Nutritional Disorders Flashcards
Micronutrients - act as _____, ______or ______ components
- coenzymes
- hormones
- structural
What are trace minerals?
Elements present in living tissues in small amounts. Includes both essential and nonessential
What are common causes of malnutrition? (4)
- Poverty: homeless, elderly, children of the poor
- Ignorance
- Chronic alcoholism
- Self-imposed dietary restrictions
Deficiencies and over-indulgance/consumption of what 3 things can result in nutritional disease?
-Macros (CHO, Pro, Fats, Cals)
-Vitamins and Minerals
-Water (dehydration and water intoxication)
Emaciation resulting from inadequate intake of calories (i.e. starvation)
marasmus
Intake of what macros are deficient in marasmus?
all of them (CHO, Pro, fats)
what occurs to the body during marasmus/starvation? (i.e. how does the body make energy?)
- uses stores of liver and muscle glycogen
- uses subcutaneous fat
- uses muscle protein (organ and blood protein conserved)
selective protein malnourishment while maintaining calories from carbs
Kwashiorkor
what CHO-rich and Pro-poor foods are often the cause of Kwashiorkor
maize (corn) and rice milk
how is protein depletion manifested in the body in Kwashiorkor
loss of organ protein (albumin) –>
-generalized edema (anasarca)
-fatty liver
-hair and skin changes (loss of pigment and flaky skin)
-parotid enlargement
why is body fat relatively spared in Kwashiorkor?
CHO supplies energy
during Kwashiorkor, does the child appear emaciated? why/why not?
no –> edema = bloating
what symptom of Kwashiorkor causes the protuberant abdomen?
fatty liver
what hair and skin changes (due to protein deficiency) can be seen in Kwashiorkor?
-depigmented hair and alopecia “hair loss”
-flaky paint skin
In marasmus visceral protein (organ and blood protein) is _______, while in Kwashiorkor it is _______.
- conserved (so near normal levels)
- lost
self-induced starvation
anorexia nervosa
what is the major population that anorexia nervosa is seen in?
young adult females
what are the 2 major clinical symptoms of anorexia nervosa?
marasmus and amenorrhea (menstruation ceases)
what causes the death of most anorexia nervosa patients?
starvation, infection, arrhythmia from hypokalemia
what has the highest death rate of any psychiatric disorder?
anorexia nervosa
purge eating followed by induced vomiting
bulimia
what is the major population that bulimia is seen in?
young adult females
what nutritional disorders result in parotid/salivary gland enlargement?
-marasmus
-Kwashiorkor
-anorexia nervosa
-bulimia
-obesity
what does bulimia result in physiologically? (3)
-electrolyte imbalance (hypokalemia) –> arrhythmia
-acid erosion of lingual upper teeth surfaces (perimolysis)
-parotid enlargement
Both Anorexia nervosa and bulimia can feature a deficiency of what 3 vitamins/minerals?
-vitamin C
-niacin
-zinc
this occurs when caloric intake exceeds expenditure with excess being stored as triglycerides in adipose
obesity
T/F overeating is multifactorial due to both genetic and voluntary components
true
what 2 things regulate overeating?
-number of fat cells
-hypothalamus (hormones)
T/F childhood overeating increases the total number of fat cells, which will then become fixed by adolescence
true
What percent overweight is associated with health risks?
20% (BMI >30)
what type of fat is more dangerous/more associated with health risks: visceral or subcuntaneous?
visceral
in an obese state, what do fat cells produce? (3)
-leptin
-adiponectin
-cytokines
what does leptin do? is the net result good or bad? (2)
-decreases appetite in hypothalamus
-causes secretion of Norepinephrine –> burns fat
-GOOD
what does adiponectin do? is the net result good or bad? (2)
-directs fatty acids to muscle for oxidation
-makes liver sensitive to insulin
-GOOD
anti- inflammatory, diabetic, atherogenic, proliferative
fat burning molecule
T/F obese people have more fat cells at birth and defects in regulatory hormones or their receptors
true
(This is bad)
during a state of obesity, what hormone is produced in more excess by the stomach? what does it do?
-ghrelin
-increases appetite
what hormone is secreted after a meal? what organs make and secrete it? what part of the brain does it act on and what does it do?
-Peptide YY
-made in ileum and colon
-acts on hypothalamus to curb appetite
what do the cytokines that are made by fat cells cause? is the net result good or bad? (2)
-subclinical inflammation
-high C-reactive protein
-BAD
what is the proposed pathogenesis on how the gut microbiome affects obesity? (3)
-bacteria break down ingested indigestible polysaccharides –> simple carbs that can be digested –> increases caloric intake
-bacterial products increase ghrelin secretion = increases appetite
-bacterial products –> gut inflammation –> mucosa permeable to cytokines –> increased insulin resistance
T/F variations in gut bacteria/the gut microbiome can affect what and how much you eat
true
where in the brain is the appetite control center?
hypothalamus
in regards to preventing/treating obesity what bacteria should be introduced to the gut microbiome?
bacteria that produce butyrate
what are systemic health risks associated with obesity? (10)
-Type II Diabetes
-Hypertriglyceridemia
-hypercholesterolemia
-low HDL
-Fatty liver disease and cirrhosis
-gallstones
-hyperestrogemia
-cancer (esophagus, thyroid, colon, kidney, prostate, gallbladder)
-parotid enlargement
-Pickwickian (hypoventilation) syndrome
how does obesity correlate with T2DM comordibity?
obesity –> adipose produces cytokines –> inflammation –> activates IL-1 –> insulin resistance, elevated BG and compensatory hyperinsulinemia
what are gallstones composed of?
cholesterol
Hypertriglyceridemia, hypercholesterolemia, and low HDL, all of which can be caused by obesity, lead to what disease states? (3)
Atherosclerosis, heart attack, stroke
the hyperestrogenemia caused by obesity contributes to what disease states? (2)
endometrial and breast cancer
what is Pickwickian (hypoventilation) syndrome?
enormous abdominal obesity –> compresses diaphragm –> restricts ventilation, sleep apnea, hypoxia
what foods are a source of vitamin A? (3)
vegetables, dairy, liver
where is vitamin A stored in the body and for how long?
Ito (stellate) cells in the liver for 6 months
what are the functions of Vitamin A? (4)
-rhodopsin for night vision
-differentiation of mucous
-antioxidant
-enhances immune system
what disease states is vitamin A used in treatment for? (2)
psoriasis and a type of leukemia
what can cause a vitamin A deficiency? (2)
-diet
-fat malabsorption or bile disease
what are symptoms of a vitamin A deficiency? (3)
-night blindness
-squamous metaplasia
-increase mortality from infection (esp measles and diarrhea)
describe the symptoms of squamous metaplasia, which is caused by a vitamin A deficiency (7)
-dry eyes
-corneal blindness
-dry mouth
-skin lesions
-premalignant oral lesions
-pneumonia
-kidney stones
what are symptoms of a vitamin A overdose/excess? (3)
-carotemia (non-toxic)
-headaches & vomiting
-birth defects
in regards to vitamin A, what are pregnant women told not to take/use due to the correlation with birth defects?
retinoids
what is carotemia?
a yellow color in the skin and fat from stored beta carotene (from Vit A)
what are good sources of vitamin D?
-suntan (UVB for 15 min; 90%)
-dairy, fish oil, grains (10%)
what are the functions of vitamin D? (2)
-mineralizes osteoid
-maintain serum Ca2+
how does vitamin D maintain serum Ca2+? (3)
-increases intestinal absorption
-mobilizes Ca2+ from bone (with PTH)
-reabsorbs calcium from distal renal tubules
what does a vitamin D deficiency result in? (3)
-Kids = rickets
-adults = osteomalacia
-increased risk of cancer (colon, breast, prostate)
what can cause a vitamin D deficiency? (6)
-diet
-no sun
-genetic dz
-kidney dz
-malabsorption
-drugs
describe what happens during rickets? what does this result in, symptom-wise?
osteoid produced but is not mineralized =
-soft, deformed bones, bow legs, hypoplastic teeth, deformed skull
-persistence of distorted cartilage masses (Rachitic rosary and pigeon breast deformity)
(children)
describe what happens during osteomalacia?
bone fractures
can a vitamin D deficiency cause hypocalcemia?
yes but rare –> only if severely deficient bc PTH will mobilize Ca2+ from the bones
what can cause someone to have an excess of vitamin D?
dietary supplementation
what does vitamin D excess cause? (2)
-hypercalcemia
-kidney stones
people do not get enough vitamin D today because of _____
protection from sunlight
what disease states have a decreased risk when someone is taking a vitamin D Rx? (3)
-DM
-cancer
-alzheimers
-sepsis (possibly)
what are good sources of vitamin E?
widely available
where is vitamin E stored in the body?
fat deposits
what is the function of vitamin E?
antioxidant –> scavenges free radicals along with selenium
is a vitamin E deficiency caused by diet?
no
when can a vitamin E deficiency be seen?
with fat malabsorption diseases
what are 4 symptoms caused by a vitamin E deficiency?
-loss of nerve cells in spinal cord and nerve myelin –> loss of reflexes, proprioception, pain sensation
-shortened RBC life
-increase cancer?
-increased atherosclerosis?
what can excess vitamin E cause?
bleeding diathesis
what are good sources of vitamin K? (2)
leafy green vegetables and gut bacteria
what are the functions of vitamin K? (2)
-cofactor to carboxylate glutmate
-gets oxidizes as it carboxylates and is recycled when reduced by liver
as a cofactor to carboxylate glutmate, vitamin K allows calcium binding sites on what?
-clotting factors VII, IX, X, and prothrombin
-osteocalcin
what does osteocalcin do?
involved in calcium binding in the bone matrix
what can cause a vitamin K deficiency? (3)
-fat malabsorption diseases
-patients of coumadin
-no gut bacteria (antibiotics, neonatal period)
what symptoms occur due to a vitamin K deficiency? (2)
-bleeding (esp in neonates)
-poor calcification of bone matrix
what is B1?
thiamine
many foods are a good source of thiamine (B1), except what?
processed rice, sugar and flour
T/F cooking lowers thiamine/B1 levels?
true
what are the functions of thiamine (B1)? (3)
-synthesis of ATP
-pentose phosphate pathway
-maintains membranes of peripheral nerves
what can cause a thiamine (B1) deficiency? (3)
-diet of processed carbs
-alcoholism
-excess vomiting
what are the 2 thiamine (B1) deficiency diseases?
-Dry beri beri
-Wet beri beri
-Wernicke-Korsakoff sx
describe the symptoms of Dry beri beri (thiamine/B1 deficiency)
symmetric demyelinization of peripheral nerves –> wrist and ankle drop, loss of reflexes and muscle weakness
describe the symptoms of wet beri beri (thiamine/B1 deficiency)
-peripheral vasodilation
-flabby heart
-AV shunting of blood
-all result in: high output cardiac failure and edema
describe the symptoms of Wernicke-Korsakoff sx (thiamine/B1 deficiency)
-unsteady gait
-mental confusion
what is a good source of riboflavin/B2?
widely distributed
what is B2?
Riboflavin
what are the functions of riboflavin/B2? (2)
-FAD –> involved in REDOX rxns in intermediary metabolism
-mitochondrial enzymes
what can lead to a riboflavin/B2 deficiency? (4)
-impoverished countries
-malabsorption diseases
-alcoholism
-debilitation
what symptoms result from a riboflavin/B2 deficiency? (6)
-anemia
-angular cheilitis
-magenta tongue
-corneal vascularization and ulceration
-dermatitis of nasolabial folds (rare)
-genital lesions
what is a good source of niacin?
-grains, legumes (NOT corn)
-can be converted from tryptophan, which is in: fish, turkey, meat, nuts, grains
what are the functions of niacin? (2)
-NAD and NADP –> needed in intermediary metabolism of fat, CHO, amino acids
-large doses –> lowers LDLs
what can a niacin (or tryptophan) deficiency result from?
-corn diets (south)
-alcoholics
-eating disorders
-debilitating dz
-seizures meds
-carcinoid syndrome
what is carcinoid syndrome?
when tryptophan is converted to 5-HT can’t be converted to niacin
what is the disease caused by a niacin deficiency?
Pellagra
what are the symptoms of pellagra (niacin deficiency)?
-thick, red, dry scaly skin patches around the neck
-oral lesions
-diarrhea caused by atrophy of columnar intestinal lining
-dementia caused by neuronal degeneration
(3Ds: dermatitis, diarrhea, dementia)
what can excess niacin result in?
-flushing of skin
-liver damage
-increases fasting blood sugar
(seen in high cholesterol tx)
what is B6?
Pyridoxine
what is a source of pyridoxine/B6?
widely distributed
what are the functions of pyridoxine/B6? (2)
-involved in metabolism of lipids and AAs
-required for heme synthesis
what can lead to a pyridoxine/B6 deficiency?
-destroyed in food processing
-antagonized by drugs (isoniazid, estrogens, alcohol)
-increased demand in pregnancy
what are the symptoms of a pyridoxine/B6 deficiency?
-elevated homocysteine –> atherosclerosis, thrombosis
-resembles riboflavin deficiency (angular cheilitis, glossitis, dermatitis, peripheral neruopathy)
-mild anemia
what are therapeutic doses of pyridoxine/B6 used for?
-carpal tunnel sx
-to counteract deficiency caused by isoniazid
what are good sources of Cobalamin/B12?
meat, gut bacteria
what is B12?
Cobalamin
what is required in order for Cobalamin/B12 to be absorbed? where is it absorbed?
-intrinsic factor (in stomach)
-absorbed in distal ileum
where is Cobalamin/B12 stored in the body and for how long?
liver; 5-20 years
what are the functions of Cobalamin/B12? (4)
-Converts homocysteine to methionine
- Converts methylmalonyl CoA to succinyl CoA
-Needed for folate metabolism and DNA synthesis
-maintenance of myelin in spinal cord
what can lead to a Cobalamin/B12 deficiency? (5)
-vegan (no other diet issue)
-chronic atrophic gastritis with loss of parietal cells (intrinsic factor)
-malabsorption in ileum (Crohn dz)
-lymphoid malignancies that steal B12
-chronic Nitric Oxide inhalation
why can chronic Nitric Oxide inhalation lead to a state of Cobalamin/B12 deficency?
NO = B12 antagonist = causes demyelination
what are symptoms of a Cobalamin/B12 deficency?
-megaloblastic anemia
-loss of other rapidly dividing cells (neutrophils, germ cells, intestinal epithelium, chronic atrophic glossitis)
-raises serum homocysteine levels
-raises methylmalonic acid levels
-demyelination
why does megaloblastic anemia occur during a Cobalamin/B12 deficency?
due to impaired folate utilization = RBCs get big but cannot divide
what do raised serum homocysteine levels (due to a Cobalamin/B12 deficency) lead to?
makes blood hypercoagulable –> accelerates atherosclerosis
what do raised methylmalonic acid levels (due to a Cobalamin/B12 deficency) lead to?
demyelination of spinal tracts –> numbness and tingling of extremities then irreversible paraplegia
what are good sources of folate?
Vegetables
T/F cooking can destroy folate
true
where is folate absorbed in the body?
proximal ileum
where is folate stored in the body and for how long?
liver; 6 mo
what is the function of folate?
required for DNA replication and cell division
what can lead to a folate deficiency? (6)
-diet
-pregnancy (6-fold increase in need)
-malignancies and chemo Rx
-alcohol (folate antagonist)
-BCP
-cigs
what symptoms can result from folate deficiency? (6)
-megaloblastic anemia (B12 anemia w/o neural defects)
-neutropenia, loss of germ cells and GI epithelium
-chronic atrophic glossitis
-colon cancer (contributes)
-increased serum homocysteine
-fetal neural tube defects (spina bifida)
what is ascorbic acid?
Vitamin C
what are goods sources of vitamin C?
fruits, vegetables, fish, milk
why are humans are one of the few animals that CANNOT make vitamin C?
missing enzyme L-gluconolactone oxidase
can vitamin C be stored?
no
what are the functions of vitamin C? (3)
-hydroxylation of procollagen
-antioxidant (with Vit W)
-synthesis of norepinephrine
what can lead to a vitamin C deficiency?
-weird diets –> only beef/dairy
-alcoholics
-elderly
-infants on formula
-faddists
-autism
-bulimia
when can a vitamin c deficiency occur?
2-3 months after 0 intake
what is a vitamin C deficiency?
Scurvy
what are symptoms of scurvy?
puerpera and hematomas in gingiva, skin, joints, and perisosteum
(swollen, bleeding gums and perifolicular hemorrhage with corkscrew hairs)
what is the pathogenesis behind the puerpera and hematomas in scurvy?
-collagen without hydroxyproline = weak (esp in caps and venules)
-deformed bones due to lack of osteoid matrix
how might vitamin C deficiency may contribute to GI cancers and atherosclerosis?
via reduced antioxidant effect
what can an excess in vitamin C result in?
kidney stones and Fe overload (only seen in high doses)
what vitamins and minerals have neurologic manifestations? (5)
-thiamine
-vitamin B12
-pyridoxine
-folate (embryonic neural tube defects)
-vitamin E
what vitamins and minerals have bone manifestations? (4)
-vitamin C (matrix)
-vitamin D (calcification)
-vitamin K (calcification)
-calcium
what vitamins and minerals are antioxidants? (4)
-Vit A, C, E
-Selenium
what vitamins and minerals have bleeding manifestations? (3)
Vit C, K and excess E
what vitamins and minerals have skin manifestations? (6)
-Vit A, C
-niacin
-riboflavin
-pyridoxine
-zinc
what vitamins and minerals have oral manifestations? (9)
-vitamin A
-vitamin B12
-folate
-riboflavin
-pyridoxine
-niacin
-iron
-vitamin C
-zinc
of the vitamins and minerals that have oral manifestations, which cause angular cheilitis and atrophic glossitis? (4)
-riboflavin
-pyridoxine
-niacin
-iron
of the vitamins and minerals that have oral manifestations, which cause bleeding gums and periodontal dz? (1)
Vitamin C
of the vitamins and minerals that have oral manifestations, which cause perioral rash?
zinc
which vitamins and minerals can be used for vitamin therapy?
-C, E (antioxidants)
-niacin (lowers LDL)
-folate and B12 (prevent neural defects, lower homocysteine, colon cancer)
-B complex (pregnancy)
-K (calcification)
-pyridoxine (carpal tunnel sx)
what is the function of calcium? (3)
-bone mineralization
-clotting factor
-regulated by PTH and Vit D
what causes hypocalcemia? (3)
-renal failure
-rickets
-no parathyroid (DiGeorge sx)
what causes hypercalcemia? (5)
-parathyroid tumor
-end stage renal dz with phosphate retention
-bone destroying tumors
-excess dietary Ca (antacids) or Vit D
-granulomatous dz (sarcoid)
what are signs of hypocalcemia? (3)
-hypocalcified teeth
-tetany
-no clotting disorder
what are signs of hypercalcemia?
metastatic calcification in alkaline tissue (stomach, lungs, kidney) –> causes nephrocalcinosis and nephrolithiasis with kidney damage
what are good sources of iron?
meat, green vegetables
how is iron stored?
conserved in the body from worn out RBC by macrophages as hemosiderin
what is the function of iron?
required for Hb, Mb, cytochromes and catalase
what can lead to an iron deficiency? (2)
-diet (rare – formula fed infants, Scandinavians)
-Chronic blood loss (menstruation, GI ulcers, cancers)
what can an iron deficiency lead to? (3)
-anemia
-oral mucosal atrophy
-Plummer Vinson Sx
what is Plummer Vinson Sx?
severe iron deficiency in Scandinavian women –> leads to oral and esophageal atrophy with cancers
what can excess iron lead to? (2)
-hemosiderosis
-hemochromatosis
what is hemosiderosis?
iron stored in macrophages of bone marrow, LNs, and spleen –> no symptoms
what is hemochromatosis?
massive iron overload in many organs –> systemic dz
what can lead to a water deficiency?
-reduced intake
-excessive excretion
what can water intoxication lead to?
death by arrhythmia due to electrolyte imbalance (hypokalemia and hyponatremia) and pulmonary edema
what malabsorptive diseases are associated with vitamin/mineral deficiencies and which vitamins/minerals are involved? (5)
-Chron Dz: vit A, C, thiamine, folate, B12, D, Fe
-Celiac Dz: Zn, vit ADEK
-autoimmune chronic gastritis: B12
-total parenteral nutrition: given to pat with chronic Gi dz due to low thiamine, vit C, and Zn
-gastric bypass and banding
______ is the most common autosomal recessive disease in caucasians and leads to a deficiency in what vitamins/minerals?
-cystic fibrosis
-vit ADEK, Zn, fats
Autism usually correlates to Vit A and C deficiencies. why?
fresh fruits and vegetables cause taste and texture aversions = avoided
alcoholism can lead to a deficiency in what?
all B vitamins (antagonist)
