126/127B Nutrition

Question 1

What are DRI’s/RDA’s?

Answer 1

Dietary reference intakes, recommended daily allowances. A set of standards for vitamin intake for normal, healthy patients that don’t have frank deficiencies to help prevent disease.

Question 2

What is the 6 food elimination diet used to treat? What does it remove from the diet?

Answer 2

EOE. Removes the top 6 allergens. Wheat, dairy, soy, nuts, eggs, fish/shellfish (creates some nutritional deficiencies)

Question 3

What does wheat provide in the diet?

Answer 3

Vitamin B, calories (makes up 60-70% of total)

Question 4

What is milk the major source of in the diet?

Answer 4

Calcium and vitamin D

Question 5

Do you get water-soluble or fat-soluble vitamin deficiencies faster?

Answer 5

Water soluble

Question 6

Lecture question: if someone goes on the 6 food elimination diet, what do you need to replace to avoid deficiencies?

Answer 6

Calories, calcium, vitamin D, folic acid, magnesium

Question 7

What is celiac disease?

Answer 7

An autoimmune enteropathy (Ab against gluten), related to DQ2/DQ8 HLA haplotype

Question 8

What is damaged in celiac disease?

Answer 8

Villi atrophy in small intestine from autoantibodies. Leads to nutrient deficiencies from disruption of the enzymes at the brush border.

Question 9

How do you treat celiac disease?

Answer 9

Lifelong gluten-free diet

Question 10

Inability to maintain normal levels of what nutrient suggests an absorption disorder?

Answer 10

Iron

Question 11

What micronutrients are you concerned about with celiac disease?

Answer 11

B vitamins (folate/B-12, thiamin, riboflavin), fat soluble vitamins (KADE), iron

Question 12

Nutritional complication of celiac disease?

Answer 12

Ostopenia/osteoporosis (vitamin D deficiency)

Question 13

Lecture question: which blood tests do you want to get if you are suspicious of celiac disease?

Answer 13

Iron, vitamin D, B12, and folic acid

Question 14

Why do people with IBD cholitis get deficiencies?

Answer 14

1) Flare-ups damage the small intestine directly and 2) they restrict their diet because of GI symptoms

Question 15

What foods should be limited during a IBD flare?

Answer 15

Lactose, fat, carbohydrates, fiber

Question 16

Lecture question: due to fecal fat loss for a patient with an IBD flare, what nutrients are you most concerned about?

Answer 16

B12 + fat soluble vitamins (KADE)

Question 17

What are the two types of IBD?

Answer 17

Crohn’s and ulcerative cholitis

Question 18

Why do people with EOE get nutrient deficiencies?

Answer 18

Because of the treatment (6-food elimination diet), not because of malabsorption

Question 19

What are the three ways Vit. D increases serum Ca?

Answer 19

1) raises PTH levels (which releases Ca from bone), 2) absorb more in gut, 3) resorb more in nephrons

Question 20

What do you have to supplement kids that are breastfed with?

Answer 20

Vitamin D - poorly disseminated in breast milk

Question 21

What is Trousseau’s sign and what does it indicate?

Answer 21

Tetany of the arm on BP cuff inflation, severe vitamin D deficiency

Question 22

What are some good food sources of Vit. D?

Answer 22

Fish, fortified milk/orange juice, supplements

Question 23

What are two functional roles of Vit. A?

Answer 23

Night vision (rhodopsin precursor), immunity (deficiency predisposes to pneumonia)

Question 24

What are Bitot spots and what do they indicate?

Answer 24

Clumps of keratinized cells in the eyes, vitamin K deficiency

Question 25

What are the two forms of Vit. A?

Answer 25

Retinal (animal products) and carotenoid (plant products)

Question 26

What are the three forms of thiamine deficiency?

Answer 26

Wet (cardiac) beriberi, dry (neuropathy) beriberi, Wernicke-Korsakoff (cerebral beriberi)

Question 27

What do you get in wet beriberi?

Answer 27

High output HF, cardiomegaly, pitting edema, neuropathy

Question 28

What do you get in dry beriberi?

Answer 28

Peripheral neuropathy, foot/wrist drop, lost of reflexes/sensation, weakness

Question 29

What do you get in Wernicke-Korsakoff?

Answer 29

Ataxia, confusion, impaired memory, confabulation

Question 30

What clinical signs do you see with riboflavin (B2) deficiency?

Answer 30

Oral symptoms. Magenta tongue, cheilosis (cracks), angular stomatitis (sores)

Question 31

What clinical signs do you see with pellagra/niacin (B3) deficiency?

Answer 31

“3 D’s” triad: dermatitis (Casal’s necklace), diarrhea, dementia. People die a lot.

Question 32

Lecture question: given a shortage of IV multivitamins, what would be the cause of death in patients presenting with acidosis?

Answer 32

B-vitamin deficiency, particularly thiamine/B12. Get a buildup of pyruvate, don’t make enough energy.

Question 33

What can folic acid deficiency cause?

Answer 33

Neural tube defects in babies, megaloblastic anemia in adults

Question 34

What drugs do you need to supplement patients with folic acid for?

Answer 34

Methotrexate, valproic acid, chronic PPI therapy

Question 35

What type of diet gets no B12?

Answer 35

Vegan

Question 36

What is a clinical manifestation of iodine deficiency?

Answer 36

Goiter

Question 37

What deficiencies do GI surgery patients get?

Answer 37

Zinc, iodine, iron

Question 38

Lecture question: woman that had gastric bypass surgery has a desire to eat non-food items (pica), especially ice. What deficiency is responsible?

Answer 38

Iron deficiency anemia

Also seen in pregnancy