Nutrtional Diseases Flashcards
What is primary malnutrition?
Either carb, fat or protein missing from the diet Or all missing
What is secondary malnutrition?
Malabsorption, impaired utilization or storage, or increased need
What is severe acute malnutrition (SAM)?
Previously known as protein energy malnutrition or PEM
Consequences of inadequate intake of proteins and calories or deficiencies in the digestion or absorption of proteins -> loss of fat and muscle tissue, weight loss, lethargy, generalized weakness
Which population is highly affected by PEM/SAM?
Residents of nursing homes
What are signs of secondary PEM?
Depletion of subQ fat in the arms, chest wall, shoulders or metacarpal regions
Wasting of the quadriceps and deltoid muscles
Ankle or sacral edema
What is marasmus?
Severe lack of calories
Leads to growth retardation and muscle loss
Serum albumin NL —> anemia, immune deficiency —> infections
Emaciated extremities
What is kwashiorkor?
Decreased protein more severe —> decrease in total calories
Hypoalbuminemia -> generalized or dependent edema, vit deficiency, immune def, secondary infections
Depletion of visceral protein compartment
Fatty liver
What are somatic proteins?
Protein in skeletal muscles —> marasmus
What are visceral proteins?
Protein in organs primarily the liver
Kwashiorkor
Albumin and transferring levels
What is anorexia nervosa?
Self induced starvation —> marked weight loss
Amenorrhea, decreased thyroid hormone, decreased bone density
Anemia, lymphopenia, hypoalbuminemia
Gelatinous transformation
Increased susceptibility to cardiac arrhythmia and sudden death due to hypokalemia
What is gelatinous formation?
Fat in BM, mucinous matrix material deposition
What is bulimia?
Binge/purge
More common than anorexia and better prognosis
Electrolyte imbalance (hypokalemia) —> cardiac arrhythmia
What is a complication of both anorexia nervous and bulimia?
Susceptibility to cardiac arrhythmia and sudden death due to hypokalemia
What are the functions of vitamin A?
A component of visual pigment
Maintenance of specialized epithelia
Maintenance of resistance to infection
What are the deficiency syndromes associated with vitamin A?
Night blindness, xerophthalmia, blindness
Squamous metaplasia
Vulnerability to infection particularly measles
What are the functions of vitamin D?
Facilitates intestinal absorption of Ca and phosphorus and mineralization of bone
What deficiency syndromes are associated with vitamin D?
Rickets in children
Osteomalacia in adults
What is the function of vitamin E?
Major antioxidant
Scavenges free radicals
What deficiency syndromes are associated with vitamin E?
Spinocerebellar degeneration
What are the functions of vitamin K?
Cofactor in hepatic carboxylation of procoagulants including factors II, VII, Ix and X + protein C and S
What deficiency syndromes are associated with vitamin K?
Bleeding diathesis
What is the function of vitamin B1 (thiamine)?
Coenzyme in decarboxylation reactions
Causes dry and wet beriberi, Wernicke syndrome, Korsakoff syndrome
What is the function of Niacin?
Incorporated into NAD and NADP Involved in redox reactions Causes pellagra (dementia, dermatitis, diarrhea)
What are the functions of vitamin B6 (pyridoxine)?
Derivatives serve as coenzymes in many intermediary reactions
Can lead to cheliosis, glossitis, dermatitis, peripheral neuropathy
What is the function of vitamin C?
Serves in many oxidation reduction reactions and hydroxylation of oxygen
Leads to scurvy, hemorrhages and healing defects
Secondary deficiency of vitamin A can occur with fat malabsorption disorders such as what?
Celiac dz, Crohn’s dz, cystic fibrosis, Bariatric surgery, mineral oil laxative
What is one of the earliest signs of vit A deficiency?
Night blindness
Describe the epithelial/squamous metaplasia and keratinization that can occur with vitamin A deficiency
Xerophthalmia (dry eyes), Bitot spots (keratin), keratomalacia (cornea destruction) —> blindness
Squamous metaplasia of resp epithelium —> increased pulmonary infections
Squamous metaplasia of urinary tract —> desquamation of keratin predisposes to urinary bladder stones
What is arcuate vitamin A toxicity?
HA, dizziness, vomiting, stupor and blurred vision
Confused with pseudotumor cerebri (increased intracranial pressure, HA and vision changes; aka iodopahtic intracranial HTN)
What are the effects of rickets?
Frontal bossing, squared head, rachitic rosary, pigeon breast deformity, lumbar lordosis, bowing of the legs
What is the major source of vitamin D?
Endogenous synthesis from a precursor, 7-dehydrocholesterol, in a photochemical reaction that requires solar or artificial UV light in the range of 390315 nm
Humans are entirely dependent on the diet for which vitamin?
C
What is the function of iron?
Essential component of Hb as well as several iron containing metalloenzymes
What is the basis of an iron deficiency?
Inadequate diet
Chronic blood loss
What are the clinical features for iron deficiency?
Hypochromic microcytic anemia
What is the normal range for BMI?
18.5-25 kg/M2
What BMI range is considered overweight?
Between 25 and 30
Excess adiposity and excess body weight are associated with what?
Increased incidence of T2DM, dyslipidemias, CVD, HTN and cancer
What is leptin?
Secreted by fat cells
It’s output is regulated by the adequacy of fat stores
What is adiponectin?
Produced in adipose tissue
Has been called a fat burning molecule
What is Ghrelin?
Produced in the stomach and is the only known gut hormone that increases food intake (orexigenic effect)
Obesity is associated with what syndrome (other than metabolic)?
Hypoventilation syndrome also called pcikwickian syndrome
Hypersomnolence both at night and during the day, often associated with sleep apnea, polycythemia, and eventual right sided heart failure (cor pulmonale)
Which cancers are associated with obesity?
Increased risk for cancers of esophagus, thyroid, colon and kidney in men
Cancers of esophagus, endometrium, gallbladder and kidney in women
Insulin resistance leads to hyperinsulinemia, how can this contribute to cancer?
Hyperinsulinemia leads to increased free insulin like growth factor (IGF-1)
IGF-1 is a mitogen
IGF-1 receptor, IGFR-1 is highly expressed in many human cancers
The proinflammatory state that is associated with obesity may itself be what?
Carcinogenic
What is aflatoxin?
Can lead to hepatocellular carcinoma
Toxin produced in fungi found in agricultural crops such as maize, peanuts and tree nuts
