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Despite a large body of literature documenting micronutrient requirements, vitamin and mineral imbalance remains an unappreciated player in altered body composition and functional integrity. The absence of routine biochemical determination of nutrient status contributes in part to the inability of the clinical staff to validate recognizable signs and symptoms of deficiency or toxicity. Disciplined use of Nutrition Physical Examination (NPE) procedures enables assessment of tissues known to reflect nutrient imbalance in a costeffective way, which can assist clinical history taking and direct nutrition intervention. Macrophotography documenting lesions observed at baseline and after nutrient supplementation, along with laboratory monitoring, can ensure objective, advanced level, outcome-based nutrition therapy. This case illustrates use of the NPE and nutrition diagnostic reasoning in a relational manner to B, and zinc imbalance evidenced by (1) mild lip desquamation with ecchymotic-like lesions; (2) angular stomatitis;(3) seborrheic-like dermatitis of the scalp and eyebrows; (4) dry, flaky skin with sparse, wiry hair and scattered corkscrew and swan-neck hairs; and (5) somatic wasting with peripheral neuropathy.Most nutrition specialists have been taught that vitamin and mineral deficiencies are rarely a problem in today's clinical settings. Although photos of nutrient deficiencies are shown in advanced nutri-Correspondence and Photograph Permission Requests: RIary Pat Kelly, hlS, RD,

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