Nutrients

Question 1

Vitamin C function

Answer 1

• antioxidant
• protein/NT metabolism
• absorption of non-iron heme

Post-translational stages of collagen synthesis

Question 2

Vitamin C deficiency

Answer 2

Scurvy 
-poor wound healing
bleeding gums
perifollicular hyperkeratosis
petechial hemorrhage
coiled hair

Tooth loss
Impaired bone growth/bowing
Impaired bone healing
CNS
Infection

Question 3

Risk fx vitamin C deficiency

Answer 3

intestinal disease
malabsorption
EtOH

Question 4

Vitamin C toxicities

Answer 4

bloating
diarrhea
Enhanced iron absorption
inc risk of oxalate kidney stones

Question 5

Risk fx vitamin C toxicity

Answer 5

supplement use

fortified diets

Question 6

Thiamine B1 function

Answer 6

Cofactor for many enzymes:

• transketolase (PPP)
• pyruvate DH (lactate)
• synthesis of Ach, GABA

Question 7

Thiamine deficiency

Answer 7

Beriberi

• peripheral neuropathy
• HF/edema

Wernicke Korsakoff

• progressive CNS disorder
• ataxia
• confusion
• amnesia
• confabulation

Question 8

Risk fx for thiamine deficiency

Answer 8

alcohol use,

persistent vomiting, GI disease, HIV/AIDS, refeeding syndrome, hyperemesis gravidarum

Question 9

Niacin (B3) function

Answer 9

Synthesis of NAD and NADP

Question 10

Niacin (B3) deficiency

Answer 10

Pellagra (4 D’s)

• dermatitis
• diarrhea
• dementia
• death

Question 11

Risk fx for Niacin deficiency

Answer 11

lower SES, primarily corn diet

• malabsorption
• Hartnup’s (AR, tryptophan transport)
• carcinoid tumor

Question 12

Niacin toxicity

Answer 12

flushing

high doses

• GI symptoms heartburn, nausea, vomiting.
• Hepatotoxicity.
• Hyperuricemia and gout (niacin competes with uric acid for excretion).
• Dec insulin sensitivity and glucose intolerance.

Question 13

Folate function

Answer 13

• nucleotide synthesis

- methylation

Question 14

Folate deficiency

Answer 14

pregnancy: neural tube defects

- megaloblastic anemia, dec regen of tissue

Question 15

Risk fx of Folate deficiency

Answer 15

• generalized poor diet via illness/limited food ability
• EtOH use
• malabsorption disorders
• anticonvulsant drugs

Question 16

Risk fx of Folate toxicity

Answer 16

upper limit is based on amount of folic acid likely to mask macrocytic anemia occurring due to vitamin B12 defciency

Question 17

Vitamin B12 function

Answer 17

Cofactor of

• homocysteine –> methionine
• methylmalonyl CoA –> sucCoA

Question 18

B12 deficiency

Answer 18

Megaloblastic anemia, neuropathies, changed mental status, glossitis, diarrhea and malabsorption

Question 19

Risk fx of B12 deficiency

Answer 19

• vegans
• decreased IF
• bacterial overgrowth consuming B12
• impaired ileal absorption
• pernicious anemia

Question 20

B12 toxicity

Answer 20

no upper limit/toxicity

Question 21

B6 function

Answer 21

• enzyme cofactor (aa metabolism)
• porphobilinogen synthesis
• glycogenolysis
• gene expression
• supplemental tx for some sideroblastic anemias

Question 22

B6 deficiency

Answer 22

• Seborrheic rash on face and extremities
• Weakness and fatigue
• Confusion
• Glossitis and cheilitis/angular stomatitis
• Peripheral neuropathy
• Seizures in infants
• Microcytic hypochromic anemia

Question 23

Risk fx B6 deficiency

Answer 23

• poor intake
• EtOH (impairs conversion to PLP)
• malabsorption syndromes
• theophylline, cycloserine, penicillamine, valproic acid, carbamezpine, phenytoin, corticosteroids steroids

Question 24

B6 toxicity

Answer 24

neurologic problems (peripheral nerves and dorsal columns (paresthesias and ataxia))

Question 25

Risk fx B6 toxicity

Answer 25

via diet supplements, not food supplements for - hyperemesis gracidarum - carpal tunnel - premenstrual syndrome *interactions w/ levodopa/phenytoin/phenobarbital/amiodarone/tetracyclines

Question 26

Risk fx Vitamin A deficiency

Answer 26

- poor diet - malabsorption - liver disease

Question 27

Vitamin A deficiency

Answer 27

``` Night blindness Abnormal epithelialization E.g. Xeropthalmia Impaired reproduction Infection E.g. respiratory, viral, diarrhea Stunting ```

Question 28

Risk fx Vitamin A toxicity

Answer 28

- supplements - renal disease - not carotenoids

Question 29

Vitamin A Toxicity

Answer 29

- anorexia - HA - abd pain - liver disease - teratogenicity - osteoporosis

Question 30

Risk fx Vitamin D Deficiency

Answer 30

``` Dietary -Exclusively breastfed infants -Fat malabsorption -Poor intake Limited sun Renal and liver disease Obesity ```

Question 31

Vitamin D Deficiency

Answer 31

Children: Rickets Adults: Osteomalacia Myopathy and weakness Long-term is contributor to osteoporosis risk

Question 32

Risk fx Vitamin D toxicity

Answer 32

Supplements and Rx Not sun Rarely food

Question 33

Vitamin D toxicity

Answer 33

Manifestations - Hypercalcemia - Nephrolithiasis

Question 34

Risk fx Vitamin E deficiency

Answer 34

Very low birth weight/preterm infants Fat malabsorption α-tocopherol transfer protein defects (rare)

Question 35

Vitamin E deficiency

Answer 35

Neuropathy Myopathy Retinopathy RBC hemolysis

Question 36

Risk fx Vitamin E toxicity

Answer 36

supplement use

Question 37

Vitamin E toxicity

Answer 37

bleeding | mortality risk >400 IU/day

Question 38

inhibitors of gastric acid

Answer 38

impaired digestion of food-bound vitamin B12

Question 39

folic acid

Answer 39

masking of vitamin 12 deficiency

Question 40

metformin

Answer 40

vitamin B12 deficiency

Question 41

zinc supplements

Answer 41

copper deficiency

Question 42

isoniazid

Answer 42

B6 deficiency with neuropathy

Question 43

orlistat

Answer 43

fat soluble vitamin deficiency

Question 44

high dose loop diuretics

Answer 44

thiamine deficiency

Question 45

Risk fx Fe deficiency

Answer 45

``` Growth Menstruation Pregnancy Dietary inhibitors Malabsorption syndromes Intestinal parasites Vegetarians/vegans Athletes Blood loss ```

Question 46

Fe deficiency

Answer 46

-anemia -fatigue and lethargy -cold intolerance ↓ psychomotor development ↓ intellectual performance Impaired immunity ↑ risk of lead poisoning

Question 47

Risk fx Zn deficiency

Answer 47

Acrodermatitis enteropathica Malabsorption Chronic diarrhea Vegetarian diet

Question 48

Zn deficiency

Answer 48

``` Rash Alopecia Diarrhea Infection Hypogeusia Hypogonadism Mental slowing Growth retardation ```