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
Women are >= 35inches
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?
Pellagra
3D’s:
photosensitive Dermatitis
Diarrhea (and other GI)
Dementia (advanced)
B3 is the 3D
Describe B6. (Name, role, dietary source, common demographic for deficiency, 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
What is a pyridoxine deficiency called?
No specific name.
General symptoms:
Anemia
Dermatitis
Stomatitis
Depression
Seizures
Describe B9. (Name, role, dietary source, common demographic for deficiency, 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
What are the symptoms of a folate deficiency?
Megaloblastic folic acid deficiency anemia
Glossitis
Stomatitis
GI upset
Fatigue
What is the most common nutrient deficiency in the US?
Folate B9
What is a MTHFR patient?
Methylenetetrahydrofolate reductase enzyme deficiency
Describe B12. (Name, role, dietary source, common demographic for deficiency, 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)
What breaks down homocysteine?
It is an AA broken down by B6, folate, and B12.
What are the symptoms of a B12 deficiency?
Megaloblastic anemia
Peripheral neuropathy (IMPORTANT!!!)
Cognitive defects
Fatigue
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
What is a vitamin C deficiency called?
Scurvy!
Fatigue
Gingitivits
Poor wound healing
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
What are the symptoms of vitamin A deficiency?
Night blindness, blurry vision, xerosis, keratomalacia
What are the symptoms of vitamin A toxicity?
AMS
Seizures
HA
Blurred vision
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.
What are the symptoms of Vitamin D deficiency?
Fatigue
Bone pain
Muscle weakness or cramps
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.
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
What are the symptoms of a vitamin E deficiency?
Ataxia, muscle weakness, impaired vision
What are the symptoms of a vitamin E toxicity?
Bleeding, muscle weakness, fatigue, nausea, vomiting
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.
What are the symptoms of a vitamin K deficiency?
Bleeding
Hemorrhage
Bone malformation
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
What are minerals?
INORGANIC compounds required for survival
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
What is the most common nutritional deficiency in the US and the world?
US: Folate
World: Iron
What are the symptoms of an iron deficiency?
Fatigue
Anemia
Cognitive difficulties
Impaired immunity
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.
What are the symptoms for an iodine deficiency?
Thyroid goiters.
Pregnant people with a deficiency can have a miscarriage, infant psychomotor retardation or cretinism.
What are the two primary bone minerals?
Calcium and Magnesium
Where do calcium and magnesium come from diet-wise?
Ca: dairy, green leafy veggies, and fortified foods
Mg: dairy, green leafy veggies, whole grains
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.
How many AAs cannot be synthesized?
9 out of 20
Where do I get the AAs that cannot be synthesized?
Egg whites, milk, meats, soybeans, beans, and lentils
How common is AA deficiency?
Rare
What two essential FAs must be consumed?
Linoleic acid and alpha-linoleic acid.
What essential FA is synthesized?
Arachidonic acid, but it is synthesized from linoleic acid.
Where do I get essential FAs from?
Veggie oils, linseed oil, flaxseed oil, seafood
Note:
Farmed fish have lower nutritional value than free
What demographic is most susceptible to a FA deficiency?
Pts on TPN
