Skin manifestation in nutritinal deficiency

Outline

• What is nutrition• Macronutrient• - Protein-energy malnutrition• - Essential Fatty acids• Micronutrient• - Fat soluble vitamin (Vit A, D, E, K)• - Water soluble vitamin (Vit Bcomplex, C)• Mineral

Nutrition

• Nutrition is the complex series of events by• Which living organism consume and assimilate

foods and other nutrients to live, grow, and maintain homeostasis

• Macronutrient Vs Micronutrient• Macronutrient : Protein Carbohydrate Fat• Micronutrient : Vitamin

Protein-Energy malnutrition

• Inadequate diet, Low education, war ,etc.• Varies degree of protein and calorie deficiency• Marasmus VS Kawashiorkor• Marasmus means : wasting • < 60% expected body weight for age• Kawashiorkor means: The one who is disposed• 60-80% expected body weight for age

• Adaptive starvation >> Marasmus - First 24 hr : muscle break down

gluconeogenesis- Fat break down : ketone body : brain • Non-Adaptive >> Kawashiorkor- Carbohydrate > Protein ; decrease protein

production

• Failure to thrive, poor weight gain, stunting• Marasmus : dry skin, look wrinkle skin,

increase lanugo hair, Monkey face, abdominal distension (abd M.hypotonia), rectal prolapse

Decrease resting BT, bradycardia• Kawashorkor : edematous or wet PEM,

Crazy pavement, Flag sign, abdominal distension(cirrhosis),

Monkey face

Essential fatty acid

• Inadequate intake, malabsorption, excessive loss, alcoholic, anorexia nervosa

• 18 20 22 carbon EFA cannot synthesis by human

• Omega-3 : Alpha linoleic acid• Omega-6 : linoleic acid

• Xerosis, scaly, diffuse erythema, poor wound healing, brittle nail, alopecia, blunted immune response

• Oleic >> 5,8,11 eicosatrienoic acid (abnormal byproduce)

• Increase 5,8,11 eicosatrienoic acid/arachinoic acid > 0.2 : EFA deficiency

• รู�ปภาพ .....+ sunflower ,safflower oil.

Vitamin A

• Retinal photoreceptor function, epithelial proliferation, keratinization

• Carotinoid = 2 retinal• Retinal >> retinol , intestinal villous cell • Liver was the retinyl ester storage

• Vitamin A deficiency : ocular and cutaneous• Inadequate intake, fat malabsorption, liver

disease• Nyctalopia > xerophthalmia• Xerosis bacillus > Bitot spot• Keratomalacia• Xerosis skin,dermomalacia, toad skin,

keratotic follicular

• Normal vitamin A level 20-50 mcg/dL• 1000-1500 IU : recommend daily allowance• 100,000-300,000 IU : treatment• Follow symptom or normalized Vit A level

• Vitamin A toxicity : Acute VS chronic• Acute : > 20 times of RDA in child• > 100 times of RDA in adule• Chronic : daily ingestion 25,000 IU/d more

than 6 years or > 100,000 more than 6 mo• Dry, scaly, large area of desquamation,

fissureing of lip, pseudo tumor cerebri, arthalgia

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