Download Nutrient Deficiency

Scurvy
Scurvy is a condition where an individual has a vitamin C (ascorbic acid) deficiency. The
name scurvy comes from the Latin scorbutus, and humans have known about the disease
since ancient Greek and Egyptian times. Scurvy commonly is associated with sailors in the
16th to 18th centuries who navigated long voyages without enough vitamin C and
frequently perished from the condition. Modern cases of scurvy are very rare.
Humans are unable to synthesize vitamin C - which is necessary for collagen production
and iron absorption - and so they must obtain it from external sources (such as citrus
fruits). Therefore, people must consume fruits and vegetables that contain or are
fortified with vitamin C in order to avoid the vitamin C deficiency known as scurvy.
Who gets scurvy?
Though scurvy is a very rare disease, it still occurs in some patients - usually elderly
people, alcoholics, or those that live on a diet devoid of fresh fruits and vegetables.
Similarly, infants or children who are on special or poor diets for any number of economic
or social reasons may be prone to scurvy.
What causes scurvy?
The primary cause of scurvy is insufficient intake of vitamin C (ascorbic acid). This may be
due to ignorance, famine, anorexia, restrictive diets (due to allergies, food fads, etc.), or
difficulty orally ingesting foods. Historically, scurvy was the result of long sea voyages
where sailors did not bring along enough foods with vitamin C.
What are the symptoms of scurvy?
Scurvy symptoms may begin with appetite loss, poor weight gain, diarrhea, rapid
breathing, fever, irritability, tenderness and discomfort in legs, swelling over long bones,
bleeding (hemorrhaging), and feelings of paralysis.
As the disease progresses, a scurvy victim may present bleeding of the gums, loosened
teeth, petechial hemorrhage of the skin and mucous membranes (a tiny pinpoint red
mark), bleeding in the eye, proptopsis of the eyeball (protruding eye), constochondral
beading (beading of the cartilage between joints), hyperkeratosis (a skin disorder),
corkscrew hair, and sicca syndrome (an automimmune disease affecting connective
tissue).
Infants with scurvy will become apprehensive, anxious, and progressively irritable. They
often will assume the frog leg posture for comfort when struck with pseudoparalysis. It is
common for infants with scurvy to present subperiosteal hemorrhage, a specific bleeding
that occurs at the lower ends of the long bones.
How is scurvy diagnosed?
Physicians initially will conduct a physical exam, looking for symptoms described above.
Actual vitamin C levels can be obtained by using laboratory tests that analyze serum
ascorbic acid levels (or white blood cell ascorbic acid concentration). Sometimes,
radiological procedures are ordered for diagnostic purposes and to see what damage
scurvy has already done.
How is scurvy treated?
Scurvy is treated by providing the patient with vitamin C, administered either orally or via
injection. Orange juice usually functions as an effective dietary remedy, but specific
vitamin supplements are also known to be effective.
How can scurvy be prevented?
Scurvy can be prevented by consuming enough vitamin C, either in the diet or as a
supplement. Foods that contain vitamin C include:
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Oranges
Lemons
Blackcurrants
Guava
Kiwifruit
Papaya
Tomatoes
Strawberries
Carrots
Bell peppers
Broccoli
Potatoes
Cabbage
Spinach
Paprika
Liver
Oysters
Written by Peter Crosta
Copyright: Medical News Today
Obesity
Key facts
Worldwide obesity has more than doubled since 1980.
In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200
million men and nearly 300 million women were obese.
65% of the world's population live in countries where overweight and obesity kills more
people than underweight.
More than 40 million children under the age of five were overweight in 2010.
Obesity is preventable.
What are overweight and obesity?
Overweight and obesity are defined as abnormal or excessive fat accumulation that may
impair health.
Body mass index (BMI) is a simple index of weight-for-height that is commonly used to
classify overweight and obesity in adults. It is defined as a person's weight in kilograms
divided by the square of his height in meters (kg/m2).
The WHO definition is:
a BMI greater than or equal to 25 is overweight
a BMI greater than or equal to 30 is obesity.
BMI provides the most useful population-level measure of overweight and obesity as it is
the same for both sexes and for all ages of adults. However, it should be considered a
rough guide because it may not correspond to the same degree of fatness in different
individuals.
Facts about overweight and obesity
Overweight and obesity are the fifth leading risk for global deaths. At least 2.8 million
adults die each year as a result of being overweight or obese. In addition, 44% of the
diabetes burden, 23% of the ischaemic heart disease burden and between 7% and 41%
of certain cancer burdens are attributable to overweight and obesity.
Some WHO global estimates from 2008 follow.
o More than 1.4 billion adults, 20 and older, were overweight.
o Of these overweight adults, over 200 million men and nearly 300 million
women were obese.
o Overall, more than one in ten of the world’s adult population was obese.
In 2010, more than 40 million children under five were overweight. Once considered a
high-income country problem, overweight and obesity are now on the rise in low- and
middle-income countries, particularly in urban settings. Close to 35 million overweight
children are living in developing countries and 8 million in developed countries.
Overweight and obesity are linked to more deaths worldwide than underweight. For
example, 65% of the world's population live in countries where overweight and obesity
kill more people than underweight (this includes all high-income and most middle-income
countries).
What causes obesity and overweight?
The fundamental cause of obesity and overweight is an energy imbalance between
calories consumed and calories expended. Globally, there has been:
o an increased intake of energy-dense foods that are high in fat, salt and
sugars but low in vitamins, minerals and other micronutrients; and
o a decrease in physical activity due to the increasingly sedentary nature of
many forms of work, changing modes of transportation, and increasing
urbanization.
Changes in dietary and physical activity patterns are often the result of environmental
and societal changes associated with development and lack of supportive policies in
sectors such as health, agriculture, transport, urban planning, environment, food
processing, distribution, marketing and education.
What are common health consequences of overweight and obesity?
Raised BMI is a major risk factor for noncommunicable diseases such as:
o cardiovascular diseases (mainly heart disease and stroke), which were the
leading cause of death in 2008;
o diabetes;
o musculoskeletal disorders (especially osteoarthritis - a highly disabling
degenerative disease of the joints);
o some cancers (endometrial, breast, and colon).
The risk for these noncommunicable diseases increases, with the increase in BMI.
Childhood obesity is associated with a higher chance of obesity, premature death and
disability in adulthood. But in addition to increased future risks, obese children
experience breathing difficulties, increased risk of fractures, hypertension, early markers
of cardiovascular disease, insulin resistance and psychological effects.
How can overweight and obesity be reduced?
Overweight and obesity, as well as their related noncommunicable diseases, are largely
preventable. Supportive environments and communities are fundamental in shaping
people’s choices, making the healthier choice of foods and regular physical activity the
easiest choice, and therefore preventing obesity.
At the individual level, people can:
o limit energy intake from total fats;
o increase consumption of fruit and vegetables, as well as legumes, whole
grains and nuts;
o limit the intake of sugars;
o engage in regular physical activity;
o achieve energy balance and a healthy weight.
Individual responsibility can only have its full effect where people have access to a
healthy lifestyle. Therefore, at the societal level it is important to:
o support individuals in following the recommendations above, through
sustained political commitment and the collaboration of many public and
private stakeholders;
o make regular physical activity and healthier dietary patterns affordable and
easily accessible too all - especially the poorest individuals.
The food industry can play a significant role in promoting healthy diets by:
o reducing the fat, sugar and salt content of processed foods;
o ensuring that healthy and nutritious choices are available and affordable to
all consumers;
o practicing responsible marketing;
o ensuring the availability of healthy food choices and supporting regular
physical activity practice in the workplace.
Rickets
What is rickets?
Rickets is a condition that affects bone development in children. It causes the
bones to become soft and can lead to bone deformities. It is often characterised
by an appearance of bowed legs. In adults, it is known as osteomalacia or soft
bones.
What are the symptoms?
Rickets causes the bones to become painful, soft and weak. This leads to
deformities of the skeleton, such as bowed legs, curvature of the spine and
thickening of the ankles, wrists and knees. Children may suffer pain and soreness,
being reluctant to walk and tiring easily. In the long term, they may have poor
growth and development and could be shorter than average, with weak tooth
enamel and increased risk of cavities. Their bones could be weaker and more
prone to fractures.
What causes it?
The most common cause of rickets is a lack of vitamin D and calcium. In rare
cases, children can be born with a genetic form of rickets. It can also develop if
another condition affects how vitamins and minerals are absorbed by the body.
Who does it affect?
There has been an increase in cases of rickets in the UK recently, with some
suggestion children may not be playing outside enough or eating a balanced diet.
Children of Asian, African-Caribbean and Middle Eastern origin are at higher risk
of the disease because their skin is darker and they need more sunlight to get
enough vitamin D. Children born prematurely and those taking medication that
interferes with vitamin D are also at greater risk.
Adults who rarely go outside or permanently cover their sun from sunlight, elderly
people and those who to not eat meat or oily fish are also at higher risk of
developing rickets.
How is it treated?
Rickets can be easily and successfully treated in most children by ensuring they
eat foods that contain calcium and vitamin D or take vitamin and mineral
supplements. Doctors may sometimes advise taking vitamin D supplements or
having yearly injections.
Can you do anything to prevent it?
Yes. In fact, it is easily prevented by making sure children have a balanced diet
and spent time in the sunshine. Critically, diets should contain plenty of vitamin D,
which is found in oily fish, liver, eggs, margarine and some breakfast cereals, and
calcium. This can be ingested by eating dairy products, green vegetables,
wholemeal bread, dried fruit and beans and pulses. It is also possible to take
vitamin supplements.
Vitamin D is also gained from sunlight, forming under the skin as it is exposed.
The NHS recommends 10 - 15 minutes of natural sun on the hands and face a
few times a week. This should not stop you using sun tan lotion to protect children
in high temperatures.
Isn’t it a historical disease?
It was common in the Victorian times but largely disappeared from the developed
world during the 1940s. This is in part due to the fortification of foods such as
margarine and cereal with vitamin D, and is linked with increased exposure to
sunlight. Doctors have now said it is making a comeback in the UK, due to a
combination of social and economic factors including diet and time children spend
playing outside.
Kwashiorkor
Kwashiorkor is a form of malnutrition most often found in children. It is caused by
not eating enough protein, despite a reasonable intake of calories.
Like other forms of malnutrition, kwashiorkor initially causes:
fatigue
irritability
drowsiness
If the person continues to be deprived of protein, they will typically:
fail to put on weight and fail to grow in height
lose muscle mass
develop swelling under the skin (oedema)
develop a 'pot belly'
have an enlarged fatty liver
be vulnerable to infections because of a failing immune system
develop red, inflamed patches of skin that darken and peel or split open ('crazy
pavement dermatosis')
develop dry, sparse, brittle hair that may turn reddish yellow or white
develop ridged nails
Many malnourished children will become intolerant to milk sugar (develop lactose
intolerance).
When does it happen?
Kwashiorkor is commonly seen in developing regions of the world, where there is famine
or a limited food supply. It is particularly seen in countries where the diet consists mainly
of corn, rice and beans.
It is more common in children than adults.
Kwashiorkor is unusual in developed countries such as the UK and the US – cases that
are seen in these countries may be a sign of child abuse and severe neglect.
How is it diagnosed?
Kwashiorkor can be diagnosed on physical appearance (the pot belly and oedema) and
knowledge about the person's diet. The diagnosis can be confirmed by blood
and urine tests showing the following:
low blood sugar levels
low blood protein levels
high levels of growth hormone and the stress hormone cortisol
low levels of salt in the blood
low level of the waste product urea in the urine
iron deficiency anaemia
low blood pH
Other tests may include growth measurements, calculating body mass index, taking a
skin biopsy and analysing a hair sample.
How is it treated?
A person with kwashiorkor must first have their blood and body fluid levels corrected,
and any infections treated. This may take 48 hours.
Only then can small amounts of food be introduced slowly – carbohydrates first, to
provide energy, followed by high-protein foods.
This reintroduction of food may take over a week. At this point, a child should be
consuming about 175 calories and 4g protein per kg of bodyweight, and an adult 60
calories and 2g protein per kg of bodyweight.
Vitamin and mineral supplements may also be given.
Outlook
How well the person does after treatment depends on their stage of malnutrition
when treatment began.
If treatment was started early, the person usually recovers well, although children will
never reach their full growth potential.
If treatment was started in the later stages of malnutrition, the person may be left with
physical and intellectual disabilities.
If kwashiorkor is not treated or treatment is delayed, it can result in death
Anorexia
About anorexia nervosa
The direct translation of the medical name 'anorexia nervosa' means loss of
appetite for nervous reasons. But in fact you don't lose your appetite if you have
anorexia - you just don't allow yourself to satisfy your appetite.
If you have anorexia, you develop a distorted idea of your body shape and size.
You try to stop or limit eating and may over-exercise. This makes you very
underweight.
Anorexia is most common in teenage girls, although you can develop the illness at
any age. About one in 250 women and one in 2,000 men get anorexia at some
time in their lives.
The other main eating disorder is bulimia nervosa. This involves cycles of
bingeing (overeating) and purging (ridding the body of the excess food usually by
vomiting or taking laxatives). Some people with anorexia may have bingeing and
purging habits too.
Symptoms of anorexia nervosa
There are many different symptoms associated with anorexia, and not everyone
has the same ones. But if you have anorexia, you will probably have a body
weight that is much less than expected for your age and height. You may do the
following:
o eat very little, if at all, or restrict certain foods, such as those
containing fat
o be secretive about food
o cut your food into tiny pieces to look as though you have eaten some,
and become obsessed with what other people are eating
o obsessively weigh yourself and measure and examine your body
o be obsessed with exercise
o be restless
o use appetite suppressants such as diet pills
o make yourself vomit after meals or use laxatives or pills that remove
water from your body (diuretics)
o wear baggy clothes to disguise your weight loss
o make yourself sick.
With anorexia, you become distracted thinking about your weight or body size.
You may:
o have a distorted body image
o deny being underweight or having a problem with food
o have mood swings
o feel depressed
o lose interest in other people
Apart from weight loss, the physical signs of anorexia can include:
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fine, downy hair on your body and face
feeling cold all the time
red or purple hands and feet
constipation
puffy face and ankles
light-headedness and dizziness
tiredness
poor sleep
delayed puberty (because anorexia affects your hormones)
missing three or more monthly periods (in women or girls who aren't
pregnant or using certain types of hormonal contraceptive such as the
pill)
Complications of anorexia nervosa
Over time, anorexia can cause serious long-term health problems such as:
o osteoporosis
o damage to your heart
o infertility
If you have severe anorexia, it's important that you receive appropriate treatment.
If untreated, the condition can be life-threatening due to health problems such as
starvation, dehydration, infections and heart failure. You are also at an increased
risk of mental health problems.
Causes of anorexia nervosa
The reasons for developing anorexia aren't understood and are probably different
for everyone. They may include emotional, physical and social reasons.
People with certain personality types such as perfectionists are more commonly
affected by anorexia.
The following emotional or mental health conditions are also associated with
anorexia:
o low self-esteem - this is not thinking highly about your self-worth and
associating it with your body weight
o mood conditions, particularly depression
o obsessive-compulsive disorder - this is a condition causing anxiety
due to obsessively thinking about things or doing certain actions
If you have a perfectionist personality or one of these conditions, an eating
disorder may give you a sense of control and achievement.
There are certain factors that make it more likely that you will develop anorexia.
For example:
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living in a Western society
being influenced by media images of thinness
having been obese in the past
having a job or hobby where a very lean body type is desirable (eg
running, athletics, modelling or dancing)
o having a family history of eating disorders due to genetic factors or by
copying the behaviour of other family members
o going through an emotionally upsetting event such as divorce or
abusive family relationships
Diagnosis of anorexia nervosa
Getting help is very important. Admitting you have a problem is the first step,
though it can be the hardest. Taking that step means you should be able to find
the support and treatment you need to stop anorexia and improve your life.
Talk to your GP first. He or she will ask about your life and eating habits and will
examine you. He or she may refer you to a psychiatrist or psychologist who is
trained in the treatment of eating disorders.
Treatment of anorexia nervosa
You should start treatment for anorexia as soon as you can. The aim is to reestablish a healthy attitude towards food and a consistent pattern of eating.
You can recover from anorexia but it may be a long process and, in times of
stress, you may relapse. But with determination, patience and support it can be
done. For treatment to work, you must want to get better.
Self-help
Keeping a diary of your eating habits and learning about healthy eating and
sensible weight control may help.
Support groups may help. It can be comforting to talk to others who have had the
same feelings and experiences.
Medicines
Medicines are not usually used to treat anorexia. However, they may be used to
treat secondary symptoms such as anxiety and depression.
Talking therapies
Talking therapies (eg counselling) are often used to treat anorexia. They can help
you to identify the feelings and fears that caused you to stop eating, and develop
a healthier attitude towards food and your body.
There are various types of talking treatment that can help with anorexia, such as
cognitive behavioural therapy (CBT). You may need to continue with these for
months or years.
You may also find it helpful to have therapy that involves your family, either
together with you or in separate counselling sessions. This helps everyone in the
family to understand the disorder properly and support each other.
Hospital treatment
Most people who have anorexia don't need to go into hospital. But if you have lost
so much weight that your life is at risk, you may need to be admitted to hospital so
that the fluids and nutrients that you have lost from your body can be replaced.
Forced treatment is always a last resort, because it can be distressing to lose
control of what you're eating and drinking.