05a: Nutrition/Vitamins Flashcards
List the various forms of Vitamin A
- Retinol (transport form)
- Retinol ester (storage)
- Retinal (visual pigment)
- Retinoic acid (oxidized)
Functions of Vit A
- Maintain normal vision (in reduced light)
- Differentiation of mucus-secreting epithelium (an other cells; ex: APML, acne)
- Enhancing immunity to infections (increase T-cells, esp CD4)
Vit A deficiency effects which systems?
- Vision (night blindness)
- Pulm (infections)
- Renal (stones)
- Skin (follicular/papular dermatitis and dry skin)
- Immunity (infections)
Acute (X) toxicity has been associated with eating liver of polar bears, sharks, whales. What are symptoms?
X = vit A
HA, dizziness, vomiting, stupor, blurry vision (pseudotumor cerebri)
Vit (X) toxicity causes extremely high risk for spontaneous abortions/birth defects.
X = A
Chronic vit A toxicity Sx:
Fatigue, skin changes, alopecia, arthralgia, sore throat
T/F: Vit A toxicity more common than Vit C toxicity.
True - lipid soluble vit toxicity more common than water soluble due to fat accumulation
Which groups/patients are at risk for lipid-soluble vitamin deficiency?
Elderly, alcoholics, liver disease pts
Vit C crucial in multiple processes, most notably (X).
X = collagen synthesis (hydroxylation of pro-collagen)
T/F: Vit C acquired entirely by diet.
True - not synthesized endogenously
Vit (X) facilitates Fe absorption by keeping it in (ox/red) state.
X = C
Red (Fe 2+)
Vit C deficiency commonly seen in which groups of people?
- Elderly
- Chronic alcoholics
- Dialysis pts
- Infants on formula
Vit C deficiency Sx:
- Hemorrhage (gum, skin/petechiae, joints)
- Disordered calcification/osteoid matrix formation
- Impaired wound healing
Vit C toxicity Sx:
N/V, diarrhea, fatigue, sleep issues
When assessing nutritional status, you realize your patient has lost weight (muscle and fat). What’s the next sign you check for?
Inflammation
When assessing nutritional status, you realize your patient has lost weight (muscle and fat). There are no signs of inflammation. What is the likely cause of malnutrition?
starvation-related malnutrition
When assessing nutritional status, you realize your patient has lost weight (muscle and fat). There is mild/moderate inflammation. What is the likely cause of malnutrition?
Chronic disease (organ failure, pancreatic cancer, Rheumatoid arthritis)
When assessing nutritional status, you realize your patient has lost weight (muscle and fat). There is severe inflammation. What is the likely cause of malnutrition?
Acute disease/injury-related (major infection, burns, trauma, head injury)
Why does Refeeding Syndrome occur?
Chronic starvation/malnutrition followed by refeeding causes high insulin secretion and high glucose/electrolyte uptake in cells (electrolyte imbalance)
Main electrolyte imbalances in Refeeding Syndrome:
- Hypophosphatemia***
- Hypokalemia
- Hypomagnesemia
Potential life-threatening complications of Refeeding Syndrome
- Cardiac dysfunction
- Rhabdo
- Hemolysis
- Resp failure
What are the internationally validated guidelines for Rx of Refeeding Syndrome?
There are none (no RCTs)
Replete electrolytes/thiamine replacement, restrict caloric intake
List some complications of jejunoileal bypass involving other organ systems
- Renal failure (oxalate storm)
2. Liver failure (bac overgrowth in blind gut)
T/F: Up to 100% of patients that undergo jejunoileal bypass have hepatic abnormalities.
True - 40% have liver failure and 10% mortality from this
Which mineral deficiency is relatively common in bariatric surgery?
Zn
Pt undergoes bariatric surg and presents a year later with some hair loss. This could be due to (X), so you look for which other key symptoms?
X = Zn deficiency
- Alopecia
- Delayed wound healing
- Hypogonadism
Pt being treated for Zn deficiency develops anemia, numbness/tingling and ataxia. What is the likely cause?
Cu deficiency (ALWAYS CHECK Zn and Cu at same time! absorbed together)
Bariatric surg patient being treated for Zn deficiency must also (take/avoid):
Take Cu supplements (1 mg Cu for each 8-15 mg Zn)
T/F: Sleeve Gastrectomy is a purely malabsorptive procedure.
False - purely restrictive (decrease stomach size) so less nutrient deficiencies
Bariatric surg pt presents with ataxia, confusion, and double vision. What’s the likely diagnosis?
Thiamine deficiency! (triad: ophthalmoplegia, ataxia, altered mental status)
Gastric bypass is a (restrictive/malabsorptive) procedure that commonly causes (X) deficiency.
Both
X = Fe
Gold standard bariatric procedure up till now
Roux en Y bypass
Patients with mild/moderate hypoglycemia have blood glucose around (X) mg/dL and which Sx?
X = 70
Sweating, trembling, difficulty concentrating, light-headed, lack of coordination
Patients with mild/moderate hypoglycemia should be treated with:
Self treat (rule of 15)
15g glucose/snack
Recheck glucose after 15 min
DM I patient feels hypoglycemic, so he goes to the fridge to pour a glass of milk. Would skim or whole milk be the better option?
Skim (or lowfat) - fat delays absorption of CHO
Self-treating hypoglycemia: (fruit juice/doughnuts/cheese/raisins/chips) would be good options for quick-acting CHOs
Fruit juice, Raisins (the rest are high in fat)
Severe hypoglycemia is usually characterized by:
Inability to self-treat (mental status change)
Your friend with DM I becomes very lethargic and you are concerned he’s hypoglycemic. What would you grab right away if he can swallow?
Glucose gel, honey, juice
Your friend with DM I becomes very lethargic and you are concerned he’s hypoglycemic. What would you grab right away if he can’t swallow?
Glucagon injection (from kit)
Atkin’s diet is (low/high) (X) diet with which adverse effects?
Low
X = CHO (induction period only 20g CHO per day!)
Restrictive, increase CV disease risk (no restrictions on intake of calories, protein, or fat (except no trans fats))
T/F: The DASH diet has no known cons
True
The DASH diet recommends (X) servings of fruit and (Y) servings of vegetables per day.
X = Y = 4-5
The (X) Diet is a vegetarian diet designed to provide calories in the following ratio: 10% (CHO/fat/protein), 20% (CHO/fat/protein), 70% (CHO/fat/protein). What are the caloric restrictions?
X = Ornish
Fat; protein; CHO
No caloric restrictions
T/F: The Ornish diet can reverse heart disease
True - if followed strictly
(X) Diet provides emphasis on exercise and stress reduction
X = Ornish
Average consumption of American population: (X)% fat, (Y)% CHO, (Z)% protein.
X = 45 Y = 30 Z = 25
Cons of vegetarian diet include potentially inadequate (X) intake
X = vit B12 and omega-3 FA
Vegetarian diet can reduce risk of:
- CV disease, HT, DM II
- Certain cancers
- RA, gallstones, kidney disease
T/F: The paleo diet is high in Na
False - low in Na, excludes salt from diet
Which major food groups are excluded in Paleo diet?
Grains and dairy
T/F: Paleo diet is high in fat intake
True
Gluten found in:
Barley, wheat, rye
Many gluten-free food is also not enriched with (X), which can lead to deficiency in these if gluten-free diet is followed
X = Fe, fiber, folate
Low CHO v low fat diet: which had greater weight loss at 12 mo?
Both had similar weight loss
Low CHO v low fat diet: which was better with regard to dyslipidemia and glycemic control?
Low CHO
(X) are orexigenic neurons located in (Y) part of brain. They (increase/decrease) satiety and (increase/decrease) food intake.
X = NPY (neuropeptide Y) Y = arcuate nucleus (hypothalamus)
Decrease; increase
(X) are anorexigenic neurons located in (Y) part of brain. They (increase/decrease) satiety and (increase/decrease) food intake.
X = POMC Y = arcuate nucleus (hypothalamus)
Increase; decrease
