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Pharmacy Y3- Inflammatory diseases > Week 6- Nutrition, Nutraceuticals and Nutrition Disorders > Flashcards

Week 6- Nutrition, Nutraceuticals and Nutrition Disorders Flashcards

1
Q

What is a healthy diet?

A

-Provides sufficient energy and nutrients to maintain
normal physiological functions, and permit growth and
replacement of body tissues
-Prevents deficiency symptoms
-Optimises body stores
-Optimises some biochemical/physiological function
-Minimises a risk factor for some chronic disease
-Minimises the incidence of a disease

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2
Q

what is the infant nutritional requirements?

A

Nutritional requirements are high – rapid growth and

development

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3
Q

what are the different types of infant formula?

A
  • newborn= birth to 1yr
  • follow-on= 6 months-1yr higher iron
  • toddler milk 1-3yrs
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4
Q

what is infant formula?

A

cows milk modified to mimic breast milk

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5
Q

what are some of the prescribable formula?

A

-soya based= cows milk protein allergy, concerns of use before 6 months
-hydrolysed formula= modified cows milk hypoallergenic
-Others, including lactose free , anti-reflux,
higher energy, colic, prem infants

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6
Q

what is weaning?

A

introducing an infant to adult diet

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7
Q

what are the reasons for weaning?

A

• ↑ requirements for energy, vitamins/minerals
• Growth and development – nutrient requirements no longer met by milk alone
• Variety of foods
Six months recommended by DOH for introduction of solid food

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8
Q

what are some of the foods to avoid during weaning?

A

• Wheat/Gluten, Fish/Shellfish, Fruit Juices, Soya, Eggs
(before 6 months)
• Salt, Sugar, Honey (before 1 yr)
• Care with textures to avoid choking

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9
Q

what is important for development in school children?

A

-physical education
-Good supply of protein, calcium, iron, vits
A and D particularly important
-Varied diet with adequate energy and
nutrients for various growth periods which
are sometimes rapid during these years

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10
Q

during adolescents what happens and what are the nutritional requirements for them?

A

-Growth and development period, growth spurt during
adolescence
• Peak bone mass occurs during adolescence so calcium and vit D requirements increase. Physical activity aids bone strength
-energy and nutritional requirement are higher in boys than girls
-Iron requirements increase in girls after onset of
menstruation and continue to be higher through until
menopause

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11
Q

what are the nutritional requirements for an adult?

A
  • requirements tend to stay the same between 19-50yrs unless pregnant/lactating
  • males 2772kcal females 2175kcals
  • protein 0.75g per kg of bw
  • carbs 50% of total energy 30g fibre
  • fat 35% total energy
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12
Q

what are the max units for alcohol a week?

A
  • 14 units/week on regular basis
  • spread evenly over 3 or more days
  • Heavy drinking once or twice a week increases risk of death from longterm illness and accidents and injuries
  • Risk of developing cancers increases the more you drink on a regular basis
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13
Q

what does the energy requirements increase by for a pregnant women?

A
  • 200 kcal/day

- Avoid shark, swordfish and marlin and limit tuna

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14
Q

what are some of the micronutrients needed for a pregnant women?

A

– 400mg folic acid/day during first trimester
– Iron-rich foods and possibly supplements needed,
particularly last trimester
– Avoid vitamin A supplements and liver and liver products
-no alcohol, limit caffeine and stay active

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15
Q

what is a common problem for older adults?

A

malnutrition
– Inadequate intake of dietary energy = loss of
body weight, depletion of body fat stores and
muscle wasting
– Nutrient deficiencies
– Widespread metabolic physiological and
functional adaptations occur

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16
Q

what are some nutrients that are needed for bone micronutrients?

A
  • Vitamin D
  • Vitamin K
  • Calcium
  • Magnesium
  • Phosphorous
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17
Q

what is vitamin D?

A 
• Family of sterol derivatives
• Calciferol (D2
); cholecalciferol (D3
); dihydrotachysterol,
alfacalcifidol and calcitriol
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18
Q

where is vitamin D from?

A

fish liver oils, egg yolk (D3
animal, D2
plant) and
synthesised in the skin under UV light D3

19
Q

What is the function of vitamin D?

A

-maintaining levels of vitamin D with parathyroid hormone
-immunopoiesis which is the synthesis of new blood cells
– Cell proliferation and differentiation
– Immunomodulatory
–10 μg/day

20
Q

how is vitamin D made in the skin?

A
  • we take cholestrol in the intestine or we make it in the liver
  • its then taken up by the skin and converted to 7-dehydrocholesterol in the presence of sunlight its converted to vitamin D3
  • its then travels in the plasma to the liver where its hydroxylated to 25-hyrdoxylation
  • then transported to kidney and again hydroxylated again to 1-hydroxlation
21
Q

what does vitamin D3 do by working with parathyroid hormone?

A

to increase Ca+ levels

22
Q

what mechanisms vitamin D3 tdo by working with parathyroid hormone?

A

promotes intestinal absorption
increase Ca2+ mobilisation
decreases Ca2+ excretion
-has a negative feedback

23
Q

what does vitamin D deficiency cause?

A

rickets

24
Q

what is the aetiology of lactose intolerance?

A

-inablility to digest lactose , due to low levels of lactase
• Congenital lactase deficiency – extremely rare autosomal
recessive disorder with absence of lactase
• Childhood-onset and adult-onset lactase deficiency – common ,
inherited in autosomal recessive manner
• Late-onset primary hypolactasia – associated with C/C of the genetic variant C–>T(-13910) upstream of the
lactase phlorizin hydrolase gene (LCT) (reduced synthesis of precursor
protein) in Caucasians – Differences in rate of gene transcription account for inter-racial variation
• Persistent lactase activity into adulthood – autosomal dominant
• Acquired lactase deficiency – transient – damage of mucosa by infection or inflammation, resolves – often in children <2yrs

25
Q

how is lactose intolerance diagnosed?

A

• Symptoms – check with GP
• Hydrogen breath test – Lactose metabolised by gut bacteria , producing
hydrogen that’s absorbed into blood and excreted
in lungs
• Dietary elimination – Does diarrhoea resolve when milk and products
removed? – Do symptoms recur upon reintroduction?

26
Q

what is coeliac disease?

A

-gluten intolerance
-autoimmune disease
-caused by – Genetic predispositionand Consumption of gluten proteins
-– >95% patients express HLA-DQ2 or DQ8 – Receptors they encode bind gliadin peptides more tightly,
activating T lymphocytes and initiating autoimmune
response – 75% concordance among monozygotic twins – Up to approx 20% of first degree relatives affected – Increased risk in Type 1 Diabetes, Down Syndrome,
Turner’s syndrome, autoimmune thyroid disease and
dermatitis herpetiformis

27
Q

what is the coeliac pathophysiology?

A

• Consumption of gluten: – Gluten proteins sometimes incompletely digested – Peptides are extremely immunogenic to affected
patients – Prolamines - alcohol-soluble fractions of gluten absorbed in small intestine and presented to APC in lamina propria, resulting in immune response in
mucosa
• Gliadins in wheat
• Hordeins in barley
• Secalins in rye
• Possibly avidins in oats

28
Q

what are some signs and symptoms for coeliac?

A

• Common – Diarrhoea – Fatigue – Borborygmus – Abdominal pain – Weight loss – Failure to thrive – Abdominal distension – Flatulence

29
Q

how is coeliac diagnosed?

A

• Symptoms – persistent diarrhoea, malabsorption, weight loss, gas, abdominal pain,
bloating or extra-gastrointestinal manifestations – Restricted to mucosa of small bowel so can differentially diagnose
from inflammatory bowel diseases
• Serological tests from blood sample – tissue transglutaminase (tTG) antibodies – endomysial antibodies – Total IgA antibodies if either of these negative but suspected disease
• Home kits eg Biocard – approx £20 in pharmacy and online
– but important to get medical diagnosis
• Endoscopy – Macroscopic changes possibly visible eg scalloping – Biopsy required to confirm diagnosis

30
Q

what is the treatment for coeliac ?

A
  • Removal of gluten from diet – No wheat, rye, barley – Check whether tolerant to oats and use pure source of oats
  • Avoid manufactured products from flours – Flans, custards, ice creams – Malted foods – Beer, ale – Sauces, gravy and thickening agents – Sausages, pate, luncheon meats, – Cheese spreads – Soups, Chocolate and milk-flavoured drinks – Chocolate bars – Any canned food unless specifies gluten-free
31
Q

what are the alternative routes for feeding for malnutrition?

A

• Avoid manufactured products from flours – Flans, custards, icecreams – Malted foods – Beer, ale – Sauces, gravy and thickening agents – Sausages, pate, luncheon meats, – Cheese spreads – Soups, Chocolate and milk-flavoured drinks – Chocolate bars – Any canned food unless specifies gluten-free

32
Q

what are the advantages and disadvantages of nasal feeding route?

A

Advantages
Nasal Not invasive
Quick
Cheap Dysphagia

Disadvantages
Irritation
Risk of sinusitis, oesophagitis
Dysphagia
Risk of misplacement
Risk of reflux
Easy tube movement or removal
Regular tube replacement
X-ray confirmation
Stigmatising
33
Q

what are the +advantages and disadvantages of abdominal feeding route?

A 
Type Advantages Disadvantages
Abdominal
\+ Less stigmatising Invasive
\+Less tube migration Sedation and antibiotics
\+Less tube removal 
Irritation at site
\+Less reflux
 Leakage into abdomen
\+No nasal irritation Translocation of bowel
\+No dysphagia 
X-ray confirmation
\+No tube replacement 
Tube clogging
Hematomas causing
bowel occlusion
34
Q

what are some problems for feding?

A

• Diarrhoea – temp of feed / rate / check
date / fibre
• Constipation – fluid balance / fibre
• Vomiting – rate of feed / position of pt /
infection?
• Blocked tube – feed / meds / not flushed

35
Q

what are causes of malnutrion under?

A 
• Reduced food intake
• Decreased absorption
• Decreased activity of co-factors eg intrinsic
factor and vitamin B12
• Increased metabolism
• Underlying disease
36
Q

what are the consequences of malnutrion under?

A

• Physical – Impaired immune function – Delayed wound healing – Decreased muscle strength and fatigue – Hypothermia – Reduced respiratory muscle function and cough
pressure, predisposing to chest infections – Immobility predisposing to venous thrombosis
and embolism and pressure sores – Reduced final height in women leading to reduced
pelvic size and small birth weight infants

• Psychological and behavioural – Depression – Anxiety – Reduced will to recover – Self-neglect – Poor bonding with mother and child – Loss of libido

37
Q

what are some reasons for taking nutraceutics?

A 
• Healthy lifestyle and increased awareness
• Prevent or decrease disease
• Explosion in range and availability
• Media coverage
• Increasing scientific evidence linking diet and
health or disease prevention
• Rising healthcare costs
• Ageing population
• Growing fixation with beauty
38
Q

what are the main supplements in the UK?

A 
• Vitamins and minerals - multi-complex and single
• Selected vitamins and minerals with extra nutraceuticals
aimed at targeting disease/health benefit
• Pick-me-ups
• Anti-oxidants
• Amino acids
• Fatty acids and oils
• Bioflavonoids and phytoestrogens
• Probiotics
• Weight loss
• Glucosamine, chondroitin sulphate
• Stimulants
39
Q

what are some foods that have benefits?

A

• Fruit, vegetables, nuts - contain antioxidants, folic acid, other
vitamins and minerals, and fibre
• Juices, tea, wine, beer, chocolate, herbs and spices – contain
vitamins, phenolic antioxidants and other active compounds
• Wholegrains – contain fibre and micronutrients
• Oily fish and low-fat products – contain PUFA, MUFA, plant sterols
and stanols
• Pre and probiotics
• Soy – contain phytoestrogens, fibre and protein
• Energy-boosting, stimulants, ‘ feel good’ drinks
• Foods with herbal extracts – novel

40
Q

what are some factors influencing affect of nutraceuticals?

A
  • genetic= will you react to it
  • adverse affects
  • drug ineraction with body and ohters
  • processing
  • active where in the body
  • physiological state
41
Q

what is Vitamin K?

A

Sources – green leafy vegetables, oils and liver K1
(+ synthesised by intestinal flora K2
)
Functions –
formation of prothrombin (II) and factors VII, IX and X
Warfarin is a competitive inhibitor
Interactions eg antibiotics
Evidence that increases bone mass
No RNI – Safe intake =1 μg/kg/d
Deficiencies – rare
newborn - ALL BABIES are given injection with consent 8

42
Q

WHAT IS CALCIUM?

A 
Most abundant mineral in body, 99% in skeleton
• Active forms are calcium phosphate and ionic form, Ca2+
• Calcium balance regulated by Vit D, parathyroid hormone and
calcitonin
Functions
• Structural - bone and teeth
• Muscle contraction
• Nerve impulse transmission
• Blood clotting
• Cell signalling and ion transport
(second messenger)
RNI = 700 mg/day adults
Low intakes in teenage girls (11-18y)
43
Q

what is magnesium?

A 
Sources
various
Functions
Enzymes eg decarboxylation, phosphorylation
Skeletal development
Protein synthesis
Muscle contraction and Neurotransmission
Closely linked with calcium metabolically
RNI – 300 mg/d men, 270 mg/d women
Low intakes in adolescents (NDNS)
44
Q

what is phophorus?

A 
Sources
various -especially protein-rich foods
Functions
Energy formation (ATP)
Bone mineralisation
Component of cell membranes
Cell signalling
Component of nucleic acids
Acid-base homeostasis
Deficiency – rare (loss of appetitie, muscle weakness,
bone fragility, numbness in extremities, rickets)
RNI – 550 mg/d men

Pharmacy Y3- Inflammatory diseases (32 decks)

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