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MET2 > 2 - Micronutrients2 > Flashcards

2 - Micronutrients2 Flashcards

1
Q

Definition of micronutrients

A

Essential compounds required in small amounts in diet

vitamins + trace elements

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2
Q

Dietary sources of vitamins

- A,D,E,K,C,B1,B2,B3,B6,Biotin, B12, Folate

A 
A - liver, fish
D - oily fish, dairy 
E - oils, nuts, soybean
K - dark green, prunes
C - Fruits, green veg
B1 - Yeast, whole grains
B2 - Dairy products, bread and cereal
B3 - Beans, milk 
B6 - Tuna, poultry 
Biotin - Liver, soy beans
B12 - Meat and dairy 
Folate - Fruits and veg
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3
Q

Uses of micronutrients

A 
Cofactor
Coenzymes
Genetic control
Anti oxidant
Structure
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4
Q

Functions of micronutrients

A

Maintains homeostasis

Energy supply, growth and development in children

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5
Q

How can preventing iron deficiency benefit children

A

Improves cognitive ability

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6
Q

Benefit of folic acid

A

Prevents spina bifida and macrocytic anaemia

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7
Q

What are the intake requirements for micronutrients

A

Intake to meet req for 98% of population

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8
Q

Fat soluble vitamins

A

ADEK

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9
Q

Features of fat soluble vitamins

A

Can be stored

Occasionally toxic

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10
Q

How are fat soluble vitamins transported

A

Converted into micelle
Becomes chylomicrons in the intestine
Goes into the lymph fluid

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11
Q

Water soluble vitamins

A

B, Biotin, Folic and C

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12
Q

Features of water soluble vitamins

A

Not stored
Excess excreted
Acts as co enzymes
Goes into the portal vein

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13
Q

What causes deficiency of fat soluble vitamins

A

Fat malabsorption
Alcoholism
Liver disease

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14
Q

Vitamin A deficiency

A

Xerophthalmia, night blindness, bitot spots, follicular hyperkeratosis, impaired embryonic development

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15
Q

Causes of vitamin A deficiency

A

Infection, measles, protein-energy malnutrition

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16
Q

Vitamin D deficiency

A

Rickets, osteomalacia

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17
Q

Causes of vitamin D deficiency

A

Ageing, lack of sunlight exposure

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18
Q

Vitamin E deficiency

A

Peripheral neuropathy, spinocerebellar ataxia, retinopathy, skeletal muscle atrophy

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19
Q

Cause of vitamin E + K def

A

Antibiotic use

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20
Q

Vitamin K deficiency

A

Coagulopathy

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21
Q

Causes of water soluble vitamin deficiency

A

Alcoholism, any maladaptive state, drugs

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22
Q

Vitamin C deficiency

A

Scurvy

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23
Q

Cause of vitamin C deficiency

A

Smoking

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24
Q

B1 deficiency

A

Beri Beri

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25
Q

B2 deficiency

A

Angular stomatitis

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26
Q

B3 deficiency

A

Pellagra

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27
Q

B6 deficiency

A

Neuropathy
Anaemia
Glossitis
caused by isoniazid use

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28
Q

B12 deficiency

A

Anaemia, neurological disorders

caused by gastric atrophy

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29
Q

Folate deficiency

A

Anaemia, atrophic glossitis, depression

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30
Q

Cause of vitamin deficiency in developed countries

A 
Decreased intake
Decreased absorption 
Renal disease
long term enteral and parental feeding
Drugs e.g methotrexate and folate
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31
Q

Alcoholism

A

B1 deficiency

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32
Q

Small bowel disease

A

Folate and B9 deficiency

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33
Q

Vegans

A

Vitamin D and B12 deficiency

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34
Q

Elderly with poor diet

A

Vitamin D and folate def

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35
Q

Anorexia

A

Folate def

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36
Q

Ileal disease + resection

A

Vitamin B12 def

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37
Q

Liver and biliary disease

A

Fat soluble vitamins

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38
Q

Intestinal bacterial overgrowth

A

Vitamin B12 def

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39
Q

Antibiotics

A

Vitamin K def

40
Q

Renal disease

A

Vitamin D deficiency

41
Q

What are trace elements

A

Dietary minerals required in minute quantities for the normal function

42
Q

Examples of trace elements

A 
Calcium
Phosphorus
Iron
Selenium
Zinc 
Copper
43
Q

Calcium deficiency

A

Osteoporosis
Paresthesia
Muscle spasms
(from dairy)

44
Q

Phosphorus deficiency

A

Bone pain, pseudofractures and proximal muscle weakness
or rickets and short stature in children
neurological manifestations
(seeds, nuts, lentils, soya)

45
Q

Iron deficieny

A

Anaemia, impaired cog development

red meat, dark veg

46
Q

Selenium deficiency

A

Cardiomyopathy

seafood, red meat, cereal

47
Q

Zinc deficiency

A

Growth retardation, alopecia, dermatitis, diarrhoea, congenital malformations
(meat, shellfish, nuts, legumes)

48
Q

Copper deficiency

A

Growth retardation, anaemia

shellfish, liver, nuts, legumes

49
Q

Amount of deaths from malnutrition

A

1/3

50
Q

What is kwashiorkor

A

Protein wasting disease
causes acites
micronutrient and antioxidant deficiency
usually in older children

51
Q

What is marasmus

A

Severe malnutrition of all types of energy sources
Muscle wasting
usually in neonates

52
Q

What is refeeding syndrome

A

Severe electrolyte disturbance (low serum levels of phosphate, magnesium and potassium and metabolic abnormalities in under-nourished patients undergoing refeeding)

53
Q

What can refeeding cause

A 
Respiratory failure (pulmonary oedema)
Confusion 
Coma
Cardiac failure
Death
54
Q

Pathophysiology of refeeding syndrome

A

o 1) Starts with chronic malnutrition and fasting
o 2) leads to reduced insulin, increased glucagon and increased cortisol
o 3) Increased glycogenolysis, gluconeogenesis and protein catabolism
o 4) Reduced electrolytes, proteins, fats, minerals and vitamins
o 5) When refeeding occurs, insulin secretion occurs
o 6) Intracellular synthesis of proteins and glycogen occurs
o 7) This requires increased uptake of thiamine, phosphorus, mangesisum and potassium
o 8) Leading to low levels in the serum and also sodium and water retention
o 9) Causes convulsion, wernicke’s encephalopathy, hypotension, arrhythmias, heart failures, renal failure.

55
Q

Management of refeeding syndrome

A 
Electrolyte replacement
Nutritional supplement 
(simple sip drinks, early ng feeding, parenteral vitamins)
Treat underlying medical problems
Early dietician review
Cardiac monitoring
56
Q

How many adults in the UK affected by malnutrition

A

> 2 million adults

2wice as common in old age and 3x in institutional care

57
Q

Why is nutrition important

A

Wound healing, immune system, cardiac function, muscle strength, inactivity (DVT, pressure sores), depression

58
Q

Normal uses of iron

A

O2 transport in haem

Myoglobin function in muscles

59
Q

Where is iron absorbed

how is it transferred and stored

A

Absorbed in upper bowel
Transferrin-iron protein transport in serum
Iron stored in lever and bone marrow as ferritin

60
Q

What do haem chelators do

A

Prevent iron overload/oxidative damage in patients

61
Q

Iron deficiency

A

Microcytic anaemia
Lethargy and fatigue - adults
Cognitive impairment (children)
Exacerbation of inflammatory states

62
Q

Iron excess

A

Haemochromatosis - Lethargy and fatigue, abdominal and joint pain, reduced libido, bronzing of skin, diabetes, cirrhosis, cardiomyopathy

63
Q

Calciferol

A

Ergo-D2

Chole - D3

64
Q

Calcidiol

A

25-hydroxyvitamin D

65
Q

Calcitriol

A

1a 25-dihydroxyvitamin D

  • short half life
  • linked to PTH production
  • not a good reflection of vitamin D status
66
Q

How much sunlight do caucasians need

A

20-30 minutes of sunlight
2000iU vitamin D
2/3 exposures a week in summer

67
Q

How much sunlight do non-caucasians need

A

Require 2-10 times than Caucasians

e.g cod liver oil, salmon, mackerel, milk

68
Q

Which months does UK have insufficient UV

A

October - March

69
Q

Contributing factors to vitamin d deficiency

A

Obesity
Smoking + betel nut (reduces calcitrol)
Alcohol
Exercise

70
Q

What percent of UK have insufficient vitamin D

A

50%

in winter 16% have severe deficincy

71
Q

What are rickets

A

In children prior to epiphyseal fusion
Growth retardation
Expansion of the growth plate

72
Q

Osteomalacia

A

Reduced bone strength, increased bone fracture, bone pain, waddling gait

73
Q

Vitamin D guidelines

A 
<25nmol/l = deficient 
>75 nmol/l = adequate
RDA guidelines 
- <1yrs- 400 IU 
- 1-70yrs - 600IU
- >70yrs - 800IU
74
Q

Where is thiamine/B1 absorbed

A

Jejunum

75
Q

What is thiamine/vitamin b1 involved in

A

Glycolysis and Krebs cycle
Involved in BCAA metabolism
Involved in pentose phosphate metabolism

76
Q

What is thiamine deficiency seen in

A

Alcoholism
Anorexia
Weight loss
= causes cognitive impairment and muscle weakness

77
Q

Types of Beri beri (b1 def)

A

Dry
Shoshin
Wet

78
Q

What is dry beri beri

A

Symmetric peripheral neuropathy

79
Q

What is shoshin beri beri

A

Fulminant cardiac failure

Lactic acidosis

80
Q

What is wet beri beri

A
  • Cardiac (enlarged heart, tachycardia, high out put CCF, peripheral oedema)
  • Neurological (peripheral neuritis)
81
Q

Wernicke’s encephalopathy

A

Horizontal nystagmus
Ophalmoplegia
Cerebellar ataxia
Metal impairment

82
Q

What does niacin/B3 deficiency cause

A

Pellagra

83
Q

What are the symptoms of early pellagra

A 
Loss of appetite
Generalised weakness
Irritability 
Abdominal pain 
Vomiting
Bright red glossitis
84
Q

Symptoms of late pellagra

A 
Casal's necklace - skin rash of area exposed to sunlight
Vaginitis
Oesophagitis
Diarrhoea
Depression
Seizures
85
Q

4 Ds of pellagra

A

Dermatitis
Diarrhoea
Dementia
Death

86
Q

What is hartnup’s disease

A

Congenital defect of kidney and intestinal absorption of tryptophan

87
Q

What is carcinoid syndrome

A

Increased conversion of tryptophan to serotonin

88
Q

Two forms of niacin

A

Nicotinic acid
nicotinamide
Form two pyridine nucleotides (NAD and NADP) which act as hydrogen acceptors in many oxidative reactions and their reduced forms (NADH and NADPH) act as hydrogen donors in reductive reactions.

89
Q

Niacin toxicity

A 
Flushing 
Glucose intolerance
Macular oedema
Macular cysts
Fulminant hepatitis
90
Q

Vitamin B12 deficiency - haematological issues

A

Megaloblastic anaemia

Neutropaenia and thrombocytopaenia

91
Q

Vitamin B12 deficiency - Gastrointestinal issues

A

Beefy red glossitis
Malabsorption and diarrhoea
Anorexia

92
Q

Vitamin B12 deficiency - Neurological problems

A

Sensory disturbance
Gait abnormalities
Memory loss and disorientation

93
Q

Vitamin B12 absorption

A

Dissociated from proteins in stomach
Complexes with intrinsic factor in small intestine
Absorbed via specific receptors in the terminal ileum
40% absorbed - the rest

94
Q

Which other forms is vitamin B12 available as

A

o Cyanocobalamin used therapeutically

o Cofactor for methionine synthase and methylmalonyl–coenzyme A (CoA) synthase

95
Q

Causes of vitamin B12 deficiency

A 
inadequate intake - vegans
Disorders of terminal ileum
o	Defective release of cobalamin from food
o	Inadequate production of IF
o	Transcobalamin II deficiency (rare)
o	Congenital enzyme defects (rare)

MET2 (28 decks)

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