WEEK 3 Flashcards by JHOANNA LYNN LUMBOY

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

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obtaining,
verifying, and interpreting data in
order to make decisions about the
nature and cause of nutrition-related
problems

Nutrition Assessment

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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

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divided into macronutrients and
micronutrients

biomarkers

Biochemical assessment/markers

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!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

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to determine the adequacy

Dietary Component

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loss from transfer of albumin between the
extravascular and the vascular compartment
(kwashiorkor)

Albumin

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Predictor of mortality in patients in long-term-care
facilities

Levels are good indicators of chronic deficiency

catabolic stress of
infection

Albumin

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> 35 g/L

albumin ref range

35
30
25

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early indicator of iron deficiency

Also low in cases of nephrotic
syndrome, liver disorders, anemia, and
neoplastic disease

Transferrin

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contains one binding
site for retinol-binding protein (RBP)

Transthyretin

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monitoring short-term
effects of nutritional therapy

Transthyretin

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indicator of the adequacy of a nutritional
feeding

Transthyretin

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liver disease does not affect transthyretin as
early or to the same extent as it affects other
serum protein markers

Transthyretin

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short-term changes in
nutritional status

Retinol-Binding Protein

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interacts strongly with plasma
transthyretin

increases in patients
with renal failure

Retinol-Binding Protein

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The molecular size and structure of
IGF-1 is similar to proinsulin

circulates bound to IGF-BP3

Insulin-Like Growth Factor 1

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serves important roles in
– cell-to-cell adherence
– tissue differentiation
– wound healing
– microvascular integrity
– Opsonization

Fibronectin

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major protein regulating phagocytosis

Fibronectin

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Indicator of sepsis in burn patients

Fibronectin

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difference between nitrogen intake and nitrogen
excretion

most widely used indicators of protein change

Nitrogen Balance

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increases
dramatically under conditions of sepsis,
inflammation, and infection

C-Reactive Protein

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rises in concentration 4 to 6 hours
before other acute-phase reactants
begin to rise

C-Reactive Protein

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predictor of cardiac disease and other
cholesterol

C-Reactive Protein

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!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