Nutritional Disorders Flashcards
(170 cards)
1
Q
Micronutrients - act as _____, ______or ______ components
A
- coenzymes
- hormones
- structural
2
Q
What are trace minerals?
A
Elements present in living tissues in small amounts. Includes both essential and nonessential
3
Q
What are common causes of malnutrition? (4)
A
- Poverty: homeless, elderly, children of the poor
- Ignorance
- Chronic alcoholism
- Self-imposed dietary restrictions
4
Q
Deficiencies and over-indulgance/consumption of what 3 things can result in nutritional disease?
A
-Macros (CHO, Pro, Fats, Cals)
-Vitamins and Minerals
-Water (dehydration and water intoxication)
5
Q
Emaciation resulting from inadequate intake of calories (i.e. starvation)
A
marasmus
6
Q
Intake of what macros are deficient in marasmus?
A
all of them (CHO, Pro, fats)
7
Q
what occurs to the body during marasmus/starvation? (i.e. how does the body make energy?)
A
- uses stores of liver and muscle glycogen
- uses subcutaneous fat
- uses muscle protein (organ and blood protein conserved)
8
Q
selective protein malnourishment while maintaining calories from carbs
A
Kwashiorkor
9
Q
what CHO-rich and Pro-poor foods are often the cause of Kwashiorkor
A
maize (corn) and rice milk
10
Q
how is protein depletion manifested in the body in Kwashiorkor
A
loss of organ protein (albumin) –>
-generalized edema (anasarca)
-fatty liver
-hair and skin changes (loss of pigment and flaky skin)
-parotid enlargement
11
Q
why is body fat relatively spared in Kwashiorkor?
A
CHO supplies energy
12
Q
during Kwashiorkor, does the child appear emaciated? why/why not?
A
no –> edema = bloating
13
Q
what symptom of Kwashiorkor causes the protuberant abdomen?
A
fatty liver
14
Q
what hair and skin changes (due to protein deficiency) can be seen in Kwashiorkor?
A
-depigmented hair and alopecia “hair loss”
-flaky paint skin
15
Q
In marasmus visceral protein (organ and blood protein) is _______, while in Kwashiorkor it is _______.
A
- conserved (so near normal levels)
- lost
16
Q
self-induced starvation
A
anorexia nervosa
17
Q
what is the major population that anorexia nervosa is seen in?
A
young adult females
18
Q
what are the 2 major clinical symptoms of anorexia nervosa?
A
marasmus and amenorrhea (menstruation ceases)
19
Q
what causes the death of most anorexia nervosa patients?
A
starvation, infection, arrhythmia from hypokalemia
20
Q
what has the highest death rate of any psychiatric disorder?
A
anorexia nervosa
21
Q
purge eating followed by induced vomiting
A
bulimia
22
Q
what is the major population that bulimia is seen in?
A
young adult females
23
Q
what nutritional disorders result in parotid/salivary gland enlargement?
A
-marasmus
-Kwashiorkor
-anorexia nervosa
-bulimia
-obesity
24
Q
what does bulimia result in physiologically? (3)
A
-electrolyte imbalance (hypokalemia) –> arrhythmia
-acid erosion of lingual upper teeth surfaces (perimolysis)
-parotid enlargement
25
Both Anorexia nervosa and bulimia can feature a deficiency of what 3 vitamins/minerals?
-vitamin C
-niacin
-zinc
26
this occurs when caloric intake exceeds expenditure with excess being stored as triglycerides in adipose
obesity
27
T/F overeating is multifactorial due to both genetic and voluntary components
true
28
what 2 things regulate overeating?
-number of fat cells
-hypothalamus (hormones)
29
T/F childhood overeating increases the total number of fat cells, which will then become fixed by adolescence
true
30
What percent overweight is associated with health risks?
20% (BMI >30)
31
what type of fat is more dangerous/more associated with health risks: visceral or subcuntaneous?
visceral
32
in an obese state, what do fat cells produce? (3)
-leptin
-adiponectin
-cytokines
33
what does leptin do? is the net result good or bad? (2)
-decreases appetite in hypothalamus
-causes secretion of Norepinephrine --> burns fat
-GOOD
34
what does adiponectin do? is the net result good or bad? (2)
-directs fatty acids to muscle for oxidation
-makes liver sensitive to insulin
-GOOD
anti- inflammatory, diabetic, atherogenic, proliferative
fat burning molecule
35
T/F obese people have more fat cells at birth and defects in regulatory hormones or their receptors
true
(This is bad)
35
during a state of obesity, what hormone is produced in more excess by the stomach? what does it do?
-ghrelin
-increases appetite
35
what hormone is secreted after a meal? what organs make and secrete it? what part of the brain does it act on and what does it do?
-Peptide YY
-made in ileum and colon
-acts on hypothalamus to curb appetite
35
what do the cytokines that are made by fat cells cause? is the net result good or bad? (2)
-subclinical inflammation
-high C-reactive protein
-BAD
35
what is the proposed pathogenesis on how the gut microbiome affects obesity? (3)
-bacteria break down ingested indigestible polysaccharides --> simple carbs that can be digested --> increases caloric intake
-bacterial products increase ghrelin secretion = increases appetite
-bacterial products --> gut inflammation --> mucosa permeable to cytokines --> increased insulin resistance
35
T/F variations in gut bacteria/the gut microbiome can affect what and how much you eat
true
35
where in the brain is the appetite control center?
hypothalamus
35
in regards to preventing/treating obesity what bacteria should be introduced to the gut microbiome?
bacteria that produce butyrate
36
what are systemic health risks associated with obesity? (10)
-Type II Diabetes
-Hypertriglyceridemia
-hypercholesterolemia
-low HDL
-Fatty liver disease and cirrhosis
-gallstones
-hyperestrogemia
-cancer (esophagus, thyroid, colon, kidney, prostate, gallbladder)
-parotid enlargement
-Pickwickian (hypoventilation) syndrome
36
how does obesity correlate with T2DM comordibity?
obesity --> adipose produces cytokines --> inflammation --> activates IL-1 --> insulin resistance, elevated BG and compensatory hyperinsulinemia
36
what are gallstones composed of?
cholesterol
36
Hypertriglyceridemia, hypercholesterolemia, and low HDL, all of which can be caused by obesity, lead to what disease states? (3)
Atherosclerosis, heart attack, stroke
37
the hyperestrogenemia caused by obesity contributes to what disease states? (2)
endometrial and breast cancer
38
what is Pickwickian (hypoventilation) syndrome?
enormous abdominal obesity --> compresses diaphragm --> restricts ventilation, sleep apnea, hypoxia
39
what foods are a source of vitamin A? (3)
vegetables, dairy, liver
40
where is vitamin A stored in the body and for how long?
Ito (stellate) cells in the liver for 6 months
41
what are the functions of Vitamin A? (4)
-rhodopsin for night vision
-differentiation of mucous
-antioxidant
-enhances immune system
42
what disease states is vitamin A used in treatment for? (2)
psoriasis and a type of leukemia
43
what can cause a vitamin A deficiency? (2)
-diet
-fat malabsorption or bile disease
44
what are symptoms of a vitamin A deficiency? (3)
-night blindness
-squamous metaplasia
-increase mortality from infection (esp measles and diarrhea)
45
describe the symptoms of squamous metaplasia, which is caused by a vitamin A deficiency (7)
-dry eyes
-corneal blindness
-dry mouth
-skin lesions
-premalignant oral lesions
-pneumonia
-kidney stones
46
what are symptoms of a vitamin A overdose/excess? (3)
-carotemia (non-toxic)
-headaches & vomiting
-birth defects
47
in regards to vitamin A, what are pregnant women told not to take/use due to the correlation with birth defects?
retinoids
48
what is carotemia?
a yellow color in the skin and fat from stored beta carotene (from Vit A)
49
what are good sources of vitamin D?
-suntan (UVB for 15 min; 90%)
-dairy, fish oil, grains (10%)
50
what are the functions of vitamin D? (2)
-mineralizes osteoid
-maintain serum Ca2+
51
how does vitamin D maintain serum Ca2+? (3)
-increases intestinal absorption
-mobilizes Ca2+ from bone (with PTH)
-reabsorbs calcium from distal renal tubules
52
what does a vitamin D deficiency result in? (3)
-Kids = rickets
-adults = osteomalacia
-increased risk of cancer (colon, breast, prostate)
53
what can cause a vitamin D deficiency? (6)
-diet
-no sun
-genetic dz
-kidney dz
-malabsorption
-drugs
54
describe what happens during rickets? what does this result in, symptom-wise?
osteoid produced but is not mineralized =
-soft, deformed bones, bow legs, hypoplastic teeth, deformed skull
-persistence of distorted cartilage masses (Rachitic rosary and pigeon breast deformity)
(children)
55
describe what happens during osteomalacia?
bone fractures
56
can a vitamin D deficiency cause hypocalcemia?
yes but rare --> only if severely deficient bc PTH will mobilize Ca2+ from the bones
57
what can cause someone to have an excess of vitamin D?
dietary supplementation
58
what does vitamin D excess cause? (2)
-hypercalcemia
-kidney stones
59
people do not get enough vitamin D today because of _____
protection from sunlight
60
what disease states have a decreased risk when someone is taking a vitamin D Rx? (3)
-DM
-cancer
-alzheimers
-sepsis (possibly)
61
what are good sources of vitamin E?
widely available
62
where is vitamin E stored in the body?
fat deposits
63
what is the function of vitamin E?
antioxidant --> scavenges free radicals along with selenium
64
is a vitamin E deficiency caused by diet?
no
65
when can a vitamin E deficiency be seen?
with fat malabsorption diseases
66
what are 4 symptoms caused by a vitamin E deficiency?
-loss of nerve cells in spinal cord and nerve myelin --> loss of reflexes, proprioception, pain sensation
-shortened RBC life
-increase cancer?
-increased atherosclerosis?
67
what can excess vitamin E cause?
bleeding diathesis
68
what are good sources of vitamin K? (2)
leafy green vegetables and gut bacteria
69
what are the functions of vitamin K? (2)
-cofactor to carboxylate glutmate
-gets oxidizes as it carboxylates and is recycled when reduced by liver
70
as a cofactor to carboxylate glutmate, vitamin K allows calcium binding sites on what?
-clotting factors VII, IX, X, and prothrombin
-osteocalcin
71
what does osteocalcin do?
involved in calcium binding in the bone matrix
72
what can cause a vitamin K deficiency? (3)
-fat malabsorption diseases
-patients of coumadin
-no gut bacteria (antibiotics, neonatal period)
73
what symptoms occur due to a vitamin K deficiency? (2)
-bleeding (esp in neonates)
-poor calcification of bone matrix
74
what is B1?
thiamine
75
many foods are a good source of thiamine (B1), except what?
processed rice, sugar and flour
76
T/F cooking lowers thiamine/B1 levels?
true
77
what are the functions of thiamine (B1)? (3)
-synthesis of ATP
-pentose phosphate pathway
-maintains membranes of peripheral nerves
78
what can cause a thiamine (B1) deficiency? (3)
-diet of processed carbs
-alcoholism
-excess vomiting
79
what are the 2 thiamine (B1) deficiency diseases?
-Dry beri beri
-Wet beri beri
-Wernicke-Korsakoff sx
80
describe the symptoms of Dry beri beri (thiamine/B1 deficiency)
symmetric demyelinization of peripheral nerves --> wrist and ankle drop, loss of reflexes and muscle weakness
81
describe the symptoms of wet beri beri (thiamine/B1 deficiency)
-peripheral vasodilation
-flabby heart
-AV shunting of blood
-all result in: high output cardiac failure and edema
82
describe the symptoms of Wernicke-Korsakoff sx (thiamine/B1 deficiency)
-unsteady gait
-mental confusion
83
what is a good source of riboflavin/B2?
widely distributed
84
what is B2?
Riboflavin
85
what are the functions of riboflavin/B2? (2)
-FAD --> involved in REDOX rxns in intermediary metabolism
-mitochondrial enzymes
86
what can lead to a riboflavin/B2 deficiency? (4)
-impoverished countries
-malabsorption diseases
-alcoholism
-debilitation
87
what symptoms result from a riboflavin/B2 deficiency? (6)
-anemia
-angular cheilitis
-magenta tongue
-corneal vascularization and ulceration
-dermatitis of nasolabial folds (rare)
-genital lesions
88
what is a good source of niacin?
-grains, legumes (NOT corn)
-can be converted from tryptophan, which is in: fish, turkey, meat, nuts, grains
89
what are the functions of niacin? (2)
-NAD and NADP --> needed in intermediary metabolism of fat, CHO, amino acids
-large doses --> lowers LDLs
90
what can a niacin (or tryptophan) deficiency result from?
-corn diets (south)
-alcoholics
-eating disorders
-debilitating dz
-seizures meds
-carcinoid syndrome
91
what is carcinoid syndrome?
when tryptophan is converted to 5-HT can't be converted to niacin
92
what is the disease caused by a niacin deficiency?
Pellagra
93
what are the symptoms of pellagra (niacin deficiency)?
-thick, red, dry scaly skin patches around the neck
-oral lesions
-diarrhea caused by atrophy of columnar intestinal lining
-dementia caused by neuronal degeneration
(3Ds: dermatitis, diarrhea, dementia)
94
what can excess niacin result in?
-flushing of skin
-liver damage
-increases fasting blood sugar
(seen in high cholesterol tx)
95
what is B6?
Pyridoxine
96
what is a source of pyridoxine/B6?
widely distributed
97
what are the functions of pyridoxine/B6? (2)
-involved in metabolism of lipids and AAs
-required for heme synthesis
98
what can lead to a pyridoxine/B6 deficiency?
-destroyed in food processing
-antagonized by drugs (isoniazid, estrogens, alcohol)
-increased demand in pregnancy
99
what are the symptoms of a pyridoxine/B6 deficiency?
-elevated homocysteine --> atherosclerosis, thrombosis
-resembles riboflavin deficiency (angular cheilitis, glossitis, dermatitis, peripheral neruopathy)
-mild anemia
100
what are therapeutic doses of pyridoxine/B6 used for?
-carpal tunnel sx
-to counteract deficiency caused by isoniazid
101
what are good sources of Cobalamin/B12?
meat, gut bacteria
102
what is B12?
Cobalamin
103
what is required in order for Cobalamin/B12 to be absorbed? where is it absorbed?
-intrinsic factor (in stomach)
-absorbed in distal ileum
104
where is Cobalamin/B12 stored in the body and for how long?
liver; 5-20 years
105
what are the functions of Cobalamin/B12? (4)
-Converts homocysteine to methionine
- Converts methylmalonyl CoA to succinyl CoA
-Needed for folate metabolism and DNA synthesis
-maintenance of myelin in spinal cord
106
what can lead to a Cobalamin/B12 deficiency? (5)
-vegan (no other diet issue)
-chronic atrophic gastritis with loss of parietal cells (intrinsic factor)
-malabsorption in ileum (Crohn dz)
-lymphoid malignancies that steal B12
-chronic Nitric Oxide inhalation
107
why can chronic Nitric Oxide inhalation lead to a state of Cobalamin/B12 deficency?
NO = B12 antagonist = causes demyelination
108
what are symptoms of a Cobalamin/B12 deficency?
-megaloblastic anemia
-loss of other rapidly dividing cells (neutrophils, germ cells, intestinal epithelium, chronic atrophic glossitis)
-raises serum homocysteine levels
-raises methylmalonic acid levels
-demyelination
109
why does megaloblastic anemia occur during a Cobalamin/B12 deficency?
due to impaired folate utilization = RBCs get big but cannot divide
110
what do raised serum homocysteine levels (due to a Cobalamin/B12 deficency) lead to?
makes blood hypercoagulable --> accelerates atherosclerosis
111
what do raised methylmalonic acid levels (due to a Cobalamin/B12 deficency) lead to?
demyelination of spinal tracts --> numbness and tingling of extremities then irreversible paraplegia
112
what are good sources of folate?
Vegetables
113
T/F cooking can destroy folate
true
114
where is folate absorbed in the body?
proximal ileum
115
where is folate stored in the body and for how long?
liver; 6 mo
116
what is the function of folate?
required for DNA replication and cell division
117
what can lead to a folate deficiency? (6)
-diet
-pregnancy (6-fold increase in need)
-malignancies and chemo Rx
-alcohol (folate antagonist)
-BCP
-cigs
118
what symptoms can result from folate deficiency? (6)
-megaloblastic anemia (B12 anemia w/o neural defects)
-neutropenia, loss of germ cells and GI epithelium
-chronic atrophic glossitis
-colon cancer (contributes)
-increased serum homocysteine
-fetal neural tube defects (spina bifida)
119
what is ascorbic acid?
Vitamin C
120
what are goods sources of vitamin C?
fruits, vegetables, fish, milk
121
why are humans are one of the few animals that CANNOT make vitamin C?
missing enzyme L-gluconolactone oxidase
122
can vitamin C be stored?
no
123
what are the functions of vitamin C? (3)
-hydroxylation of procollagen
-antioxidant (with Vit W)
-synthesis of norepinephrine
124
what can lead to a vitamin C deficiency?
-weird diets --> only beef/dairy
-alcoholics
-elderly
-infants on formula
-faddists
-autism
-bulimia
125
when can a vitamin c deficiency occur?
2-3 months after 0 intake
126
what is a vitamin C deficiency?
Scurvy
127
what are symptoms of scurvy?
puerpera and hematomas in gingiva, skin, joints, and perisosteum
(swollen, bleeding gums and perifolicular hemorrhage with corkscrew hairs)
128
what is the pathogenesis behind the puerpera and hematomas in scurvy?
-collagen without hydroxyproline = weak (esp in caps and venules)
-deformed bones due to lack of osteoid matrix
129
how might vitamin C deficiency may contribute to GI cancers and atherosclerosis?
via reduced antioxidant effect
130
what can an excess in vitamin C result in?
kidney stones and Fe overload (only seen in high doses)
131
what vitamins and minerals have neurologic manifestations? (5)
-thiamine
-vitamin B12
-pyridoxine
-folate (embryonic neural tube defects)
-vitamin E
132
what vitamins and minerals have bone manifestations? (4)
-vitamin C (matrix)
-vitamin D (calcification)
-vitamin K (calcification)
-calcium
133
what vitamins and minerals are antioxidants? (4)
-Vit A, C, E
-Selenium
134
what vitamins and minerals have bleeding manifestations? (3)
Vit C, K and excess E
135
what vitamins and minerals have skin manifestations? (6)
-Vit A, C
-niacin
-riboflavin
-pyridoxine
-zinc
136
what vitamins and minerals have oral manifestations? (9)
-vitamin A
-vitamin B12
-folate
-riboflavin
-pyridoxine
-niacin
-iron
-vitamin C
-zinc
137
of the vitamins and minerals that have oral manifestations, which cause angular cheilitis and atrophic glossitis? (4)
-riboflavin
-pyridoxine
-niacin
-iron
138
of the vitamins and minerals that have oral manifestations, which cause bleeding gums and periodontal dz? (1)
Vitamin C
139
of the vitamins and minerals that have oral manifestations, which cause perioral rash?
zinc
140
which vitamins and minerals can be used for vitamin therapy?
-C, E (antioxidants)
-niacin (lowers LDL)
-folate and B12 (prevent neural defects, lower homocysteine, colon cancer)
-B complex (pregnancy)
-K (calcification)
-pyridoxine (carpal tunnel sx)
141
what is the function of calcium? (3)
-bone mineralization
-clotting factor
-regulated by PTH and Vit D
142
what causes hypocalcemia? (3)
-renal failure
-rickets
-no parathyroid (DiGeorge sx)
143
what causes hypercalcemia? (5)
-parathyroid tumor
-end stage renal dz with phosphate retention
-bone destroying tumors
-excess dietary Ca (antacids) or Vit D
-granulomatous dz (sarcoid)
144
what are signs of hypocalcemia? (3)
-hypocalcified teeth
-tetany
-no clotting disorder
145
what are signs of hypercalcemia?
metastatic calcification in alkaline tissue (stomach, lungs, kidney) --> causes nephrocalcinosis and nephrolithiasis with kidney damage
146
what are good sources of iron?
meat, green vegetables
147
how is iron stored?
conserved in the body from worn out RBC by macrophages as hemosiderin
148
what is the function of iron?
required for Hb, Mb, cytochromes and catalase
149
what can lead to an iron deficiency? (2)
-diet (rare -- formula fed infants, Scandinavians)
-Chronic blood loss (menstruation, GI ulcers, cancers)
150
what can an iron deficiency lead to? (3)
-anemia
-oral mucosal atrophy
-Plummer Vinson Sx
151
what is Plummer Vinson Sx?
severe iron deficiency in Scandinavian women --> leads to oral and esophageal atrophy with cancers
152
what can excess iron lead to? (2)
-hemosiderosis
-hemochromatosis
153
what is hemosiderosis?
iron stored in macrophages of bone marrow, LNs, and spleen --> no symptoms
154
what is hemochromatosis?
massive iron overload in many organs --> systemic dz
155
what can lead to a water deficiency?
-reduced intake
-excessive excretion
156
what can water intoxication lead to?
death by arrhythmia due to electrolyte imbalance (hypokalemia and hyponatremia) and pulmonary edema
157
what malabsorptive diseases are associated with vitamin/mineral deficiencies and which vitamins/minerals are involved? (5)
-Chron Dz: vit A, C, thiamine, folate, B12, D, Fe
-Celiac Dz: Zn, vit ADEK
-autoimmune chronic gastritis: B12
-total parenteral nutrition: given to pat with chronic Gi dz due to low thiamine, vit C, and Zn
-gastric bypass and banding
158
______ is the most common autosomal recessive disease in caucasians and leads to a deficiency in what vitamins/minerals?
-cystic fibrosis
-vit ADEK, Zn, fats
159
Autism usually correlates to Vit A and C deficiencies. why?
fresh fruits and vegetables cause taste and texture aversions = avoided
160
alcoholism can lead to a deficiency in what?
all B vitamins (antagonist)
