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Nutrition Sum 2023 > Lecture 1: Assessment and Micronutrients > Flashcards

Lecture 1: Assessment and Micronutrients Flashcards

1
Q

What is important to ask when asking for medical history in regards to nutrition?

A

Conditions that are affected by nutrition intake (ex: megaloblastic anemias)
Conditions that affect nutritional intake (allergies, intolerances)

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2
Q

Where does diet history go in the history?

A

Social history.

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3
Q

What set of factors has a huge impact on a pt’s food selection and preparation?

A

Socioeconomic factors

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4
Q

What is the typical way we ask for diet history?

A

24 hour recall retrospectively of everything eaten.

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5
Q

How off are self-estimations of people’s diet?

A

Normal BMI = 20% underestimation
Overweight/Obese BMI = 40% underestimation

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6
Q

What is the prospective form of a diet history?

A

3 day nutritional intake log.
Ask pt to write it down daily as they actually eat it.

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7
Q

What are some pertinent ROS findings that can have nutritional implications?

A

Anemia (weakness, dizziness, fatige, palps)
Gluten sensitivity/Celiac (HA, fatigue, GI symptoms)
Anorexia (amenorrhea, palpitations, weakness)

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8
Q

When is weight loss considered significant?

A

Depends on the time frame.

Significant:
1 week = 1-2%
1 month = 5%
3 months = 7.5%
6 months = 10%
1 year = 20%

Severe would be greater than any of these.

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9
Q

What do we need to make sure to do if we’re writing things like malnourished or obese in the general assessment?

A

PE findings must support it.

Add to problem list.

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10
Q

What BMI is considered overweight?

A

At least 25.

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11
Q

How does obese waist circumference vary between men and women?

A

Men are >= 40inches (102cm)
Women are >= 35inches (88cm)

Also varies with ethnicity.

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12
Q

What does a large waist circumference correlate with?

A

Increased risk of morbidity, DM, HLD, HTN, CVD

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13
Q

What falls under micronutrients?

A

Vitamins and vitamin-like substances
Minerals
Essential AAs
Essential FAs

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14
Q

What is a micronutrient?

A

Dietary substance consumed in smaller amts than macronutrients but still essential.

Generally, they are not made by the body in sufficient amts and need to be ingested to some degree.

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15
Q

What are vitamins?

A

ORGANIC COMPOUNDS required by body but NOT MADE ENDOGENOUSLY IN SUFFICIENT AMTS.

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16
Q

What are the fat-soluble vitamins?

A

DEAK.

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17
Q

Where are excess fat vitamins stored?

A

Fatty tissues.

Deficiency is seen in fat malabsorption syndromes like bariatric surgery or a GI illness.

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18
Q

What are the water-soluble vitamins

A

B complex & C

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19
Q

Where are excess water-soluble vitamins stored?

A

Not mentioned, but storage is limited since unable to store in fat.

Deficiency is seen in poor nutritional intake or malabsorption.

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20
Q

What vitamin class are patients more likely to have toxicity from?

A

Fat-soluble.

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21
Q

What are the vitamin-like substances?

A

Similar metabolic role to vitamins but no known deficiency syndrome and are usually made endogenously.

Choline
Taurine
l-carnitine
Inositol
Bioflavonoids
Alpha-lipoic acid
CoQ

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22
Q

Describe B1. (Name, role, dietary source, common demographic for deficiency, and lab test)

A

Thiamine
Glucose metabolism, antioxidant, NEURO metabolism
Pork, fortified grains, seeds, nuts
ALCOHOLICS, poor diet/restricted diets
Whole blood test for thiamine.

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23
Q

What is a thiamine deficiency called?

A

Beriberi.

Wet beriberi is CV related, involving HF, cardiomegaly, edema, tachycardia, and SOB.

Dry beriberi is neurologic, involving symmetrical sensory and motor neuropathy.
Dry beriberi includes Wernicke’s encephalopathy and korsakoff syndrome.

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24
Q

Describe B3. (Name, role, dietary source, common demographic for deficiency, and lab test)

A

Niacin
Create NAD/NADP coenzymes, aka general metabolic processes.
Meat, eggs, dairy, legumes, nuts, seeds, fortified grains. (Plant-based is harder for body to use)
Alcoholics, anorexics, HIV+, malabsorption pts
Niacin lab test

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25
What is a niacin deficiency called? What does this consist of?
Pellagra 3D's: photosensitive Dermatitis Diarrhea (and other GI) Dementia (advanced) B3 is the 3D
26
Describe B6. (Name, role, dietary source, common demographic for deficiency, special consideration meds, and lab test)
Pyridoxine Protein and NT metabolism, gluconeogenesis Fish, poultry, potatoes, fortified grains. (secondary: avocado, bananas, spinach, nuts) CKD, GI disease (IBD/celiac), autoimmune pts. Special: people on OCPs, anti-TB, theophylline, or L-dopa Pyridoxine lab test
27
What is a pyridoxine deficiency called?
No specific name. General symptoms: Anemia Dermatitis Stomatitis Depression Seizures DADSS (because this not hving a name gets me every time, just like a dad joke)
28
Describe B9. (Name, role, dietary source, common demographic for deficiency, special med considerations, and lab test)
Folic acid/Folate AA and nucleic acid metabolism, cell division, NTD in utero Green leafy veggies, broccoli, asparagus, and fortified grains Alcoholics, poor diet (aka green haters), smokers, malabsorption pts, MTHFR patients Special: people on TMP, methotrexate, or phenytoin Serum folic acid (superior/cheaper than RBC folate) or a homocysteine test
29
What are the symptoms of a folate deficiency?
Megaloblastic folic acid deficiency anemia Glossitis Stomatitis GI upset Fatigue
30
What is the most common nutrient deficiency in the US?
Folate B9
31
What is a MTHFR patient?
Methylenetetrahydrofolate reductase enzyme deficiency
32
Describe B12. (Name, role, dietary source, common demographic for deficiency, special concern meds, and lab test)
Cobalamin/Cyanocobalamin Nucleic acid metabolism, conversion of FOLATE to active form, etc. Meats, dairy products, shellfish, eggs, fortified grains (DOES NOT NATURALLY OCCUR IN PLANTS) Vegans, GI illness with malabsoprtion (gastritis, gastric bypass, chronic H pylori, pernicious anemia) Special: people on chronic PPIs for GERD B12, MMA, homocysteine, serum MMA (more reliable but more expensive)
33
What breaks down homocysteine?
It is an AA broken down by B6, folate, and B12.
34
What are the symptoms of a B12 deficiency?
Megaloblastic anemia Peripheral neuropathy (IMPORTANT!!!) Cognitive defects Fatigue
35
Describe Vitamin C. (Name, role, dietary source, common demographic for deficiency, and lab test)
Ascorbic acid Antioxidant, gene expression, production of many proteins including collagen. Fruits (esp. citrus), bell peppers, tomatoes, green leafy veggies Alcoholics, smokers, poor/restricted diet, dialysis Vitamin C lab test
36
What is a vitamin C deficiency called?
Scurvy! Fatigue Gingitivits Poor wound healing
37
Describe Vitamin A. (Name, role, dietary source, common demographic for deficiency, and lab test)
Retinol/Retinoids (Precursors include beta-carotene, alpha-carotene, and cryptoxanthin) Key component of rods and cones, epithelial cell reproduction, bone/teeth/reproductive/immune function. Organ meats, egg yolks, fortfied milk, orange foods (for carotenes) Underdeveloped countries, poor diet, fat malabsorption (falls under DEAK) Vitamin A, or beta-carotene lab test
38
What are the symptoms of vitamin A deficiency?
Night blindness, blurry vision, xerosis, keratomalacia
39
What are the symptoms of vitamin A toxicity?
AMS Seizures HA Blurred vision
40
Describe vitamin D. (Name, role, dietary source, common demographic for deficiency, and lab test)
Calciferol, active is calcitriol in the body Needed for absorption of calcium in gut. D3 comes from fatty fish, egg yolks, fortified dairy. D2 comes from mushrooms. Low sunlight exposure, darker-skinned people, poor diet, RENAL OR LIVER disease, breastfed newborns Vitamin D or calcitriol lab test Note: D3 is active. D2 is inactive. Kidney converts D2 to D3.
41
What are the symptoms of Vitamin D deficiency?
Fatigue Bone pain Muscle weakness or cramps
42
What are the symptoms of Vitamin D toxicity?
Fatigue Bone pain Muscle weakness or cramps Note: Its literally impossible to tell deficiency or toxicity for Vit D based on symptoms.
43
Describe Vitamin E. (Name, role, dietary source, common demographic for deficiency, and lab test)
Tocopherol and alpha-tocopherol Antioxidant, cell membranes Veggie oils, nuts, seeds RARE but malnourished and fat malabsorption Vitamin E lab test
44
What are the symptoms of a vitamin E deficiency?
Ataxia, muscle weakness, impaired vision
45
What are the symptoms of a vitamin E toxicity?
Bleeding, muscle weakness, fatigue, nausea, vomiting
46
Describe Vitamin K. (Name, role, dietary source, common demographic for deficiency, and lab test)
Vitamin K has no actual name i guess :( Blood clotting, bone and kidney metabolism Green leafy veggies, cruciferous veggies, parsley, and gut microflora NEWBORNS, fat malabsorption, warfarin pts Vitamin K lab test note: We don't need vit K consumption as much since gut microflora can produce pretty sufficient amts. Newborns get a Vit K shot since they lack the microflora.
47
What are the symptoms of a vitamin K deficiency?
Bleeding Hemorrhage Bone malformation
48
What falls under minerals?
Macrominerals like Ca, P, Mg, K, Na, Cl, and S Trace elements like Iron, Copper, zinc, iodine, chromium, fluoride, nickel, arsenic, molybdenum, selenium, manganese, silicon, boron, tin, and vanadium
49
What are minerals?
INORGANIC compounds required for survival
50
Where does iron come from and who is at highest risk for a deficiency?
Dietary: Heme: meat, poultry, seafood Non-heme: green leafy veggies, legumes, nuts Risk: Plant-based diet, women, chronic bleeders
51
What is the most common nutritional deficiency in the US and the world?
US: Folate World: Iron
52
What are the symptoms of an iron deficiency?
Fatigue Anemia Cognitive difficulties Impaired immunity
53
Describe Iodine (Purpose, dietary source, risk for deficiency)
Majority is incorporated into thyroid hormones for metabolic function. Dietary sources include seaweed, fish, shellfish, and fortified foods like SALT and DAIRY Risk: Countries with low iodine salt in soil or no requirement for fortification. Note: Sea salt is NON-iodized.
54
What are the symptoms for an iodine deficiency?
Thyroid goiters. Pregnant people with a deficiency can have a miscarriage, infant psychomotor retardation or cretinism.
55
What are the two primary bone minerals?
Calcium and Magnesium
56
Where do calcium and magnesium come from diet-wise?
Ca: dairy, green leafy veggies, and fortified foods Mg: dairy, green leafy veggies, whole grains
57
What are the risk factors for Ca and Mg deficiencies?
Ca: Restricted diet, malabsorption/GI disease Mg: Restricted diet, malaabsorption/GI disease, renal disease, DIURETICS, and PPIs.
58
How many AAs cannot be synthesized?
9 out of 20
59
Where do I get the AAs that cannot be synthesized?
Egg whites, milk, meats, soybeans, beans, and lentils
60
How common is AA deficiency?
Rare
61
What two essential FAs must be consumed?
Linoleic acid and alpha-linoleic acid.
62
What essential FA is synthesized?
Arachidonic acid, but it is synthesized from linoleic acid.
63
Where do I get essential FAs from?
Veggie oils, linseed oil, flaxseed oil, seafood Note: Farmed fish have lower nutritional value than free
64
What demographic is most susceptible to a FA deficiency?
Pts on TPN

Nutrition Sum 2023 (10 decks)

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