Define Protein Energy Malnutrition (PEM)
The disease is characterized by inadequate intake of protein and calories to meet the body's needs.
identify and define two compartments for nutrition
1. Somatic protein compartment represented by skeletal muscle
2. the visceral protein compartment represented by protein stores in visceral organs primarily the liver.
When the current weight of a child is measured at 60% of normal weight for their sex and age, the child is considered to have __________.
The loss of muscle mass results from what?
catabolism and depletion of somatic protein compartmentalization
___________ when protein deprivation is relatively greater than the reduction in total calories
__________ is a more severe form of malnutrition than marasmus
Kwashiorkor is associated with severe loss of________compartment and the resultant _________ gives rise to generalized edema.
visceral protein; hypoalbuminemia
Children with Kwashiorkor children have a characteristic ___________ appearance
________is a common complication in advance cancer patients and in patients with AIDS
Patients with ___________ have an increase risk of infection, sepsis, impaired wound healing and death after surgery
The malnutrition presents as____.
__________ that are involved in cachexia include tumor necrosis factor α (TNFα), interleukin 1, interleukin 6 and Gamma interferon.
In summary, the central anatomic changes of PEM are
1) Growth failure
2) Peripheral edema in Kwashiorkor
3) Loss of body fat and atrophy of muscle more marked in Marasmus
__________ is defined as self-induced starvation resulting in marked weight loss.
The clinical manifestations of anorexia nervosa include_______.
amenorrhea, decreased thyroid hormone release, includes cold intolerance, bradycardia, constipation, and changes in skin and hair.Bone density is decreased. In addition anemia and hypoalbuminemia may be present.
A major complication of anorexia nervosa is the increase susceptibility of_____________.
________is a condition in which the patient binges food and then vomits
The 3 major medical complications of bulimia include:
1) electrolyte imbalances
2) pulmonary aspiration of gastric contents
3) esophageal and cardiac rupture.
Vitamin deficiencies may be___________or _________
primary or secondary
_________ is the most important form of Vitamin A. It is oxidized in vivo to ______which is used for visual pigment.
The yellow and leafy green vegetables contain _________ which can be metabolized into the active form of vitamin A
beta-carotene A (carotenoids)
_______ is transported via chylomicrons to the liver for esterification and storage
Function of Vitamin A:
1.Maintaining normal vision in reduced light
2.Maintaining the integrity of mucus-secreting cells
3.Enhancing immunity to infections particularly in childre
Deficiency of Vitamin A leads to:
Keratomalacia (destruction of the cornea)
Urinary stone formation
Vitamin A toxicity is associated with the following:
Acute toxicity and Chronic toxicity
symptoms of acute toxicity from vitamin A include
symptoms of chronic toxicity from vitamin A include
1. weight loss
4. dryness of the mucosa of the lips
5. bone and joint pain
6. hyperostosis and hepatomegaly
Vitamin D maintains the normal plasma level of ______ and _________
1. The metabolism of vitamin D
Absorption of vitamin is through the ______ or synthesis from precursors in the _____
2.Binding to a plasma alpha-globulin (D-binding protein) and transported to the liver
3.Conversion of 25-hydroxyvitmamin D, 25(OH)D, by 25-hydroxylase in the ________
4.Conversion of 25(OH)D to 1, 25 (OH)₂ D by α₁hydroxylase in the _________ (this is the most biologically active form of vitamin D)
Vitamin D deficiency results in the following:
2. in adults?
1.Rickets(softening of bone)
2.Osteomalacia (softening of bone)
Vitamin D deficiency state may occur as a result of:
1. Disorders of Vitamin D absorption or metabolism
2. Disorders that affect vitamin D function
3. Disorders that disturb calcium or phosphorus homeostasis
Homeostatic correction of vitamin D deficiency leads to increase production of _____ resulting in:
1.Mobilization of calcium from the bone
2.Decrease renal excretion of calcium
3.Increase renal excretion of phosphate
Clinical presentation of Rickets in children presents as the following:
a.During infancy the head is ____ and the parietal bones buckle inward.
b.Deformation of the chest causes a _________ deformity.
c.As the child ambulates the pelvis becomes deformed with _______ the legs.
________is a fat soluble vitamin that requires a normal biliary tract and pancreatic function to be absorbed.
Deficiency of vitamin E results from a genetic disease in which a rare _______disorder of fats leads to failure to transport vitamin E.
Vitamin E may inhibit atherosclerosis by ___________and therefore, reduces the formation of fat plaques in blood vessels. It reduces mutagenesis as an antioxidant and therefore is considered a _________
reducing LDL oxidation;
cancer fighting agent
___________ is cofactor mainly required for clotting factors VII, IX, X and prothrombin.
Vitamin K is obtained by two forms.
1.________, which are synthesized by intestinal bacterial flora
2. ______ through diet
Endogenous form ;
__________ is symmetrical and takes the form of a nonspecific peripheral neuropathy with myelin degeneration. This is seen clinical as foot-drop, toe-drop, wrist-drop, muscle weakness and hyporeflexia (poor reflexes).
Polyneuropathy (dry berberi) - Polyneuropathy
_________ (wet beriberi) - dilated or enlarged heart.
Describe a syndrome that is a combination of anatomical and psychological abnormalities
__________ encephalopathy is marked by opthalmoplegia, nystagmus, ataxia of gait, derangement of mental function, global confusion and disorientation.
_________ takes the form of serious impairment of remote recall or recall events from immediate past (retrograde amnesia), inability to acquire new information and confabulation (lying).
Niacin in its bound form in corn is not available to the diet and therefore, can result in _______
___________lowers plasma LDL by reducing VLDL. It is also used in the treatment of hypercholesterolemia
_______ is usually bilateral and symmetrical and found on the exposed areas of the body. However similar lesions may occur on the mouth and vagina.
_________ ulceration and atrophy of the columnar epithelium of the gastrointestinal tract.
__________degeneration of the neuron in the brain and corresponding tract in the spinal cord.
The three naturally occurring substances- pyridoxine, pyridoxal and pyridoxamine, possess vitamin B6 activity and are generically referred to as ___________
Long-term treatment of tuberculosis with ____________
_____________ is seen most often seen in the following drugs that act as pyridoxine antagonist
Secondary hypovitaminosis of B6 or secondaryB6 deficiency
Treatment of menopause with ________
Treatment of rheumatoid arthritis with _________
_______ may also retard atherosclerosis by reducing LDL
__________ decrease the risk of neural tube defects.
what agents interfere with folate absorption in persons with adequate diets:
1. Oral contraceptive
4. Cigarette smoking
5. Chronic disease i.e. intestinal malabsorption and metastatic cancer
Distinctive rash around the eyes, nose, mouth, anus and distal parts of the intestines are called _______
Selenium is protective against oxidative damage of membrane lipids. The deficiency of this element is known in China as _______ which presents as congestive _________ in children and women.
cardiomyopathy (heart failure)
It is now known that adipocytes (fat cells) communicate with the hypothalamus by secreting a polypeptide hormone known as__________
Leptin acts as an ________factor.
__________is required for the initiation of puberty and the development of secondary sexual characteristics.