Malnutrition malabsorption

We found that supplementation of vitamin A in the form of an aerosol is an effective, safe, and routinely manageable method to enhance vitamin A and RBP concentrations. Consequently, this modality of treatment may serve as an alternative vitamin A therapy during chronic or acute episodes of malnutrition, malabsorption, or in case of insufficient compliance to other therapies and might be useful in respiratory diseases associated with vitamin A deficiency. 

Q13 Magnesium is a major intracellular cation which acts as a co-factor in many intracellular enzyme reactions. Plasma concentration is normally 2 mg dl-1. This ion is abundant in the diet, and hypomagnesaemia is relatively uncommon, unless there is malabsorption or excessive loss via the kidney. However, when present, hypomagnesaemia can lead to hypoparathyroidism. Adjustment to the levels of magnesium can shift the function of the parathyroid glands back to normal. Chronic alcoholism, malnutrition, malabsorption, renal tubular dysfunction and excessive use of diuretics, such as loop and thiazide diuretics, may lead to hypomagnesaemia. Symptoms of magnesium deficiency include depression, confusion, muscle weakness and sometimes convulsions. 

Drugs Alcohol, estrogens, isotretinoin, beta blockers, glucocorticoids, bile-acid resins, thiazides asparaginase, interferons, azole antifungals, mirtazapine, anabolic steroids, sirolimus, bexarotene Malnutrition Malabsorption Myeloproliferative diseases Chronic infectiousdiseases AIDS, tuberculosis Monoclonal gammopathy Chronic liver disease Malnutrition Obesity... 

Short stature also occurs with several conditions that are not associated with a trne GH deficiency or insnfficiency. These conditions inclnde intranterine growth restriction constitntional growth delay malnutrition malabsorption of nntrients associated with inflammatory bowel disease, celiac disease, and cystic fibrosis chronic renal failure skeletal and cartilage dysplasia and genetic syndromes... 

B. Vitamin K deficiency (eg, malnutrition, malabsorption, or hemorrhagic disease of the newborn) with coagulopathy. 

Decreased serum copper levels are found in Wilson s disease and in a number of hypoproteinaemic states, e.g. malnutrition, malabsorption and nephrotic syndrome. 

When there is decreased synthesis of protein, as in malnutrition, malabsorption and severe liver disease. 

The morbidity and mortality that are often associated with human GI helminth infections reflect in part the nutritional consequences of diarrhoea and malabsorption, and the resulting malnutrition that can accentuate the effects of infection by suppressing the protective immune response as well as compromising intestinal repair (Ferguson et al., 1980 Keymer and Tarlton, 1991 Cooper et al, 1992). In experimental rodents the pathology associated with infection is characterized by villus atrophy, crypt hyperplasia, goblet cell hyperplasia and infiltration of the mucosa by a variety of... 

Lactoferrin, a protein found in secondary granules of polymorphonuclear cells, was observed to be mildly to moderately elevated in the stools of children with endemic cryptosporidiosis [91] and healthy adult volunteers with experimental infection [92], Indeed, in another study of malnourished children in Haiti, cryptosporidiosis was noted to stimulate an inflammatory response, as evidenced by elevated IL-8, TNF-a, lactoferrin, IL-13 and IL-10 [93]. Further studies are needed to elucidate the role of inflammatory mediators in the development of prolonged diarrhea, malabsorption and malnutrition in immunocompromised hosts and children in endemic areas. 

Essential fatty acid deficiency is rare but can occur with prolonged lipid-free parenteral nutrition, very low fat enteral formulas, severe fat malabsorption, or severe malnutrition. The body can synthesize all fatty acids except for linoleic and linolenic acid, which should constitute approximately 2% to 4% of total calorie intake. 

Malnutrition can also cause secondary osteoporosis in persons with different deficiencies of substances such as calcium and vitamin D. Malnutrition due to starvation caused by most severe or terminal chronic diseases and malabsorption due to inflammatory bowel diseases (colitis, Mb Crohn) can give rise to rapidly diminishing bone tissue. 

Malnutrition in animals with drug-induced anorexia or malabsorption can trigger immune suppression. 

Vitamin A deficiency can result from insufficient dietary intake, from malabsorption and it has been recognized that also malfunction of RAR-receptors can lead to symptoms of vitamin A deficiency. These symptoms include skin lesions, night blindness, corneal ulcerations and conjunctivitis and poor bone remodeling. Vitamin A deficiency associated with malnutrition is wide spread in large parts of the world and may be fatal in infants and young children suffering from kwashiorkor or marasmus. 

Vitamin E may be indicated in some rare forms of anemia such as macrocytic, megaloblastic anemia observed in children with severe malnutrition and the hemolytic anemia seen in premature infants on a diet rich in polyunsaturated fatty acids. Also anemia s in malabsorption syndromes have shown to be responsive to vitamin E treatment. Finally, hemolysis in patients with the acanthocytosis syndrome, a rare genetic disorder where there is a lack of plasma jS-lipoprotein and consequently no circulating alpha tocopherol, responds to vitamin E treatment. In neonates requiring oxygen therapy vitamin E has been used for its antioxidant properties to prevent the development retrolental fibroplasia. It should be noted that high dose vitamin E supplements are associated with an increased risk in allcause mortality. 

Malnutrition from dietary deficiency and vitamin deficiencies due to malabsorption are common in alcoholism. 

CFD is further associated with the following inherited metabolic disorders 5,10-methylen-tetrahydrofolate reductase (MTHFR) deficiency [7], 3-phos-phoglycerate dehydrogenase (PGDH) deficiency [8], dihydropteridine reductase (DHPR) deficiency [9], as well as with Rett syndrome [10], and Aicardi-Gou res Syndrome [11]. Furthermore, folate deficiency may be associated with congenital folate malabsorption, severe malnutrition, and formiminotransferase deficiency. 

The causes of human copper deficiency include (1) low intake - malnutrition, total parenteral nutrition (TPN) (2) high loss - cystic fibrosis, nephrotic syndromes and (3) genetic factors — Menkes disease. Copper deficiency may also be associated with chronic malabsorption, a situation which is made much worse in cases of gastric and bowel resection. Several special diets, including powdered milk, liquid protein and standard hospital diets are a means of inducing copper deficiency. The amount of copper in US food has decreased steadily since 1942, and may be related to the rising incidence of coronary artery disease. A copper deficiency may also occur as the result of the use of chelators for other purposes for example, diethyl dithiocarbamate is an in vivo metabolite of ANTABUSE (disulfiram). 

Malnutrition is found in 80-100% of patients with decompensated liver disease, and in up to 40% of those with compensated disease. As the disease progresses patients become malnourished. Dry weight decreases, as they often reduce their food intake due to anorexia, malabsorption. 

Causes of malnutrition include (7.) reduced quantity and quality of nutrition, (2.) maldigestion and malabsorption, (3.) accelerated protein breakdown and protein loss as well as reduced protein synthesis (PEM), 4.) increased energy requirement, especially in the case of complications, and (5.) metabolic disturbances (e.g. insulin resistance, sympathicotonia, loss of metabolic efficiency), (s. p. 741)... 

Ihe normal functioning of the cells of the crypts and villi is disrupted in certain malabsorptive diseases such as celiac disease, which involves a Rattening of the intestinal mucosa. This flattening results from disappearance of the villi, as shown in Figure 2,50, The depth of the crypt may or may not change. (Figure 2.50 indicates a slight increase in crypt depth,) Extensive disappearance of intestinal villi leads to malabsorption and serious malnutrition. 

Fat malabsorption, particularly caused by celiac disease or chronic pancreatitis, and protein-energy malnutrition predispose to vitamin A deficiency. Liver disease diminishes RBP synthesis, and ethanol abuse leads both to hepatic injury and to a competition with retinol for alcohol dehydrogenase, which is necessary for the oxidation of retinol to retinal and retinoic acid. Vitamin A deficiency may lead to anemia, though the precise mechanism is not known. ... 

Prolonged nasogastric suction Malabsorption syndromes Extensive bowel resection Acute and chronic diarrhea Intestinal and biliary fistulas Protein-calorie malnutrition Acute hemorrhagic pancreatitis Primary hypomagnesemia (neonatal)... 

Thickened secretions from the pancreas lead to deficiencies of digestive enzymes and bicarbonate, which lead to maldigestion of foodstuffs. This maldigestion leads to malabsorption and malnutrition. 

A Dermatitis, night blindness, keratomalacia, xerophthalmia Serum vitamin A Teratogenic effects, liver toxicity with excessive intake alcohol intake, liver disease, hyperlipidemia, and severe protein malnutrition increase susceptibility to adverse effects of high intake , 6-carotene supplements recommended only for those at risk of deficiency (fat malabsorption)... 

Improved nutrition stains enhances snrvival and improves treatment tolerance in many but not all children. Mahmtrition in cancer patients due to simple starvation, characterized by normal metabolism but inadequate nutrient intake or malabsorption, appears to be responsive to nutrition intervention. However, malnutrition due to cancer cachexia, characterized by altered nutrient use despite adequate supply, does not. " ... 

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