B5-060 Nutrition Metabolism I Flashcards
impaired absorption of nutrients
malabsorption
impaired digestion of nutrients
maldigestion
rome IV criteria for IBS
recurrent abdominal pain at least 1 day/week with two or more of the following:
- related to defecation
- change in stool frequency
- change in stool form
what symptoms should NOT be associated with IBS
- weight loss
- rectal bleeding
- anemia
- should not be nocturnal or progressive
what carbohydrates are absorbed through NA+ dependent cotransport?
2
glucose
galactose
what carbohydrate is absorbed through facillitated diffusion?
fructose
carbohydrates, proteins, and lipids are absorbed in the
small intestine
the surface area for absorption in the small intestine is greatly increased by the
brush border
lactose intolerance is due to […] deficiency
lactase
what kind of diarrhea does lactose intolerance cause?
osmotic diarrhea
malabsorption of sugars greatly mimics
IBS
bloating, diarrhea, gas
oligosaccharides are […] sugar units
3-10
hydrolyze polysaccarides to monosaccarides in the brush border
a-glucosidases
have B-glycosidic bonds and are undigestible
fiber
FODMAP
Fermentable
Oligo
Di
Monosaccharides
And
Polyols
family of poorly absorbed, short-chain carbohydrates
FODMAP
lactose, fructose, fructo/galacto oligosaccharides, polyols
hallmark feature of carbohydrate maldigestion
osmotic diarrhea
richest food sources of fructo-oliogsaccharides
4
wheat
rye
onion
garlic
richest food sources of galacto-oligosaccharides
legumes
richest food sources of fructose
5
honey
apples
pears
watermelon
mango
richest food sources of sorbitol
4
apples
pears
peaches
sugar free items
richest food sources of mannitol
3
mushrooms
cauliflower
sugar free items
what type of fiber is more beneficial for IBS symptoms?
soluble or insoluble
soluble (psyllium husk)
what type of fiber are cellulose, hemicellulose, and lignin?
insoluble
what type of fiber are gum, pectin, and mucliage?
soluble
what type of fiber functions to increase fecal bulk and decrease transit time?
insoluble
food sources of insoluble fiber
2
whole grains
vegetables
which type of fiber functions to delay gastric emptying, slow glucose absorption, and decrease blood cholesterol?
soluble
food sources of soluble fibers
4
fruits
vegetables
psyllium seed
rice bran
the Big Nine food allergens in US
- milk
- eggs
- peanuts
- tree nuts
- soy
- fish
- shellfish
- wheat
- sesame
resistant to or escape from gastic acid or enzymatic digestion
food allergens
symptoms of food allergens
3; most common to least common
- GI (70%)
- cutaneous (24%)
- respiratory (6%)
causes:
lowered bp
respiratory and GI distress
can be fatal
anaphylaxis
proteins are made up of […] different amino acids, […] of which are essential
20
9
what makes each amino acid unique?
it’s side chain
almost all disorders of amino acid transport are inherited in what pattern?
autosomal recessive
- deficiency results in the inability to convert trypsinogen to trysin
- leads to protein malnutrition
enterokinase deficiency
why do we need protein every day?
excess protein cannot be stored as protein
stored as muscle
- fat and lean mass loss
- edema from low plasma oncotic pressure
- hair pluckability
- skin breakdown
Kwashiorkor
protein malnutrition
what kinds of patients are susceptible to Kwashiorkor?
trauma/sepsis patients
- body fat stores have been exhausted due to starvation, muscle wasting follows
- may figdet a lot in the muscle wasting stage
marasmus
substantial loss of fat and lean body mass in the presence of chronic inflammation and disease
cachexia
in kidney failure, you’d expect to see decreased production of:
- 1,25-dihydroxycholecalciferol (active form of vitamin D)
- erythropoietin
diet for persons with CKD stage 4
general
- 23-35 kcal
- low protein
- low sodium
- no fluid restriction
[…] restriction slows the progression of diabetic nephropathy
protein
what three things must happen to develop celiac disease?
- inherit gene
- consume gluten
- have gene triggered due to stress
what HLA haplotype is associated with celiac disease?
HLA DQ2/DQ8
adverse response to gliadin that triggers immune response
celiac disease
classic celiac symptom
steatorrhea
what are the consequences of gliadin ingestion in celiac?
5
- villous atrophy
- decreased surface area
- chronic inflammation down regulates transport proteins
- decreased CCK and secretin -> pancreatic insufficiency
- bacterial overgrowth
persons with celiac disease can get secondary […] due to changes in enzymatic function at the brush border
lactase deficiency
what should be restricted from the diet while the gut is recovering in celiac disease?
- gluten
- fat
- dietary lactose
what is required to break down lipids into micelles?
2
pancreatic lipase
conjugated bile acids
what type of lipids do not require pancreatic lipolysis?
medium chain
absorbed by intestinal epithelial cells
what causes steatorrhea in the malabsorption of lipids?
2
lipase deficiency
maybe also depleted bile acid pool
how to correct nutrient deficiencies in pancreatic insufficiency?
2
low fat diet
PERT
what is causing these malabsorption symptoms?
bloating, gas, explosive diarrhea
sugar malabsorption
what is causing these malabsorption symptoms?
dry hair, hair loss, fluid retention
protein malabsorption
what is causing these malabsorption symptoms?
- light colored, foul smelling stools that are soft and bulky
- stools may be difficult to flush
fat malabsorption
is whole wheat a low FODMAP food?
no
single preferred test for detection of celiac disease
IgA-TTG test
when should testing for celiac disease be performed?
while the patient is still on a gluten rich diet
what should be done for a patient experiencing extreme weight loss, rectal bleeding, anemia, progressive abdominal pain?
colonoscopy
if the patient has a positive TTGA, what kind of biopsy can be done?
duodenal
what is the best treatment advice for a newly diagnosed celiac patient?
gluten free diet
refer to skilled dietician
without diet education, most celiac patients have inadequate intake of
B vitamins, iron, fiber
transported into intestinal cells by a Na+ dependent cotransport
3
galactose
glucose
dipeptides
incorporated into micelles
fatty acids
transported into intestinal cells via facilitated diffusion
fructose
need to be digested to di or tri peptides to be absorbed
oligopeptides
need further lipolysis into fatty acids and incorporated into micelles
TGs
binds to recptors in brush border of the ileum for absorption
vitamin B12
if a patient reports recurrent GI symptoms after big nine allergens
suspect IgE mediated allergy and refer to allergy specialist and GI
is skin testing for food allergies productive?
no