nutritional assessment and micronutrients Flashcards

1
Q

evaluation of a patient’s nutritional status based on subjective and objective clinical information

A

nutrition assessment

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2
Q

4 functions of nutrition assessment

A
  1. assess quality and quantity of intake
  2. determine if medical nutrition therapy or counseling is warranted
  3. evaluate effectiveness of nutritional interventions
  4. monitor changes in nutritional status
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3
Q

why are nutritional assessments important?

A
  1. obesity and malnourishment are common
  2. accurate nutritional assessment = better dx/tx
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4
Q

4 things to consider while taking medical history

A
  1. Medical Hx - full history of past and current health problems
  2. Medication Use - full list of prescription and OTC meds
  3. Family Hx - emphasis on conditions that affect or are affected by nutritional intake
  4. Social Hx - traditional place in the history where diet information is obtained
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5
Q

place where they live, who they live with, their income, their transportation, etc., that have a big impact on a pt’s food selection and preparation

A

socioeconomic factors
considered when taking social hx

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6
Q

what is retrospective questioning method

A

Ask the patient to write down everything consumed in the last 24 hours

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7
Q

what is prospective dietary evaluation

A
  • Ask the patient to write down everything consumed daily, as they consume it
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8
Q

how does prospective dietary evaluation help mitigate recall bias and provide a more accurate estimation

A
  • Requires greater patient compliance and later-date follow-up
  • Longer log period = greater accuracy
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9
Q

BMI value for obese

A

+30

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10
Q
  • A measure of risk in normal weight and overweight/obese patients
  • Indicates excess fat in the abdominal area (visceral adipose tissue)
A

waist circumference

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11
Q

what are macronutrients

A

proteins, carbs, fats

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12
Q

what are micronutrients

A

dietary substances consumed in smaller amounts than macronutrients, but still essential to the body
- vitamins
- mineral
-essential AA
- essential FA

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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 fat-soluble vitamins

A
  • A, D, E, K
  • excess intake is stored in fatty tissues
  • Deficiency usually seen in fat malabsorption syndromes (bariatric surgery, GI illness)
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15
Q

what are water-soluble vitamins

A
  • B complex and C
  • generally widely available in foods, only limited storage in the body
  • Deficiency usually seen in patients with poor nutritional intake or malabsorption
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16
Q

which vitamin class would patients have a higher chance of toxicity from?

A

fat-soluble

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17
Q

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

A

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

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18
Q

role of thiamine (B1)

A

neuro metabolism*
glucose metabolism
antioxidant

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19
Q

who is usually deficient in thiamine (B1)

A

alcoholics*
poor diet/restricted diet

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20
Q

symptoms of deficiency of thiamine B1

A

Beriberi - classic syndrome of deficiency
- Wet beriberi - cardiovascular - heart failure, cardiomegaly, edema, ↑ HR, SOB (fluid retention)
- Dry beriberi - neurologic - symmetrical sensory and motor neuropathy - Includes Wernicke’s Encephalopathy and Korsakoff Syndrome

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21
Q

role of niacin B3

A

General metabolic processes throughout the body* - create NAD and NADP coenzymes, used for energy

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22
Q

who is usually deficient of niacin B3

A

alcoholics, anorexics, HIV*, malabsorption pts

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23
Q

Symptoms of deficiency of niacin B3

A

Pellagra - classic syndrome of deficiency
- “3 Ds” - photosensitive dermatitis*, diarrhea (with other GI symptoms), dementia (advanced)

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24
Q

role of pyridoxine B6

A

protein and neurotransmitter metabolism, gluconeogenesis

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25
who is usually deficient of pyridoxine B6
- CKD, GI disease (IBD, celiac), autoimmune pts (kidney and gut problems)* - meds: oral contraceptives*, anti-TB, theophylline, L-dopa
26
symptoms of deficiency of B6
anemia, dermatitis (including stomatitis), depression, seizures
27
role of folate B9
amino acid and nucleic acid metabolism, cell division
28
what is the most common nutrient deficiency in the US
folic acid/folate
29
who is usually deficient of folate
- alcoholics, poor diet (low veggie intake), smokers, malabsorption pts, MTHFR patients - meds: trimethoprim, methotrexate, phenytoin
30
symptoms of deficiency of folate
anemia, glossitis/stomatitis, GI upset, fatigue
31
role of Cobalamin/Cyanocobalamin (B12)
nucleic acid metabolism, conversion of folate to active form, numerous other metabolic roles
32
who is usually deficient of B12
- vegan diet*, GI illness causing malabsorption - Meds: chronic PPI (for GERD)
33
symptoms of deficiency of B12
anemia, peripheral neuropathy, cognitive defects, fatigue
34
role of vit. C
antioxidant, gene expression, production of many important proteins including collagen
35
who is usually deficient of vit. C
alcoholics, smokers, poor/restricted diet, dialysis
36
classic syndrome of vitamin C deficiency
Scurvy fatigue, gingivitis, poor wound healing
37
role of vitamin A
key component of rods and cones in the retina, epithelial cell reproduction, bone/teeth/reproductive/immune function
38
Who is usually deficient of vitamin A
underdeveloped countries, poor diet, fat malabsorption
39
symptoms of deficiency of vitamin A
night blindness, blurry vision, xerosis, keratomalacia
40
who gets toxicity of vitamin A? s/s?
excessive supplements altered mental status, seizures, headache, blurred vision
41
role of vitamin D
needed for absorption of calcium in gut; receptors found throughout the body
42
what is the active form of vitamin D
calcitriol D3 D2 - inactive
43
Who is usually deficient of vitamin D
low sunlight exposure, darker-skinned individuals, poor diet, renal or liver disease pts, breastfed newborns
44
symptoms of deficiency of vitamin D
MSK* - fatigue, bone pain, muscle weakness or cramps
45
who is usually toxic of vitamin D? s/s?
excessive supplements MSK - fatigue, bone pain, muscle weakness or cramps
46
role of vitamin E
antioxidant, cell membranes
47
who is usually deficient of vitamin E
malnourished pts, fat malabsorption RARE
48
symptoms of deficiency of vitamin E
ataxia, muscle weakness, impaired vision
49
s/s of toxicity of vitamin E
bleeding, muscle weakness, fatigue, nausea, vomiting
50
role of vitamin K
blood clotting* bone and kidney metabolism
51
who is deficient of vitamin K
newborns*, fat malabsorption, warfarin pts newborn bc they dont have the gut flora yet
52
symptoms of deficiency of vitamin K
bleeding, including hemorrhage; bone malformation
53
inorganic compounds required for survival
minerals
54
inorganic compounds found most abundantly in human tissues
macrominerals Calcium, phosphorus, magnesium, potassium, sodium, chloride, sulfur
55
inorganic compounds found in small amounts
trace elements Iron, copper, zinc, iodine, chromium, fluoride, nickel, arsenic, molybdenum, selenium, manganese, silicon, boron, tin, vanadium
56
role of iron
majority is found in RBCs to transport O2
57
2 types of iron
heme - meat nonheme - green leafy veggies - not as wall absorbed compared to heme
58
symptoms of deficiency of iron
fatigue, anemia, cognitive difficulties, impaired immunity
59
what is the most common nutritional deficiency worldwide
iron
60
role of iodine
majority is incorporated into thyroid hormones for metabolic function
61
risk for deficiency of iodine
Countries with low iodine content in soil and no required fortification
62
s/s of deficiency of iodine
- thyroid goiter - In pregnant women - pregnancy loss, infant psychomotor retardation, cretinism
63
what are the 2 bone minerals and what are their differences
1. calcium - fortified foods - s/s of deficiency: neuro/MSK symptoms (weakness, AMS, muscle spasm, muscle weakness, thinned bones) - Risk factors: restricted diet, malabsorption/GI disease 2. magnesium - s/s of deficiency - neuro/MSK symptoms (fatigue, weakness, AMS, muscle spasm, muscle weakness) - Risk factors: + renal disease, diuretics, PPIs
64
9 out of 20 dietary amino acids cannot be synthesized and must be consumed
essential amino acids deficiency is rare
65
linoleic acid and alpha-linoleic acid that must be consumed
essential fatty acids deficiency is rare
66
arachidonic acid is synthesized from ?
linoleic acid
67
essential fatty acid deficiency is rare but can be seen in
pts on total parenteral nutrition (TPN)