Approach to Patient With Nutritional Deficiency & Weight Loss

8/8/2019 Approach to Patient With Nutritional Deficiency & Weight Loss

1/29

Approach to a patient with Approach to a patient withnutritional deficiency &nutritional deficiency &weight lossweight loss


2/29

Objectives:

Definition of weight loss

Causes of weight loss

Types of nutritional deficiencies


3/29

W eight loss

W eight loss is the result of decreasedenergy intake, increased energyexpenditure, or loss of energy in the urineor stools.


4/29


5/29

PA TIENT HISTORY

Clinically important weight loss may bedefined as the loss of 4.5 kg (10 lb), or

more than 5 percent of baseline bodyweight over a period of 6 to 12 months.

Family members should be queried aboutthe patient's weight loss and changes ineating habits.


6/29

The following information should beobtained in an initial history:

Is the weight loss voluntary or involuntary?

Has the patient's appetite increased or decreased? There are many causes of weight loss with poor appetite (anorexia),

but only a few with an increased appetite.


7/29

Has the patient's physical activity recentlyincreased?

W hat is the magnitude of the loss of weight, according to the previousdefinition.

For how long has the patient been losingweight?


8/29


9/29

Changes in diet or activity level.Skipping meals, a mild illness, eatingon the run, a hectic schedule or eatingless fat may contribute to unexpectedweight loss.


10/29

G astrointestinal diseases:

Inflammatory bowel disease (ulcerativecolitis or Crohn's disease), peptic ulcer disease, celiac disease and others.

Endocrine disorders:Diabetes, hyperthyroidism,

hypothyroidism, adrenal insufficiencyand hypercalcemia.


11/29

Infection:

Tuberculosis, fungal diseases, parasitesand human immunodeficiency virus(HIV).

Aging-related appetite changes or medications are more likely to decreaseappetite.


12/29

M edications. Some drugs may causeweight loss. e.g. amantadine, someantibiotics, amphetamines, digoxin.

Cardiovascular and lung disease.Congestive heart failure or chronic

obstructive pulmonary disease (COPD).

Neurological illness:Stroke, multiple sclerosis, dementia and

Parkinson disease.


13/29

K idney disease:Due to nausea, vomiting, and losing

protein through your urine.

M ood or mental health changes:

Anxiety, stress and depression can affectyour weight.

Cancer. cancer cause unintentionalweight loss, and cancer treatment mayhave the same effect.


14/29


15/29

Nutritional deficiency diseases resultprimarily from a diet that does not haveenough of the nutrients that are essentialto health or development.

A nother cause is that an individual maynot be able to utilize properly the nutrientsconsumed in the diet.


16/29

Deficiency diseases may result from aperson's abnormally high metabolic needsfor a nutrient or from some imbalance inthe nutrients ingested. Certain drugs or medicines may also affect nutrient use.


17/29

DEFICIENCY DISE A SES

Humans obtain energy (measured incalories or joules) from carbohydrates, fat,and protein.


18/29

kwashiorkor M ineral DeficiencyMarasmus Vitamin Deficiency


19/29

P rotein-Energy Malnutrition

A failure to consume adequate quantitiesof food energy may lead to loss of weight

or growth failure in children, wasting of tissues, and eventually starvation.

This condition is aggravated by commoninfections, such as diarrhea, andsometimes by the irregular intervals atwhich a child may have food to eat.


20/29

Most severe deficiency disease is

StarvationStarvation : marked weight reduction, lossof fat and other tissues, including from theliver and intestines.


21/29

The two clinical forms of P EM arenutritional Marasmus and kwashiorkor.

Marasmus is due primarily to an energy(calorie) deficiency.

Kwashiorkor, protein deficiencypredominates.


22/29

Mineral Deficiency

The most prevalent and important mineraldeficiencies are iron deficiency, the mostcommon cause of anemia.

Iodine deficiency, a cause of endemicgoiter and mental retardation (cretinism).

Low fluoride intake, which contributes totooth decay.


23/29

V itamin Deficiency

V itamin A deficiency: (xerophthalmia) Itcan result in ulceration of the cornea of theeye, sometimes blindness, as well asincreased mortality rates.

V itamin K deficiency (chronic liver disease,obstructive jaundice): easy bleeding.


24/29

V itamin D deficiency: Rickets in childrenand osteomalacia in adults (softening of the bones).


25/29

V itamin B1 (thiamine) deficiency: (Beriberi)is commonly found among rice-eatingpeoples and occurs in alcoholics.

W et beriberi; it causes a combination of heart failure and weakening of thecapillary walls, which causes theperipheral tissues to become edematous.

Dry beriberi ( e nd em ic n eu ritis) wastingand partial paralysis resulting from

damaged peripheral nerves.


26/29

V itamin B2 (riboflavin) deficiency(ariboflavinosis): in which there may becracks of the lips and lesions in the genitalareas.

Niacin deficiency ( P ellagra) is associatedwith persons whose staple diet is corn or maize, (dermatitis, dementia, diarrhea).


27/29

Folic-acid deficiency: (pregnancy or drugs)causes macrocytic anemias (involving

abnormally large red blood cells).

V itamin B12 deficiency: (perniciousanemia, terminal ileitis) causes macrocyticanemias & subacute combineddegeneration.

V itamin C deficiency (scurvy): spots on theskin, spongy gums, and bleeding from themucous membranes.


28/29

TRE A TMENT

provision of appropriate doses of thenutrient in question and also an assurancethat foods rich in these nutrients areconsumed in the diet.


29/29

Reference textbook: Kumar & Clark.

W hat are metabolic causes of weight loss?

A 55 years old male farmer complaining of rough rash over lace area, elbows, &

greater trochanter, diarrhea, dementia,what is the probable diagnosis?

Documents

Approach to Patient With Nutritional Deficiency & Weight Loss