Nutritional deficiency diseases

Jan 2014  Nutritional deficiency diseases
Nutritional deficiency diseases occur mainly due chronic dearth of essential nutrients in required quantities in the food. In some cases, though the availability exists, the body is unable to digest, absorb or utilize food.
Nutritional deficiency diseases have become a universal problem. The Vitamin and Mineral Nutrition Information System (VMNIS) was established by WHO "to strengthen surveillance of micronutrient deficiencies at the global level." One of the objective of VMNIS is to "Track progress towards the goal of eliminating major vitamin and mineral deficiencies." These nutritional diseases can be classified as carbohydrate, protein, fat, vitamin or mineral deficiency diseases which are briefly discussed here.

Vitamin A:
The nutritional deficiency of vitamin A causes diseases like night blindness, growth impairment, immune impairment, xerophthalmia, keratomalacia, hyperkeratosis, acne, dry hair and blindness. it is common in underdeveloped countries affecting one third of the children under the age of five around the world.

Beriberi is caused by dearth of thiamine (vit-B1). involves nervous system. Thiamine is found in the bran of rice. In populations, where the staple food is polished rice, as in South Asia, this nutritional disease was prevalent. Beriberi is rare in developed nations and in regions where the food habits include other cereals.

Riboflavin (vit-B2) nutritional deficiency is medically known as ariboflavinosis. The symptoms include photophobia, bloodshot eyes, angular cheilitis, angular stomatitis, inflammation of the lining of mouth and tongue, mouth ulcers, iron-deficiency anemia, scrotal dermatitis and dry and scaling skin. It is mostly caused by inadequacy in food, impaired liver function and alcoholism.

is caused by the chronic nutritional deficiency of niacin (Vit-B3) in the food. Maize (corn) is a very poor source of niacin and in populations which mainly subsist on maize this disease is very common. Pellagra is common in Africa, Indonesia, North Korea, and China.

Pantothenic acid:
Pantothenic acid (Vit-B5) is found in most of the foods and pantothenic acid deficiency is very rare. Nutritional sources include animal products like fish and meat, rice and wheat bran, vegetables, such as broccoli, cabbage and avocados and yeast. Pantothenic acid deficiency causes impaired energy production and neurological symptoms like numbness, paresthesia, and muscle cramps.

Pyridoxine (Vit-B6) nutritional deficiency is a rare disease affecting children. Its symptoms include seizures, depression, dizziness, irritability, fatigue, cheilitis, impaired wound healing, conjunctivitis, loss of appetite and sideroblastic anemia. It is caused by paucity of pyridoxine in the food and use of tuberculostatic medication.

Deficiency of biotin (Vit-B7) is rare as its daily requirement is very low. Intestinal bacteria synthesize smaller amounts and we also get it from various food sources. Biotin deficiency occurs when raw egg white is consumed over long periods. The protein avidin present in raw egg white binds to biotin and makes it unavailable to the body. Erythematous periorofacial macular rashes (red, patchy rashes near the mouth) and dermatitis are caused when biotin is not available for the body. If not treated, biotin deficiency may become fatal.

Folic acid:
Birth defects and neural tube defects in fetus occur when the mother suffers deficiency of folic acid (vit-B9).

Megaloblastic anemia, an anemia with larger-than-normal red blood cells, is caused when there is nutritional dearth of cobalamins (vit-B12) (and/or folic acid) in the food.

Vitamin C (ascorbic acid):
Ascorbic acid deficiency causes or subclinical scurvy. The symptoms of scurvy include malaise, lethargy, shortness of breath, bone pain, myalgias, gum bleeding, loosening of teeth, jaundice, edema, oliguria, neuropathy, suppurating wounds and mental disability.

Vitamin D:
Rickets () in children and cause weak, malformed brittle bones. Its deficiency in the food and non exposure to sun brings on rickets or osteomalacia.

Vitamin E:
Its deficiency is very rare and usually nutritional inadequacy may never occur. However in persons with impaired absorption of fats and persons suffering from abetalipoproteinemia (genetic disease) vitamin E absorption is impaired. Such persons may suffer from neuromuscular problems such as dysarthria, proprioception spinocerebellar ataxia, absence of deep tendon reflexes, and loss of vibratory sensation. They may also have symptoms of anemia, retinopathy, male infertility and impairment of the immune response.

Vitamin K:
Its nutritional deficiency is very rare as it is present in both plant and animal sources of food. Further it is synthesized by the intestinal bacteria. The nutritional deficiency may arise in infants and elderly with poor intestinal flora, persons under prolonged broad-spectrum antibiotics and persons suffering from intestinal malabsorption. They may have diseases like ecchymosis, petechiae, hematomas and massive uncontrolled bleeding at the sites of injury or surgery.

Calcium deficiency leads to weakening and stoppage calcium replacement in the bones and results in osteoporosis.

Chromium is available in many food sources and its nutritional deficiency normally does not occur. However, in patients on long-term total parenteral nutrition, chromium deficiency occurs. In such situations impaired glucose tolerance and/or peripheral neuropathy may be caused.

Copper deficiency is very rare as body's copper requirement is very low. Copper deficiency diseases occurs when in case prolonged excess consumption of zinc. in gastrointestinal surgery which requires removal of part of gastrointestinal canal, malabsorption of copper may occur. Nutritional non-availability of copper can cause hematological manifestations like myelodysplasia, anemia, leukopenia and neutropenia. Neurological manifestations include ataxia, spasticity, and peripheral neuropathy.

Nutritional deficiency of fluoride results in dental caries and osteoporosis. This happens when the food is very poor in fluoride.

Hypothyroidism, goiter (thyroid enlargement) and cretinism diseases occurs when a decrease in thyroid hormone production is caused by poor nutritional intake of iodine.

Iron deficiency anemia, which is due to deficiency of hemoglobin in the red blood cells, is characterized by severe fatigue and breathlessness. Hemoglobin is a protein containing iron.

Magnesium is required for bone formation and its can affect calcium absorption and utilization for bone building. The nutritional deficiency of magnesium alone or in combination with that of calcium can lead to osteoporosis.

Manganese deficiency is very rare as the requirement is very small. However it can cause skeletal deformation, bone demineralization and malformation. Relatively higher intake of minerals like iron, magnesium, and calcium may impact the manganese absorption. Nutritional sources of manganese include leafy green vegetables, fruits, nuts and whole grains.

Hypokalemia is the result of nutritional potassium deficiency disease. It affects the electrolyte balance in the body impairing the neuromuscular functions. Potassium deficiency symptoms include abnormal heart rhythm, fatigue, lethargy, sleepiness, muscle weakness, muscles spasm, hypokalemic nephropathy and renal failure. The causes being food poor in potassium, excessive sweating, vomiting, use of medical diuretics or diarrhea.

is one of the causes of Keshan disease and Kashin-Beck disease. Its symptoms include atrophy, extreme fatigue, mental slow down, myocardial necrosis, goiter, degeneration and necrosis of cartilage. Nutritional shortfall may occur in cases of total dependency on food grown on selenium poor soils. It may occur in persons undergoing total parenteral nutrition or gastrointestinal bypass surgery and also in very elderly people with poor intestinal absorption.

Sodium depletion causes hyponatremia. Congestive heart failure, liver failure, renal failure, or pneumonia are manifestations of hyponatremia. Normally nutritional hyponatremia is rare. Loss of body fluids retention of body fluids can upset the sodium balance in the body plasma.

Zinc is vital for body functions and many enzymatic reactions are brought about by this trace mineral. causes hypozincemia. Anorexia, cognitive and motor function impairment, diarrhea, low testosterone in men, Esophageal Squamous Cell Carcinoma, psychological disorders, low birth weight and dysmenorrhea are some of the effects of hypozincemia.

Essential fatty acids:
Alpha-linolenic acid (an omega-3 fatty acid) and linoleic acid (an omega-6 fatty acid) are the two essential fatty acids required in human nutrition. Essential fatty acid deficiency results in diseases like dermatitis, diarrhea, depression, liver degeneration, osteoporosis and suicidal tendencies.

Low intake of carbohydrates causes the fat reserves in the body to be used for energy production. Severe dearth of carbohydrates in the food causes the protein also to be used for energy production. Nutritional deficiency of carbohydrates in the food causes reduced stamina, loss of sodium in the body, muscle cramps, excessive appetite, constipation, poor brain functioning, sleeplessness, irritability, general weakness, loss of muscle mass and ketosis.

Protein nutritional deficiency arises due low intake of proteins. Proteins are made up of amino acids. Many of the amino acids are synthesized by the human body. Nine essential amino acids are not synthesized by the body and they have to be sourced through food. Protein deficiency can cause depression, anxiety, mental retardation, trouble falling asleep, fatty liver, lethargy, apathy, diarrhea, weakness, skin rashes, flaky skin, growth retardation, weight loss, edema of the belly and legs and kwashiorkor.

Protein and protein-energy deficiency diseases are Kwashiorkor and Marasmus.

Kwashiorkor: In Kwashiorkor lack of protein in food is predominant, though calorie intake is sufficient. It is characterized by edema, distended abdomen, liver enlargement, ulcerating dermatoses, pedal edema, thinning hair, irritability and anorexia.

Marasmus: Marasmus is a severe form of malnutrition disorder wherein there is severe nutritional deficiency of both energy and protein. Its symptoms include drastic loss of adipose tissue, fretfulness, dry skin, loose skin folds, infections, loss of fluids and circulation disorders.
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Author: James Heilman, MD (
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