Nutritional Deficiency States Research Articles

A prospective real-world study evaluating serum levels of arginine and cysteine in women with chronic telogen effluvium: do we really need blanket prescription of amino acid supplementation?

Amino acids form a major component of hair fibres and are prescribed routinely in the form of nutritional supplements in patients with chronic telogen effluvium (CTE). Such a practice is based on assumption of a nutritional deficiency state in such patients. In this prospective study, we evaluated the serum levels of cysteine and arginine in 30 women with CTE and in healthy controls. We found no significant difference between the two groups in terms of serum arginine levels. Cysteine levels were higher in patients with CTE (P < 0.001). No correlation was found between levels of serum amino acids (cysteine and arginine) and either diet type (vegetarian or not) or body mass index, and no significant correlation between levels of the two amino acids and severity of disease. Our work suggests that arginine and cysteine deficiency is not present in women with CTE. Supplementation is unlikely to be of any benefit in nutrient-replete populations and only adds to the cost of therapy.

Food insecurity and nutritional status of preconception women in a rural population of North Karnataka, India

BackgroundAs per the World Health Organization, the nutritional status of women of reproductive age is important, as effects of undernutrition are propagated to future generations. More than one-third of Indian women in the reproductive age group are in a state of chronic nutritional deficiency during the preconception period leading to poor health and likely resulting in low birth weight babies. This study was aimed to assess the food insecurity and nutritional status of preconception women in a rural population of north Karnataka.MethodsA total of 770 preconception women were enrolled across a district in Karnataka from selected primary health centre areas by a cluster sampling method. Data on socioeconomic status, food insecurity and obstetric history were collected by trained research assistants, interviewing women at home. In half of the participants, a 1 day 24 –hour dietary recalls were conducted by dietary assistants to assess the dietary intakes. Anthropometric measurements and haemoglobin estimation were carried out at the health centres.ResultsIn the present study, a majority of the participants (64.8%) belonged to the lower socio-economic classes and the prevalence of food insecurity was 27.4%. A majority of the participants had mild (15.5%) to moderate (78.6%) anaemia. About one-third of the participants (36.6%) were underweight. Significant associations were found between socio-economic status and anaemia (p = 0.0006) and between food insecurity and anaemia (p = 0.0001).ConclusionThe nutritional status of preconception women was poor and anemia was more prevalent in low-socioeconomic and food insecure population.

The Relationship of Infectious Diseases History and Mother Factors to Under Red Line Among Toddler

Abstract: Nutrition under the red line is a state of severe nutritional deficiency caused by low consumption of energy and protein from daily food. Sungai Tiung is the village that has the highest number of children under five with under red line (BGM) from other villages in the working area of Rawat Inap Cempaka Health Center. This study aims to know the relationship of infectious diseases history and mother factors to under red line (BGM) among toddler in Sungai Tiung. This research uses cross-sectional design. The samples are 90 respondents. Sampling used purposive sampling. The independent variables are a history of infectious disease, knowledge, education, and mother care pattern. The dependent variable is under red line (BGM). The instrument in this study used questionaire and Kartu Menuju Sehat (KMS). The result showed that there is a relationship history of infectious diseases with BGM (p-value = 0.03). The results also showed no relationship of knowledge (p-value = 0.12), education (p-value = 0.75) and mother care pattern (p-value = 0.32) with BGM. There is a relationship history of infectious diseases with BGM. So that, there should be efforts to prevent infectious diseases in toddler. Keywords : under red line, toddler, infectious diseases

Intravenous Iron Treatment in Pregnancy: Ferric Carboxymaltose for Correction of Iron Deficiency Anaemia

Iron deficiency is the most common nutritional deficiency state of women in childbearing age. Peri-partum iron deficiency anaemia (IDA) is associated with significant maternal, fetal and infant morbidity. An effective management is needed to prevent adverse outcomes. Current options for treatment are limited; these include oral iron supplements, which are usually ineffective and poorly tolerated, and whole blood transfusion, which carries an inherent risk, should be avoided during pregnancy. Intravenous ferric carboxymaltose is a new treatment option and it is better tolerated with a good result. The study was designed to assess the safety and efficacy of intravenous ferric carboxymaltose for correction of IDA in pregnant women in third trimester. It was a prospective study; 260 anaemic pregnant women received Injection ferric carboxymaltose, as a total dose of 500-1000 mg between 28 to 36 weeks of pregnancy. Safety was assessed by analyzing adverse drug reactions. Ferric carboxy maltose significantly increased Hb level (p&lt;0.001) in all women in this study group. Increased Hb value was observed 3-4 weeks after infusion. None of the women felt worse. No serious adverse effects were found and minor side effects occurred in 34(13%) patients.Our study revealed that the Hb level increased significantly, was well tolerated and without significant side effects.Faridpur Med. Coll. J. Jul 2017;12(2): 54-57

An unusual case of multiple intestinal perforations secondary to pica

Habitual ingestion of non-nutritive substances is the characteristic feature of a medical condition known as pica. It is usually associated with nutritional deficiency state, mental illness and at times with pregnancy. Most of the ingested foreign bodies pass through the digestive tract without causing complications however in about 1% cases, it can result in fatal complications such as intoxication, gastrointestinal perforation etc. Here we report a case of multiple intestinal perforations in a 28 year old patient secondary to his psychiatric illness Pica. The aim of this case report is to demonstrate its unusual presentation and to discuss the management of this rare case.

Clinical Appearance of Oral Candida Infection and Therapeutic Strategies.

Candida species present both as commensals and opportunistic pathogens of the oral cavity. For decades, it has enthralled the clinicians to investigate its pathogenicity and to improvise newer therapeutic regimens based on the updated molecular research. Candida is readily isolated from the oral cavity, but simple carriage does not predictably result in development of an infection. Whether it remains as a commensal, or transmutes into a pathogen, is usually determined by pre-existing or associated variations in the host immune system. The candida infections may range from non-life threatening superficial mucocutaneous disorders to invasive disseminated disease involving multiple organs. In fact, with the increase in number of AIDS cases, there is a resurgence of less common forms of oral candida infections. The treatment after confirmation of the diagnosis should include recognizing and eliminating the underlying causes such as ill-fitting oral appliances, history of medications (antibiotics, corticosteroids, etc.), immunological and endocrine disorders, nutritional deficiency states and prolonged hospitalization. Treatment with appropriate topical antifungal agents such as amphotericin, nystatin, or miconazole usually resolves the symptoms of superficial infection. Occasionally, administration of systemic antifungal agents may be necessary in immunocompromised patients, the selection of which should be based upon history of recent azole exposure, a history of intolerance to an antifungal agent, the dominant Candida species and current susceptibility data.

Developments in the fight against cancer Cachexia

Cachexia is a wasting syndrome in which both fat and muscle are lost due to the presence of tumor or inflammation. It implies a state of profound nutritional deficiency. This word is derived from the Greek words kakos meaning bad, and hexis meaning condition. This term is most often used to describe patients with chronic or end stage diseases such as cancer, AIDS, or cystic fibrosis. Affected patients lose weight and appetite and as a result become weak and fatigued. Drastic losses of body mass may lead to alterations in metabolic functions such as electrolyte balance. Electrolyte imbalances reduce strength, increase fatigue and weakness, and can cause numbness, tingling, involuntary twitching, and even pain. Severely malnourished individuals have difficulties performing even basic tasks such as bathing and grooming. In severe cases, starvation can result in death. Death is most likely a result of severe electrolyte imbalances that lead to arrhythmias. Death has also been reported due to weakened respiratory muscles leading to pneumonias that spread to the blood stream and result in fatal infection. Unfortunately, in cancer, Cachexia is present all too often. Cachexia is really one of the most devastating symptoms of cancer – up to 75% of cancer patients suffer from this condition. It robs patients of their energy, quality of life, enjoyment, and ultimately sense of independence. Most patients afflicted with cancer Cachexia are those with cancers of the upper gastrointestinal tract. These include cancers of the esophagus, stomach, and pancreas. One study noted that 85% of all patients with pancreatic cancer develop Cachexia and loose a median of 14.2% of their pre-cancer weight just by the time of diagnosis. Average survival for patients diagnosed with pancreatic cancer is only nine to twelve months. Cachexia is also seen frequently in lung cancer but is rare in patients with breast cancer, for example. Specifically, cancer related Cachexia does not usually occur in early stage cancer. It is seen almost exclusively with advanced and metastatic disease.

Cognition enhancers for the treatment of dementia.

Dementia is a broad term used to describe several chronic progressive neurological disorders that adversely affect higher mental functions including memory, language, behaviour, abstract thinking, comprehension, calculation, learning capacity and judgement. Alzheimer's disease is the most common form of dementia but other neurological conditions such as Parkinson's disease, cerebrovascular disease and chronic infections such as syphilis can also lead to the clinical syndrome of dementia. Initial investigations should always focus on finding any treatable cause for dementia such as HIV, structural lesions such as subdural haematomas or specific nutritional deficiency states such as that due to vitamin B12 and treated appropriately. Where no treatable or reversible aetiology is found, a referral to a specialist should be considered who may initiate further investigations including magnetic resonance imaging or perfusion single-photon emission computerised tomography scans of the brain, and sometimes cerebrospinal fluid examination or an electroencephalogram.

Neurologic complications of alcoholism.

This review serves as an overview of neurologic conditions associated with alcohol abuse or withdrawal, including epidemiology, clinical symptoms, diagnostic approach, and treatment. Frequent alcohol abuse and frank alcoholism are very common among adults in the United States. Although rates decline with each decade, as many as 10% of the elderly drink excessively. Given the ubiquitous nature of alcoholism in society, its complications have been clinically recognized for generations, with recent advances focusing on improved understanding of ethanol's biochemical targets and the pathophysiology of its complications. The chronic effects of alcohol abuse are myriad and include neurologic complications through both direct and indirect effects on the central and peripheral nervous systems. These disorders include several encephalopathic states related to alcohol intoxication, withdrawal, and related nutritional deficiencies; acute and chronic toxic and nutritional peripheral neuropathies; and myopathy. Although prevention of alcoholism and its neurologic complications is the optimal strategy, this article reviews the specific treatment algorithms for alcohol withdrawal and its related nutritional deficiency states.

Dietary Assessment and Food Intake In Elderly Individuals Attending Public Health Centers In Urban Areas of Baghdad City In Iraq .

Background: The population composition in all countries is changing very rapidly, with the result that there will now be Increasing numbers of elderly in all communities and in all countries of the world .Age-related changes in body habits, and disease and medication-related interactions can affect the nutritional requirements of elderly persons. This can further compounded by difficulties that older persons experience in accessing grocery stores and in cooking healthy food Many older persons relay on the convenience of buying processed foods or ordering fast food that can contribute to both obesity and deficiencies in essential nutritional requirements . The diagnosis of nutritional deficiency states in elderly people is made more difficult by the usual symptoms and signs being masked by diseases. &#x0D; Objectives: To assess the dietary and food intake in a sample of elderly subjects.&#x0D; Patients and methods: A random sample of 184 elderly persons were included in the study 58.2% males and 41.7% females selected randomly from a list of public health centers in urban areas of Baghdad city , it was carried out during the period between the first of March and the end of August 2005. &#x0D; Results: Highest proportion of the studied males and females aged 65-74years, the total number of males and females in this age group constitute (65.8%) of the studied sample. The highest frequency of elderly subjects with inadequate dietary intake was observed in vitamin B12 (59.2%) .The frequency of inadequate dietary intake was higher among elderly females than that in males for energy 28.6%, iron 18.2%,vitamin C 54.5%, vitamin B1262.3%, while it was higher among elderly males for protein 13.1%. It was found that high proportion of the studied sample had mean food daily intake less than the recommended mean values for milk 98.4% , vegetables 97.3% , fruits 96.7% , fish and sea food 95.1% . Furthermore 70.7%, of the studied elderly subjects had mean food daily intake less than the recommended mean values of meat/poultry, legumes 59.3% , egg and products 57.6% respectively , while 88% of them had high recommended mean food daily intake of cereals. The mean ± SD of BMI of elderly subjects of present study was 27.6 ± 4.8 . &#x0D; Conclusion: The mean food daily intake of milk , meat/poultry/fish ,vegetables and fruits are deficient in a high proportion of the studied elderly subjects .Acceptable percentage of the studied sample had high mean food daily intake of cereals .The frequency of inadequate dietary intake was higher for energy , iron ,vitamin c, vitamin b12 in the study sample .

Acquired Myelodysplasia or Myelodysplastic Syndrome: Clearing the Fog

Myelodysplastic syndromes (MDS) are clonal myeloid disorders characterized by progressive peripheral blood cytopenias associated with ineffective myelopoiesis. They are typically considered neoplasms because of frequent genetic aberrations and patient-limited survival with progression to acute myeloid leukemia (AML) or death related to the consequences of bone marrow failure including infection, hemorrhage, and iron overload. A progression to AML has always been recognized among the myeloproliferative disorders (MPD) but occurs only rarely among those with essential thrombocythemia (ET). Yet, the World Health Organization (WHO) has chosen to apply the designation myeloproliferative neoplasms (MPN), for all MPD but has not similarly recommended that all MDS become the myelodysplastic neoplasms (MDN). This apparent dichotomy may reflect the extremely diverse nature of MDS. Moreover, the term MDS is occasionally inappropriately applied to hematologic disorders associated with acquired morphologic myelodysplastic features which may rather represent potentially reversible hematological responses to immune-mediated factors, nutritional deficiency states, and disordered myelopoietic responses to various pharmaceutical, herbal, or other potentially myelotoxic compounds. We emphasize the clinical settings, and the histopathologic features, of such AMD that should trigger a search for a reversible underlying condition that may be nonneoplastic and not MDS.

Oral and peri-oral signs and symptoms of herbal dentifrices in patients in two oral medicine clinics in Lagos—A preliminary study

Background: Herbal dentifrices appear to have become an attractive alternative for some consumers and its use has gained appreciable acceptance in Nigeria. This could be partly due to the perception that herbal toothpastes like other herbal products are “natural”, devoid of chemicals and therefore superior to regular toothpastes. Aggressive advertisement of the products may also contribute to this new trend. Mucosal symptoms such as glossitis and intolerance to spicy foods seen in patients attending the oral diagnosis clinic are usually associated with anaemia and nutritional deficiency states. The disturbing trend of an increasing number of patients presenting with such oral mucosal symptoms associated with the use of herbal dentifrices prompted this study. This trend was observed in two isolated oral medicine clinics. Objective: To sensitize oral health, allied professionals and consumers on the possible adverse effects of regular use of some herbal dentifrices sold in Nigeria. Materials and Methods: Routine patients of two oral medicine clinics in Lagos, namely the Randle General Hospital and the Lagos University Teaching Hospital who complained of some adverse mucosal signs and symptoms following the regular use of two identified herbal toothpastes made up the study population. The study was conducted between April 2010-April 2011. A detailed history and examination was carried out on these patients and clinical photographs of oral signs observed was taken in consenting patients. Data analysis was done using the Epi-info 6 software. P values ≤ 0.05 was considered statistically significant and data was presented in table format. Results: A total of 45 patients, 9 (20%) males and 36 (80%) fe-males were seen. The age range of patients was 14 - 78 years; mean age 45.5 ± 14.9 years. The duration of use of herbal dentifrices ranged from 2 weeks - 84 months (mean 24 ± 11.5 months). Oral signs and symptoms seen include, burning mouth and peppery sensation, mucosal erythema, lichenoid reaction, xerostomia, loss of taste sensation, angio-oedema and oral and peri-oral pigmentation. In many patients, resolution of symptoms was progressive within 2 weeks of withdrawal of the herbal toothpaste and its replacement with a conventional fluoride toothpaste. Most of the patients however required further treatment. A statistically significant association was found between the use of the identified herbal dentifrices and the following mucosal signs and symptoms namely, burning mouth and peppery sensation ,loss of taste sensation, soreness, erythema and lichenoid straie (p value ≤ 0.05). There was no statistically significant association between the use of herbal toothpaste and mucosal signs and symptoms of xerostomia, angular cheilitis, mucosal itching, angio-oedema and numbness (p value > 0.0.5) Conclusion: The regular use of the herbal dentifrices identified in this study can result in oral signs and symptoms affecting taste , nutrition, aesthetics and general oral physiology in some consumers. These findings suggest that further long term clinical trials need to be conducted on the herbal dentifrices to identify the noxious agents causing these symptoms. The formulation and use of these dentifrices need to be standardized and regulated. There is also a need to formulate a treatment protocol for these patients.

Syndromes associated with nutritional deficiency and excess

Normal functioning of the human body requires a balance between nutritional intake and metabolism, and imbalances manifest as nutritional deficiencies or excess. Nutritional deficiency states are associated with social factors (war, poverty, famine, and food fads), medical illnesses with malabsorption (such as Crohn disease, cystic fibrosis, and after bariatric surgery), psychiatric illnesses (eating disorders, autism, alcoholism), and medications. Nutritional excess states result from inadvertent or intentional excessive intake. Cutaneous manifestations of nutritional imbalance can herald other systemic manifestations. This contribution discusses nutritional deficiency and excess syndromes with cutaneous manifestations of particular interest to clinical dermatologists.

The role of nutritional deficiency states in depression

The role of nutritional deficiency states in depression

Lumbosacral plexopathy associated with aortoiliac occlusive disease

Lumbosacral plexopathy associated with aortoiliac occlusive disease

Training For Dental Professionals: Nutrition And Disease In The Elderly

The geriatric population is the most rapidly growing segment of the general population and will have dramatic implications for systemic and oral health in future. Poor hygiene in elderly led to the spread of infectious diseases that were responsible for most deaths. Nutritional deficiency states in old people may lead to diseases. So a good diet is not only necessary for development of the masticatory system, it also keep this system functioning properly. To help patients improve their diet without taking on the role of a dentists, a dietitian like all other health professionals, must posses basic nutritional knowledge and be familiar with the physiologic processes at play, as well as the effects of nutrition on the body. The educational programmes that are most comprehensive in this respect offer, in the first year, a basic nutrition course preceded or accompanied by courses in biochemistry and physiology. The dentist trained to assess their patients diet and counsel the in this regard, would be able to diagnose a patient's general state of health by examining the mouth and tissues, as well as the results of laboratory tests.

Global strategies to prevent non-communicable diseases: A view for the low-income societies

Two facts of public health in the low-income societies are becoming overwhelmingly apparent. First the incidence and prevalence of non-communicable diseases (NCDs) has been accelerating rapidly throughout the world (not just in affluent industrialised nations) with deaths from heart disease and cancer surpassing those from infections and undernutrition. The second is the persistence of conditions of food insecurity underweight and micronutrient deficiency (hidden hunger). To illustrate this dichotomy some time in 2001 the earths population moved into an interesting and historically unprecedented situation; an equal number of individuals across the world suffered from undernutrition (defined as a 2 standard deviation deficit in weight for age) and overnutrition (defined as a body mass index (BMI) in excess of 25 kg/m2). Of course there is generally a segregation in age and geographical demography with the undernutrition occurring among the young of the poor nations of the tropical world and overnutrition among adults in affluent nations. This traditional separation however is by no means hermetic as overweight rates continue to rise in developing societies in the face of widespread undernutrition. These apparently paradoxical situations have been termed nutrition transition a phase in societal development during which chronic diseases emerge and coexist with nutritional deficiency states. Resolving the apparent paradox invokes the multifaceted adversity of poverty which influences ones capacity to access both the quantity and the quality of diet for optimal nutrition and health. (excerpt)

Integrating nutrition with ecology: balancing the health of humans and biosphere

To show that current rates of global population growth, production and consumption of food, and use of living and physical resources, are evidently not sustainable. To consider ways in which nutrition and allied sciences can respond to this great challenge of the twenty-first century. Past, current and future projected trends in production and consumption patterns are examined. These show that overall present and projected patterns cannot be sustained; and also show increasing unacceptable inequity between and within rich and poor regions and countries. Nutrition science classically focuses on nutrients in relation to human physiology, metabolism, growth, health and disease. The social and environmental conditions of the modern, interconnected, market-oriented world, and the consequences for food production and consumption, are extending the research and policy agenda with which nutrition science must now urgently engage. Historically, much attention has been paid to eliminating nutritional deficiency states, and this remains an important task. In modern urban populations 'malnutrition' encompasses new forms of dietary imbalance, especially excesses of certain nutrients. These contribute to various non-communicable diseases and, particularly, to overweight/obesity and its attendant metabolic derangements and disease risks. As a mass phenomenon the current surge in obesity has no historical precedent. The escalating impact of humankind on the natural environment, with its ramifications for present and future food production, is also unprecedented. The essential challenge for nutrition science is to develop new understanding and strategies to enable a balance between promoting, equitably, the health of humans while sustaining the long-term health of the biosphere. Extension of nutrition science and food policy to meet those goals will be aided by understanding better how dietary conditions shaped the biological evolution of humankind. The fundamental long-term task is to integrate human health with the health of the biosphere.

Oral Lesions in Scurvy

Scurvy is the nutritional deficiency state associated with lowered levels of ascorbic acid (vitamin C). Lack of ascorbic acid leads to suppression of collagen synthesis and the synthesis of defective collagen among other metabolic derangements. Weakening of vascular walls results in signs and symptoms mimicking other diseases such as bleeding diatheses and deep vein thrombosis. Scurvy is rarely encountered in Western countries where there is a broad community understanding of the importance of nutritional requirements and where foods containing ascorbic acid are readily available. As a result of these factors early diagnosis may be hampered where it is not considered in the differential diagnosis, and consequently, prolonged suffering of the patient. Scurvy is easily treated with high doses of oral ascorbic acid, although recurrences may occur. Education of health care providers in recognizing the signs and symptoms of scurvy therefore cannot be over emphasized, particularly in societies in which nutritional deficiencies are considered uncommon. A case of scurvy presenting primarily with oral manifestations is reported here.

Neurological manifestations of gastrointestinal disorders, with particular reference to the differential diagnosis of multiple sclerosis.

Neurological manifestations of gastrointestinal disorders are described, with particular reference to those resembling multiple sclerosis (MS) on clinical or MRI grounds. Patients with celiac disease can present cerebellar ataxia, progressive myoclonic ataxia, myelopathy, or cerebral, brainstem and peripheral nerve involvement. Antigliadin antibodies can be found in subjects with neurological dysfunction of unknown cause, particularly in sporadic cerebellar ataxia ("gluten ataxia"). Patients with Whipple's disease can develop mental and psychiatric changes, supranuclear gaze palsy, upper motoneuron signs, hypothalamic dysfunction, cranial nerve abnormalities, seizures, ataxia, myorhythmia and sensory deficits. Neurological manifestations can complicate inflammatory bowel disease (e.g. ulcerative colitis and Crohn's disease) due to vascular or vasculitic mechanisms. Cases with both Crohn's disease and MS or cerebral vasculitis are described. Epilepsy, chronic inflammatory polyneuropathy, muscle involvement and myasthenia gravis are also reported. The central nervous system can be affected in patients with hepatitis C virus (HCV) infection because of vasculitis associated with HCV-related cryoglobulinemia. Mitochondrial neurogastrointestinal encephalopathy (MNGIE) is a disease caused by multiple deletions of mitochondrial DNA. It is characterized by peripheral neuropathy, ophthalmoplegia, deafness, leukoencephalopathy, and gastrointestinal symptoms due to visceral neuropathy. Neurological manifestations can be the consequence of vitamin B1, nicotinamide, vitamin B12, vitamin D, or vitamin E deficiency and from nutritional deficiency states following gastric surgery.