NUTRITIONAL DISORDERS

DR. NJAU.N.N.

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OVERWEIGHT AND OBESITY

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 INTRODUCTION
• Obesity is defined as excess body fat
accumulation with multiple organ-specific
pathologic consequences.
• Obesity results from an imbalance between
energy intake and energy consumption
• Obesity is defined in terms of the Body Mass
Index (BMI) and according to WHO classification
• one is overweight if the BMI is between 25 to
29 and
• one is obese if the BMI is greater than 30.
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 BMI
• The formula is BMI = kg/m2 where kg is a
person's weight in kilograms and m2 is their
height in meters squared.

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 Causes of obesity
1. Genetics-obesity is known to run in families,
2. poor diet and eating habits (high carbohydrate diet)
3. sedentary lifestyle,
4. factors during pregnancy that could affect the
weight of the child like gestational diabetes,
smoking and intrauterine under nutrition.
5. Breastfed infants are less likely to be obese later in
life
6. psychological factors like using food as a reward,
comfort and a means of getting attention.
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 Types of obesity
• Upper body/android obesity- Mostly around
the trunk (abdominal, visceral, central area).
Individuals are at a risk of cardiovascular
diseases

• Lower body/ female gynoid obesity- Mostly

around the lower body parts (peripheral,
gluteal-femoral area). Individuals are at a risk
of arthritis and varicose veins in the legs
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 Health risks associated with obesity
• Cardiometabolic diseases/metabolic syndrome like; type
2 diabetes mellitus, hypertension, hyperlipidaemia, stroke
and peripheral vascular disease
• gallbladder disease,
• infertility
• various cancers
• osteoarthritis
• sleep apnea,
• pulmonary dysfunction,
• pregnancy complications,
• psychological distress, and
• non alcoholic fatty liver disease 7
 Prevention of obesity
• a low fat and high fiber diet
• standard meal times and less snaking,
• regular physical activity

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 Treatment of obesity
• individualized lifestyle modifications and
should include a combination of reduced
calorie diet, increased physical activity

• behavioral therapy

• pharmacotherapy and surgery can be added

as ADJUNCTS.
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 Dietary therapy
• The dietary goals should be between 500-
1000kcal/day LESS than the current dietary
intake.
• The total dietary intake should be spread into
four or five meals per day that are in small
proportions.

• The aim initially is to lose weight but later it is

to maintain the new weight.
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 Physical activity
• Exercise

• Independently physical activity does NOT lead

to a significant loss in weight but it may help
• reduce abdominal fat,
• increase cardiopulmonary fitness and
• prevent the loss of muscle mass associated
with weight loss.

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 Behavioral therapy
• These include;
• self-monitoring of eating habits and physical
activity,
• HEALTHY stress management,
• problem solving,
• stimulus control/trigger factors,
• contingency management,
• social support and
• relapse prevention.

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 Pharmacotherapy
• Medication reduces weight by 4 to 6 kgs
beyond what would have been achieved had
the patient changed their diet alone.

• Drugs used here include;

• sibutramine and
• orlistat.

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• Sibutramine inhibits the uptake of serotonin,
dopamine and norepinephrine thus producing
weight loss by appetite reduction.

• Orlistat is a lipase inhibitor that decreases fat

absorption from the small intestines and its
mode of action is also its cause of adverse effects
like diarrhea, bloating and abdominal cramps
therefore avoid a high fatty meal.

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 Weight loss surgery/Bariatric surgery
• Bariatric surgery causes significant weight loss,
long-term weight reduction maintenance,
reduces the risk of developing cardio
metabolic disorders, decreases mortality and
improves the quality of life.

• Bariatric surgery works by

• decreasing energy intake and absorption,
• increases satiety and aversion to food.
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MALNUTRITION AND
STARVATION

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 Introduction
• In contrast to obesity, malnutrition and
starvation is a disease experienced mostly in
underdeveloped and developing countries
and they are diseases in which an individual is
unable or does not receive adequate
nutrients for bodily functions.

• Malnutrition can be classified as primary or

secondary malnutrition.
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• In primary malnutrition, one or all of the nutrients are
missing from the diet and this is mainly seen in poverty
stricken people.

• By contrast, in secondary, or conditioned, malnutrition, the

supply of nutrients is adequate, but malnutrition results from
nutrient malabsorption, impaired nutrient utilization or
storage, excess nutrient losses, or increased need for
nutrients.

• The causes of secondary malnutrition can be grouped into

three general but overlapping categories:
• GI diseases,
• chronic wasting diseases, and
• Acute critical illness. 18
 Causes of malnutrition
• Poverty-in poverty stricken individuals especially in the
developing countries, individuals mainly suffer from
protein energy malnutrition (PEM) and also trace
nutrients deficiency.

• Ignorance-ignorance on the nutritional content of various

foods and also the nutrient requirement of various people
e.g. pregnant women, infants and adolescents.

• Chronic alcoholism-this can lead to protein energy

malnutrition and also a deficiency in thiamine (B1),
pyridoxine (B6), folic acid and vitamin A. 19
• Acute and chronic illness-in many illnesses and traumas
like extensive burns the basal metabolic rate is accelerated
increasing the nutrient demand of all nutrients and failure
to recognize this may lead to malnutrition and delayed
recovery.

• Self imposed dietary restrictions-this is common in people

who are overly concerned about body image or who have
an excessive fear of cardiovascular diseases and it leads to
eating disorders like anorexia nervosa and bulimia which is
especially common in the developed countries.

• Others- GI diseases, malabsorption syndromes, drugs, total

parenteral nutrition 20
Protein-Energy Malnutrition (PEM)
• Protein energy malnutrition is most common in
poor countries with children being the most
common victims and is characterized by
inadequate intake of proteins and calories to
meet the body’s requirements.

• It has two syndromes

• marasmus and
• kwashiorkor
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• The body usually has two protein compartments;

• the somatic compartment represented by

proteins stored in the skeletal muscles and
this is what is affected in marasmus and

• the visceral compartment (which is more

important for survival) represented by
proteins stored in the visceral organs mainly
the liver and this is what is affected in
kwashiorkor
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 Marasmus
• In marasmus there is increased catabolism
and depletion of proteins from the somatic
compartment stores leading to a loss of
muscle mass that is reflected by reduced
circumference of the midarm and this is due
to decreased calorie intake resulting to an
adaptive response mechanism of the body
that uses amino acids as an alternative source
of energy.
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• In marasmus the body weight reduces to 60%
of the normal body weight.

• A child with marasmus also suffers from

growth retardation.

• The extremities are emaciated which makes

the head appears larger than normal.
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• In addition there is multivitamin deficiency
and bone marrow hypoplasia leading mainly
to hypochromic microcytic anaemia and there
is also an immune deficiency especially the T-
cell mediated immunity leading to multiple
infections

• In marasmus the visceral compartment is

hardly touched
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 Kwashiorkor
• It is prevalent in children who have been
weaned too early and put on a mainly
carbohydrate diet.

• Kwashiorkor is due to protein deprivation that

is usually greater than the total calorie
deprivation and it’s usually the commonest
PEM in Africa.

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• The protein lost is that from the visceral
compartment that results in hypoalbuminemia
leading to edema that usually masks the true
weight lost by the child.

• In Kwashiorkor, the subcutaneous and muscle loss

is usually less but even this little loss is masked by
edema.

• The weight is usually 60-80% the normal weight.

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 Clinical presentation
• The children usually present with skin hyper
and hypopigmentation and areas of
desquamation giving the skin a flaky
appearance.

• The hair attachment to the scalp is usually

weakened leading to hair loss and thinning
and it appears reddish in color due to hair
color loss and it usually has a fine texture.
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• There is also an enlarged fatty liver.

• There is also multivitamin deficiencies and

bone marrow hypoplasia leading to mainly
hypochromic microcytic anemia and also
increased infections.

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• There’s also reversible mucosal atrophy of the
small bowel and villi and microvilli loss and
loss of the small intestine enzymes e.g.
dissacharidase hence these children do NOT
respond well to milk based diets

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 Cachexia
• This is a secondary PEM seen in cancer
patients that usually presents with severe
wasting that presages death and is due to an
elevated basal metabolic rate and the
production of tumor necrosis factor that
stimulates the usage of lipids from lipid stores.

• A decreased appetite may also contribute.

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 Management
• Nutritional supplement: foods rich in protein
(and carbohydrates in the case of marasmus
and cachexia)

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