A nutritional history is directed toward identifying underlying mechanisms that put patients at risk for nutritional depletion or excess. These mechanisms include inadequate intake, impaired absorption, decreased utilization, increased losses, and increased requirements of nutrients.
Individuals with the characteristics listed in Table 72-3 are at particular risk for nutritional deficiencies.
Nutrition is one of those subjects which comes up every day in general practice—or should do—yet in most undergraduate medical
schools it is crowded out by the big clinical specialities and high technology procedures. It is for subjects like nutrition that the British
Medical Journal’s ABC series is extremely useful.
This book was started when Dr Stephen Lock, previous editor of the BMJ asked me to write a series of weekly articles for an
imagined general practitioner, in an unfashionable provincial town who had been taught almost no nutrition at medical school.
The vitamins are a chemically disparate group of compounds whose only common
feature is that they are dietary essentials that are required in small amounts for the
normal functioning of the body and maintenance of metabolic integrity.Metabolically,
they have diverse functions, such as coenzymes, hormones, antioxidants,
mediators of cell signaling, and regulators of cell and tissue growth and differentiation.
Early interest in selenium by nutritionists concerned its high concentration in
certain range plants and the consequent toxicosis in animals that grazed those plants.
More recently, the essential nature of selenium has become the center of attention, and
this element is now known to be required by laboratory animals, food animals (including
fish), and humans. Its role as an integral feature of glutathione peroxidase has been
established, and other possible functions are under active investigation.
The end stage of cachexia, marasmus is a state in which virtually all available body fat stores have been exhausted due to starvation. Conditions that produce marasmus in developed countries tend to be chronic and indolent, such as cancer, chronic pulmonary disease, and anorexia nervosa.
Marasmus is easy to detect because of the patient's starved appearance. The diagnosis is based on severe fat and muscle wastage resulting from prolonged calorie deficiency.
As a research scientist in the area of human nutrition, I have observed a sea change in
emphasis within my field over the past 10–15 years. There have always been dynamics
within the subject: During the first half of the twentieth century, scientists grappled with
discovering the essential micronutrients and with characterizing the biological effects of
their deficiency. This interest in “too little” was supplanted in the mid-1980s by a preoccupation
with too much—too much fat, too much sugar, and too much obesity.
Citrus nutrition - Macroelements present of nitrogen deficiency in leafs of grapefruit; high potassium application causes; potassium deficiency symptoms; potassium increases fruit size of Valencia; magnesium deficiency in 'Shmouti' orange.
Estimated Average Requirement When florid manifestations of the classic dietary deficiency diseases such as rickets, scurvy, xerophthalmia, and protein-calorie malnutrition were common, nutrient adequacy was inferred from the absence of their clinical signs. Later, it was determined that biochemical and other changes were evident long before the clinical deficiency became apparent. Consequently, criteria of nutrient adequacy are now based on biologic markers when they are available.
Table 73-8 Selected Metabolic Disturbances and Their Correction
Corrective Action with PN
water or decreased total body water sodium sodium
Occurs commonly with
or water to produce net
hypertonic fluid followed by positive fluid balance diuretic administration with maintaining sodium
free water clearance; can also and chloride balance occur with dehydration and normal total body sodium
Inadequate relative to need
For half a billion women in developing
regions worldwide, anemia is a life-long burden,
one which affects most of their infants
and young children as well. Controlling anemia
in these vulnerable groups could significantly
reduce maternal and infant morbidity.
It would also enhance intellectual and work
capacity, thereby improving family, community
and national socioeconomic development.
In May 2002, the General Assembly of
the United Nations reemphasized that control
of nutritional anemia should be one of the
global Development Goals to be achieved in
the early years of this new millennium.
Nutritional Iron Balance The balance of iron in humans is tightly controlled and designed to conserve iron for reutilization. There is no regulated excretory pathway for iron, and the only mechanisms by which iron is lost from the body are blood loss (via gastrointestinal bleeding, menses, or other forms of bleeding) and the loss of epithelial cells from the skin, gut, and genitourinary tract.
Normally, the only route by which iron comes into the body is via absorption from food or from medicinal iron taken orally.
Chlorine is classified as a micronutrient, but it is often taken up by plants at levels comparable to a
macronutrient. Supplies of chlorine in nature are often plentiful, and obvious symptoms of
deficiency are seldom observed.
It has been recognized for many years that states of nutrient deficiency are associated
with an impaired immune response and with increased susceptibility to infectious
disease. In turn, infection can affect the status of several nutrients, thus setting
up a vicious circle of under nutrition, compromised immune function and infection.
Nickel (Ni), the most recently discovered essential element (1), is unique among plant nutrients in
that its metabolic function was determined well before it was determined that its deficiency could
disrupt plant growth.
This book is for anyone who wants an understanding of the fascinating role vitamins
and minerals play in nutrition. It can be used as a supplementary textbook for
nutrition classes, as a self-learning guide, and as a refresher for health professionals.
This book broadens and explains the vitamin and mineral information found in
standard nutrition courses.
Throughout the text are many figures, graphs, and tables that visually display
information and relationships. If you have not taken a class in biochemistry, then
this will be an interesting and relevant way to be introduced to it....
Nutritional deficiencies during pregnancy usually lead to intrauterine growth retardation,
which is one of the main causes of foetal and infant undernutrition in developing countries.
Every year, 30 million newborns, or 23% of 126 million births per year, are affected by
intrauterine growth retardation; by contrast, in developed countries the rate is only about 2%
(World Health Organization 2000a).
In 2000, the WHO Regional Committee for Europe requested the Regional Director,
in resolution EUR/RC50/R8, to take action to help fulfil WHO’s role in
implementing its first food and nutrition action plan for the WHO European
Region. This included presenting Member States with a review of the scientific
evidence needed to develop integrated and comprehensive national food and nutrition
There is no doubt that the protection of women during pregnancy and lactation must be one
of the major priorities of health systems and social policies. The effect of women’s nutritional
status on pregnancy outcomes is particularly strong, and adequate maternal nutrition is
closely related to the survival and well-being of babies and children. However, not all women
are mothers, and their nutritional and health needs go far beyond motherhood and
Women of all ages in developing countries face elevated risks of nutritional deficiencies.
Research has suggested a link between nutritional deficiencies in early (including prenatal)
life, and the development of chronic diseases—cardiovascular disease, diabetes mellitus,
hypertension, stroke, cancer, and osteoporosis, among others—some decades later (World
Health Organization 2000a, 2000b; Jacoby 2004). A possible link between early nutritional
deficiencies and obesity has also been suggested, and it remains an area of ongoing research
(Pan American Health Organization 2003).
From John Glenn s mission to orbit Earth to the
International Space Station program, space food
research has met the challenge of providing food
that tastes good and travels well in space. To better understand
this process, we can look back through history.
Explorers have always had to face the problem of how to
carry enough food for their journeys. Whether those
explorers are onboard a sailing ship or on the Space
Shuttle, adequate storage space has been a problem.