Nutrition Flashcards
(135 cards)
1
Q
How many kcal in a gram of
carbs
protein
fat
A
carbs - 4 kcal
protein - 4 kcal
fat - 9 kcal
2
Q
What substances can be used to make glucose in gluconeogenesis?
A
amino acids, triglycerides, lactate
3
Q
What is marasmus?
A
protein deficiency with inadequate calorie intake
NONEDEMATOUS malnutrition
4
Q
What is kwashiorkor?
A
protein deficiency with adequate carbohydrate intake
EDEMATOUS malnutrition
5
Q
What is the RDA for protein for adults?
A
56g/day men
45 g/day women
10-35% of total calories
6
Q
What is the RDA for fat?
A
20-35% of total calories
7
Q
What is the RDA for carbohydrates?
A
45-65% of total calories
130 g/day
8
Q
Name 3 monosaccharides
A
glucose
fructose
galactose
9
Q
Name 3 disaccharides
A
sucrose (glucose + fructose)
maltose (glucose + glucose)
lactose (glucose + galactose)
10
Q
What is the RDA for fiber?
A
38 g/day men
25 g/day women
11
Q
What are some benefits of fiber?
A
lower cholesterol
lower blood sugar
stool softener
12
Q
What eating disorder is the deadliest and most difficult to treat? What are the signs and symptoms of this disorder? What are the health problems associated with this disorder?
A
Anorexia nervosa signs/symptoms: BMI 17.5 or less amenorrhea lanugo malnutrition Health problems: osteoporosis, cardiac failure, electrolyte disturbances
13
Q
What are the signs/symptoms of bulimia nervosa?
A
binge episodes 2x/wk for 3+ months plus inappropriate compensatory behaviors like vomiting and/or laxative use 2x/wk for 3+ months, or excessive exercise or periods of fasting (nonpurge type of bulimia) --raw fingers/hands from vomiting --tooth erosion
14
Q
What are the 3 subgroups of ‘eating disorder not otherwise specified’?
A
- Subthreshold cases of AN or BN - e.g. BMI above 17.5 or binge episodes only once a week - give them time and they will likely become anorexic/bulimic
- Mixed cases - largest subgroup
- Binge Eating Disorder:
binge episodes 2x/wk for 6 months without compensatory behaviors; loss of control, rapid eating, feeling uncomfortably full, eating when not hungry, eating alone because embarrassed
15
Q
What are the 2 subtypes of AN?
A
nonbinge/nonpurge
binge/purge
16
Q
What is the female athlete triad?
A
eating disorder, amenorrhea, osteoporosis
17
Q
Which disorder is ego syntonic and which disorder is ego dystonic? (AN or BN)
A
AN: ego syntonic - the disorder becomes who they are, gives them an identity; they respond to any questions about it as attacks on their being; they are not embarrassed about their behavior
BN: ego dystonic - they know what they are doing is “weird” but they can’t help themselves and they are embarrassed about their behavior
18
Q
What are the criteria for hospitalization for AN?
A
- unstable vitals
- bradycardia < 30 bpm or < 40 bpm if hypotension
- hypothermia 95F or below
- cardiac dysrhythmia
- less than 70% of normal body weight
- marked dehydration
- acute medical complications of malnutrition e.g. syncope, seizures, cardiac failure, liver failure, electrolyte disturbance
19
Q
What is the BMI defined as obesity?
A
BMI 30-40
20
Q
What is the BMI defined as malnutrition?
A
BMI of less than 20
21
Q
What is the BMI defined as normal?
A
BMI 20-25
22
Q
What is the BMI defined as overweight?
A
BMI 25-30
23
Q
What is the BMI defined as morbid obesity?
A
BMI above 40
24
Q
What are the three hormones of satiety?
A
Ghrelin
Orexin
Leptin
25
What is the function of ghrelin?
Where is ghrelin produced?
When is it released?
How is ghrelin related to obesity?
Ghrelin: peptide hormone that stimulates hunger, growth hormone, and orexin
Produced by stomach and pancreas
Levels increase before meals and decrease after meals
People with obesity have blunted after-meal ghrelin response
26
What is the function of orexin?
Where is orexin produced?
What stimulates its release?
Orexin: neurotransmitter that regulates energy expenditure, wakefulness, and appetite
Produced by hypothalamus
Release stimulated by hypoglycemia and ghrelin; release inhibited by leptin
27
What is the function of leptin?
Where is leptin produced?
When is it released?
What happens if you have impaired leptin response?
Leptin: acts on hypothalamus to signal satiety (done eating); inhibits orexin
Produced by adipocytes
Levels should rise as you eat
Leptin knockout mouse eats continuously and gets very fat
28
hypertriglyceridemia: drugs of choice to treat?
fibrates, niacin
29
familial hypercholesteremia (FH): drugs of choice to treat?
bile acid sequestrates, niacin
30
What is the most effective drug for increasing HDL levels?
niacin
31
What are fibrates best at (lower LDL, raise HDL, lower TG)?
lowering triglycerides
32
What is niacin best at (lower LDL, raise HDL, lower TG)?
increasing HDL
33
What are statins best at (lower LDL, raise HDL, lower TG)?
lowering LDL
34
What are bile acid sequestrants best at (lower LDL, raise HDL, lower TG)?
lowering LDL
35
What is the desirable blood level of total cholesterol?
Less than 200 mg/dL
36
What is the optimal blood level of LDL?
< 130 mg/dL for patient with no risk factors (note that elevated cholesterol is a risk factor. So someone with LDL 180, their treatment goal is 100, not 130.)
< 70 mg/dL with history of CHD or metabolic syndrome
< 100 mg/dL with risk factors for CHD
37
What is the optimal blood level of HDL?
above 60 mg/dL is optimal
38
What is the normal level of triglycerides?
normal is < 165 mg/dL
39
Name 3 primary causes of dyslipidemia.
familial hypercholesterolemia,
familial hypertriglyceridemia,
familial hyperchylomicronemia
40
Name 4 secondary causes of dyslipidemia.
Obesity
uncontrolled diabetes mellitus
sedentary lifestyle
obstructive liver disease
41
What are the 5 A's of the 5A intervention framework for weight loss?
ASSESS: ask about behaviors; assess BMI every visit; assess if they're ready to change
ADVISE: give clear, specific personalized behavior change advice; urge every obese patient to work on weight loss
AGREE: collaborate with the patient in selecting attainable goals
ASSIST: use counseling with or without pharmacotherapy; aid patient in acquiring the necessary skills/support system/etc to make changes
ARRANGE: schedule followup appts within the first week after starting each major change
42
What is the difference between roux-en-y gastric bypass and gastric banding?
In Roux-en-Y Gastric Bypass, a small part of the stomach is used to make a pouch that is connected directly to the jejunum.
In Gastric Banding, a band is placed around the upper part of the stomach to limit the amount of food a person can eat (no change in where the intestine joins the stomach).
43
What are the major complications of roux-en-y gastric bypass?
1. peritonitis due to leakage
2. nutritional deficiencies! B12, folate, calcium, vitamin D
3. DUMPING syndrome!
44
What are the major complications of gastric banding?
1. band slips out of place
| 2. vomiting/reflux (from eating more than the stomach can now hold)
45
Which weight loss surgery is associated with dumping syndrome?
gastric bypass (roux-en-y)
46
B1 is
thiamin
47
B2 is
riboflavin
48
B3 is
niacin
49
B5 is
pantothenic acid
50
B6 is
pyroxidine
51
B7 is
biotin
52
B9 is
folate
53
B12 is
cyanocabalamin
54
If you have an alcoholic patient, what is their most likely vitamin deficiency?
thiamin
55
What is the name of the disease associated with thiamin deficiency?
beriberi
56
Most water-soluble vitamins don't have an associated toxicity, but a few do - which are these?
niacin, pyroxidine, vitamin C
57
What is the most common cause of riboflavin deficiency?
malnutrition
58
What are symptoms of riboflavin deficiency?
cheilosis, glossitis
59
What is a risk factor for niacin deficiency?
diets based on corn
60
What is the name of the disease associated with niacin deficiency? What are its symptoms?
pellagra
| triad of pellagra: diarrhea, dementia, dermatitis
61
What are the effects of niacin toxicity?
flushing, hyperglycemia, gout
62
What is the vitamin your patients are LEAST LIKELY to be deficient in?
pantothenic acid, B5
63
What is the most likely cause of pyroxidine deficiency?
medication interactions
| pyroxidine supplements are often prescribed to patients taking isoniazid (anti-TB)
64
What are the symptoms of pyroxidine deficiency?
cheilosis, glossitis
65
What is a serious toxicity effect of pyroxidine?
sensory neuropathy, potentially irreversible
66
What is the most likely cause of a biotin deficiency?
inborn errors of metabolism
67
Folate:
causes of deficiency
serious effects of deficiency
causes of deficiency:
inadequate dietary intake
decreased absorption due to drugs like phenytoin, TMP-SMX
serious effects of deficiency: megaloblastic anemia, spina bifida in fetus of mom with folate deficiency
68
cyanocabalamin:
causes of deficiency
how to supplement for deficient patients
```
causes of deficiency:
decreased production of INTRINSIC FACTOR, which is produced by the stomach and is required for absorption of B12 (e.g. gastrectomy, h. pylori infection)
decreased absorption (absorbed in ileum of intestine): crohn's disease, surgical resection, PPIs
```
how to supplement: IM injections
69
What is the most common cause of vitamin C deficiency?
inadequate dietary intake (in U.S. - urban poor, elderly, alcoholism)
70
What are the symptoms of vitamin C deficiency?
| and what is the name of the condition associated with vitamin C deficiency?
Scurvy: petechiae, purpura, bleeding gums, impaired wound healing
71
What are the effects of vitamin C toxicity?
flatulence, diarrhea; can cause false-negative fecal occult tests as well as erroneous urine glucose tests
72
What is the most toxic vitamin?
| What is the least toxic fat-soluble vitamin?
most toxic: vitamin A
| least toxic fat-soluble: vitamin E
73
What is the optimal ratio of LDL:HDL?
3-3.5:1
74
What time of day are statins given? Why?
At night; because that is when your body makes cholesterol (while sleeping)
75
What is the definition of metabolic syndrome?
| What is metabolic syndrome a precursor to?
3 of the following 5 factors:
- -high waist circumference (men over 40 inches/102 cm, women over 35 inches/88 cm)
- -high blood pressure
- -high triglycerides
- -high blood sugar
- -low HDL (if you have high HDL, it can "cancel out" one of the previous bad factors)
* Metabolic syndrome is a precursor to DM2*
76
Which familial dyslipidemia increases the risk for pancreatitis?
familial hypertriglyceridemia
77
What is a critical lifestyle change for trying to increase HDL and lower LDL?
stop smoking
78
What other lifestyle change (besides stopping smoking) may be able to increase HDL?
aerobic exercise
79
What is the herbal supplement that has the most documented interactions with prescription drugs?
St. John's wort. This herbal supplement can reduce levels of verapamil, statins, antiretrovirals, antidepressants, etc. St. John's wort makes warfarin less effective.
80
What supplements should not be taken or should be taken with caution with warfarin?
St. John's wort
vitamin E
ginseng
81
What is the difference between the FDA requirements for safety and efficacy for drugs vs supplements?
Drugs: manufacturers must prove safe before drug is approved
Supplements: for supplements it's the opposite - the FDA must prove, after some adverse effects are observed, that the product poses a significant risk to the health of Americans.
Also, supplements are self-prescribed, so there is no controlled system for reporting adverse effects.
82
What do people take echinacea for?
Used to treat or prevent colds, flu, URI. Studies have shown no effect.
83
What do people take ginseng for?
| What are the interactions?
Overall health, immune system, boost energy.
| Interacts with warfarin and digoxin; do not take if previous CVA.
84
What do people take valerian for?
| What are the interactions?
Mild sedative for insomnia or anxiety.
Should not be taken with other sedatives.
No evidence to support the use of valerian for insomnia/anxiety.
85
What do people take gingko for?
| What does it interact with?
Memory, dementia.
Interacts with antiplatelets like aspirin and anticoagulants such as warfarin and heparin.
Reports of severe bleeding.
No studies have shown any improvement in cognition.
86
What vitamin is important for vision?
Vitamin A
87
What is the major effect of vitamin A deficiency (seen mostly in developing world)?
xerophthalmia (inadequate tears)
mild xerophthalmia causes night blindness
severe xerophthalmia causes blindness (from corneal ulceration/necrosis)
Also see Bitot spots in early deficiency (white patches on the conjunctiva)
88
What are the effects of vitamin A toxicity (seen mostly in developed countries)?
diplopia
bulging fontanels in infants
increased intracranial pressure, with papilledema, headaches, and decreased cognition
89
What are the functions of vitamin D?
vitamin D promotes calcium absorption - therefore vitamin D is important for bone health
90
What is a unique clinical finding that indicates vitamin D deficiency?
thoracic rosary, aka rachitic rosary
91
Vitamin D toxicity is not common, but what could it cause?
HYPERCALCEMIA
| stones, bones, groans, thrones (pee a lot), psychiatric overtones
92
What is the name of the condition associated with vitamin D deficiency? What are its symptoms?
rickets
rickets is impaired mineralization of growing bones, and can be observed clinically especially in weight-bearing long bones (curved).
93
What happens to adults with vitamin D deficiency?
Osteomalacia - poorly mineralized bones-> increased fracture risk
94
What symptoms can vitamin E deficiency cause?
ataxic gait
impaired balance & coordination
damage to retina of eye
95
Vitamin E is very low toxicity, but excessive supplementation can cause problems.
What is a population that may oversupplement vitamin E?
What is an effect of vitamin E toxicity?
Some elderly men oversupplement vitamin E, having heard that taking a lot of vitamin E is good for the prostate.
Vitamin E toxicity can impair the function of vitamin K, which would interfere with blood clotting.
96
Because of vitamin K's role in clotting, what dietary advice is given to patients with history of DVT and/or patients taking warfarin?
Vitamin K is primarily found in dark green leafy vegetables, so patients may be advised to decrease or at least not increase their consumption of these veggies.
97
What are some patient populations that may have vitamin K deficiency?
newborns
celiac disease/small bowel resection
patients taking broad-spectrum antibiotics
98
What is a drug prescribed for obesity and how does it work?
| What are some side effects?
Orlistat, or Alli (smaller dose)
interferes with fat absorption in the intestines (take the drug with meals)
diarrhea, gas, cramps
reduced absorption of fat-soluble vitamins
99
What are two other drugs prescribed for obesity?
| How do they work?
lorcaserin - increases feeling of satiety = eat less
| phentermine + topiramate = appetite suppressant + feelings of fullness
100
What is the current recommendation for referring patients for bariatric surgery?
BMI over 40, or BMI over 35 with obesity-related comorbities
101
What drug class should not be taken with vitamin A?
acne drugs in the Accutane class are a form of vitamin A; taking them with vitamin A can lead to vitamin A toxicity
102
How is hypercarotenosis (excess intake of beta carotenes) distinguished from jaundice?
Hypercarotenosis: palms and soles become pigmented, but not sclera
Jaundice: sclera will be pigmented as well
103
What is a main benefit of omega-3 fatty acids?
lower TG
104
What patients benefit from low protein diet?
chronic kidney disease, chronic liver disease
105
In what conditions is a high fiber diet recommended?
irritable bowel syndrome, diverticulitis
106
In what conditions is a diet low in potassium and phosphate recommended?
chronic kidney disease
107
What is the most common cause of hypocalcemia?
advanced CKD
108
What are the symptoms of hypocalcemia?
tetany, arrhythmias, seizures
109
What are the two main causes of hypercalcemia?
| What are two other causes?
```
two main causes:
--hyperparathyroidism
--malignancy
two other causes:
--excess intake of vitamin D
--thiazide diuretics
```
110
What is the treatment for malignant hypercalcemia?
bisphosphonates
111
Hyponatremia usually reflects _____ rather than ______.
Hyponatremia usually reflects excess water retention relative to sodium rather than sodium deficiency.
112
What are the symptoms of hyponatremia?
headache, lethargy, disorientation
| respiratory arrest, seizure, coma, brain damage
113
What are the elements of treatment for hyponatremia?
For all: restrict free water/hypotonic intake
For hypovolemic: IV isotonic fluids (e.g. normal saline, lactated Ringer's)
For hypervolemic: diuretics or dialysis
For euvolemic: restricting free water may be sufficient
114
What are the main defenses against hypernatremia? And, therefore, what is the main cause of hypernatremia?
The main defenses against hypernatremia are intact thirst mechanism and access to water (hypothalamus can detect minute changes in serum osmolality, triggering thirst mechanism and increased water intake).
Whatever the underlying mechanism, excess water loss can cause hypernatremia (but only when adequate water intake is not possible).
115
What are the symptoms of dehydration?
| What are subsequent signs of hypernatremia?
dehydration: orthostatic hypotension, oliguria
subsequently: lethargy, weakness, irritability
hyperthermia, delirium, seizures, coma
116
What is the general treatment for hypernatremia?
Correcting the cause of the fluid loss, replacing water, replacing electrolytes
117
complication of NG tube:
aspiration
118
complications of TPN (parenteral nutrition into central or peripheral line):
2 categories of complications, catheter-related and metabolic (due to what you're actually infusing into the person)
catheter-related: infiltration, phlebitis
ALSO - gut mucosal breakdown!
metabolic: various over or under levels of nutrients/components -> increase or decrease concentrations of the components in the solution you're infusing
119
Name 3 sports supplements
androstenedione
creatine
phosphocreatine
120
Why do people take androstenedione? What are its adverse effects?
supposedly builds muscle
Adverse effects:
1. decrease HDL
2. increase estrogen levels
3. false positive for anabolic steroids on urine test
4. banned by NCAA and International Doping Agency
121
Why do people take creatine and phosphocreatine? What are their adverse effects?
Since creatine and phosphocreatine in the body are used to create ATP, these supplements are thought to increase the amount of ATP available for intense exercise.
Adverse effects:
1. weight gain
2. muscle cramps
122
What are the most potent statins?
atorvastatin, rosuvastatin
123
```
What are the BMIs for
class I obesity
class II obesity
class III obesity
```
```
class I obesity: 30 - 34.9
class II obesity: 35 - 39.9
class III obesity: 40 and higher
```
124
What is the main difference in the treatment of kwashiorkor and marasmus?
For kwashiorkor, aggressive nutritional support is indicated.
For marasmus, treatment should be cautious and slow to avoid life-threatening imbalances.
125
Severe hypophosphatemia is common in ______
alcoholics
126
Symptoms of severe hypophospatemia are:
rhabdomyolysis, paresthesias, encephalopathy
127
What is the most common cause of hyperphosphatemia?
advanced CKD
128
Hyperkalemia can develop in patients taking ______, ______, _______
Hyperkalemia can develop in patients taking ACE inhibitors, angiotension-receptor blockers (ARBs), potassium-sparing diuretics
129
What is the most common cause of hypokalemia?
The most common cause of hypokalemia, especially in developing countries, is GI loss from diarrhea.
130
What are the visible symptoms of familial hypercholesteremia?
Corneal arcus, xanthomas
131
What is tested with a lipid profile/lipid panel?
total cholesterol, LDL, HDL, triglycerides
132
How is folate related to heart disease?
Homocysteine levels have been associated with an increased risk of heart disease.
Folate plays a role in converting homocysteine to methionine.
Therefore low levels of folate would lead to increased homocysteine -> heart disease risk.
High folate levels -> more conversion of homocysteine -> decreased risk of heart disease.
133
What are the differences in COMPOSITION and USE of the following oral rehydration solutions?
Resomal
ORS (oral rehydration solution/salts)
Both contain salt, chloride, glucose
Resomal also contains POTASSIUM and is used after LONG-TERM/SEVERE malnutrition
ORS does not contain potassium and is used after short-term malnutrition problems
134
What are the top 3 drugs for lowering LDL, in order from best to less-best?
Best: statins
next: bile sequestrants
next: niacin
135
How do you test for dehydration (hypernatremia)?
serum electrolytes, serum creatinine, serum osmolality, urine sodium
