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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
What are the 4 populations at risk of B12 deficiency?
1. Elderly: low intake, poor absorption 2. Vegans: low intake 3. Hyperthyroidism 4. Fish tapeworm or bacteria in ileum
26
What are the 2 clinical symptoms of B12 deficiency?
1. Indigestion | 2. Diarrhea*
27
What are the 4 psychiatric symptoms of B12 deficiency?
1. Depression* 2. Irritability* 3. Confusion 4. Dementia
28
What are the 2 symptoms of B12 deficiency seen in the elderly?
1. Enlarged spleen/liver | 2. Congestive heart failure
29
What are the 6 peripheral neuropathies seen with B12 deficiency? What are these due to? Are these reversible?
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
What do B12 and folate symptoms have in common?
Anemia with hypersegmented neutrophils and some psych/clinical symptoms
31
Describe the 3 steps of B12 absorption.
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
What can inhibit the dimerization of B12 and IF-1 in the duodenum?
Too much acid
33
What molecules transport B12 in the blood?
Transcobalamins (TC-II)
34
Where is B12 stored?
Liver
35
How much B12 is stored in the liver?
1-10 mg
36
How long do B12 stores last?
- 3-6 months after cessation of absorption | - 20-30 years after cessation of intake
37
Why is B12 so well preserved in the body?
Because you can only lose it in bile which is reabsorbed
38
What are the 3 lab tests to detect B12 deficiency? What is each a measure of?
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
What can serum B12 be decreased by other than deficiency?
1. Fe deficiency 2. Folate deficiency 3. Pregnancy 4. Multiple myeloma
40
How do B12 stores change with age?
They increase
41
What are 2 food sources of B12? What do they have in common?
1. Animal foods 2. Yeast Both provide B12 from microbial origins
42
Does food processing/cooking have an effect on B12 content?
NOPE
43
What is the treatment for B12 malabsorption?
Injections of cyanocobalamin or high-dose B12 supplement (IF-1 is too expensive)
44
What does a decrease in the mean corpuscular volume suggest?
Iron deficiency
45
What is the diagnosis if serum hemoglobin and RBC are low but mean corpuscular volume is normal?
Normocytic anemia
46
When should women start taking a folate supplement?
When they are trying to conceive because neural tube closes before pregnancy is detected
47
When should women start taking an iron supplement? Why?
During the 2nd and 3rd trimesters to support the increase in BV, placenta, and fetus
48
How can black tea affect absorption?
It can inhibit absorption
49
What can increase iron absorption? 3 things
1. Fruits 2. Veggies 3. Vitamin C
50
How much folate does the liver store?
Half the folate in the body, which constitutes 30-70x the daily requirement)

SMP - MNE Exam 1 (25 decks)

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