Dieticians play an important role in helping us understand what we eat and how this affects us.
If you have ever consulted with a dietician, you may be aware that assessment of food intake is a critical part of the procedures they perform to understand what we eat.
But what about assessment of how what we eat is affecting our health?
The dietician gains valuable insight into this through the nutrition-focused physical exam which is performed to assess nutritional status or evaluate malnutrition.
To understand how this works, take note that malnutrition, such as micronutrient deficiencies (i.e. deficiencies in vitamins and minerals) can lead to abnormalities in the skin, nail and even hair.
Now consider the wealth of information that the dietician can glean from an examination of the skin, hair and nails.
Skin: Deficiencies in riboflavin, vitamin B12 and vitamin B6, usually obtained from food sources such as beef, diary, salmon, tuna, eggs etc., tend to cause various skin conditions, for example eczema and dandruff, cheilitis (i.e. sores on the lip) and stomatitis (general sore at any location in the mouth).
These deficiencies are often as a result of conditions which cause poor absorption of some of these nutrients.
Alcohol abuse, as well as long-term use of certain types of antibiotics, can also result in poor absorption and, therefore, deficiency in these nutrients.
Hair: Biotin, zinc and copper are among the essential nutrients for healthy scalp and hair. These nutrients can be obtained from food sources such as soybeans, legumes like beans, chickpeas, cashew nuts etc.
Deficiencies in these nutrients often result in scalp and hair conditions such as diffuse alopecia (i.e. thinning hair loss) and kinky hair syndrome (characterised by sparse, kinky hair).
Chronic alcohol use, as well as inadequate intake from food sources can cause deficiency of these micronutrients.
Nails: Brittle nails and Koilonychia (spoon nails) are common symptoms of iron and biotin deficiency.
Common food sources of iron and biotin include the following: legumes, red lean meat, fish, soybeans etc.
When nails are brittle, noticeable symptoms include easy breakage or splitting of nails, ridging, peeling at nail tips and nails that do not grow easily.
Some descriptive features of koilonychia (spoon nails) are: centre of the nail looks like it is scooped out, thin nails, turned-up outer edges and abnormal changes in the colour, texture and shape of the nails.
Underlying factors may include malabsorptive disorders and chronic alcohol use.
Micronutrient deficiencies are common when there is over-reliance on staples (e.g. cereal grains, roots and tubers) and diversity of diet is limited – or – ‘one way’ and does not meet the requirements for vitamins and minerals.
It may also be because of malabsorption due to some underlying medical condition or chronic alcohol use.
Even though micronutrient deficiency may remain undetected for a time (the reason why this type of deficiency is sometimes referred to as ‘hidden hunger’), it may be eventually revealed in a nutrition-focused physical examination.
Once it is identified, the individual’s well-being can then be improved with appropriate interventions.
The writers are with the Department of Dietetics, School of Biomedical and Allied Health Sciences, University of Ghana.