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The oral manifestations of vitamin deficiencies are often the first indications of malnutrition. This is especially true among the elderly, whose more frequent physical and/or psychological disorders may prevent them from eating a balanced diet. The following is a guide to the dentist, who is often the first health professional to recognize nutritional deficiencies in this age group.
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The benefits of parenteral feeding need no longer be emphasised. However, qualitative and quantitative food supplements raise a certain number of difficulties which should be better known. Infection is the most frequent complication. It may be avoided by strict aseptic precautions throughout parenteral feeding. Hypoglycemia is a major risk owing to the possible consequence. Hyperglycemia and its consequence of osmotic polyuria is more frequent and should be controlled to avoid loss of water and salt. Complications due to the use of lipid emulsions are exceptional when soya oil is used. Hypophosphoremia should be corrected by increasing phosphate intake. Hypocalcemia is common; it is often associated with hypoproteinemia and sometime a low calcium intake, vitamin D deficiency or a sudden increase in phosphate intake. Vitamin deficiencies, hypomagnesemia, and oligo-element deficiencies should be correcty by appropriate supplements.
UNLABELLED: Idiopathic gastroparesis (IG), a disorder characterized by abnormally delayed emptying of food from the stomach, is associated with many symptoms that could have an impact on dietary intake. The intake of dietary protein, carbohydrate, fat, fiber, vitamins, and minerals was prospectively evaluated in patients with symptomatic IG and compared with asymptomatic controls. Twenty-four patients and 24 age- and sex-matched controls completed a detailed 7-day diet record while consuming a self-selected diet. Dietary information was entered into a computer and analyzed using the Nutranal program. Results were expressed as daily intake and percent recommended dietary allowance (%RDA) when applicable. Patients consumed a diet containing fewer calories than would have been predicted based on age, height, sex, frame, and weight (85% of calculated energy expenditure vs 100%) for controls. Although patients with IG consumed significantly fewer calories than controls (1112 kcal vs 1431 kcal), the proportion of fat (32% vs 34%), carbohydrate (49% vs 48%), and protein (17% vs 16%) was similar in the two groups. Intake of vitamins B6, vitamin C, folate, niacin, riboflavin, thiamine, calcium, copper, iron, magnesium, phosphorus, and zinc were below the %RDA. Intake of vitamin B12, vitamin C, folate, thiamine, niacin, magnesium, phosphorus, and zinc were significantly less than controls. Vitamin A intake was above the RDA and not different from that of controls. Prolonged t1/2 of solids correlated with diminished intake of protein, iron, niacin, and potassium. They correlated inversely with serum albumin in patients with idiopathic gastroparesis. CONCLUSION: Although eating less, patients with IG do not consistently alter the proportion of fat, carbohydrate, and protein in their diets. Because their diet is markedly deficient in a number of essential vitamins and minerals, dietary evaluation and counseling is suggested for all patients with idiopathic gastroparesis.
It was established that chronic alcohol intoxication is accompanied by development of multivitamin insufficiency. In the initial stage of the disease the patients showed only biochemical signs and at later stages also clinical signs of hypovitaminosis.
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Parenteral nutrition is incomplete without vitamins. Marginal vitamin deficiency under parenteral nutrition is certainly more common than generally recognized. Even marginal and undiscernable vitamin deficiency interferes with healing processes and increases the rate of complications since vitamins are involved in a variety of ways in wound healing, regeneration processes and immune function. If total parenteral nutrition is necessary for longer periods of time, exceeding 5 days, vitamins should be substituted in the recommended doses. The assessment of a marginal vitamin deficiency is difficult to perform and extremely expensive. It is therefore easier, safer and cheaper to substitute vitamins in total parenteral nutrition from the beginning, if preceeding malnutrition is likely. Recommendations for dosage and mode of application are reported and explained.
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The authors have presented a discussion of some of the more common nutritional deficiency syndromes. A discussion of the etiology, clinical manifestation, diagnosis, and prognosis has been provided. Special attention has been given to the relationship between nutritional deficiency and the development of peripheral neuropathies. When patients suffering from peripheral neuropathy present, the possibility of a nutritional deficiency should be considered. The diagnosis of a nutritional deficiency neuropathy is rarely established. This may not merely be the result of a low incidence of the problem. The prompt diagnosis and treatment may afford dramatic results. The more protracted the course for diagnosis, the less favorable the prognosis. It is often difficult to pinpoint the exact nutritional deficiency present. Various methods have been discussed in this article; however, often multiple deficiencies are present simultaneously. The treatment with pharmacologic supplementation is usually very innocuous. It often proves beneficial to administer pharmacologic supplementation for a short period. This will aid in the differential diagnosis. Often prescribing a patient large doses of the B-complex vitamins for a limited time will allow the physician to determine if a nutritional neuropathy is present. It should also be remembered that just because a patient is suffering from a peripheral neuropathy from a metabolic disease or secondary to medication, they may also be suffering from a nutritional deficiency simultaneously. We believe that the podiatric physician is well trained to extend comprehensive treatment of pedal manifestations of peripheral neuropathies. Podiatric physicians have a large armamentarium at their disposal to treat the pedal manifestations of the disease sufficiently. These treatments may be conservative or surgical in nature, as previously discussed. We hope that this discussion will increase the awareness of the physician to the various ramifications of nutritionally induced neuropathies as well as the provision of insight into the most efficacious means available for appropriate management.
Peripheral neuropathy is a common and potentially incapacitating complication of prolonged overuse of alcohol. As a relatively early feature of chronic alcoholism, its early identification is of value in the prevention of other and more dangerous consequences of alcohol abuse. With vigilance, peripheral neuropathy is easily diagnosed before gross incapacity has resulted, but its management entails all the problems encountered in the treatment of chronic alcoholism.
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In conclusion, glossodynia may present to a number of specialists. A wide variety of conditions may be responsible and the cause may be multifactorial. A systemic approach to assessment is essential and the opinion of other specialities, particularly dentistry, may be of help. Treatment is of the underlying cause but in many cases no specific aetiological factor is identified. The reassurance that there is no significant underlying pathology may in itself be sufficient to alleviate the symptom.
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Periosteal reaction is frequently the first sign of systemic disease affecting the skeleton, including generalized osteopathia. It can be generalized, focal, monostotic or polyostotic and shows solid, lamellary or interrrupted spiculae-like reaction. A reliable diagnosis is possible from the interpretation of these changes, as for instance with spiculae: Very dense and evenly arranged spiculae are only seen in hemolytic anemias and metastases of neurogenic tumors. Onionskin like periosteal reaction with simultaneous transformation of the diaphyseal cortex are difficult to interpret. However, in case of hyperparathyreoidism, subperiosteal resorption and transformation of the diaphyseal cortex permit precise diagnosis. Follow-up examinations have prognostic and therapeutic value. The knowledge of the different morphology of periosteal reaction associated with systemic disease (including generalized osteopathias) is important in diagnostic radiology.
The authors report data of an investigation of the vitamin status in 154 patients with ischemic heart disease. A deficit of B1-, B2, PP-, B6 and C vitamins was found in the absolute majority of patients. Multivitamin deficiency was as a rule found. It is indicated that multivitamins should be given during the entire course of treatment of patients with ischemic heart disease.
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