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MALNUTRITION

protein nutrients, with the individual being very thin from the loss of muscle and body fat. The wet form, kwashiorkor, is caused primarily by protein deficiency, with energy deficiency being secondary, and is accompa- nied by edema. The combined form, marasmic kwash- iorkor, results from protein and energy deficiency with edema and more body fat than is seen in marasmus.

There are also water-soluble vitamins in addition to the fat-soluble vitamins. Because water-soluble vitamins are not stored in any appreciable amounts in the body, but are excreted readily in urine, it is relatively easy to become depleted of them. Fat-soluble, in contrast, are stored in adipose tissue and the liver, and consequently it is more difficult to become deficient of them. The water- soluble vitamins are the B vitamins and vitamin C. The B vitamins are thiamin, riboflavin, niacin, pantothenic acid, biotin, pyridoxine, folate, and vitamin B12

. All of the

deficiency); and poor wound healing, bleeding gums (vitamin C deficiency).

Minerals are important nutrients that must be ob- tained from foods consumed, as the human body is un- able to synthesize them. Some factors that influence mineral bioavailability (the extent to which minerals in food consumed is available for the body to put to use) are the amount of mineral content in the soil in which the food providing the mineral was grown; dietary fiber con- sumed in the same meal as a food containing the miner- als; mineral-mineral interactions; and vitamin-mineral interactions. Sodium, potassium, chloride, calcium, phos- phorus, magnesium, and sulfur are the major minerals. Deficiencies of these minerals lead to such symptoms as muscle cramps (sodium), irregular heartbeat (potassium), convulsions in infants (chloride), an increased risk for os- teoporosis (calcium), diminished bone support (phospho- rus), and poor heart function (magnesium). There are also so-called trace minerals that are only required in very small amounts to contribute to optimal health. These trace minerals are iron, zinc, selenium, iodide, copper, fluoride, chromium, manganese, and molybdenum. When inadequate amounts of foods containing the trace miner- als are consumed, symptoms begin to appear. These symptoms include low blood iron (iron), skin rash/poor

ENCYCLOPEDIA OF FOOD AND CULTURE

water-soluble vitamins except vitamin C have coenzyme functions and are involved in a variety of reactions in- cluding energy metabolism, DNA synthesis, nerve func- tion, protein and carbohydrate metabolism, and fat synthesis. Vitamin C is involved in protecting the body from oxidative damage caused by substances called free radicals. It also functions in connective tissue synthesis, hormone synthesis, and neurotransmitter synthesis. Phys- iological consequences of deficiency include inflammation of the mouth and tongue (riboflavin deficiency); diarrhea, dermatitis (niacin deficiency); edema, weakness (thiamin deficiency); tongue soreness, anemia (biotin deficiency); fatigue, tingling in hands (pantothenic acid deficiency); poor growth, inflammation of the tongue (folate defi- ciency); poor nerve function, macrocytic anemia (vitamin

B12

growth and development (zinc), muscle weakness (sele- nium), goiter (iodide), anemia/poor growth (copper), in- creased risk for dental cavities (fluoride), and high blood glucose after eating (chromium).

Developed countries typically have water supplies that are monitored for safety by government agencies and are provided in large enough quantities that a lack of drinking water is not the norm. Developing countries, however, may not have water that is free from contami- nation, or because of drought or other natural disasters do not have a large enough water supply for human con- sumption or to provide water for livestock or crops. Wa- ter is vital for life and, without it, an adult can survive only a few days because the human body does not have the ability to store water. Water is found inside of cells as intracellular fluid and outside of cells as extracellular fluid. A proper balance between intracellular and extracellular water is necessary to prevent complications such as edema. Water also is responsible for regulating body temperature, most notably through the cooling-off process accom- plished by perspiration. Water is necessary to provide lu- brication for joints such as the knees. Without adequate water in the form of amniotic fluid in the womb of a preg- nant woman, the growing fetus does not have sufficient support to prevent injury should the mother fall or be oth- erwise jarred abruptly. Water is also the primary avenue utilized by the body to rid itself of waste products. While water does not supply energy as carbohydrates, protein, and fats are able to do, it is still a very important nutrient necessary to prevent malnutrition.

Overnutrition

Overnutrition results when energy expenditure is grossly exceeded by energy intake and leads to overweight and obesity. Developed countries, with their abundant food supplies and processed foods, are most afflicted with overnutrition and the medical complications associated with it. Due to the excessive intake of food products, the amount of fat-soluble vitamins and minerals in the body can rise to toxic levels because they are stored in the body. Developed countries have greater incidences of cardio- vascular disease, blood lipids, diabetes mellitus, hyper- tension, respiratory problems, gallbladder disease, arthritis, and cancer, all of which are connected to com- plications stemming directly from overnutrition.

Methods of Evaluating Malnutrition

Malnutrition is diagnosed based on the findings of a med- ical and diet history, physical examination, and labora- tory tests. The results are then compared with norms of weight for height, body mass index (body weight in kilo- grams divided by height in meters squared), dietary in- take, physical findings, and plasma levels of nutrients and nutrient-dependent substances such as hemoglobin. The physical examination would necessarily include anthro- pometric measurements, as well as close examination of the skin, hair, and mouth for symptoms of malnutrition.

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