Final Exam SQs Flashcards
- Why could a multivitamin-mineral formula be called a nutritional insurance policy?
A) It is a safe and simple way for one to get recommended amounts of micronutrients if amount is not achieved from diet that may prevent chronic disease due to insufficiency/deficiency
- Why should a multivitamin be the only source of concentrated folic acid present in the daily dietary
and supplement intake?
A) Folate shows to decrease breast cancer in women who drink alcohol and lower odds of developing colorectal cancer
B) Folate is good for decreasing neural tube defects in pregnant women
C) Folate lowers coronary heart disease
- Why is it difficult to design enough randomized controlled trials to answer questions about the
value of multiple vitamins?
A) Generally lengthy studies, high doses can be lethal, information can contradict each other, flawed studies, etc.
- How has a shift in public health priorities from preventing acute disease to preventing chronic
disease changed the way we think about micronutrients?
A) Studies show that multivitamins may prevent us from chronic disease and have proven that multivitamins do not cure acute disease but starting intake once diagnosed with illness.
- Which vitamins and minerals may be especially helpful in amounts significantly above the RDA?
A) Vitamin C, D, E, and Calcium
- Which vitamins and minerals will be difficult to get in optimum amounts from most multivitamin-
mineral formulas?
A)
- For which micronutrients is the outdated Daily Value significantly different from current
recommendations?
A) Biotin
- Which minerals and trace elements are not important to include in a daily multivitamin-mineral
formula?
A) Phosphorus, Potassium, Chloride
- Which non-essential nutrients frequently found in multivitamin-mineral formulas have uncertain
benefit?
A) Beta-Carotene, Flavinoids
- For which micronutrients does the LPI recommend choosing the form of the micronutrient
carefully when selecting a multivitamin-mineral formula?
A) Vitamin A
- Which micronutrients may not be adequately supplied by many multivitamin-mineral formulas,
which leads the LPI or Healthnotes to recommend a separate supplement of these micronutrients?
A) Vitamin D, E, C, K
- Which micronutrient should be avoided in a multivitamin-mineral formula by some people?
A) Iron should be avoided for most men and post menopausal women
- What vitamin should not be taken by people using warfarin (Coumadin) without first consulting the prescribing doctor?
A) Vitamin K
- What verification mark indicates that a supplement contains the ingredients listed on the label, contains the amount of each ingredient listed on the label, dissolves effectively, does not contain harmful contaminants, and was manufactured using safe and sanitary procedures.
A) USP dietary supplementation verification mark
- Why is it best to take vitamins and minerals with meals?
A) Best to take with meals because it will help with stomach upset and they will be better absorbed when taken with a meal.
- List the benefits of using multivitamin-mineral supplements to improve nutrition status
A) Inexpensive, convenient source, Insurance against deficiencies, help reach optimum intakes, documented potential benefits
- What are the documented health benefits of vitamin/mineral combinations?
A) Decreased risk of pediatric brain tumors, neuroblastoma, leukemia, reduced incidence of infection in elderly and those with diabetes, decreased risk of Colorectal cancer, reduced effects of stress.
- Why is it often difficult to demonstrate protective effects of micronutrients against chronic
disease?
A) Large scale trials have mixed results, groups studied are generally those whom are severely deficient, high dosages may cause harmful/ negative effects
- How can professionals guide their patients in selecting high-quality multivitamin-mineral
supplements?
A) One with no more than 2500IU retinol, phosphorus not needed, get potassium from food, Iron for only high risk groups, Biotin (new DRI is 10% old DV), get extra C, D, E, K, B12 (for seniors), Se (for men). Get Ca and Mg separately.
B) Look for lead free supplements and labeled expiration date.
C) Look for capsules/liquids over tablets from reputable sources.
- Which nutrients or forms of nutrients should be low or absent in multivitamins for many people?
A) Lead Free and less than 2500IU of retinol, Iron (for high risk groups= men and postmenopausal women) Biotin, Phosphorus
- For which nutrients is it impractical to expect a one-a-day multivitamin to provide 100% of the
Daily Value?
A) Potassium, Calcium, and Magnesium, Vitamins C, A, D, E, K, and B12 for seniors
- For which nutrients is the Daily Value, which is based on older versions of the RDA, most out of
line with current recommendations?
A) Little evidence for Biotin
- What are the important biochemical and physiological functions of magnesium in the human
body?
A) Cofactor in over 300 reactions: energy production, metabolism of CHO & fat, stabilizes ATP molecule, synthesis of molecules, bone structure/ bone mineralization, prevents osteoporosis, ion transport for nerve, muscle, and heart.
- What conditions increase the risk of magnesium deficiency?
A) Those with GI/malabsorption disorders or increased fecal losses (diarrhea), kidney disorders, those taking diuretics, alcoholism, elderly
- What is the evidence for the effectiveness of magnesium supplements for improving the symptoms
of muscle disorders? Has reducing muscle spasms caused by musculoskeletal trauma with
magnesium supplementation been proven effective?
A) Severe deficiency affects nerves and muscles causing tremors and muscle spasms, but effects of mild deficiency are less clear Mg may help with problems of smooth and cardiac muscle in some cases but not research has been shot to prove that Mg is effective therapy for reducing/preventing muscle spasms associated with musculoskeletal trauma or prolonged exercise. It is shown to be helpful for nocturnal leg cramps and sometimes for pregnancy induced leg cramps.
- Why are typical multivitamin-minerals not always adequate in magnesium?
A) Low in Mg due to high requirement needed and lack of room but should be found in Ca supplements
- Which food groups are high in magnesium?
A) Green leafy vegetables, whole grain (especially bran products and brown rice), nuts, fortified food
- What is the most likely side effect from taking a magnesium supplement?
A) Potential laxative effect at 400mg/day, cation with renal impairment; risk of hypotension and cardiac disturbances
- What individuals are at highest risk of serious adverse effects from magnesium supplementation?
A) Patients with renal impairment. Mg can increase risk of high blood Mg leading to hypotension and cardiac disturbances
- What is the best strategy to ensure adequate absorption of combinations of mineral supplements
such as magnesium and calcium?
A) Greater absorption taking natural/ organic sources of Mg (seen as Magnesium Citrate or chelate)
B) don’t take magnesium with calcium and take less than 400-500mg/day
- Why is the effect of fiber on magnesium absorption not likely to be important?
A) Fiber reduces magnesium absorption from MV however, this is compensated by the high Mg content of high fiber foods. It also reduced Mg urinary excretion
- What is the earliest symptom of excessive magnesium ingestion?
A) Potential Laxative
- According to the Healthnotes Evidence Table, in what situations may magnesium supplementation help lower blood pressure?
A) For people taking potassium depleting diuretics Mg may decreased high blood pressure
- Explain the possible role of magnesium in migraine headache prevention.
A) Magnesium has an effect on serotonin receptors, nitric oxide synthesis and release, NMDA receptors and a variety of other migraine related receptors and neurotransmitters. During migraine attack patients generally have low levels of ionizing Mg, infusion of Mg supplies rapid and sustained relief.
- What are the important biochemical and physiological functions of zinc in the human body?
A) Catalyzes enzymes, Structural role (stabilizes proteins and membranes ex SOD), Cell regulation for growth, development and immune function
- Absorption of which mineral may be impaired by taking large quantities of zinc over a period of
weeks?
A) Copper and Iron
- Supplementation of which minerals may decrease zinc absorption?
A) Iron and Calcium (Ca only in postmenopausal women)
- Why have some developing countries been especially prone to zinc deficiency?
A) Due to diets low in high zinc foods (low in animal protein), where diet is high in unleavened whole grain foods rich in phytates.
- What zinc-deficiency symptom can appear in children, even in Western countries, which can also
be reversible with supplementation?
A) Growth retardation
- What information from a patient history would lead you to be concerned that they were at risk of zinc deficiency?
A) What types of wheat products the eat (unleavened wheat), Malnourishment and GI problems
- Why should there be special concern about the adequacy of zinc intake among older adults?
A) Zn insufficiency may lead to certain types of cancer
- What non-specific symptoms can result from zinc deficiency?
A) Poor wound healing, hair and skin changes, and loss of sense of smell and taste along with poor appetite
- Name the genetic disease that results in zinc deficiency
A) Acrodermatitis enteropathica
- How do average US dietary zinc intakes compare with current recommendations?
A) Most diets are at or slightly above the RDA, but 50% or more strict vegans are not getting RDA.
- What foods are the best sources of bioavailable zinc?
A) Flesh foods/meats, other protein foods (less bioavailable when phytates are present)
B) Oysters, Crab, Beef, Turkey and other meats
- How can the level of phytic acid in grain products be reduced by certain cooking processes?
A) Leavening of bread will lower phytic acid found in beans, wheat bran, whole grains.
- What side effects are common at higher doses of zinc (e.g. over 50 mg per day)?
A) GI upset (#1) and Fatigue, and malabsorption of other minerals
- What zinc-containing cold remedy is not recommended due to the risk of irreversible side effects?
A) Nasal preparation of zinc gel including Intranasal Zinc Gluconate causes zinc induced anosmia or hyposmia.
- What is the current understanding of the role of zinc supplementation to improve immune
response in the elderly?
A) Zn can enhances immunity and decreases incidence of infection when deficiency is present. However, high dose supplementation may lead to adverse affects interfering with mineral absoprtion (esp Copper)
- How might the conflicting results of zinc lozenge trials for treatment of the common cold be
explained?
A) Different cold treatments have different formulations of Zinc lozenges
- What are the important biochemical and physiological functions of copper in the human body?
A) Co factor for redox enzymes: CT and bone formation, Iron Transport, Mitochondrial energy production
B) Antioxidant function: SOD cofactor, etc.
- What copper containing protein in the blood may function as an antioxidant or a pro-oxidant?
A) eruloplasmin, prevents oxidative stress by binding excess free Cu and Fe ion and under certain circumstances may act as pro-oxidant. SOD uses copper as cofactor.
- Supplementation of which minerals may decrease copper absorption?
A) Zinc and Iron
- What clinical situation might warrant checking copper status in a patient?
A) Microcytic anemias
- How do average US dietary copper intakes compare with current recommendations?
A) Is uncommon in the US, RDA is 900mcg/day and men and women get at least 1.0-1.2mcg/day.
- The health of what organ is the basis for establishing an upper limit (UL) for copper intake?
A) Liver
- What genetic disease of copper metabolism can lead to copper toxicity?
A) Wilson’s Disease
- Summarize the evidence for and against the theory that increased intake of copper could increase
the risk of cardiovascular disease
A) There is inconsistent benefits to blood lipids and inconsistent hazard of increased oxidative stress.
- Why might adequate copper intake be important for maintaining bone density?
A) Lysyl oxidase is a copper dependent enzyme required for normal collagen synthesis, which is needed for formation of the organic matrix of bone
- What is the important biochemical and physiological function of iodine in the human body?
Component of thyroid hormone T3 and T4, essential for regulatory processes
- Why would you not suspect your patient with hypothyroidism would be helped by iodine
supplements?
Iodine deficiency is rare in the western world because we get enough iodine in our diets since it is added to our food supply via table salt
- How does iodine deficiency lead to goiter?
The thyroid gland enlarges because the gland will start to hypertrophy trying to make more hormone but without iodine it doesn’t help
- What worldwide health problem is caused by iodine deficiency?
Permanent brain damage
- What are the symptoms of iodine deficiency in different age groups?
Adults: goiter, hypothyroidism, mental impairment are all partially irreversible
Children: goiter, lower IQ, learning disabilities all partially irreversible
Prenatal: “creatinism” mental retardation are not reversible
- How has preventing iodine deficiency been successfully addressed on an international scale?
Iodine has been added to food via table salt, etc
- How can iodine deficiency increase the risk of one type of thyroid cancer?
(Cant find answer in notes)? possibly
- What other mineral besides iodine supports normal thyroid hormone function?
Selenium
- What are goitrogens and under what conditions might they have clinical importance?
Natural parts of vegetables and soy, they are iodine or thyroid antagonists, not clinically important unless large amounts are consumed along with marginal iodine intake
- What individuals in developed countries might be at risk of iodine deficiency?
Those who avoid iodized salt, seafood, and seaweed
- How do average US dietary iodine intakes compare with current recommendations?
RDA is 150mcg/day and men get 240mcg/day while women get 190 or more mcg/day
- What are the best food sources of iodine?
Iodized salt, seafood, sea vegetables
- Explain how iodine supplementation could result in either hyper- or hypothyroidism depending on the iodine status of an individual.
Individuals with autonomous thyroid nodules can become hyperthyroid if they were iodine deficient. Large amounts of iodine can elevate TSH indicating low thyroid function in iodine sufficient individuals.
- What are the important biochemical and physiological functions of manganese in the human
body?
Antioxidant SOD, Collagen synthesis, glycosaminoglycan synthesis
- Which antioxidant enzyme contains manganese, whose activity may be a useful test of manganese
status?
Superoxide Dismutase
- What enzymes important for normal collagen, cartilage, and bone formation require manganese
Collagen synthesis, glycosaminoglycan synthesis
- Supplementation with which minerals might reduce the bioavailability and/or nutritional status of manganese?
Iron, Calcium, Magnesium
- What other nutrients were combined with manganese and calcium to demonstrate superior effects on bone density preservation over calcium alone in a clinical study?
Glucosamine, Chondrotian
- Are vegetarians more or less at risk for manganese deficiency than non-vegetarians?
Less, they get up to 10mg/day
- What substances found in vegetarian foods may have a mild effect on manganese absorption?
Whole grains, tea
- What is the evidence for the effectiveness of manganese supplements for improving recovery from
musculoskeletal injuries?
1 trial found adding 5mg Mn, 2.5mg Cu and 1.5 mg Zn to a Ca formula prevented spinal bone loss beta than Ca alone. There has been no research for DJD or musculoskeletal trauma injuries
- What popular joint health product contains large amounts of manganese?
Glucosamine, Chondrotian
- What types of toxicity symptoms have been associated with ingested of large amounts of
manganese? What is the typical source of this high intake?
Multiple Neurological Problems, occupational and environmental Mn.
