Module 3: Nutritional Deficiency and Diseases

Case Study links

1.https://pmc.ncbi.nlm.nih.gov/articles/PMC9642367/#:~:
text=In%20children%2C%20severe%20vitamin%20D,delayed%20motor%20skills%20%5B5%5D.
• The above case study is on : severe vitamin D deficiency can lead to rickets. Rickets is a common
childhood skeletal disorder that causes the bones to soften and become weak resulting in bone
deformities. The patients can present with symptoms of bone pain, poor growth, and delayed motor
skills.
• 2.https://www.researchgate.net/
publication/364647088_Nutrition_and_Nutritional_Deficiency_Disease_A_Case_Study
• The purpose of the studied was to see nutrition and nutritional deficiency diseases of the rural
population of the selected villages of the area Manipur (India). The aim is to assess the real
nutritional value of the diets of the villagers and the diseases from which they suffer owing to
nutritional deficiency. The deficiency diseases has been studied in two groups-firstly, the deficiency
diseases which most often occur due to prolonged deficiency of nutrients in the diet; secondly, the
disease which are basically produced by deficiency and are accentuated due to the deficiency
 3.https://pmc.ncbi.nlm.nih.gov/articles/PMC5614218/#:~:text=Case%20presentation-,
A%2047%2Dyear%2Dold%20woman%20presented%20with%20a%204%2D,
reporting%20blurred%20vision%20and%20photophobia.
• The above case study is based on A 47-year-old woman presented with a 4-week
history of progressive loss of vision, first manifesting as night blindness.
Additionally, the patient reported frequent severe episodes of diarrhea over the past
month. Her medical history included end-stage renal failure(also known as kidney
failure, occurs when your kidneys can no longer adequately filter waste and excess
fluid from your blood, leading to a buildup of harmful substances in the body) for
which she was currently on haemodialysis after a failed renal transplant, chronic
pancreatitis and autonomic diabetes mellitus.
4.https://karger.com/cop/article/6/3/427/70953/Vitamin-A-Deficiency-Presenting-with-
Itchy-Eyes
We present the case of an 88-year-old female living in metropolitan Melbourne,
Australia who developed vitamin A deficiency manifesting as 'itchy eyes' due to a
bizarre dietary habit.
Meaning
Meaning
• Nutritional deficiency occurs when the body does not receive adequate
amounts of essential nutrients such as vitamins, minerals, proteins,
carbohydrates, or fats. This can lead to various health issues, known as
deficiency diseases.
 Types of Nutritional Deficiencies and Associated Diseases

• Macronutrient Deficiencies (Proteins, Carbohydrates, and Fats)

• Protein-Energy Malnutrition (PEM)
• Kwashiorkor : Caused by protein deficiency; symptoms include swollen belly, skin lesions, and stunted growth.
• Marasmus : Caused by protein and calorie deficiency; symptoms include severe weight loss, muscle wasting, and weakness.
• Micronutrient Deficiencies (Vitamins and Minerals)
• Vitamin Deficiencies
• Vitamin A Deficiency: Causes night blindness and dry eyes (xerophthalmia).
• Vitamin B1 (Thiamine) Deficiency: Leads to beriberi (weakness, nerve damage, and heart issues).
• Vitamin B12 Deficiency: Causes anemia, fatigue, and nerve damage.
• Vitamin C Deficiency: Leads to scurvy (bleeding gums, fatigue, and poor wound healing).
• Vitamin D Deficiency: Causes rickets in children (weak bones) and osteomalacia in adults.
• Vitamin K Deficiency: Leads to excessive bleeding due to poor blood clotting.
• Mineral Deficiencies
• Iron Deficiency : Causes anemia, fatigue, and reduced immunity.
• Iodine Deficiency: Leads to goiter (thyroid enlargement) and cretinism in infants.
• Calcium Deficiency: Causes weak bones, osteoporosis, and muscle cramps.
• Zinc Deficiency: Leads to stunted growth, weakened immunity, and poor wound healing.
Measurement of Nutritional Deficiencies

• Clinical Examination – Observing physical signs such as pale skin, swollen

belly, brittle nails, and poor growth.
• Biochemical Tests – Blood and urine tests to check for levels of vitamins,
minerals, and other nutrients (e.g., hemoglobin test for anemia).
• Dietary Assessment – Analyzing food intake through recall methods, food
diaries, or surveys.
• Anthropometric Measurements – Measuring body weight, height, BMI, and
mid-upper arm circumference to assess malnutrition.
Protein-Energy Malnutrition (PEM)
Protein-energy malnutrition (PEM) is a condition caused by a deficiency of
protein, calories, or both. It commonly affects children and people in poverty-
stricken areas where food availability is limited. PEM can lead to severe
growth impairment, weakened immunity, and even death if untreated.
 Types of Protein-Energy Malnutrition
• Kwashiorkor
• Cause: Severe protein deficiency despite adequate calorie intake (mainly carbohydrate-based diet).
• Symptoms:
• Swollen belly (due to fluid retention)
• Dry, peeling skin with discoloration
• Hair loss and discoloration
• Stunted growth
• Weakness and lethargy
• Enlarged liver (fatty liver)
• Common in: Children aged 1-5 years who are weaned off breast milk onto a low-protein diet.
• Marasmus
• Cause: Severe deficiency of both calories and protein.
• Symptoms:
• Extreme weight loss and muscle wasting
• Thin, frail body with visible bones
• Loose, wrinkled skin
• Weak immune system, leading to infections
• Growth failure
• Irritability and lethargy
• Common in: Infants and young children in famine or poverty-stricken areas.
• Marasmic Kwashiorkor
• A combination of both conditions, showing features of severe malnutrition, including muscle wasting and swelling (edema).
Causes of PEM

• Inadequate intake of protein and calories due to poverty, famine, or poor

dietary habits.
• Chronic infections such as tuberculosis, HIV/AIDS, or diarrhea that increase
nutrient loss.
• Poor maternal nutrition, leading to malnourished infants.
• Improper weaning practices in young children.
 Diagnosis and Measurement
Anthropometric Measurements:
• Low weight-for-height (wasting) and low height-for-age (stunting).
• Mid-upper arm circumference (MUAC) < 11.5 cm in children indicates severe malnutrition.
Biochemical Tests:
• Low serum albumin (in kwashiorkor).
• Low blood glucose and electrolyte imbalances.
Clinical Symptoms:
• Visible muscle wasting, skin changes, swollen belly, lethargy.
Treatment and Prevention
Immediate Care:
• Rehydration with oral rehydration solutions (ORS) and electrolytes.
• Gradual introduction of nutrients with ready-to-use therapeutic foods (RUTF) like Plumpy'Nut.
• High-calorie, high-protein diets with essential vitamins and minerals.
Long-term Prevention:
❑ Breastfeeding( Feeding infants with breast milk, which provides essential nutrients, antibodies, and immune support for healthy growth
and development. Exclusive breastfeeding is recommended for the first six months of life) and proper weaning practices(The gradual
transition from breast milk to solid foods after six months. This includes:Introducing soft, mashed foods (e.g., porridge, mashed fruits, and
vegetables),Providing nutrient-rich foods with proteins (eggs, fish, dairy, legumes),Ensuring a balanced diet to prevent malnutrition.
❑ Educating communities about balanced diets.
❑ Improving food security and access to healthcare.
 Biological Value (BV) of Protein
• Definition:
Biological Value (BV) is a measure of how efficiently the body can utilize the protein from a particular food source. It indicates the proportion of absorbed protein that is retained and used for
growth, maintenance, and repair of body tissues.
• Formula:
• BV=(Nitrogen retained/Nitrogen absorbed)×100
• Key points
• BV Ranges from 0 to 100+
• Higher BV means the protein is more efficiently used by the body.
• Lower BV means the protein is less efficiently used.
• BV of Some Common Proteins:
• Egg Protein (Whole Egg) – 100 (Gold standard)
• Whey Protein – 104-110 (More than eggs due to high digestibility)
• Milk (Casein) – 77-80
• Beef – 80
• Soy Protein – 74
• Rice – 59
• Wheat – 54
• Importance of BV:
• Helps determine protein quality in diets.
• Essential for athletes, bodybuilders, and people recovering from illness to select the best protein sources.
• Supports muscle growth and tissue repair effectively.
• Limitations of BV:
• Does not consider protein digestibility fully.
• Does not reflect how different proteins work together in a diet.
Protein Efficiency Ratio (PER)
1. Protein Efficiency Ratio - an overview | ScienceDirect Topics
2. Draft Guidance for Industry: Protein Efficiency Ratio (PER) Rat
Bioassay Studies to Demonstrate that a New Infant Formula
Supports the Quality Factor of Sufficient Biological Quality of
Protein | FDA
• Protein Efficiency Ratio (PER) is a measure of the effectiveness of a protein in promoting body growth. It is calculated
by determining the weight gain of a test subject (usually a growing rat) per gram of protein consumed.
• Key Features of PER:
• Used to Measure Protein Quality:
• PER helps determine how efficiently a protein supports growth and body weight gain.
• A higher PER indicates a more effective protein for promoting growth.
• Common PER Values of Food Proteins:
• Egg protein – 3.8
• Milk protein (Casein) – 2.5
• Beef – 2.9
• Soy protein – 2.1
• Wheat protein – 1.5
• Importance of PER:
• Used in infant nutrition and animal feed formulations.
• Helps in selecting high-quality protein sources for growth and development.
• Limitations of PER:
• It is based on rat growth studies, which may not fully represent human protein needs.
• Does not account for protein digestibility and amino acid composition.
• Less relevant for adult nutrition, where protein is needed more for maintenance rather than growth.
Vitamin A and D Deficiencies
✅
Vitamin A Deficiency (VAD)
Causes:
• Insufficient dietary intake (common in malnourished populations)
• Fat malabsorption disorders (e.g., liver disease)

✅
• Increased need (e.g., during pregnancy, infections)
Symptoms:
• Night blindness (Nyctalopia)
• Xerophthalmia (dry eyes leading to blindness)
• Bitot's spots (foamy white patches on the eye)
• Weakened immunity (higher risk of infections)

✅
• Delayed growth and development
Prevention & Treatment:
• Eat carrots, leafy greens, eggs, liver, dairy products
• Vitamin A supplementation in at-risk populations
• Fortified foods (e.g., fortified milk, margarine)
 Vitamin D Deficiency
✅ Causes:
• Lack of sunlight exposure
• Poor dietary intake (common in vegetarians, elderly)

✅
• Kidney or liver disorders affecting vitamin D metabolism
Symptoms:
• Rickets (in children) – soft, weak bones, bowed legs
• Osteomalacia (in adults) – bone pain, fractures
• Muscle weakness and fatigue

✅
• Weakened immunity
Prevention & Treatment:
• Sun exposure (15–30 mins daily)
• Eat fatty fish, egg yolks, fortified dairy
• Vitamin D supplements, especially for high-risk groups
 Iron Deficiency & Disorders
✅ Causes:
• Poor dietary intake (low iron foods)
• Blood loss (menstruation, ulcers, injuries)
• Pregnancy & rapid growth phases
•
✅ Symptoms & Disorders:
Poor absorption (due to gut issues or inhibitors like tea, coffee)

• Iron Deficiency Anemia – fatigue, pale skin, dizziness

• Weak immunity – increased infections
• Poor concentration – affects cognitive function
•
✅ Prevention & Treatment:
Delayed growth & development (in children)

• Eat red meat, liver, spinach, beans, fortified cereals

• Improve iron absorption by consuming vitamin C-rich foods
• Iron supplements for at-risk groups
 Iodine Deficiency & Disorders
✅ Causes:
• Low iodine intake (common in inland areas)
• Excess consumption of goitrogens (e.g., cabbage, soy)

✅
• Pregnancy (increased iodine need)
Symptoms & Disorders:
• Goiter – enlarged thyroid gland
• Cretinism – severe mental & physical retardation in infants
• Hypothyroidism – fatigue, weight gain, slow metabolism

✅
• Brain damage & low IQ in children
Prevention & Treatment:
• Eat iodized salt, seafood, dairy, eggs
• Iodine supplements in iodine-deficient areas
 Zinc Deficiency & Disorders

✅ Causes:
• Poor diet (low in animal proteins)
• Malabsorption disorders (e.g., Crohn's disease)

✅
• High phytate intake (found in whole grains, legumes)
Symptoms & Disorders:
• Poor wound healing
• Growth retardation in children
• Hair loss, skin rashes, weak immunity

✅
• Loss of taste & appetite
Prevention & Treatment:
• Eat meat, shellfish, nuts, seeds, whole grains
• Zinc supplements for those at risk
 Fluorosis
Fluorosis is a condition caused by excessive fluoride intake, leading to dental and skeletal damage. It mainly affects the

✅
teeth and bones.
Causes:
• High fluoride levels in drinking water (>1.5 mg/L)
• Excessive use of fluoride toothpaste/mouthwash

✅
• Consumption of fluoride-rich foods or industrial exposure
Types & Symptoms:
• Dental Fluorosis:
• Affects developing teeth (children under 8 years)
• Causes white spots, streaks, or brown stains on teeth
• Severe cases lead to pitted, weak enamel
• Skeletal Fluorosis:
• Affects bones and joints
• Causes stiffness, joint pain, and bone deformities

✅
• In severe cases, can lead to crippling disability
Prevention & Treatment:
• Monitor fluoride levels in drinking water (ideal: 0.7–1.2 mg/L)
• Avoid excessive fluoride-containing products
• Use defluoridation techniques (e.g., activated alumina filters)
• Medical treatment in severe cases
 Fluoride
Fluoride is a naturally occurring mineral that helps strengthen teeth and prevent cavities. It is found in water, soil, food, and some dental

✅
products .
• Sources of Fluoride (Examples):
• Natural Sources:
• Fluoridated water (tap water in some areas)
• Tea (especially black and green tea)
• Seafood (e.g., shrimp, crab, fish)
• Fluoride-rich vegetables (e.g., spinach, potatoes)
• Artificial Sources:
• Fluoride toothpaste & mouthwash
• Fluoridated salt (used in some countries)

✅
• Dental treatments (fluoride varnishes, gels)
• Functions of Fluoride:
• Strengthens tooth enamel (prevents cavities)
• Helps in bone health (in small amounts)
• Reduces tooth decay by remineralizing enamel
 What is Etiology?
• Etiology refers to the cause or origin of a disease or medical condition. It
helps in understanding the factors that contribute to the development of a
disease.
• In the case of obesity, etiology includes genetic, environmental, lifestyle,
psychological, and medical factors that lead to excessive weight gain.
Identifying the etiology is essential for prevention and treatment.
 Obesity results from an imbalance between calorie intake and energy expenditure. The main causes
include:
• A. Genetic Factors
• Family history of obesity increases the risk.
• Certain genetic mutations affect metabolism and appetite regulation (e.g., mutations in the MC4R
gene).
• B. Environmental & Lifestyle Factors
• Dietary Habits: High-calorie, processed food consumption.
• Sedentary Lifestyle: Lack of physical activity.
• Urbanization: Increased fast food availability and reduced physical activity opportunities.
• C. Psychological Factors
• Emotional stress and depression may lead to overeating.
• Binge eating disorder is linked to obesity.
• D. Hormonal & Medical Conditions
• Endocrine disorders: Hypothyroidism, Cushing's syndrome.
• Medications: Some antidepressants, antipsychotics, and corticosteroids can cause weight gain.
Treatment of Obesity
Lifestyle Modifications
• Dietary Changes:
• Reduce calorie intake, especially from refined sugars and saturated fats.
• Increase fiber-rich foods, lean proteins, and healthy fats.
• Physical Activity:
• At least 150–300 minutes of moderate-intensity exercise per week.
• Strength training to improve metabolism.
• Behavioral Therapy:
• Counseling, cognitive behavioral therapy (CBT), and support groups.
• B. Pharmacological Treatment
• Orlistat: Inhibits fat absorption.
• Liraglutide & Semaglutide: Appetite suppressants.
• Metformin: Used in obese patients with insulin resistance.
• C. Surgical Treatment (Bariatric Surgery)
• Gastric Bypass: Reduces stomach size and nutrient absorption.
• Gastric Banding: Limits food intake by placing a band around the stomach.
• Sleeve Gastrectomy: Removes part of the stomach to reduce appetite.
 Consequences of Obesity

Physical Health Risks

• Cardiovascular Diseases: Hypertension, heart disease, stroke.
• Type 2 Diabetes: Insulin resistance leads to increased blood sugar levels.
• Joint Problems: Osteoarthritis due to excess weight.
• Respiratory Disorders: Sleep apnea, obesity hypoventilation syndrome.
• Fatty Liver Disease: Non-alcoholic fatty liver disease (NAFLD).
• Certain Cancers: Higher risk of breast, colon, and endometrial cancer.
• B. Psychological & Social Consequences
• Increased risk of depression, anxiety, and low self-esteem.
• Social stigma and discrimination can impact quality of life.
 Prevention of Obesity
Healthy Eating Habits
• Balanced diet with portion control.
• Avoid processed foods and sugary drinks.
• B. Regular Physical Activity
• Encourage daily movement, walking, or sports activities.
• Reduce screen time and sedentary behaviors.
• C. Public Health Measures
• Government policies promoting healthy food choices.
• School programs encouraging physical education and nutrition awareness.
• D. Early Intervention
• Regular health check-ups to monitor weight gain.
• Address risk factors early in childhood and adolescence.
Obesity is a complex disease with multiple causes, requiring a combination of lifestyle changes, medical interventions, and preventive strategies.
Managing obesity effectively can reduce the risk of severe health conditions and improve overall well-being.
Diabetes mellitus and its Types
• Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose (sugar) levels
due to the body's inability to produce enough insulin or use it effectively. Insulin is a hormone
produced by the pancreas that helps regulate blood sugar levels.
• Types of Diabetes Mellitus (Brief Explanation):
• Type 1 Diabetes Mellitus:
• An autoimmune condition where the immune system attacks and destroys insulin-producing beta cells in the
pancreas.
• Usually develops in childhood or adolescence.
• Requires lifelong insulin therapy.
• Type 2 Diabetes Mellitus:
• The most common type.
• Caused by insulin resistance and/or reduced insulin production.
• Common in adults but increasingly seen in younger people due to obesity and sedentary lifestyle.
• Managed through lifestyle changes, oral medications, and sometimes insulin.
• Gestational Diabetes Mellitus (GDM):
• Occurs during pregnancy due to hormonal changes causing insulin resistance.
• Usually resolves after delivery but increases the risk of developing type 2 diabetes later.
• Other Specific Types (Secondary Diabetes):
• Caused by other medical conditions or medications (e.g., pancreatitis, steroid use, genetic disorders).
• Includes conditions like MODY (Maturity Onset Diabetes of the Young) and LADA (Latent Autoimmune
Diabetes in Adults).
Case Study examples for each type of
Diabetes Mellitus
1. Type 1 Diabetes Mellitus – Case Study
• Patient: Aarav, 12-year-old boy
History: Sudden weight loss, frequent urination, excessive thirst, fatigue
Diagnosis: Blood glucose >300 mg/dL, ketones in urine, HbA1c 9.5%
Management: Started on insulin therapy (basal-bolus), educated on carb
counting, regular blood glucose monitoring.
2. Type 2 Diabetes Mellitus – Case Study
• Patient: Meena, 48-year-old woman, overweight (BMI 29), sedentary
lifestyle
Symptoms: Increased fatigue, blurred vision, frequent infections
Diagnosis: Fasting glucose 150 mg/dL, HbA1c 8.2%
Management: Prescribed metformin, advised lifestyle changes (diet +
exercise), regular monitoring, weight loss goal
 3. Gestational Diabetes Mellitus (GDM) – Case Study
• Patient: Sita, 30-year-old, 26 weeks pregnant
Screening: Failed oral glucose tolerance test (OGTT)
Diagnosis: GDM confirmed
Management: Managed initially with diet and exercise; later needed
insulin; monitored fetal growth and blood sugar
Outcome: Delivered healthy baby; advised postpartum screening for
type 2 diabetes.
4. Secondary Diabetes (MODY) – Case Study
• Patient: Rahul, 22-year-old, family history of early-onset diabetes
History: Mild hyperglycemia since teenage years
Diagnosis: Genetic testing confirmed MODY (HNF1A mutation)
Management: Responded well to low-dose sulfonylureas instead of
insulin
 Dietary Treatment for Diabetes Mellitus (Type I and Type II)
1. Type 1 Diabetes Mellitus (T1DM) – Dietary Management
• Type 1 diabetes is insulin-dependent. Diet must match insulin action to avoid hypoglycemia or hyperglycemia.
• Goals:
• Prevent hypoglycemia/hyperglycemia
• Maintain ideal body weight and nutritional needs (especially in children)
• Support growth in pediatric patients
• Adjust diet to match insulin doses (or vice versa)
• Key Dietary Principles:
• Carbohydrate Counting:
• Helps in insulin dose adjustment based on carb intake.
• 1 carb exchange = 15 g carbohydrate.
• Glycemic Index (GI):
• Encourage low GI foods (whole grains, legumes).
• Meal Timing & Consistency:
• 3 meals + 2–3 snacks per day
• Maintain timing to match insulin action
• Balanced Macronutrients:
• Carbs: 50–55%
• Protein: 15–20%
• Fat: 25–30% (mostly unsaturated)
• Limit Simple Sugars: Avoid sweets, sugary drinks.
 2. Type 2 Diabetes Mellitus (T2DM) – Dietary Management
• T2DM is often related to obesity and insulin resistance. Dietary
management focuses on weight control and improving insulin sensitivity.
• Goals:
• Achieve and maintain healthy weight
• Control blood glucose and lipid levels
• Prevent complications (heart disease, kidney issues)
• Key Dietary Principles:
• Calorie Control: Based on age, weight, physical activity
• Low Glycemic Index Foods: Reduce blood sugar spikes
• High-Fiber Diet: Whole grains, fruits, vegetables, legumes (25–40 g/day)
• Healthy Fats: Use MUFA (olive oil, nuts), limit saturated fats and trans fats
• Portion Control: Avoid overeating, even healthy foods
• Limit Refined Carbs and Sugars: No sugary drinks, white bread
• Meal Frequency: Small, frequent meals to avoid sugar swings
• Hydration: Encourage water, avoid sugary beverages
 Case Study Examples Type 2 Diabetes – Case Study
• Type 1 Diabetes – Case Study • Patient: Mr. Ramesh, 55 years old, overweight (BMI 31),
sedentary job
• Patient: Ananya, 14-year-old schoolgirl Diagnosis: Type 2 Diabetes, HbA1c 8.5%, Fasting glucose 160
History: Diagnosed with T1DM at age 10, on insulin (basal- mg/dL
bolus) Diet Plan Highlights:
Diet Plan Highlights:
• Calorie intake: 1600 kcal/day for weight loss
• Breakfast: 1 boiled egg, 2 whole wheat toasts, 1 glass milk
(low fat) • Carbs from low GI foods (e.g., oats, brown rice, legumes)
• Mid-morning: Apple + 5 almonds • Protein: Paneer, dals, egg whites
• Lunch: Brown rice, dal, vegetables, salad, curd • Fats: Switched to olive oil, limited ghee
• Evening Snack: Roasted chana + tea (no sugar) • No added sugar or sweets
• Dinner: 2 chapatis, paneer, mixed veg, cucumber • Exercise: 30-minute walk daily
• Late night: 1 glass warm milk • Outcome: Lost 6 kg in 3 months, HbA1c reduced to 6.9%, no
insulin needed.
• Outcome: Maintained stable sugars (HbA1c 6.8%), active in
school sports.

Summary / conclusion
Diet is key to diabetes management for both types.
Type 1 : Focus on matching carbs with insulin.
Type 2 : Focus on weight loss, insulin sensitivity, and sugar control.
Individualized meal planning is essential.
Regular monitoring and dietitian follow-up improves outcomes.
 Complications of Diabetes Mellitus
Diabetes mellitus, if not well-controlled, can lead to several acute and chronic complications due to prolonged high blood sugar
levels. These complications can affect almost every organ system in the body.
1. Acute Complications
a. Hypoglycemia
• Cause: Too much insulin, missed meals, excessive exercise
• Symptoms: Sweating, tremors, confusion, dizziness, unconsciousness
• Emergency treatment: Fast-acting carbs (glucose tablets, juice)
b. Diabetic Ketoacidosis (DKA) – Common in Type 1
• Cause: Severe insulin deficiency
• Features: Nausea, vomiting, abdominal pain, fruity breath, deep breathing, coma
• Requires urgent medical care
c. Hyperosmolar Hyperglycemic State (HHS) – Common in Type 2
• Cause: Very high blood sugar without ketosis
• Features: Extreme dehydration, confusion, seizures
• Requires hospitalization
 2. Chronic Complications
These develop over time due to persistent hyperglycemia.
a. Microvascular Complications:
• Diabetic Retinopathy – Damage to eye blood vessels
→ Can cause blindness if untreated
• Diabetic Nephropathy – Kidney damage
→ Leads to proteinuria, kidney failure
• Diabetic Neuropathy – Nerve damage
→ Symptoms: Burning pain, numbness, especially in feet
b. Macrovascular Complications:
• Cardiovascular Disease – Heart attack, stroke
• Peripheral Artery Disease (PAD) – Poor circulation in legs
→ May lead to non-healing ulcers, gangrene
c. Diabetic Foot:
• Ulcers, infections, and risk of amputation due to poor circulation and nerve damage
 Case Study Example
• Patient: Mrs. Lakshmi, 60 years old, diabetic for 15 years (Type 2
DM)
• History: Outcome:
• Poor sugar control for several years (HbA1c 9.5%) • With proper multidisciplinary care,
• Complains of blurred vision, tingling in feet, fatigue progression of complications slowed, and
• Clinical Findings: quality of life improved.
• Retinopathy: Diagnosed with background diabetic retinopathy Conclusion
during an eye exam
• Complications of diabetes can be life-
• Neuropathy: Reports burning sensation in feet; monofilament threatening and debilitating.
test confirms nerve damage
• Nephropathy: Urine test shows proteinuria; eGFR mildly reduced • Regular monitoring, good glycemic
control, and early detection are essential.
• Foot Care: Has a non-healing ulcer on the right foot
• Management:
• Case studies show that complications can
be prevented or delayed with proper
• Tight glucose control (HbA1c goal <7%) management.
• Referred to ophthalmologist
• Nephrologist follow-up for kidney monitoring
• Started on ACE inhibitors for kidney protection
• Foot care education and daily inspection
 Diseases of the Heart and Blood Vessels
Diseases of the heart and blood vessels are collectively referred to as cardiovascular diseases (CVDs). They are the leading cause of death
globally. These conditions include coronary artery disease, hypertension, heart failure, stroke, and peripheral artery disease.
Etiology (Causes)
• - Atherosclerosis (plaque buildup in arteries)
- Hypertension (high blood pressure)
- Smoking and alcohol consumption
- High cholesterol and obesity
- Diabetes mellitus
- Sedentary lifestyle
- Genetic predisposition and age
- Chronic stress
Symptoms
• - Chest pain or discomfort (angina)
- Shortness of breath
- Fatigue and weakness
- Palpitations
- Swelling in legs, ankles, and feet (edema)
- Dizziness or fainting
- Sudden numbness or weakness (stroke symptoms)
Diagnosis
• - Physical examination and patient history
- Blood tests (cholesterol, blood sugar)
- Electrocardiogram (ECG/EKG)
- Echocardiogram (heart ultrasound)
- Stress test (exercise ECG)
- Coronary angiography (to visualize blood flow)
- CT or MRI scans
- Blood pressure monitoring
Case Study Example
Patient: Mr. Rajesh, 58 years old
History: Smoker, diabetic, overweight
Symptoms: Chest pain, shortness of breath during walking
Diagnosis: ECG showed ST segment depression, elevated LDL cholesterol,
angiography revealed 70% blockage in coronary arteries
Management: Advised lifestyle changes, started on statins and antihypertensives,
scheduled for angioplasty
Outcome: Improved exercise tolerance and reduced symptoms with proper
management and follow-up.
Atherosclerosis,lipids and other dietary factors
responsible for CHD(Coronary heart diseases)
Atherosclerosis is a chronic inflammatory disease of the arteries characterized by
the buildup of plaque (fat, cholesterol, calcium, and cellular waste) on the inner
walls of arteries. This causes:
• Narrowing and hardening of arteries
• Reduced blood flow to the heart (leading to angina)
• Complete blockage can result in a heart attack (myocardial infarction)
Process of Atherosclerosis:
• Damage to arterial lining (due to high BP, smoking, high sugar)
• LDL cholesterol penetrates damaged wall
• Immune cells react, forming fatty streaks
• Over time, plaque forms, hardens, and narrows the artery
• Plaque rupture can trigger blood clots → Heart Attack or Stroke
:

Role of Lipids in CHD(Coronary heart diseases)

Key Lipid Components

Role in CHD
Lipid Type

LDL (Low-Density Lipoprotein) "Bad cholesterol" – major contributor to plaque

HDL (High-Density Lipoprotein) "Good cholesterol" – removes excess cholesterol

Triglycerides Elevated levels → increased CHD risk

Total Cholesterol High levels → higher CHD risk

 Dietary Factors Responsible for CHD
A. Harmful Dietary Factors:
• Saturated Fats: Found in red meat, butter, full-fat dairy → increases LDL
• Trans Fats: Found in margarine, bakery items → raises LDL, lowers HDL
• Cholesterol: High intake (eggs, organ meat) can raise blood cholesterol in some individuals
• Refined Carbohydrates & Sugars: White bread, pastries, sugary drinks → increase triglycerides,
insulin resistance
• Excess Caloric Intake: Leads to obesity, metabolic syndrome
B. Protective Dietary Factors:
• Omega-3 Fatty Acids: From fatty fish, flaxseed – reduce triglycerides and inflammation
• Fiber: Soluble fiber (oats, legumes) lowers LDL
• Antioxidants: Fruits and vegetables help reduce oxidative stress
• Plant Sterols/Stanols: Lower cholesterol absorption
• Monounsaturated & Polyunsaturated Fats: Olive oil, nuts, seeds – help improve lipid profile
Case Study Example:
Patient: Mr. Suresh, 52 years old
Background:
BMI: 29 (Overweight) Outcome:
Smoker, high-stress job • After 6 months: Weight loss of 8 kg, LDL dropped to 110 mg/dL, improved
Eats fast food 4–5 times a week energy and walking endurance
Minimal physical activity
Symptoms: Conclusion
Chest discomfort during exertion • Atherosclerosis is the underlying cause of CHD, driven largely by lipid
imbalance and poor dietary habits.
Fatigue, shortness of breath
• A heart-healthy diet, rich in fiber, healthy fats, and antioxidants, and
Tests: low in saturated/trans fats and sugars, plays a crucial role in prevention
and management.
LDL: 180 mg/dL (high)
• Lifestyle modifications can significantly reverse or slow the progression
HDL: 35 mg/dL (low) of CHD, as seen in the case study.
Triglycerides: 250 mg/dL
ECG: Suggestive of ischemia
Angiography: 70% blockage in left anterior descending artery
Diagnosis: Coronary Artery Disease due to Atherosclerosis
Dietary Management:
Reduced saturated fat intake (<7% of total calories)
Eliminated trans fats entirely
Switched to olive oil, added nuts and seeds
High-fiber diet (30 g/day) with more fruits, vegetables, oats, legumes
Weekly fish intake (2 servings)
Limit salt to <5g/day
Reduced calorie intake to promote weight loss
 Dietary Habits for CHD
• CHD is caused by atherosclerosis (plaque buildup in arteries), reducing blood flow
to the heart.
Recommended Dietary Habits:
- Low saturated and trans fat intake
- High fiber diet (whole grains, fruits, vegetables)
- Omega-3 rich foods (fish, flaxseeds)
- Limit salt and sugar
- Use plant-based oils (olive oil)
- Control portion size and maintain healthy weight

• Case Study: Mr. Sharma, 55, with chest pain and diagnosed CHD. Diet included high-
fat snacks and red meat. Post-diagnosis, he shifted to a Mediterranean-style diet,
reduced weight, and improved lipid profile.
Hypertension
Hypertension is high blood pressure, increasing risk for stroke, heart, and kidney
disease.
Recommended Dietary Habits:
- Low sodium diet (<1500 mg/day)
- DASH diet (rich in fruits, vegetables, low-fat dairy)
- Limit processed foods
- Avoid alcohol and caffeine excess
- Increase potassium (bananas, spinach, sweet potatoes)

• Case Study: Mrs. Lakshmi, 60, had BP 160/100 mmHg. Advised DASH diet and
reduced salt use. Within 3 months, BP reduced to 130/85 mmHg without medication.
 Hyperlipidemia
• Hyperlipidemia is elevated levels of lipids in blood (cholesterol, triglycerides),
increasing CHD risk.
Recommended Dietary Habits:
- Avoid saturated fats (butter, ghee, red meat)
- Avoid trans fats (processed snacks)
- Include soluble fiber (oats, legumes, fruits)
- Increase intake of nuts, seeds, and omega-3
- Maintain healthy weight and exercise regularly

• Case Study: Anil, 42, had LDL 190 mg/dL and triglycerides 280 mg/dL. With dietary
changes (more fiber, less fat) and exercise, lipid levels normalized in 5 months.
 Fatty Liver conditions
Non-alcoholic fatty liver disease is excess fat in liver not caused by alcohol.
Recommended Dietary Habits:
- Calorie-controlled diet for weight loss
- Avoid sugar-sweetened beverages and processed foods
- Low glycemic index foods (whole grains, legumes)
- Limit saturated fat and simple sugars
- Include antioxidants (green tea, berries, leafy greens)

• Case Study: Ravi, 35, obese with fatty liver on ultrasound. Advised low-sugar, high-
fiber, plant-based diet. Liver enzymes normalized and weight reduced by 10 kg over
6 months.