Malnutrition

Observations on children and experimental animals have shown that gross insufficiency of food early in life interferes with brain development. Decreased protein intake seems to be particularly critical. However, once the central nervous system has matured, such deficiencies create little, if any, harm. 

The rat model, most commonly used for studies of malnutrition, differs from the human in that the peak of the brain growth spurt occurs after birth (Nowak Jr. and Munro, 1977). In rats, cerebellar neurons proliferate after birth while cells are still migrating into the hippocampus. In 

Well-controlled studies isolating nutrition as the single independent factor are nearly impossible to perform because of social and ethical considerations. Freeman et al. (1980) attempted to isolate nutritional factors by analyzing the results of a voluntary, 7-year food supplementation program, supplying different nutrients to two sets of rural Guatemalan vil- 

The evidence presented supports the contention that severe global malnutrition in early life is deleterious to cognitive development. Such a premise is not particularly relevant in developed countries, where marked protein-energy starvation is rare. Are there demonstrable effects of selective nutrient lack or of milder degrees of malnutrition  

Dickie and Bender (1982) tested the widespread belief that midmorning mental performance is suboptimal in school children who skip breakfast. They did not confirm the results of previous suggestive studies. Children who did or did not eat breakfast performed equally well on the cancellation test. The authors also found no difference between mental performance as assessed by tests of short-term memory, serial addition, and attentiveness when breakfast was omitted by those accustomed to eating the morning meal. 

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Malic acid [97-d7-d] Malnutrition Malodor evaluation Malolacticfermentation Malonate [1797-75-7] Malonate esters Malonates... 

Human growth hormone, used as a human pharmaceutical, is approved for only one indication in the United States, treatment of growth failure owing to hGH deficiency, a condition known as pituitary dwarfism. However, clinical trials are under way to test its efficacy in Turner s syndrome, bums, wound healing, cachexia, osteoporosis, constitutional growth delay, aging, malnutrition, and obesity. 

In humans, vitamin A deficiency manifests itself in the following ways night blindness, xerophthalmia, Bitot s spots, and corneal involvement and ulceration. Changes in the skin have also been observed. Although vitamin A deficiency is seen in adults, the condition is particularly harmful in the very young. Often, this results from malnutrition (56). 

Generally, nephrotoxicity is not a problem. Some cephalosporins, especially those with the 3-methylthiotetrazole side chain, such as moxalactam (48), show a tendency to promote bleeding. This appears to be due to a reduction in the synthesis of prothrombin and can be a problem especially in elderly patients, patients with renal insufficiency, or patients suffering from malnutrition (219). The same side chain seems to promote a disulfiramlike reaction in patients consuming alcohol following a cephalosporin dose (80,219). 

Pantothenic acid is found in extracts from nearly all plants, bacteria, and animals, and the name derives from the Greek pantos, meaning everywhere. It is required in the diet of all vertebrates, but some microorganisms produce it in the rumens of animals such as cattle and sheep. This vitamin is widely distributed in foods common to the human diet, and deficiencies are only observed in cases of severe malnutrition. The eminent German-born biochemist Fritz Lipmann was the first to show that a coenzyme was required to facilitate biological acetylation reactions. (The A in... 

Organoselenium compounds in particular, once ingested, are slowly released over prolonged periods and result in foul-smelling breath and perspiration. The element is also highly toxic towards grazing sheep, cattle and other animals, and, at concentrations above about 5 ppm, causes severe disorders. Despite this, Se was found (in 1957) to play an essential dietary role in animals and also in humans — it is required in the formation of the enzyme glutathione peroxidase which is involved in fat metabolism. It has also been found that the Incidence of kwashiorkor (severe protein malnutrition) in children is associated with inadequate uptake of Se, and it may well be involved in protection... 

Bulusu S, Chakravarty I. 1988. Profile on drug metabolizing enz5mies in rats treated with parathion, malathion, and phosalone under various conditions of protein energy malnutrition. Bull Environ Contam Toxicol 40 110-118. 

In arterioles, the hydrostatic pressure is about 37 mm Hg, with an interstitial (tissue) pressure of 1 mm Hg opposing it. The osmotic pressure (oncotic pressure) exerted by the plasma proteins is approximately 25 mm Hg. Thus, a net outward force of about 11 mm Hg drives fluid out into the interstitial spaces. In venules, the hydrostatic pressure is about 17 mm Hg, with the oncotic and interstitial pressures as described above thus, a net force of about 9 mm Hg attracts water back into the circulation. The above pressures are often referred to as the Starling forces. If the concentration of plasma proteins is markedly diminished (eg, due to severe protein malnutrition), fluid is not attracted back into the intravascular compartment and accumulates in the extravascular tissue spaces, a condition known as edema. Edema has many causes protein deficiency is one of them. 

In historical terms, folates are among the most recently identified of the vitamins. Wills was the first to describe a form of anaemia associated with pregnancy and malnutrition which could be cured by yeast or liver extract (Wills, 1933 Wills et al, 1937). The active constituent of these dietary... 

An inadequate intake in the diet of those food chemicals that are essential nutrients results in health risks. Indeed these risks are by far the most important in terms of the world s population where malnutrition is a major public health problem. But, unlike the toxic chemicals, they would show a very different dose-response if they were subject to similar animal bioassays. At very low doses there would be a high risk of disease that would decrease as the dose was increased, the curve would then plateau until exposure was at such a level that toxicity could occur. Figure 11.2 shows this relationship which is U- or J-shaped rather than the essentially linear dose-response that is assumed for chemicals that are only toxic. The plateau region reflects what is commonly regarded as the homeostatic region where the cell is able to maintain its function and any excess nutrient is excreted, or mechanisms are induced that are completely reversible. 

Presence of malnutrition and diarrhea can lead to zinc deficiency... 

Hepatobiliary disease occurs due to bile duct obstruction from abnormal bile composition and flow. Hepatomegaly, splenomegaly, and cholecystitis may be present. Hepatic steatosis may also be present due to effects of malnutrition. The progression from cholestasis (impaired bile flow) to portal fibrosis and to focal and multilobar cirrhosis, esophageal varices, and portal hypertension takes several years. Many patients are compensated and asymptomatic but maybe susceptible to acute decompensation in the event of extrinsic hepatic insult from viruses, medications, or other factors.7... 

Most CF patients have an increased caloric need due to increased energy expenditure through increased work of breathing and increased basal metabolism. Prevention of malnutrition requires early nutritional intervention. In patients with mild lung disease and well-controlled absorption, required caloric intake is approximately 100% to 120% of the recommended daily allowance (RDA) for age.15 As lung disease progresses, caloric requirements increase. 

Ulcerative colitis Diarrhea (bloody, watery, or mucopurulent), rectal bleeding, abdominal pain/cramping, weight loss and malnutrition, tenesmus, constipation (with proctitis)... 

Vitamin K is an essential factor in the production of coagulation proteins within the liver. Elevated clotting times from decreased protein synthesis are indistinguishable from those produced by low vitamin K levels caused by malnutrition or poor intestinal absorption. Vitamin K (phytonadione) 10 mg subcutaneously daily for 3 days can help to establish whether the prolonged bleeding time results from loss of synthetic function in the liver or vitamin K deficiency. 

Reduction in dietary protein intake has been shown to slow the progression of kidney disease.8 However, protein restriction must be balanced with the risk of malnutrition in patients with CKD. Patients with a GFR less than 25 mL/minute/ 1.73 m2 received the most benefit from protein restriction 8 therefore, patients with a GFR above this level should not restrict protein intake. The NKF recommends that patients who have a GFR less than 25 mL/minute/1.73 m2 who are not receiving dialysis, however, should restrict protein intake to 0.6 g/kg per day. If patients are not able to maintain adequate dietary energy intake, protein intake maybe increased up to 0.75 g/kg per day.15 Malnutrition is common in patients with ESRD for various reasons, including decreased appetite, hypercatabolism, and nutrient losses through dialysis. For this reason, patients receiving dialysis should maintain protein intake of 1.2 g/kg per day to 1.3 g/kg per day. 

Water-soluble vitamins removed by hemodialysis (HD) contribute to malnutrition and vitamin deficiency syndromes. Patients receiving HD often require replacement of water-soluble vitamins to prevent adverse effects. The vitamins that may require replacement are ascorbic acid, thiamine, biotin, folic acid, riboflavin, and pyridoxine. Patients receiving HD should receive a multivitamin B complex with vitamin C supplement, but should not take supplements that include fat-soluble vitamins, such as vitamins A, E, or K, which can accumulate in patients with renal failure. 

Protein and amino acid losses through the peritoneum and reduced appetite owing to continuous glucose load and sense of abdominal fullness predispose to malnutrition. 

Rare forms of DM have been reported and account for 1% to 5% of all diagnosed cases. Causes of these rare forms of DM include specific genetic conditions, surgery, drugs, malnutrition,... 

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