Lecture 1: Assessment and Micronutrients Flashcards
What is important to ask when asking for medical history in regards to nutrition?
Conditions that are affected by nutrition intake (ex: megaloblastic anemias)
Conditions that affect nutritional intake (allergies, intolerances)
Where does diet history go in the history?
Social history.
What set of factors has a huge impact on a pt’s food selection and preparation?
Socioeconomic factors
What is the typical way we ask for diet history?
24 hour recall retrospectively of everything eaten.
How off are self-estimations of people’s diet?
Normal BMI = 20% underestimation
Overweight/Obese BMI = 40% underestimation
What is the prospective form of a diet history?
3 day nutritional intake log.
Ask pt to write it down daily as they actually eat it.
What are some pertinent ROS findings that can have nutritional implications?
Anemia (weakness, dizziness, fatige, palps)
Gluten sensitivity/Celiac (HA, fatigue, GI symptoms)
Anorexia (amenorrhea, palpitations, weakness)
When is weight loss considered significant?
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.
What do we need to make sure to do if we’re writing things like malnourished or obese in the general assessment?
PE findings must support it.
Add to problem list.
What BMI is considered overweight?
At least 25.
How does obese waist circumference vary between men and women?
Men are >= 40inches (102cm)
Women are >= 35inches (88cm)
Also varies with ethnicity.
What does a large waist circumference correlate with?
Increased risk of morbidity, DM, HLD, HTN, CVD
What falls under micronutrients?
Vitamins and vitamin-like substances
Minerals
Essential AAs
Essential FAs
What is a micronutrient?
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.
What are vitamins?
ORGANIC COMPOUNDS required by body but NOT MADE ENDOGENOUSLY IN SUFFICIENT AMTS.
What are the fat-soluble vitamins?
DEAK.
Where are excess fat vitamins stored?
Fatty tissues.
Deficiency is seen in fat malabsorption syndromes like bariatric surgery or a GI illness.
What are the water-soluble vitamins
B complex & C
Where are excess water-soluble vitamins stored?
Not mentioned, but storage is limited since unable to store in fat.
Deficiency is seen in poor nutritional intake or malabsorption.
What vitamin class are patients more likely to have toxicity from?
Fat-soluble.
What are the vitamin-like substances?
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
Describe B1. (Name, role, dietary source, common demographic for deficiency, and lab test)
Thiamine
Glucose metabolism, antioxidant, NEURO metabolism
Pork, fortified grains, seeds, nuts
ALCOHOLICS, poor diet/restricted diets
Whole blood test for thiamine.
What is a thiamine deficiency called?
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.
Describe B3. (Name, role, dietary source, common demographic for deficiency, and lab test)
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
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