copper deficiency in children can result from the X-linked Menkes syndrome, which is associated with growth retardation, peculiar hair, and focal degeneration of the cerebrum and cerebellum.

CONCLUSIONEven though nutritional deficiencies can have profound impacts on the health of children, timely identification and management of these imbalances can reduce their deleterious effects. Physicians would be advised to elicit a complete history, perform a physical examination, and order relevant laboratory tests if suspicions of a nutritional deficiency are raised. If a nutritional deficiency is confirmed, appropriate counselling regarding adjustments in diet and supplementation would then be indicated.

REFERENCES