 Welcome back to today's class and we have seen all the nutrients, their functions, their sources, what are the symptoms of deficiency, what are the symptoms when we take in excess and let us just very quickly brush up what are the various nutritional disorders that are caused by the excess or deficient intake of all these nutrients. So protein energy malnutrition is a very important disorder, then vitamin A deficiency, iron deficiency, P complex deficiency and iodine deficiency, these are the important main nutritional disorders that occur because of excess or deficient intake of various nutrients. Tell me the protein energy malnutrition, so this is a deficiency of protein and calories in the diet, so it refers to the form of malnutrition. The types of protein energy malnutrition are one is the when there is only protein deficiency, the deficiency is called as quashyorker and merasmus is when there is deficiency in the calorie intake. So there may be merasmus alone or quashyorker alone and sometimes there is merasmic quashyorker. So this occurs when there is protein deficiency and also calorie deficiency present in the individual. Now merasmus is a form of severe malnutrition, it is characterized by a severe energy deficiency. So the child who is a merasmic looks very emaciated, so body weight is reduced less than 60% of the normal or standard body weight expected for that age and merasmus occurs increasing to the prior to age 1. See this happens when the second child is born and the mother puts off the first baby from the breast and it has to be weaned early, then under such conditions the child becomes merasmic. So this is how the merasmic child looks and you can see the clinical manifestation there is lot of wasting, there is no muscle at all and growth retardation is there because the weight reduces by 60% of the normal weight and there are mental changes, there is no edema at all and the temperature is sub normal because there is no subcutaneous fat and muscle in the body and there is no appetite and often there is diarrhea present in the child. And quashyakur it occurs after 18 months of age. So the merasmus can be when the child is put on to the adult diet, the child is not able to feed it itself properly therefore under such conditions protein deficiency also occurs and the child comes to quashyakur stage. So this is how the quashyakur child looks like, it is looking like a normal child, isn't it? So very difficult to assess how whether the child is having a quashyakur or a normal child, there is no change in the body weight. So we have to go only by the diagnostic test. So there is edema, muscle wasting, muscle wasting is covered by edema so that does not look as the child is muscle wasting and psychomotor changes and you have common signs like hair changes, hair becomes brown in color, there is diffuse de pigmentation of the skin, the face looks like a moon face because of edema it becomes very round. You may think the child is chubby but it is a deficient child then there is anemia. So this is got only by testing the blood of the child. See the difference between the quashyakur and the merasmic child, the quashyakur child has swelling of legs, then sparse hair, the hair is lost, moon face with little interest in surroundings. He is not at all interested in surroundings, he keeps on crying. Then flaky appearance of the skin because the skin becomes dry and flaky and swollen abdomen and the muscles are thin but fat is present whereas in the merasmic child the hair is normal. You can see the hair is normal but the child looks like a pocket sized old man and the limbs become very thin without any muscle or fat and the body weight is only less than 60 percent of standard weight. Next vitamin A deficiency also commonly occurs in children who are not fed properly. So this is lack of vitamin A in body. In generally it is very common in poor countries and rarely seen in developed countries. So the first symptom of vitamin A deficiency is nictolopia or night blindness and this is the first sign that is the child will not be able to see in dark. Generally when we get into a dark place within seconds we get adapted to the darkness and we are able to see some objects very slightly but a child who is deficient in vitamin A will not be able to adapt to the darkness and cannot see in night. Then xerophthalmia that is the cornea and the retina are involved. So congenitiva and cornea both are involved and there is ulceration finally there is complete blindness the eye just melts down. So this can occur in the children below 6 years that is why the government has given a prophylaxis program of giving 2 lakh international units of vitamin A every 6 months to a child below 6 years. So this is how the eye looks like it just melts down the cornea the congenitiva everything is involved and the child becomes cyclist. Now next the iron deficiency iron deficiency causes anemia in any age. So this comes quickly after the great symptoms like confusion then feeling that one is going to pass out that means you feel so much of palpitation is there so much of confusion is there there is increased thirst and there is need for to be significant anemia before a person becomes notably plain that is the paleness is seen only after the anemic condition goes very severe. Till then these clinical symptoms are not seen so there may be additional symptoms depending upon the cause that is behind causing anemia. So the anemic person becomes easily fatigued and there is loss of energy and there is rapid heartbeat that is palpitations occur in the heart and particularly with exercise the individual cannot do exercise for a longer period there is shortness of breath because the oxygen carrying capacity of the blood decreases then there is headache and particularly with exercise the headache increases then the person is not able to concentrate because the level of hemoglobin is less oxygen consumption is less the energy input is less and it causes dizziness the skin becomes pale the eyelids become pale there are cramps in the leg and there is sleeplessness that is insomnia so this is how the eyelids look pale and the tongue looks pale and you can see the fingers and if the anemia becomes very severe then your nails become like spoon shaped which is coiled as coilo nicchia. Then deficiency of B complex vitamins so vitamin B1 you have already seen that deficiency of thymine causes berry-berry and if it affects both the heart and the nervous system and there is irregular heartbeat and edema and riboflavin deficiency generally it causes a riboflavinosis which causes chelosis, angular chelitis and glossitis that is the tongue gets cracked it starts bleeding there are cracks on the lips and the angles of the mouth also get cracked which is called as angular stomatitis. Then niacin deficiency we have already seen that it is caused because of deficiency of tryptophan and it is called as pellagra there is it is a disease of 3Ds that is dermatitis, dementia and diarrhea and this again causes insomnia sleeplessness and weakness and there is mental confusion this is dementia. And if this is neglected over a long period it may lead to death, pantothenic acid deficiency causes acne and parasthesia so that is tingling sensation in the periphery of the body and vitamin B6 that is pyridoxin it causes dermatitis especially in the wherever the sebaceous glands are present it causes seborrheic dermatitis. Then biotin deficiency it causes symptoms like impaired growth and neurological disorders and vitamin B9 or folic acid we were talking about it that it does not help the RBCs to mature properly so that they decrease in size at the megaloblastic stage it is stopped therefore it leads to macrositic anemia and it also elevates the homocysteine levels which affects the heart and when it is deficient in pregnant women it can lead to birth defects like neural tube defects which is called as spina bifida. Then vitamin B12 deficiency this again like folic acid results in the megaloblastic anemia or macrositic anemia so vitamin B12 and folic acid both are involved in maturation of RBCs. So this anemia is called as pernicious anemia again there are elevated levels of homocysteine and causes peripheral neuropathy and the deficiency occurs because of the lack of intrinsic factor in this stomach so deficiency occurs only because of lack of absorption and there is synthesis of vitamin B12 in the large intestine which is of no use. Now iodine deficiency it is lack of the iodine that is taken in the food it leads to goiter and creatinism and in children it leads to developmental delays and other health problems so this again iodine also is has become a public health problem because more and more population are getting into the iodine deficiency therefore the government has started it has banned the normal salt and it is forced to implement the intake of iodized salt in the population. So we have seen the pictures of goiter and creatinism in children in short about all the nutrient disorders that occur which are more common and which have a great impact on the health of the children and adults. Thank you.