nutrition Flashcards
1
Q
what are the fat sol vits
A
A D E K
2
Q
are you more likely to be deficient or in excess of fat sol vits
A
stored in adipose tissue – so uncommon to be deficient in these
More likely in excess
3
Q
what is vit A
A
retinol
4
Q
excess and def in vit A - and test
A
E:
* exfoliation
* hepatitis
D
* colour blindness
serology - only do if had bariatric surgery and present with blindness
5
Q
what is vit D
A
cholecalciferol
6
Q
excess and def in vit D - and test
A
E
* hypercalcaemia
D
* osteomalacia/rickets
serum
7
Q
what is vit E
A
tocopherol
8
Q
excess and def in vit E - and test
A
D
* anaemia
* neuropathy
* ?malignancy
* IHD
serum - but not done
very rare
9
Q
what is vit K
A
phytomenadione
10
Q
def in vit K - and test
A
defective clotting
PTT or INR
can replace with tablet/injection
11
Q
What are the water sol vits
A
B1
B2
B6
B12
C
folaite
niacin
12
Q
what is B1
A
thiamine
13
Q
what is B2
A
riboflavin
14
Q
what is B6
A
pyridoxine
15
Q
what is B12
A
cobalamin
16
Q
def of B1 and test
A
beri-beri
neuropathy
wernicke syndrome
test - RBC transketolase
17
Q
what is beri-beri
A
2 types
- wet: where get CVD, oedema, HF.
- Dry : neuro problems, some may have Wernicke syndrome
18
Q
features of wernicke syndrome
A
confused,
ataxia,
oculomotor dysfunction
19
Q
def of B2 and test
A
glossitis
test - RBC glutathione reductase
20
Q
def and excess of B6 and test
A
D
* dermatitis
* anaemia
E - neuropathy
test - RBC AST activation
21
Q
def of B12 and test
A
pernicious anaemia
test - B12 serum - do if:
* other autoimmune
* macrocytic anaemia
22
Q
what is vit V
A
ascorbate
23
Q
def and excess of vit C and test
A
D - scurvy
E - renal stones
test - plasma - rarely done
24
Q
def and test for folate
A
- megaloblastic anaemia
- neural tube defect
Test - RBC folate
25
def of niacin
pellagra
present with:
* dementia
* diarrhoea
* dermatitis
* death
26
def and excess and tests of iron
Haemochromatosis ie high iron – iron deposition in:
testes -> primary hypogonadism, low libido,
high ferritin
27
iodine def and test
goitre
hypothyroid
*Test - TFTs*
28
zinc def
dermatitis
29
copper def and excess
D - anaemia
E - wilson's : copper in eye, brian and liver
*test - Cu, **caeroplasmin***
30
def and excess of fluride
D - dental caries
E - flourosis (staining of teeth)
31
what makes up energy expenditure
resting energy expenditure (REE) - metabolic rate - fixed
can change diet and exercise - if change either then the REE can change
* reduce food and increase exercise - REE changes = harder to lose wht
* better wht loss to reduce calorie than increase exercise
exercise
thermogenesis
faclultative t
32
ideal diet
33
summarise energy homeostasis
**White adipose tissue** is the majority of adipose tissue in body – **largest endocrine gland** in body
Direct link to hypothalamus.
After eating:
* **satiety levels increase**,
* **energy expenditure increase due to insulin**
**PYY** made from small intestine – **satiety hormone** – increase after eating
Adiponectin production from adipose tissue
* is lower in obese -> insulin resistance
Leptin is anti-hunger hormone
Ghrelin – hunger hormone
34
normal body weight composition
98% O2, C, H, Na, Ca
60-70% H2O, 10-35% fat, 10-15% protein, 3-5% minerals
Fat content is what changes between individuals – measure by looking at waist circumference, or fat expenditure from biceps
35
BMI definition of obesity
25-30 kg/m2 overweight
>30 kg/m2 obese
>40 kg/m2 morbidly obese
36
problem with BMI and what is a better measurement
muscle can increase BMI
**Ethnic variations** – south Asian, have lower cut offs than Caucasian
South Asian = more risk of dm or CVD – **adipose tissue is central – at risk of CVD because of visceral adiposity**
So **waist circumference is more accurate**
If have**BMI >40 – then have a lot of adiposity at front – difficult to measure waist circumference – so BMI is better **
37
consequence of bad BMI
Mortality dependant on BMI
**U shaped – mortality if >25BMI, if less than 20 BMI – mortality rate alsoincrases**
Risk of onchology problems
Smoker = low wht and risk of lung cancer
High BMI risk – CVD
38
obesity co-morbidities
psych morbidity
chest disease
malignancy - bowel, breast, endometrial, prostate
diabetes and metabolic syndrome
gynae disease
* PCOS
* infertility
* risk to fetus
* high risk pregnancy
* fetus may become obese later in life
rheum disease
CVS disease
39
protein intake
84gm men,
64gm women
40
different types of amino acid
Indispensable (e.g. leucine)
* we cannot make in body
* if don’t get from the diet -> protein deficient
“conditionally” indispensable (e.g. Cysteine)
* need at certain points in life eg childhood/pregnancy
* deficiencies can happen, but if have in diet then it is unlikely for deficiency to occur
Dispensable (e.g. alanine)
* body can make
41
assessments for protein
Nitrogen excretion and balance
Tracer techniques
*Don’t use these assessments on clinical basis – just look at muscle bulk to assess status*
42
what are the types of lipid
Polyunsaturated fatty acid (PUFA) include essential fatty acids (EFA)
Dietary fat determines LDL-C
* **saturated fat increases [chol] **because of the higher LDL (marker of CVD)
* **PUFA reduces total [chol]** because of lower LDL
high [HDL] associated **reduced IHD risk**
* HDL is **higher in women and some alcohol**
* HDL is lower in obesity
**want non-HDL level less than 4** as marker of cardiovascular risk.
Can now do cholesterol levels non-fasting as HDL and LDL are not effected
43
metabolism of fat
Fat in diet made up of triglycerides – glycerol and fatty acids
Intestine will reabsorb in a form of monoglycerides
Pancreatic lipase break down fatty acids by hydroxylation
Through intestine have build up as fatty acids – then go around the body and stored as adipose
44
what does the structure of the fatty acids mean in terms of disease
**Saturated are bad **
Monosaturated are better
And polyunsaturated are the best
*Sat have no carbon double bonds
Monosat – have one carbon bond
Polyunsat and have many*
**trans - saturated are worse than cis** - and are a marker of CVD
45
summarise carb intake
**40-80% total energy intake**
Polymerisation into sugars, oligosaccharides and polysaccharides
**80 % should be complex** = polyunsaturated = starch/wholemeal
20 % simple
fibre - not absorbed, but used to bulk stool - if not much fibre = constipation
46
what conditions are nutrients linked to
Cardiovascular disease
Obesity
Alcoholism
T2DM
Pregnancy
Most malignancy
Many GI conditions
47
what is metabolic syndrome
have a multitude of conditions - risk of all obesity related conditions
48
endocrine causes of obesity
Hypothyroid
Cushings syndrome – excess cortisol – get rapid onset wht gain, rather than in obesity where there is wht gain through yrs
Acromegaly
Pit disease – absence GH
49
approach to obesity
Exclude endocrine cause
Exclude complications of obesity
Educate
Diet and exercise
Medical therapy (Orlistat, GLP-1 agonist)
Surgical therapy
50
what is orlistat
inhibit absorption of fat
prevents breakdown of fatty acid in intestine
can lose 5% of wht
51
use of GLP-1 agonist
gut hormone that can make us more full.
We can replace by an injection
lose 8-10% wht
52
benefit of wht loss
helps all of:
* Psychological benefit
* PCOS
* Oesophagitis
* CVD
* Osteoarthritis
* Liver function
* Pregnancy
* reduce mortality
* BP
* HbA1c
* DM
* LDL
* HDL
53
what are the different types of bariatric surgery
**Adjustable band**
* silicone ring above top of stomach,
* ring attached to port in adipose tissue –
* put fluid into ring to make it tigher or take it away make looser.
* Band can erode into mucosa – emergency and may need a reoperation
**sleeve gastrectomy**
**gastric bypass**
* Reduce stomach size
* 1st part of duodenum is bypassed (150cm)
* Most of stomach is bypassed
* And 2nd part of intestine goes into pouch
* Metabolic operation – direct treatment of t2dm – can go into remission – don’t need to take meds for a long time
54
health benefits of bariatric surgery
* Resolution/improvement of T2DM
* Resolution/improvement of hypertension
* Improved lipid profile
* Resulting in overall reduction in cardiac risk
* Resolution of obstructive sleep apnoea
* Resolution of PCOS and improved fertility
* Reduced cancer related deaths
* Regression of non-alcoholic fatty liver disease
* Reduced mortality
55
what is the duodenal-jejunal sleeve
Silicone ring – food goes in, inserted with endoscope
Food not mixed with bile salts
People with dm get better
But cant stay in >1yr – so more of an interim treatment
56
what is marasmus and sx
Low calorie intake of carb, protein and lipids:
* Shrivelled
* Growth retarded
* Severe muscle wasting
* No s/c fat
57
what is kwashiokor
Lack only of protein – still have carbs and lipids
More common at times of famine
Protein go down more than carb and lipid in times of famine
* Oedematous
* Scaling/ulcerated
* Lethargic
* Large liver, s/c fat
* Protein deficient
