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Nutrition > Micronutrients > Flashcards

Micronutrients Flashcards

1
Q

How do you calculate percent weight change?

A
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2
Q

BMI categories: What is considered underweight?

A

less than 18.5

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3
Q

BMI categories: What is considered normal weight?

A

18.5-24.9

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4
Q

BMI categories: What is considered overweight?

A

25-29.9

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5
Q

BMI categories: What is considered obese?

A

anything 30 and above

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6
Q

What is another measurable physical sign that points to obesity?

A

waist circumference

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7
Q

What is considered overweight/obese in male patients?

A

greater or equal to 40 inches

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8
Q

What is considered overweight/obese in female patients?

A

greater than or equal to 35 inches

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9
Q

What are the three macronutrients?

A

proteins, carbs, fats

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10
Q

Define micronutrients

A

dietary substances consumed in smaller amounts than macronutrients, but still essential to the body

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11
Q

give some examples of broad categories of micronutrients

A

vitamins and vitamin-like substances
minerals
essential AA
essential FA

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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

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13
Q

______ organic compounds required by the body for survival but generally not produced endogenously in sufficient amounts

A

vitamins

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14
Q

What are the fat-soluble vitamins?

A

vitamins: K, A, D, E

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15
Q

Where are fatty soluble vitamins stored?

A

excess intake is stored in fatty tissues

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16
Q

In what type of patients do you usually see fat soluble vitamin deficiencies?

A

bariatric surgery and GI illnesses

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17
Q

Name the water-soluble vitamins

A

Biotin, B complex, C

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18
Q

Which type of vitamins are generally widely available in foods, only limited storage in the body?

A

water-soluble vitamins

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19
Q

In what kind of patients are deficiency usually seen in patients with poor nutritional intake or malabsorption?

A

water-soluble vitamins

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20
Q

_____ similar metabolic roles to vitamins, but have no known deficiency syndrome and/or are made endogenously

A

vitamin-like substances

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21
Q

Name 7 vitamin like substances

A

Choline
Taurine
l-Carnitine
Inositol
Bioflavonoids
Alpha-Lipoic Acid
Coenzyme Q (CoQ)

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22
Q

What is another name for B1?

A

Thiamine

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23
Q

What is thiamine’s role in the body?

A

glucose metabolism, antioxidant, neuro metabolism

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23
Q

Where is Thiamine commonly found naturally?

A

pork
fortified grains
seeds
nuts

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24
Q

Who is usually thiamine deficient?

A

alcholism
poor diet/restricted diets

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25
Q

Name some symptoms of thiamine deficiency

A

Beriberi
Wernicke’s Encephalopathy
Korsakoff Syndrome

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26
Q

What are some symptoms of wet beriberi?

A

cardiovascular - heart failure, cardiomegaly, edema, ↑ HR, SOB

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27
Q

What are some symptoms of dry beriberi?

A

neurologic - symmetrical sensory and motor neuropathy

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28
Q

**What are some symptoms of Wernicke’s Encephalopathy / Korsakoff Syndrome?

A

Nystagmus, opthalmoplegia, ataxia, and confusion
Can evolve to long-term neuro changes–impaired short-term memory and confabulation

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29
Q

**_____ and _____ can cause Wernicke’s Encephalopathy / Korsakoff Syndrome

A

chronic alcoholism and s/p bariatric surgery

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30
Q

What is another name for B2?

A

Riboflavin

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31
Q

What is Riboflavin’s role in the body?

A

general metabolic reactions (ATP production)

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32
Q

What are the dietary sources of riboflavin?

A

milk, eggs, meats, fish, green vegetables, fortified grains

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33
Q

What kind of patients are usually deficient in riboflavin?

A

malabsorption, poor diet/restricted diet, long-term barbiturates

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34
Q

**What lab test is used to test for riboflavin levels?

A

erythrocyte glutathione reductase assay

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35
Q

**Why do you not just test for riboflavin when testing for riboflavin?

A

Riboflavin levels fluctuate too much

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36
Q

Name some symptoms of riboflavin defiency?

A

Red, swollen, inflamed mucous membranes (cheilitis, stomatitis, glossitis, sore throat)
Anemia
Seborrheic dermatitis

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37
Q

What is another name for B3?

A

Niacin

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38
Q

What is the role of niacin in the body?

A

create NAD and NADP coenzymes, used for energy/metabolism
General metabolic processes throughout the body

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39
Q

What are the dietary sources of niacin?

A

-meats, eggs, dairy, legumes, nuts, seeds, fortified grains
(Plant-based niacin is not as easily used by the body)

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40
Q

What kinds of patients are usually niacin deficient?

A

-alcoholism, anorexia, HIV+, malabsorption pts
-May also see in patients from resource-limited countries

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41
Q

What are some symptoms of niacin deficiency?

A

Pellagra:
“3 Ds” - photosensitive dermatitis, diarrhea (with other GI symptoms), dementia (advanced)

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42
Q

Describe symptoms of niacin toxicity

A

flushing and pruritus, hives, N/V, elevated LFTs - usually only at high daily doses

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43
Q

What is another name for B5?

A

pantothenic acid

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44
Q

What is another name for B6?

A

pyridoxine

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45
Q

What is the role in the body of B6?

A

protein and neurotransmitter metabolism, gluconeogenesis

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46
Q

What are the dietary sources of B6?

A

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%

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47
Q

Name some patients that are commonly associated with B6 defiency?

A

CKD, GI disease (IBD, celiac), autoimmune pts

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48
Q

Some some types of medications that can cause B6 defiency?

A

oral contraceptives, anti-TB, theophylline, L-dopa

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49
Q

Name 2 lab tests that test for B6

A

pyridoxine, may also consider erythrocyte transaminase activity

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50
Q

Name some symptoms of B6 deficiency

A

anemia, dermatitis, stomatitis
Neuro - depression, seizures, peripheral neuropathy

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51
Q

Name some symptoms of B6 toxicity

A

peripheral neuropathy, dizziness, rash - usually only at high daily doses

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52
Q

What two B vitamins should you test for when thinking about an anemic pt?

A

B6 and B12

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53
Q

What is another name for B9?

A

Folic acid/Folate

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54
Q

What is the role of folate in the body?

A

amino acid and nucleic acid metabolism, cell division
Strong link to neural development in utero

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55
Q

What is the most common nutrient deficiency in the US?

A

folic acide/folate

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56
Q

What are the dietary sources of folate?

A

green leafy veggies, broccoli, asparagus, fortified grains

Required by law to fortify all grains in US due to association with NTDs

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57
Q

What type of patients are folate deficient?

A

alcoholism, poor diet (low veggie intake), smokers, malabsorption pts, MTHFR patients

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58
Q

What medications are associated with folate defiency?

A

trimethoprim, methotrexate, phenytoin

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59
Q

What labs can you order to test for folate?

A

serum folic acid (superior/cheaper vs RBC folate), homocysteine

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60
Q

Name some symptoms of folate deficency?

A

anemia, glossitis/stomatitis, GI upset, fatigue
neural tube defect during embryogenesis

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61
Q

What is folate toxicity associated with?

A

high intake possibly associated with cancer risk and developmental delay

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62
Q

What is another name for B12?

A

Cobalamin/Cyanocobalamin

63
Q

What is the role of B12 in the body?

A

nucleic acid metabolism, conversion of folate to active form, numerous other metabolic roles

64
Q

What are some dietary sources of B12?

A

meats, dairy products, shellfish, eggs, fortified grains

Does not naturally occur in plant-based foods

65
Q

What type of patients are commonly B12 deficient?

A

vegan diet, GI illness causing malabsorption
gastritis, gastric bypass, chronic H. pylori, pernicious anemia

66
Q

What medications can cause B12 deficiency?

A

chronic PPI (for GERD), metformin

67
Q

What 3 lab test can you order for B12?

A

B12, methylmalonic acid (MMA), homocysteine

68
Q

Of the 3 labs for B12, which one is the most reliable?

A

serum MMA thought to be more reliable, but can be much more expensive

69
Q

What are some symptoms of B12 deficiency?

A

anemia, peripheral neuropathy, cognitive defects, fatigue

70
Q

____ and _____ are associated with B12 toxicity

A

high intake possibly associated with cancer risk and developmental delay

71
Q

What is another name for vit C?

A

ascorbic acid

72
Q

What is the role in the body for ascorbic acid?

A

antioxidant, gene expression, production of many important proteins including collagen

73
Q

Name some dietary sources for Vit C

A

fruits (especially citrus), bell peppers, tomatoes, green leafy vegetables

74
Q

What mirconutrient can get broken down with cooking/processing?

A

Vit C

75
Q

Who is usually deficient with Vit C?

A

alcoholism, smokers, poor/restricted diet, dialysis

76
Q

What is the classic syndrome associated with Vit C deficiency? What are the s/s?

A

Scurvy

fatigue, gingivitis, poor wound healing (not able to make collagen)

77
Q

What are some s/s of Vit C toxicity?

A

GI upset, false-negative stool guaiac, oxalate kidney stone

78
Q

What is the role of biotin in the body?

A

cofactor for carb, amino acid, and lipid metabolism

79
Q

What are some dietary sources of biotin?

A

liver, eggs, nuts, meats, yeast, bananas, mushrooms
Also synthesized in the small intestine by bacteria

80
Q

What type of pts are usually biotin deficient?

A

rare - long term parenteral nutrition, infants (formula)

aka feeding tube pts

81
Q

What is the lab test for biotin?

A

urine biotin excretion

82
Q

What are s/s of biotin deficiency?

A

Dermatitis around eyes/nose/mouth, conjunctivitis, alopecia, altered mental status

83
Q

What are the s/s of biotin toxicity?

A

may interfere with labs - cardiac enzymes, thyroid, parathyroid, electrolytes

84
Q

Is a person more likely to have a biotin toxicity or defiency?

A

toxicity

85
Q

What is another name for Vit A?

A

Retinol/Retinoids

86
Q

What are the precursors to Vit A?

A

Beta-carotene, alpha-carotene, cryptoxanthin

87
Q

What is the role of Vit A in the body?

A

key component of rods and cones in the retina
epithelial cell reproduction
bone/teeth/reproductive/immune function

88
Q

What are the dietary sources of Vit A?

A

organ meats, egg yolks, fortified milk
Carotenoids - in “orange” foods (carrots, sweet potatoes, squash, tangerines)

89
Q

What is a carotenoid?

A

in “orange” foods (carrots, sweet potatoes, squash, tangerines)

90
Q

What are the lab tests for Vit A?

A

serum retinol (preferably fasting), may order beta-carotene

91
Q

What kind of pts are usually deficient in Vit A?

A

resource-poor countries, poor diet
Fat malabsorption, bariatric surgery

92
Q

What are some s/s of Vit A deficiency?

A

night blindness, blurry vision, xerosis, keratomalacia

93
Q

Children with measles, what micronutrient should you consider supplementing?

A

Vit A

94
Q

What are some s/s of acute Vit A toxicity?

A

altered mental status, seizures, headache, blurred vision

95
Q

What are some s/s of chronic vit A toxicity?

A

xerosis, headache, fatigue, hepatomegaly, alopecia, hyperostosis, pseudotumor cerebri

96
Q

What micronutrient toxicity can be teratogenic?

A

Vit A toxicity

97
Q

What is another name for Vit D?

A

calciferol

98
Q

What is another name for Vit D3?

A

cholecalciferol

99
Q

What is another name for Vit D2?

A

ergocalciferol

100
Q

What are the two vit D metabolites?

A

calcidiol, calcitriol

101
Q

What is the role in the body of Vit D?

A

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
Q

What are some dietary sources of D3?

A

fatty fish, egg yolks, fortified dairy

103
Q

What are some dietary sources of D2?

A

mushrooms

104
Q

What are the 2 lab tests for vit D? Which one is the most accurate?

A

vitamin D (serum 25(OH)D level is most accurate)

105
Q

What kind of patients are commonly Vit D deficient?

A

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
Q

What are some s/s of vit D deficiency?

A

Fatigue, bone pain, muscle weakness or cramps, low bone density
Many patients have no symptoms at all!

107
Q

What are some s/s of acute vit D toxicity?

A

Hypercalcemia - fatigue, bone pain, muscle weakness or cramps

108
Q

What are some s/s of chronic vit D toxicity?

A

nephrocalcinosis, kidney stones, bone demineralization

109
Q

______ and ______ can be given to a patient who is severely hypercalcemic due to Vit D toxicity

A

calcitonin and/or bisphosphonate drugs

110
Q

What is another name for Vit E

A

tocopherol, alpha-tocopherol

111
Q

What is Vit E’s role in the body?

A

antioxidant, cell membranes, helps platelet aggregation

112
Q

What are the dietary sources of Vit E?

A

vegetable oils, nuts, seeds

113
Q

What kind of micronutrient deficiency is rare? In what kind of patients?

A

Vit E

Cholestasis, bowel resection, pancreatic insufficiency

114
Q

What are the s/s of Vit E deficiency? What may it lead to?

A

Ataxia, muscle weakness, impaired vision

May also lead to hemolytic anemia

115
Q

_______ is more common to be toxic than deficient

A

vit E

116
Q

What is the role of Vit K in the body?

A

blood clotting; also bone and kidney metabolism

117
Q

What the the dietary sources of Vit K?

A

green leafy vegetables, cruciferous vegetables, parsley

Can also be manufactured by some gut microflora

118
Q

What lab test do you order for Vit K if the patient is NOT showing any signs?

A

PIVKA-II

119
Q

What 4 lab tests can you order for Vit K?

A

PT, INR, PIVKA-II (if no symptoms), vitamin K

120
Q

**What type of patients are usually Vit K deficient?

A

newborns, fat malabsorption, warfarin pts,

Consider in patients on prolonged/long-term antibiotic use

121
Q

What diseases are commonly associated with Vit K deficiencies?

A

Cystic fibrosis, biliary disorders/cholestasis, intestinal disease, liver disease

122
Q

Name some s/s of Vit K deficiency

A

bleeding, including hemorrhage
bone malformation

123
Q

What micronutrient do you also consider fresh frozen plasma or prothrombin complex if acute hemorrhaging?

A

Vit K

124
Q

What are the common symptoms of Vit K toxicity?

A

hemolytic anemia, hyperbilirubinemia, jaundice

125
Q

_____ inorganic compounds required for survival

A

minerals

126
Q

Name 7 macrominerals

A

Calcium, phosphorus, magnesium, potassium, sodium, chloride, sulfur

127
Q

Name some common trace elements

A

Iron, copper, zinc, iodine, chromium, fluoride, nickel, arsenic, molybdenum, selenium, manganese, silicon, boron, tin, vanadium

128
Q

T/F: Minerals are carbon based

A

False, minerals are NOT carbon based

129
Q

_____ majority is found in RBCs as Hgb to transport O2

A

iron

130
Q

Where is heme iron naturally found?

A

meat, poultry, seafood

131
Q

Where is nonheme iron naturally found?

A

green leafy veggies, legumes, nuts

132
Q

What is the absorption of iron enhanced by?

A

acidic stomach environment, vitamin C

133
Q

What is the absorption of iron inhibited by?

A

neutral/basic stomach environment, calcium, tannins

134
Q

_____ is the most common nutritional deficiency worldwide

A

iron deficiency

135
Q

Name two instances in which the patient is usually iron deficient

A

chronic blood loss, plant-based diets

136
Q

Name some patients that are likely to be iron deficient

A

Bariatric surgery, malabsorption, chronic acid-reducing GI medications also a concern

137
Q

Name some symptoms of iron deficiency

A

Neuro: fatigue, cognitive deficits, developmental delays, restless leg-like symptoms
Late: microcytic, hypochromic anemia

138
Q

Name some examples where one would find iron toxicity

A

hemochromatosis, extravascular hemolytic anemia, frequent transfusions, excessive supplementation (rare)

139
Q

What are some s/s of iron toxicity

A

liver cirrhosis, liver cancer, cardiomyopathy

140
Q

How do you treat iron toxicity?

A

holding iron supplements; regular phlebotomy; chelation

141
Q

_____ majority is incorporated into thyroid hormones for metabolic function

A

iodine

142
Q

What are some naturally sources of iodine?

A

seaweed, fish, shellfish, fortified foods (salt, dairy)

143
Q

What does iodine deficiency lead to?

A

thyroid goiter

144
Q

What does iodine deficiency lead to in pregnant women?

A

pregnancy loss, infant psychomotor retardation, cretinism

145
Q

What are some common s/s of calcium deficiency?

A

neuro/MSK symptoms (weakness, AMS, muscle spasm, muscle weakness, thinned bones)

146
Q

What are some risk factors for calcium deficiency?

A

restricted diet, malabsorption/GI disease

147
Q

What are some common s/s of magnesium deficiency?

A

neuro/MSK symptoms (fatigue, weakness, AMS, muscle spasm, muscle weakness)

148
Q

What are some risk factors for magnesium deficiency?

A

restricted diet, malabsorption/GI disease, renal disease, diuretics, PPIs

149
Q

How many essential AA cannot by synthesized and must be consumed?

A

9 out of 20

150
Q

What are sources of essential AAs?

A

Egg whites, milk, meats, soybeans, beans, lentils

151
Q

What two essentials FAs must be consumed?

A

linoleic acid and alpha-linoleic acid

152
Q

______ is synthesized from linoleic acid

A

arachidonic acid

153
Q

Essential FA deficiency is rare but is most common among what patient population?

A

total parenteral nutrition patients

154
Q

What are some sources of essential fatty acids?

A

vegetable oils; linseed oil; flaxseed oil; seafood

Nutrition (11 decks)

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