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SMP - MNE Exam 1 > Nutrition Module #4: Nutritional Anemias > Flashcards

Nutrition Module #4: Nutritional Anemias Flashcards

1
Q

Who are the 11 populations at risk for folate deficiency?

A
  1. Adolescents: poor intake
  2. Elderly: poor intake, malabsorption, medications that may interfere with metabolism (barbiturates)
  3. Alcoholics: poor intake, alcohol interfering with metabolism
  4. Premature babies: increased needs
  5. Pregnant women: increased needs
  6. Malabsorption diseases: celiac’s disease, HIV, Crohn’s
  7. Low-income: limited access to fresh veggies
  8. Psoriases (and other skin diseases) patients: increase loss of folate
  9. Women who take oral contraceptives: increase loss of folate
  10. Kids during rapid growth: increased folate requirements
  11. Patients with hemoglobinopathies: increased erythropoiesis
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2
Q

Are there any specific symptoms for folate and B12 deficiencies?

A

NOPE

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3
Q

What are the 9 non-specific symptoms of folate deficiency?

A
  1. Loss of appetite
  2. Irritability*
  3. Hostility
  4. Diarrhea*
  5. Paranoia
  6. Forgetfulness
  7. Depression*
  8. Macrocytic anemia*
  9. Increased homocysteine blood concentration
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4
Q

What is the risk of folate deficiency on a fetus?

A

Neural tube defects

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5
Q

What is the risk of folate deficiency in adults?

A

Cancer and CVD

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6
Q

What are the different forms of folate?

A

They have 3-8 glutamate residues

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7
Q

Which form of folate can cross cell membranes?

A

Monoglutamate folate

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8
Q

What do polyglutamate folate serve as? Which kind?

A

Coenzyme that accept or donate 1 C units in :

  1. DNA synthesis
  2. Catabolism or interconversion of Met, His, Ser, and Gly
  3. Choline synthesis and degradation

Fully reduced tetrahydrofolate

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9
Q

How do we regenerate methionine from homocysteine? Why is this needed?

A

We need folate and B12

Methionine donates a methyl group forming homocysteine

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10
Q

What 3 nutrients are needed for normal neural tube closure?

A
  1. Folate
  2. B6
  3. B12
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11
Q

Which have a higher bioavailability of folate: vegetables or supplements?

A

Supplements

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12
Q

Where is folate found in the body? 2 places.

A
  1. Blood bound to albumin (monoglutamates)

2. Liver

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13
Q

What are the 2 lab tests to detect folate deficiency? What is each a measure of?

A
  1. Serum folate: recent folate intake

2. RBC folate: liver folate levels (past intakes)

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14
Q

What is megaloblastic anemia caused by? Symptoms?

A

Cause: folate and B12 deficiency
Symptoms: macrocytic anemia, segmented neutrophils, absence of platelets, megaloblasts (large nucleated RBCs), diarrhea, malabsorption of nutrients

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15
Q

What are the 5 stages of folate deficiency?

A
  1. Serum folate decreases
  2. RBC folate and liver folate decrease
  3. Hypersegmented neutrophils appear
  4. Mean corpuscular volume increases
  5. Serum hemoglobin decreases
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16
Q

What can increase serum folate other than increase intake?

A

B12 deficiency

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17
Q

What can decrease serum folate other than poor intake?

A
  1. Smoking
  2. Estrogen
  3. Contraceptives
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18
Q

What can increase RBC folate other than increase intake?

A
  1. Reticulocytosis

2. Fe deficiency

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19
Q

What can decrease RBC folate other than decrease intake?

A

B12 deficiency

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20
Q

How to distinguish between folate and B12 deficiencies? 1 test

A

Serum (more sensitive) or urine methylmalonyl-CoA: if elevated, B12 deficiency because needed to convert it to succinyl CoA

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21
Q

What are 6 good food sources of folate?

A
  1. Fresh dark leafy veggies
  2. Legumes
  3. Cereal
  4. Citrus fruits
  5. Organ meats
  6. Yeast
22
Q

What can decrease the folate content of vegetables?

A

Boiling them

23
Q

What is the normal folate daily requirement?

A

2-3 servings of folate-rich foods

24
Q

How much folate supplement should be given when necessary?

A

200-400 microg

25
Q

What are the 4 populations at risk of B12 deficiency?

A
  1. Elderly: low intake, poor absorption
  2. Vegans: low intake
  3. Hyperthyroidism
  4. Fish tapeworm or bacteria in ileum
26
Q

What are the 2 clinical symptoms of B12 deficiency?

A
  1. Indigestion

2. Diarrhea*

27
Q

What are the 4 psychiatric symptoms of B12 deficiency?

A
  1. Depression*
  2. Irritability*
  3. Confusion
  4. Dementia
28
Q

What are the 2 symptoms of B12 deficiency seen in the elderly?

A
  1. Enlarged spleen/liver

2. Congestive heart failure

29
Q

What are the 6 peripheral neuropathies seen with B12 deficiency? What are these due to? Are these reversible?

A
  1. Bilateral vision loss
  2. Loss of coordination
  3. Loss of postural sense
  4. Loss of vibration sense in feet
  5. Symmetric abnormal sensations in feet/hands
  6. Reduced sensations of pain, temperature, and touching
    Due to inadequate myelin synthesis
    Reversible if treated quickly
30
Q

What do B12 and folate symptoms have in common?

A

Anemia with hypersegmented neutrophils and some psych/clinical symptoms

31
Q

Describe the 3 steps of B12 absorption.

A
  1. Stomach: gastric acid, peptin, and intrinsic factor 1 release B12 from proteins
  2. Duodenum: same and B12 forms a dimer with IF-1
  3. Ileum: B12-IF-1 binds to receptors which requires Ca2+/Mg2+ and a pH
32
Q

What can inhibit the dimerization of B12 and IF-1 in the duodenum?

A

Too much acid

33
Q

What molecules transport B12 in the blood?

A

Transcobalamins (TC-II)

34
Q

Where is B12 stored?

A

Liver

35
Q

How much B12 is stored in the liver?

A

1-10 mg

36
Q

How long do B12 stores last?

A
  • 3-6 months after cessation of absorption

- 20-30 years after cessation of intake

37
Q

Why is B12 so well preserved in the body?

A

Because you can only lose it in bile which is reabsorbed

38
Q

What are the 3 lab tests to detect B12 deficiency? What is each a measure of?

A
  1. Serum B12
  2. Methylmalonic CoA (serum or urine)
  3. Schilling test: determines whether malabsorption is the cause by measuring radioactive B12 in the urine when provided with and without IF-1
39
Q

What can serum B12 be decreased by other than deficiency?

A
  1. Fe deficiency
  2. Folate deficiency
  3. Pregnancy
  4. Multiple myeloma
40
Q

How do B12 stores change with age?

A

They increase

41
Q

What are 2 food sources of B12? What do they have in common?

A
  1. Animal foods
  2. Yeast
    Both provide B12 from microbial origins
42
Q

Does food processing/cooking have an effect on B12 content?

A

NOPE

43
Q

What is the treatment for B12 malabsorption?

A

Injections of cyanocobalamin or high-dose B12 supplement (IF-1 is too expensive)

44
Q

What does a decrease in the mean corpuscular volume suggest?

A

Iron deficiency

45
Q

What is the diagnosis if serum hemoglobin and RBC are low but mean corpuscular volume is normal?

A

Normocytic anemia

46
Q

When should women start taking a folate supplement?

A

When they are trying to conceive because neural tube closes before pregnancy is detected

47
Q

When should women start taking an iron supplement? Why?

A

During the 2nd and 3rd trimesters to support the increase in BV, placenta, and fetus

48
Q

How can black tea affect absorption?

A

It can inhibit absorption

49
Q

What can increase iron absorption? 3 things

A
  1. Fruits
  2. Veggies
  3. Vitamin C
50
Q

How much folate does the liver store?

A

Half the folate in the body, which constitutes 30-70x the daily requirement)

SMP - MNE Exam 1 (25 decks)

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