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NUTRIENT DEFICIENCIES

Meeting daily needs

Definition

What are nutritional deficiencies ?

Etymology helps us learn about nutrient deficiency, with “nutrient” deriving from the Latin verb nutrire, “to nourish” and “deficiency” also owing its roots to the Latin language - deficere - “to be lacking or left wanting”.

In a nutshell, this term describes the state when the body has insufficient levels of one or more nutrients, making the body unable to normally perform its functions".3-5

There are 2 types of nutrients

                               MACROnutrientS                           

MICROnutrients

ProteinsMinerals: Calcium (Ca), Magnesium (Mg)
CarbohydratesTrace elements: Zinc (Zn), Iron (Fe), Copper (Cu), iodine
LipidsVitamins: Vit D, Vit C, Vit B

Today, more than 2 billion people worldwide suffer from vitamin and mineral deficiencies1 .

Across the globe, malnutrition was the number one cause of death in 2017 6 .Such dietary deficiency is a public health problem that can induce increasingly common conditions like iron deficiency anemia and osteoporosis7.

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MALNUTRITION IS THE NUMBER-ONE CAUSE OF DEATH WORLWILDE (2017)6, 8

11 million deaths and 255 million deaths in terms of disability-adjusted life years.

map nutrient deficiencies

 

Risk factors: Top 3

1. High sodium diet
2. Whole-grain-deficient diet Iron, Zinc, Vit B1, B2, B6, Folates)
3. Fruit-deficient diet Vit C, Vit A, Folates)

Causes

What causes nutrient deficiencies ?

Various nutritional deficiencies have multiple causes8:

Decreased intakeIncreased lossesIncreased needs
MalabsorptionMenstrual cyclePregnancy
Drug/nutrient interactionsDiarrheaBreastfeeding
Monotonous dietParasitic infectionsGrowth periods
Low animal food intake Acute, chronic diseases
Poverty, poor economic status  
Food seasonality  
Food shortages  
causes

Consequences

What are the consequences of these nutritional deficiencies, and related symptoms8? 

  • Anemia
  • Dental disease
  • Disorders - cognitive, hepato-digestive, visual, skin conditions
  • Cardiovascular disease
  • Cancer
  • Neural tube defects (NTDs)
  • All other birth defects (orofacial cleft palate, heart defects)
  • Osteoporosis
  • Stunted growth
  • Mental delay
  • Œdema
symptoms

Most common nutrient deficiencies

What are the most common nutrient deficiencies?

There are 8 common nutrient deficiencies 5, 9-11:

  • Vitamin A - essential for maintaining the integrity of epithelial tissues in the eye, as well as in the urinary, intestinal, and respiratory tracts;
  • Folate - crucial for the synthesis of purines and thymidylate, it plays a significant role in DNA synthesis, repair, and stability. It is also involved in carbon metabolism and changes in DNA methylation patterns.
  • Iodine - this trace element that plays a major role in thyroid hormone synthesis;
  • Zinc - essential for health, associated with cellular metabolism. It is necessary for the proper functioning of over 200 enzymes and is crucial for normal growth and development, immune system function, DNA and protein synthesis, and cell division;
  • Vitamin D – essential for the intestinal absorption and metabolism of calcium, magnesium, and phosphorus;
  • Iron - major contributor in hemoglobin synthesis;
  • Vitamin B12 - required for the development, myelination, and function of the central nervous system; healthy red blood cell formation; and DNA synthesis;
  • Calcium - crucial throughout life to maintain bone health.

Iron deficiency (ID) and iron deficiency anemia (IDA)

On the one hand, iron deficiency (ID) refers to a depletion in the body’s total iron content. On the other, iron deficiency anemia (IDA) denotes distinctly low iron levels in our body which are unable to support red blood cell (RBC) production. Of all chronic anemia conditions, it is the most prevalent.

anemia

What is anemia ?

Anemia is a common condition affecting 1 in 3 people the world over. It defines a decrease in red blood cells (RBCs), induced by the body’s iron deficiency. Depleted iron levels equal less hemoglobin, meaning fewer and smaller RBCs. Since hemoglobin is the protein that carries oxygen, the body doesn't get all the oxygen it needs13.

Patients at high risk of iron deficiency anemia:

CHILDREN

What are nutritional deficiencies?

Why?

The World Health Organization (WHO) reported that toddlers and preschool children have the highest anemia prevalence, representing 42,6% of their demographic, largely owing to nutritional choices. 15

While children require higher iron levels for growth many receive less than their recommended daily intake. In fact, this age group receives a healthy dairy supply, which is deficient in iron, heightening risk of children developing iron-deficiency anemia8.

What are the consequences of anemia in children?17, 18, 19

  • Disrupted learning

  • Impaired cognitive ability

  • Stunted growth

  • Disturbed immune status

WOMAN OF CHILDBEARING AGE

What are nutritional deficiencies?

Why?

With a global prevalence of 29.4% for all women of reproductive age and 38.2% for pregnant women, this demographic suffers a higher anemic risk. 15

This is due to blood loss experienced in menstruation and increased blood pressure required for foetal development during pregnancy.20, 21. 

Women of childbearing age represent the most at-risk demographic for contracting iron deficiency anemia (IDA). The WHO 22 estimates that 496 million are non-pregnant women. 

 

What are the consequences of anemia in women of childbearing age?

Whilst this population segment is vulnerable to iron deficiency anemia, pregnant women run a greater risk due to high iron requirements.

Pregnant women with IDA can experience23, 24

  • Low birth weights

  • Spontaneous abortions

  • Delayed fetal growth

  • Premature births

SURGERY PATIENTS
What are nutritional deficiencies?

Why?

The mean prevalence of pre-operative anemia is around 35%26. The aetiology of pre-operative anemia may be multifactorial and complex (nutritional deficiencies, specific drugs, immune system activation). The mean prevalence of post-operative anemia can reach 90%, mainly induced by pre-operative anemia and important blood loss during surgery.25

What are the consequences of anemia in surgical patients?
As risk factors, preoperative and postoperative anemia are independent from increased post-operative morbidity and mortality, in addition to extended hospital stays.25, 26

ELDERLY
What are nutritional deficiencies?

Why?

Anemia is common in the elderly, its prevalence increasing with age.

The second most frequent cause among the elderly, iron deficiency anemia is typically triggered chronic gastrointestinal blood loss, in turn caused by nonsteroidal anti-inflammatory drug–induced gastritis, ulcers, colon cancer, diverticula and angiodysplasia. Generally, older persons lack iron intake and absorption.27

What are the consequences of anaemia in elderly patients?
Anemia represents poor prognosis in mortality and morbidity terms and poses a risk to the elderly’s frailty. 28

VEGETARIANS

Why?

Because of vegetarians’ diet, which is low in nutrient deficiency, notably animal foods – a requisite source of iron.29

How?

The poor bioavailabilty of nutrients induces anemia since vegetarians’ recommended daily intake of iron is 1.8 times higher than those who eat meat.30

ATHLETES

Why?

The intensity of elite-level sports calls for increased iron demand, in turn accelerating low iron levels.

How?

Anemia therefore results from athletes’ elevated iron loss, which in turn, blocks iron absorption caused by hepcidin bursts.31

What are symptoms of iron deficiency anemia?32-36 

  • Fatigue
  • Difficulty in concentrating
  • Dizziness or lightheadedness
  • Cold hands and feet
  • Pale skin
  • Dyspnea on exertion
  • Brittle nails
  • Hair loss

How do you treat anemia?

Anemia treatment depends on two factors; severity and its underlying cause. 14

IRON SUPPLEMENTS
DIETARY CHANGES
Generally, IDA treatment will include iron supplements and lifestyle changes to remedy symptoms by increasing iron. Adults should discuss dietary benefits with a health professional.

Certain foods are iron-rich and need encouraging 37

  • Protein-based foods - Lean meat, seafood.
  • Nuts, vegetables, and fortified grain products.
  • Cereals and bread with extra iron.
  • Legumes (beans, peas and lentils).                                                                                                                                                                                                                                                                                                        

Which foods should be avoided if one is anemic?

Other food and drinks display low iron levels, with deficient absorption (avoid in large quantities) 38.

  • Tea39.
  • Coffee.
  • Dairy products.
  • Foods with high levels of phytic acid - wholegrain cereals.

Calcium & Vitamin D deficiencies

Common nutritional deficiencies, also concern calcium and vitamin D. Both types of  nutrient deficiency are on the rise: according to the US Department of Agriculture  (USDA), close to 30 % of men and 60 % of women older than age 19 years do not  consume enough calcium, and more than 90 % of Americans do not consume  enough vitamin D40.

calcium-vit-D

Why are calcium and vitamin D of significance ?

  • The benefits of Vitamin D include bone mineralization and calcium absorption from the intestine.
  • As a micronutrient, calcium fortifies the body (bones). 

Calcium also involves metabolism, via blood clotting, cell adhesion, muscle  contraction, hormone neurotransmitter release, glycogen metabolism, and cell  proliferation and differentiation. 8, 41

Which disease is caused by a calcium and vitamin D deficiency ?

Nutrient deficiency in vitamin D and calcium terms can cause skeletal problems, manifested as rickets (children) and osteoporosis (adults). 8

Who is at high risk? 8, 41-44: 

YOUNG PEOPLE
CHILDREN AND ADOLESCENTS 42

What are nutritional deficiencies?

Why?

Childhood and adolescence are key skeletal formation stages, requiring increased calcium intake. However, many young people do not eat a traditional, calcium-rich breakfast.

Low levels of vitamin D in children have been reported in studies worldwide, with the cause attributed to indoor lifestyle, urban pollution and even sunscreen.

Which consequences?

Although rare in industrialized countries, children with severe vitamin D deficiency experience growth retardation, low bone density and deformities.

Bones that are not healthy during youth are more prone to result in an increased susceptibility to osteoporosis and fractures in later life and tend to suffer from increased osteoporosis.

MENOPAUSAL
WOMEN DURING OR POST MENOPAUSAL PERIOD 43

What are nutritional deficiencies?

Why?

Estrogen health key to regulating bone turnover throughout life. However, as women become estrogen-deficient when menses cease, bone resorption exceeds bone formation, decreasing calcium intestinal absorption and kidney retention.

Which consequences?

Did you know? One in three women aged over 50 suffers a skeletal fracture caused by osteoporosis. 

ELDERLY
THE ELDERLY 43, 44

What are nutritional deficiencies?

Why?

More often than not, the elderly:

  • experience malnutrition;
  • spend lots of time indoors, therefore lacking exposure to weather elements, which is not compensated by a vitamin D-rich diet;
  • display low calcium intestinal absorption and kidney retention;
  • and are unable to synthesize and convert vitamin D.

Which consequences?

Osteoporosis inflicts pain, long-term disability and loss of independence among older adults, potentially inducing premature death. 

What are the long-term risks and associated signs of a severe vitamine d deficiency and calcium imbalance? What are the associated signs or symptoms?41, 43

  • Increased fractures
  • Exacerbated development or worsening of skeletal disorders -: rickets, osteomalacia.
  • Stunted growth.
  • Osteoporosis.

There are often no clear symptoms of vitamin D and calcium deficiencies, except in more severe cases.

How do tou treat vitamin D and calcium deficiency?

RESPONSIBLE SUN EXPOSURE

Our skin produces vitamin D from the sun’s rays (UVB irradiation), the main “free” source

However sunlight is not the most reliable nutrient deficiency remedy due to its related risk of skin aging and cancer.41 

DIETARY CHANGES
Calcium
Vitamin D
  • Milk
  • Yogurt, cheese
  • Tofu, Soybean
  • Curly kale
  • Sardines
  • Figs, whitebait, almonds
  • Salmon, sardines, mackerel
  • Tuna
  • Cod liver oil
  • Shiitake mushrooms
  • Egg yolk

Gentle reminder

Your expert dieticians can assist you in determining your body's calcium & vitamin D needs.

References

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