Nutritional Diseases Flashcards

Question

Pathology of vitamin K deficiency

Answer 1

Normal platelet count Elevated prothrombin time (PT) – extrinsic pathway Elevated partial thromboplastin time (PTT) – intrinsic pathway Bleeding gums/nose

Answer 2

BERIBERI The classic deficiency is known as beriberi “dry” – involves nervous system damage “wet” – associated with cardiomyopathy -characterized by a peripheral neuropathy that affects sensation particularly in the legs (associated with demyelination of peripheral nerves) In severe cases, korsakoff syndrome (characterized by impaired ocular motility, ataxia, mental confusion), edema and cardiomyopathy can occur -As a practical matter, when thiamine deficiency is suspected, usually all water-soluble vitamins (particularly B group) are supplemented

Answer 3

PELLAGRA nicotinamide, vitamin B3 The classic deficiency is known as pellagra (rough skin) Commonly associated with alcoholism 3 D’s – dermatitis, diarrhea, and dementia Hyperkeratosis and vesiculation of skin (skin on neck, chest and back of hands can become brown and scaly) Nausea, vomiting and diarrhea Insomnia, depression, confusion, and rapid mood change

Answer 4

ANEMIA AND POLYNEUROPATHY also known as cobalamin Widely distributed in foods, also produced by intestinal bacteria Deficiency results in pernicious anemia, spinal cord sclerosis, and atrophy of mucous tissue Taken up from the GI tract by intrinsic factor protein Nearly all instances of B12 deficiency are associated with gastric atrophy and lower intrinsic factor mediated uptake. In severe cases, can also be associated with a peripheral neuropathy, spinal cord sclerosis, and atrophy of some mucous tissue

Answer 5

SCURVY Classic deficiency is known as scurvy (e.g. traveling at see and lack of access to fruit) Required for maturation of collagen – deficiency results in an inability to produce mature collagen (connective tissue disorder) Inability to synthesize osteoid and dentin Decreased wound healing and loss of blood vessel wall integrity Fatique, purpura, dermatistis – in severe cases oral lesions

Answer 6

peripheral neuropathy Deficiency associated with anemia In severe cases can lead to a peripheral neuropathy Primary deficiencies are rare, but sub-clinical deficiencies may be more common

Answer 7

Angular chelitis – A painful inflammation and cracking in the corners of the mouth. It usually is related to a fungal infection Recurrent aphthous stomatitis – (recurring canker sores) Anemia, which can be induced by vitamin B deficiency, can increase the risk of these sores Chronic oral mucosal candidiasis – a fungal infection in the mouth, the candida albicans fungus is found naturally in the mouth. It does not normally cause problems. However, B vitamin deficiency increases susceptibility to overgrowth Atropic glossitis – A condition that causes the taste buds to degenerate, making the tongue look “bald.” This condition affects the sense of taste. It can occur with a severe vitamin deficiency. Burning mouth syndrome – burning sensation in the mouth, especially on the tongue. People with this deficiency can also have trouble swallowing. The tongue may feel swollen. The tissue of the inner cheeks can be pale and may break apart easily and slough off

Answer 8

Iodine – deficiency causes hypothyroidism and goiter Calcium-Required for bone mineralization, doses above the RDA delay bone loss observed in the elderly. Low dietary calcium is associated with an increased risk of periodontal disease Iron – deficiency causes anemia

Answer 9

Many elements are required in small amounts for normal development and metabolism, but there are only a few for which overt deficiency syndromes have been reported. Zinc –an exception; sometimes a secondary effect; deficiency originally described in patients receiving total parenteral nutrition. Can also be a secondary effect of acrodermatitis enteropathica. Characterized by alopecia, dermatitis, and diarrhea. Copper – deficiencies associated with severe malabsorption syndromes or total parenteral nutrition. Deficiency resembles iron deficiency anemia and osteoporosis Fluoride – level in drinking water greater than 1 ppm can cause mottling of teeth. Chronic fluorosis can produce abnormal calcification of tendons and ligaments.

Answer 10

Usually associated with megavitamin dietary regimes Vitamin A – LIVER DAMAGE. Both acute and chronic effects. Intake 6-7 times the RDA can produce decreased growth, bone pain, and liver damage. Vitamin D – ABNORMAL CALCIFICATION. Chronic effects include abnormal calcification in heart and kidney. Vitamin E – Daily doses above 800 IU have been reported to cause elevated serum lipids and depressed thyroxine (rare). Main effect is to antagonize vitamin K (increased bleeding times)

Answer 11

-Nicotinic acid – skin flushing, itching & skin rashes. Some altered liver function (requires hundreds of mgs) -Thiamine – when injected, hypersensitivity reaction at site of injection. -Vitamin C – G.I. disturbances & skin rash (very rare) -Folic acid – may cause birth defects -Pyridoxine – sensory neuropathy

Answer 12

-Controls – in most nutritional studies there are no unexposed controls. -Multiple variables – some nutrients are highly correlated (so-called co-correlates) -Animal studies: Rarely duplicate the nutritional status of humans and Physiological differences between species Must compress what happens in years to week or months -Accurate reporting – human diets are complex and constantly changing. Most individuals cannot accurately recall meaningful details for any reasonable period of time – limits the usefulness of “controlled case studies.”

Answer 13

suggests rates are dependent on UV; higher prostate cancer in northern states

Answer 14

-The main known environmental causes of human cancers are smoking, dietary imbalances (excess fat/calories), and chronic infections leading to chronic inflammation (hepatitis B/C, H. pylori infection, schistosomiasis, etc.) An increased risk of certain cancers is related to obesity and/or dietary fat (type as well as amount) (KNOW THIS) Colon Endometrium Breast Ovary Prostate Kidney There does not appear to be a clear and simple relationship between dietary fiber and colon cancer.

Answer 15

Additives – nitrates (converted to nitrosamines) Naturally occurring – 99.9% or more of chemicals we eat are from natural sources. A wide variety of natural substances are known mutagens or can cause cancer in rodent test. Storage and processing products. Cooking food also generates many chemicals (pyrolysis products).

Answer 16

mold metabolites knows as aflatoxins--some of the most potent carcinogens

Answer 17

convert natural metabolites into heterocyclic amines (HCAs) | -HCA are mutagenic

Answer 18

- epidemiology evidence for relationship between the intake of highly salted foods and stomach cancer - Incidence of stomach cancer in Japan is high while stomach cancer rates in US are low and declining (has decreased 4-fold since 1930) - appears to be correlation between the decline in stomach cancer and the decline in the use of salt-pickling to preserve food

Answer 19

Association between alcohol consumption and “aerodigestive” cancers-KNOW THESE CANCER Oral cavity Pharynx Esophagus Larynx Liver Weaker association with breast, colorectal and lung cancer Smoking seems to have a multiplicative effect

Answer 20

Vitamin A – Initial studies found that β-carotene or retinoid supplements had no beneficial effect on cancer risk. T-hese supplements may actually increase the incidence of lung cancer in high-risk smokers. Vitamin C – no conclusive evidence dietary supplements affect cancer risk. Vitamin D – Some evidence of an inverse relationship between Vitamin D levels and incidence of certain cancers (particular colon cancer) Vitamin E – Initial human studies are suggestive, but not clearly shown an effect of dietary supplements on cancer risk with the exception of prostate cancer (esp. smokers) However, two recent studies indicated that taking a multi-vitamin supplement over an 8 year period had no effect on cancer risk, CVD risk, or overall mortality.

Answer 21

Epidemiological studies suggest a relationship between plant constituents and decreased cancer risk. A ``` Carotenoids – carotene, lycopene, lutein Terpenes – perillyl alcohol Indoles – indole-3-carbinol Soy isoflavones – genestein, daidzin Polyphenols - curcumin Organosulphur compounds – diallyl sulphide ```

Answer 22

``` What is obesity? ≥ 25% body fat in men ≥ 30% body fat in women Body Mass Index Wt (kg) Wt in lbs x 0.454 ht2 (m) (ht in inches x 0.0253)2 ``` Values greater than 25-27 indicates increased health risk Values of 30 or more are consider obese Overestimates fatness in muscular or athletic people. Not a good index for adolescents or children

Answer 23

``` Cardiovascular disease Type II diabetes (maturity-onset) Cholelithiasis (gall bladder disease) Cancer – specific types Hypertension Osteoarthritis Thrombosis While anemia may be the most common nutritional disorder, obesity is the most serious (in U.S.). ```

Answer 24

- Drinking too much can raise blood pressure, cause heart failure and lead to stroke. It can contribute to high triglycerides, cancer and other diseases. - The risk of heart disease in people who drink moderate amounts (average of one drink for women or two drinks for men per day) is 30-50% lower than in nondrinkers - One drink is defined as 1-1/2 fluid ounces (fl oz) of 80-proof spirits (such as bourbon, scotch, vokka, gin etc.), 1 fl oz of 100-proof spirits, 4 fl oz of wine, of 12 fl oz of beer. - AHA does not recommend that nondrinkers start using alcohol or that drinkers increase the amount they drink

Answer 25

- Low-carbohydrate/high fat diets are slightly more effective in inducing weight loss in the short term (i.e. 6 months), but little is known about long-term effects. - Low-carbohydrate/high fat diets can have beneficial effects on the risk of heart disease provided that they are high in polyunsaturated and mono-unsaturated fatty acids and limit saturated and trans fat intake (Mediterranean pattern) - Long term fat restriction has negligible effect on weight loss and risk of cardiovascular disease - There is no conclusive evidence that one popular diet is superior to another in long-term weight control - Finally, compliance and the “rebound effect” on all diets are major problems

Answer 26

despite the widespread view that there is a relationship between dietary sucrose and hyperactivity in children, controlled experiments have not been able to demonstrate a direct effect.

Answer 27

-P-artially hydrogenated oils (trans fats or TFAs) are linked to coronary artery disease (epidemiological studies) -TFAs ↑ LDL cholesterol and ↓ HDL cholesterol levels Little is know nabout the mechanism of TFA action It is no clear what dietary intake of TFAs is clinically significant

Answer 28

Niacin: Very high levels of niacin supplements (500-2,500 mg/day) have been shown to reduce serum cholesterol and triglycerides in many people. Very high levels (0.5-2.5 gms/day) can decrease total cholesterol, increase HDL and decrease LDL. In some studies, niacin was as effective as “statin-type” drugs in reducing serum cholesterol. Contra-indicated for individuals with abnormal liver function or high blood pressure. 20-30% of individuals experience an unpleasant skin flushing reaction to niacin. ``` mega-3 (n-3) fatty acids – constituent of fish oil ↓ Triglycerides ↑ HDL-cholesterol ↓ Platelet reactivity ↓ Monocyte and neutrophil reactivity ↓ Blood pressure Antiarrhythmic properties n practical doses, n-3 PUFA slightly increase HDL cholesterol, substantially decrease plasma triglycerides, reduce the reactivity of platelets, monocytes, and neutrophils, reduce blood pressure, and have antiarrhythmic properties. ```

Answer 29

Requirement ~4 gms Na/Cl/day (70meq/day) In Japan daily intake is >400 meq/day, cerebrovascular disease is the second most common cause of death Direct relationship between sodium intake and blood pressure;not clear how much salt is required to produce a clinically significant increase; more acute in renal dialysis patients ~50 million people in US are hypertensive (≥140/90) ~30% of the US population is genetically “sensitive” to dietary sodium. Individuals who do not produce enough ADH (adrenal insufficiency) should not be on low sodium diets. Recommended daily salt consumption (NHLBI) is no more than 2.4 gms Na (~6 gms NaCl) In Japan, where cerebrovascular disease is a leading cause of death, the average daily intake is over 400 meq (~20 gm/day).

Answer 30

``` a secondary manifestation of an underlying primary condition or disorder. Chronic alcoholism Pregnancy and lactation Renal dialysis Eating disorders Prolonged use of diuretics Malabsorption syndromes (celiac disease) Neoplasms Food fads Vegans ```

Answer 31

Prospective studies show that high fat diets are a risk factor in atherosclerosis. The American Heart Association recommends that dietary fat represent no more than 30% of total caloric intake. High serum cholesterol levels are clearly a risk factor in atherosclerosis, however the relationship between dietary cholesterol intake and serum cholesterol levels is not a direct function (because of hepatic cholesterol synthesis).

Answer 32

calories (not fat/carbs)

Answer 33

increase LDL cholesterol levels and decrease HDL cholesterol levels

Answer 34

Risks of low sodium diets - For individuals with adrenal insufficiency (low ADH - lose sodium) - hyponatremia.

Nutritional Diseases Flashcards

(58 cards)