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By:

DR. ANTOINETTE T. LEUTERIO

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FORMS

> UNDERNUTRITION

> OVERNUTRITION

> NUTRITIONAL DEFICIENCY

> NUTRITIONAL EXCESS

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PATHOGENESIS

> TISSUE DEPLETION

> BIOCHEMICAL CHANGES

FUNCTIONAL CHANGES

SUBJECTIVE SYMPTOMS

CLASSICAL SYMPTOMS

ANATOMIC LESIONS

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UNDERNUTRITION

> PROTEIN CALORIE MALNUTRITION

MARASMUS

KWASHIORKOR

> EATING DISORDERSANOREXIA NERVOSA

BULIMIA

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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 - irritableAppetite: 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- oftenHepatic 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)

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TABLE 2

EATING DISORDERSANOREXIA 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 normalRitualized 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- rareHypothermia: A- usual B- rare

Edema- : both A & B - + /-

Medical complication: both HYPOKALEMIA

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DEFINITION

BMI > 30 kg/m2 ( obese)

normal BMI 25 kg/m2overwt BMI bet 25 to 29.9kg/m2

ETIOLOGY

heredity, environmental, psychosocial

ASSOCIATED DISODERS

HYPOVENTILATION SYNDROME / PICKWIKIAN SYN

OVERNUTRITION- OBESITY

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Adult- onset diabetes mellitusM- due to increased resistance to insulin action

C- atherosclerosis

HypertensionM due increased adrenal glucocorticoids

C- stroke

Hyperlipidemia

M- increased lipoprotein synthesisC- hypercholesterolemia

Atherosclerotic arterial diseaseCholelithiasis: M- inc cholesterol in bile C- cholecystitisOsteoarthrosis: M- cartilage degeneration in wt bearing joints

C- hips

TABLE 3

DISEASES ASSOCIATED WITH

OBESITY

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FAT-SOLUBLE VITS

A, D, E, K

WATER-SOLUBLE VITS

VIT C & B

VITAMINS AND MINERALS

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FAT SOLUBLE VITSVIT 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- eggyolkVIT K ( naphthoquinones):D- bleeding E-hemolytic A. S-tomato

WATER SOLUBLE VITSVIT C ( ascorbic acid):D-scurvy E- oxaluria S- citrus fruit

VIT B COMPLEX

Thiamine( B1): D-beri-beri (Korsakoffs / Wernikes ) E- noneS- 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-meatFolate folic acid :D-me aloblastic A E- unknownS- reen v

TABLE 4

VITAMINS FX / DEF/ EXCESS/ SOURCES

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MINERALSMINERALS

a FunctionsFunctions Sodium, potassium, chloride, magnesiumSodium, potassium, chloride, magnesium

Neuromuscular excitationNeuromuscular excitation

Calcium & phosphorousCalcium & phosphorous Bone metabolismBone metabolism

ZincZinc Cofactor for certain enzymesCofactor for certain enzymes

ManganeseManganese Involved in protein metablismInvolved in protein metablism

CopperCopper Involved in electron transportInvolved in electron transport

IronIron Production of normal red cellsProduction of normal red cells

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Def iciencySODIUM- muscle cramps

POTASSSIUM- muscle weakness

CHLORIDE- with sodiumMAGNESIUM- with CA

CALCIUM- with Vit D

PHOSPHOROUS- w/ CA & VIT D

ZINC- delayed wound healing

MANGANESECOPPER- Wilsons dses

IRON- hypochromic macrocytic anemia

IODINE- goiter, cretinism

FLOURINE- dental caries

SELENIUM

TABLE 5

MINERALS FX / DEF/ EXCESS/ SOURCES

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MINERALSMINERALS

a EXCESS C a lc i um - mi l k a l k al i sy bdro me Iro n h emoc hrom ato si s Coppe r Wi lso ns di sea se