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Year 5 Chemical Pathology > 10s: Nutrition > Flashcards

10s: Nutrition Flashcards

1
Q

What are the 4 fat-soluble vitamins? and their names

A

ADEK

  • A = retinol
  • D = cholecalciferol
  • E = tocoferol
  • K = phytomenadione
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2
Q

Retinol: deficiency, excess, test

A

vitamin A, colour blindness, exfoliation + hepatitis, serum

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3
Q

Chole-calciferol: deficiency , excess, test

A

Vitamin D, osteomalacia/rickets, hypercalcaemia, serum

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4
Q

Tocopherol: deficiency, excess, test

A

Vitamin E, anaemia/neuropathy + ?malignancy/IHD, na excess, serum

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5
Q

Phytomenadione: deficiency, excess, test

A

vitamin K, defective clotting, no excess, PTT

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6
Q

Name the 7 water-soluble vitamins

A
  • B1 = thiamine
  • B2 = riboflavin
  • B3 = niacin
  • B6 = pyridoxine
  • B12 = cobalamin
  • C = ascorbate
  • F = folate
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7
Q

Thiamine: Deficiency, excess, serum

A

B1

Beri-Beri, neuropathy, Wernicke syndrome

no excess

RBC transketolase

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8
Q

Riboflavin: deficiency, excess, test

A

B2

Glossitis

No excess

RBC glutathione reductase

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9
Q

Niacin: deficiency, excess, test

A

B3

Pellagra - 3Ds (dementia, dermatitis, diarrhoea)

no excess

no tests

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10
Q

Pyridoxine: deficiency, excess, test

A

B6

Dermatitis, Anaemia

Neuropathy

RBC AST activation

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11
Q

Cobalamin: deficiency, excess, serum

A

B12

Pernicious anaemia

no excess

Serum B12

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12
Q

Ascorbate: deficiency, excess, test

A

C

scurvy

renal stones

plasma

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13
Q

Folate: deficiency, excess, tests

A

Megaloblastic anaemia, NTDs

no excess

RBC folate

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14
Q

What are the 5 trace elements

A
  • iron
  • iodine
  • zinc
  • copper
  • fluoride
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15
Q

Iron: deficiency, excess, tests

A

Hypochromic anaemia

Haemochromatosis

FBC, Fe, ferritin

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16
Q

Iodine: deficiency, excess, tests

A

Goitre hypothyroid

no excess

TFT

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17
Q

Zinc: deficiency, excess, tests

A

dermatitis

no excess

no tests

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18
Q

Copper: deficiency, excess, tests

A

Anaemia

Wilson’s disease

Cu, caeruloplasmin

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19
Q

Fluoride: deficiency, excess, tests

A

dental caries

fluorosis

no tests

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20
Q

Fat-soluble vitamins facts

A

Stored in adipose tissue

Rare to have deficiency in UK

  • more at risk of excess vitamins
  • vitamin A rarely tested
  • Vit D deficiency quite common (25-OH vit D precursor that is measured)
21
Q

More common for deficiency, water-soluble vs fat-soluble

A

water-soluble

22
Q

Beri-beri: 2 types

A

B1/thiamine deficiency

  • wet = CVD (oedema and other HF features)
  • Dry = neurological disease (some may have WE, Pabrinex given to alcoholics to prevent WE)

tests takes a while so tx on assumption

22
Q

Beri-beri: 2 types

A

B1/thiamine deficiency

  • wet = CVD (oedema and other HF features)
  • Dry = neurological disease (some may have WE, Pabrinex given to alcoholics to prevent WE)

tests takes a while so tx on assumption

23
Q

Pellagra

A

niacin/B3 deficiency is a triad of 3Ds:

  • diarrhoea
  • dermatitis
  • dementia
24
Q

trace element extra notes

A
  • Haemochromatosis can result in infertility
  • Cereals are fortified with iodine
  • Caeruloplasmin is a copper-binding protein
25
Q

What is an ideal diet? carbohydrates, fat, protein

A
  • 50% carbohydrates
  • 33% fat (western diets have gradually increased in fat)
  • 17% protein
26
Q

Satiety and adipose

A

reduced adiponectin → insulin resistance (i.e. in obese people)

anti-hunger = insulin, leptin, PYY (made in intestines, increases after eating a meal)

hunger = gherkin

26
Q

Satiety and adipose

A

reduced adiponectin → insulin resistance (i.e. in obese people)

anti-hunger = insulin, leptin, PYY (made in intestines, increases after eating a meal)

hunger = gherkin

27
Q

Definition of obesity (4)

A
  • weight
  • BMI (25-30 overweight, >30 obese, >40 morbid obesity)
  • waist-hip ratio
  • waist circumference (linked to CHD risk)
28
Q

Mortality and BMI

A
  • Increased risk of mortality with extreme low BMI and extreme high BMI
29
Q

Complications of obesity + Western diet

A

OSA common issue

increases risk of 12 types of cancer

Western diet = increased fat, decreased CHO

30
Q

Normal daily intake of protein for males and females

31
Q

Uses of protein

A

protein synthesis, breakdown, oxidation

indispensable (can’t be made in diet and must be obtained from diet i.e. leucine)

conditionally indispensable (AAs needed at certain parts of life, some can’t be synthesised when young, foetus needs certain AAs in pregnancy e.g. cysteine)

dispensable (the body can product them) → 5 of these i.e. alanine

32
Q

Assessment of protein intake

A
  • Nitrogen excretion and balance
  • Tracer techniques
33
Q

Good and bad lipids

A

Polyunsaturated fatty acids (PUFA) are good lipids

  • I.E. essential fatty acids (EFA)

Trans-fatty acids are bad

Dietary fat determines LDL cholesterol

  • Patients with high saturated fat → high LDLs
  • Patients with high intake of PUFA → lower cholesterol (mainly LDL)

Increased HDL is associated with reduced ischaemic heart disease risk

  • Women have higher HDL levels
  • Alcohol can cause an increase in HDLs
  • Obesity lowers HDLs
34
Q

How much CHO in diet?

A
  • Should be 40-80% of energy intake
  • CHO → polymerise into sugar, oligosaccharides and polysaccharides
    • 80% of carbohydrate intake should be complex carbohydrates
    • 20% should be simple carbohydrates (from good sources such as fruit)
  • Non-starch polysaccharides = fibre (this is not absorbed but helps bulk up the stools)
35
Q

What are 5 features of metabolic syndrome → increases risk of all obesity-associated conditions

A
  1. fasting glucose >6 mmol/L
  2. HDL <1, <1.3
  3. HTN > 135/80
  4. Microalbumin, IR
  5. WC = >102, >88
36
Q

Obesity treatment

A

Exclude endocrine causes

  • Hypothyroidism
  • Cushing’s syndrome
  • Acromegaly

Exclude complications of obesity

Educate

Diet and exercise

Medical therapy

  • Orlistat (pancreatic lipase inhibitor)
  • GLP-1 (causes a feeling of satiety)

Surgical therapy

37
Q

Benefits of a 100kg person losing 10kg of bodyweight

38
Q

Bariatric surgery: a form of METABOLIC surgery (3 types)

A

Adjustable band

Roux-en-Y gastric bypass

duodenal jejunal sleeve

39
Q

Adjustable band

A
  • Silicone ring put around top of the stomach
  • Silicone ring is attached to a port that sits in the adipose tissue near the stomach
  • Needle can be inserted into port and fluid adjusted
  • WARNING: the band can erode into the mucosa
40
Q

Roux-en-Y Gastric Bypass

A
  • The stomach is made much smaller
  • The first part of the duodenum and most of the stomach is bypassed
  • The second part of the intestine is connected to the small stomach
  • This can cause rapid resolution of T2DM
41
Q
  • Duodenal-Jejunal sleeve (sleeve from stomach pyloric sphincter → jejunum)
A
  • This can be inserted with an endoscope → allow food to bypass the duodenum (no mix with bile salts
  • It can only stay in for a year
42
Q

Benefits of bariatric surgery

43
Q

Benefits of bariatric surgery

44
Q

2 deficiency conditions with protein

A

Marasmus = lack of CHO intake, lipids and protein

  • shrivelled
  • severe muscle wasting
  • growth retarded
  • no SC-fat

Kwashiorkor = protein deficiency

  • oedematous
  • lethargic
  • protein deficient
  • scaling/ulcerated
  • large liver, SC-fat
45
Q

Crohn’s

46
Q

Coeliac

47
Q

CLD, CKD, pancreatic insufficiency

Year 5 Chemical Pathology (18 decks)

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