NUTRITION IN DISEASE MANAGEMENT

Diet: are the regularly consumed meals

Therapy; treatment
Diet therapy/ nutritional therapy; use of diet in treatment or prevention of diseases
Normal diet; diet designed for a normal health person
Therapeutic diet; diet designed for a sick person, or a person with additional nutrient needs as a
result of an illness or a physiological condition
Nutritional disorders are infections or illnesses that come as a result of lack of a certain nutrient
in the diet of excess intake of certain nutrients in the diet.
The following are some of the disorders that can be managed by use of diet;

a) Iron Deficiency Aneamia (IDA)

IDA is also known as nutritional aneamia. This is a type of aneamia that occurs as a result of
inadequate iron in the diet leading to low levels of heamoglobin hence anaemia. Iron is an
essential nutrient in the formation of heamoglobin in the blood, and heamoglobin is an essential
component in the blood that helps in the transportation of oxygen.
Nutritional aneamia can be caused by;
i. Inadequate iron intake. Iron rich foods include meat, eggs, beans, dark green leafy
vegetables etc
ii. Inadequate consumption of vitamin C rich foods. Vitamin C helps in absorption of iron
in the body, therefore a meal dense in iron should be accompanied by foods rich in
vitamin C such as watermelon, apples, citric fruits etc
iii. Blood losses. For example excessive loss of blood due to heavy menstruation or during
child birth can lead to aneamia.
iv. Parasitic infestations eg tapeworms
v. Accompanying foods dense in iron with foods that inhibits iron absorption in the body
leading to inadequate absorption of iron hence its deficiency. For example tea has
tannins that inhibits iron absorption in the body. It is therefore advisable not to consume
tea together with an iron rich food, since the tannins in tea will inhibit absorption of iron
in the meal.
Signs and symptoms of IDA
i. Reduced cognitive development in children
ii. Irritability and restlessness
iii. Pale skin colour
iv. Pale pink colour on the inside of the lower eyelids instead of red
v. Spoon like finger nails
 vi. Fatigue
vii. Breathlessness
viii. Dizziness
ix. Headache
x. Insomnia
xi. Dimness of vision
xii. Increased heart rate

Risk factors

These groups of people may have an increased risk of iron deficiency anemia:

 Women. Because women lose blood during menstruation, women in general are at
greater risk of iron deficiency anemia especially during pregnancy.
 Infants and children. Infants, especially those who were low birth weight or born
prematurely, who don't get enough iron from breast milk or formula may be at risk of
iron deficiency. Children need extra iron during growth spurts. If your child isn't eating a
healthy, varied diet, he or she may be at risk of anemia.
 Vegetarians. People who don't eat meat may have a greater risk of iron deficiency
anemia if they don't eat other iron-rich foods.
 Frequent blood donors. People who routinely donate blood may have an increased risk
of iron deficiency anemia since blood donation can deplete iron stores. Low hemoglobin
related to blood donation may be a temporary problem remedied by eating more iron-rich
foods. If you're told that you can't donate blood because of low hemoglobin, ask your
doctor whether you should be concerned.

Complications

Mild iron deficiency anemia usually doesn't cause complications. However, left untreated, iron
deficiency anemia can become severe and lead to health problems, including the following:

 Heart problems. Iron deficiency anemia may lead to a rapid or irregular heartbeat. Your
heart must pump more blood to compensate for the lack of oxygen carried in your blood
when you're anemic. This can lead to an enlarged heart or heart failure.
 Problems during pregnancy. In pregnant women, severe iron deficiency anemia has
been linked to premature births and low birth weight babies. But the condition is
preventable in pregnant women who receive iron supplements as part of their prenatal
care.
 Growth problems. In infants and children, severe iron deficiency can lead to anemia as
well as delayed growth and development. Additionally, iron deficiency anemia is
associated with an increased susceptibility to infections.

Prevention and Management

 i. Increase in intake of foods rich in iron e.g beans, meat, eggs, poultry, dark green leafy
vegetables.
ii. Increase in intake of foods that helps in absorption of iron for example vitamin C rich
foods
iii. Avoid taking foods containing tannins, phosphates and phytates together with iron
rich diets since they will inhibit its absorption
iv. Iron supplementation in cases of severe anaeamia
v. Deworming to prevent parasitic infestation
vi. Treatment of underlying disaeses eg malaria which can cause aneamia

b) Beri beri

Beriberi is a serious and potentially life-threatening condition that develops if a person has a
severe thiamine deficiency (Vitamin B1 deficiency).

Thiamine is an essential nutrient that people obtain through the diet. It plays a role in many
bodily functions, including:

 breaking down carbohydrate

 muscle contraction
 conduction in nerve cells
 creating glucose
 creating acids that help digestion

A severe thiamine deficiency may prevent the body from performing these functions properly.

Part of what makes beriberi dangerous is that thiamine does not take long to deplete in the body.
In people with a deficiency, it is possible to deplete thiamine stores in the body in as little as 2 to
3 weeks.

There are two main forms of beriberi:

 Wet beriberi, which mainly affects the cardiovascular system, causing poor circulation
and fluid buildup in the tissues (oedema.)
 Dry beriberi, which primarily affects the nervous system, leading to the degeneration of
the nerves. Degeneration typically begins in the legs and arms and may lead to muscle
atrophy and loss of reflexes.

Causes of beriberi

The leading cause of beriberi is either a diet low in thiamine or a problem that limits the body’s
ability to process thiamine.
Beriberi is rare in developed countries. In the United States, many foods that people eat every
day, such as bread and cereals, are fortified with thiamine. Eating these foods should be enough
to prevent a deficiency in most cases.

In developed nations with easy access to these foods, the main cause of beriberi is alcohol
misuse. Alcohol makes it more difficult for the body to process and absorb thiamine.

Babies may also develop beriberi if the breast milk that they drink is lacking in thiamine or if
they only drink formula without this vitamin.

Although most cases occur with no known family connection, a rare condition called genetic
beriberi can block the body’s ability to absorb the vitamin from foods.

Other people who may have a higher risk of beriberi include:

 older adults
 people with diabetes
 people with HIV
 people who have had bariatric surgery
 alcoholics

symptoms of beriberi

The symptoms of beriberi may vary depending on its type.

Symptoms of wet beriberi include:

 increased heart rate

 severe lack of energy or constant fatigue
 shortness of breath
 waking at night due to shortness of breath
 swelling in the legs and feet

Symptoms of dry beriberi include:

 general pain and body aches

 vomiting
 difficulty walking
 confusion
 numbness in the hands or feet
 paralysis in the lower legs

In rare, extreme cases of deficiency, beriberi may lead to a condition called Wernicke-Korsakoff
syndrome. This syndrome is a form of brain damage resulting from severe thiamine deficiency.

A person with Wernicke-Korsakoff syndrome may experience other symptoms, including:

  memory loss or inability to form new memories
 general confusion
 rapid eye movement
 involuntary eye movement
 blurred or double vision
 loss of muscle coordination
 hallucinations

Prevention and management

The goal of treatment for beriberi is to increase thiamine levels in the body. This can be achieved
by;

 increasing intake of foods rich in thiamine /vitamin B1 e.g. meat, nuts and seeds, beans
and legumes, seafood, dairy products e.t.c.

 thiamine supplementation in severe cases

 reducing alcohol intake since excess alcohol consumption lowers thiamine absorption in
the body
 using milk formulas fortified with thiamine

Without treatment, beriberi can be life-threatening due to the risk of heart failure or deterioration
in the nervous system.

With treatment, the outlook for people with this condition is much better. In most cases, the
damage to the heart and nervous system is reversible with early intervention. However, some
people may experience long-term symptoms, even after successful treatment.

If the deficiency leads to Wernicke-Korsakoff syndrome, a person’s outlook may be poor, as the
brain damage that this condition causes is usually permanent.

c) Vitamin A Deficiency (VAD)

Vitamin A is a fat-soluble vitamin that is important for many bodily functions, including;

 proper vision
 a strong immune system
 reproduction
 good skin health.
 Acts as an antioxidant (prevent tissues from damages associated with free radicles)

There are two types of vitamin A that are found in the diet.
  Preformed vitamin A is found in animal products such as meat, fish, poultry, and dairy
foods.
 Provitamin A is found in plant-based foods such as fruits and vegetables.

The food sources of vitamin A include;

 coloured vegetables eg. Carrots, yellow sweet potatoes, tomatoes etc

 liver
 Poultry
 Dairy foods

While deficiency is rare in developed countries, many people in developing countries do not get
enough vitamin A. In Kenya, breastfeeding mothers, pregnant mothers and children below five
years of age are at great risk of Vitamin A Deficiency (VAD).

Causes of VAD

 Inadequate intake of foods rich in vitamin A

 Fat restricted diet, inadequate fat reduces absorption of vitamin A along the
gastrointestinal tract
 Liver disorders
 Underlying diseases such as gastrointestinal diseases

Signs and symptoms of VAD

 Growth retardation in children

 Impaired immunity leading to increase in susceptibility to infections
 Dry lips and tongue
 Dry and scaly skin
 Keratomalacia (erosion of the cornea)
 Xerophthalimia (dry cornea)
 Night blindness
 In severe cases can lead to total blindness

Prevention and management

 Increase intake of foods rich in vitamin A

 Accompany meals rich in vitamin A with a little fat to help in its absorption
 Vitamin A supplementation (VAS). In Kenya, VAS is done to every child below five
years of age so as to curb VAD.
 Encouraging exclusive breastfeeding so as to reduce risk of VAD among infants below
six months of age
 d) Scurvy
Scurvy is the name for a vitamin C deficiency. It can lead to anemia, debility, exhaustion,
spontaneous bleeding, pain in the limbs, and especially the legs, swelling in some parts of the
body, and sometimes ulceration of the gums and loss of teeth.

Scurvy happens when there is a lack of vitamin C, or ascorbic acid. The deficiency leads to
symptoms of weakness, anemia, gum disease, and skin problems.

This is because vitamin C is needed for making collagen, an important component in connective
tissues. Connective tissues are essential for structure and support in the body, including the
structure of blood vessels.

A lack of vitamin C will also affect the immune system, absorption of iron, metabolism of
cholesterol and other functions.

Signs and symptoms

 anemia
 myalgia, or pain, including bone pain
 swelling, or edema
 petechiae, or small red spots resulting from bleeding under the skin
 corkscrew hairs
 gum disease and loss of teeth
 poor wound healing
 shortness of breath
 mood changes, and depression

In time, the person will show signs of generalized edema, severe jaundice, destruction of red
blood cells, known as hemolysis, sudden and spontaneous bleeding, neuropathy, fever, and
convulsions. It can be fatal.

Infants with scurvy will become anxious and irritable. They may experience pain that causes
them to assume a frog-leg posture for comfort.

There may also be subperiosteal hemorrhage, a type of bleeding that occurs at the ends of the
long bones.
Prevention and management
 vitamin C supplementation
 encourage consumption of foods rich in vitamin C e.g. oranges, lemon, watermelon,
apples e.t.c.
 encourage consumption of foods that helps in absorption of vitamin C in the body
 treat any underlying medical condition

e) Osteoporosis/ Osteomalacia

Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild
stresses such as bending over or coughing can cause a fracture. Osteoporosis-related fractures
most commonly occur in the hip, wrist or spine.

Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs
when the creation of new bone doesn't keep up with the loss of old bone.

Symptoms of osteoporosis

There typically are no symptoms in the early stages of bone loss. But once your bones have been
weakened by osteoporosis, you might have signs and symptoms that include:

 Back pain, caused by a fractured or collapsed vertebra

 Loss of height over time
 A stooped posture
 A bone that breaks much more easily than expected

Osteomalacia is a weakening of the bones. Problems with bone formation or the bone-building
process causes osteomalacia. Other symptoms of osteomalacia include hip bone pain, bone
fractures and muscle weakness.

A lack of vitamin D and calcium is the most common cause of osteomalacia and osteoporosis.
Vitamin D is an important nutrient that helps you absorb calcium in your stomach.

Vitamin D also helps maintain calcium and phosphate levels to help your bones form properly.
It’s made within the skin from exposure to ultraviolet (UV) rays in sunlight. It can also be
absorbed from foods like dairy products and fish.

Your body can’t process the calcium your bones need to stay strong if you have low levels of
vitamin D. A vitamin D deficiency can result from:

 a problem with your diet

 a lack of sun exposure
  an issue with your intestines

prevention and management

Good nutrition and regular exercise are essential for keeping your bones healthy throughout your
life.

f. Obesity

Obesity is a complex disease involving an excessive amount of body fat. It is a medical problem
that increases the risk of other diseases and health problems, such as heart disease, diabetes, high
blood pressure and certain cancers.

There are many reasons why some people have difficulty avoiding obesity. Usually, obesity
results from a combination of inherited factors, combined with the environment and personal diet
and exercise choices.

Signs/ symptoms of obesity

Obesity is diagnosed when your body mass index (BMI) is 30 or higher. To determine your body
mass index, divide your weight in kilograms by the height in metres squared.

BMI Weight status

Below 18.5 Underweight
18.5-24.9 Normal
25.0-29.9 Overweight
30.0 and higher Obesity

Causes

Although there are genetic, behavioral, metabolic and hormonal influences on body weight,
obesity occurs when you take in more calories than you burn through exercise and normal daily
activities. Your body stores these excess calories as fat

Risk factors

Obesity usually results from a combination of causes and contributing factors:

 Family inheritance and influences

The genes you inherit from your parents may affect the amount of body fat you store, and where
that fat is distributed. Genetics may also play a role in how efficiently your body converts food
into energy, how your body regulates your appetite and how your body burns calories during
exercise.

Obesity tends to run in families. That's not just because of the genes they share. Family members
also tend to share similar eating and activity habits.

 Lifestyle choices

 Unhealthy diet. A diet that's high in calories, lacking in fruits and vegetables, full of fast
food, with high-calorie beverages and oversized portions contributes to weight gain.

 Inactivity. If you have a sedentary lifestyle, you can easily take in more calories every
day than you burn through exercise and routine daily activities

 Certain diseases and medications In some people, obesity can be traced to a medical
cause, such as Prader-Willi syndrome, Cushing syndrome and other conditions. Medical
problems, such as arthritis, also can lead to decreased activity, which may result in
weight gain.

Social and economic issues

Social and economic factors are linked to obesity. Avoiding obesity is difficult if you don't have
safe areas to walk or exercise. Similarly, you may not have been taught healthy ways of cooking,
or you may not have access to healthier foods. In addition, the people you spend time with may
influence your weight — you're more likely to develop obesity if you have friends or relatives
with obesity.

Other factors

 Pregnancy. Weight gain is common during pregnancy. Some women find this weight
difficult to lose after the baby is born. This weight gain may contribute to the
development of obesity in women. Breast-feeding may be the best option to lose the
weight gained during pregnancy.
 Lack of sleep. Not getting enough sleep or getting too much sleep can cause changes in
hormones that increase your appetite. You may also crave foods high in calories and
carbohydrates, which can contribute to weight gain.
 Stress. Many external factors that affect your mood and well-being may contribute to
obesity. People often seek more high-calorie food when experiencing stressful situations.

Complications
People with obesity are more likely to develop a number of potentially serious health problems,
including:

 Heart disease and strokes. Obesity makes you more likely to have high blood pressure
and abnormal cholesterol levels, which are risk factors for heart disease and strokes.
 Type 2 diabetes. Obesity can affect the way your body uses insulin to control blood
sugar levels. This raises your risk of insulin resistance and diabetes.
 Certain cancers. Obesity may increase your risk of cancer of the uterus, cervix,
endometrium, ovary, breast, colon, rectum, esophagus, liver, gallbladder, pancreas,
kidney and prostate.
 Digestive problems. Obesity increases the likelihood that you'll develop heartburn,
gallbladder disease and liver problems.
 Gynecological and sexual problems. Obesity may cause infertility and irregular periods
in women. Obesity also can cause erectile dysfunction in men.
 Sleep apnea. People with obesity are more likely to have sleep apnea, a potentially
serious disorder in which breathing repeatedly stops and starts during sleep.
 Osteoarthritis. Obesity increases the stress placed on weight-bearing joints, in addition
to promoting inflammation within the body. These factors may lead to complications
such as osteoarthritis.

Prevention

Whether you're at risk of obesity, currently overweight or at a healthy weight, you can take steps
to prevent unhealthy weight gain and related health problems. Not surprisingly, the steps to
prevent weight gain are the same as the steps to lose weight: daily exercise, a healthy diet, and a
long-term commitment to watch what you eat and drink.

 Exercise regularly. You need to get 150 to 300 minutes of moderate-intensity activity a
week to prevent weight gain. Moderately intense physical activities include fast walking
and swimming.
 Follow a healthy-eating plan. Focus on low-calorie, nutrient-dense foods, such as fruits,
vegetables and whole grains. Avoid saturated fat and limit sweets and alcohol. Eat three
regular meals a day with limited snacking. You can still enjoy small amounts of high-fat,
high-calorie foods as an infrequent treat. Just be sure to choose foods that promote a
healthy weight and good health most of the time.
 Know and avoid the food traps that cause you to eat. Identify situations that trigger
out-of-control eating. Try keeping a journal and write down what you eat, how much you
eat, when you eat, how you're feeling and how hungry you are. After a while, you should
see patterns emerge. You can plan ahead and develop strategies for handling these types
of situations and stay in control of your eating behaviors.
 Monitor your weight regularly. People who weigh themselves at least once a week are
more successful in keeping off excess pounds. Monitoring your weight can tell you
whether your efforts are working and can help you detect small weight gains before they
become big problems.
 g. Cardiovascular diseases
Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood
vessels that can lead to a heart attack, chest pain (angina) or stroke.

Symptoms

Heart disease symptoms depend on what type of heart disease you have.

Cardiovascular disease symptoms may be different for men and women. For instance, men are
more likely to have chest pain; women are more likely to have other symptoms along with chest
discomfort, such as shortness of breath, nausea and extreme fatigue.

Symptoms can include:

 Chest pain, chest tightness, chest pressure and chest discomfort (angina)
 Shortness of breath
 Pain, numbness, weakness or coldness in your legs or arms if the blood vessels in those
parts of your body are narrowed
 Pain in the neck, jaw, throat, upper abdomen or back

One might not be diagnosed with cardiovascular disease until he/she have a heart attack, angina,
stroke or heart failure. It's important to watch for cardiovascular symptoms and discuss concerns
with your doctor. Cardiovascular disease can sometimes be found early with regular evaluations.

Risk factors

Risk factors for developing heart disease include:

 Age. Aging increases your risk of damaged and narrowed arteries and weakened or
thickened heart muscle.
 Sex. Men are generally at greater risk of heart disease. However, women's risk increases
after menopause.
 Family history. A family history of heart disease increases your risk of coronary artery
disease, especially if a parent developed it at an early age (before age 55 for a male
relative, such as your brother or father, and 65 for a female relative, such as your mother
or sister).
  Smoking. Nicotine constricts your blood vessels, and carbon monoxide can damage their
inner lining, making them more susceptible to atherosclerosis. Heart attacks are more
common in smokers than in nonsmokers.
 Certain chemotherapy drugs and radiation therapy for cancer. Some chemotherapy
drugs and radiation therapies may increase the risk of cardiovascular disease.
 Poor diet. A diet that's high in fat, salt, sugar and cholesterol can contribute to the
development of heart disease.
 High blood pressure. Uncontrolled high blood pressure can result in hardening and
thickening of your arteries, narrowing the vessels through which blood flows.
 High blood cholesterol levels. High levels of cholesterol in your blood can increase the
risk of formation of plaques and atherosclerosis.
 Diabetes. Diabetes increases your risk of heart disease. Both conditions share similar risk
factors, such as obesity and high blood pressure.
 Obesity. Excess weight typically worsens other risk factors.
 Physical inactivity. Lack of exercise also is associated with many forms of heart disease
and some of its other risk factors, as well.
 Stress. Unrelieved stress may damage your arteries and worsen other risk factors for
heart disease.
 Poor hygiene. Not regularly washing your hands and not establishing other habits that
can help prevent viral or bacterial infections can put you at risk of heart infections,
especially if you already have an underlying heart condition. Poor dental health also may
contribute to heart disease.

Complications

Complications of heart disease include:

 Heart failure. One of the most common complications of heart disease, heart failure
occurs when your heart can't pump enough blood to meet your body's needs. Heart failure
can result from many forms of heart disease, including heart defects, cardiovascular
disease, valvular heart disease, heart infections or cardiomyopathy.
 Heart attack. A blood clot blocking the blood flow through a blood vessel that feeds the
heart causes a heart attack, possibly damaging or destroying a part of the heart muscle.
Atherosclerosis can cause a heart attack.
 Stroke. The risk factors that lead to cardiovascular disease also can lead to an ischemic
stroke, which happens when the arteries to your brain are narrowed or blocked so that too
little blood reaches your brain. A stroke is a medical emergency — brain tissue begins to
die within just a few minutes of a stroke.

Prevention

Certain types of heart disease, such as heart defects, can't be prevented. However, you can help
prevent many other types of heart disease by making the same lifestyle changes that can improve
your heart disease, such as:

 Quit smoking
  Control other health conditions, such as high blood pressure, high cholesterol and
diabetes
 Exercise at least 30 minutes a day on most days of the week
 Eat a diet that's low in salt and saturated fat
 Maintain a healthy weight
 Reduce and manage stress
 Practice good hygiene

h. Diabetes mellitus

Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar
(glucose). Glucose is vital to your health because it's an important source of energy for the cells
that make up your muscles and tissues. It's also your brain's main source of fuel.

The underlying cause of diabetes varies by type. But, no matter what type of diabetes you have,
it can lead to excess sugar in your blood. Too much sugar in your blood can lead to serious
health problems.

Chronic diabetes conditions include type 1 diabetes and type 2 diabetes.

Gestational diabetes occurs during pregnancy but may resolve after the baby is delivered.

Symptoms

Some of the signs and symptoms of type 1 diabetes and type 2 diabetes are:

 Increased thirst
 Frequent urination
 Extreme hunger
 Unexplained weight loss
 Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and
fat that happens when there's not enough available insulin)
 Fatigue
 Irritability
 Blurred vision
 Slow-healing sores
 Frequent infections, such as gums or skin infections and vaginal infections

Causes of type 1 diabetes

The exact cause of type 1 diabetes is unknown. What is known is that your immune system —
which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing
cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into
your cells, sugar builds up in your bloodstream.
Type 1 is thought to be caused by a combination of genetic susceptibility and environmental
factors, though exactly what those factors are is still unclear. Weight is not believed to be a
factor in type 1 diabetes.

Causes of type 2 diabetes

In type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is
unable to make enough insulin to overcome this resistance. Instead of moving into your cells
where it's needed for energy, sugar builds up in your bloodstream.

Exactly why this happens is uncertain, although it's believed that genetic and environmental
factors play a role in the development of type 2 diabetes too. Being overweight is strongly linked
to the development of type 2 diabetes, but not everyone with type 2 is overweight.

Causes of gestational diabetes

During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones
make your cells more resistant to insulin.

Normally, your pancreas responds by producing enough extra insulin to overcome this
resistance. But sometimes your pancreas can't keep up. When this happens, too little glucose gets
into your cells and too much stays in your blood, resulting in gestational diabetes.

Prevention

Type 1 diabetes can't be prevented. However, the same healthy lifestyle choices that help treat
type 2 diabetes and gestational diabetes can also help prevent them:

 Eat healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on
fruits, vegetables and whole grains. Strive for variety to prevent boredom.
 Get more physical activity. Aim for about 30 minutes of moderate aerobic activity on
most days of the week, or at least 150 minutes of moderate aerobic activity a week.
 Lose excess weight. If you're overweight, losing even 7% of your body weight can
reduce the risk of diabetes.

Don't try to lose weight during pregnancy, however.

 i. Cancer

Cancer refers to any one of a large number of diseases characterized by the development of
abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal
body tissue. Cancer often has the ability to spread throughout your body.

Cancer is the second-leading cause of death in the world.

Symptoms

Signs and symptoms caused by cancer will vary depending on what part of the body is affected.

Some general signs and symptoms associated with, but not specific to, cancer, include:

 Fatigue
 Lump or area of thickening that can be felt under the skin
 Weight changes, including unintended loss or gain
 Skin changes, such as yellowing, darkening or redness of the skin, sores that won't heal,
or changes to existing moles
 Changes in bowel or bladder habits
 Persistent cough or trouble breathing
 Difficulty swallowing
 Hoarseness
 Persistent indigestion or discomfort after eating
 Persistent, unexplained muscle or joint pain
 Persistent, unexplained fevers or night sweats
 Unexplained bleeding or bruising

Risk factors/ Causes

Factors known to increase your risk of cancer include

 age

Cancer can take decades to develop. That's why most people diagnosed with cancer are 65 or
older. While it's more common in older adults, cancer isn't exclusively an adult disease — cancer
can be diagnosed at any age
  lifestyle choices

Certain lifestyle choices are known to increase your risk of cancer. Smoking, drinking more than
one alcoholic drink a day, excessive exposure to the sun or frequent blistering sunburns, being
obese, and having unsafe sex can contribute to cancer.

 family history

Only a small portion of cancers are due to an inherited condition. If cancer is common in your
family, it's possible that mutations are being passed from one generation to the next.

 health conditions

Some chronic health conditions, such as ulcerative colitis, can markedly increase your risk of
developing certain cancers.

 environment

The environment around you may contain harmful chemicals that can increase your risk of
cancer. Even if you don't smoke, you might inhale secondhand smoke if you go where people are
smoking or if you live with someone who smokes. Chemicals in your home or workplace, such
as asbestos and benzene, also are associated with an increased risk of cancer.

Complications

Cancer and its treatment can cause several complications, including:

 Pain. Pain can be caused by cancer or by cancer treatment, though not all cancer is
painful. Medications and other approaches can effectively treat cancer-related pain.
 Fatigue. Fatigue in people with cancer has many causes, but it can often be managed.
Fatigue associated with chemotherapy or radiation therapy treatments is common, but it's
usually temporary.
 Difficulty breathing. Cancer or cancer treatment may cause a feeling of being short of
breath. Treatments may bring relief.
 Nausea. Certain cancers and cancer treatments can cause nausea. Your doctor can
sometimes predict if your treatment is likely to cause nausea. Medications and other
treatments may help you prevent or decrease nausea.
 Diarrhea or constipation. Cancer and cancer treatment can affect your bowels and cause
diarrhea or constipation.
 Weight loss. Cancer and cancer treatment may cause weight loss. Cancer steals food
from normal cells and deprives them of nutrients. This is often not affected by how many
calories or what kind of food is eaten; it's difficult to treat..
  Chemical changes in your body. Cancer can upset the normal chemical balance in your
body and increase your risk of serious complications. Signs and symptoms of chemical
imbalances might include excessive thirst, frequent urination, constipation and confusion.
 Brain and nervous system problems. Cancer can press on nearby nerves and cause pain
and loss of function of one part of your body. Cancer that involves the brain can cause
headaches and stroke-like signs and symptoms, such as weakness on one side of your
body.

Prevention

There's no certain way to prevent cancer. But doctors have identified several ways of reducing
your cancer risk, such as:

 Stop smoking. If you smoke, quit. If you don't smoke, don't start. Smoking is linked to
several types of cancer — not just lung cancer. Stopping now will reduce your risk of
cancer in the future.
 Avoid excessive sun exposure. Harmful ultraviolet (UV) rays from the sun can increase
your risk of skin cancer. Limit your sun exposure by staying in the shade, wearing
protective clothing or applying sunscreen.
 Eat a healthy diet. Choose a diet rich in fruits and vegetables. Select whole grains and
lean proteins.
 Exercise most days of the week. Regular exercise is linked to a lower risk of cancer.
Aim for at least 30 minutes of exercise most days of the week. If you haven't been
exercising regularly, start out slowly and work your way up to 30 minutes or longer.
 Maintain a healthy weight. Being overweight or obese may increase your risk of cancer.
Work to achieve and maintain a healthy weight through a combination of a healthy diet
and regular exercise.
 Drink alcohol in moderation, if you choose to drink. If you choose to drink alcohol,
limit yourself to one drink a day if you're a woman of any age or a man older than age 65,
or two drinks a day if you're a man 65 years old or younger.
 Schedule cancer screening exams. Talk to your doctor about what types of cancer
screening exams are best for you based on your risk factors.
 immunizations. Certain viruses increase your risk of cancer. Immunizations may help
prevent those viruses, including hepatitis B, which increases the risk of liver cancer, and
human papillomavirus (HPV), which increases the risk of cervical cancer and other
cancers.

Assignment

Discuss the following eating disorders indicating their causes, signs/ symptoms and
diet management;
a. anorexia nervosa
b. bulimia nervosa