Revision slides Weeks 7, 8 and 9 Flashcards
1
Q
What is coeliac disease?
A
Autoimmune condition: immune system attacks healthy tissue.
2
Q
Explain how damage to the intestinal mucosa affects in coeliac disease?
A
- reduced production of digestive enzymes
- subsequent reduction of digestive capability
3
Q
What are some deficiencies common to coeliac disease?
A
- Iron deficiency anaemia
- Low serum folate
- Low serum B12
4
Q
What happens if there is steatorrhea in coeliac disease?
A
limited absorption of calcium and fat-soluble vitamins
Osteoporosis (due to LBM density)
5
Q
How is coeliac disease diagnosed?
A
Blood test for the gliadin antibodies and gut biopsy.
6
Q
What is the treatment for coeliac disease?
A
Gluten free diet for life. Avoiding wheat, barley, and rye, sometimes oats.
7
Q
Where is the location of inflammation in ulcerative colitis and in crohn’s disease?
A
Ulcerative colitis: Limited to the large intestine/colon
Crohn’s disease: Anywhere in the GI tract
8
Q
What is the pattern of inflammation in ulcerative colitis and in Crohn’s disease?
A
Ulcerative colitis: inflammed areas are continuous with no patchiness
Crohn’s disease: Patches of inflammation found in large sections of the bowel
9
Q
Where is the appearance of inflammation, and where is the pain located in ulcerative colitis and Crohn’s disease?
A
Ulcerative colitis: Ulcers penetrate the inner lining of the abdomen only.
Chron’s disease: Ulcers penetrate the entire thickness (several layers of the abdominal lining)
10
Q
What are some nutritional consequences of Ulcerative Colitis and Crohn’s disease?
A
- Malnutrition in UC is often less severe than in CD
- Nutritional intake: people reduce to ease symptoms
- Malabsorption: Absorptive area may reduce as a result of inflammation or surgery Ileum reduces the absorption of B12
- Loss of terminal ileum leads to malabsorption of fat-soluble vitamins
- Large intestine: Loss of albumin and iron due to leakage of blood and plasma
- Rapid intestinal transit may lead to loss of fluid and electrolytes
11
Q
Are there periods of remission and relapse in chronic GI inflammation?
A
Yes
12
Q
What are the protein requirements in people with Crohn’s disease?
A
1-2g/kg/bw depending on disease severity
13
Q
What drug is used in the treatment of active Crohn’s disease?
A
Steroids. It can reduce calcium absorption and increase urinary excretion.
14
Q
Why protein-energy malnutrition may appear in Crohn’s disease?
A
Reduced intake, increased metabolism and intestinal losses
15
Q
Outline some nutrition facts for ulcerative colitis:
A
- Little place for diet as first line of therapy
- Some studies have reported relapse in patients when cow’s milk was reintroduced into diets of patients on a milk-free diet
- supplementation with omega-3 fatty acids did not prove successful
- research has been carried out on links between the MedDiet
- there may be a link between the gut microbiota and UC
16
Q
What are probiotics?
A
Live microorganisms which, when administered in adequate amounts, confer a health benefit on the host
17
Q
What are prebiotics?
A
Nondigestible substances that provide a beneficial physiological effect for the host by selectively stimulating the favourable growth or activity of a limited number of indigenous bacteria.
18
Q
Explain 7 facts about food allergies:
A
- Immune system is involved
- Timing of symptoms is closely associated with food intake
- IgE mediated occurs suddenly within seconds or minutes of eating the food. In extreme cases, it can be life-threatening (IgE only: anaphylaxis)
- Symptoms are acute, typical and involve more than one organ
- Even a tiny trace of the food is usually easily identified
- It is easily diagnosed with tests
- There is a family history or personal history of atopic disorders (IgE)
19
Q
Explain Food Intolerance (non-immune mediated FHS)
A
- Symptoms come on more slowly and are long-lasting (72 hrs)
- They mainly involve the digestive system.
- It is never life-threatening.
- A reasonable portion of food is usually needed to cause a reaction, although some people can be sensitive to small amounts.
- You may crave the problem food.
It is difficult to diagnose as there are only a few reliable tests.
20
Q
What are the 3 types of non-immune mediated Food intolerances?
A
- Enzymatic
- Pharmacological
- Other
21
Q
Adverse reactions to food can be categorised into:
A
-Toxic (microbiological pharmacological)
- Non toxic: Immune-mediated (food allergy) and non immune-mediated (food intolerance)
22
Q
Explain the types of food intolerance non-immune mediated FHS
A
- Does not involve the immune system
- Pharmacological reactions. E.g. to vasoactive amine (serotonin, tyramine and histamine)
- Enzymatic, e.g. lactose intolerance due to deficiency of gut digestive enzymes.
- Reactions to food toxins. e.g. from fish mushrooms.
23
Q
What are the tests to diagnose an allergy?
A
- Blood test
- Skin prick tests
- Elimination / provocation tests
24
Q
What are the tests to diagnose a food intolerance?
A
Elimination / provocation tests
25
Give some example of common food allergies:
Celery
Egg
Shellfish
Fish
Mollusc
Mustard
Peanut and nuts
Sesame seeds
Soy
Milk
Lupine
Cocoa
26
Give some example of common food intolerance:
Histamine
Gluten (immune system involved)
Sulphite
Lactose
Glutamate
Fructose
FODMAPs
27
What is an Epitope?
Epitope is the area of the food allergen which provokes the immune response (located on the surface of the allergen)
28
What is the structure of an epitope?
- Linear epitopes are composed of short chains of amino acids
- Conformational epitopes depend on the 3D structure of the protein
29
Explain the sensitisation phase in immune response:
- The allergen-specific IgE attaches to the surface mast cells
- No symptoms during this phase but one completed the individual is primed to react to the offending
30
What happen on a subsequent exposure in food allergy?
- The epitopes will cross link to IgEs bound to the mast cell
- Leading to perforation of the membrane and the release of performed mediators such as histamine and leukotrienes
31
Explain the steps of an allergic reaction:
1. initial contact with allergen B Cell
2. Plasma cell releases IgE antibodies
3. Mast cell IgE receptor
4. Subsequent contact with allergen, allergen binds in mast cell
5. Allergic reaction
32
What happen when a person eats the food for the second time (allergic reaction)?
- The protein enters the body
- Binds to and cross links to IgE antibodies
- Causes the mast cell or basophil to degranulate
- Granules contain 40 different substances that cause allergic responses, histamine, prostaglandins, leukotrienes
33
Explain how to protect against allergies:
- Exclusive breastfeeding for 4 months
- A home with 2 more older siblings
- Pet ownership (specially dogs & early exposure to animal farms)
- Exposure to parasite or hookworm infections (IgE was design to combat worms)
- Early introduction of probiotic bacteria (acidophilus GG promotes gut immunity)
- Micro-bacteria in spoilt and drinking water
- Dietary anti-oxidants, folate, fish oils, and vitamins (Beta carotene)
34
What is the test for lactose intolerance?
Hydrogen breath test
35
What is the test for a Non-IgE-mediated FHS?
Patch test
36
What is the test for an IgE-mediated FHS?
Skin prick test
Specific IgE test
Blood test/RAST
37
Give 2 examples of a nutritionally balance diet for those with food allergies:
Milk Allergy: (source of protein, calcium, vitamin B12 and vitamin D, Vitamin A, riboflavin)
- Need to have alternative source of protein and calcium
- Replacement milk alternatives must be fortified with B12 and calcium and have enough energy
Egg Allergy: (source of iron and vitamin B12, A, E, Biotin and pantothenic acid, selenium)
38
Explain FODMAPs:
Rapidly fermented foods, short chain carbohydrates, poorly absorbed, osmotic effect
39
Type of sugars in FODMAPs:
- Fermetable
- Oligosaccharides (fructo-oligosaccharides -fructans and galactans)
- Disaccharides (sucrose, lactose, and maltose)
- Polyols (sugar alcohols)
40
Which syndrome could be involve intolerance to FODMAPs?
Irritable Bowel Syndrome IBS
41
How would you help a client with IBS?
The aim will be to reduce symptoms.
First line: Healthy eating and lifestyle management
Second line: low FODMAP diet
42
Explain the DSM-5 diagnostic criteria for anorexia nervosa
- Markedly low weight (body weight <85% of expected in DSM-IV)
- Intense fear of gaining weight or persistent behaviour to avoid weight gain
- Weight and shape disturbance
- (Amenorrhoea in DSM-IV)
- Restricting type and binge-eating/purging type
43
Anorexia Nervosa signs:
- Psychological signs
- Food behaviour - fear of weight gain drives
- Excessive exercising
44
Anorexia Nervosa Clinical features:
- Plasma cortisol levels fall
- Raise growth hormone levels (as a result of starvation)
- Menstrual periods can stop
- Breast development fails
- Low blood pressure and pulse
45
Anorexia Nervosa Clinical Consequences:
- Loss of bone density
- Erosion of tooth enamel
- Difficulty conceiving, infertility
- Heart problems
- Damage to other organs, such as the kidneys and liver
- Delayed onset of puberty or stunted growth in children and young teenagers
46
What are the two types of anorexia nervosa?
Restricting (starvation)
Binge eating / purging type
47
What are the long term health consequences of binge-purging?
- Permanent damage to teeth
- Damage to the vocal chords and throat
- Damage to the intestines and stomach
- Increased risk of heart problems
- Kidney damage
48
Explain the Female athlete triad:
Interrelationship: menstrual dysfunction, low energy availability (with or without an eating disorder), and decreased bone mineral density
- eating habits
- menstrual cycle
- bone mass
49
Female athlete triad, Who are at risk?
- competitive athletes
- obsess with being thin
- coach pressure
50
Signs and symptoms of the Female athlete triad:
* Fasting or limiting food intake
* Binge eating
* Self-induced vomiting
* Extreme exercise
* Fatigue
* Weight loss
* Bone loss
* Absent or abnormal periods
* Stress fracture
51
What are the main phases in the treatment of Anorexia Nervosa?
- Restoring weight loss
- Treating the psychological issues such as distortion of body image and interpersonal conflicts
- Achieving long term remission and rehabilitation
- Early diagnosis and treatment increases treatment success rate
52
What is the weight goal in the treatment of AN?
1-2 lbs a week (0.5kg)
1500 kcal per day building up to 3000 kcal per day
53
What are the factors linked to the microbiome?
- diet
- pharmaceuticals
- geography
- lifecycle stages
- birthing process
- infant feeding method
- stress (exercise, metabolic, psychological)
54
Alterations in gut microbiota have been linked with:
FBD
Metabolic diseases
IBD
C Diff infections
Coeliac disease
Autism
Depression
Obesity
Malignancy
Type I DM
Allergies
55
Briefly discuss, named nutritional elements directly influencing gene expression:
- Vitamin A: by regulating the expression of over 500 retinoid responsive genes. Retinoic acid isomers play major roles in cellular pluripotency, proliferation and differentiation. (Retinol for wrinkles)
- Vitamin D: by regulating expression of over 200 vitamin D responsive genes. Vitamin D plays a major roles in immune system anabolic functions, especially related to bone. Osteocalcin promoter can be triggered by both Vitamin D and retinol.
- Vitamin E: Changes in cell proliferation, platelet aggregation and NADPH-oxidase activation
56
Briefly discuss, with named examples, how nutrients (or lack thereof) can alter chromatic presentation, so that gene expression is altered (with respect to; imprinting, programming and/or adaptation)
- Folate (Vitamin B9) A methyl donor. Lack of this vital nutritional element will lead to hypo-methylation in some areas of the DNA, causing aberrant gene expression.
- Biotin (Vitamin B7) water soluble vitamin serves as a coenzyme for five human carboxylases. Vital for biotinylation of Histones, deficiency will results in aberrant formation of the chromatin and altered gene expression.
- Vitamin D affect the epigenome via the modulation of transcription.
- Vitamin C maintains genomic stability through interactions with epigenetic regulators, tumour suppressor up-regulation and telomere maintenance.
57
Briefly discuss, giving named examples, how genetic variations can alter or be associated with the alteration of gene expression?
1. Choline metabolism; Human daily requirements for dietary choline are much higher for approximately 50 percent of the population. These people
are mostly those with one or more genetic variants associated
with choline metabolism and methylation (SNPs - common variations in DNA sequences)
2. Methylmalonic aciduria and homocystinuria,
cblC type (MMACHC) gene (CNVs - alterations of the DNA of a genome that resulst in the cell having an abnormal number of copies of one or more sections of the DNA)
58
What type of interactions may inadvertently cause harm to patients with anorexia nervosa?
- Overprotection
- Criticism or confrontation
- Coercive treatments
- Accommodation
- Enabling
59
In which situations do protein requirements increase?
In hypermetabolic states such as trauma, injuries and burns
60
How can energy requirements be estimated? (clinical condition)
Use standard equations for estimating Basal Metabolic Rate e.g. Harris-Benedict or Henry or Schofield.
Add to the BMR a stress factor for a specific clinical condition
61
What is enteral nutrition?
Tube feeding.- is a method of delivering nutrition directly into the gastrointestinal (GI) tract through a tube, bypassing the mouth and oesophagus
62
Some advantages of enteral nutrition:
-Provides all dietary constituents, including some essential e.g. glutamine, which may not be added to intravenous formulae.
- Provides (usually) dietary fibre, which stimulates short-chain fatty acid production, optimising bowel function.
- Microbiologically safer than intravenous feeding.
- Cheaper and easier for staff, carers, and patients to manage.
63
What is parental nutrition?
Intravenous nutrition.- delivers nutrients directly into the bloodstream, bypassing the digestive system, and is used when someone cannot eat or absorb nutrients through the gut
64
Food first is always the first approach, unless:
Dysphagia
65
Tube feeding uses routes as clinically appropriate:
- Nasogastric
- Nasojejunal
- Gastrostomy
- Jejunostomy
66
Refeeding syndrome can be fatal in very malnourished patients and result in fluid and electrolyte shifts, causing:
Pathophysiology:
- Weakness and paralysis
- Haemolytic anaemia
- Respiratory depression and failure
- Kidney failure and decrease in glomerular filtration rate
- Liver dysfunction
- Ileus constipation and diarrhoea
- Seizures, coma and sudden death
67
What are the 4 sub-types of IBS?
IBS-Constipation
IBS-Diarrhea
IBS-Mixed pattern
IBS-Unspecified
68
What are the IBS symptoms?
-Diarrhoea
-Incomplete defecation
-Constipation
-Frequency and urge
-Wind and bloating
69
