CIS Nutrition Flashcards
What BMI is considered underweight?
<18.5
What is the normal range for BMI?
18.5-24.9
What is considered overweight BMI?
25-29.9
Which BMI is considered to be obese?
greater than or equal to 30
Obese class I BMI
30-34.9
Obese class II BMI
35-39.9
Obese class III BMI
Greater than or equal to 40
A PE finding of xanthelasma palpebarum and corneal arcus are associated with what??
Elevated cholesterol
A PE finding of acanthosis nigricans is associated with what?
Possible elevated blood sugar indicating DM
For metabolic syndrome you have to have one of what?
DM, impaired glucose tolerance, impaired fasting glucose and insulin resistance
For metabolic syndrome you also have to have two of what?
Blood pressure greater than 140/90 or on BP meds,
Dyslipidemia, central obesity and microalbuminuria
Which diseases are cardiac risk factors?
Dyslipidemia, hyperglycemia and HTN
Describe the metabolic pathways involved in metabolic syndrome
Peripheral tissues are insulin resistant -> HSL activated -> increased FFAs from adipocytes
Insulin is overproduced
Gluconeogenesis inhibited and FA synthesis stimulated
Increased insulin and insulin resistance increases FA and TAG synthesis in the liver —> fat deposition in the liver —> dyslipidemia
What are some general abnormalities suggesting IEM?
Dysmorphic features, deafness, hydrops, self mutilation, abnormal body or urine odor, hepatosplenomegaly and abnormal hair growth
Neurologic abnormalities suggesting IEM?
Hypo/hypertonia, coma, persistent lethargy, seizures, not meeting developmental milestones
GI abnormalities suggesting IEM?
Poor feeding, recurrent vomiting, jaundice
Eye abnormalities suggesting IEM?
Cataracts, cherry red macula, dislocated lens, glaucoma
Muscle and joint abnormalities suggesting IEM?
Myopathy and abnormal mobility
Describe Hartnup disease
Effects absorption of nonpolar amino acids particularly tryptophan
Treat with a high protein diet
Sx: diarrhea, mood swings, red scaly skin rash usually when exposed to light, photosensitivity, short stature and uncoordinated movements
Describe maple syrup urine disease
Sweet smelling urine
Branched chain ketoacid dehydrogenase deficiency (BCAA: leu, Ile, Val)
Treat with low protein diet
Sx: poor feeding, vomiting, lack of energy (lethargy), abnormal movements, delayed development and may lead to seizures, coma or death
Describe phenylketonuria (PKU)
Phenylalanine hydroxylase deficiency
Autosomal recessive
Sx: intellectual disorders, seizures, must smelling urine/sweat due to phenylacetate, decreased pigmentation of hair and skin, eczema often accompany the mental retardation in untreated children
Treat with severely decreased protein intake
Phenyllactate and phenylacetate disrupt neurotransmission and block amino acid transport in the brain as well as myelin formation resulting in severe impairment of brain function
Describe albinism
Absence or defect of tyrosinase
Sx: sunburns/skin cancer, photophobia, nystagmus and amblyopia
Describe the progression seen with PKU
Infants are normal at birth Bc mother metabolizes extra Phe
Usually by 6 months of life severe mental retardation becomes evident
About 1/3 of children are never able to walk and 2/3 cannot talk
Describe newborn screenings
Performed between 24-48 hours
Heel stick, hearing screen
Early detection of otherwise devastating diseases
Missouri tests over 70
What occurs when galactokinase is defective?
Juvenile cataracts
Decreased conversion of galactose to galactose 1 phosphate by galactokinase
Describe what occurs when dihydopterine reductase is defective
Impaired renewal of tetrahydrobiopterin
Malignant hyperphenylalaninemia
Decreased levels of dopamine, serotonin and folate
Sx: psychomotor delay, low muscle tone (hypotonia), seizures, abnormal movements, too much salvation, swallowing difficulties
Tx: supplement BH4 and folate
No Phe
Meds to restore neurotransmitters in the brain
Describe what happens when galactosylceramidase is defective
Also called Krabbe’s disease
Impairment of the GALC gene
Galactosylceramidase hydrolyzes galactosylceramide, an important component of myelin
Sx: hypertonia/spasticity, impaired development, optic atrophy and blindness, unexplained fevers, seizures, irritability, eating problems and deafness
Tx: anticonvulsant meds to stop seizures, muscle relaxers, PY to help slow deterioration of muscles, OT to help older children with common tasks, bone marrow transplant and cord blood transplant
What occurs with GALT deficiency?
Failure to metabolize galactose/lactose into glucose
Back up of galactose causes sx
Sx: feeding difficulties, lethargy, failure to thrive, jaundice, females have premature ovarian insufficiency, liver damage, abnormal bleeding, sepsis, developmental delay and cataracts
Tx: eliminate lactose and galactose from the diet such as dairy products, avocados and sugar beets
Describe malnutrition in reference to Kwashiorkor disease
Severe protein deficiency
Sufficient calories, but insufficient protein
Usually occurs after weaning
Sx: edema of hands and feet, light colored skin, thinning hair, distended abdomen, shiny skin, ulcerating dermatoses, anemia, irritable and enlarged fatty liver
Describe malnutrition in reference to marasmus
Protein calorie deficiency
Sx: emaciated, chronic diarrhea, respiratory infections, intellectual disability, stunted growth, apathy, no energy
Weight is less than 62% of expected
What are some characteristics of vitamin A deficiency?
Nyctalopia (night blindness), xerophthalmia (failure to produce tears), major player in phototransduction (changing light into electrical signals)
What are characteristics of vitamin B1 (thiamine deficiency) deficiency?
Sx: malaise, weight loss, confusion, wet or dry beriberi, and possible Wernicke-Korsakoff syndrome
What are sx of wet beriberi?
Fast HR, SOB, difficulty moving the legs and pain
What are sx of dry beriberi?
Numbness, confusion, difficulty moving the legs
What are characteristics of Wernicke-Korsakoff syndrome?
Vision changes, ataxia, impaired memory
What are characteristics of vitamin B12 deficiency?
Sx: fatigue, inflammation of the tongue (decreased taste), numbness/tingling
Sign: megaloblastic anemia
What are some sx associated with vitamin C deficiency?
Fatigue, SOB, dizziness, pale or yellowish skin, irregular heartbeats, weight loss, numbness or tingling in hands and feet, muscle weakness, personality changes, unsteady movements and mental confusion or forgetfulness
What sx are associated with vitamin K deficiency?
Easy bruising, oozing from nose or gums, excessive bleeding from injuries, heavy menstrual periods, bleeding from the GI tract, blood in the urine and/or stool, increased prothrombin time (PT)
What sx are associated with vitamin B2 (riboflavin) deficiency?
Stomatitis (inflamed tongue), sore throat, chapped/fissured lips, oily/scaly rashes on the scrotum, vulva, philtrum of the lip and nasolabial folds, itch, watery, blood shot eyes, sensitivity to light and anemia (normocytic, normochromic)
What sx are associated with mild vitamin B3 (niacin) deficiency
Indigestion, fatigue, canker sores, vomiting and depression
What sx are associated with severe vitamin B3 (niacin) deficiency
Called Pellagra
Thick, scaly pigmented rash on skin exposed to sunlight
Swollen mouth and tongue, vomiting and diarrhea, HA, apathy, depression, disorientation, memory loss
What sx are associated with vitamin B6 (pyridoxine) deficiency?
Microcytic anemia, EEG abnormalities, dermatitis with cheilosis (scaling on the lips and cracks at the corners of the mouth), glossitis, depression, confusion and weakened immune function
What sx and risks are associated with vitamin D deficiency?
Sx: subtle to none
Risks: increased risk of death from cardiovascular disease, cognitive impairment in older adults, severe asthma in children and cancer
Describe vitamin E deficiency
Digestive system requires fat to absorb vitamin E
Conditions that impair this: abetaliproprotenemia, Crohn’s disease, cystic fibrosis, AVED (ataxia and vitamin E deficiency)
Sx: peripheral neuropathy, ataxia, skeletal myopathy, retinopathy, immune impairment and infertility
Normal fasting glucose
70-110
Normal total cholesterol
<200
Normal HDL
30-75
Normal LDL
<130
Normal triglycerides
<150
