Nutritional and metabolic disorders
Introduction
Introduction to nutritional metabolic disorders The exogenous substances required by the organism to maintain normal life activities and ensure growth and reproduction are called nutrients, and are composed of six categories: water, minerals, carbohydrates (sugar), fat, protein and vitamins. Among them, water and mineral salts are inorganic substances, fats, proteins and vitamins are organic substances. In addition to the large amount of macro elements, mineral salts are rare in part, but they are also involved in many life activities of the body. These nutrient elements enter the body through the act of eating. The normal eating behavior is controlled by many life activities such as neurological and endocrine behaviors, and the hypothalamus plays an important role. But in fact, in human society, eating behavior is also limited by culture, family, personal experience, personal economic conditions, market supply, etc., and the content of eating is absorbed by the gastrointestinal tract. Most of the larger nutrients are converted into soluble macronutrient nutrients in the digestive tract, and then absorbed by the intestinal epithelial cells. Many nutrient elements need to be combined with transporters when they are absorbed, while the latter Often the concentration of the substance in the receptor and the effects of related hormones involved in the metabolism of the substance. The nutrients that are absorbed can be sent to various organ tissues for utilization. In addition, many nutrients can be stored in the body, especially in energy materials, which can be released to the circulation for use when the body needs it. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: periodontal disease nodular goiter
Cause
The cause of nutritional disorders
Congenital defects (30%):
Vitamin-dependent genetic diseases are diseases caused by the lack of specific biochemical reactions catalyzed by certain vitamins. Only the specific vitamins can be corrected to correct the absorption of congenital vitamin B12, for example, because the vitamin B12 is absorbed and the globulin is lacking. Intramuscular injection of vitamin B12 twice a week to maintain normal blood
Acquired factors (25%):
(1) Physiological factors: The growth of various nutrients in the human body during pregnancy and lactation is significantly increased. In the first 4 months of pregnancy, the basal metabolism is not much different from that of normal people. Gradually increase the amount of heat energy is gradually increased to meet the needs of fetal development. The demand for protein calcium, phosphorus, iron and various vitamins is also increased accordingly. For example, the fetal iron storage in the second month of pregnancy is increased from 80mg to 400mg. The need for iron within 5 to 6 months is therefore necessary to supply more iron to pregnant women during the second trimester. If the supply of various nutrients during pregnancy is insufficient, it will affect the health of the pregnant woman and the development of the fetus.
(2) Diseases: The following diseases will significantly increase the body's need for various nutrients: a barrier to nutrient absorption caused by an inflammatory diarrhea syndrome. 2 sputum erythrocyte hemolytic anemia. 3 chronic wasting diseases such as tuberculosis with fever. 4 inflammatory bowel diseases such as ulcerative colitis.
(3) Malnutrition caused by drugs: malnutrition caused by drugs develops slowly at the beginning of drug use. With the prolongation of drug use, the trend of malnutrition gradually increases, leading to the occurrence of specific nutrient-deficient diseases or multiple nutrient deficiency syndromes. For example, patients with epilepsy take vitamin D and folate deficiency caused by anticonvulsants for a long time; oral antituberculosis drugs can cause pyridoxine folate and niacin deficiency because the drug blocks the absorption or utilization of vitamins in the body more than other nutrients. Most of the drugs can induce B vitamin deficiency and followed by other vitamin deficiency.
(4) Increased demand due to environmental and occupational factors: People who live or work in a special production or living environment, such as people living or working in high-temperature and low-temperature conditions, may be exposed to certain toxic substances to allow the body's normal physiological processes, including nutrients. The metabolic process within the complex changes, so the need for certain nutrients is also significantly increased, such as high temperature workers, body temperature regulation, water and salt metabolism, digestive system and cardiovascular system function have changed greatly.
Prevention
Nutritional metabolic disorder prevention
Carrying out publicity and education on health and promoting rational nutrition are the fundamental measures to prevent primary nutritional deficiencies. The so-called rational nutrition requires both the rational allocation of foods to meet the needs of various nutrients and heat under different physiological conditions, and various The balance between nutrients should also consider a reasonable dietary system and cooking methods to facilitate the digestion, absorption and utilization of various nutrients. Since the nutrients required by the human body are diverse, there is no food in the natural world that can provide the human body. All the nutrients needed, therefore, in order to provide reasonable nutrition to the people, on the one hand, the competent authorities should be rationalized and diversified in the production and supply of main and non-staple foods, and on the other hand, through publicity and education, Main and non-staple food, a mixed diet of animal food and plant food, reasonable cooking, establishment of a regular, qualitative, quantitative dietary system, correcting overeating habits such as overeating, partial eclipse, abuse of nourishing food or strengthening nutritious food.
In order to prevent the occurrence of nutritional deficiencies, local health authorities and medical and health systems should establish a population nutrition monitoring system. According to the recommendations of the WHO Nutrition Monitoring Symposium, indicators of nutritional status monitoring include population health status survey indicators, socioeconomic and agricultural data analysis. Indicators and indicators for assessing social nutritional conditions, nutrition-related health indicators include neonatal weight, weight of each age group, body weight of different height groups, weight of preschool children, mortality of all age groups, breastfeeding, artificial feeding, special nutrition In the absence of new cases of illness, etc., according to the feedback provided by the nutrition monitoring system, the competent health authorities at all levels should inform the people in a timely manner, and formulate macroeconomic countermeasures related to the rationalization of nutrition with the main and auxiliary food production and supply departments and the health care departments. .
In areas where endemic nutritional deficiencies are prevalent, in addition to publicity and education, group-oriented prevention and control measures should also be adopted. For example, in areas where endemic goiter is endemic, we use edible iodized salt (potassium iodide per ton of salt 5~) 10g) measures effectively control the prevalence of endemic goiter, and as in China, in 1950, the regulations for the production of 92 meters and eight sides were made, which not only improved the yield of raw grain, but also refined white rice and white noodles. Compared with vitamins and inorganic salts, the content of vitamins and inorganic salts is also significantly improved, thus effectively preventing the occurrence of beriberi.
In order to meet the nutritional needs of workers in special production environments or in contact with toxic substances, all relevant departments should work on the supply of health foods in accordance with the types of work and in public canteens. At present, it is not advisable for many units to adopt the method of granting nutrition fees. .
In order to prevent the occurrence of secondary nutritional deficiencies, in addition to the active treatment of diseases that cause nutritional deficiencies, nutrition guidance and management of patients' diets should be done. Strict nutrients should be supplied according to the specific conditions of patients. Heat, because many drugs can affect the absorption and utilization of nutrients, the supply of certain nutrients should also be supplemented when using therapeutic drugs.
Complication
Nutritional metabolic disorder complications Complications periodontal disease nodular goiter
Due to lack of nutrition, it can cause complications in various systems of the body, such as hyperkeratosis of follicles, flat dermatitis, periodontal disease, neck nodular goiter, hand, foot and ankle.
Symptom
Symptoms of nutritional metabolic disorders, common symptoms, infectious fever, nutritional disorders, water and salt metabolism disorders, loss of appetite, nausea, appearance
Eating conditions, loss of appetite, weight loss, swallowing discomfort, and even nausea, sleep disorders, etc., are often a prelude to a nutritional disorder, if the patient has both infectious fever, open wounds, burns, and even recently experienced Surgery, pancreatic dysfunction, etc., should be highly suspected of the existence of malnutrition disorders, in the elderly cases, the deterioration of the patient's economic situation, changes in living environment and habits, etc. often promote the manifestation of nutritional disorders.
Examine
Examination of nutritional metabolic disorders
(1) Physical measurement: Physical measurement can provide patients with protein and fat storage conditions, especially during dynamic testing, to understand the trend of the disease, the effect of intervention therapy, etc., usually measured in height, weight, and body Disproportionately too high or too low weight, often indicates a nutritional disorder, in general, within 6 months without special causes, weight loss of more than 10% often need further examination to confirm the existence of pathological conditions, but sometimes even in six months A decrease of only 6% in internal weight can also be a sign of severe physical illness. Puffiness, ascites, etc. can sometimes mask the weight loss caused by consumptive diseases. The measurement of triceps subcutaneous fat can help to understand the fat storage of patients and is less affected. Influenced by factors such as edema, upper arm muscle measurements are helpful in understanding the actual number of skeletal muscles.
(B) clinical situation: although the clinical situation is not as accurate as the laboratory test indicators, but often can provide a variety of signs of malnutrition, such as loss of appetite, weight loss, mostly suggestion of hot card and protein deficiency; taste abnormalities can indicate zinc deficiency; skin color Pale, hyperfollicular follicles, flat dermatitis, itching, pigmentation, and scrotal dermatitis, respectively, may indicate folic acid, iron, vitamin B12, A, C, riboflavin, and nicotinamide and other metabolic disorders, hair loss, Hair sparseness is common in protein deficiency; night blindness, photophobia suggests vitamin A and riboflavin barrier; glossitis often indicates riboflavin deficiency in oral examination; gingival bleeding should be noted in addition to periodontal disease, VitC deficiency Neck nodular goiter is iodine deficiency; abdominal forceless expansion with hepatic enlargement is insufficient for protein and calorie; iron deficiency often shows spoon-shaped nails, hand and foot spasm, reflex disappearance, etc., suggesting that there are calcium, magnesium, and B Family vitamins, etc., the above clinical examination can be combined with special laboratory tests to obtain more accurate information, such as the above zinc deficiency can appear taste Often, but it may also be a number of reasons smoking, caused by medication, determination of blood zinc levels can be diagnosed.
(3) Biochemical testing: It can prompt more accurate and specific diagnostic significance. The commonly used indicators are: 1. Serum albumin can be reduced in many chronic dystrophic diseases, but it can also be observed after acute gastrointestinal bleeding. Since albumin half-life is about two weeks, it can be observed even when nutritional disorders have been corrected. Gradually rising to its level, 2. Serum transferrin is considered to be more sensitive and reliable than albumin determination, but its level can be high in iron deficiency, some malignant tumors, rheumatoid arthritis, and chronic infection, and should be noted. The blood amino acid level needs special testing equipment to complete, but if it can be measured, it can often reflect the disease and cause more accurately. For example, in the chronic kidney disease, most amino acids (cyst, melon, asparagus, cheese, bright, etc.) can be observed. The levels of different light, lysine, serine, etc. are too low; in the case of liver disease, the abnormalities of the above amino acids are different.
Diagnosis
Diagnosis and diagnosis of nutritional metabolic disorders
diagnosis
1, subcutaneous fat atrophy: fat malnutrition, also known as subcutaneous fat atrophy, fat dystrophy. In 1885, Weir-Miechell first reported partial lipodystrophy (lipodystrophy), and later reported that the patient had neck, arms, chest and abdomen fat malnutrition, with increased fat deposition in the hips and legs, Lawrence reported in 1946 Complete fat dystrophy, patients with malnutrition are systemic, completely or patchy, and fat deficiency is often accompanied by a series of metabolic disorders.
2, subcutaneous fat increase: obesity (Obesity) refers to the body caused by a variety of fat components, significantly more than the normal average amount of normal people called obesity. The fat stored under the skin accounts for about 50% of the total fat. Obesity can occur at any age, is more common in middle-aged people, and more women than men. The weight gain of obese people is due to the increase of adipose tissue, while the muscle tissue does not increase or decline, but the athletes' muscles are particularly developed, or the weight gain of edema is not included. When the calorie intake exceeds the body's consumption, the excess calories are stored in the body in the form of fat, so that those who weigh more than 20% of the standard weight are obese, more than 10% are overweight; and according to height and weight, the body mass index (weight team) Kg / height (m2) is calculated, more than 24 is obese. The World Health Organization (WH 0) standards are: men > 27, and women > 25 are obese.
3, subcutaneous fat disappears: subcutaneous fat atrophy (lipoatrophy): the occurrence may be related to the patient receiving subcutaneous or intramuscular corticosteroids. Subcutaneous fat atrophy mainly manifests as the disappearance or weight loss of progressive subcutaneous fat tissue, which may cause skin wrinkles and depression, difficulty in pinching, often on the face, and then affect the neck, shoulders, arms and trunk, some patients disappear only fat Limited to the face or half-side, half body, muscle, bone, hair, breast and sweat glands are normal, no muscle disorders, most physical strength is not affected. Most of the disease occurs around the age of 5-10, and women are more common. The clinical condition of the disease is accurate and is mainly differentiated from its complications.
Differential diagnosis
The clinical condition of the disease is accurate and is mainly differentiated from its complications.
