Micronutrients Deficiency

1. Micronutrients Deficiency Dr. ShreedharPaudel 6th April, 2009

2. Vitamin A • Deficiency:- – blindness -- ↑ childhood and maternal mortality • Sources:- --cod liver oil --shark liver oil --liver --butter, ghee --egg, yolk --carrots, green leafy veg, yellow red veg and fruits

3. Vitamin A • Fat soluble vitamin • Cooking, especially frying in oil improves the absorption of carotenes • Stored in liver • Zinc is required to mobilise from liver

4. Vitamin A • Functions:- --essential for normal maintenance and function of body tissues for -vision -cellular integrity -immune competence -growth --anti-infective vitamin --anti-oxidant property—reduces incidences of cancer

5. C/F of Vitamin A deficiency • Subclinical deficiency:- increased severity of infections • Early features:- defective dark adaptation → night blindness • Xerophthalmia:- on prolonged deficiency presents with a syndrome of xerophthalmia

6. C/F of Vitamin A deficiency

7. C/F of Vitamin A deficiency

8. C/F of Vitamin A deficiency • Skin– scaly and toad like ( phrynoderma) • More prone to respiratory infections • Alteration in mucosa of renal pelvis and urinary bladder predispose to formation of renal and vesical calculi

9. Treatment of Vit A deficiency • Immediately on diagnosis– oral vit A --50,000 International units→ < 6 mo of age --1 lakh → 6-12 months of age --2 lakh → more than 1 yr -same dose repeated next day and 4 weeks later

10. Treatment of Vit A deficiency…. • Local treatment:- -antibiotics drops or ointment—3 times a day to prevent secondary infection in corneal ulcer -padding eye—prevents dehydration, enhances healing, reduces pain and photophobia

11. Prevention of Vit A deficiency • Infants who are not breastfed– 50,000 IU supplement of vit A by two months of age • Every infant– one dose of 1 lakh units of vit A along with measles vaccine at 9 months • Encourage consumption of vit A rich food ( locally available and cheap too—green leafy veg, yellow and orange veg and fruits)

12. Vitamin D • Sources:- -fish, liver, oils, yolk of eggs, butter • Fat soluble vitamin • Function:- -absorption of calcium from gut -absorption or deposition of calcium from or to the bone depending on level of calcium in blood

13. Vitamin D deficiency • Rickets:- -craniotabes — ping pong ball like skull bones -large anterior fontanelle -bossing of frontal bones -rachitic rosary—prominent costochondral junction -pigeon breast—sternum projecting forward

14. Vitamin D deficiency • Rickets:- -Harrison’s groove—horizontal depression on lower border of chest (corresponding to insertion of diaphragm) -delayed eruption of primary teeth -deformation of long bones when child start bearing body wt -protuberant abdomen—pot belly

15. Vit D deficiency

16. Vitamin D deficiency…. • Rickets diagnosis:- -clinical manifestations -x-ray changes in lower ends of radius and ulna → cup shaped depression -larger gap between epiphyses and metaphyses

17. Vitamin D deficiency…. • Management of rickets:- -supplementation of vit D (oral or IM) -deformities of bone → orthopedic measures • If vit D deficiency is present along with PEM:- once the child starts gaining weight, vitamin D will be required to support growth (400 IU/day)

18. Iron deficiency • Iron deficiency anaemia is responsible for a fifth of early neonatal mortality • Also affects growth and development • Limits the learning capacity • Reduces cognitive development • Reduces work capacity of the affected

19. Iron deficiency • Maternal anemia is associated with intrauterine growth retardation, premature delivery, increased fetal loss • Prevented by antenatal supplementation of iron capsules • Iron rich diet—child, mother • If deficiency is present along with PEM iron in the form of ferrous sulphate can be given but only after 7 days of admission when the child is on the way to recovery

20. Iodine Deficiency Disorders • Iodine deficiency in pregnancy → cretinism and possible fetal wastage • Wide spectrum of effects on growth and development --endemic goitre --endemic cretinism --impaired mental function --increased stillbirths and perinatal and infant mortality

21. Iodine deficiency disorders • Seafoods and vegetables grown on iodine rich soil are good sources • Goitrogens– maize, bamboo shoots, sweet potatoes, cauliflower, cabbage

22. Iodine deficiency disorders • Clinical features:- --abortion and still birth --congenital anomalies --neurological and myxedematous cretinism --psychomotor defects in newborn --juvenile hypothyroidism --impaired mental function --retardation of physical and sexual growth

23. Iodine deficiency disorders • Clinical features:- --Neurological cretinism → deaf-mutism, rigid extremities, gait disturbances --Myxedematous cretinism → retarded psychomotor development, short stature, coarse facial features but without deaf mutism

24. Iodine deficiency disorders • Management:- --prevention- iodinated salt, iodized oil --treatment with iodine or thyroxine— eliminate signs of hypothyroidism but neuromotor and intellectual deficiency are irreversible --so prevention is the best management

25. ZINC • Zinc is present in all organs, tissues, fluids and secretions of body • Necessary for RNA, DNA and ribosome stabilization • Critical for functioning of biomembranes • Supplementation results in improved growth in children, lower rates of diarrhoea, malaria and pneumonia

26. Zinc • Sources:-red meat, pork, cheese, whole wheat, nuts, legumes • Deficiency states:- • Growth retardation • Hypogonadism • Anorexia • Alopecia • Acral dermatitis • Enteropathica • Behavioural changes • Increased susceptibility to infections

27. Zinc • Deficiency states in pregnant women:- --premature delivery --intrauterine growth retardation --neural tube defects • Management:- Zinc fortification of diets