Ch10: Vitamins, Minerals and Other Dietary Supplements Flashcards
(82 cards)
1
Q
Vitamin A is necessary for heath of …(4)
A
Skin, vision, bone growth, immune function
2
Q
Vitamin A deficiency is associated with…
A
Eye problems, night blindness and conjunctival dryness
3
Q
2 forms of vitamin A
A
Retinol, preformed vitamin A
Beta carotene, provitamin A
4
Q
DRI for vitamin A for women >50y
A
700 mcg, 2330 IU
5
Q
Populations at risk for vitamin A deficiency and malabsorption (3)
A
Pancreatic insufficiency
Cystic fibrosis
Fat malabsorption condition
6
Q
Prolonged high doses of vitamin A may cause…(3)
A
Bleeding from gums
Dry or sore mouth
Drying, cracking, or peeling of lips
7
Q
Vitamin A food sources (13)
A
Liver, eggs, sweet potato, pumpkin, carrots, spinach, collards, kale, turnip greens, egg yolk, milk, cheese, butter
8
Q
UL for vitamin A
A
3000mcg, 10,000IU
9
Q
Excessive intake of vitamin A may…
A
Stimulate bone loss, increase risk of hip fracture
Counteract effects of calcium supplements
Cause hypercalcemia, hair loss, hepatotoxicity
10
Q
Vitamin B1
A
Thiamin
11
Q
Vitamin B2
A
Riboflavin
12
Q
Vitamin B3
A
Niacin
13
Q
Vitamin B5
A
Pantothenic acid
14
Q
Vitamin B6
A
Pyridoxine
15
Q
Vitamin B9
A
Folic acid
16
Q
Vitamin B12
A
Cyanocobalamin
17
Q
Vitamin B1 food sources (4)
Thiamin
A
Whole grain products, meat, fish, fortified foods
18
Q
Populations at risk of vitamin B1 deficiency (5)
Thiamin
A
Chronic alcohol use, malnutrition, history of bariatric surgery, heart failure, history of critical illness
Associated with dementia
19
Q
DRI for vitamin B1
A
1.1 mg
20
Q
UL for vitamin B1
A
None
21
Q
Vitamin B2 food sources (4)
Riboflavin
A
Eggs, meat, dairy, fortified foods
22
Q
Populations at risk for vitamin B2 deficiency (3)
Riboflavin
A
Vegan
Vegetarian diets
Pregnant women
23
Q
Vitamin B3 food sources (5)
A
Meat, fish, poultry, enriched and whole-grain breads, fortified cereals
24
Q
DRI for vitamin B3
Niacin, niacinamide
A
14 mg
25
AEs of vitamin B3 intake
Flushing, itching, GI discomfort
| More common with therapeutic dose used for hyperlipidemia, rather that nutritional dose
26
Vitamin B6 food sources (4)
Fish, organ meats, potatoes, fruit
27
DRI for vitamin B6
| Pyridoxine
1.5 mg
| Increased if taking cyclosporine, antiepileptics or theophylline
28
UL for vitamin B6
| Pyridoxine
100 mg
29
Populations at risk for vitamin B6 deficiency (3)
Chronic renal insufficiency, autoimmune disease, alcohol use
30
Vitamin B9 food sources (4)
| Folate, folic acid
Dark leafy greens, nuts, seafood, fortified foods
31
DRI for vitamin B9
400 mcg
32
UL for vitamin B9
1000 mcg
33
Populations at risk for vitamin B9 deficiency
| Folate, folic acid
Chronic alcoholics, malabsorption syndromes
34
Vitamin B12 food sources (5)
| Cyanocobalamin
Fish, seafood, egg yolk, milk, fermented cheeses
35
Populations at risk of vitamin B12 deficiency (5)
| Cyanocobalamin
Alcoholism, gastritis with achlorhydria, lack of intrinsic factor (pernicious anemia), gastrectomy, older adults.
36
DRI for vitamin B12
2.4 mcg
| May need to be increase in women taking metformin, PPIs
37
Vitamin C food sources (6)
Citrus fruits, peppers, broccoli, cabbage, tomatoes, potatoes
38
DRI for vitamin C
75 mg
| 110 mg in smokers
39
Populations at risk for deficiency
Smoker, secondhand smoke, restricted diets, malabsorption syndromes
40
UL for vitamin C
2000 mg
41
Deficiency in vitamin C causes...
Scurvy, extreme weakness, lethargy, easy bruising, bleeding
42
High dose of vitamin C can cause...
Kidney stones/oxalate stones, diarrhea, iron overload, exacerbation of hemochromatosis
43
Biologically inactive vitamin D
D3, cholecalciferol
Synthesized in skin via photochemical reaction between 7-dehydrocholesterol and UV light
Transported to liver and hydroxylated to 25(OH)D
44
Functional indicator for vitamin D status
25-hydroxyvitamin D, 25(OH)D
| Cholecalciferol (D3) is transported from skin to liver and hydroxlyated to 25(OH)D
45
Calcitriol
Final hydroxylation in kidney, 1,25-dihydroxycholecalciferol
| Instrumental in calcium metabolism and balance
46
Vitamin D2
Ergocalciferol
Produced synthetically by irradiation of product of ergot mold
D3 more potent that D2 by a factor of at least 4
47
UL for vitamin D
4,000 IU
48
Optimal range for 25(OH)D levels
Minimum 20-30 ng/mL
Optimal 30-44 ng/mL
Without additional benefit >60 mg/mL
1ng/mL rise for every 100IU per day of additional cholecalciferol (D3)
49
Food sources for vitamin D
Oily fish such as salmon, mackerel, wild-caught fish, eggs and fortified foods such as milk and orange juice.
50
Food sources for vitamin E (5)
Nuts, seeds, vegetable oil, vegetables, wheat germ
51
DRI for vitamin E
15 mg, 22.5 IU
52
UL for vitamin E
1500 IU, 1000 mg/d
However, increased risk of hemorrhagic stroke at 400 IU qod
Therefor, avoid >400 IU/day in people taking medication that increase risk of bleeding.
53
Population at risk of vitamin E deficiency (3)
Very few, extremely limited diets, fat malabsorption conditions
54
Food sources for vitamin K1
Phylloquinone
| Green leafy vegetables
55
Food sources for vitamin K2 (4)
Menaquinone
| Meat, eggs, dairy, fermented soy
56
Contraindication for vitamin K supplement
Women taking warfarin and other vitamin-K dependent anticoagulants
57
Factors that limit calcium absorption (6)
Dietary: oxalic acid (spinach, rhubarb, certain green vegetables), phytates (wheat bran, soy protein isolates), tannins (tea)
Vitamin D deficiency
Estrogen deficiency
Increasing age due to decrease in intestinal absorption
Decreased gastric acid production
Malabsorptive disorders
58
DRI for calcium
1000 mg for <50y
| 1200 mg for >50y
59
UL for calcium
2000-2500 mg/d
60
Populations at risk for inadequate calcium intake (3)
Lactose intolerant
Vegetarian diet
Poor eating habits
61
Foods containing 300 mg calcium
8 oz serving of milk/yogurt
| 1.5 oz cube of hard cheese
62
DRI for iron
18 mg/d for menstruating women
| 8 mg/d after menopause
63
Populations at risk for iron deficiency anemia (5)
```
End-stage kidney failure
Chronic infectious disorders
Inflammatory disorders
Malignancy
GI malabsorption diseases: celiac disease, Crohn disease
```
64
Signs of iron deficiency anemia (5)
```
Fatigue, weakness
Decrease work performance
Difficulty maintaining body temperature
Decreased immune function
Glossitis
```
65
Food sources for iron (8)
Organ meats, beef, turkey, clams, oysters, oatmeal, beans, fortified foods
66
Symptom of phosphorus deficiency
Bone pain
67
Populations at risk for low phosphorus levels (4)
Excessive urinary loss
Excessive use of antacids
Poor diet
Intestinal malabsorption
68
Food sources for phosphorus (10)
Milk, yogurt, ice cream, cheese, soft drinks, peas, meat, eggs, some cereals and breads
69
Symptoms of selenium overdose
Hair and nail brittleness and loss
70
Symptoms of boron overdose
Nausea, vomiting and diarrhea
71
AEs and interactions from coenzyme Q10
Nausea, epigastric pain, heartburn, headache, fatigue
| Lower blood pressure
72
Coenzyme Q10 and CHF, HTN, statin-induced myopathies, migraine, breast cancer
CHF: not recommended as therapy
HTN: effective as adjunctive therapy, unclear as single therapy
Statin-induced myopathies: no sig benefit
Migraine: may prevent, may take up to 3 months to see benefit
Breast ca: limited studies, no sig difference in level of fatigue
73
Omega 3 fatty acids
3 major dietary polyunsaturated fats
(1) alpha-linolenic acid: plants such as flaxseeds and walnuts, canola, soy, dairy products and some red meat
(2) eicosapentaenoic acid and (3) docosahexaenoic acid: fish oil and algae, mainly fatty fish such as salmon, sardines, herring, mackerel, black cod and bluefish
74
Omega 6 fatty acids
Polyunsaturated fatty acids (3)
linoleic acid: plant-based oil such as corn, safflower, soybean, and evening primrose seed
gamma-linoleic acid
arachidonic acid
Most American diets have 10x more omega 6 than omega 3.
75
AEs and interactions from fish oil supplements
Heartburn, nausea, dyspepsia, loose stools, bad breath, fishy aftertaste
Potential to slow blood clotting and increase bleeding by decreasing platelet aggregation (stop using fish oil supplements before surgical procedures)
76
AEs and interactions from glucosamine and chondroitin
No serious AES
Use caution with shellfish allergies, supplements obtained from chitin, extracted from marine exoskeletons
May increase anticoagulation effects of warfarin
77
Fish oil and CVD, Alzheimer’s, and depression
CVD: lowers triglycerides in those with very high baseline levels, no affect of HDL-C, ?improve BP, prevent arrhythmia, decrease platelet aggregation
Alzheimer’s: may be protective, need larger and longer clinical trials
Depression: nonsignifcan efficacy in meta-analysis
78
S-adenosylmethionine (SAM-e) and depression, osteoarthritis, and liver disease
Depression: not well-studied
Osteoarthritis: studies not adequately sized and too heterogenous to make conclusions
Liver disease: limited data, cannot yet suggest for clinical practice
79
AEs from S-adenosylmethionine
Generally well-tolerated
| Occ GI upset, nausea, dry mouth, headache, dizziness, restlessness, insomnia
80
Melatonin and circadian rhythm sleep disorders, insomnia, nocturnal blood pressure, benzodiazepine withdrawal
Circadian rhythm disorders: may shift circadian rhythm, ie. shift work, jet leg, dementia
Insomnia: improve sleep latency and duration, no effect on quality
Nocturnal blood pressure: inconsistent results
Benzodiazepine withdrawal: limited studies, no sig effect
81
AEs and interactions from melatonin
Abdominal cramps, hangover effects, dizziness, fatigue, irritability, impaired balance
High doses may exacerbate depression
Use cautiously with other CNS depressants/sedatives/anxiolytics due to possible additive effect
May impair antiHTN effect of nifedipine
Conflicting reports of increased insulin resistance with DM
82
Dosing of melatonin
0.5 to 5 mg daily
Taken 1.5-2h prior to going to bed
Generally safe for short-term use, <3 months
Quick release for initiating sleep/sleep latency
Sustained-release for sleep duration/sustain sleep
