Nutritional Deficiencies Flashcards
Lack of consistent access to enough food for a
household to live healthy is defined as
Food insecurity
Health outcomes when malnourished
● Poor wound healing
● Immunocompromising
● Impaired organ function
● Increased length of hospital stays
● Increased mortality
● Inflammation acute or chronic can lead to malnutrition
Sources of caloric malnutrition
● Famine and starvation
● Disease
● Surgery
● Injury
● Socioeconomic factors
steatorrhea
- increased fat in the stool
Causes of vitamin insufficiency
● Food insecurity, hunger, poverty
● Abuse and neglect
● Insufficient diets
● Behavioral
● Medical problems, absorption
Thiamin defined and its solubility
Vitamin B1
■ Also spelled thiamine
■ Water-soluble
Functions of Thiamin
– Production of energy from food (Think Krebs Cycle and the Pentose Phosphate Cycle)
– DNA synthesis
– Conduction of nerve impulses
Dietary sources of Thiamin
– Yeast
– Pork
– Beef
– Whole grains
– Organ meat
– Legumes
– Nuts
In the US, processed flour must be enriched with ______
thiamin, riboflavin, niacin, folic acid, and iron
When healthy individuals are deprived of
thiamine, thiamine stores are depleted
within ______
1 month
However, within a week after thiamine
intake stops, healthy people develop
- Anorexia
- Resting tachycardia
- Weakness
- Decreased deep tendon reflexes
- Peripheral neuropathy
Thiamin Primary deficiency
- Caused by inadequate intake
- Common due to diet of highly refined carbohydrates eg. milled rice
and grain. Common in cultures who rely on these. - Occurs with mixed B vitamin deficiencies
Thiamin Secondary deficiency
Increased demand
– Hyperthyroidism, pregnancy, lactation, strenuous exercise, fever
Impaired absorption
– Prolonged diarrhea, bariatric surgery
Medications
- eg. diuretics and ↑ urine excretion
Impaired metabolism
– Hepatic insufficiency
Alcoholics & Thiamin
Multiple mechanisms- Low intake, and lower absorption
Dry beriberi
- Neurologic Findings
– Peripheral neurologic deficits
– Bilateral and roughly symmetric
– Occurs in stocking-glove distribution
– Paresthesia in the toes, burning in the
feet (particularly severe at
night),muscle cramps in the calves,
pains in the legs, and plantar
dysesthesias
Wernicke-Korsakoff Syndrome
– Occurs in alcoholics who do not consume food
fortified with thiamin. Can occur in
nonalcoholics. Combination of two syndromes
– Often underrecognized
Wernickeʼs encephalopathy
Triad of: Confusion, ataxia, nystagmus
■ Psychomotor slowing, nystagmus, ataxia,
ophthalmoplegia, impaired consciousness
Korsakoffʼs Syndrome
■ Mental confusion, dysphonia, confabulation
■ Impaired memory of recent events
■ If left untreated, coma and death ensue
Wet beriberi
Cardiovascular Involvement, although overlaps with dry beriberi
Myocardial disease
■ Vasodilation → High Cardiac Output
■ Tachycardia
■ Wide pulse pressure
■ Sweating, warm skin
■ Lactic acidosis
Later stages
■ Heart failure
– Pulmonary and peripheral edema
■ Vasodilation → Shock
Infantile beriberi
– Usually occurs by age 3-4 weeks
– Babies who are breastfed by
thiamin-deficient mothers
– Heart failure (sudden)
– Aphonia
– Absent deep tendon reflexes
Thiamin Diagnosis
– Usually based on response to treatment with
thiamin
■ Labs
– B vitamins
– Erythrocyte transketolase activity
– 24-h urinary thiamine excretion
– CMP
Treatment for Dry beriberi
Oral thiamin
Treatment for Wet beriberi
IV Thiamin
Treatment for Wernicke-Korsakoff syndrome
IM or IV Thiamin followed
by oral thiamin
Riboflavin and its solubility
■ Vitamin B2
■ Water-soluble
Riboflavin functions
– Convert carbohydrates into glucose
– Neutralize free radicals
– Convert vitamins B6 and B9 into active forms
Riboflavin dietary sources
– Milk and dairy
– Cheese
– Eggs
Riboflavin primary deficiency
– Inadequate intake
Riboflavin Secondary deficiency
– Chronic diarrhea
– Liver disorders
– Hemodialysis
– Peritoneal dialysis
– Long-term barbiturates
– Chronic alcoholism
Riboflavin deficiency clinical manifestations
Angular stomatitis (or Cheilosis)
– Can become infected by Candida
albicans
– Causes grayish/white lesions
– Tongue may appear magenta- glossitis
– Sore throat
– Dermatitis
– Anemia and corneal vascularization
when severe
Riboflavin diagnosis
– Characteristic signs and
other B vitamin deficiencies
– B vitamins
– Urinary excretion of riboflavin
Niacin and solubility
■ Vitamin B3
■ Water-soluble
Niacin Functions
Functions mainly in active form as a coenzyme nicotinamide adenine dinucleotide (NAD) and NADP – cellular respiration
– Aids in releasing energy from carbohydrates, fats, alcohol, and proteins
– Essential for DNA synthesis and repair
– Necessary for healthy skin, nerves, and digestive system
– Production of steroid hormones in the adrenal glands- (Role of NADP)
Niacin effects for cholesterol
– Supplements in high doses
– Lowers LDL
– Lowers triglyceride levels
– Increases HDL
Side effects of niacin supplementation
■ Flushing
■ Hepatotoxicity
■ Atherosclerosis?
■ Possible relationship to hardening of
arteries
– Increases levels of homocysteine
Niacin dietary sources
– Meat
– Red fish
– Poultry
– Milk
– Yeast
Niacin primary deficiency
– Inadequate intake of niacin
and tryptophan
– Occurs in areas where corn is
the primary dietary staple
Deficiency
– Rare in the US
– more in Developing countries
Niacin Secondary deficiency
– Alcoholism
– Cirrhosis
– Diarrhea
– Carcinoid syndrome
– Hartnup Disease
Niacin mild deficiency symptoms
– Loss of appetite
– Weakness/ Fatigue
– Irritability
– Depression
– Indigestion
– Burning sensation in the mouth
– GI symptoms
Niacin - Pellagra
Severe deficiency
The 4 Dʼs
1. Diarrhea
2. Dermatitis
3. Dementia
4. Death
Pellagra skin effects
● Bilateral, symmetric lesions
● Pressure points of sun-exposed skin
● Pellagrous glove
● Pellagrous boots
● Sunlight may cause butterfly-shaped lesions on the face
Niacin deficiency diagnosis
– May be straightforward if dermatitis,
diarrhea, and dementia occur
simultaneously
– Presentation often not very specific
■ Labs
– B vitamins
– Urinary excretion
What may this child have?
Marasmus - PEM
What do these children likely have?
Kwashiorkor - Wet form PEM
