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

 .....+ 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