Nutritional imbalance can cause growth problems, specific diseases, and even death. Nutritional imbalances, deficiencies, and excesses are becoming more apparent as causes of health problems worldwide. Nutritional deficiencies can cause grave intellectual and physical impairments as well as affect an individual’s overall well-being. Causes of nutritional imbalances include malnourishment, vitamin and mineral deficiencies and excesses, obesity, and starvation.
Malnourishment (ICD-9: 263.x) may be due to:
- Improper intake of foodstuffs in both quality and quantity, as seen in people with alcoholism (ICD-9: 303.xx), anorexia nervosa, and bulimia or in those who engage in diet faddism.
- Improper intake of foodstuffs because of GI problems, as exhibited in individuals who have no taste or smell and little tolerance for food, those with postoperative anorexia, those being treated with chemotherapy, or those who have a lesion in the throat.
- Malabsorption or poor utilization of foodstuffs, as seen when an individual is unable to absorb nutrients properly.
- Increased need for food or certain nutrients, as seen in marathon runners, people in a febrile state, and people with cancer.
- Impaired metabolism of foodstuffs, as in both hereditary and acquired biochemical disorders.
- Food and drug interactions, as seen in those taking corticosteroid medications, which are known to deplete muscle protein, lower glucose tolerance, and induce osteoporosis.
Vitamin Deficiencies and Excesses
Early signs of vitamin deficiency (ICD-9: 269.2) are generally vague and nonspecific. Vitamin deficiency diseases include scurvy (ICD-9: 267), which is caused by a lack of vitamin C and is characterized by abnormal bone formation and hemorrhages of mucous membranes, and rickets and some cancers and infectious diseases that are due to a lack of vitamin D (ICD-9: 268.x) and a prolonged lack of vitamin B 12 (ICD-9: 266.2) causing neurological damage. Vitamin D deficiency is quite common among teenagers and infants. Treatment typically consists of a diet high in protein and the required vitamin. Vitamin excess (ICD-9: 278.x) may occur when people take vitamins in an attempt to cover missed or inadequate meals, when they hope to prevent some disease, or when they self-treat a condition. Large doses of a number of vitamins can accumulate in the body and become toxic. They may cause illness, especially when taken over a long period of time.
Mineral Deficiencies and Excesses
Minerals are a vital component of a balanced diet. Mineral deficiencies (ICD-9: 269.3) of chloride, potassium, sodium, calcium, and magnesium are the most common deficiencies. Causes include dietary deficiencies and metabolic disorders. Treatment may involve increasing the intake of a deficient mineral through foodstuffs or medication or addressing any underlying metabolic disorder. Mineral excess also may be caused by diet, medication, or a metabolic error. Treatment consists of locating the cause and correcting the problem.
Obesity (ICD-9: 278.0x) is a condition in which body weight is 10% to 20% above the ideal. Of course, “ideal” is difficult to determine, and such factors as family history and body build must be considered. One measure of obesity is a calculation known as the body mass index, or BMI. This index expresses the relationship between height and weight.
The cause of obesity may be too many calories, too little activity, or, less frequently, an endocrine and metabolic problem. In addition, fluid retention may cause an increase in weight. Treatment may include lowering caloric intake, increasing physical activity, or, in the case of metabolic disorders, correcting the error. If fluid retention is a problem, drugs that promote the secretion of urine, or diuretics, may be prescribed, and any underlying cause of the retention should be detected and treated.
The prognosis for obesity is not good. Although a small percentage of obese individuals are able to lose weight, an even smaller percentage are able to maintain permanent weight reduction. Obesity poses a serious risk for the development of hypertension and stroke, diabetes mellitus, gallbladder disease, and heart disease.
Gary Whitlock, a member of a research group at the University of Oxford in the United Kingdom, reported the following data gathered from nearly 900,000 men and women from Western Europe and North America who participated in 57 studies related to obesity:
- A BMI over 25 translates to a 40% increase in the risk of heart disease and stroke and a 60% increase in the risk of diabetes.
- A BMI over 30 reduces a person’s life span by 2 to 4 years; a BMI over 40 reduces life span by 8 to 10 years.
Much media attention regarding obesity has translated into healthier choices available at school cafeterias and restaurants and a greater awareness of food choices. Also, a number of obese individuals opt for gastric bypass or lap band surgery in search of a more permanent solution to obesity.
Causes of starvation (ICD-9: 994.2) include lack of food or an unbalanced diet over a long period of time, causing metabolic and physiological body changes. A starved person generally is one who does not have adequate food, whereas someone who is malnourished generally has adequate food available but the food is of inadequate nutritive value. Starvation can be the result of illness, poverty, and poor dietary planning. It is seen at any age; however, infants and children ages 1 to 3 suffer more severely than do adults. Pregnant women and elderly people are also vulnerable.