WEEK 3 Flashcards
to address nutrition-related problems
and provide safe and effective quality
nutrition care
used by the registered dietitian (RD)
to identify, diagnose, and treat any
nutrition- related problems or disorders
Nutrition Care Process
obtaining,
verifying, and interpreting data in
order to make decisions about the
nature and cause of nutrition-related
problems
Nutrition Assessment
height and weight
Body mass index (BMI)
Weight history
waist circumference measurement
Other (skinfold thickness, hydrostatic
weighing, air-displacement plethysmography,
dual-energy x-ray absorptiometry, and
bioelectrical impedance analysis)
Anthropometric measurements
divided into macronutrients and
micronutrients
biomarkers
Biochemical assessment/markers
!history of present illness
!the past medical history
!an inquiry into the family history
!physical examination
!careful review of systems looking for
signs of disease/illness
Clinical Component
to determine the adequacy
Dietary Component
loss from transfer of albumin between the
extravascular and the vascular compartment
(kwashiorkor)
Albumin
Predictor of mortality in patients in long-term-care
facilities
Levels are good indicators of chronic deficiency
catabolic stress of
infection
Albumin
> 35 g/L
albumin ref range
35
30
25
early indicator of iron deficiency
Also low in cases of nephrotic
syndrome, liver disorders, anemia, and
neoplastic disease
Transferrin
contains one binding
site for retinol-binding protein (RBP)
Transthyretin
monitoring short-term
effects of nutritional therapy
Transthyretin
indicator of the adequacy of a nutritional
feeding
Transthyretin
liver disease does not affect transthyretin as
early or to the same extent as it affects other
serum protein markers
Transthyretin
short-term changes in
nutritional status
Retinol-Binding Protein
interacts strongly with plasma
transthyretin
increases in patients
with renal failure
Retinol-Binding Protein
The molecular size and structure of
IGF-1 is similar to proinsulin
circulates bound to IGF-BP3
Insulin-Like Growth Factor 1
serves important roles in
– cell-to-cell adherence
– tissue differentiation
– wound healing
– microvascular integrity
– Opsonization
Fibronectin
major protein regulating phagocytosis
Fibronectin
Indicator of sepsis in burn patients
Fibronectin
difference between nitrogen intake and nitrogen
excretion
most widely used indicators of protein change
Nitrogen Balance
increases
dramatically under conditions of sepsis,
inflammation, and infection
C-Reactive Protein
rises in concentration 4 to 6 hours
before other acute-phase reactants
begin to rise
C-Reactive Protein
predictor of cardiac disease and other
cholesterol
C-Reactive Protein
!the interleukins
!Produced by macrophages and Tlymphocytes, in response to antigenic or
mitogenic stimulation, and affect
primary T-lymphocyte function.
Cytokines
appropriate amounts, is needed for a
balanced diet
Fats
!Nutrition assessment for type 1 and
type 2 diabetes mellitus
–blood glucose
–glycosylated hemoglobin/proteins
– fructosamine
Carbohydrates
supporting patients who are
malnourished
administering appropriate
amounts of carbohydrate, amino acid,
and lipid solutions, as well as
electrolytes, vitamins, minerals, and
trace elements, to meet the caloric,
protein, and nutrient requirements while
maintaining water and electrolyte
balance
Parenteral Nutrition
a common problem in
children after heel stick was done
Hyperkalemia
metabolic acidosis is a
problem when crystal amino acid
solutions are used
Hyperchloremia
Supplying some of the sodium and
potassium requirements as – can reduce the
required amount of chloride
acetate or
phosphate salts
cofactors in many
enzymatic reactions
Vitamins
refers to abnormal
increases of metabolism requiring high
supplies of one of the cofactors
(vitamins)
Vitamin Insufficiency or Vitamin
Dependency
(vitamin C, sailors and lime
consumption, limeys)
scurvy
(vitamin D in the early industrial
age)
rickets
alcoholics and thiamine
beriberi
niacin
pellagra
night blindness
vitamin A
folic acid or
vitamin B12
megaloblastic anemia
spina bifida
folic acid
– pernicious anemia with neuropathy
vitamin B12
– pernicious anemia with neuropathy
vitamin B12
! Vitamin A1
! Vitamin D
! Vitamin E
! Vitamin K
FAT-SOLUBLE
VITAMINS
Vitamin B
Folic Acid
Vitamin C
WATER-SOLUBLE
VITAMINS
dietary carotenoids
stored in the liver and transported in
the circulation complexed to RBP and
transthyretin.
vision, cellular
differentiation, growth, reproduction,
and immune system function
Vitamin A
Deficiency: (nyctalopia)
Most Common Method: HPLC
Vitamin A
900 μg per
day (MALES)
700 μg (FEMALES)
Vitamin A
powerful antioxidant and the
primary defense
protecting
unsaturated lipids from peroxidation
Dietary sources: vegetable oil, fresh
leafy vegetables, egg yolk, legumes,
peanuts, and margarine
Vitamin E
Vitamin E
is the predominant
isomer in plasma
Alpha-tocopherol
major symptom if deficient:
hemolytic anemia
fat malabsorption (cystic fibrosis)
abetalipoproteinemia
Vitamin E
Synergistic with two other essential
nutrients, selenium and ascorbic acid
Vitamin E
RDA is 15 mg/d
HPLC methods
Vitamin E
for proper skeleton formation and
mineral homeostasis
Exposure of the skin to sunlight (ultraviolet
light) catalyzes the formation of
cholecalciferol from 7-dehydrocholesterol.
Vitamin D
Occurs in foods as cholecalciferol or
ergocalciferol
Vitamin D
The most active metabolite of vitamin – is
1,25(OH)2D3
Vitamin D
The RDA for adults is 15 to 20 μg/d
Vitamin D
intestinal absorption of
calcium and phosphate
increases mobilization of calcium
and phosphate
Vitamin D
Undermineralization of bone matrix in
remodeling (Osteomalacia-Adults)
failure to calcify cartilage at the growth
plate in metaphysical bone formation
(Rickets in Children)
Vitamin D
produces hypercalcemia and
hypercalciuria, which can lead to calcium
deposits in soft tissue and irreversible
renal and cardiac damage
Vitamin D
major circulating form of vitamin D
good indicator of vitamin D nutritional
status and vitamin D intoxication
25(OH)D3
vitamin D
Reference Range
– 22 to 42 ng/mL for –
(RIA) or HPLC
25(OH) D3
vitamin D
Reference Range
30 to 53 pg/mL for –
(RIA) or HPLC
1,25(OH)2D3
converting precursor forms
of coagulation proteins to functional
forms
Vitamin K
Synthesized by intestinal bacteria; this
synthesis provides 50% of the vitamin –
requirement.
Vitamin K
Deficiency may be caused by antibiotic
therapy or when using anticoagulants
(warfarin sodium)
Effects of deficiency
hemorrhagic episode
Vitamin K
Prothrombin time is prolonged in
vitamin – deficiency
vitamin K
The normal prothrombin time is
11 to 15s
The adult average intake
– 120 μg/d (males) and 90 μg/d (females)
Vitamin K
coenzyme in
decarboxylation reactions in major
carbohydrate
Thiamine
associated with beriberi
(chronic alcoholism)
Thiamine
best
measured by erythrocyte transketolase
activity, before and after the addition of
thiamine pyrophosphate (TPP).
Thiamine
The RDA is 1.2 mg/d (males) and 1.1
mg/d (females)
Thiamine
component of
two coenzymes, flavin mononucleotide
and flavin adenine dinucleotide
(oxidation–reduction reactions)
Riboflavin
antagonize the action
phenothiazine, oral contraceptives,
and tricyclic antidepressants
Riboflavin
antagonize the action
phenothiazine, oral contraceptives,
and tricyclic antidepressants
Riboflavin
The RDA is 1.3 mg/d for adult males
and 1.1 mg/d for adult females
Riboflavin
Reduced glutathione reductase
activity greater than 40% is an
indication of deficiency
Riboflavin
High intake of proteins increases the
requirements for vitamin
Pyridoxine
pyridoxine
plants
The RDA
– 1.3 to 1.7 mg/d for adult males
– 1.3 to 1.5 mg/d for adult females
Pyridoxine
coenzymes nicotinamide adenine
dinucleotide and nicotinamide
adenine dinucleotide phosphate
Niacin
deficiency may result from
alcoholism
Pellagra, the clinical syndrome resulting
from
Niacin
The RDA is
– 16 mg/d for adult males
– 14 mg/d for adult female
Niacin
– and vitamin B12 are closely
related metabolically
Boiling food and using large
quantities of water result in –
destruction
Symptom: Megaloblastic anemia
Folate
concentration is
accepted as the best laboratory index
of folate deficiency
Erythrocyte folate
Homocysteine elevation in serum and
urine occurs in
folate deficiency
requirement is increased
during pregnancy and especially during
lactation
supplementation of –in
pregnant women reduces the incidence
of fetal neural tube defects
Folate
Certain anticonvulsants and other
drugs that interfere with –
metabolism include sulfasalazine,
isoniazid, and cycloserine
folate
accelerates folate excretion and
interferes with folate absorption and
metabolism.
Phenytoin (Dilantin)
interferes with folate’s
enterohepatic circulation
Alcohol
inhibits the enzyme
dihydrofolate reductase
Methotrexate
RDA is
– 400 μg/d for adult males and females
folate
microbiologic assay with Lactobacillus
casei
folate
necessary for
hematopoiesis and fatty acid
metabolism
Vitamin B12
bears a corrin ring
Vitamin B12
Therefore, total vegetarian
diets are likely to be deficient or low
in vitamin –
vitamin B12
Schilling test, the patient
receives a small, oral dose of
radiolabeled vitamin –
Patients who cannot absorb usually a deficiency of intrinsic
factor, as in pernicious anemia)
vitamin B12
Loss of vitamin – also occurs in
– fish tapeworm infection
– malabsorption diseases (sprue or celiac
disease)
B12
The RDA for adults is 2.4 μg/d
– RIA or an enzyme immunoassay.
B12
The reference range
– 110 to 800 pg/mL (81.2 to 590.4 pmol/L)
B12
The most common methods for
determination of vitamin –
competitive protein-binding RIAs
B12
role in
gluconeogenesis, lipogenesis, and
fatty acid synthesis
Biotin
deficiency can be produced by
ingestion of large amounts of avidin,
found in raw egg whites that bind to –
Biotin
Reference ranges of 200 to 500 pg/mL
(0.82 to 2.05 nmol/L)
Lactobacillus organism
Biotin
was first
designated as vitamin B3
metabolically converted to 4′-
phosphopantetheine, which becomes
covalently bound to either serum acyl
carrier protein or coenzyme A.
Pantothenic Acid
Pantothenic Acid
highly important acylgroup transfer coenzyme involved in
many reaction types
Coenzyme A i
Assays using a load test look for
excretion of the acetylated paminobenzoic acid that is formed
Pantothenic Acid
strong reducing compound
formation
and stabilization of collagen by
hydroxylation of proline and lysine
Ascorbic Acid
most widely used assay for
– is the 2,4-
dinitrophenylhydrazine method
HPLC- increased sensitivity and specificity.
ascorbic acid
The reference range for – is
0.4 to 0.6 mg/dL (23 to 34 µmol/L)
ascorbic acid
major signs of carnitine deficiency are
muscle weakness and fatigue
hereditary
or acquired—
Carnitine
