Micronutrients Flashcards
(155 cards)
1
Q
How do you calculate percent weight change?
A
2
Q
BMI categories: What is considered underweight?
A
less than 18.5
3
Q
BMI categories: What is considered normal weight?
A
18.5-24.9
4
Q
BMI categories: What is considered overweight?
A
25-29.9
5
Q
BMI categories: What is considered obese?
A
anything 30 and above
6
Q
What is another measurable physical sign that points to obesity?
A
waist circumference
7
Q
What is considered overweight/obese in male patients?
A
greater or equal to 40 inches
8
Q
What is considered overweight/obese in female patients?
A
greater than or equal to 35 inches
9
Q
What are the three macronutrients?
A
proteins, carbs, fats
10
Q
Define micronutrients
A
dietary substances consumed in smaller amounts than macronutrients, but still essential to the body
11
Q
give some examples of broad categories of micronutrients
A
vitamins and vitamin-like substances
minerals
essential AA
essential FA
12
Q
micronutrients are always made by the body and do not need to be ingested.
A
false! Typically (not always) not made by the body in sufficient amounts and therefore must be ingested to some degree
13
Q
______ organic compounds required by the body for survival but generally not produced endogenously in sufficient amounts
A
vitamins
14
Q
What are the fat-soluble vitamins?
A
vitamins: K, A, D, E
15
Q
Where are fatty soluble vitamins stored?
A
excess intake is stored in fatty tissues
16
Q
In what type of patients do you usually see fat soluble vitamin deficiencies?
A
bariatric surgery and GI illnesses
17
Q
Name the water-soluble vitamins
A
Biotin, B complex, C
18
Q
Which type of vitamins are generally widely available in foods, only limited storage in the body?
A
water-soluble vitamins
19
Q
In what kind of patients are deficiency usually seen in patients with poor nutritional intake or malabsorption?
A
water-soluble vitamins
20
Q
_____ similar metabolic roles to vitamins, but have no known deficiency syndrome and/or are made endogenously
A
vitamin-like substances
21
Q
Name 7 vitamin like substances
A
Choline
Taurine
l-Carnitine
Inositol
Bioflavonoids
Alpha-Lipoic Acid
Coenzyme Q (CoQ)
22
Q
What is another name for B1?
A
Thiamine
23
Q
What is thiamine’s role in the body?
A
glucose metabolism, antioxidant, neuro metabolism
23
Q
Where is Thiamine commonly found naturally?
A
pork
fortified grains
seeds
nuts
24
Who is usually thiamine deficient?
alcholism
poor diet/restricted diets
25
Name some symptoms of thiamine deficiency
Beriberi
Wernicke's Encephalopathy
Korsakoff Syndrome
26
What are some symptoms of wet beriberi?
cardiovascular - heart failure, cardiomegaly, edema, ↑ HR, SOB
27
What are some symptoms of dry beriberi?
neurologic - symmetrical sensory and motor neuropathy
28
**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
29
**_____ and _____ can cause Wernicke’s Encephalopathy / Korsakoff Syndrome
chronic alcoholism and s/p bariatric surgery
30
What is another name for B2?
Riboflavin
31
What is Riboflavin's role in the body?
general metabolic reactions (ATP production)
32
What are the dietary sources of riboflavin?
milk, eggs, meats, fish, green vegetables, fortified grains
33
What kind of patients are usually deficient in riboflavin?
malabsorption, poor diet/restricted diet, long-term barbiturates
34
**What lab test is used to test for riboflavin levels?
erythrocyte glutathione reductase assay
35
**Why do you not just test for riboflavin when testing for riboflavin?
Riboflavin levels fluctuate too much
36
Name some symptoms of riboflavin defiency?
Red, swollen, inflamed mucous membranes (cheilitis, stomatitis, glossitis, sore throat)
Anemia
Seborrheic dermatitis
37
What is another name for B3?
Niacin
38
What is the role of niacin in the body?
create NAD and NADP coenzymes, used for energy/metabolism
General metabolic processes throughout the body
39
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)
40
What kinds of patients are usually niacin deficient?
-alcoholism, anorexia, HIV+, malabsorption pts
-May also see in patients from resource-limited countries
41
What are some symptoms of niacin deficiency?
Pellagra:
“3 Ds” - photosensitive dermatitis, diarrhea (with other GI symptoms), dementia (advanced)
42
Describe symptoms of niacin toxicity
flushing and pruritus, hives, N/V, elevated LFTs - usually only at high daily doses
43
What is another name for B5?
pantothenic acid
44
What is another name for B6?
pyridoxine
45
What is the role in the body of B6?
protein and neurotransmitter metabolism, gluconeogenesis
46
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%
47
Name some patients that are commonly associated with B6 defiency?
CKD, GI disease (IBD, celiac), autoimmune pts
48
Some some types of medications that can cause B6 defiency?
oral contraceptives, anti-TB, theophylline, L-dopa
49
Name 2 lab tests that test for B6
pyridoxine, may also consider erythrocyte transaminase activity
50
Name some symptoms of B6 deficiency
anemia, dermatitis, stomatitis
Neuro - depression, seizures, peripheral neuropathy
51
Name some symptoms of B6 toxicity
peripheral neuropathy, dizziness, rash - usually only at high daily doses
52
What two B vitamins should you test for when thinking about an anemic pt?
B6 and B12
53
What is another name for B9?
Folic acid/Folate
54
What is the role of folate in the body?
amino acid and nucleic acid metabolism, cell division
Strong link to neural development in utero
55
What is the most common nutrient deficiency in the US?
folic acide/folate
56
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
57
What type of patients are folate deficient?
alcoholism, poor diet (low veggie intake), smokers, malabsorption pts, MTHFR patients
58
What medications are associated with folate defiency?
trimethoprim, methotrexate, phenytoin
59
What labs can you order to test for folate?
serum folic acid (superior/cheaper vs RBC folate), homocysteine
60
Name some symptoms of folate deficency?
anemia, glossitis/stomatitis, GI upset, fatigue
neural tube defect during embryogenesis
61
What is folate toxicity associated with?
high intake possibly associated with cancer risk and developmental delay
62
What is another name for B12?
Cobalamin/Cyanocobalamin
63
What is the role of B12 in the body?
nucleic acid metabolism, conversion of folate to active form, numerous other metabolic roles
64
What are some dietary sources of B12?
meats, dairy products, shellfish, eggs, fortified grains
Does not naturally occur in plant-based foods
65
What type of patients are commonly B12 deficient?
vegan diet, GI illness causing malabsorption
gastritis, gastric bypass, chronic H. pylori, pernicious anemia
66
What medications can cause B12 deficiency?
chronic PPI (for GERD), metformin
67
What 3 lab test can you order for B12?
B12, methylmalonic acid (MMA), homocysteine
68
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
69
What are some symptoms of B12 deficiency?
anemia, peripheral neuropathy, cognitive defects, fatigue
70
____ and _____ are associated with B12 toxicity
high intake possibly associated with cancer risk and developmental delay
71
What is another name for vit C?
ascorbic acid
72
What is the role in the body for ascorbic acid?
antioxidant, gene expression, production of many important proteins including collagen
73
Name some dietary sources for Vit C
fruits (especially citrus), bell peppers, tomatoes, green leafy vegetables
74
What mirconutrient can get broken down with cooking/processing?
Vit C
75
Who is usually deficient with Vit C?
alcoholism, smokers, poor/restricted diet, dialysis
76
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)
77
What are some s/s of Vit C toxicity?
GI upset, false-negative stool guaiac, oxalate kidney stone
78
What is the role of biotin in the body?
cofactor for carb, amino acid, and lipid metabolism
79
What are some dietary sources of biotin?
liver, eggs, nuts, meats, yeast, bananas, mushrooms
Also synthesized in the small intestine by bacteria
80
What type of pts are usually biotin deficient?
rare - long term parenteral nutrition, infants (formula)
aka feeding tube pts
81
What is the lab test for biotin?
urine biotin excretion
82
What are s/s of biotin deficiency?
Dermatitis around eyes/nose/mouth, conjunctivitis, alopecia, altered mental status
83
What are the s/s of biotin toxicity?
may interfere with labs - cardiac enzymes, thyroid, parathyroid, electrolytes
84
Is a person more likely to have a biotin toxicity or defiency?
toxicity
85
What is another name for Vit A?
Retinol/Retinoids
86
What are the precursors to Vit A?
Beta-carotene, alpha-carotene, cryptoxanthin
87
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
88
What are the dietary sources of Vit A?
organ meats, egg yolks, fortified milk
Carotenoids - in “orange” foods (carrots, sweet potatoes, squash, tangerines)
89
What is a carotenoid?
in “orange” foods (carrots, sweet potatoes, squash, tangerines)
90
What are the lab tests for Vit A?
serum retinol (preferably fasting), may order beta-carotene
91
What kind of pts are usually deficient in Vit A?
resource-poor countries, poor diet
Fat malabsorption, bariatric surgery
92
What are some s/s of Vit A deficiency?
night blindness, blurry vision, xerosis, keratomalacia
93
Children with measles, what micronutrient should you consider supplementing?
Vit A
94
What are some s/s of acute Vit A toxicity?
altered mental status, seizures, headache, blurred vision
95
What are some s/s of chronic vit A toxicity?
xerosis, headache, fatigue, hepatomegaly, alopecia, hyperostosis, pseudotumor cerebri
96
What micronutrient toxicity can be teratogenic?
Vit A toxicity
97
What is another name for Vit D?
calciferol
98
What is another name for Vit D3?
cholecalciferol
99
What is another name for Vit D2?
ergocalciferol
100
What are the two vit D metabolites?
calcidiol, calcitriol
101
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
102
What are some dietary sources of D3?
fatty fish, egg yolks, fortified dairy
103
What are some dietary sources of D2?
mushrooms
104
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)
105
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
106
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!
107
What are some s/s of acute vit D toxicity?
Hypercalcemia - fatigue, bone pain, muscle weakness or cramps
108
What are some s/s of chronic vit D toxicity?
nephrocalcinosis, kidney stones, bone demineralization
109
______ and ______ can be given to a patient who is severely hypercalcemic due to Vit D toxicity
calcitonin and/or bisphosphonate drugs
110
What is another name for Vit E
tocopherol, alpha-tocopherol
111
What is Vit E's role in the body?
antioxidant, cell membranes, helps platelet aggregation
112
What are the dietary sources of Vit E?
vegetable oils, nuts, seeds
113
What kind of micronutrient deficiency is rare? In what kind of patients?
Vit E
Cholestasis, bowel resection, pancreatic insufficiency
114
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
115
_______ is more common to be toxic than deficient
vit E
116
What is the role of Vit K in the body?
blood clotting; also bone and kidney metabolism
117
What the the dietary sources of Vit K?
green leafy vegetables, cruciferous vegetables, parsley
Can also be manufactured by some gut microflora
118
What lab test do you order for Vit K if the patient is NOT showing any signs?
PIVKA-II
119
What 4 lab tests can you order for Vit K?
PT, INR, PIVKA-II (if no symptoms), vitamin K
120
**What type of patients are usually Vit K deficient?
**newborns**, fat malabsorption, warfarin pts,
Consider in patients on prolonged/long-term antibiotic use
121
What diseases are commonly associated with Vit K deficiencies?
Cystic fibrosis, biliary disorders/cholestasis, intestinal disease, liver disease
122
Name some s/s of Vit K deficiency
bleeding, including hemorrhage
bone malformation
123
What micronutrient do you also consider fresh frozen plasma or prothrombin complex if acute hemorrhaging?
Vit K
124
What are the common symptoms of Vit K toxicity?
hemolytic anemia, hyperbilirubinemia, jaundice
125
_____ inorganic compounds required for survival
minerals
126
Name 7 macrominerals
Calcium, phosphorus, magnesium, potassium, sodium, chloride, sulfur
127
Name some common trace elements
Iron, copper, zinc, iodine, chromium, fluoride, nickel, arsenic, molybdenum, selenium, manganese, silicon, boron, tin, vanadium
128
T/F: Minerals are carbon based
False, minerals are NOT carbon based
129
_____ majority is found in RBCs as Hgb to transport O2
iron
130
Where is heme iron naturally found?
meat, poultry, seafood
131
Where is nonheme iron naturally found?
green leafy veggies, legumes, nuts
132
What is the absorption of iron enhanced by?
acidic stomach environment, vitamin C
133
What is the absorption of iron inhibited by?
neutral/basic stomach environment, calcium, tannins
134
_____ is the most common nutritional deficiency worldwide
iron deficiency
135
Name two instances in which the patient is usually iron deficient
chronic blood loss, plant-based diets
136
Name some patients that are likely to be iron deficient
Bariatric surgery, malabsorption, chronic acid-reducing GI medications also a concern
137
Name some symptoms of iron deficiency
Neuro: fatigue, cognitive deficits, developmental delays, restless leg-like symptoms
Late: microcytic, hypochromic anemia
138
Name some examples where one would find iron toxicity
hemochromatosis, extravascular hemolytic anemia, frequent transfusions, excessive supplementation (rare)
139
What are some s/s of iron toxicity
liver cirrhosis, liver cancer, cardiomyopathy
140
How do you treat iron toxicity?
holding iron supplements; regular phlebotomy; chelation
141
_____ majority is incorporated into thyroid hormones for metabolic function
iodine
142
What are some naturally sources of iodine?
seaweed, fish, shellfish, fortified foods (salt, dairy)
143
What does iodine deficiency lead to?
thyroid goiter
144
What does iodine deficiency lead to in pregnant women?
pregnancy loss, infant psychomotor retardation, cretinism
145
What are some common s/s of calcium deficiency?
neuro/MSK symptoms (weakness, AMS, muscle spasm, muscle weakness, thinned bones)
146
What are some risk factors for calcium deficiency?
restricted diet, malabsorption/GI disease
147
What are some common s/s of magnesium deficiency?
neuro/MSK symptoms (fatigue, weakness, AMS, muscle spasm, muscle weakness)
148
What are some risk factors for magnesium deficiency?
restricted diet, malabsorption/GI disease, renal disease, diuretics, PPIs
149
How many essential AA cannot by synthesized and must be consumed?
9 out of 20
150
What are sources of essential AAs?
Egg whites, milk, meats, soybeans, beans, lentils
151
What two essentials FAs must be consumed?
linoleic acid and alpha-linoleic acid
152
______ is synthesized from linoleic acid
arachidonic acid
153
Essential FA deficiency is rare but is most common among what patient population?
total parenteral nutrition patients
154
What are some sources of essential fatty acids?
vegetable oils; linseed oil; flaxseed oil; seafood
