NITROGEN BALANCE
MALNUTRITION
DR.Manoj kangra
Department of Biochemistry
Nitrogen balance:
A state where the amount of nitrogen ingested each
day is balanced by the amount excreted.
(no change in the amount of body Nitrogen)
Dietary intake of Nitrogen equals to the daily loss of N2 in
Urine(U), Faeces(F) and Sweat(S)
Nitrogen equilibrium I = U+F+S
Dietary intake of Nitrogen = I
Daily Loss of Urine = (U)
Daily Loss Faeces = (F)
Daily Loss Sweat = (S)
There are 2 type nitrogen balance
a. Positive Nitrogen balance
b. Negative nitrogen balance
Positive Nitrogen balance:
Intake of N2 is higher than output Nitrogen. It cause net increase
of protein in body. It observed in growing children, who are
increasing their body weight and incorporating more amino
acids into proteins than they breakdown.
pregnant women and during recovery after serious illness
Negative Nitrogen balance:
Output of Nitrogen higher than intake of N2. It may decrease the
body protein level. Prolonged negative balance may lead to
death. This occurs in starvation and certain diseases.
It may occur due to inadequate dietary of protein.
Factors affecting Nitrogen balance:
i. During active growth, positive nitrogen balance
exist.
ii. Insulin and androgens promotes positive nitrogen
balance where as corticosteroids cause negative
nitrogen balance
iii. A pregnancy women will be in state of positive
nitrogen balance
iv. Negative nitrogen balance seen in subject
immediately after surgery, trauma and burns
v. Protein deficiency cause negative nitrogen balance
Quality of protein: The quality of protein depends on the composition of
essential amino acid
It is determined by 4 methods
a. Protein efficiency ratio(PER)
b. Biological Value(BV)
c. Net Protein Utilisation(NPU)
d. Chemical Scores(CS)
Protein Efficiency Ratio(PER)
Gain in body weight in gm
PER =
Protein ingested in gm
PER for egg protein = 4.5
Milk protein = 2.2
Biological Value(BV)
It is ratio between the amount of nitrogen retained and
nitrogen absorbed during a specific interval.
Retained Nitrogen
BV = × 100
Absorbed nitrogen
Net protein Utilization(NPU)
It is better nutritional index than biological value. The
experimental procedure is similar to Biological Value(BV)
Retained Nitrogen
NPU = × 100
Ingested nitrogen
Chemical Score(CS)
It is based on chemical analysis of protein for the composition
essential amino acid which is compared with reference protein
(usually egg protein). The chemical score is defined as the ratio
between the quantity of most of limiting essential amino acid in
the test protein to the quantity of limiting essential amino acid in
egg protein
Limiting amino acid: Certain protein are deficient in one or more
essential amino acid. If this particular protein is fed to livings as
the only source of protein, it fails to grow. This amino acid said to
Limiting amino acid ex : Lysine and threonine in rice and Wheat
Bengal gram is limited in methionine & cystein.
Tryptophan in milk, phenyl alanine and tyrosine in fish
mg of the limiting amino acid in
test protein
CS = × 100
mg of the limiting amino acid in
egg protein
MALNUTRITION
A pathological state resulting from a
relative or absolute deficiency or
excess of one or more essential
nutrients; clinically manifested or
detected only by biochemical or
physiological tests.
Forms of Malnutrition
1. Undernutrition: Marasmus
2. Overnutrition: Obesity,
Hypervitaminoses
3. Specific Deficiency: Kwashiorkor,
Hypovitaminoses,
Mineral Deficiencies
4. Imbalance: Electrolyte Imbalance
ETIOLOGY
Protein malnutrition
• Infants and young children
– High nutritional needs
– Early weaning or late weaning
– Poor hygiene
• Primary: inadequate food intake
• Secondary: result of disease
• Kwashiorkor and Marasmus are two extreme forms
of protein malnutrition and both are widely
prevalent in the infants and preschool children
• Kwashiorkor: protein deficiency
• Marasmus: energy deficiency
kwashoikor
It is discovered by cicely william in 1933
• It means sickness of the deposed child that is
disease the child gets when the next baby is
born
Occurrence and causes
• It is found in children between 1 – 5 years of
the age
• It is mainly due to insufficient intake of protein
Symptoms
• Stunned growth, Edema(particularly legs and hands),
diarrhea, discoloration of hair and skin, Anemia and moon
face.
• Plasma albumin level is decreased(<2g/dl) against normal(3 –
4.5g/dl)
• Fatty liver
• Deficiency of potassium(electrolyte) due to diarrhea
• Odema will occur due to lack of adequate plasma protein
• Irregualtion of carbohydrate, protein and fat metabolism
• Several vitamin deficiency will occur
• Amount of Plasma Retinol Binding protein(PBP) gradually
reduced
• Immune system become weak
Marasmus
• It means “to waste”
• It mainly occur in children under 1 year
• It mainly due to deficiency of calories
Symptoms
• Growth retardation, muscle wasting, anemia and weakness but
odema is found not in marasmus which is major different
between marasmus and kwashirkor
• Dehydration will occur
• It may affect growth
• Skin become dry and atrophic
• No characteristic change in hair
• Muscles become weak
Biologic differences
• Marasmus • Kwashiorkor
– Weight loss – NO weight loss
– N or low protein – High extracellular water
– Boarderline hgb, – Low hgb,
– N AA profile – Low protein
– Low CBH – Elevated AA profile
– N enzymes – Low enzymes
– N transaminase – High transaminase
– Normal K – Low K
Nutritional Anemia
Anemia is characterized by lower concentration of hemoglobin.
There are 3 type of nutritional anemia
a. Microcytic anemia
b. Macrocytic anemia
c. Normocytic anemia
Microcytic anemia: Most common with reduced RBC size.
Occurs due to dietary deficiency iron, copper and pyridoxine
Macrocytic anemia: RBC are larger and immature. Mostly due to
the deficiency of folic acid and VItB12
Normocytic anemia: RBC size is normal but their quantity in
blood is low. Mostly found in protein energy malnutrition
