Determining Deficiency Diseases Caused by Malnutrition
Introduction
In finding deficiency diseases, there are a couple of reasons to look at the children first - They are the least able to fend for themselves and because their bodies are growing, nutritional deficiencies manifest themselves much more quickly in children. One thing's for sure. When we go hungry for too long, we not only get abnormally skinny, but the rest of our systems start to operate poorly as well. There just isn't enough of 'life's energies' present when the body is missing the many nutrients necessary to carry on the many thousands of processes that must continue for good health.
Most of us have seen photographs of children, usually in Africa, literally starving to death. There's a name for it - Kwashirkor - a Ghanan word. Kwashirkor's most obvious symptoms are complete wasting away of the child. Their limbs aren't much larger than the bones underneath the skin. Often, their bellies are huge and protruding. This is called 'pot belly.' And always, there is a look of distraught on their faces. Anyone can recognize this in a child already deep into Kwashirkor, but there are many, many other signs as well you can train yourself to look for. This page will briefly explain many of these signs. It's important to remember that a person doesn't have to be starving to death to have a nutritional deficiency disease. A total lack of any one of the many important nutrients we must have to stay healthy will cause illness, and eventually death, if it's withheld in it's entirety for a long enough period of time. That's why they are called "essential nutrients." We just can't do without them. If we only get some of any nutrient but not enough for good health, it won't kill us, at least right away, anyway, but we will not enjoy good health. And if this continues over the years our lives will be shortened because of it.
The Symptoms
Psychological Symptoms:
A child can be unresponsive or disinterested in what's happening around him. When someone picks up the child or tries to examine him, he may show excessive signs of over reaction. For example, if you try to look into the child's eyes, mouth or ears, the child may fight you, screaming and hollering the whole time. The child may also show exaggerated fear from relatively insignificant happenings. This is not a happy youngster.
General Physical Symptoms:
We've all seen little kids who were skinny as a rail yet this was perfectly normal for that particular child. If there's malnutrition involved, there are always other accompanying signs as well. Many of the psychological symptoms above may be present. The eyes may appear unusually bright or dull. If the malnutrition has been going on for a long time, the child will usually be very small for his/her age and the hair may appear to be very unhealthy. More on this later. Often the child can be swollen up from excess water under the skin. Bad cases of swelling will show little reverse bumps, or indentations down into the skin. This is called Edema, and can hide how much muscle has actually been lost. There can also be a loss of skin color. This includes the coloring underneath the fingernails. The skin can also have pronounced wrinkle marks as it has lost much of it's elasticity. We'll also cover this in greater detail.
Hair:
The traditional signs of malnutrition include stiff, wiry hair that looks unkempt. It can have a lighter color than what would be normal for the child. The hair will not only be lighter, but some of the pigmentation will be gone, making the hair a bit more gray. You will generally be able to see a definite pigment change if the malnutrition came on quickly rather than over a long period of time. This would be shown as poor looking hair next to the scalp with healthy looking hair towards the ends. This hair will often be a different color. It's the opposite from what you'd see if the hair had been bleached then allowed to grow out without other coloring treatments. This might not be easily seen but should be observable from combing the hair up and looking along the length of the hair down to the roots. This change in hair color has a name - Flag Sign - and is one of the key things to look for when suspecting malnutrition. Among Black people, this depigmentation can make the hair look red in color. Generally, a few strands of hair can be easily pulled out with just a gentle tug with little or no pain being felt by the child. This is also an important sign to look for.
Skin:
Xerosis - a clinical term used to describe dry and crinkled skin that looks worse visibly by moving one piece of skin parallel to the skin next to it. This can be easily done by grabbing an arm or ankle with both hands then twisting each wrist in a different direction. As the condition grows worse, the skin is often mottled, or has dark blotches with different shades of color. It can also pick up a pattern that looks much like alligator skin, usually, with each individual section being no bigger than 1/4 inch in diameter (0.5cm). Scientists aren't sure exactly what causes Xerosis yet, but poor nutrition can certainly cause the problem.
The skin can develop scales larger than those found with the abnormal skin dryness of Xerosis and the condition becomes more acute in cold weather. The skin can be tight from excess fluids just under the skin caused by edema. "Flaky-paint" dermatosis can develop on the extremities. This can be recognized by large, peeling scales of the outer skin layers. As deficiency symptoms increase, this condition can move up the extremities and onto the trunk. In association with this, small circular sores may accompany the scaling as the child moves into a Kwashiorkoric state. Rather deep parallel cracks or wrinkles in the outer layer of the skin also appear, most notably around areas where the skin gets more movement such as around the mouth and joints in the extremities. This can also manifest itself as a multi-sided pattern on the skin resembling the microscopic skin cell and is sometimes called 'crazy pavement.'
You've surely seen goose bumps when your skin has been cold. This is a natural reaction by the skin to make the hairs stand up, slowing down the transfer of heat from your skin to the air. There is a symptom very similar to this caused by malnutrition - it's called Follicular Hyperkeratosis. Only this deficiency disease doesn't go away when the skin is warmed. Sometimes it's hard to see this and it's much easier to feel these small bumps by rubbing your hand across the skin. These hard spots are formed in each hair follicle and gives the skin a rough feel. The surrounding skin is dry. There is another type of hyperkeratosis called scorbutic perifolliculosis. This disease can be identified by a tiny ring of capillary blood vessels around each hair follicle making each follicle a dark little spot on the skin.
Pellagra: This skin disease, caused by a deficiency in niacin, starts on the skin that is exposed to sunlight. The skin blisters into round sores and becomes dark in color, sometimes covering the entire skin of the affected area.
Purpura or Petechia: The skin can also develop small, microscopic hemorrhages where the capillaries break and cause minor bleeding creating dark spots on the skin. Usually, these spots will be more pronounced at points where there is pressure on the skin.
Bones:
Look for children with bowed legs. And the following symptom would most likely require a doctor to find - Costochondral Beading. This is beading of the cartilage between all the movable joints. It can be felt by rubbing the joints with your fingers, but you'd probably need to be a doctor to know if what you were feeling was abnormal or not.
In severe cases that have gone on for years, the frontal area of the forehead or the spots just above the temples can also be enlarged. If you could see a frontal view of the little boy at the right, you would no doubt see these symptoms.
The bone joints of victims who have suffered long term malnutrition also become enlarged. These little people can begin to look like walking skeletons. And one last sign - the shoulder blades. The sides of the shoulder blades that are nearest the spine can abnormally protrude.
Muscles:
The muscles waste away. If the child lives a somewhat lethargic life, the muscles can actually atrophy away faster than the body fat. This is because of famine mechanisms built into our makeup tell the body to use up a good percentage of the muscle first as energy before it uses the fat - holding the fat in reserve for really tough times. Aside from the obvious signs of muscle loss, the undue degree of the folding skin on the buttocks or the jelly like feel of the muscles that still remain are also good signs. Of course, the obvious muscular signs of malnutrition are the lack of muscle tone and in progressed cases, the skeletal look of the body.
Eyes:
The eyes can have problems that range all the way from minor symptoms to total, permanent blindness. Look for small circular grayish spots with perhaps a tint of yellow in them on the eye. These spots will look dull, dry and perhaps foamy on the white of the eye. They most often appear in the corners of the eye on the parts of the eye ball that are exposed when the eye is open. Be aware there is an eye disease called pterygium that can look very much like this.
The eye lids can be inflamed or swollen and the cornea of the eye, or that clear outer layer over the iris of the eye, can become soft. I don't expect an untrained person could check for this.
The inner surfaces of the eye lids can get thicker as well as the outer layer of the eye ball itself. The blueness of the whites of the eyes may disappear. They may also pick up a wrinkled appearance with the addition of an increase of those small capillary blood vessels that make the eyes look 'red.' As the symptoms worsen, the thickened outer layers of the eye and inner layers of the eye lid may create a glazed, porcelainlike appearance that can actually hide the small capillaries that are making the eyes red. Holding the eye open and asking the subject to roll their eyes around, you may see what appears like a dull, lusterless or roughened surface on the eyes, created by that thickened layer of outer tissue.
Face:
Angular wrinkles radiating out from the mouth become more pronounced when the mouth is held half open. As malnutrition increases, these lines can turn into scars. The soft skin (it's not really skin but rather a mucous membrane) found inside the mouth can protrude out so it's seen as part of the lips. The lips can be reddened with sores and deep cracks may be found in the corners of the mouth. The small area between the top of the upper lip and the nose can have a definite greasy, yellow scaling that is more easily seen when it's scratched with a fingernail.
Inside The Mouth:
The taste buds cover the top of normal tongues. In cases of malnutrition, the taste buds can disappear. In mild cases this would be noticed on the tip and sides of the tongue. As the condition worsens, the loss of taste buds can spread. In severe cases this can cover as much as 3/4ths of the tongue. The sides and top of the mouth can appear more red in color and there will often be sores inside the mouth. There can also be white patches of fungus growing on the tongue. This same symptom is also found in advanced AIDS patients and is a sure sign the immune system is shutting down. It can be painful to eat because of all these sores in the mouth.
Teeth:
The teeth can have a lot of decay. There can be paper white areas on the enamel of the tooth ranging from a few specks to the whole tooth. The teeth can also have a brown stain on them accompanied by various degrees of pitting because of decay. In addition, the teeth can have a general corroded appearance. The gums can be red and swollen which would include all the gums, not just a spot or two between teeth. There can also be puss oozing out of the gums from the bone below the gum line. The bones that hold the teeth in place can break down. This bone can become thin and fragile - easily broken, and as a result the teeth can easily come out.
Glands:
Check for a swollen thyroid gland just below the Adams apple. This gland, when abnormally large, can be clearly visible in the form of a goiter. You should also be able to feel it if it has only enlarged a small amount. There's another gland to check for enlargement, the Parotid gland. Actually, there's four of these glands that generate saliva, but we are most interested in the two glands towards the back of the jaw, one on each side. These are the glands that enlarge when we get the mumps. There's one located under the jaw bone on each side next to the neck. It will probably take a trained doctor to find this small abnormality unless it's really swollen up - mump-like.
Summary
There's many things the untrained eye can catch in finding deficiency diseases. Always use the help of a medical doctor in correctly diagnosing these things as many of these symptoms can just as easily be brought about by other problems. Hopefully, learning what can happen when we don't take adequate care of ourselves will give us added incentive to go that extra mile to insure we do what's necessary to keep ourselves and family healthy.
| Information for this page was re-written from Appendix 28 in Krause's Food, Nutrition, & Diet Therapy. See the bibliography on the home page for full information. |
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Revised: 14 Sep 99