Malnutrition/Vitamin & Mineral Deficiences Flashcards
1
Q
Which energy providing nutrients does our body need to maintain optimal health?
A
Protein, fats, carbs
2
Q
What other nutrients does the body require?
A
Vitamins, minerals, water
3
Q
Relationship for energy and maintaining stable weight?
A
Energy input should = energy output
4
Q
What is energy output?
A
Physical activity, resting energy expenditure, energy cost of metabolizing food, shivering thermogenesis
5
Q
Normal nutrient requirements will change depending on what?
A
Sex, age, activity level, stress, disease state
6
Q
What is the nutrient that is the main source of fuel?
A
Carbs (easily used by body for energy)
7
Q
Where are carbohydrates stored in the body?
A
Liver and muscle for later use
8
Q
What foods are carbohydrates found in?
A
Grains, potatoes, fruits, milk, vegetables
9
Q
What is the importance of protein in nutrients?
A
Needed for growth, tissue repair/immune function, energy source when carbs not available, preserves lean muscle mass
10
Q
What food is protein found in?
A
Meats, poultry, fish, cheese, milk, nuts
11
Q
What is the importance of fat in nutrients?
A
Some needed for survival, normal growth/development, absorbs some vitamins, cushion for organs
12
Q
What food is fat found in?
A
Meat, poultry, nuts, dairy, butter, oil
13
Q
What allows people to regulate core temperature?
A
Body water
14
Q
Water allows for transport of what in the body?
A
Nutrients, oxygen, waste
15
Q
What happens to body water amount during aging?
A
Decreases with aging
16
Q
Water accounts for how much of an infant’s weight?
A
75%
17
Q
Water accounts for how much of a young adult’s weight?
A
60%
18
Q
Water accounts for how much of a 50 year old adult’s weight?
A
50%
19
Q
Malnutrition contributes to what percentage of all deaths in children under 5 years of age?
A
45%
20
Q
According to the World Health Organization, 80% of the world’s undernourished children live in how many countries around the world?
A
Just 20 countries
21
Q
In the U.S., a conservative estimate is that 20% of the population, if not actually malnourished, is what?
A
Chronically or intermittently food insecure (affects both rural and urban populations)
22
Q
According to the WHO, how many adults are overweight or obese globally?
A
1.9 billion
23
Q
According to the WHO, how many adults are underweight globally?
A
462 million
24
Q
Globally in 2020, how many children under 5 were estimated to be stunted (too short for age)?
A
149 million
25
Globally in 2020, how many children under 5 were estimated to be wasted (too thin for height)?
45 million
26
Globally in 2020, how many children under 5 were estimated to be overweight/obese?
38.9 million
27
How many deaths among children under 5 are linked to undernutrition?
45%
28
Where do deaths among children under 5 linked to undernutrition mostly occur?
Low and middle income countries
29
What is also rising in low and middle income countries?
Childhood overweight/obesity
30
How many direct causes pf malnutrition?
Two (primary and secondary)
31
Primary cause of malnutrition?
Inadequate food intake
32
Secondary cause of malnutrition?
Underlying disease such as HIV/AIDS
33
Indirect causes of malnutrition?
Poverty, poor health conditions, war, discrimination, governmental, lack of knowledge
34
What % of body weight loss is usually tolerated without loss of physiologic function?
5-10%
35
Loss of 35-40% of body weight usually results in what?
death
36
Malnutrition affects which organ systems?
All of them
37
Malnutrition causes what to be stunted?
Physical and mental growth
38
A deficiency of what decreases protein synthesis in all tissues (pathophys of malnutrition) ?
Dietary amino acids
39
Pressure changes that can result in generalized edema is caused by a lack of what (pathophys of malnutrition) ?
Sufficient plasma proteins
40
Deficiency of dietary amino acids/protein synthesis and lack of sufficient plasma proteins/generalized edema leads to what (pathophys of malnutrition)?
Loss of K+, liver swelling, pancreatic atrophy, reduced bone density, impaired renal function, muscle wasting
41
Values for underweight?
BMI < 18.5 and/or recent loss of > or = 10% usual body mass
42
What could cause poor intake of nutrition?
Anorexia, food avoidance (psychiatric, etc.), NPO status >5 days
43
What could cause protracted nutrient losses?
Malabsorption, enteric fistulas, draining abscesses/wounds, renal dialysis
44
What are some hypermetabolic states that could cause weight loss/malnutrition?
Sepsis, protracted fever, extensive trauma/burns
45
Malnutrition/weight loss can be caused by alcohol abuse and use of what drugs?
Drugs with anti-nutrient or catabolic properties: steroids, antimetabolites (ex. methotrexate), immunosuppressants, anti-tumor agents
46
Other factors that may contribute to malnutrition?
Impoverishment, isolation, advanced age
47
Labs for malnutrition screening?
CBC, CMP, LFTs, pre-albumin/albumin, TIBC, serum & 24hr creatinine, prothrombin time, BUN, Vitamin & mineral levels
48
Testing for malnutrition is specific to what?
Suspected disease entity
49
Tools for assessing for malnutrition?
Mini Nutritional Assessment (MNA), Malnutrition Screening tool (MST)
50
MNA score for normal nutritional status?
24-30 points
51
MNA score for risk of malnutrition?
17-23.5 points
52
MNA score for malnourishment?
<17 points
53
MST score that does not have a risk of malnutrition?
<2 (0-1)
54
MST score that is at risk of malnutrition?
> or = 2 (2-5)
55
Differential diagnosis for malnutrition?
Malignancy, chronic inflammatory state, infectious illness, metabolic disorder, med related, self induced/physchiatric, aging, poverty/famine/neglect
56
Treatment for malnutrition?
Tx underlying process, diet modification, replenish micronutrients, referrals
57
What are the two major types of protein energy malnutrition?
Marasmus/Cachexia
and
Kwashiorkor/Protein calorie malnutrition
58
What is marasmus?
Starvation related malnutrition
59
What happens in marasmus?
All available body fat stores exhausted from starvation, decreased energy intake
(seen when adequate food supply not available)
60
How long can marasmus take to develop?
May take months to years
61
Can marasmus be a chronic state?
Yes
62
What involves weight loss from muscle mass due to chronic systemic inflammation?
Cachexia
63
What is an example of a condition that could cause marasmus?
anorexia
64
What is an example of a condition that could cause cachexia?
COPD
65
Clinical appearance of Marasmus?
Starved skin and bones appearance, head appears large w/ staring gaze, absolute weakness
66
Weight values in Marasmus?
<80% standard for height
67
Triceps skinfold value in marasmus?
< 3mm
68
Mid-arm muscle circumference is marasmus?
<115 mm (severe)
69
Bradycardia, hypotension, and hypothermia are present in which malnutrition condition?
Marasmus
70
What is Cachexia?
Chronic disease related malnutrition
71
Lab findings for Marasmus?
Relatively unremarkable
(low creatinine height index from loss of muscle mass, slight decrease in serum albumin, iron deficiency anemia)
72
Treatment of Marasmus?
Cautious and slow, body needs to re-adapt, oral nutritional support preferred
73
What is Kwashiorkor?
Acute or injury related edematous malnutrition
74
What causes of Kwashiorkor?
Protein calorie malnutrition/decreased protein intake
*body has greater protein & energy demands while intake is limited
75
When does Kwashiorkor occur?
In acute life threatening illness (ex. sepsis, trauma), starvation states
76
Can there be a marasmus and kwashiorkor overlap with starvation states?
Yes
77
Clinical features of Kwashiorkor?
May be subtle at first, easy hair pluck, edema skin breakdown, poor wound healing, pot belly appearance
78
What causes pot belly appearance in Kwashiorkor?
Hepatomegaly
79
What kind of edema happens in Kwashiorkor?
Peripheral pitting, moon face
80
Lab findings with Kwashiorkor?
Drastic abnormalities:
serum albumin <2.8g/dL (4-6), electrolyte depletion, iron deficiency anemia
81
Treatment for Kwashiorkor is the same as what condition?
Marasmus
82
Treatment for trauma induced Kwashiorkor?
Aggressive nutritional support, restore metabolic balance quickly, parenteral nutrient replacement
83
Prognosis for trauma induced Kwashiorkor?
Poor with high mortality rate
84
Clinically significant involuntary weight loss (IWL) is a loss of what amount?
10 lbs or >5% of body weight over 6-12 months
*insidious (gradual, but w harmful effects)
85
What can involuntary weight loss (IWL) be a warning sign of?
Serious underlying disease (cancer)
86
IWL is seen in what % of the adult outpatient population?
8%
87
IWL is seen in what % of frail people aged 65+?
27%
88
IWL is associated with what?
Increased mortality
89
In the elderly, IWL can be associated with what effects?
Hip fracture, Pressure ulcers, Impaired immune function, Decreased functional status, Death
90
What are the four main cause categories of IWL?
1. Malignant neoplasms
2. Chronic inflammatory or infectious diseases
3. Metabolic disorders (ex. diabetes)
4. Psychiatric disorders
91
Malignant neoplasms revealed though IWL have what prognosis?
Poor
92
Other causes of IWL?
Meds, social/economic factors, age related factors, neurologic
93
What are the four major manifestations of IWL?
Anorexia, Cachexia, Sarcopenia, Dehydration
94
What is anorexia?
Loss of appetite
95
What is Cachexia?
Loss of muscle mass
96
What is Sarcopenia?
Combo of weight loss, muscle and fat loss, anorexia and weakness
97
Treatment of IWL focuses on what?
Find/treat underlying cause
98
What should be evaluated in the treatment of IWL?
Current meds, d/c or change if necessary/possible
99
Treatment for IWL?
Oral nutrition (ex. high energy drinks), supplements between meals (not with meals)
100
Patients with wasting conditions may benefit from what?
Exercise programs to gain muscle, protein mass, strength, endurance
101
Metabolic rate in starvation/semistarvation?
Between 10-30% (body's response to energy restriction)
102
Lower metabolic rate in starvation/semistarvation slows what process?
Weight loss
103
Resting metabolic rate rises with what?
Physiologic stress
104
Degree of rise in metabolic rate during physiologic stress depends on what?
Degree of stress
105
Rise of metabolic rate as a result of elective surgery stress?
10%
106
Rise of metabolic rate as a result of bone fracture stress?
20-30%
107
Rise of metabolic rate as a result of severe infection stress?
30-60%
108
Rise of metabolic rate as a result of major burn stress?
110%
109
What is hypermetabolic state? What risk does this hold?
Stress from injury, infection with Kwashiorkor risk
110
What is Hypometabolic state? What risk does this hold?
Unstressed but chronically starved, Marasmus risk
111
What happens to the rate of protein breakdown (catabolism) to supply energy needs during uncomplicated energy deprivation?
Usually falls
112
After 10 days of total starvation, an unstressed person loses how much protein?
12-18g/dL
113
What happens to the rate of catabolism with stress or injury?
Rate increases proportional to the degree of injury
114
Synthesis of glucose is from which non-carbohydrate precursors?
Glucogenic amino acids, lactate, glycerol, propionate
115
Which organs are the major gluconeogenic tissues?
Liver and kidneys
116
Key gluceneogenic enzymes are expressed where?
Small intestine
117
Glucose is especially necessary for what?
Nervous system function, erythrocytes
118
Failure of gluconeogenesis can result in what?
death
119
Excessive gluconeogenesis can occur in who?
ill patients
120
What is micronutrient malnutrition?
Deficiencies or excess in vitamins and minerals
121
What vitamin is thiamine?
Vitamin B1
122
What is Vitamin B1 (Thiamine) found in?
Fortified breads and cereals, fish, lean meats, and milk
123
Causes of Vitamin B1 (Thiamine) deficiency?
Lack of thiamine intake, increased depletion, decreased absorption
124
What can cause lack of thiamine intake?
Alcoholism, starvation, gastric bypass, food choices
125
What can cause increased depletion of thiamine?
Diuretics, diarrhea
126
What can cause decreased absorption of thiamine?
Chronic intestinal disease, malnutrition
127
Prolonged thiamine deficiency causes what?
Beriberi
128
What are the two main types of Beriberi?
Wet and Dry
129
Dry beriberi affects what system?
Neurologic system (neuropathy, muscle weakness, pain, hyperreflexia)
130
Wet beriberi affects what system?
CV system (tachycardia, SOB, lower extremity edema, can lead to HF)
131
What syndrome can thiamine deficiency cause?
Wernicke-Korsakoff Syndrome
132
Wernicke encephalopathy occurs in which patients?
Alcoholic patients with chronic thiamine deficiency
133
An orderly sequence of symptoms occurs in Wernicke encephalopathy including what?
Vomiting, horizontal nystagmus, palsies of eye movements, fever, ataxia, progressive mental impairment
134
What happens during Korsakoff syndrome?
Memory loss and confabulatory psychosis (chronic)
135
Which vitamin is Riboflavin?
Vitamin B2
136
How could glass milk containers cause riboflavin deficiency?
Promote degradation of the vitamin from exposure to light
137
Daily consumption of what would be expected to provide adequate intake of riboflavin?
Breakfast cereal and milk
138
Clinical findings with riboflavin (B2) deficiency?
Cheilitis (chapping/fissure of the lips), sore/red tongue, oily/scaly skin
139
Which vitamin is Niacin?
Vitamin B3
140
Inability to absorb Niacin (B3) or the amino acid tryptophan may cause what?
Pallagra - disease characterized by scaly sores, mucosal changes, mental symptoms
141
What are the 4 D's of Pellagra?
Dermatitis, Diarrhea, Dementia, Death
142
What is vitmain B12 found in?
Eggs, meat, milk, oysters, poultry
143
How can malabsorption of Vitamin B12 occur?
Food vit B-12 malabsorption, Lack of intrinsic factor or parietal cell, Ileal malabsorption, Bacterial overgrowth
144
How can defective transport of Vitamin B12 occur?
Transcobalamin deficiency (genetic)
145
What conditions can cause malabsorption of B12 by lack of intrinsic factor or parietal cell?
Pernicious anemia, Atrophic gastritis, Postgastrectomy
146
What conditions can cause malabsorption of B12 by ileal malabsorption?
Ileal resection, Crohn's disease
147
Before the body can use B12, what is needed?
Intrinsic factor (IF)
148
What is IF made by?
Parietal cells in a healthy stomach lining
149
If B12 deficiency occurs in infants and is not detected and treated, what can it lead to?
Severe and permanent damage to the nervous system
150
New mothers who follow a vegetarian diet should have what levels checked in their babies?
B12 levels
151
Mild vitamin B12 deficiency can cause what symptoms?
Mild, if any
152
As vitamin B12 deficiency anemia worsens, what symptoms can occur?
Weakness, tiredness, light-headedness, pale skin, sore tongue, rapid heartbeat/breathing, easy bruising/bleeding, bleeding gums, stomach upset, weight loss, diarrhea or constipation
153
If Vitamin B12 is not corrected, it can damage nerve cells and cause what effects?
Tingling or numbness in fingers/toes, difficulty walking, mood changes/depression, memory loss, disorientation, dementia
154
Which vitamin is Folate?
Vitamin B9
155
Folate can be found in which foods?
Beans/legumes, citrus fruits/juices, whole grains, dark green leafy vegetables, poultry, pork, shellfish, liver
156
What does folate (folic acid) aid in?
Production of RBCs, synthesis of DNA, works with B12 and C to help body digest/utilize proteins
157
Causes of B9 (folic acid) deficiency?
Poor diet, malabsorption, deficiency in Vitamin B12, drugs (ex. anticonvulsants)
158
Clinical findings of Vitamin B9 (Folic acid) deficiency?
Sore tongue, Depression, Anemia (macrocytic, megaloblastic) in advanced deficiency
159
What can happen with Vitamin B9 (Folic acid) in pregnant women?
Low birth weight, premature birth, neural tube defects in fetus
160
What condition can Vitamin B12 deficiency cause in a fetus?
Spina bifida (open defect): spinal cord/fluid project through and push out dura mater
161
Vitamin C can be found in what foods?
Citrus fruits, green peppers, strawberries, tomatoes, broccoli, sweet & white potatoes
162
Which vitamin is ascorbic acid?
Vitamin C
163
Function of Vitamin C in the body?
Promotes healthy immune system, helps wounds heal, maintains connective tissue, aids in absorption of iron
164
Which vitamin deficiency is rare in modernized countries?
Vitamin C deficiency
165
Causes of Vitamin C (ascorbic acid) deficiency?
Poor diet, smoking, increased consumption states (ex. pregnancy and lactation)
166
What is Scurvy?
Vitamin C deficiency condition leading to: easy bruising, gingivitis, decreased wound-healing, dry/splitting hair, swollen/painful joints
167
What vitamin is beta-carotene a precursor of?
Vitamin A
168
What foods contain vitamin A?
Animal sources: eggs, meat, dairy
169
What foods contain beta-carotene?
Green, leafy vegetables
Intensely colored fruits/vegetables (bright colored)
170
Benefits of Vitamin A?
Maintains health if specialized tissues (ex. retina), aids in growth/health of skin and mucous membranes, promotes normal development of teeth, soft tissue, and skeletal tissue
171
Is Vitamin A deficiency common in the US?
No, more common in developing countries
172
Causes of Vitamin A deficiency?
Poor diet, malabsorption disorders, vegan diet, alcoholism
173
Clinical features of Vitamin A deficiency?
Bitot spots, night blindness, dry skin/hair, xeropthalmia, follicular hyperkeratosis (phrynoderma)
174
What are bitot spots?
Areas of abnormal squamous cell proliferation and keratinization of conjunctiva (seen in young children w/ Vit. A deficiency)
175
What is xeropthalmia from vitamin A deficiency?
Lack of tear production
176
What is follicular hyperkeratosis (phrynoderma) from vitamin A deficiency secondary to?
Blockage of hair follicles with plugs of keratin
177
Sources of Vitamin D?
Natural sunlight, fortified milk, cheese, butter/margarine, cereal, fish
178
Vitamin D deficiency or inability of the body to utilize vitamin D may lead to which condition?
Rickets - weakening/softening of the bones from extreme calcium loss
179
Causes of Vitamin D deficiency?
Poor diet, inadequate sun exposure, malabsorption, breast milk without supplementation of Vit. D, Meds
180
Clinical features of Vitamin D deficiency?
Muscle aches/weakness, bone pain, muscle twitching, osteomalacia, osteoporosis, Rickets
181
What is osteomalacia?
Bone thinning disorder that occurs exclusively in adults
*Characterized by proximal muscle weakness & bone fragility
182
What is osteoporosis?
Condition characterized by reduced bone mineral density & increased bone fragility
183
What is Rickets?
Childhood disease characterized by impeded growth & deformity of long bones
*bowing of long bones
184
What causes soft bones and skeletal deformities in Rickets?
Bone tissues failing to properly mineralize
185
Which vitamin is Tocopherol?
Vitamin E
186
What foods is Vitamin E found in?
Corn, nuts, olives, green leafy vegetables, vegetable oils, wheat germ
187
Can food alone provide a beneficial amount of vitamin E?
No, supplements may be helpful
188
Benefits of Vitamin E?
Protects cell membranes/tissues from oxidation damage, aids in formation of RBCs and use of Vitamin K, Promotes function of healthy circulatory system
189
Causes of Vitamin E deficiency?
Those who cannot absorb dietary fat, premature infants with very low birth weight, rare disorders of fat metabolism
190
What can Vitamin E deficiency cause?
Anemia, impairment of immune response, male infertility, neuromuscular problems
191
Neuromuscular problems that can be related to vitamin E deficiency?
Spinocerebellar ataxia and myopathies, dysarthria, absence of deep tendon reflexes, loss of vibratory sensation/proprioception, positive Babinski sign
192
What is a positive Babinski sign?
Lateral forefoot stimulation causes big toe to flex and other toes to spread out like a fan
193
What foods contain vitamin K?
Cabbage, cauliflower, spinach/other green leafy vegetables, cereals
194
Vitamin K functions?
Blood clotting, bone health, antioxidant, anti-inflammatory, fights calcification
195
Causes of Vitamin K deficiency in infants?
Low transmission across the placenta, liver prematurity w/ prothrombin synthesis, lack of vit. K in breast milk, sterile gut
196
Why is Vitamin K deficiency uncommon?
Present in variety of foods, body can recycle Vit. K, adequate gut flora production of Vit. K
197
Causes of Vitamin K deficiency?
Chronic illness, malnutrition, alcoholism, multiple abdominal surgeries, long-term parenteral nutrition, malabsorption, drugs
198
Which drugs can cause Vitamin K deficiency?
Antibiotics (Cephalosporin), Cholestyramines, Warfarin, Salicylates, Anticonvulsants, certain Sulfa drugs
199
Possible effects of Vitamin K deficiency?
Epistaxis, Hematoma, GI bleeding, Menorrhagia, Hematuria, Gum bleeding, Ecchymosis, Petechiae/purpura
200
Possible effects of Vitamin K deficiency in infants?
Some birth defects: underdevelopment of the face, nose, bones, fingers
201
Food sources of calcium?
Dairy, vegetables (spinach), nuts (almonds), beans, figs
202
Role of calcium?
Building stronger/denser bones early in life, keeping bones strong and healthy later in life
Also involved in NT release, muscle contraction, electrical conduction of heart
203
How much of the body's calcium is stored in the bones and teeth?
Approximately 99%
204
Effects of acute calcium deficiency?
Convulsions, arrhythmias, tetany and numbness/parasthesias in hands, feet, & around mouth/lips
205
Effects of long term calcium deficiency?
Rickets, Osteoporosis
206
Causes of Calcium deficiency?
Hypoparathyroidism, eating disorders, excessive dietary magnesium, chronic renal failure, absence of Vitamin D
207
What is Wilson's Disease?
Congenital disease that causes excess copper to accumulate in the liver and brain
(Kayser-Fleischer rings in the eye: sign)
208
Food sources of magnesium?
Dark/leafy greens, nuts/seeds, fish, beans/lentils, whole grains, avocados, bananas, dried fruit, dark chocolate
209
What diverse biochemical reactions does magnesium regulate in the body?
Protein synthesis, muscle & nerve function, blood glucose control, BP regulation
210
What is magnesium required for?
Energy production, oxidative phosphorylation, glycolysis, synthesis of DNA, RNA, & the antioxidant glutathione
211
Magnesium contributes to the structural development of what?
Bone
212
Magnesium plays a role in active transport of what ions across cell membranes?
Calcium and Potassium ions
213
What is transport of calcium and potassium across the cell membrane important for?
Nerve impulse conduction, muscle contraction, normal heart rhythm
214
Causes of Magnesium deficiency?
Poor diet, alcohol abuse, poorly controlled diabetes, excessive/chronic vomiting and/or diarrhea
215
Which drugs can deplete magnesium levels?
Osmotic diuretics, cisplatin, cyclosporine, amphetamines, possibly PPIs
216
Early signs of Magnesium deficiency?
Loss of appetite, N/V, fatigue, weakness
217
As magnesium deficiency worsens, what symptoms can occur?
Numbness, tingling, muscle contractions/cramps, seizures, personality changes, abnormal heart rhythms, coronary spasms
218
Severe magnesium deficiency can result in what conditions?
Hypocalcemia or hypokalemia (due to mineral homeostasis disruption)
