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Chapter 9 Part 3 Flashcards

1
Q

Definition of malnutrition

A

consequence of inadequate intiake of proteins and calories or deficiency in digestion or absorption of proteins resulting in loss of fat and muscle tissue, weight loss, lethargy, and generalized weakness

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2
Q

An appropriate diet should consist of what three things?

A

sufficient energy source, amino acids/protein, vitamins and minerals

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3
Q

Definition of primary dietary insufficiency

A

one or all components of appropriate diet are missing

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4
Q

Definition of secondary malnutrition

A

results from malabsorption, impaired utilization or storage, excess loss, or increased need for nutrients

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5
Q

Things that lead to dietary insufficiency?

A

poverty, infection, acute and chronic illness, chronic alcoholism, ignorance and failure of supplementation, self-imposed restriction, etc.

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6
Q

What groups of people are most at risk for protein-energy malnutrition?

A

infants and children in developing countries, older and debilitated patients in nursing homes and hospitals

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7
Q

Two functional protein compartments in the body

A

somatic (skeletal m.) and visceral (liver)

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8
Q

Clinical sxs of secondary PEM

A

depletion of subcutaneous fat, wasting of quads and deltoids, ankle or sacral edema

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9
Q

Marasmus diagnostic criteria

A

weight<60% normal for sex, ht, and age

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10
Q

Clinical sxs of marasmus

A

growth retardation and muscle loss; serum albumin NL, anemia, immune deficiency

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11
Q

Pathogenesis of Marasmus

A

catabolism and depletion of somatic protein compartment

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12
Q

Fuels used by body in marasmic children

A

muscle proteins, subcutaneous fat

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13
Q

Etiology of Kwashiorkor

A

protein deficiency more severe than caloric deficit; due to chronic diarrhea, protein losing enteropathies, nephrotic syndrome, extensive burns

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14
Q

Clinical sxs of kwashiorkor

A

hypoalbuminea leading to generalized edema, vitamin and immune deficiency, hair and skin changes, fatty liver

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15
Q

Pathogenesis of Kwashiorkor

A

depletion of visceral protein compartment with sparing of subcutaneous fat and muscle

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16
Q

Small bowel changes in Kwashiorkor

A

decrease in mitotic index, mucosal atrophy and loss of villi

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17
Q

Bone marrow changes in PEM

A

hypoplastic

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18
Q

Brain changes in PEM

A

cerebral atrophy, reduced neurons, impaired myelination

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19
Q

Populations most affected by cachexia

A

AIDS, advanced cancers (esp. GI, pancreatic, lung)

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20
Q

Clinical characteristics of cachexia

A

extreme weight loss, fatigue, muscle atrophy, anemia, anorexia, edema

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21
Q

Pathogenesis of cachexia

A

proteolysis-inducing factor and lipid-mobilizing factor cause muscle breakdown through ubiquitin-proteasome pathway, typically breakdown structural proteins

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22
Q

Anorexia nervosa

A

self induced starvation leading to marked weight loss

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23
Q

What psychiatric DO has the highest death rate?

A

anorexia nervosa

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24
Q

Clinical sxs of anorexia nervosa

A

amenorrhea, decreased thyroid hormone, decreased bone density; death may result from cardiac arrhythmia or sudden death (hypokalemia)

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25
Bulimia
binge eating and induced vomiting, often better prognosis than anorexia
26
Major complications of bulimia
electrolyte imbalance, pulmonary aspiration, esophageal and gastric rupture; due to vomiting and laxative use; hypokalemia/cardiac arrhythmia may result
27
Fat soluble vitamins
A, D, E, K
28
What vitamins can be synthesized endogenously
vitamin D, vitamin K, biotin, niacin
29
Major functions of vitamin A
maintenance of vision, regulation of cell growth and differentiation, and regulation of lipid metabolism
30
Transport/storage form of vitamin A
Retinol
31
Dietary source of vitamin A
liver, fish, eggs, milk, butter, yellow and green vegetables
32
Where is vitamin A absorbed?
small intestine
33
Causes of secondary vitamin A deficiency
fat malabsorption syndromes (Crohn, CF, colitis, celiac)
34
Causes of vitamin A deficiency i children
depletion in presence of infection, poor absorption in newborns
35
Side affects of vitamin A deficiency
night blindness, squamous metaplasia and keratinization of epithelia, xerophthalmia, bitot spots that erode cornea and lead to blindness, respiratory and UT squamous metaplasia, immune deficiency
36
Clinical sxs of vitamin A toxicity
headache, dizziness, vomiting, stupor, blurred vision; weight loss, anorexia, bone and joint pain
37
Major function of vitamin D
maintain plasma levels of calcium and phosphorus, bone mineralization, neuromuscular transmission
38
Hypocalcemic tetany
convulsive state caused by insufficient extracellular Ca required for muscle relaxation
39
Rickets clinical sxs
frontal bossing, squared head, rachitic rosary, pigeon breast deformity, lumbar lordosis, bowing of legs
40
Osteomalacia clinical sxs
inadequate mineralization of bone, weak and prone to fracture
41
Major source of vitamin D
endogenous synthesis from precursor, 7-dehyrocholesterol reaction that requires UV light
42
Dietary sources of vitamin D
deep-sea fish, plants, grains
43
Steps in vitamin D metabolism
1. photochemical synthesis from 7-dehydrocholesterol in skin 2. binding of vitamin D to DBP and transportation to liver 3. conversion to 25-hydroxycholecalciferol through CYP27A1 4. Conversion to 1,25 dehydroxytitamin D by 1alpha hydroxylase in kidney
44
What regulates production of active vitamin D?
parathyroid hormone (triggered by hypocalcemia), hypophosphatemia activating 1alpha-hydroxylase, feed back (inhibits its own activity)
45
Effects of vitamin D on Ca and PO4 homeostasis
stimulation of intestinal Ca absorption thru TRPV6, stimulation of kidney Ca absorption thru TRPV5, expression of RANKL on osteoblasts triggering osteoclast differentiation, mineralization of osteoid matrix
46
Morphological changes of bone in Rickets
loss of cartilage palisades, overgrowth of epiphyseal cartilage, persistence of cartilage masses that project into the marrow cavity, abnormal overgrowth of capillaries and fibroblasts, deformation of skeleton
47
Function of Vitamin K
cofactor for Factors II, VII, IX, X, Protein S and protein C
48
Clinical sxs of vitamin K deficiency
bleeding diathesis
49
Function of vitamin B1
thiamine, coenzyme in decarboxylation reactions
50
Clinical sxs of thiamine deficiency
dry and wet beriberi, Wernicke-Korsakoff syndrome
51
Function of niacin
incorporated into NAD and NADP, involved in redox readtions
52
Clinical sxs of niacin deficiency
dementia, dermatitis, diarrhea (pellagra)
53
Function of Vitamin B6
pyridoxine, derivatives used as coenzymes in intermediary reactions
54
Clinical sxs of pyridoxine deficiency
cheilosis, glossitis, dermatitis, peripheral neuropathy
55
Function of Vitamin C
re-dox reactions and hydroxylation of collagen
56
Dietary sources of vitamin C
milk, some animal products, many fruits and vegetables
57
Scurvy
bone disease in growing children, hemorrhages and healing defects
58
Populations most likely to have vitamin C deficiency
chronic alcoholic, people who live alone (have erratic and inadequate eating patterns)
59
Clinical signs of vitamin C deficiency
bleeding of skin, gums, and joints, inadequate osteoid synthesis, impaired wound healing
60
Clinical features of zinc deficiency
acrodermatitis enteropathica, anorexia, diarrhea, growth retardation, depressed mental function, impaired night vision, depressed wound healing
61
Clinical feature of iron deficiency
hypochromic microcytic anemia
62
Clinical feature of iodine deficiency
goiter and hypothyroidism
63
Clinical features of copper deficiency
muscle weakness, neuro defects, abnormal collagen cross-linking
64
Clinical features of fluoride deficiency
dental caries
65
Clinical features of selenium deficiency
myopathy, cardiomyopathy
66
Vitamin C excess sxs
iron overload, hemolytic anemia if G6PD deficient, calcium oxylate kidney stones
67
Vitamin D toxicity sxs
metastatic calcifications in kidney, bone pain, hypercalcemia
68
What diseases are obesity and excess body weight associated with?
increased incidence of type 2 diabetes, dyslipidemias, CV disease, HTN, CA
69
Definition of obesity
accumulation of adipose tissue sufficient magnitude to impair health
70
Normal BMI
18.5-25
71
BMI>30
obese
72
BMI25-30
overweight
73
Components of afferent system
leptin, adiponectin, ghrelin, PYY, insulin
74
Neurons in arcuate nucleus responsible for feeding
POMC and NPY/AgRP
75
Function of POMC neurons
satiety, anorexigenic
76
Function of NPY neurons
feeding, orexigenic
77
When is leptin release stimulated
abundance of fat stores
78
Functions of adiponectin
fatty acid oxidation, causing decrease in fat mass
79
Consequences of obesity
metabolic syndrome characterized by adiposity, insulin resistance, hyperinsulinemia, glucose intolerance, HTN, hypertriglyceridemia, decreased HDL
80
Increased risk of CAD for obese persons due to what two factors?
hypertriglyceridemia, low HDL
81
Percentage of cancers attributable to obesity
4% in men, 7% in women
82
What types of CAs associated with obesity
esophagus, pancreas, colon, rectum, breast, endometrium, kidney, thyroid, gallbladder
83
How might elevated insulin levels lead to CA?
elevated levels of IGF-1, a mitogen expressed in many CAs - promotes PI3/AKT path
84
Increased levels of what adipose-related hormone may cause CA?
estrogen
85
Aspects of diet that are of most concern in carcinogenesis?
content of exogenous carcinogens, endogenous synthesis of carcinogens, lack of protective factors
86
What might aflatoxin cause?
hepatocellular carcinoma
87
What two molecules are associated with generation of gastric tumors
nitrosamines, nitrosamides
88
Dietary causation of colon CA
high animal fat, low fiber
89
What vitamins and minerals are associated with anticarcinogenic effects?
Vitamin C, Vitamin E, B-carotenes, selenium

MOD (34 decks)

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