Nutritional disorders Premed 3 Pathophysiology Dr. ROOPA

Protein energy malnutrition Protein energy malnutrition There are two imp. Conditions There are two imp. Conditions Marasmus Marasmus kwashiorkar kwashiorkar

Water soluble vitamins B1 – Thiamine B1 – Thiamine B2 – Riboflavin B2 – Riboflavin B3 – Niacin B3 – Niacin B6 – Pyridoxine B6 – Pyridoxine B12 – Cobalamin B12 – Cobalamin Folic acid Folic acid Vitamin C – Ascorbic acid Vitamin C – Ascorbic acid

Water soluble vitamins Regular intake is necessary Regular intake is necessary B12 – stored in liver in large amounts B12 – stored in liver in large amounts - deficiency takes years to develop - deficiency takes years to develop Toxicity rare Toxicity rare Excreted in the urine Excreted in the urine Sources: vegetables, cereals, grains, meat, dairy products, fruits Sources: vegetables, cereals, grains, meat, dairy products, fruits

Thiamine deficiency (B1) Sources: liver, eggs, whole grain cereal, rice,wheat Sources: liver, eggs, whole grain cereal, rice,wheat Outer layers of grain and the seed- lowers thiamine content. Outer layers of grain and the seed- lowers thiamine content. Common in Western countries: alcoholism, diet of nonenriched rice. Common in Western countries: alcoholism, diet of nonenriched rice. 1. Dry Beri-beri causes wasting and partial paralysis resulting from damaged peripheral nerves( peripheral neuropathy) 1. Dry Beri-beri causes wasting and partial paralysis resulting from damaged peripheral nerves( peripheral neuropathy) paralysis nerves paralysis nerves neuropathy of the peripheral limbs muscle atrophy

2.Wet beriberi( cardiovascular syndrome) affects the heart; it is sometimes fatal, as it causes a combination of heart failure and weakening of the capillary walls, which causes high cardiac output failure, the peripheral tissues to become edematous. 2.Wet beriberi( cardiovascular syndrome) affects the heart; it is sometimes fatal, as it causes a combination of heart failure and weakening of the capillary walls, which causes high cardiac output failure, the peripheral tissues to become edematous.heart failurecapillaryheart failurecapillary

Thiamine deficiency (B1) 3. Wernicke-Korsakoff deficiency 3. Wernicke-Korsakoff deficiency - alchoholics -brain stem, diencephalon degenerates -hemorrhage in the brain -Wernicke’s triad: confusion ataxia( loss of muscular cordination) ophthalmoplegia -memory loss, confabulation( the replacement of a gap in a person's memory by a falsification that he or she believes to be true.

RIBOFLAVIN (B2) Rare deficiency Rare deficiency Always added to bread, cereal products Always added to bread, cereal products Deficiency: Angular stomatitis Deficiency: Angular stomatitis cheilosis (cracked lips) glossitis (inflammation of the tongue) increased blood vessels in the cornea( corneal neovascularisation) seborrheic dermatitis

NIACIN(B3) Niacin, tryptophan deficiency Niacin, tryptophan deficiency Important part of nicotinamide adenine dinucleotides (NAD, NADP) Important part of nicotinamide adenine dinucleotides (NAD, NADP) PELLAGRA:three Ds PELLAGRA:three Dsdementiadermatitisdiarrhea

PYRIDOXINE (B6) May lead to deficiency of GABA May lead to deficiency of GABA Convulsions in kids Convulsions in kids Seen also in alcoholism, antiTB drug use Seen also in alcoholism, antiTB drug use Glutamate ( glutamic acid decarboxylase and pyridoxal phosphate as a cofactor)----GABA Glutamate ( glutamic acid decarboxylase and pyridoxal phosphate as a cofactor)----GABA B6 deficiency can result in SIDEROBLASTIC ANEMIA B6 deficiency can result in SIDEROBLASTIC ANEMIA

Cobalamin (B12) Reduced DNA replication Reduced DNA replication Reduced cell division Reduced cell division Found almost always in MALABSORPTION, Pernicious anemia, Found almost always in MALABSORPTION, Pernicious anemia, Crohn’s disease, Fish tapeworm infection (Diphyllobotrium latum, vegetarians. Crohn’s disease, Fish tapeworm infection (Diphyllobotrium latum, vegetarians. MEGALOBLASTIC ANEMIA + NEUROLOGIC ABNORMALITIES MEGALOBLASTIC ANEMIA + NEUROLOGIC ABNORMALITIES

FOLIC ACID Absorbed in the small intestine. Absorbed in the small intestine. Sources: leafy vege., liver, kidney. Sources: leafy vege., liver, kidney. May be due to malabsorption or due to increase demand May be due to malabsorption or due to increase demand Cancer therapy, alcoholic, dieters Cancer therapy, alcoholic, dieters MEGALOBLASTIC ANEMIA MEGALOBLASTIC ANEMIA Open neural defect Open neural defect

ASCORBIC ACID Serves as cofactor of the synthesis of proline and hydroxyproline ---- collagen synthesis Serves as cofactor of the synthesis of proline and hydroxyproline ---- collagen synthesis SCURVY SCURVY Poor wound healing Poor wound healing Abnormal bleeding Abnormal bleeding Bone changes Bone changes

Biotin (B7) Co factor in carboxylation reactions. Co factor in carboxylation reactions. Dermatitis, alopecia, nausea, loss of appetite. Dermatitis, alopecia, nausea, loss of appetite.