Obeesiteh & PCOS Flashcards
What is Kwashiorkor caused by?
protein deficiency (but adequate energy)
When is Kwashiorkor often seen?
often seen in weaning infants at birth of a sibling in areas where protein foods aren’t abundant
-can occur even in overweight
onset and protein levels of Kwashiorkor
may be abrupt onset and low albumin (edema, etc)
Marasmus caused by
deficiency of both protein and energy
Where is marasmus seen
in areas where not enough food available
-associated with fat and muscle wasting
onset, protein levels of marasmus
slower onset and albumin level may be normal
Kwashiorkor-like secondary protein-energy malnutrition
-associated with what?
hypermetabolic acute illness like trauma, burns, sepsis
Marasmus-like secondary protein-energy malnutrition
associated with what?
COPD, CHF, AIDS, cancer
-number of calories they’re taking in aren’t enough to keep up w/ energy expended from/by diseases
list of things that cause protein-energy malnutrition
- not enough energy or protein ingested
- increased nutrient losses
- increased nutrient requirements by underlying illness
Refeeding in protein-energy malnutrition
- ***must be slow and careful b/c mineral/electrolyte problems during referring
- will need vitamin and mineral supplements
Main vitamin that should be supplemented?
Vitamin D
- essential for bone mineralization
- deficiency associated with increased risk for colorectal, breast, and prostate cancers
Thiamine deficiency usually associated with
alcohol
riboflavin deficiency usually because
of multiple vitamin deficiencies
niacin deficiency
usually alcohol related
- niacin helpful for treating lipids
- severe deficiency causes dermatitis, diarrhea
vitamin C deficiency
urban poor, elderly, renal failure
-scurvy, bleeding gums, edema
What two vitamins necessary for RBC division
and what if deficient
B12 and folate
macrocytosis if deficient
B vitamin deficiencies
mouth soreness, glossitis, weakness, irritability
B12 deficiency
- Macrocytic anemia, neuropathy
- B12 stores last a long time
- Intrinsic factor protects is (schilling test to see if IF is reason for B12 deficiency)
Folate deficiency
- usually dietary deficiency
- **folate stores are short-lived so highly dependent on diet
- macrocytic anemia without neurologic defects
If B12 deficiency and supply folate, what happens?
macrocytic anemia will correct but neurological will become permanent
Vit A deficiency and excess
- Deficiency can cause blindness
- hypervitaminosis very toxic
Vit D
-essential for what?
bone mineralization
Vit E deficiency
usually due to malabsorption
Vit E supplementation
causes more harm than good for CVD
D-xylose test
- tests for bacterial overgrowth in gut
- we can’t digest xylose but bacteria can
- look for labeled Co2 when xylose broken down
underweight BMI range
less than 18.5
normal BMI range
18.5-24
overweight BMI range
25-29
Obese BMI range
> 29
30+
Obesity causes increased risk for
- insulin resistance/diabetes
- metabolic syndrome
- CVD, stroke, MI
- cancer
- MS problems/arthritis
What does adiponectin do?
What happens when obese?
repairs vascular walls and regulates inflammation
-adiponectin decreases with obesity
Obesity is worse/ higher CVD risk if what?
higher level of inflammation within fat
Drugs indicated for chronic obesity treatment
Xenical/orlistat
short term weight loss drugs
amphetamines suppress appetite, other drugs with unintentional weight loss side effect
Types of Bariatric surgeries
- Restrictive reduces stomach size for earlier satiety
- Malabsorptive more effective, prevents nutrients from being absorbed
- Combination also very effective- gastric bypass with some malabsorption
PCOS general definition
- ovulatory dysfxn
- hyperandrogenism (must exclude other causes like ovarian tumor, etc)
- exclusion of other disorders
- possible polycystic ovaries
Things usually present with PCOS
- usually overweight/obese
- insulin resistance or hyperinsulinemia
- elevated LH levels
- hyperandrogenism from hyperinsulinemia
- anovulation
- strong family clustering
- prevalence of metabolic syndrome higher than general population
PCOS Lab Findings
- elevated LH but normal FSH
- increased testosterone
- ***insulin resistance with compensatory hyperinsulinemia (key pathogenic factor in PCOS)
Clinical Features of PCOS
- acanthosis nigricans
- acne
- alopecia
- amenorrhea or dysfxnl menses
- central obesity
- hirsutism
PCOS pts have increased risk of what CVD disease?
7-fold increased risk of MI
Best first-line treatment for PCOS
- lifestyle modification with diet & exercise
* *weight loss, low fat and low carb diet
What medicine to treat infertility in PCOS?
Clomiphene
How to treat complaints of PCOS?
- oligomenorrhea: estrogen-progestin therapy
- hirsutism- estrogen progestin
- anovulation/infertility: clomiphene
drug treatments for weight loss
- Orlistat fat blocker
- amphetamines for short term appetite suppression
- bariatric surgery
insulin sensitizing agents
- metformin (biguanide) and
- thiazolidinediones
