Major Nutritional Deficiency Diseases

A body needs calories, protein, and overall general nutrients to function.

Without adequate nutrition:

• your muscles waste away,

• your bones become brittle, and
• your thinking become foggy.

When you don’t consume enough nutrients, your body becomes malnourished.
Undernutrition can occur for multiple reasons. Food resources may be unavailable, or you may
have a condition that makes it difficult to eat, absorb nutrition, or prepare food. Drinking too
much alcohol can also lead to undernutrition.
The symptoms of undernutrition include:
• fatigue
• difficulty staying warm
• a lower body temperature
• diarrhea
• reduced appetite
• a lack of emotion
• irritability
• weakness
• slower breathing
• numbness or
tingling of the hands and feet
• dry skin
• hair loss
• bruises
 Protein Energy Malnutrition (PEM)
One type of malnourishment is protein-energy undernutrition.

Protein-energy malnutrition world map

Protein energy malnutrition (PEM) is a common problem worldwide and occurs in both developing and
industrialized nations.
In the developing world, it is frequently a result of socioeconomic, political, or environmental factors.
In contrast, protein energy malnutrition in the developed world usually occurs in the context of chronic
disease.
Protein-energy undernutrition is sometimes called protein-energy malnutrition. You have this if your body
has a severe calorie or protein deficiency. This can occur if you don’t consume the amount of calories
and protein your body needs to function.

Protein-energy undernutrition doesn’t occur due to short-term illnesses. It’s more likely due to malnutrition
over a long period.

Two main types of this undernutrition are marasmus and kwashiorkor.

• Kwashiorkor:
- Insufficient protein consumption
- Child weaned: mother’s milk to starchy vegetables

• Marasmus
- Energy deficiency

• Marasmic-Kwashiorkor
- Deficiency of both calories and protein
face
 alopecia: loss of hair/ baldness

face

Weight loss: “skin and bones”

• Prominent of ribs
• Drastic loss of adipose tissue
• Growth retardation
• Chronic diarrhea
• stomach shrinkage
• Muscle atrophy
• Skin folds
• “old man” face
Marasmus symptoms Kwashiorkor symptoms

weight loss an inability to grow or gain weight

dehydration edema, or swelling of the hands and feet

stomach shrinkage stomach bulging

diarrhea
The main cause of both of these conditions is a lack of access to food. Some things that may affect
a person’s access to food include:
• famine
• a caregiver’s inability to get food due to lack of transportation or a physical inability
• living in poverty
Other things that may lead to these conditions include:
• having an eating disorder
• lacking education about dietary needs
• taking medication that interferes with the absorption of nutrients
• having a medical condition that increases your body’s need for calories
Complications of PEM
• Hypoglycemia
• Hypothermia
• Dehydration and shock
• Electrolyte imbalance
- hypokalemia
- hyponatremia
• Infections
• Micronutrient deficiencies
 Treatment and prevention
• Correction of water and electrolyte balance
• Treat infection and worm infestations
• Dietary support
- 3-4g protein and 200 cal/ kg body weight/day
- Vitamins and minerals
• Prevention of hypothermia
• Counsel parents and plan future including immunization and diet supplements

Initial “refeeding"
• Continue breast feeding
• Add frequent small feeds
• Use liquid diet
• Give vitamin A and folic acid on admission
• With diarrhea use lactose- free or soya bean formula

Both conditions are treatable by slowly increasing calorie intake through several, small meals.
Your doctor may add liquid protein supplements if you have problems digesting food.
Doctors often recommend multivitamin supplements and may prescribe medications to
improve appetite. If the symptoms are severe, hospitalization may be necessary.
 Iodine Deficiency Disorders (IDD)
IODINE REQUIREMENTS — Iodide is essential for thyroid hormone synthesis. In
order for the thyroid gland to synthesize adequate amounts of T4, approximately 52
mcg of iodide must be taken up daily by the thyroid gland.
Severe iodine deficiency develops when iodide intake is
chronically <20 mcg/day.
The World Health Organization (WHO) recommends
●90 mcg of iodine daily for infants and children up to 5 years
●120 mcg for children 6 to 12 years
●150 mcg daily for children ≥12 years and adults
●250 mcg daily during pregnancy and lactation
Signs and symptoms of iodine deficiency include:
Swelling of the thyroid glands in the neck
This can cause a visible lump, called a goiter, to form on your neck.
Low levels of thyroid hormones (hypothyroidism)
Hypothyroidism typically causes symptoms that can include:
• fatigue
• increased sensitivity to cold In infants, hypothyroidism is likely to cause symptoms like:
• constipation • frequent choking
• large tongue
• dry skin
• puffy face
• weight gain
• constipation
• puffy face • poor muscle tone
• muscle weakness • extreme sleepiness
• elevated blood cholesterol levels In children and teens, this condition may cause:
• pain or stiffness in the muscles and joints • poor growth
• slowed heart rate • delayed tooth development
• thinning hair • delayed puberty
• depression • poor mental development
• poor memory
• a heavier-than-normal period in menstruating women

Cognitive issues
Symptoms can include:
• low IQ
• trouble learning
• mental disabilities (especially in children)
Iodine deficiency disorders and complications
When left untreated, iodine deficiency can lead to severe hypothyroidism.
Complications may include:
• heart disease and related disorders, such as an enlarged heart and
heart failure
• mental health issues such as depression and cognitive impairment
• damage to the body’s peripheral nerves, known as peripheral
neuropathy
• impaired ovulation, which may cause infertility in women

Low amounts of thyroid hormone in pregnant women can increase their

child’s risk of birth defects. Pregnancy-related issues that iodine
deficiency can cause include:
• miscarriages
• stillbirth
• preterm delivery
• congenital abnormalities in newborns
In severe cases, iodine deficiency can cause a condition called cretinism.
abnormal sensation in skin

heavy menstruation
 PROPHYLAXIS AND TREATMENT
Community — Iodine deficiency is a global public health problem and, in combating it, emphasis should be placed on
diagnosis and correction at the level of the community rather than the individual. Achieving sufficient iodine nutrition in
the population would eliminate the need for specific supplementation during pregnancy and lactation.
Iodization of salt — Iodization of salt is the preferred method of increasing iodine intake in a community. Salt iodination
is legally mandated in many countries. Salt is a dietary necessity and often the only one that communities cannot
provide for themselves. Adding iodine during the packaging or processing of salt is an efficient means for distributing
iodine on a mass basis. It is technically easy (and can even be done manually), and the cost is low, although the
accompanying changes in salt processing may increase the price to the consumer. The usual "dose" is between 10 and
50 mg of iodine/kg salt (sodium chloride) as potassium iodide or iodate.
The optimal amount to be added for a particular country or region can be calculated from the daily per capita salt
consumption, the amount of iodine consumed from other sources, and any losses of iodine between production and
consumption. Potassium iodide is added in the United States, Canada, and many countries in Western Europe.
However, in hot tropical climates or suboptimal conditions of purity or storage, potassium iodate is preferred over
potassium iodide because it is more stable. In Finland, iodization of animal feed resulted in a five- to sevenfold increase
in the average individual's iodine intake.
The success of salt iodization programs relates to sources of salt within a country. Some countries, such as Congo,
Nigeria, and Zimbabwe, import all their salt, making control of iodization fairly simple. In other countries with numerous
scattered salt deposits and a complex distribution system, implementation of salt iodization has been more difficult. A
determined international effort towards eliminating iodine deficiency by the year 2005 has resulted in major progress,
with approximately 70 percent of households worldwide using adequately iodized salt. In Denmark, the use of iodized
salt resulted in a 6 and 14 percent reduction in thyroid gland volume in individuals from areas of mild or moderate iodine
deficiency, respectively

Other options — Alternatives are needed when salt iodization is impractical or delayed. Effective options are iodized
oil (Lipiodol), iodized water, and iodine tablets or drops. Water is an occasional iodization vehicle because it is a daily
necessity like salt. The technology can be as simple as adding a few drops of iodine to standing drinking water.
Addition of molecular iodine (but not iodide or iodate) carries the additional benefit of sterilizing the water.
In addition, alternative methods of food iodine enrichment are currently under study. Hydroponic experiments were
carried out to investigate the possibility of enriching the iodine uptake by spinach or other vegetables such as
tomatoes and potatoes. In one study, biofortification of vegetables with iodine increased urinary iodine concentration
and, together with the habitual use of iodized salt, improved the iodine nutritional status of the study participants .
Iodine can be obtained by consumption of foods that naturally contain it
(fish, seafood, kelp, some drinking water, and vegetables grown in iodine-sufficient soil) or
to which it is added (table salt).
Sea salt naturally contains only a small amount of iodine.

Cow's milk is a source of iodine owing to iodine in cattle feed and the use of iodophor
udder cleansers in the dairy industry.
 Iron Deficiency
About 25 percent of the iron in the body is stored as ferritin, found in
cells and circulates in the blood. The average adult male has about
1,000 mg of stored iron (enough for about three years), whereas women
on average have only about 300 mg (enough for about six months).
When iron intake is chronically low, stores can become depleted,
decreasing hemoglobin levels.

When iron stores are exhausted, the condition is called iron depletion.
Further decreases may be called iron-deficient erythropoiesis and
still further decreases produce iron deficiency anemia.

Iron is not made in the body and must be absorbed from what you eat.
The adult minimum daily requirement of iron is 1.8 mg.
Only about 10 to 30 percent of the iron you consume is absorbed and used by
the body.
Iron Deficiency Disorders

Microcytosis

Hypochromia
Iron deficiency is the most common cause of anemia.
There are many reasons why a person might become deficient in iron.

These include:
Inadequate iron intake
Eating too little iron over an extended amount of time can cause a shortage in your body. Foods such as meat, eggs, and
some green leafy vegetables are high in iron. Because iron is essential during times of rapid growth and development,
pregnant women and young children may need even more iron-rich foods in their diet.

Pregnancy or blood loss due to menstruation

Heavy menstrual bleeding and blood loss during childbirth are the most common causes of iron deficiency anemia in
women of childbearing age.

Internal bleeding
Certain medical conditions can cause internal bleeding, which can lead to iron deficiency anemia.
Examples include an ulcer in your stomach, polyps in the colon or intestines, or colon cancer.
Regular use of pain relievers, such as aspirin, can also cause bleeding in the stomach.

Inability to absorb iron

Certain disorders or surgeries that affect the intestines can also interfere with how your body absorbs iron.
Even if you get enough iron in your diet, celiac disease or intestinal surgery such as gastric bypass may limit the amount
of iron your body can absorb.

Endometriosis
If a woman has endometriosis she may have heavy blood loss that she can not see because it is hidden in the abdominal
or pelvic area.
 Iron Deficiency Disorders
The symptoms of moderate to severe iron deficiency anemia include:
• general fatigue
• weakness
• pale skin
• shortness of breath
• dizziness
• strange cravings to eat items that aren’t food,
such as dirt, ice, or clay
• a tingling or crawling feeling in the legs
• tongue swelling or soreness
• cold hands and feet
• fast or irregular heartbeat
• brittle nails
• headaches
 Some foods rich in iron include:
Meat and Poultry
• Lean beef
• Pork
• Lamb
• Chicken
• Turkey
• Liver (except fish liver)

Seafood
• Fish
• Mussels
• Shellfish

Vegetables
• Greens, all kinds
• Tofu
• Broccoli
• Sweet Peas
• Sprouts
• Tomatoes
• Potatoes
• Green Beans
• Corn
• Beets
• Cabbage

The daily requirement of iron can be achieved by taking iron supplements. Ferrous sulfate 325 mg, taken orally once a day,
and by eating foods high in iron.
Foods high in vitamin C also are recommended because vitamin C helps your body absorb iron.
Cooking in iron pots can add up to 80 percent more iron to your foods.
Consult with your primary care provider before taking iron supplements.