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?

    <p>Vitamin K</p> Signup and view all the answers

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

    <p>Lanugo</p> Signup and view all the answers

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

    <p>Increased amylase levels</p> Signup and view all the answers

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

    <p>Leptin</p> 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?

    <p>Orlistat</p> Signup and view all the answers

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

    <p>Gastric banding</p> Signup and view all the answers

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

    <p>Vitamin D</p> 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?

    <p>Vitamin B9 (Folic Acid)</p> Signup and view all the answers

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

    <p>Vitamin B12 (Cobalamin)</p> Signup and view all the answers

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

    <p>Weight gain</p> Signup and view all the answers

    Which vitamin deficiencies can result in oral crusting and ulcerations?

    <p>Vitamin B and C</p> Signup and view all the answers

    What condition results from excessive intake of nutrients?

    <p>Over-nutrition</p> Signup and view all the answers

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

    <p>Fats</p> Signup and view all the answers

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

    <p>Cultural beliefs</p> Signup and view all the answers

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

    <p>Hypophosphatemia</p> Signup and view all the answers

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

    <p>Gradually reintroduce calories</p> Signup and view all the answers

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

    <p>Irritability and confusion</p> Signup and view all the answers

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

    <p>Hypokalemia</p> Signup and view all the answers

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

    <p>Starvation-related malnutrition</p> Signup and view all the answers

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

    <p>Food insecurity</p> Signup and view all the answers

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

    <p>400 IU</p> Signup and view all the answers

    Which symptom is associated with anorexia nervosa?

    <p>Compulsive exercising</p> Signup and view all the answers

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

    <p>Bulimia nervosa</p> Signup and view all the answers

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

    <p>Environmental toxin-related malnutrition</p> Signup and view all the answers

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

    <p>Malabsorption syndrome</p> Signup and view all the answers

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

    <p>Vomiting or overuse of diuretics</p> Signup and view all the answers

    What might someone with bulimia nervosa present with?

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

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

    <p>Hypokalemia</p> Signup and view all the answers

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

    <p>Fluid retention due to electrolyte imbalances</p> Signup and view all the answers

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

    <p>Ketones</p> Signup and view all the answers

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

    <p>Fat oxidation</p> Signup and view all the answers

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

    <p>Exactly or greater than 102 cm</p> Signup and view all the answers

    Which health risk is NOT commonly associated with obesity?

    <p>Hypoglycemia</p> Signup and view all the answers

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

    <p>Diet rich in fruits and vegetables</p> Signup and view all the answers

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

    <p>Insulin resistance</p> 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?

    <p>Health-behavior changes</p> Signup and view all the answers

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

    <p>Increased food intake</p> Signup and view all the answers

    What BMI range is classified as overweight?

    <p>25 - 29.9</p> Signup and view all the answers

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

    <p>Ghrelin</p> Signup and view all the answers

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

    <p>Hypertension</p> Signup and view all the answers

    What is the optimal waist-to-hip ratio?

    <p>&lt; 0.8</p> Signup and view all the answers

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

    <p>FTO gene</p> Signup and view all the answers

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

    <p>Elevated levels of ghrelin</p> Signup and view all the answers

    What role does the hypothalamus play in regulating weight gain?

    <p>Influences nutrient usage and storage through hormone production</p> Signup and view all the answers

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

    <p>Naltrexone</p> Signup and view all the answers

    What is a common side effect of Naltrexone/Bupropion?

    <p>Nausea</p> Signup and view all the answers

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

    <p>Chronic malabsorption syndrome</p> Signup and view all the answers

    What main action does Orlistat perform in the gastrointestinal tract?

    <p>Reduces metabolism and absorption of fat</p> Signup and view all the answers

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

    <p>Vertical sleeve gastrectomy</p> Signup and view all the answers

    What role is Naltrexone thought to play in weight loss?

    <p>Regulates appetite via the hypothalamus</p> Signup and view all the answers

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

    <p>Seizures</p> Signup and view all the answers

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

    <p>Reduced total &amp; LDL cholesterol</p> Signup and view all the answers

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

    <p>Long-term lifestyle changes</p> Signup and view all the answers

    What symptom is most commonly associated with wet beriberi?

    <p>Shortness of breath</p> Signup and view all the answers

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

    <p>Vitamin B9</p> Signup and view all the answers

    Which dietary source is particularly rich in Vitamin B12?

    <p>Clams</p> Signup and view all the answers

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

    <p>Neural tube defects</p> Signup and view all the answers

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

    <p>Vitamin B6</p> Signup and view all the answers

    Which of these is a primary function of Vitamin B6?

    <p>Amino acid metabolism</p> Signup and view all the answers

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

    <p>Numbness</p> Signup and view all the answers

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

    <p>Vitamin C</p> Signup and view all the answers

    What condition may result from Vitamin D deficiency in adults?

    <p>Osteomalacia</p> Signup and view all the answers

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

    <p>Clumsy movement</p> Signup and view all the answers

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

    <p>Problems with teeth and bones development</p> Signup and view all the answers

    Which vitamins play a role in the synthesis of neurotransmitters?

    <p>Vitamin B1 and Vitamin C</p> Signup and view all the answers

    What is a significant dietary source of Vitamin C?

    <p>Citrus fruits</p> Signup and view all the answers

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

    <p>Enriched, fortified, or whole-grain products</p> 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.

    Vitamin C

    • Multiple functions include:
      • Collagen synthesis.
      • Improved iron absorption.
      • Antioxidant activity to protect cells from free radicals.
      • Production and function of white blood cells.
      • Synthesis of neurotransmitters.
    • Dietary sources include: citrus fruits and juices, tomatoes, potatoes, strawberries, melons, spinach, and broccoli.
    • Deficiency can lead to problems with tooth and bone development, gingivitis, and poor wound healing.
    • Scurvy, a rare condition in North America, can occur in individuals with extremely poor diets.

    Vitamin B1 (Thiamine)

    • Multiple functions include:
      • Energy metabolism (coenzyme role).
      • Nerve signal conduction.
      • Heart muscle function.
      • Neurotransmitter synthesis.
      • Cellular growth and development.
    • Increased risk of deficiency in individuals with alcohol use disorder, after bariatric surgery, and in older age.
    • Dietary sources include: enriched, fortified, or whole-grain products, fish (especially tuna and salmon), liver, chicken, and beef.
    • Wernicke-Korsakoff syndrome is associated with long-standing alcohol use disorder.
      • This neurologic disorder presents with ataxia, decreased or absent short-term memory, diplopia, and nystagmus.
    • Severe deficiency results in beriberi, which can be either wet or dry.
      • Wet beriberi affects the cardiovascular system and leads to shortness of breath, tachycardia, lower extremity edema, and in extreme cases, heart failure.
      • Dry beriberi affects the nervous system and leads to numbness, tingling in the extremities, muscle weakness, and eventually paralysis.

    Vitamin B2 (Riboflavin)

    • Multiple functions include:
      • Carbohydrate metabolism and helping to metabolize other B vitamins (coenzyme role).
      • Supporting cell growth, development, and function.
      • Antioxidant activity.
      • Red blood cell production.
    • Dietary sources include: dairy products, eggs, meat, fortified cereal and bread, almonds, and spinach.
    • Deficiency may cause cracked lips, glossitis, hair loss, and anemia.
    • Vegan diets and pregnancy may increase the risk of deficiency.

    Vitamin B6 (Pyridoxine)

    • Multiple functions include:
      • Metabolism of amino acids and gluconeogenesis and glycogenolysis (coenzyme role).
      • Neurotransmitter synthesis.
      • Hemoglobin synthesis.
      • Supporting immune function.
      • Supporting normal brain development and function.
    • Dietary sources include: fortified cereals, meat, fish, poultry, potatoes, non-citrus fruits, and organ meat.
    • Increased risk of deficiency with the use of isoniazid (used in tuberculosis treatment), as well as in alcohol use disorder, impaired renal function, and autoimmune disorders.
    • Drug interaction: Pyridoxine interferes with levodopa.

    Vitamin B9 (Folate)

    • Multiple functions include:
      • Synthesis of nucleic acids and metabolism of amino acids (coenzyme role).
      • Red blood cell production and maturation.
      • DNA and RNA synthesis and repair (adequate folate levels support rapid cell division required for neural tube formation and other embryonic structures during gestation).
      • Synthesis of neurotransmitters.
      • Cellular growth and function.
    • Folate and folic acid are two forms of vitamin B9.
      • Folate is the naturally occurring form.
      • Folic acid is the synthetic form.
    • Used prenatally to prevent neural tube defects in the fetus.
      • These defects can manifest as anencephaly or spinal bifida.
    • Dietary sources include: liver, spinach, asparagus, green leafy vegetables, and enriched grain products.

    Vitamin B12 (Cobalamin)

    • Multiple functions include:
      • Energy production and DNA synthesis and repair (coenzyme role).
      • Red blood cell formation.
      • Nervous system function (synthesis of neurotransmitters, maintenance of the myelin sheath).
    • Cyanocobalamin is a synthetic form of vitamin B12.
    • Dietary sources include: clams, liver, meat, fish, poultry, and eggs.
      • Not available in plant-based sources.
    • Risk for deficiency exists in individuals following vegan diets, older age, and those on proton pump inhibitor therapy.

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    Description

    This quiz covers essential aspects of nutrition, focusing on fat-soluble vitamins, macronutrient utilization during starvation, and the functions of proteins. It also addresses clinical manifestations of anorexia and bulimia nervosa, appetite-regulating hormones, and medications affecting fat absorption.

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