Skeletal Fluorosis)

UNIT 19 OTHER NUTRFIIONAL PROBLEMS Structure 19.1 Introduction 19.2 B-Complex Deficiencies (Nature, clinical features, causes, treatment and prevention) 19.2.1 Ariboflavinosis (Riboflavin deficiency) 19.2.2 Pellagra (Niacin deficiency) 19.2.3 Beriberi (Thiamine ddiciency) 19.3 Vitamin D deficiency-Rickets and Osteomalacia (Nature, clinical features, causes, treatment and prevention) 19.4 Vitamin C deficiency-Scurvy (Nature, clinical.features, causes, treatment and prevention) 19.5 Fluorosis 19.6 Lathyrism 19.7 Let Us Sum Up 19.8 Glossary 19.9 Answers to Check Your Progress Exercises 19.1 INTRODUCTION Units 17 and 18 of this block discussed sofi,e of the most important deficiency diseases which are not only widely prevalent but, more importantly, lead to complications and death as well. There are also other deficiencies which may occur in a large number of people. Some may cause irreversible changes in the body while others may not cause irreversible complications. Yet, these can interfere with the normal functions of the body. Some vitamin deficiencies are important examples. In this unit, we will discuss vitamin deficiencies like ariboflavinosis, beriberi, scurvy. You will also learn about fluorosis and lathyrism. The latter two diseases are not deficiency diseases. Lathyrism is caused by a toxin present in a foodstuff. On the other hand, fluorosis occurs because of excessive consumption of fluoride in water and foods. Objectives After studying this unit, you will be able to : describe vitamin deficiencies like ariboflavinosis, beriberi, scurvy, rickets and pellagra discuss the major features of fluorosis and lathyrism caused by consumption of excessive amounts of a nutrient (fluoride) or a toxin and enumerate the measures taken to treat and prevent, these disorders. 19.2 B-COMPLEX DEFICIENCIES You have learnt that vitamins like thiamine, riboflavin, niacin, folic acid and B12 are the vitamins of the Bcomplex group. In this section, you will learn about what happens when there is a deficiency of these vitamins in the body. Let us begin with ariboflavinosis or riboflavin deficiency. 19.2.1 Ariboflavinosis (Riboflavin deficiency) This is a nutritional deficiency occuring due to reduced intakes of riboflavin through 30 the diet. Riboflavin deficiency is one of the most common amdng the Ecomplex deficiencies. How can we make out that a person is suffering from this Other Nutritional Disorders deficiency? As in the case of other deficiency diseases you have studied about, this disease is also associated with certain obvious clinical features. Clinical Features : The major clinical features of ariboflavinosis include: a) Angular Stomatitis : One of the clinical signs of ariboflavinosis is ,angular stomatitis. The subjects develop cracks on both the sides (angles of upper and lower lips) of the mouth (Fig 19.1). This is a very common sign noticed among children, and as high as 30-35% of the children exhibit angular stomatitis. There is usually not much of discomfort and because of this, children and adults ignore it. Fig. 19.1 Angular Stomatitis (Photo Courtesy : National Institute of Nutrltlon, Hyderabad) b) Glossitis :This is particularly common among women, especially during pregnancy. The tongue becomes raw and red. There will be a burning sensation whenever foods which are hot and rich in spices are consumed. The tip of the tongue is affected first. In severe deficiency, the tongue may develop cracks as well. c) Cheilosis :The lips develop cracks and become red. The subjects may also lose appetite. Causes : Ariboflavinosis is due to dietary inadequacy of riboflavin. You already know that green leafy vegetables, milk, organ meats are good sources of riboflavin. Whole grain cereals, and pulses, nuts provide riboflavin in moderate amounts. As we have already discussed, in the families of poor rural communities, diets contain negligible amounts of pulses and milk. Meat is consumed, but very rarely. As a result, riboflavin deficiency is very common in our country. In fact, the requirements of riboflavin are directly associated with the amount of food energy consumed. Higher the amount of food energy consumed, higher will be the requirements of riboflavin. Turn back to dnit 6 of Block 2 for more information. You have learnt that Indian diets are mainly cereal-based. Cereals are not good sources of riboflavin. Therefore, our diets tend to be deficient in riboflavin. Treatment : Patients suffering from ariboflavinosis should be given one tablet of B-complex daily for about one week to ten days. Prevention : Milk is a good source of riboflavin. However, poorer communities cannot afford milk in view of its high cost. We have to make sure that the communities include foods rich in riboflavin like green leafy vegetables, whole cereals and pulses and cheaper nuts in their every day diet to prevent ariboflavinosis. 3 1 Nutrition-Related Disorders Check Your Progress Exercise 1 1) List the clinical features of ariboflavinosis. 2) What dietary advice would you give to prevent ariboflavinosis? Answer in three sentences. ....................................................................... 3) Fill in the blanks : a) Milk is a ........................... source of riboflavin. b) Higher the consumption of energy in food,. .........................will be the iequirement of riboflavin. c) The changes noticed in the tongue due to ariboflavinosis are'referred to as1 ......................... 19.2.2 Pellagra (Niacin deficiency) This is a nutritional disorder due to the deficiency of niacin, one of the B-complex group of vitamins in the diet. Though it is not as common a ariboflavinosis, pellagra is more frequently seen in the Telengana region of Andhra Pradesh and adjoining parts of Maharashtra and Karnataka. Clinical features : Pellagra is characterized by typical skin changes (dermatosis), diarrhoea .and mental changes. Dennatosis means changes in the skin. The patients suffering from pellagra exhibit typical skin changes. These changes are symmetrical and are evident only on the parts of the body exposed to the sun like forearms and legs, face and the exposed parts of the neck. The skin becomes dry and scaly (Fie;. 19.2). Fig. 19.2 Pellagra (Photo courtesy : National Institute of Nutrition, Hyderbad) Diarrhoea i.e. loose motions is also present. In some cases, of course, this may be absent. Patients of pellagra have slight mental changes. These include irritability, forgetfulness and loss of orientation. We are using the word 'orientation' to mean the sense of being able to relate to time, place and events. There may be headache and sleeplessness, tremors of hands and legs and mental depression. Mental changes may be very noticeable when the patient suffers from severe niacin deficiency. It is- Nutritional Disorders estimated that a number of patients with pellagra go to mental hospitals for treatment because of these mental changes. Usually glossitis is also seen in individuals with pellagra. Causes : Pellagra has been known to he common in countries where maize is a staple such as Mexico. The niacin in maize is in a bound form and is not available to the body. Hence, people who consume maize as the staple cereal have greater chances of developing pellagra. In India, however, the disease is common in areas where jowar is the staple cereal like in the Telengana region of Andhra Pradesh and the adjoining Maharashtra and Karnataka. This is because of the presence of excessive amounts of the amino acid leucine in jowar leadittg to an imbulance between leucine and isoleucine. You may wonder as to what is imbalance between amino acids. The human body, for normal functioning, has to maintain a balance between various amino acids. When this balance is affected and one amino acid is more than the other it is known as imbalance. You have already learnt that the body needs eight essential amino acids, leucine and isoleucine being two of these. Please refer to Unit 3 of Block 1. Treatment : Nicotinamide is the drug of choice. It is a compound of which niacin is a part. Niacin as such is not given bebause when taken in large,doses, it produces some unpleasant effects like the face and body becoming hot and red, nausea and vomiting. Nicotinamide brings dramaticerelief to patients suffering from pellagra. Generally, a dose of 300 mg peryday is given. Along with it, B-complex tablets are Prevention : You know that pellagra is a preventable disease. The important aspect of prevention is encouraging communities to consume mixed cereal diets so that adequate niacin is available in the diet. The communities should be educated to consume diets based not only on jowar but also rice or wheat. In addition, inclusion of pulses, even in small amounts, is useful in the prevention of pellagra. Nuts, oilseeds and organ meats are also good sources. YOUlearnt in Unit 4, Block 2 that milk contains high amounts of tryptophan which the body converts into niacin. 19.2.3 Beriberi (Thiamine deficiency) Beriberi is a nutritional deficiency disease caused by the deficiency of the vitamin thiamine in the diet. Thqdisease is rare in our country. Please refer to Unit 4 of Block 2 for more information on thiamine. Clinical features : Beriberi is a disease of slow origin. Generally, the individual to . start with, experiences loss of appetite, weakness and heaviness in the legs. The person also becomes tired easily. The patient complains of the feeling of pins and needles and numbness in the legs. There may be loss of sensation i.e. loss of the feeling of touch over the legs. The disease occurs in two forms. It manifests itself either as wet beriberi or dry beriberi. Wet beriberi is characterized by accumulation of fluid in the body. This can ultimately lead to heart failure. The patient may complain of'palpitation (forcible and rapid hem beats felt by the patient) and sometimes of chest pain. There may also be pain in the leg muscles on application of pressure. In the case of dry beriberi, the patient will feel a weakness in the legs progressively making the patient completely bedridden.

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