NUTRITION

1. Nutrition- process by which food or food components are taken in, processed, and utilized
by the body for growth, proper functioning, and over-all well being
2. Nutrients are classified : macronutrients & micronutrients
3. Significant contributor to health and disease affecting &interacting with various organ
systems
1.Interaction of nutrition & brain structure & function
2. Relationship among nutrition, infection, and immunity
3. Effects of nutrition to renal, cardiac, bone metabolism
4. Affects continuum of various life stages prenatal & infant nutrition may have an impact
to nutrition later in life which may contribute in the devt of lifestyle diseases: HPN, DM,
obesity
NUTRITIONAL DISORDERS
1. Results from: excess, deficiency, imbalance of nutrients, alteration at the gene leve
2. Malnutrition- undernutrition & overnutrition
3. Specific deficiency
BASIC ASSUMPTIONS OF NURITIONAL DISORDERS

1. A deficiency state seldom occurs alone, eso if the cause is inadequate intake of food or
nutrients
2. The clinical presentation of a nutritional d/o in the form of anatomic lesions is an indication
of chronic nature
Vitamin A deficiency- starts with biochemical alterations in the rods & cones of the retina
nyctalopia or night blindness Bitot;s spots & xeropthalmia
VITAMINS
Category
Water soluble

Fat soluble

Examples
B1 Thiamine
B2 Riboflavin
B3 Niacin
B5 Panthotenic acid
B6 Pyridoxine
B7 Biotin
B9 Folic acid
B12 Cobalamin
C
Ascorbic acid
A Retinol
D Calciferol
E Tocopherol
K Phylloquinone or Phytomenadione

DEFICIENCIES OF NUTRIETNS
1. Type 1 Deficiency
1.Micronutrient deficiency
2. Do not result in growth failure
3. leads to clinical manifestations related to the depletion outcome of tissue
concentration & nutrient reserves

2. Type 2 Deficiency
1.results in growth failure: poor growth, stunting, wasting
2. appears normal children
3. body adapts by conserving the nutrient & reducing its excretion however in
severe cases, tissues & muscle breakdown ensue & appetite is reduced
Picture- Cant see

MICRONUTRIENT MALNUTRITION
1. hidden hunger of hidden malnutrition
2. Lack or inadequate intake, malabsorption, undernutrition or one or more vitamins or
minerals
3. Epidemiology
Global data
Iron deficiency anemia (IDA)- most common micronutrient deficiency
Iodine & vit A
Philippines:2008 survey
IDA
Vit A deficiency
Iodine deficiency d/o (IDD)
Zinc deficiency
Folate deficiency
Vit B6 deficiency
IMPACT OF VITAMIN & MINERAL DEFICIENCIES
Impact on nations
1. Lowering of as much as 10-15% in
intellectual capacity due to iodine
deficiency
2. Unnecessary loss of more than 2% of the
nations gross domestic products
3. Heavy toll on health systems
4. High level of people condemned to living
in poverty

Impact on individual
1. Inhibition of full intellectual & physical
potential
2. 40-60% of children affected from
developing countries had iron deficiency
3. Impairment of immune systems
4. 40% of children affected from developing
countries had Vit A deficiency
5. Approximately 200,000 preventable birth
defects annually due to folate deficiency

MICRONUTRIENT MALNUTRITION- IRON DEFICIENCY

Overall prevalence rate: 19.5%
6-11 mo- highest prevalence at 55.7%
1-12y/o
13-19y/o
Pregnant & lactating mothers
MICRONUTRIENT MALNUTRITION- VIT A DEFICIENCY
Philippines: 5.9 % classified by WHO as mild: 2-9%) public significance
6 mo- 5 years old at 15.2%
Pregnant women 9.5%

Lactating women 6.4%

MICRONUTRIENT MALNUTRITION- IODINE & ZINC DEFICIENCIES
Iodine
Preventable course of mental retardation & affects maternal reproductive health
MIMAROPA, Western & Central Visayas, SOCCSKSARGEN, CARAGA, Davao, & Zamboanga

VITAMIN A
1. 1913: Osborne & Mnedel- Yale University
McCollum & Davis- University of Wisconsin
First fat soluble vitamin to be discovered
Family of compounds called retinoids
Have the biologic activity of retinol, which was originally isolated from the retina
2. 3 Forms
Retinoids
Beta carotene
Caretenoids
Retinol
1. Preformed vit A
2. Most active form & is mostly found in animal tissues
Beta carotene
1. Provitamin A
2. Plant source of retinal form which mammals make 2/3 of their vitamin
Caretenoids
1. Largest group of the 3 forms
2. Contain multiple conjugated double bonds
3. Exist in a free alcohol or in a fatty acyl-ester form
3. In the human body:
Retinol is the predominant form & 11-cis-retinol is the active form
Retinol binding protein (RBP) binds Vit A and regulates its absorption & metabolism
Functions
1. Essential for vision (especialluy dark adaptation), immune response, bone
growth, reproduction, maintenance of the surface linings of the eyes, epithelial
cell growth and repair, and the epithelial integrity of the respiratoy, urinary, and
intestinal tracts
2. Important for embryonic development and the regulation of adult genes
3. Functions as an activator of gene expression by retinoid alpha-receptor
transcription factor and ligand dependent transcription factor
4. Formation of mucopolysaccharides
5. Maintenance of lysosomal stability
6. Protein synthesis
4.CAROTENOIDS

60% OF Vit A ingested

Utilization of the precursors of Vit A (carotenoids) depends upon the following factors
1. Absorption
Reduced if there is inadequate fat in the diet
(+) steatorrhea
2. Conversion to Vit A in the intestinal mucos
5. BETA CAROTENE
Highest potency provitamin A among the biologically active carotenoids
Absorption: small intestine converted into Vit A ester in the intestinal wall lymphatics
blood stored in the liver released when needed

VITAMIN DEFICIENCY
1. Daily requirement
1000 iu- children
3000 iu- adults
6000 iu- lactating mothers
2. Etiology of Vit A deficiency
1. Low vitamin A content of liver at birth- rapidly increased by intake of milk
2. Colustrum, cows milk
3. Preformed Vit A sources: liver, kidneys, fat, human, & cows milk, butter, egg
yolk, fish liver oil
4. Provitamin/carotenoids (B-carotene): green leafy vegetables, yellow fruits &
vegetables
5. Etiologic factors of Vit A deficiency
1. Poor storage during fetal life to maternal malnutrition
2. Absence of Vit A in the diet of the child
3. Poor absorption of Vit A: low fat diet, chronic gastroenteritis,
malabsorption syndromes, hookworm infestation
3. Pathology of Vit A deficiency
1. Retina: Vitamin A is metabolized converted to retinaldehyde & rhodopsin
(visual purple): small but readily available amounts of Vit A are required for the
deposition of rhodopsin in the rods to the retina
2. Delayed in Vit A in the serum is low poor vision in light of low intensity or in the
dark
3. Deficiency of Vit A will also lead to the following
1. Damage to the epithelial, nervous, & bony tissues
2. Ocular mainfestations e.g. nyctalopia
3. Generalized or localized xerosis of the conjunctivae and
keratomalacia
4. Clinical s/s of Vit A deficiency
1. Principal manifestations are in the EYE
1.Nyctalopia or night blindness
1.inability to see in dim light
2. stumbles at dusk, bumps against objects in dim light
3. photophobia: eye are firmly closed
4. itchiness or pricking pain

2.Xerosis conjunctivae
1.thickening, loss of luster producing frequent blinking
2.conjunctivae forms vertical crescentic wrinkles in the corners
of the eyes
3. Bitots spots
Well demarcated, superficial, dry, grayish, silvery, or chalk-like.
Foamy plaques, usually triangular or irregularly circular in shape,
situated lateral to the cornea
4.Corneal xerosis or xeropthalmia
1.Cornea is hazy or opaque, with bluish, milk appearance
2.Due to cellular infiltration of the corneal stroma
3.Corneal ulcers develop in the form of small erosions with
opaque areola
4.If these ulcers perforate, aqueous humor flows out to the iris
usually plugging the hole
5.large perforation, lens may escape through the pupils
5.Keratomalacia
1.cornea becomes soft & gelatinous
2.metaplaia &degeneration of the corneal epithelium producing
opacities or characteristic softening of the entire thickness of
part or whole of cornea
3.Blindness due to opacities
4.Collapse of the eyeball following corneal perforation
2. Skin signs
1.Xerosis of the skin: generalized dryness with branny desquamation or
scaling
2. follicular hyperkeratosis or phrynoderma- horny papules on the back of
arm, thighs, and buttocks: hyperplastic metaplasia of the epithelium &
plugging of hair follicles with dense masses of keratin
3. Generalized s/s
1.apathy
2.mental retardation
3.stunting & wasting
4.faulty epiphyseal bone formation
5.defective enamel of teeth
DIAGNOSIS
1. PE- malnourished
Eye signs
Skin signs
2. Biochemical tests: plasma carotene level
PREVENTION
1. Infants <12 mon
2. >12 mo: 200,000 iu
3. Pregnant women (last trimester): 5000 iu