Micronutrients Flashcards
How do you calculate percent weight change?
BMI categories: What is considered underweight?
less than 18.5
BMI categories: What is considered normal weight?
18.5-24.9
BMI categories: What is considered overweight?
25-29.9
BMI categories: What is considered obese?
anything 30 and above
What is another measurable physical sign that points to obesity?
waist circumference
What is considered overweight/obese in male patients?
greater or equal to 40 inches
What is considered overweight/obese in female patients?
greater than or equal to 35 inches
What are the three macronutrients?
proteins, carbs, fats
Define micronutrients
dietary substances consumed in smaller amounts than macronutrients, but still essential to the body
give some examples of broad categories of micronutrients
vitamins and vitamin-like substances
minerals
essential AA
essential FA
micronutrients are always made by the body and do not need to be ingested.
false! Typically (not always) not made by the body in sufficient amounts and therefore must be ingested to some degree
______ organic compounds required by the body for survival but generally not produced endogenously in sufficient amounts
vitamins
What are the fat-soluble vitamins?
vitamins: K, A, D, E
Where are fatty soluble vitamins stored?
excess intake is stored in fatty tissues
In what type of patients do you usually see fat soluble vitamin deficiencies?
bariatric surgery and GI illnesses
Name the water-soluble vitamins
Biotin, B complex, C
Which type of vitamins are generally widely available in foods, only limited storage in the body?
water-soluble vitamins
In what kind of patients are deficiency usually seen in patients with poor nutritional intake or malabsorption?
water-soluble vitamins
_____ similar metabolic roles to vitamins, but have no known deficiency syndrome and/or are made endogenously
vitamin-like substances
Name 7 vitamin like substances
Choline
Taurine
l-Carnitine
Inositol
Bioflavonoids
Alpha-Lipoic Acid
Coenzyme Q (CoQ)
What is another name for B1?
Thiamine
What is thiamine’s role in the body?
glucose metabolism, antioxidant, neuro metabolism
Where is Thiamine commonly found naturally?
pork
fortified grains
seeds
nuts
Who is usually thiamine deficient?
alcholism
poor diet/restricted diets
Name some symptoms of thiamine deficiency
Beriberi
Wernicke’s Encephalopathy
Korsakoff Syndrome
What are some symptoms of wet beriberi?
cardiovascular - heart failure, cardiomegaly, edema, ↑ HR, SOB
What are some symptoms of dry beriberi?
neurologic - symmetrical sensory and motor neuropathy
**What are some symptoms of Wernicke’s Encephalopathy / Korsakoff Syndrome?
Nystagmus, opthalmoplegia, ataxia, and confusion
Can evolve to long-term neuro changes–impaired short-term memory and confabulation
**_____ and _____ can cause Wernicke’s Encephalopathy / Korsakoff Syndrome
chronic alcoholism and s/p bariatric surgery
What is another name for B2?
Riboflavin
What is Riboflavin’s role in the body?
general metabolic reactions (ATP production)
What are the dietary sources of riboflavin?
milk, eggs, meats, fish, green vegetables, fortified grains
What kind of patients are usually deficient in riboflavin?
malabsorption, poor diet/restricted diet, long-term barbiturates
**What lab test is used to test for riboflavin levels?
erythrocyte glutathione reductase assay
**Why do you not just test for riboflavin when testing for riboflavin?
Riboflavin levels fluctuate too much
Name some symptoms of riboflavin defiency?
Red, swollen, inflamed mucous membranes (cheilitis, stomatitis, glossitis, sore throat)
Anemia
Seborrheic dermatitis
What is another name for B3?
Niacin
What is the role of niacin in the body?
create NAD and NADP coenzymes, used for energy/metabolism
General metabolic processes throughout the body
What are the dietary sources of niacin?
-meats, eggs, dairy, legumes, nuts, seeds, fortified grains
(Plant-based niacin is not as easily used by the body)
What kinds of patients are usually niacin deficient?
-alcoholism, anorexia, HIV+, malabsorption pts
-May also see in patients from resource-limited countries
What are some symptoms of niacin deficiency?
Pellagra:
“3 Ds” - photosensitive dermatitis, diarrhea (with other GI symptoms), dementia (advanced)
Describe symptoms of niacin toxicity
flushing and pruritus, hives, N/V, elevated LFTs - usually only at high daily doses
What is another name for B5?
pantothenic acid
What is another name for B6?
pyridoxine
What is the role in the body of B6?
protein and neurotransmitter metabolism, gluconeogenesis
What are the dietary sources of B6?
fish, poultry, potatoes, fortified grains
Avocado, bananas, spinach, nuts - not as prolific but can also provide
Food processing and cooking can reduce B6 content by 10-50%
Name some patients that are commonly associated with B6 defiency?
CKD, GI disease (IBD, celiac), autoimmune pts
Some some types of medications that can cause B6 defiency?
oral contraceptives, anti-TB, theophylline, L-dopa
Name 2 lab tests that test for B6
pyridoxine, may also consider erythrocyte transaminase activity
Name some symptoms of B6 deficiency
anemia, dermatitis, stomatitis
Neuro - depression, seizures, peripheral neuropathy
Name some symptoms of B6 toxicity
peripheral neuropathy, dizziness, rash - usually only at high daily doses
What two B vitamins should you test for when thinking about an anemic pt?
B6 and B12
What is another name for B9?
Folic acid/Folate
What is the role of folate in the body?
amino acid and nucleic acid metabolism, cell division
Strong link to neural development in utero
What is the most common nutrient deficiency in the US?
folic acide/folate
What are the dietary sources of folate?
green leafy veggies, broccoli, asparagus, fortified grains
Required by law to fortify all grains in US due to association with NTDs
What type of patients are folate deficient?
alcoholism, poor diet (low veggie intake), smokers, malabsorption pts, MTHFR patients
What medications are associated with folate defiency?
trimethoprim, methotrexate, phenytoin
What labs can you order to test for folate?
serum folic acid (superior/cheaper vs RBC folate), homocysteine
Name some symptoms of folate deficency?
anemia, glossitis/stomatitis, GI upset, fatigue
neural tube defect during embryogenesis
What is folate toxicity associated with?
high intake possibly associated with cancer risk and developmental delay
What is another name for B12?
Cobalamin/Cyanocobalamin
What is the role of B12 in the body?
nucleic acid metabolism, conversion of folate to active form, numerous other metabolic roles
What are some dietary sources of B12?
meats, dairy products, shellfish, eggs, fortified grains
Does not naturally occur in plant-based foods
What type of patients are commonly B12 deficient?
vegan diet, GI illness causing malabsorption
gastritis, gastric bypass, chronic H. pylori, pernicious anemia
What medications can cause B12 deficiency?
chronic PPI (for GERD), metformin
What 3 lab test can you order for B12?
B12, methylmalonic acid (MMA), homocysteine
Of the 3 labs for B12, which one is the most reliable?
serum MMA thought to be more reliable, but can be much more expensive
What are some symptoms of B12 deficiency?
anemia, peripheral neuropathy, cognitive defects, fatigue
____ and _____ are associated with B12 toxicity
high intake possibly associated with cancer risk and developmental delay
What is another name for vit C?
ascorbic acid
What is the role in the body for ascorbic acid?
antioxidant, gene expression, production of many important proteins including collagen
Name some dietary sources for Vit C
fruits (especially citrus), bell peppers, tomatoes, green leafy vegetables
What mirconutrient can get broken down with cooking/processing?
Vit C
Who is usually deficient with Vit C?
alcoholism, smokers, poor/restricted diet, dialysis
What is the classic syndrome associated with Vit C deficiency? What are the s/s?
Scurvy
fatigue, gingivitis, poor wound healing (not able to make collagen)
What are some s/s of Vit C toxicity?
GI upset, false-negative stool guaiac, oxalate kidney stone
What is the role of biotin in the body?
cofactor for carb, amino acid, and lipid metabolism
What are some dietary sources of biotin?
liver, eggs, nuts, meats, yeast, bananas, mushrooms
Also synthesized in the small intestine by bacteria
What type of pts are usually biotin deficient?
rare - long term parenteral nutrition, infants (formula)
aka feeding tube pts
What is the lab test for biotin?
urine biotin excretion
What are s/s of biotin deficiency?
Dermatitis around eyes/nose/mouth, conjunctivitis, alopecia, altered mental status
What are the s/s of biotin toxicity?
may interfere with labs - cardiac enzymes, thyroid, parathyroid, electrolytes
Is a person more likely to have a biotin toxicity or defiency?
toxicity
What is another name for Vit A?
Retinol/Retinoids
What are the precursors to Vit A?
Beta-carotene, alpha-carotene, cryptoxanthin
What is the role of Vit A in the body?
key component of rods and cones in the retina
epithelial cell reproduction
bone/teeth/reproductive/immune function
What are the dietary sources of Vit A?
organ meats, egg yolks, fortified milk
Carotenoids - in “orange” foods (carrots, sweet potatoes, squash, tangerines)
What is a carotenoid?
in “orange” foods (carrots, sweet potatoes, squash, tangerines)
What are the lab tests for Vit A?
serum retinol (preferably fasting), may order beta-carotene
What kind of pts are usually deficient in Vit A?
resource-poor countries, poor diet
Fat malabsorption, bariatric surgery
What are some s/s of Vit A deficiency?
night blindness, blurry vision, xerosis, keratomalacia
Children with measles, what micronutrient should you consider supplementing?
Vit A
What are some s/s of acute Vit A toxicity?
altered mental status, seizures, headache, blurred vision
What are some s/s of chronic vit A toxicity?
xerosis, headache, fatigue, hepatomegaly, alopecia, hyperostosis, pseudotumor cerebri
What micronutrient toxicity can be teratogenic?
Vit A toxicity
What is another name for Vit D?
calciferol
What is another name for Vit D3?
cholecalciferol
What is another name for Vit D2?
ergocalciferol
What are the two vit D metabolites?
calcidiol, calcitriol
What is the role in the body of Vit D?
needed for absorption of calcium in gut; receptors found throughout the body
Inactive form synthesized in skin or obtained from diet
Liver converts to intermediate form
Kidneys finish conversion to fully active form
What are some dietary sources of D3?
fatty fish, egg yolks, fortified dairy
What are some dietary sources of D2?
mushrooms
What are the 2 lab tests for vit D? Which one is the most accurate?
vitamin D (serum 25(OH)D level is most accurate)
What kind of patients are commonly Vit D deficient?
Lifestyle - low sunlight exposure, obesity, hospitalized/LTC, poor overall diet
Demographics - darker-skinned pts, breastfed newborns
Chronic disease - renal or liver disease pts, hyperparathyroid, malabsorption
What are some s/s of vit D deficiency?
Fatigue, bone pain, muscle weakness or cramps, low bone density
Many patients have no symptoms at all!
What are some s/s of acute vit D toxicity?
Hypercalcemia - fatigue, bone pain, muscle weakness or cramps
What are some s/s of chronic vit D toxicity?
nephrocalcinosis, kidney stones, bone demineralization
______ and ______ can be given to a patient who is severely hypercalcemic due to Vit D toxicity
calcitonin and/or bisphosphonate drugs
What is another name for Vit E
tocopherol, alpha-tocopherol
What is Vit E’s role in the body?
antioxidant, cell membranes, helps platelet aggregation
What are the dietary sources of Vit E?
vegetable oils, nuts, seeds
What kind of micronutrient deficiency is rare? In what kind of patients?
Vit E
Cholestasis, bowel resection, pancreatic insufficiency
What are the s/s of Vit E deficiency? What may it lead to?
Ataxia, muscle weakness, impaired vision
May also lead to hemolytic anemia
_______ is more common to be toxic than deficient
vit E
What is the role of Vit K in the body?
blood clotting; also bone and kidney metabolism
What the the dietary sources of Vit K?
green leafy vegetables, cruciferous vegetables, parsley
Can also be manufactured by some gut microflora
What lab test do you order for Vit K if the patient is NOT showing any signs?
PIVKA-II
What 4 lab tests can you order for Vit K?
PT, INR, PIVKA-II (if no symptoms), vitamin K
**What type of patients are usually Vit K deficient?
newborns, fat malabsorption, warfarin pts,
Consider in patients on prolonged/long-term antibiotic use
What diseases are commonly associated with Vit K deficiencies?
Cystic fibrosis, biliary disorders/cholestasis, intestinal disease, liver disease
Name some s/s of Vit K deficiency
bleeding, including hemorrhage
bone malformation
What micronutrient do you also consider fresh frozen plasma or prothrombin complex if acute hemorrhaging?
Vit K
What are the common symptoms of Vit K toxicity?
hemolytic anemia, hyperbilirubinemia, jaundice
_____ inorganic compounds required for survival
minerals
Name 7 macrominerals
Calcium, phosphorus, magnesium, potassium, sodium, chloride, sulfur
Name some common trace elements
Iron, copper, zinc, iodine, chromium, fluoride, nickel, arsenic, molybdenum, selenium, manganese, silicon, boron, tin, vanadium
T/F: Minerals are carbon based
False, minerals are NOT carbon based
_____ majority is found in RBCs as Hgb to transport O2
iron
Where is heme iron naturally found?
meat, poultry, seafood
Where is nonheme iron naturally found?
green leafy veggies, legumes, nuts
What is the absorption of iron enhanced by?
acidic stomach environment, vitamin C
What is the absorption of iron inhibited by?
neutral/basic stomach environment, calcium, tannins
_____ is the most common nutritional deficiency worldwide
iron deficiency
Name two instances in which the patient is usually iron deficient
chronic blood loss, plant-based diets
Name some patients that are likely to be iron deficient
Bariatric surgery, malabsorption, chronic acid-reducing GI medications also a concern
Name some symptoms of iron deficiency
Neuro: fatigue, cognitive deficits, developmental delays, restless leg-like symptoms
Late: microcytic, hypochromic anemia
Name some examples where one would find iron toxicity
hemochromatosis, extravascular hemolytic anemia, frequent transfusions, excessive supplementation (rare)
What are some s/s of iron toxicity
liver cirrhosis, liver cancer, cardiomyopathy
How do you treat iron toxicity?
holding iron supplements; regular phlebotomy; chelation
_____ majority is incorporated into thyroid hormones for metabolic function
iodine
What are some naturally sources of iodine?
seaweed, fish, shellfish, fortified foods (salt, dairy)
What does iodine deficiency lead to?
thyroid goiter
What does iodine deficiency lead to in pregnant women?
pregnancy loss, infant psychomotor retardation, cretinism
What are some common s/s of calcium deficiency?
neuro/MSK symptoms (weakness, AMS, muscle spasm, muscle weakness, thinned bones)
What are some risk factors for calcium deficiency?
restricted diet, malabsorption/GI disease
What are some common s/s of magnesium deficiency?
neuro/MSK symptoms (fatigue, weakness, AMS, muscle spasm, muscle weakness)
What are some risk factors for magnesium deficiency?
restricted diet, malabsorption/GI disease, renal disease, diuretics, PPIs
How many essential AA cannot by synthesized and must be consumed?
9 out of 20
What are sources of essential AAs?
Egg whites, milk, meats, soybeans, beans, lentils
What two essentials FAs must be consumed?
linoleic acid and alpha-linoleic acid
______ is synthesized from linoleic acid
arachidonic acid
Essential FA deficiency is rare but is most common among what patient population?
total parenteral nutrition patients
What are some sources of essential fatty acids?
vegetable oils; linseed oil; flaxseed oil; seafood
