126/127B Nutrition Flashcards
What are DRI’s/RDA’s?
Dietary reference intakes, recommended daily allowances. A set of standards for vitamin intake for normal, healthy patients that don’t have frank deficiencies to help prevent disease.
What is the 6 food elimination diet used to treat? What does it remove from the diet?
EOE. Removes the top 6 allergens. Wheat, dairy, soy, nuts, eggs, fish/shellfish (creates some nutritional deficiencies)
What does wheat provide in the diet?
Vitamin B, calories (makes up 60-70% of total)
What is milk the major source of in the diet?
Calcium and vitamin D
Do you get water-soluble or fat-soluble vitamin deficiencies faster?
Water soluble
Lecture question: if someone goes on the 6 food elimination diet, what do you need to replace to avoid deficiencies?
Calories, calcium, vitamin D, folic acid, magnesium
What is celiac disease?
An autoimmune enteropathy (Ab against gluten), related to DQ2/DQ8 HLA haplotype
What is damaged in celiac disease?
Villi atrophy in small intestine from autoantibodies. Leads to nutrient deficiencies from disruption of the enzymes at the brush border.
How do you treat celiac disease?
Lifelong gluten-free diet
Inability to maintain normal levels of what nutrient suggests an absorption disorder?
Iron
What micronutrients are you concerned about with celiac disease?
B vitamins (folate/B-12, thiamin, riboflavin), fat soluble vitamins (KADE), iron
Nutritional complication of celiac disease?
Ostopenia/osteoporosis (vitamin D deficiency)
Lecture question: which blood tests do you want to get if you are suspicious of celiac disease?
Iron, vitamin D, B12, and folic acid
Why do people with IBD cholitis get deficiencies?
1) Flare-ups damage the small intestine directly and 2) they restrict their diet because of GI symptoms
What foods should be limited during a IBD flare?
Lactose, fat, carbohydrates, fiber
Lecture question: due to fecal fat loss for a patient with an IBD flare, what nutrients are you most concerned about?
B12 + fat soluble vitamins (KADE)
What are the two types of IBD?
Crohn’s and ulcerative cholitis
Why do people with EOE get nutrient deficiencies?
Because of the treatment (6-food elimination diet), not because of malabsorption
What are the three ways Vit. D increases serum Ca?
1) raises PTH levels (which releases Ca from bone), 2) absorb more in gut, 3) resorb more in nephrons
What do you have to supplement kids that are breastfed with?
Vitamin D - poorly disseminated in breast milk
What is Trousseau’s sign and what does it indicate?
Tetany of the arm on BP cuff inflation, severe vitamin D deficiency
What are some good food sources of Vit. D?
Fish, fortified milk/orange juice, supplements
What are two functional roles of Vit. A?
Night vision (rhodopsin precursor), immunity (deficiency predisposes to pneumonia)
What are Bitot spots and what do they indicate?
Clumps of keratinized cells in the eyes, vitamin K deficiency
What are the two forms of Vit. A?
Retinal (animal products) and carotenoid (plant products)
What are the three forms of thiamine deficiency?
Wet (cardiac) beriberi, dry (neuropathy) beriberi, Wernicke-Korsakoff (cerebral beriberi)
What do you get in wet beriberi?
High output HF, cardiomegaly, pitting edema, neuropathy
What do you get in dry beriberi?
Peripheral neuropathy, foot/wrist drop, lost of reflexes/sensation, weakness
What do you get in Wernicke-Korsakoff?
Ataxia, confusion, impaired memory, confabulation
What clinical signs do you see with riboflavin (B2) deficiency?
Oral symptoms. Magenta tongue, cheilosis (cracks), angular stomatitis (sores)
What clinical signs do you see with pellagra/niacin (B3) deficiency?
“3 D’s” triad: dermatitis (Casal’s necklace), diarrhea, dementia. People die a lot.
Lecture question: given a shortage of IV multivitamins, what would be the cause of death in patients presenting with acidosis?
B-vitamin deficiency, particularly thiamine/B12. Get a buildup of pyruvate, don’t make enough energy.
What can folic acid deficiency cause?
Neural tube defects in babies, megaloblastic anemia in adults
What drugs do you need to supplement patients with folic acid for?
Methotrexate, valproic acid, chronic PPI therapy
What type of diet gets no B12?
Vegan
What is a clinical manifestation of iodine deficiency?
Goiter
What deficiencies do GI surgery patients get?
Zinc, iodine, iron
Lecture question: woman that had gastric bypass surgery has a desire to eat non-food items (pica), especially ice. What deficiency is responsible?
Iron deficiency anemia
Also seen in pregnancy
