Physical Signs of Malnutrition

10 May

Sorry for the delay with this post – I’ve been crazy busy starting a new rotation at the hospital as well as having assessments due… and helping my boyfriend prepare his meals for the week, as well as my own separately, took longer than I’d anticipated! He loves it though, he says it’s so much easier throughout the week now! Hate to say I told him so 🙂

Ok so I’ve decided that this week I’m just going to cover the signs of malnutrition – I originally wanted to cover sources of vitamins, recommended daily levels of vitamin intake, supplements etc, but that will be way too much to squeeze into one post! I’ll try to cover a part of nutrition each week; if anyone wants anything covered in particular please feel free to let me know!

Nutritional assessment includes finding out about dietary intake, however in this post I will be focusing on physical findings. Often malnutrition can just cause people to feel rundown, inappropriately tired, and to be certain of malnutrition it is best to get blood tests done. However here are some signs that may be seen when certain deficiencies are present:

 

Vitamin A (retinoids)

– Loss of vision, especially at night

 

Vitamin B1 (thiamine)

– Constipation

– Decreased appetite

– Nausea

– Mental depression

– Pins and needles/numbness in fingers or toes

– Fatigue

– Muscle loss (more severe stage)

 

Vitamin B2 (riboflavin)

– Cracked, red lips

– Inflammation of mouth and tongue (hot, painful, swollen)

– Mouth ulcers

– Cracks at the corners of the mouth

– Sore throat

– Dry, scaly skin

– Anaemia  (often presents with general fatigue, shortness of breath on little physical exertion, pale gums/nail beds, oncholysis/finger nails come away from the nail bed (see image)) – symptoms vary depending on severityImage

– Bloodshot, itchy, watery eyes that are sensitive to light

 

Vitamin B3 (niacin)

Lack of vitamin B3 causes pallegra which is characterised by the ‘4 Ds’:

– Diarrhoea

– Dermatitis (red, itchy, irritated skin)

– Dementia

– Death (in severe cases!)

 

Vitamin B4 (biotin) – RARE

– Rashes

– Fine, brittle hair

– Hair loss or total baldness

– Anaemia (see above)

– Tiredness

– Decreased appetite

– Inappropriate muscle pains

– Pins and needles

 

Vitamin B5 (pantothenic acid) – RARE

– Fatigue

– Pins and needles/numbness

– Hypoglycaemia: restlessness, sleep disturbances, nausea, vomiting, abdominal cramps

 

Vitamin B6 (pyridoxine)

– Nausea and vomiting

– Mental depression

– Confusion

– Mouth ulcers/cuts

– Pins and needles/numbness in fingers or toes

– Weakened muscles

– Anaemia (see above)

– Rough/red/greasy skin (aka seborrhoeic dermatitis)

 

Vitamin B9 (folate/folic acid)

– Fatigue

– Mouth ulcers

– Swollen tongue (may have ‘smooth’ appearance, aka glossitis (see image))Image

 

Vitamin B12 (cobalamin)

– Anaemia

– Pins and needles/numbness in fingers or toes

– Diarrhoea or gut pain

– Reduced reflexes

– Brittle hair

Vitamin C (ascorbic acid)

Deficiency of vitamin C causes scurvy:

– Small bruising (may appear like little pinpricks over the body, aka petechiae (see image))

– Bleeding gums

– Reopening of scar tissue

– Sore joints/bones

– Mental deterioration

– Increased infectionsImage

 

Vitamin D

Vitamin D can be obtained from UV sunlight

– Osteoporosis: increased risk of fractures, muscle weakness, back/neck pain, bone pain/tenderness

– Premature ageing

– Decreased immune function (more infections – hence why people tend to get more sick during winter)

 

Vitamin E – RARE

– Reduced reflexes

– Pins and needles/numbness

– Confusions

– Difficulty with speech

– Anaemia (see above)

– Decreased immune function

 

Vitamin K – RARE

– Generalised bleeding

 

Calcium

– Osteoporosis (see above)

 

Phosphorus

– Weak bones/teeth

– Joint pain/stiffness

– Less energy

– Decreased appetite

 

Magnesium

– Weakness

– Confusion

– Convulsion

– Abnormal eye movements

– Decreased appetite

– Nausea and vomiting

 

Sodium

– Nausea and vomiting

– Confusion

– Tiredness

– Decreased appetite

– Restlessness and irritability

– Muscle weakness and muscle spasms/cramps

– Decreased consciousness/coma (more severe)

 

Potassium

– Muscular weakness

– Muscle cramps

 

Chloride – RARE

– Muscular weakness

– Tiredness

– Abnormal shortness of breath on physical exertion

 

Zinc

– Impaired growth

– Decreased immune function

– Loss of taste

– Abnormal behaviour

 

Iron

Iron deficiency is very common in females!

– Anaemia (see above)

– Impaired learning capacity

– Muscle weakness

– Fatigue

– Reduced physical activity and lower work productivity

– Decreased immune function

 

Iodine

– Lump in the neck (aka goitre (see image))Image

– Impaired intellectual function

– Hypothyroidism: abnormal weight gain, decreased physical activity, sensitivity to the cold temperature, fatigue

 

OK! Sorry about the long boring list, but I wasn’t sure of the best way to set this information out.

PLEASE keep in mind that this is a very basic list and many symptoms are extremely vague – everything in medicine is subjective!! To get an accurate knowledge of your nutritional status it is essential to get a blood test done and I strongly advise doing this if you are feeling generally unwell and run down, especially if it is for an unusually long amount of time and if you believe your diet might not quite be providing you with enough vitamins and minerals.

In other posts I will explain what the best sources of specific vitamins and minerals are, as well as supplementation etc.

PS we are told that our fingernails give indication as to our nutritional status and in SOME cases this is true – however nails can show signs of anything, from heart infection to the normal ageing process. The main sign that can be relied upon if seen in the fingernails is the oncholysis (which I mention above, and is a sign of anaemia).

I hope you found this a bit interesting and helpful – if you have any tips or topics that you would like me to cover I would love to hear from you!! blhat1@student.monash.edu, or leave a comment 🙂

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10 Responses to “Physical Signs of Malnutrition”

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  2. Laurena April 23, 2013 at 5:03 pm #

    Thanks for the list! I found it a great review of the signs & symptoms. I’ve graduated from medical school in 1999 in Australia. Much like you I’m a fitness freak, anti-aging doctor and run a busy clinic! I came across your page looking for clean recipes for my post-training meals.
    My experience with nutritional deficiencies in clinical practice is that they are very subtle and what we are taught to look for in med school are seen in only very severe deficiencies! The majority of patients present with fatigue, insomnia, mood swings, chronic diseases and often blood tests turn up normal. This is because some minerals like zinc in blood only reflect what was recently eaten and not tissue levels where our bodies need them. I’ve started looking at hair tissues to try and find another way of testing for subtle changes – they are helpful but I also have to take a proper nutritional history. We need a Tally & O’conner section on nutritional examination!
    By the way I also like your post on supplements. I’m taking mine based on training needs as well as my nutrigenetic profile.
    Keep learning & challenging traditions on nutrition!

    • brizah90 May 2, 2013 at 9:43 pm #

      Hi Laurena! If you don’t mind me asking, what type of clinic do you run? How have you integrated your interest in fitness, health etc into medicine? I’d love to somehow involve my passion into medicine, but I’m not sure exactly how to do this.
      I’m on placement at the moment and a few weeks ago I spent a day with a general practitioner that specialises in nutrition. She incorporated hair testing to determine zinc levels and I find it really interesting! So many medical students are skeptical about incorporating vitamins and nutrients as treatment because there is so little reliable evidence, but I believe that surely what we put in our bodies is going to influence the way that both our mind and body function!! I really want to somehow initiate a large scale study looking at, for example, the effect of zinc on mood disturbances, but I’m not sure how I’ll get the funding for it (pharmaceutical companies probably wont be keen to get involved hah).
      I’m excited to hear that I’m not the only medical student passionate about this sort of this, and I’m glad you’ve found my blog helpful!! Hopefully some of the recipes were appropriate for your post-workout meal 🙂

      • Laurena May 18, 2013 at 9:40 pm #

        I’m in private practice with my own Anti-aging clinic. Mostly using laser technology and injectables for facial rejuvenation. All my patients want good skin and are interested in how nutrition & lifestyle can contribute to looking and feeling good. I also provide nutritional support to members of a private fitness program and teach group fitness – so I get to meet people who are quite pro-active with their health.
        One thing I learnt is that you cannot look at nutrients in isolation. There is a synergy that exists. So if we only use evidence-based reductionist approaches to study nutrients in isolation we are missing the point – if nature intended our bodies to eat whole foods for nutrition & healing how can we study it? Medical school taught us EBM mostly so we have the ability to undertand the risks & benefits that apply specific drugs or interventions on a condition and we think we should use the same approach for every intervention. Is this really correct?
        What has really helped me was finding colleagues who thought the same – the Australasian College of Nutritional & Environmental Medicine (ACNEM) would be a great starting place.
        I’ve also been reading a book written by a family doctor on this area ‘Good Health In The 21st Century – A Family Doctor’s Unconventional Guide’ Dr Carole Hungerford. You are not alone! I strongly think you should pursue this passion!

      • brizah90 May 23, 2013 at 5:34 pm #

        Oh fantastic!! I think it’s great that you’re still running group fitness on the side – I think it sets a really good example when doctors are practicing what they preach, and I believe patients will be more likely to comply with that advice.
        I personally find it very difficult to stray away from EBM, and prefer to have all of my opinions and practice supported by research.
        I’ve actually joined ACNEM but haven’t had much time to really check the group out but I’ll have to look into it more.
        Thanks Laurena, I find it really inspiring to talk to a fellow medical professional who has stuck by the importance of nutrition and fitness 🙂

      • Laurena May 23, 2013 at 7:06 pm #

        Hi Bri,

        I agree – I think doctor’s should practice what they preach – otherwise it is just lip service!
        I agree that EBM is important. I didn’t mean to disregard it – in fact I always look for research that has been done well on nutritional and exercise interventions. I just mean that we have to look at methodologies carefully as when nutrients are tested incorrectly we find negative or even harmful results!
        There are two textbooks that I find really useful “”Herbs and Natural Supplements” Lesley Braun and “Integrative and Complementary Medicine” Vicki Kotsirilos – which uses NHMRC levels of evidence to grade therapies. They are a great investment!

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