Week 7 NUR 425 - Nutrition Review Questions

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Questions and Answers

Which of the following is a fat-soluble vitamin?

Vitamin D (correct)

Vitamin B6

Vitamin C

Vitamin B12

During starvation, how does the body utilize different macronutrients?

Uses carbohydrates and proteins simultaneously, then fats

Uses proteins first, then fats, and finally carbohydrates

Uses fats first, then carbohydrates, and finally proteins

Uses carbohydrates first, then fats, and finally proteins (correct)

Which of the following is a primary function of protein in the body?

Energy storage

Hormone production

Insulation

Tissue growth and repair (correct)

Which vitamin deficiency is most likely to occur with a decreased intake of fats?

Vitamin K Signup and view all the answers

A patient with anorexia nervosa is most likely to present with which of the following clinical manifestations? (SATA)

Lanugo Signup and view all the answers

A patient with bulimia nervosa may present with which of the following laboratory findings?

Increased amylase levels Signup and view all the answers

Which hormone, primarily produced by adipocytes acts as an appetite suppressant?

Leptin Signup and view all the answers

Which medication reduces the metabolism and absorption of fat in the GI tract by inhibiting the action of digestive enzymes?

Orlistat Signup and view all the answers

Which surgical approach involves reducing the size of the stomach by placing an inflatable band around it?

Gastric banding Signup and view all the answers

Which of the following vitamins is essential for the metabolism of calcium and maintenance of bone health?

Vitamin D Signup and view all the answers

Which vitamin is used prenatally to prevent neural tube defects in the fetus and can manifest as anencephaly or spina bifida if deficient?

Vitamin B9 (Folic Acid) Signup and view all the answers

What vitamin deficiency is a vegan diet most likely to cause?

Vitamin B12 (Cobalamin) Signup and view all the answers

What physical exam finding is NOT typically associated with Vitamin B, iron, and protein deficiency?

Weight gain Signup and view all the answers

Which vitamin deficiencies can result in oral crusting and ulcerations?

Vitamin B and C Signup and view all the answers

What condition results from excessive intake of nutrients?

Over-nutrition Signup and view all the answers

Which nutrient makes up 25-35% of daily calorie intake and carries essential fatty acids?

Fats Signup and view all the answers

Which of the following factors is most likely to influence personal dietary choices?

Cultural beliefs Signup and view all the answers

Which electrolyte imbalance is most likely to cause muscle weakness and respiratory failure during refeeding syndrome?

Hypophosphatemia Signup and view all the answers

What is a critical strategy to prevent refeeding syndrome when introducing nutrition to a malnourished individual?

Gradually reintroduce calories Signup and view all the answers

Which symptom is associated with both lack of glucose and essential vitamins and minerals?

Irritability and confusion Signup and view all the answers

Which electrolyte imbalance is commonly associated with cardiovascular issues during refeeding syndrome?

Hypokalemia Signup and view all the answers

What type of malnutrition is characterized by a prolonged lack of food intake?

Starvation-related malnutrition Signup and view all the answers

What is a common cause of malnutrition linked to inadequate financial resources?

Food insecurity Signup and view all the answers

What daily supplement of Vitamin D is recommended for individuals aged 50 and above?

400 IU Signup and view all the answers

Which symptom is associated with anorexia nervosa?

Compulsive exercising Signup and view all the answers

Which eating disorder is characterized by periods of food restriction followed by binge eating?

Bulimia nervosa Signup and view all the answers

Which of the following is NOT one of the types of malnutrition?

Environmental toxin-related malnutrition Signup and view all the answers

What condition is associated with the impaired absorption of nutrients in the small intestine?

Malabsorption syndrome Signup and view all the answers

What can cause significant potassium loss in individuals with eating disorders?

Vomiting or overuse of diuretics Signup and view all the answers

What might someone with bulimia nervosa present with?

Tooth decay and erosion, swollen salivary glands, broken blood vessels in eyes, peripheral edema Signup and view all the answers

What physiological change might be observed in individuals with bulimia nervosa?

Hypokalemia Signup and view all the answers

What is the result of peripheral edema in the context of eating disorders?

Fluid retention due to electrolyte imbalances Signup and view all the answers

Which metabolic product can be generated from fatty acids during starvation?

Ketones Signup and view all the answers

What metabolic process primarily occurs after carbohydrate stores are depleted during starvation?

Fat oxidation Signup and view all the answers

What condition is primarily associated with increased waist circumference in metabolic syndrome for AMAB (Assigned Male At Birth)?

Exactly or greater than 102 cm Signup and view all the answers

Which health risk is NOT commonly associated with obesity?

Hypoglycemia Signup and view all the answers

Which dietary change is considered beneficial for controlling blood sugar levels in obesity management?

Diet rich in fruits and vegetables Signup and view all the answers

What is the main underlying risk factor for developing metabolic syndrome?

Insulin resistance Signup and view all the answers

Which health-management approach for obesity emphasizes improving metabolic and mental health rather than solely focusing on weight loss?

Health-behavior changes Signup and view all the answers

What is a major consequence of hyperinsulinemia in the context of insulin resistance?

Increased food intake Signup and view all the answers

What BMI range is classified as overweight?

25 - 29.9 Signup and view all the answers

Which of the following hormones is primarily associated with stimulating appetite?

Ghrelin Signup and view all the answers

What health risk is higher in individuals with android obesity compared to gynoid obesity?

Hypertension Signup and view all the answers

What is the optimal waist-to-hip ratio?

< 0.8 Signup and view all the answers

Which genetic factor is linked to weight gain, particularly regarding BMI?

FTO gene Signup and view all the answers

What is a primary cause of weight gain related to hormone dysregulation?

Elevated levels of ghrelin Signup and view all the answers

What role does the hypothalamus play in regulating weight gain?

Influences nutrient usage and storage through hormone production Signup and view all the answers

Which medication is known to be an opioid antagonist and is utilized for weight loss management?

Naltrexone Signup and view all the answers

What is a common side effect of Naltrexone/Bupropion?

Nausea Signup and view all the answers

Which of the following is a contraindication for the use of Orlistat?

Chronic malabsorption syndrome Signup and view all the answers

What main action does Orlistat perform in the gastrointestinal tract?

Reduces metabolism and absorption of fat Signup and view all the answers

Which surgery reduces the stomach size by removing approximately 75% of it?

Vertical sleeve gastrectomy Signup and view all the answers

What role is Naltrexone thought to play in weight loss?

Regulates appetite via the hypothalamus Signup and view all the answers

What is a potential rare adverse effect of Naltrexone/Bupropion?

Seizures Signup and view all the answers

Which of the following is a health benefit associated with Orlistat?

Reduced total & LDL cholesterol Signup and view all the answers

What is required for the success of bariatric surgery after the procedure?

Long-term lifestyle changes Signup and view all the answers

What symptom is most commonly associated with wet beriberi?

Shortness of breath Signup and view all the answers

Which vitamin plays a significant role in red blood cell production and can cause anemia if deficient? (SATA)

Vitamin B9 Signup and view all the answers

Which dietary source is particularly rich in Vitamin B12?

Clams Signup and view all the answers

What condition may result from a deficiency in Vitamin B9 during pregnancy?

Neural tube defects Signup and view all the answers

Which vitamin’s deficiency might be more likely in individuals with autoimmune disorders?

Vitamin B6 Signup and view all the answers

Which of these is a primary function of Vitamin B6?

Amino acid metabolism Signup and view all the answers

Which of the following is NOT a common symptom of Vitamin B2 riboflavin deficiency?

Numbness Signup and view all the answers

Which vitamin is primarily responsible for collagen synthesis and the absorption of iron?

Vitamin C Signup and view all the answers

What condition may result from Vitamin D deficiency in adults?

Osteomalacia Signup and view all the answers

Which of the following is a potential symptom of Vitamin B1 (Thiamine) deficiency?

Clumsy movement Signup and view all the answers

What is a potential consequence of a severe deficiency in Vitamin C?

Problems with teeth and bones development Signup and view all the answers

Which vitamins play a role in the synthesis of neurotransmitters?

Vitamin B1 and Vitamin C Signup and view all the answers

What is a significant dietary source of Vitamin C?

Citrus fruits Signup and view all the answers

What are common dietary sources of Vitamin B1 (Thiamine)?

Enriched, fortified, or whole-grain products Signup and view all the answers

Study Notes

Fat-Soluble Vitamins

Vitamin D is fat-soluble.

Macronutrient Utilization during Starvation

The body carbohydrates first, then fats, and finally proteins during starvation.

Protein Function

Protein is essential for tissue growth and repair.

Fat-Soluble Vitamin Deficiency

A decreased intake of fats can lead to a deficiency in Vitamin K.

Anorexia Nervosa Clinical Manifestations

Anorexia nervosa can manifest as lanugo, hypophosphatemia, sensitivity to cold, and ocular edema.
Oily skin is not a clinical manifestation of Anorexia nervosa.

Bulimia Nervosa Laboratory Findings

Bulimia nervosa can present with increased amylase levels.
Hyperkalemia, hyperglycemia, and hypercalcemia are not associated with Bulimia nervosa.

Appetite Suppressant Hormone

Leptin, primarily produced by adipocytes, acts as an appetite suppressant.

Fat Absorption Inhibition Medication

Orlistat reduces fat metabolism and absorption in the GI tract by inhibiting digestive enzymes.

Gastric Banding

Gastric banding involves reducing the size of the stomach by placing an inflatable band around it.

Vitamin Essential for Calcium Metabolism and Bone Health

Vitamin D is essential for calcium metabolism and bone health.

Neural Tube Defect Prevention

Vitamin B9 (Folic Acid) is essential for the prevention of neural tube defects, which can manifest as anencephaly or spina bifida if deficient.

Vegan Diet & Vitamin Deficiency

A vegan diet is associated with an increased risk of Vitamin B12 (Cobalamin) deficiency.

Vitamin B9 (Folic Acid) and Neural Tube Defects

Folic acid is essential for preventing neural tube defects in fetuses.
Deficiency in folic acid can lead to anencephaly or spina bifida.

Vitamin B12 (Cobalamin) and Vegan Diets

Vegans are at a higher risk of vitamin B12 deficiency.
Vitamin B12 is primarily found in animal products.

Energy Source

When fat stores are exhausted, the body breaks down proteins into amino acids, which are converted into glucose.

Malnutrition: Physical Exam Findings

Dry, scaly skin, brittle nails, hair loss can indicate a deficiency in Vitamin B, iron, and protein.
Oral crusting and ulcerations may suggest Vitamin B and C deficiencies.
Decreased muscle mass and weakness can be signs of malnutrition.
Irritability and confusion can indicate lack of glucose and essential vitamins and minerals.
Older adults may have more pronounced malnutrition signs due to decreased appetite, metabolic changes, and underlying health issues.

Refeeding Syndrome

A serious and potentially life-threatening condition that can occur when a malnourished individual is reintroduced to nutrition too quickly.
It causes fluid and electrolyte imbalances, leading to potential complications in the cardiovascular, hematologic, and neurological systems.
Common electrolyte imbalances include hypophosphatemia, hypokalemia, and hypomagnesemia.
To prevent refeeding syndrome, calories should be gradually reintroduced while closely monitoring electrolyte levels and clinical signs.

Malnutrition

A deficit, excess, or imbalance of essential nutrients in a balanced diet.
Types of malnutrition include:
- Starvation-related malnutrition: Prolonged lack of food intake.
- Chronic disease-related malnutrition: Associated with long-term health conditions.
- Acute disease or injury-related malnutrition: Due to sudden illness or trauma.

Causes of Malnutrition

Food insecurity: Limited access to food due to financial constraints.
Physical illness: Impact of illness, surgery, injury, and hospitalization.
Malabsorption syndrome: Impaired absorption of nutrients in the small intestine.
Incomplete diet: Dietary patterns lacking essential nutrients, possibly due to dietary restrictions, poor food choices, or lack of nutritional knowledge.
Eating disorders:
- Anorexia nervosa:
  - Deliberate self-starvation and intense fear of gaining weight.
  - May present with:
    - Lanugo: Fine, soft hair growth as the body tries to insulate.
    - Sensitivity to cold: Due to lack of body fat insulation.
    - Compulsive exercising: To control weight or cope with anxiety related to distorted body image.
    - Absent or irregular menstruation: Hormonal imbalance caused by low body fat prioritizes survival over reproductive processes.
    - Dry skin: Lack of essential fatty acids.
    - Constipation: Reduced food intake, low fiber consumption, and potential dehydration.
  - Hypokalemia: Can occur with inadequate potassium intake or purging behaviors, contributing to muscle weakness, irregular heart rhythms, and potential cardiac complications.
- Bulimia nervosa:
  - Cycles of food restriction followed by binge eating, accompanied by feelings of loss of control and body image concerns.
  - May present with:
    - Dental issues: Tooth decay and erosion from stomach acid exposure due to vomiting.
    - Swollen salivary glands: Frequent vomiting stimulates the glands, causing inflammation and enlargement.
    - Broken blood vessels in the eyes: Physical strain from purging increases pressure in the head.
    - Peripheral edema: Electrolyte imbalances from purging lead to fluid retention.
  - Increased amylase and hypokalemia: Increased amylase production due to salivary gland stimulation, and hypokalemia may result from purging behaviors.

Pathophysiology of Starvation

During starvation, the body undergoes metabolic changes to meet energy needs.
Initially, carbohydrates in the form of glycogen provide energy. As glycogen stores deplete, fats are converted into glycerol and fatty acids.
Glycerol is converted into glucose, while fatty acids produce ketones, serving as an alternative energy source.

Nutrition

The process of how the body utilizes food for energy, growth, maintenance, and tissue repair.
Nutritional status:
- Under-nutrition: Insufficient nutrient intake leading to health issues.
- Optimal nutrition: Balanced intake of essential nutrients supporting overall health and well-being.
- Over-nutrition: Excessive intake of nutrients, potentially causing obesity and related health problems.
Role of bias: Personal and cultural biases can influence dietary choices and perceptions of a healthy diet.

Major Nutrients

Carbohydrates (including fiber): Primary source of energy.
Fat: Provides energy and acts as insulation.
Protein: Essential for tissue growth, repair, and maintenance.
Vitamins & Minerals: Crucial for metabolic processes and maintaining health.
Water: Essential for hydration and bodily functions.
Average adults require about 20-35 kcal/kg of body weight daily, with increased needs during illness or activity.

Carbohydrates

Primary source of energy for the body.
Make up 45-65% of daily calories generally.
Types:
- Simple: Monosaccharides and disaccharides.
- Complex: Polysaccharides.
Fiber:
- Indigestible part of plant foods.
- High levels associate with improved cholesterol and better glycemic control.
Sources of healthy carbohydrates: Fruits, vegetables, legumes, nuts, seeds, and whole grain foods (e.g., whole grain breads, brown rice, oats, quinoa, barley).

Fats

Source of energy and insulation.
Essential for cell membrane structure, cell functioning, and hormone synthesis.
Make up 25-35% of daily calories generally.
Carry essential fatty acids and fat-soluble vitamins (A, D, E, K).
Types:
- Monounsaturated: (e.g., olive oil, avocados, nuts) – Healthy fats, help reduce LDL cholesterol levels and lower heart disease/stroke risk.
- Polyunsaturated: (e.g., salmon, flaxseeds, walnuts) – Healthy fats, essential for brain function and cell growth.
- Saturated: (e.g., butter, fatty meats, full-fat dairy) – Should be consumed in moderation, potential for raising LDL cholesterol levels.
- Trans fats: (e.g., processed foods, fried foods) – Unhealthy fats, contribute to increased LDL cholesterol and risk of heart disease, should be avoided.

Protein

Essential for building and repairing tissues, making enzymes, hormones, and antibodies.
It is important for maintaining fluid balance and regulating blood sugar levels.
Should make up 10-35% of daily calories.
Types:
- Complete proteins: Contain all 9 essential amino acids (e.g., meat, poultry, fish, eggs, dairy).
- Incomplete proteins: Lack one or more essential amino acids (e.g., beans, lentils, nuts, seeds).
Sources of protein: Meat, poultry, fish, eggs, dairy, beans, lentils, nuts, seeds, soy products.

Vitamins

Organic compounds needed for various metabolic function and maintaining health.
Classified as fat-soluble (A, D, E, K) or water-soluble (B vitamins and C).
Deficiencies can lead to health issues, while excessive intake can be harmful.

Minerals

Inorganic substances essential for numerous bodily functions.
Major minerals are needed in larger amounts (e.g., calcium, phosphorus, potassium, magnesium).
Trace minerals are required in smaller amounts (e.g., iron, zinc, copper, iodine).
Deficiencies and excesses can negatively impact health.

Water

Crucial for hydration, supporting various bodily functions.
Involved in temperature regulation, nutrient transport, waste removal, and joint lubrication.
Adequate water intake is essential for overall health.

Metabolic Syndrome

A cluster of risk factors that increases the risk of developing cardiovascular disease (CVD) and diabetes.
The main underlying risk factor is insulin resistance.
Insulin resistance is a decreased ability of the body to respond to insulin.
The pancreas tries to compensate for this by producing more insulin, leading to hyperinsulinemia.
Diagnosis requires at least 3 of the following:
- Increased waist circumference: greater than 102 cm for AMAB, greater than 88 cm for AFAB
- Elevated triglyceride levels: greater than 1.7 mmol/L or medical treatment for elevated triglyceride levels
- Reduced HDL cholesterol level: less than 1.0 mmol/L for AMAB, less than 1.3 mmol/L for AFAB, or medication treatment for hypertension
- Elevated fasting glucose level: greater than 5.6 mmol/L or medication treatment for elevated glucose levels

Metabolic Syndrome: Management

It involves managing risk factors and making lifestyle changes.
Regular exercise is beneficial.
- Improves insulin sensitivity, reduces blood pressure, and helps manage weight.
A healthy diet is essential.
- A diet rich in fruits, vegetables, whole grains, and lean proteins is ideal.
- This can help control blood sugar levels, lower cholesterol, and reduce inflammation.

Health Risks Associated with Obesity

Increased risk of:
- Respiratory: sleep apnea
- Type 2 diabetes
- Osteoarthritis
- GERD
- Cholelithiasis (gallstones)
- Cancer: Increased risk for certain types.

Obesity: Management

Prioritize enhancing health factors such as metabolic, mechanical, mental health, and QoL, not just weight loss.
Management should encompass outcomes significant to the patient.
Management options include:
- Health-behavior changes:
  - Diet and physical activity
  - Behavioral strategies like goal setting and stress management.
  - Medications
  - Surgery

Assessment of Obesity

Body Mass Index (BMI):
- Measured in kilograms per meter squared.
- A BMI of 25-29.9 is considered overweight.
- A BMI of 30 and over is classified as obesity.
- Limitations: Does not account for muscle mass or fat distribution.
Waist Circumference:
- Greater than 102 cm for AMAB, greater than 88 cm for AFAB.
Waist-to-Hip Ratio:
- Calculated by dividing waist measurement by hip measurement.
- Less than 0.8 is optimal.
- AMAB: 0.9 or greater, AFAB: 0.85 or greater.
Body Shape
- Android obesity (apple shaped):
  - Higher health risks compared to Gynoid obesity.
- Gynoid obesity (pear shaped)

Obesity: Genetic Factors

These are not fully understood.
Several genes are thought to be associated with weight gain.
A link has been found between the FTO (fat mass and obesity-associated) gene and BMI.
Variants of this gene may play a role in weight gain.

Obesity: Role of Hypothalamus

The hypothalamus produces peptides that influence how nutrients are used and stored.
Decreased neuropeptide production is associated with weight gain.
Research is investigating how hormones and peptides interacting with the hypothalamus influence weight gain.

Obesity: Role of Hormone Dysregulation

Weight gain can be influenced by hormones that stimulate and suppress appetite.
Ghrelin: Appetite stimulant
- Primarily produced by the stomach and is regulated by food intake patterns.
- Levels usually decrease after eating and rise before a meal or after fasting, causing hunger.
Leptin: Appetite suppressant
- Primarily produced by adipocytes (fat cells).
- Signals satiety.
- In leptin resistance, the brain does not respond to increased leptin levels, contributing to continued hunger and overeating.

Obesity: Other Factors

Environmental factors:
- Availability and accessibility of healthy foods and opportunities for physical activity.
- These factors can contribute to the management of obesity and type 2 diabetes.

Medications for Obesity Management

Naltrexone/Bupropion (Contrave)
- Naltrexone: Opioid antagonist
- Bupropion: Atypical antidepressant, also used for smoking cessation.
- Mechanism of action is unclear.
- Thought to play a role in appetite regulation by the hypothalamus.
- Oral administration twice daily.
- Contraindications: Seizure disorders, uncontrolled hypertension, opioid use, pregnancy.
- Common side effects: Nausea, constipation, headache, dizziness, insomnia, dry mouth, increased sweating.
- Rare AEs: Suicidal thoughts or feelings, seizures, increased heart rate, hypertension, liver damage.
Orlistat (Xenical)
- Reduces fat absorption in the digestive tract by inhibiting enzymes.
- Undigested fat is excreted in the feces.
- Modest weight loss.
- Also associated with reduced total and LDL cholesterol, increased HDL, and reduced fasting blood glucose.
- Can reduce the absorption of fat-soluble vitamins.
- Oral administration, up to three times daily with each main meal containing fat.
- Contraindications: Chronic malabsorption syndrome, cholestasis, pregnancy.
- Common side effects: Stool leakage, diarrhea, flatulence, abdominal bloating.
- Rare AEs: Liver damage, acute pancreatitis, kidney stones.

Surgical Approaches

Bariatric surgery: Reduces the size of the stomach.
- Gastric banding: A band is placed around the stomach, limiting its size.
- Vertical sleeve gastrectomy: Approximately 75% of the stomach is removed, leaving a sleeve-shaped stomach.
Risks are associated with these surgeries and require commitment to long-term lifestyle changes:
- Healthy eating
- Physical activity
- Behavioral strategies like goal setting and stress management.

Pharmacotherapy for Obesity Management

Indicated for individuals:
- BMI of 30 kg/m² or greater
- BMI of 27 kg/m² or greater with weight-related complications.
Used alongside lifestyle changes.
Can help with:
- Weight loss maintenance
- Delaying type 2 diabetes
- Improving glycemic control
- Improving outcomes for health conditions like NAFLD (nonalcoholic fatty liver disease).

Medications in Canada for Long-term Obesity Management

Liraglutide (Saxenda)
Semaglutide (Wegovy)
Naltrexone/bupropion (Contrave)
Orlistat (Xenical)
Liraglutide & Semaglutide:*
Glucagon-like peptide-1 (GLP-1) receptor agonists: Also used to manage type 2 diabetes.
GLP-1 is a hormone secreted by the small intestine.
Liraglutide: Subcutaneous injections daily
Semaglutide: Subcutaneous injections weekly.
Contraindications: Personal or family history of medullary thyroid carcinoma, pregnancy.
Common side effects: Nausea, vomiting, diarrhea, abdominal pain, constipation.
Rare AEs: Pancreatitis, renal insufficiency and retinopathy, thyroid tumors.
GLP-1 Actions:*
Enhances insulin secretion from pancreatic beta cells, leading to lower blood sugar levels when blood glucose is high..
Inhibits glucagon secretion from pancreatic alpha cells, preventing excessive glucose release into the bloodstream.
Slows gastric emptying: Aids in weight management by moderating blood sugar spikes after meals and prolonging feelings of fullness.
Acts on the brain to promote satiety: Reduces overall food intake.
GLP-1 receptor agonists mimic the action of GLP-1.

Vitamin D

Plays a key role in calcium metabolism and bone health maintenance.
May have a protective effect in conditions such as arthritis, autoimmune disorders, and certain cancers.
Is a fat-soluble vitamin.
Deficiency in children presents as rickets and in adults as osteomalacia.
Sunlight exposure is crucial for maintaining good bone health and overall well-being.