Nutritional diseases –I

1. Nutritional diseases –I Shoukat Ali Arain Senior Lecturer, Pathology Shali@alfaisal.edu

2. Learning Objectives • To outline the nutritional disease • To describe factors responsible for energy balance in the body • To describe causes and effects of obesity • To outline causes of malnutrition • To describe different clinical syndromes associated with PEM • To compare the features of marasmus and kwashiorkor • To describe causes and clinical features of anorexia nervosa and bulimia

3. Nutritional diseases • Diseases of energy imbalance • Obesity • Protein-Energy Malnutrition • Marasmus • Kwashiorkor • Anorexia nervosa/bulimia • Vitamin Deficiencies • Vitamin A deficiency • Vitamin D deficiency • Rickets and osteomalacia • Vitamin C deficiency

4. Obesity • Definition • State of increased body weight due to adipose tissue accumulation • 20% excess in weight is associated with health risks • BMI • Skin fold measurement • Mid-arm circumference • Waist-hip ratio • Central vs. peripheral • Energy imbalance

5. Energy Balance

6. Response to state of nutrition

7. Mechanisms of obesity • Poorly understood! • Mutations in leptin gene or any of the receptors in this pathway (4-5%) • In many obese persons serum leptin levels are high suggesting leptin resistance • Environmental influences • Type and amount of dietary intake • Psychological factors

8. Consequences of obesity • Increases risk for • Hypertension: Insulin resistance – increased insulin – increased Na retention and norepinephrine, smooth muscle proliferation • Diabetes • Hypertriglyceridemia • Low HDL • Metabolic syndrome • Obesity, dyslipidemia, hypertension, insulin resistance • NASH • Cholelithiasis • Osteoarthritis • Stroke • Breast and endometrial cancers

9. Malnutrition • Causes • Poverty • Ignorance • Chronic alcoholism • Self-imposed dietary restrictions • Acute and chronic illnesses • Malabsorption syndromes

10. Malnutrition • PEM • Inadequate protein and calories • A weight of < 80% of the normal • Ends of the spectrum are Marasmus and Kwashiorkor • Two protein compartments • Somatic and Visceral • Mid-arm circumference • Serum proteins (albumin, transferrin etc.)

11. Malnutrition Marasmus Kwashiorkor Because of protein deficiency Weight from 60-80 % Visceral affected more than somatic Serum proteins are decreased - edema Loss in muscle mass is masked by edema Fatty liver and abdominal distention • Because of caloric deficiency • Weight less than 60% • Somatic component is affected more • Serum proteins are normal or marginally decreased • Extremities are emaciated – head large for the body • Fatty liver not present

12. Malnutrition

13. Anorexia nervosa and Bulimia • Obsession for thinness • M/F ratio • Anorexia nervosa • Self induced starvation • Features of malnutrition • Endocrine deficiency • Amenorrhea • Osteoporosis • Hypothyroidism • Electrolyte imbalances • Bulimia • Lot of eating followed by induction of vomiting • Weight is near normal • Menstrual irregularities – amenorrhea is less common • Electrolyte imbalances • Complications of vomiting like aspiration and rupture of esophagus and stomach

14. References • Robbins Basic Pathology 8th ed. • Davidsons Principles and Practice of Medicine 21st ed. Thanks ?