Ch. 9. Dietary deficiency diseases

Q1. Define the following terms.

1. Scurvy: - Disease caused due to deficiency of vitamin C in an individual is called as scurvy. It is characterised by swelling and bleeding of gums, anaemia and weakness.
2. Enrichment: - Enrichment means addition of dietary essentials to a food to restore the total content of the food in natural state.
3. Trace element: - The minerals which are required by the human body are called ‘trace elements’. 14 trace elements are essential for animal life.
4. Malnutrition: - Malnutrition is defined as a pathological state resulting from a partial or entire deficiency or excess of one or more essential nutrients.
5. Imbalanced nutrition: - The pathological state resulting from a disproportion among essential nutrients with or without the absolute deficiency of any nutrient is called imbalanced nutrition.
6. PEM: - When the nutrients such as proteins, fats and carbohydrates are quantitatively and qualitatively insufficient in diet. The condition is called Protein Energy Malnutrition (PEM).
7. Balanced diet: - The diet wh9ch includes all the required nutrients in appropriate proportions is known as a balanced diet.
8. Over nutrition: - The condition resulting from the consumption of excessive quantity of food for a long period of time is called over nutrition. Over nutrition may lead to obesity, atherosclerosis and diabetes.
9. Specific deficiency: - The pathological state resulting from partial or complete lack of individual nutrients is called specific deficiency.
10. Under nutrition: - The condition resulting from eating insufficient food for a long period of time is called under nutrition. In extreme cases under nutrition is called starvation.

Q2. Give scientific reasons

1. Deficiency of vitamin K does not occur normally.

Ans.

1. Vitamin K helps in blood clothing.
2. It is synthesized by microorganisms present in the intestine of higher animals including human beings.
3. Since most of the required vitamin K is manufactured by the body itself, deficiency of vitamin K does not occur normally.

2. The races like Negroes develop rickets more likely than light skinned people.

Ans.

1. Our body is capable of vitamin D synthesis with the help of sunlight under our skin.
2. The pigment melanin present in the dark skin of negroes filter out essential rays of sunlight required in the biological synthesis of vitamin D.
3. This obstructs the synthesis of vitamin D leading to its deficiency and the disease rickets.
4. In light skinned people, as the melanin content in their skin is low, vitamin D is synthesized adequately.
5. hence, races like negroes develop rickets more likely than light skinned people.

3. In adults, osteomalacia occurs due to deficiency of calcium and phosphorus minerals.

Ans.

1. Minerals like calcium and phosphorus are essential for proper growth and development of strong bones and teeth.
2. Deficiency of both these minerals in adults results in softening of the bones.
3. This condition is called as osteomalacia.
4. Hence, in adults, osteomalacia occurs due to deficiency of calcium and phosphorus minerals.

4. Iron deficiency causes anaemia.

Ans.

1. Iron is essential for the formation of haemoglobin in the blood.
2. Haemoglobin carries oxygen to various cell in our body.
3. Due to the deficiency of iron, the haemoglobin level in the blood goes down which leads to anaemia.

5. The common salt fortified with small quantities of sodium or potassium iodate is widely used throughout India.

Ans.

1. Iodine is required for the synthesis of thyroid hormones thyroxine and triodothyronine.
2. Iodine deficiency leads to various diseases such as cretinism, neonated hypothyroidism, juvenile hypothyroidism, impaired hearing and brain development and function.
3. Fortification of common salt with small quantities of sodium or potassium iodate supplies the required quantity of iodine to the body.  
4. It is the most economical, convenient and effective means of mass prophylaxis.
5. Hence the common salt fortified with small quantities of sodium or potassium iodate is widely used throughout India to prevent iodine deficiency.

6. Kwashiorkor is characterised by swollen belly and growth failure.

Ans.

1. Kwashiorkor is caused due to deficiency of proteins in both quality and quantity.
2. Fat accumulation occurs in the liver leading to liver enlargement (hepatomegaly)
3. This results into swollen belly.
4. As proteins are responsible for growth and development in an individual, deficiency of proteins leads to retarded growth and development.
5. Hence, kwashiorkor is characterised by swollen belly and growth failure.

7. In a child suffering from marasmus sever growth retardation is seen.

Ans.

1. The disease marasmus is due to severe and prolonged restriction not only of protein but of all types of food.
2. The main clinical features of this disease are growth retardation, wasting of muscle and of subcutaneous fat.
3. Since the body is deprived of almost all nutrients required for the growth and development of the body, severe growth retardation is seen in a marasmus child.

8. Breast feeding should be promoted.

Ans.

1. Deficiency of nutrients like dietary carbohydrates, proteins and fats leads to protein energy malnutrition. (PEM)
2. Mother’s milk provides all the necessary dietary proteins along with other nutrients required for the proper growth and development of an infant.
3. This results into increase in the resistance power of the child and helps to build its immune system.
4. Hence, breast feeding should be promote to prevent PEM.

9. Pregnant and lactating women should include more proteins in their diet.

Ans.

1. Proteins are the major constituents of our cells and tissues and are responsible for the growth and development of the body.
2. Lack of proteins in the diet leads to growth failure in a developing embryo or in a newborn baby.
3. This can lead to disorders such as kwashiorkor or marasmus in children.
4. Hence, pregnant and lactating women should include more proteins in the diet to avoid protein energy malnutrition in the newborn children.

10. Deficiency of calcium and phosphorus occur rarely.

Ans.

1. Calcium and phosphorus are required for proper formation of bones and teeth in our body.
2. Deficiency of these minerals can lead to rickets in children and osteomalacia in adults.
3. But as these minerals are widely distributed in various foodstuffs, their deficiency rarely occurs.

11. Mothers should be educated about the exposure of children to the sun.

Ans.

1. Our body manufactures vitamin D under the skin on exposure to sunlight rich in uv rays.
2. Deficiency of vitamin D in children leads to rickets.
3. It is characterised by deformities in bones.
4. So mothers should be educated about the exposure of children to the sun to avoid vitamin D deficiency.

12. Supplementation of breast milk by vitamin D sources for the infants after the age of 3rd or 4th month is necessary.

Ans

1. Vitamin D is necessary for proper bone and teeth development in human beings.
2. Deficiency of vitamin D in children leads to rickets which is characterised by deformities in bones.
3. Hence, Supplementation of breast milk by vitamin D sources for the infants after the age of 3rd or 4th month is essential to avoid deficiency of vitamin D.

Q3. Distinguish between

1. Nyctalopia and Xerophthalmia

Nyctalopia	Xerophthalmia
It is characterised by poor vision in dim light. It occurs when liver stores of vitamin A are nearly exhausted. It is also known as Night blindness.	It is characterised by conjuctival xerosis, bitot’s spots, corneal xerosis, corneal ulceration with Xerosis or Keratomalacia. It occurs when there is severe deficiency of vitamin A in the body. It is also known as ‘dry eye’.

2. Kwashiorkor and Marasmus

Kwashiorkor	Marasmus
Kwashiorkor is caused due to deficiency of only proteins. It results into fatty liver (Hepatomegaly). There is mild or no muscle wasting. Appetite is usually good. Moon face is observed. Growth rate reduction.	Marasmus is caused due to deficiency of protein and all types of food. Hepatomegaly is absent. There may be severe muscle wasting. Appetite is usually poor. Moon face is absent. Growth rate reduction is severe.

3. Scurvy and Rickets

Scurvy	Rickets
Deficiency of vitamin C leads to scurvy. It leads to swelling and bleeding of gums. It shows symptoms like anaemia and weakness.	Deficiency of vitamin D leads to rickets. It leads to deformities in bones. Symptoms seen are late eruption of teeth and swollen knees, ankles, wrists etc.

4. Beri – Beri and Pellagra.

Beri – Beri	Pellagra
Deficiency of vitamin B1 (Thiamine) causes Beri – Beri. It is characterised by polyneuritis, muscular atrophy and cardiovascular changes.	Deficiency of vitamin B5 (Niacin) causes pellagra. It is characterised by diarrhoea, dermatitis and dementia.

Q4. Write short notes on

1. Kwashiorkor

Ans.

1. It is caused due to the deficiency in both, the quality and quantity of proteins.
2. It is characterised by oedema, swollen belly, growth failure, dermatosis, anaemia etc.
3. The swollen belly is due to enlargement of liver (haepatomegaly) caused by fat accumulation.
4. The condition of pre – kwashiorkor is characterised by retarded growth and development.
5. The low dietary intake of protein in kwashiorkor results in decreased synthesis of plasma, proteins, especially albumin and transferring and also of haemoglobin.
6. In kwashiorkor there occurs anorexia which further leads to restriction of food intake.

2. Marasmus.

Ans.

1. Marasmus occurs due to severe and prolonged restriction not only of protein but of all types of food.
2. It is characterised by severe wasting of tissues and muscles of a child.
3. The main features are growth retardation, wasting of muscle and subcutaneous fat.
4. The growth retardation is in terms of marasmus is also seen in children who have been deprived of touch of body weight.

3. Socio – economic factors of malnutrition.

Ans.

1. Food consumption is influenced by various social factors such as
1. laws or regulations of state,
2. disruption of national economy,
3. war and other emergencies,
4. food policy,
5. religious taboos and prescription,
6. ignorance and level of education,
7. contents and commercialisation of mass – media,
8. social structure etc.
2. Urbanisation is leading to greater dependence upon processed foodstuffs with resultant hazards from food additives and loss of nutrients.
3. A large proportion of world population obtains its food by purchase or exchange.
4. The opportunity of such purchase is limited for many individuals or groups with small incomes.
5. The protective foods such as eggs, meat, fish, milk and fruits are relatively costly so that the poor people cannot afford them.

4. Xerophthalmia OR Symptoms of Xerophthalmia

Ans.

1. The literal meaning of Xerophthalmia is dry eye.
2. An evidence of Xerophthalmia is considered when one or more of the following changes occur in eyes.
1. Conjunctival xerosis: - The conjunctiva instead of looking clear and transparent, appears muddy and wrinkled.
2. Bitot’s spots: - These are greyish, triangular, foamy, rough and raised patches on the bulbar conjuctival. They are frequently bilateral.
3. Corneal xerosis: - The corneal surface becomes dry and hazy like ground glass.
4. Corneal ulceration with xerosis: - If the ulcer progress, iris falls down.
5. Keratomalacia: - The part or entire cornea becomes soft rapidly. As a result eyeball gets destructed leading to blindness.

5. Rickets OR Symptoms of Rickets.

Ans.

1. It is characterised by deformities in bones.
2. The ends of long bones become bulky and soft. Bending of long bones takes place giving rise to deformities.
3. These deformities occur as bow – legs and knock – knees when the child attempts to stand up and walk.
4. The ankles, knees, wrists and elbows become swollen.
5. Teeth erupt late and are deformed.

6. Mineral waters

Ans.

1. Mineral waters may be natural or artificial.
2. Natural mineral water is derived from springs.
3. They contain natural ingredients aerated with carbon dioxide gas.
4. Artificial mineral water is prepared by dissolving mineral salts and sugar in water and then charging it with CO2 gas.
5. In many preparations, artificial colours and flavours are added.

7. Alcohol

Ans.

1. The term alcohol used under alcoholic beverages is ethyl – alcohol.
2. It is produced by fermentation of sugars like glucose and fructose by yeast.
3. Alcohol acts as stimulant even in small doses.
4. But the disadvantage of its use leads to habit formation which shortens the life when taken in excess.

8. Fast food

Ans.

1. The foods like pizza, vada – pav, burger, dosa, samosa, noodles, sandwitch etc. may be included under the term fast food.
2. Now – a – days the use of such fast foods is increasing in urban areas.
3. Most of the school going children use these foods instead of lunch boxes.

Q5. Give the deficiency of diseases of the following elements / vitamins.

Proteins	Deficiency of proteins causes diseases like kwashiorkor and marasmus.
Ascorbic acid	Deficiency of ascorbic acid leads to scurvy.
Vitamin D	Deficiency of vitamin D in children leads to rickets and osteomalacia in adults.
Vitamin A	Deficiency of vitamin A leads to night blindness (Nyctalopia) and Xerophthalmia (Dry eye)
Vitamin E	It is characterized by testicular degeneration, habitual abortion, muscular dystrophy, haemolysis of RBCs and laboratory animals (Dry eye)
Vitamin K	It is characterised by haemorrhage or delay in blood clotting.
Thiamine	Deficiency of vitamin Thiamine (B1) leads to disease called Beri – Beri.
Niacin	Deficiency of Niacin (B3) leads to a disease called pellagra.
Sodium	The decrease in sodium chloride level in the body causes muscular cramps. Common salt deficiency causes hyponatremia.
Copper	Deficiency of copper causes neutropenia.
Molybdenum	Deficiency of molybdenum causes mouth and oesophageal cancer.
Iodine	Deficiency of iodine leads to various disorders such as still birth, cretinism, neonated hypothyroidism, juvenile hypothyroidism, impaired hearing and brain development and functions.
Fluorine	Deficiency of fluorine leads to dental caries.
Calcium and phosphorus	Deficiency of calcium and phosphorus leads to rickets in children and osteomalacia in adults.
Magnesium	Deficiency of magnesium leads to irritability, titanus hyperreflexia and occasionally hyporeflexia.

Q6. Answer the following questions.

1. What is PEM? Give its brief treatment.

Ans.

1. When the nutrients such as proteins, fats and carbohydrates are quantitatively and qualitatively insufficient in diet, the condition is called Protein Energy Malnutrition or PEM.
2. PEM has two forms namely Kwashiorkor and Marasmus.
3. The national institute of Nutrition, Hyderabad has formulated an energy protein rich mixture to treat PEM at home level.
4. It is consists of

Whole wheat	Roasted	40 gm.
Bengal gram	Roasted	16gm.
Groundnut	Roasted	10 gm.
Jaggery		20 gm.
Total		86
Energy		330 Kcal
Proteins		11.3 gm

2. Give the deficiency of calcium and phosphorus.

Ans.

1. As both these minerals are widely distributed in food stuffs, their deficiency rarely occurs.
2. When there is defect in the absorption of calcium and phosphorus, then only the deficiency occurs.
3. Their deficiency causes rickets in children and osteomalacia in adults.

3. What is Goitre?

Ans.

1. Goitre is a disease caused in individuals due to deficiency of mineral called iodine.
2. Due to iodine deficiency in the body the thyroid gland increases in size 9enlarges) to produce goitre.

4. Give the forms of malnutrition.

Ans. Malnutrition is defined as a pathological state resulting from a partial or entire deficiency or excess of one or more essential nutrients. The four forms of malnutrition are as follows.

1. Under nutrition: - This is the condition resulting from eating insufficient food for a long period of time.
2. Over nutrition: - This condition results from the consumption of excessive quantity of food for a long period of time.
3. Imbalance: - It is the pathological state resulting from a disproportion among essential nutrients with or without the absolute deficiency of any nutrient.
4. Specific deficiency: - It is the pathological state resulting from partial or complete lack of an individual nutrient.

5. List the cultural factors of malnutrition.

Ans. Cultural factors of malnutrition are

1. Foods habits, customs, beliefs and traditions.
2. Food fads.
3. Cooking practices
4. Child rearing practices and
5. Miscellaneous e.g. chronic alcoholism.

6. Give the names of nutritional programmes initiated by Government of India.

Ans. The government of India have initiated several programmes in nutrition on a national scale to control and prevent major nutritional problems.

They are

1. Supplementary feeding programmes.
2. Mid – day meal programme.
3. Vitamin – A prophylaxis programme.
4. National Goitre control programme.
5. Anaemia control programme.

7. Give the causes, signs and symptoms and treatment of iron deficiency.

Ans. Causes of iron deficiency.

1. Inadequate iron intake.
2. Poor absorption of dietary iron due to presence of excess phytates, phosphates and exudates.
3. Decreased absorption due to hypoacidity in the stomach.
4. Increased requirements e.g. pregnancy, childhood, adolescence.
5. Poor absorption due to defect in intestinal mucose i.e. malabsorption syndrome.

Signs and Symptoms.

Women:

The clinical features of anaemia are due to diminished supplies of iron to tissues. It results in low haemoglobin content of blood. The principal clinical features are general fatigue, breathlessness on exertion, giddiness and pallor of the skin. In severe cases, oedema of the ankles may be present.

Weaned infants and young children: -

The haemoglobin content is low (5 – 8 %). The children are weak, inactive and show pallor of the skin.

Treatment:

Ferron sulphate tablets should be given twice daily.