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Flashcards in Dietary issues Deck (79):
1

Physical exercise and fibre decrease the risk of ___ cancer

colorectal cancers`

2

vegetables and fruits decrease the risk of ____(3) cancers

mouth-larynx
oesophagus
stomach

3

red and processed meat increases the risk of ___ cancer

colorectal

4

salt increases the risk of ____ cancer

stomach

5

alcohol increases the risk of _____(4) cancers

mouth-larynx
oesophagus
liver
colorectal

6

increased body fatness increases the risk of ___ (3) cnacers

oesophagus
gall bladder
colorectal

7

Neural centre for monitoring body weight =

hypothalamus

8

lesioning ventromedial hypothalamus =>

obesity

9

leisioning lateral hypothalamus =>

Lateral = Leanness

10

Feeling of fullness =

satiation

11

length of time from 1 meal until the next

satiety

12

CCK is secreted from ______ in the ___
release is proportional to intake of __+__
causes afferents to be sent to ___ and get satiation

I / enteroendocrine cells in duodenum and jejunum
lipids and protein
NTS -> hindbrain stimulated

13

mucosal L cells in GI tract release this rapidly post-meal =>
stimulates the ___

PYY3-36
decreases gastric motility, emptying and food intake (satiety signal)
hypothalamus

14

GLP-1 is released from ___ due to ingestion
It causes __
stimulates ___

L cells
decreased gastric emptying and intake of food
NTS andhypothalamus

15

Satiety signal released from oxyntic cells of small intestine post-meal =

OXM - oxyntomodulin

16

Obestatin is a ___ signal released from ____ which may antagonise ghrelin

satiety
stomach/small intestine cells

17

Satiety+satiation signals =

CCK
PYY3-36
GLP-1
Oxyntomodulin
Obestatin

18

Hunger signal =

ghrelin

19

Ghrelin is released from ___
it __ before meals and ___ after
___ fat utilisation
__+__ increase ghrelin

oxyntic cells in the stomach
increases before and decreases after meals
decreases fat utilisation
hypoglycaemia and fasting

20

`_+_+_ stim. hypothalamus to increase food intake in adiposity -ve feedback

glutamate, GABA, opioids

21

__ stim hypothalamus to decrease food intake in adiposity -ve feedback

monoamines

22

Hormones whose levels are proportional to fat stores
they tell hypothalamus to __+_

leptin and insulin
decrease intake and increase energy expediture

23

If have a lack of ___ or ___ receptors then have an unrestrained appetite => obesity
are also __,__+__

leptin
hyperglycaemic, hyperinsulinaemic and insulin resistant

24

Roles of leptin = (6)

food intake/expenditure/fat deposition
peripheral glucose homeostasis/insulin sensitivity
maintainenc of immune and reprod. system
angio+tumouri-genesis
bone formation

25

There are lots of insulin receptor in the ___ in the brain

hypothalamus

26

Adiponectin goes to the ___ and ___ food intake

hyothalamus
decreases

27

food reward has a role in ___ pathways in the brain
same pathway areas that are affected by ___

dopamine
substance abuse

28

Orlistat (Xenical/Alli) is for:
mechanism=
side effects:

diet-induced obesity
inhibits pancreatic lipas to less tri absorption
cramping, vomiting and need ADEK supplements

29

Diet induced obesity => ___ resistance
due to ___/___

leptin
defective transport of leptin to brain
altered signal transduction after leptin receptors

30

malnutrition definition

deficiency, excess or imbalance of E, protein + other nutrients => measurable adverse effects

31

diagnosis of malnutrition is by

anthropometry eg. MUAC, BMI, grip strength
biochem: low albumin, transferrin, vitamin and urinary creatinine

32

factors for needing nutritional support

BMI less than 18.5
more than 10% unintentional wt loss in 3-6 months
BMI less than 20 with more than 5% unintentional wt loss in 3-6 months
eaten/will eat little or nothing for more than or equal to 5days
decreased absorptive capacity/increased nutritional needs

33

enteral tubes are not given if patient has:

lower GI obstrction, prolonged intestinal ileus
severe d/v
high enterocutaneous fistula
intestinal ischaemia

34

Refeeding syndrome =

fatal shifts in fluids and electrolytes and organ + metabolic regulation dysfunction
due to rapid start of refeeding after period of undernutrition
more common in enteral/parenteral feeding

35

Refeeding syndrome pathology:
increased protein and glycogen synthesis uses up (5)
this causes

glucose, K+, thiamin, Mg2+, PO4-
hypokalaemia/magnesaemia/phosphataemia
thiamin deficiency
salt and H2O retention

36

refeeding syndrome can cause

arrhythmias
altered consciousness, seizures, respiratory failure, CV collapse

37

prevent refeeding syndrome by:

start on 50% of required and increase feeding
monitor electrolytes
adjust fluids
supplement vitamins

38

easy bruising is a sign of which vitamin deficiency

C/K

39

___ is an autorecessive form of impaired zinc uptake
need ___
signs =

acrodermatitis enteropathica
supplements
alopecia
perioral and acral rash

40

glossitis and angular stomatitis are signs of which deficiency

vitamin B/iron

41

Koilonychia is a sign of __ deficiency or __ problems

iron
thyroid

42

Baseline investigations for malabsorption =

FBC, coagulation, LFTs, albumin, Ca2+/Mg2+, stool culture
=>
endoscopy, barium imaging, CT, MRI

43

Calcium is absorbed from the gut by __ and ___

passively - paracellularly - whole length of small intestine
actively (mainly) - transcellularly - due to low concn in lumen

44

active transport of Ca2+ is regulated by ___+_

calcitriol - hormonally active product of vit D3
PTH (increases calcitriol)

45

apical channel involved in Ca2+ absorption in the gut and its expression is increased by ___

TRPV6
calcitriol

46

in the enterocytes Ca2+ is bound to ___ and so decreases free Ca2+ and maintains driving force for Ca2+ absorption

calbindin D

47

2 basolateral membranes involved in Ca2+ absorption =

Ca2+ATPase/PMCA1 (increased expression caused by calcitriol)
Na/Ca exchanger/NCX

48

Females or males absorb more iron

females

49

form of iron that is absorbable

ferrous (Fe2+)

50

form of iron that is ingested and is converted to ___ by ___

ferric (Fe3+) by HCl and vitamin C is converted to ferrous (Fe2+)

51

apical membrane transported for gut Fe2+ absorption
coupled to ___
and reduced by __ eg. __

DMT1
H+ transport
HFE mutations eg. hereditary haemochromatosis

52

apical membrane transporter that absorbs Hb

Hb carrier protein 1 - Hb oxidase transports Hb in and then is changed to Fe2+

53

enzyme that changes iron to stored state (___) =

apoferratin converts ferrous to ferritin

54

Basolateral membrane transporter of iron in gut
negatively regulated by ___ from ___ when Fe levels are high = major control of absorption

feroportin
hepcidin hormone
liver

55

cobalamin=

vitamin B12

56

When B12 is ingested salivary glands secrete ___ and it binds to B12 when ___ releases B12 from protein it was bound to. Parietal cells release ___
___ digest ___ to release B12 which then binds to ___
and is absorbed in terminal ileum by ___

salivary = haptocorin
HCl releases
Parietal = intrinsic factor
Pancreatic proteases digest haptocorin
binds to intrinsic factor
endocytosis

57

Water soluble vitamins =

Vitamin B (not 12)
Vit C
Vit H

58

Vitamin H =

biotin

59

ascorbate =

vit C

60

folate =
Na independant/dependant absorption

Vitamin B9
independant

61

Vitamin H and C are Na independant/independant absorption

Na dependant

62

fat soluble vitamins need __+__ for asorption
They are incorporated into___

bile salts and intaact intestinal mucosa
mixed micelles > passive transport in enterocytes > chylomicrons/VLDL>lymphatics

63

Guidelines for alcohol consumption

no more than 14 units per week
ideally spread over 3 or more days

64

Wernicke-Korsakoff syndrome is due to a lack of ___ caused by __

Vitamin B1 - thiamine
alcoholism

65

Alcohol is broken down in the liver by __+__

cytochrome p450 2E1
alcohol dehydrogenase

66

___ grades cirrhosis and is based on ascites, encephalopathy, PT, bilirubin and albumin

Childs A/B/C

67

MELD score grades cirrhosis based on _+_+_

INR, bilirubin, creatinine

68

In alcoholic hepatitis AST:ALT ratio =
AST =
bilirubin =

AST: ALT is more than 1.5
AST less than 500
bilirubin more than 80

69

__+_ Alcoholic hepatitis scores are used for prognostic scoring

Maddrey's and Glasgow

70

Limit of alcohol to pass for drink driving

50mg

71

How to calculate alcohol units in a drink =

(volume(ml)xAlcohol%) / 1000

72

Globus sensation =

feeling of something stuck in throat

73

Malingering =

make up illness for own gain eg. benefits/drugs

74

factitious disease =

only want to occupy "sick" role - not for personal gain

75

Diagnosis of typical anorexia nervosa

significant self-induced wt. loss / failure to gain wt in a child
BMI less than 17.5
Skinny ideal
Endocrine abnormalities

76

Restricting type of anorexia nervosa =

not binge eating/purging type

77

No endocrine abnormalities are seen in patients with ___ nervosa

bulimia

78

Anorexia and bulimia nervos are more common in F/M and by how much?

F 10:1

79

Anorexia/bulimia nervosa patients are made inpatients if:

suicide risk
more than 5yrs of condition
co-morbidity - depression, extreme social isolation