Vitamin Deficiencies

Question 1

Water Soluble Vitamins vs Fat Soluble Vitamins

Answer 1

Water Soluble Vitamins
- Do not reach toxic levels
- Are excreted by kidneys so are needed more frequently

Fat Soluble Vitamins
- Accumulate and are stored in adipose tissue
- Can reach toxic levels

Question 2

Dietary Factors - Inadequate Intake

Answer 2

Poor dietary habits
Food Insecurity
Restricted Diets - Vegans
Elderly

Question 3

Dietary Factors - Unbalanced Diets

Answer 3

High Intake of refined carbohydrates and processed foods
- Deficient: B vitamins, Iron, Zinc

Low Consumption of fruits and veggies
- Deficient: Vitamin C, Folate, Potassium

Question 4

Malabsorption - Celiac Disease

Answer 4

Iron
Calcium
Vitamin B
VItamin D

Question 5

Malabsorption - IBD

Answer 5

Fat Soluble Vitamins (A, D, E, K)
+
Iron, Zinc

Question 6

Malabsorption - Chronic Diarrhea

Answer 6

Loss of water soluble vitamins and electrolytes

Question 7

Malabsorption - Post-Bariatric surgery

Answer 7

Reduces absorption of:
- Iron
- Calcium
- Vitamin B12
- Fat Soluble Vitamins

Question 8

Malabsorption - Chronic Pancreatitis

Answer 8

Reduced digestive enzyme production
- Less Fat Absorption (A, D, E, K)

Question 9

Increased Nutrient Requirements - Pregnancy and Lactation

Answer 9

Needs more:
- Calcium
- Vitamin D
- Iron
- Folic Acid

Question 10

Increased Nutrient Requirements - Infancy and Adolescent

Answer 10

Needs more:
- Calcium
- Vitamin D
- Iron
- Zinc

Question 11

Increased Nutrient Requirements - Elderly

Answer 11

Reduced efficiency in nutrient absorption, needs higher intake of
- Calcium
- Vitamin D
- Vitamin B12

Question 12

Medications that affect absorption of vitamins

Answer 12

PPI
Metformin
Diuretics
Anticonvulsants
Corticosteroids

Question 13

Medication Use - PPIs

Answer 13

Reduces stomach acid, lowering absorption of
- Vitamin B12
- Calcium
- Magnesium

Question 14

Medication Use - Metformin

Answer 14

Long term use can cause Vitamin B12 deficiency

Question 15

Medication Use - Diuretics

Answer 15

Potassium, Magnesium, Calcium depletion

Question 16

Medication Use - Anticonvulsants

Answer 16

Reduces Vitamin D levels, increasing chances of osteoporosis

Question 17

Medication Use - Corticosteroids

Answer 17

Depletes calcium and potassium
- Can cause sodium retention

Question 18

Chronic Medical Conditions - Liver Disease

Answer 18

Impairs vitamin storage and metabolism:
- Vitamin A, D, E, K

Question 19

Chronic Medical Conditions - Kidney Disease

Answer 19

Loss of water soluble vitamins due to dialysis
- Disturbances in calcium, phosphorus homeostasis

Question 20

Chronic Medical Conditions - Heart Failure

Answer 20

Increased nutrient need due to medication use and fluid balance issues

Question 21

Alcohol Use

Answer 21

Reduces absorption and utilization of B vitamins
- Especially thiamine
- Also folate, magnesium, zinc

Can damage liver which impairs fat soluble vitamin storage

Question 22

Substance Use Disorder

Answer 22

Poor dietary intake and nutrient depletion

Potential for micronutrient deficiencies

Question 23

Smoking

Answer 23

Increases oxidative stress
- Higher Vitamin C requirements
- Deficiency in folate and Vitamin E

Question 24

Limited Sunlight

Answer 24

Needs more vitamin D

Question 25

Hemochromatosis

Answer 25

Build up of iron leading to damage to organs - Restrict proteins

Question 26

Phenylketonuria

Answer 26

Body can not break down pheynlalanine, can build up to toxic levels - Restrict proteins

Question 27

24 Hour Dietary Recall

Answer 27

Snapshot of what patient eats in a day

Question 28

Food Frequency Questionnaire

Answer 28

Checklist to see frequency of consumption of key groups (week/month) - How often do you eat leafy veggies

Question 29

Typical Day Diet Assessment

Answer 29

Meal patterns, portion sizes, common food sizes - Simialr to 24 hour dietary recall with just a bit of structure and more detaield info

Question 30

Food Group Inquiry

Answer 30

Specifc questions on patient's intake of specific groups that can impact their health

Question 31

Subjective Global Assessment

Answer 31

Focuses on risk factors of malnutrition - Weight changes - Dietary changes - GI symptoms - Functional capacity - Disease states

Question 32

Symptoms Suggestive of Deficiency

Answer 32

Fatigue Hair Loss Brittle Nails Poor wound healing Twitching Impaired cognition

Question 33

Recommendations for Vitamin Deficiency

Answer 33

Nutrional Counseling (Dietary sources) Supplement Recommendation (If indicated) Referral to other health care providers (dietician)