Cns Primer Section 6

Front 1

What are the three forms of acne?

Back 1

acne vulgaris

acne conglobata

acne rosacea.

Front 2

True of False:

Acne is more common in females.

Back 2

False!

more common in males during puberty due to hormonal changes (testosterone), butmay occur throughout life in both males and females

Front 3

Avoidance of what foods may minimize acne?

Back 3

sugar, fried foods, milk, and iodine.

Front 4

What supplements may help with acne?

Back 4

chromium, vitamin A, vitamin E, selenium and zinc.

Front 5

___% of patients infected with (HIV) will experience some form of malnutrition resultingfrom alterations in nutrient intake, absorption and metabolism. Muscle wasting is common andmortality is closely related to weight loss.

Back 5

50-80%

Muscle wasting is common and mortality is closely related to weight loss.

Front 6

In HIV, alteredmetabolism, inadequate dietary intake and malabsorption of nutrients are common and furtherimpair immune function and contribute to wasting. Early nutritional assessment, attention tonutritional requirements and prompt intervention can minimize wasting and replete body cellmass. Daily protein intake should be as high as ___g/kg of body weight.

Back 6

2

Front 7

In HIV, daily use of _________ is associated with reduced risk of declining CD4+ T-lymphocytecounts, extends the latency period of the development of overt disease by years, and extendssurvival time significantly.

Back 7

multivitamins

Front 8

HIV-infected patients and those with symptomatic Acquired ImmuneDeficiency Syndrome (AIDS) have elevated levels of ________and require supplementalantioxidants.

Back 8

oxidative stress

Supplemental antioxidants reduce oxidative stress and accelerate cellular apoptosis.

benefits include β-carotene induced increases in the numbers ofcirculating CD4+ helper T-lymphocytes, leukocytes and B-lymphocytes.

Glutathione and Nacetylcysteinereduce oxidative stress, extend the latency period of the onset of symptoms, andinhibit HIV replication.

Front 9

True of False?

In Acute Bowel Inflammation it is best to eat only fruits and vegetables.

Back 9

FALSE

Exacerbated by dietary fiber so need to restrict until symptoms subside

avoidance of dry, fresh,ripe fruits (except ripe banana), whole grains, tough or fibrous meats, nuts, seeds, dried beans,and corn. Fruits should be limited to canned fruits and pulp-free juices. Vegetables should belimited to pulp-free juices and cooked seedless low-fiber species (asparagus, spinach, beets).

Only highly-refined flour should be used.

Front 10

Some symptoms of Chronic alcoholism:

Back 10

1.fatty infiltration of the liver with excessiveaccumulation of vitamin A

2. hepatic hypersensitivity to vitamin A toxicity

3. symptomatic thiamin deficiency characterized by mentalconfusion, memory loss, delusions, and amnesia (Korsakoff Syndrome)

4. apathy, delusion, anddelirium (Wernicke Disease

**these may appear concurrently as Wernicke- Korsakoff Syndromeor alcoholic dementia)

Front 11

Are Skin-prick test or skin- scratch test valuable in the diagnosis of suspected food allergies?

Back 11

Not really

Measurements of circulating antigenspecificimmunoglobulin concentrations may be more effective in screening for food allergies.

Front 12

True or False?

With allergic patience, dysbiosis is not important.

Back 12

FALSE

it should be considered and presence of food sensitivities should be evaluated; any offendingfoods should be avoided. Severely affected individuals may require supplemental hydrochloricacid or pancreatic enzymes.

Front 13

_____ deficiency has been suggested asa possible etiologic factor associated with eating disorders secondary to loss of taste acuity.

Back 13

Zinc

Front 14

Anorexia Nervosa (voluntary starvation) an Bulimia produces many nutrient deficiencies; the most dangerousare deficiencies in:

Back 14

1. electrolytes

2. essential fatty acids

3. folate

4. vitamin B12

5. calcium

6. zinc(induced zinc deficiency may cause loss of taste acuity which can reinforce loss of interest infood).

Front 15

Other physiologic disturbances in Anorexia include:

Back 15

-decreased glomerular filtration rate withinability to excrete nitrogen or concentrate urine

-ketosis

-electrocardiographic abnormalities

-intestinal atony

-gallstones

-osteopenia

-brittle hair and nails

-hypothyroidism

-hypercortisolism

-amenorrhea

-bone marrow suppression

-various neuropathies

Front 16

initial therapy for both anorexia and bulimia should focus on what two things?

Back 16

1.removing fear of food

2. consumption of complete liquid diets.

Front 17

Other physiologic disturbances in Bulimia:

Back 17

-ketosis

-electrocardiographic abnormalities

-acid damage tothe upper digestive tract, mouth and teeth

-intestinal atony

-gallstones

-osteopenia

-brittle hair andnails,

-myopathy and various neuropathies.

Front 18

Biliary Insufficiency: Inadequate production of bile requires efforts to restore bileproduction.

What foods/supplements may be useful to increase bile production?

Back 18

taurine

raw beets

choline

Spanish black radishes

inositol

Aloe vera extract

methionine

Front 19

What foods/supplements may increase bile FLOW?

Back 19

dandelion root

artichokes

peppermint tea

rosemary.

Front 20

Any burn accelerates the resting metabolic rate, increases oxidative stress andevaporative water losses and requires abundant nutrient supplies for wound healing. Fluid intakeand dietary protein can enhance healing. What supplements may help with healing?

Back 20

vitamin A

vitamin C

vitamin E

zinc.

Topical application of Aloe vera extract often reducespain and aids healing of first degree burns.

Front 21

The most effective nutritional means to reduce the risk of all cancers is to:

1. eliminate________

2. reduce _______

3. increase consumptionof ____________

Back 21

1. eliminate alcoholic beverages

2. reduce saturated fat

3. increase consumption of high fiber foods, fruits, vegetables, whole grains, foods rich in carotenoids and vitamin C (such as green leafy and orange foods), and foods from the cabbage family (such as broccoli, brussels sprouts, Kohlrabi and cauliflower).

*this diet also best maximizes the success of therapeutic measures

Front 22

Fun Facts:

The following may be chemopreventative:

Antioxidant micronutrients(such as vitamin A, vitamin C, vitamin E, β-carotene and selenium)

and...

Back 22

Plant constituents (phytochemicals) including plant flavonoids, sulphorafane, ellagic acid, indoles, flavones, saponins, and triterpenoids.

Front 23

___________ may be useful in cancer prevention and treatment. These compoundsare sufficiently similar to estrogens in three-dimensional structure to act as weak agonists ofestrogens.

Back 23

Soy phytoestrogens

-typically concentrations (~1 cup of cookedsoybean product or 150 to 200 mg soy isoflavones), soy phytoestrogens are weakly antiproliferative with little estrogenic effect.

-much higher concentrations (virtuallyimpossible to achieve via consumption), they are estrogenic.

Front 24

In order to exert anyeffect on carcinogenesis, cardiovascular disease, osteoporosis, or any other estrogen-sensitivecondition, soy phytoestrogens must undergo biological processing.

What compound makes them unabsorbable?

Back 24

unabsorbable glucosides that must be deconjugated by intestinal microflora. Thedeconjugated isoflavones are then absorbed.

Need a healthyfermentive large intestinal microflora

compromised flora (antibiotics and low fiber diet ) will not absorb

Front 25

True or False:

Semi-purified, purified and synthetic soy isoflavones are readily absorbable and should be taken liberally.

Back 25

False:

They are much more potent than are soy foods and must be consumedwith greater care.

Front 26

The electrical activity of the heart is dependent on ____,____ and _____, ions to assure normal cardiac electrical and contraction activity.

Back 26

Ca++, Mg++ and K+ ions

Front 27

Blood fluid volume and pressure are dependent on Na+, K+ and _________ homeostasis.

Back 27

free water

Front 28

Symptomatic inappropriate anti-diuretic hormone secretion (SIADH) can cause dilutional_________, which must be distinguished from salt depletion.

Back 28

hyponatremia

Front 29

________ and ________ intake should be monitored during concurrent administration of coumadin, digoxin, calcium channel blockers,beta-blockers, diuretics, ACE inhibitors, peripheral vasodilators, central and peripheral alphablockingagents or amiodarone or other antiarrhythmic medications.

Back 29

Dietary fluid and electrolyte

Front 30

The symptoms of celiac disease are secondaryto disease-induced abnormalities.

Fluid and electrolyte imbalances occur secondary to ___________.

Back 30

chronic diarrhea.

Front 31

In celiac, Malabsorption (severity proportional to the extent of disease associated intestinalmucosal damage) of B-vitamins, fats, sugars, iron, calcium magnesium and zinc is common.Symptoms that themselves are secondary to induced malabsorption include:

Back 31

weight loss, edema,steatorrhea, dermatoses, folate-deficiency seizures and anemias and osteoporosis.

Front 32

In Celiac, symptoms thatthemselves are secondary to increased intestinal permeability include:

Back 32

bone pain, joint pain,“autoimmune-like diseases” and food allergies.

Front 33

Gluten is a plantprotein complex consisting of about 50% _______and 50% ______.

Back 33

prolamins - inducesensitivity to gluten; each disease-triggering food provides a unique prolamin:wheat contains gliadin, oats contain avenin, barley contains hordein and rye contains secalin.

glutenins

Front 34

In Celiac, once gluten enters the small intestine, brush-border intestinal ________ digests thegluten complex, exposing the prolamins.

Back 34

transglutaminase

High transglutaminase activity accelerates release ofprolamins, suggesting that susceptibility is conferred by an overabundance of intestinaltransglutaminase.

Front 35

Prolamins all share an amino acid sequence that is exposed by the action of intestinaltransglutaminase. The sequence can rememble?

Back 35

antigens presented by severalviruses, bacterial toxins or hallucinogenic peptides to which the individual had been exposedpreviously.

T-lymphocytes of the GALT, previously sensitized to these antigens, migrate intothe intestinal epithelium and generate a local inflammatory response (including IgG secretion).

Front 36

Translocation of IgG into blood triggers cross reactivity of IgG with host cell components,initiating responses that mimic ____________.

Back 36

autoimmune diseases

Front 37

For treatment of celiac, aside from a prolaimin (gluten free) diet, adjunctive therapy should be provided in order to restore intestinal impermeability. What would you recommend?

Back 37

supplemental digestive enzymes (ingested 15 to 20 minutes before food intake), dietary fiber and a prebiotic/probiotic combination.

Front 38

Metabolic abnormalities, such as __________, are well documented in Chronic Fatigue Syndrome (CFS).

Back 38

acylcarnitine deficiency

Front 39

Liver disease may cause secondary manifestations of malnutrition inseveral ways. Acute viral infection, particularly with A- and B-type hepatitis viruses, may cause :

Back 39

hepatic inflammation

severe nausea

anorexia

a marked decrease in protein synthesis.

chronic liver dysfunction, malnutrition may be caused by concurrent orcausative alcoholism, decreased food intake, severe ascites (which may aggravateanorexia), or obstructive jaundice (which may decrease food intake, alter digestion andinduce malabsorption).

Front 40

FACTS:

“Dynamic tension” exists betweennutrition and colonocytes; excess SCFA’s stimulate cell proliferation, increasing the risk forcolorectal cancer, while SCFA deficiency retards cellular apoptosis, increasing the risk forcolorectal cancer.

Back 40

-Colon tissue is arranged in crypts composed of single layers of cells.

-Daughter cells are created in the “bottoms” of the crypts and “migrate” toward the lumen.

-Undifferentiated colonocytes continue to divide while in transit.

- Colonocytes differentiate at the“tops” of the crypts.

-After about 3 days, differentiated colonocytes undergo apoptosis and areexfoliated.

-Short-chain fatty acids (SCFAs) stimulate colonocyte proliferation during migration.Butyrate maintains the sequence of cellular apoptosis.

Front 41

Secondary bile salts increase colonic mucosal activity of _________, the rate-limiting enzyme in the pathway of polyamine synthesis.

Back 41

diamine oxidase

-Polyamines are required forcolonocyte proliferation.

-Diamine oxidase does not affect colonocyte apoptosis

-increaseddiamine oxidase activity increases colonocyte numbers without a compensating increase inapoptotic rate.

Front 42

__________ diamine oxidase activity in the colon is associated with increased riskfor colorectal cancer. Diamine oxidase activity is stimulated by meat and alcohol and isinhibited by olive oil and by calcium binding to bile salts.

Back 42

Increased

Front 43

Risk for colorectal cancer is increased by

Back 43

consumption of hydrogenated polyunsaturated fattyacids, lard, insoluble dietary fiber, corn oil and beef.

Front 44

Risk for colorectal cancer is decreased by

Back 44

consumption of rice, fruits, beans, vegetables, olive oil, fish oils, folic acid and calcium (unlessbound by insoluble dietary fiber).

Increased bone density

Front 45

Fun Facts:

Normal glucose homeostasis (glycemiccontrol) requires coordination among insulin, glucagon, corticosteroids, growth hormone andinsulin-like growth factor-I (IGF).

Back 45

Requires frequentself-monitoring of plasma glucose concentrations and periodic clinical measurements of serumglycosylated protein concentrations and urinary microalbumin and macroalbumin excretion.

Front 46

Thetreatment of type I (autoimmune) diabetes includes

1. dietary restrictions

2. avoidance of ______________

3. the use of exogenous insulins.

Back 46

2. avoidance of diabetogenic ketoacids

*avoidance of alcoholic beverages and minimization of ingestion ofsimple sugars and saturated fats.

Front 47

The treatment of type II (adult-onset) diabetes includes

1. dietaryrestrictions

2. adherance to exercise regimens

3. pharmacologic minimization of postprandialhyperglycemic episodes.

What supplements may help?

Back 47

chromium nicotinate can attenuate postprandialhyperglycemic episodes.

colosolicacid and extracts of Gymnema sylvestre, fenugreek and tamarind may improve plasma glucosehomeostasis.

Front 48

___________ (dumping syndrome; lactose intolerance) is caused by the presenceof poorly absorbed solutes in the digesta.

Back 48

Osmotic diarrhea

Front 49

_____________(bacterial diarrhea, viral diarrhea)results from the secretion of excessive amounts of water and electrolytes into the intestinal lumen.

Back 49

Secretory diarrhea

Front 50

___________ (ulcerative colitis, radiation enteritis) occurs secondary to mucosal damageand often is accompanied by loss of blood, mucus and plasma proteins.

Back 50

Exudative diarrhea

Front 51

___________ (Crohn’s disease) results from inadequate mixing of chyme and insufficientcontact of chyme with the intestinal epithelium.

Back 51

“Limited mucosalcontact” diarrhea

Front 52

Nutritional therapy for diarrheas is to eliminate the cause, replace water and electrolytes withoral rehydration solutions (such as chicken broth and rice water) and restore colonic harmony.

Is fasting advised?

Back 52

NO - Fasting is contraindicated.

Front 53

_________ disorders thataffect esophageal motility are caused by:

- cerebrovascular accidents,

- achalasia (failure of loweresophageal sphincter to relax)

- scleroderma.

Back 53

Neuromuscular

Front 54

________ disorders that affect swallowing may berelated to infection (e.g., Candida albicans), acid reflux from the stomach with esophagealstenosis, or esophageal cancer.

Back 54

Luminal

Front 55

Gastric neuromuscular disorders affecting gastric emptying may be secondary to _______ resection, diabetic neuropathy, or pseudo-intestinal obstruction.

Back 55

vagal nerve

Front 56

Small intestinal disorders of nutritional importance include:

Back 56

selective enzyme deficiency (such as in lactase deficiency and subsequent lactose intolerance);

mucosal atrophy and inflammation;

lymphatic and vascular occlusion;

decreased bile salt delivery;

bile duct obstruction;

bacterial overgrowth;

lymphangiectasia; and

loss of digestive function (e.g., fat malabsorption) secondary to primary pancreatic insufficiency.

Front 57

From 10% to 25% of patients with diverticulosisdevelop diverticulitis. Therapy consists of:

Back 57

low fat, high fiber diet (45 g/day to 55 g/day ofsoluble fiber)

2 to 3 liters of water daily,

avoidance of seeds, nuts and plant skins that maydamage extravaginated sections of the colonic wall.

Front 58

Loss of regulation of stomach emptying with excessively rapid passage ofincompletely acidified food into the small intestine produces maldigestion and diarrhea.

Back 58

Dumping Syndrome:

Beneficial practices may include

-reduction in meal size and increase infrequency;

-a highprotein, moderate fat, low starch diet;

-lying down after eating;

-avoidance of ingesting liquids withfood and of simple sugars and milk (too osmotically active)

-supplementation with MCT’s (toprevent steatorrhea), pectin (slows carbohydrate digestion; reduces osmotic load), digestiveenzymes and multivitamins and multiminerals.

Front 59

Nutrition treatment of chronic hyperlipidemia:

Back 59

Restricted dietary fats, simple sugars, cholesterol, alcohol and total calories

increased dietary fiber

Exercise

Front 60

Supplements that may aid hypertension:

Back 60

potassium, calcium, and magnesium.

Front 61

Inadequate stomach acidification causes incompleteacidification of food and inability to activate intrinsic factor

Back 61

Hypochlorhydria; Achlorhydria:

supplemental HCl or betaine consumed with food.

Front 62

Two generally recognized forms of inflammatorybowel disease (IBD):

Back 62

Crohn’s disease is a transmuralinflammatory disorder which can involve the entire GI tract but usually is limited tothe small intestine or colon.

Ulcerative colitis is a mucosal inflammatory disorder that involvesonly the colon.

Front 63

IBD may be accompanied bya markedly increased sensitivity to commensal _________.

Back 63

bacteria.

Front 64

Steroid drugs suppress inflammation in IBD but exascerbate the catabolic effects of the __________ that accompanies bowelinflammation.

Back 64

malabsorption

*NSAIDs also reduce inflammation but impair enterocytetransluminal transport pathways, worsening malabsorption, and may directly damage the gutmucosa, increasing intestinal permeability.

Front 65

Active lesions of IBD are rich in IFN-γ, tumor necrosis factor-α(TNF-α) and the proinflammatory interleukins (IL), IL-1, IL-6,IL-8 and IL-12 that increase secretion of IFN-γ by TH-1 T-helper lymphocytes.

Back 65

In contrast, antiinflammatoryIL-2, IL-4, IL-5 and IL-10 that inhibit the secretion of IFN-γ by TH-1 T- helperlymphocytes are absent.

Front 66

_________ inhibitsactivation of NF-κB in macrophages and acute deficiency may predispose to IBD activation.

Back 66

butyrate

~enemas have been reported to induce remission of symptoms andhealing of lesions. Oral butyrate also has induced symptomatic relief

Front 67

Other TX for IBD?

Back 67

prebiotic/probiotic combinations containing Bifidobacteria, Lactobacilli,fructooligosaccharides

pectin that increase fiber fermentation capacity and stimulates recovery of damaged villi.

digestive enzymes may decreasethe fermentable sugar supply to the colon and reduce the production of acetyl CoA-suppressingSH2

L-glutamine stimulates proliferation of “replacement” enterocytes and colonocytes and mayaccelerate healing; also increases intracellularglutathione. (at least 35 g/day) orally in adults.

Omega-3 fatty acids; 1800 mg/day to 2000 mg/day (EPA) combined with 900 mg/day to 1200 mg/day(DHA).

***“Bowel rest” is contraindicated because intentional starvation of enterocytes andcolonocytes will exascerbate lesions and delay healing.

Front 68

Herbs for IBD?

Back 68

Boswelia serrata (inhibits 5-lipooxygenase and reduces synthesis ofinflammatory leukotrienes),

Uncaria tomentosa (cat’s claw; inhibits activation of NF-κB andnitric acid production)

goldenseal (300 mg/day; inhibits bacterial adhesion to enterocytes).

Herbs may reduce inflammation in IBD (at 100 mg/day to 200 mg/day)include garlic, ginger, licorice root, onion, slippery elm bark powder, turmeric and whitewillow bark.

Herbs that can improve colonic microbial balance include artemesia, garlic andgoldenseal.

Front 69

Fun Facts:

The causes of malnutrition in IBD include decreased food intake, malabsorption, excessivenitrogen loss, and increased nutrient requirements secondary to the catabolic effects of chronicillness.

Back 69

Overtmalabsorption in Crohn’s disease is caused by either extensive mucosal involvement or changesin luminal factors that are needed for digestion and absorption.

Front 70

Individuals with IBDshould avoid foods that stimulate production of ________(sugars, meats and allergenic foods) and correct the likely nutritional deficiencies accompanying chronic intestinalmucosal damage (especially those involving calcium, potassium magnesium, zinc and allantioxidant nutrients).

Back 70

prostaglandin PGE2

Front 71

If a IBD patient is receiving sulfasalazine, ____supplementation isrequired (800 mcg/day).

Back 71

folic acid

Front 72

Fragrant intestinal gas and flatulence iscaused by methane from fermentation of indigestible stachyose and raffinose in legumes.Effective nutritional practices are to decrease legume and starch consumption and supplementwith ___________ to reduce production of SH2 from fermentation ofundigested starch.

Back 72

dietary enzymes (especially amylase)

Front 73

Irritable Bowel Syndrome (colitis; spastic colon; functional bowel is recognized by:

Back 73

abdominal pain that is relieved by a bowel movement.

Often,primary constipation with episodic diarrhea is present and may be triggered by the ingestion of chocolate, fatty foods, caffeine, alcohol or dairy foods.

Front 74

The initial onset of IBS often coincides with an episode of:

Back 74

anxiety, clinicaldepression, fibromyalgia, traumatic stress or abdominal surgery.

The “pain” may result from “an increased perception of pain” that occurs when an intestinalwall becomes distended (“visceral hyperalgesia”) which often triggersintestinal hypermotility.

Front 75

Smooth muscle relaxing medications may control colonic spasms in IBS such as:

1.

2.

Back 75

1. peppermint oil in enteric coated capsules (0.2 ml b.i.d.)

2. caraway oil (effective dosage not established).

Front 76

IBS treatments include:

Back 76

-frequent small meals

-increased dietary fiber

-prebiotic/probiotic combinations

-psyllium and pectin (apples).

-maintaining hydration

-low fat diet (fat stimulates asynchronous colon contractions)

-avoidance of caffeine(stimulates asynchronous colon contractions), simple sugars (predispose to osmotic diarrhea)and raw vegetables (bulk stimulates colon contractility).

-Stress reduction

Front 77

True or False:

Renal failure affects the excretion, metabolism, and intestinal absorption ofvirtually all nutrients. It progresses quickly and nutrition intervention doesn't help.

Back 77

FALSE!

It progresses slowly...nutritonal intervention can delay the development of protein and energy malnutrition,uremic toxicity and alterations in mineral and vitamin metabolism.

Front 78

True or False:

Protein restriction may delay dialysis?

Back 78

TRUE!

restriction of dietary protein intake to 0.6 g protein/kg daily may delay the need for dialysis.

Replacement of some protein with alpha- kept analoguesof essential amino acids may aid the preservation of body nitrogen stores when lowtotal protein intakes are necessary.

Front 79

Individuals receiving hemodialysis should receive _______ g protein/kg daily.

Back 79

1.1 to 1.3

At least 50% of this protein should be of high biological value.

Front 80

Because of the high incidence of hyperlipidemia and atherosclerosis in individuals in chronicrenal failure, a diet should provide:

- less than ___ of total calories from fats

-less than ___ fromsaturated fats

-less than ___mg/day of cholesterol

Back 80

- less than 30% of total calories from fats

- less than 20% from saturated fats

- less than 300 mg/day of cholesterol

Front 81

What supplements can be used to reduce circulating triglyceride concentrations?

Back 81

Omega-3-fatty acids

and

L- carnitine

Front 82

When glomerular filtration rate decreases to very low levels, dietary restriction of ________ and use of oral _____ binders is recommended.

(1 answer for both)

Back 82

phosphorus

Front 83

Individuals in end stage renal disease require approximately1200-1600 mg/day of elemental calcium to maintain calcium homeostasis.

What causes reduced calcium for them?

Back 83

inadequate calcium intakeaccompanying diets low in protein and phosphorus

and

the typically poor gastrointestinalabsorption of individuals with uremia

*Ingestion of calcium containingphosphate binders will add to the daily consumption of calcium.

Front 84

Are antacids and cathartics containing magnesium recommended for those with renal disease? Why?

Back 84

No, impairedrenal excretion of magnesium during renal disease may lead to hypermagnesemia.

Front 85

daily intakes in renal disease should be?

- sodium -

- water -

- Potassium -

Back 85

- sodium - < 3 g (less if dialysis)

- water - 1200 to 2000 ml.

- Potassium -not more than 60-70 mEq per day.

Front 86

Hemodialysis patience may also need to supplement:

Back 86

- trace minerals because dialysis tends to remove them

- iron because Loss of blood and dialysis membrane binding of iron

-watersoluble vitamins - lost during dialysis and b/c lower food intake

Front 87

This systemic disorder results from colonization of the colon byLactobacilli species that ferment carbohydrate to D-lactate via D-lactate dehydrogenase. D-lactate is absorbable but not metabolizable.

Back 87

D-Lactic Acidosis

resolved by restriction of carbohydrate intake and restructuring of the colonicmicrobial populations.

Front 88

______ deficiencycan result in severe malnutrition.

Back 88

Potassium

Malnutrition - can be overnutrion or undernutrion or imbalanced intake

Front 89

Vitamin B12 deficiency usually results from loss of gastricintrinsic factor secretion, resulting in vitamin B12 malabsorption and _______anemia.

Back 89

pernicious

Front 90

Osteoporosis recommendations:

Back 90

1200-2000 mg per day in divided doses, obtained from the diet plussupplements

-vitamin D intake of 600-800 IU per day obtained from dairy products andsupplements.

magnesium and boron may also help

Front 91

Why should patients with respiratory failure avoid high carb diets?

Back 91

because the carbon dioxide produced during oxidation oflarge amounts of carbs may exceed the excretory capacity of the compromised lung.

Respiratory Quotient(RQ) = CO2 expired/O2 consumed:

carbs: 1.0 / protein: 0.8

fat: 0.7 / mixed diet: 0.85

*high protein nutritional supplements may be required due to nutritional def in RF

Front 92

In Short Bowel Syndrome (surgical removal of a portion of the smallintestine) why type of fatty acids are needed?

Back 92

feeding MCT’s (Long chain cant be digested/absorbed and may induce diarrhea)

also recommend dietary fiber andsucrose while restricting starch and long-chain fatty acid intakes.

Front 93

Malabsorption of dietary fats and fatty stool:

Back 93

Steatorrhea

may be secondary to biliaryinsufficiency or obstruction, pancreatic insufficiency, mucosal damage (IBD; celiac disease), shortbowel syndrome, bacterial overgrowth of the small intestine, gastrointestinal radiation therapyand medications

***Therapy is to eliminate the cause and, if necessary, substitute dietary MCT’sfor long-chain fatty acids

Front 94

Zinc carnosine supplementation contributes to the reduction of the incidence of:

a. Obesity

b. Insulin resistance

c. GERD

d. Skeletal muscle weakness

Back 94

d. Skeletal muscle weakness

Front 95

An inborn error of metabolism may result from:

a. polyploidy.

b. DNA replication errors.

c. congenital malnutrition.

d. neonatal infection.

Back 95

b. DNA replication errors.

Front 96

A factor that does not predispose an infant to iron deficiency is:

a. consumption of large amounts of homogenized milk.

b. premature birth.

c. hemorrhage from the umbilicus during delivery.

d. slow growth rate.

Back 96

d. slow growth rate.

Front 97

Dumping syndrome is accompanied by symptoms of:

a. faintness, weakness, and profuse perspiration.

b. acute gastritis.

c. peptic ulcer disease.

d. intestinal malabsorption

Back 97

a. faintness, weakness, and profuse perspiration

Front 98

Dietary modifications appropriate for an individual with uncomplicated infectioushepatitis include:

a. increasing energy intake to more than 3000 Kcal daily.

b. restricting protein intake to less than 30 g daily.

c. restricting fat intake to less than 30 g daily.

d. restricting fluid intake to less than 2000 mL daily.

Back 98

a. increasing energy intake to more than 3000 Kcal daily.

Front 99

Which of the following best describes the initial priority of nutritiontherapy in type 2 diabetes patients:

a. focus on cutting out sugars and carbohydrates

b. focus on eliminating alcohol

c. focus on nutritional approaches that will improve the outcomes of blood glucose,lipid profiles and blood pressure

d. focus on ideal body weight

Back 99

c. focus on nutritional approaches that will improve the outcomes of blood glucose, lipid profiles and blood pressure

Front 100

How is Enteral Nutrition delivered?

Back 100

gastrointestinal intubation

indicted for: patients with a patent functioning alimentary tract who cannot orwill not ingest adequate amounts of food or who have a digestive disorder but whose intestinaltract can absorb adequate amounts of nutrients.

maintains health of GI tract and protects against sepsis and hyper metabolism.

Some patients mayrequire delivery of nutrition support via nasogastric, nasoduodenal, nasojejunal, esophagostomy,gastrostomy or jejunostomy tubes.

Contraindications to enteral nutrition are:1) severe malabsorption; 2) total bowel obstruction; 3) persistent uncontrollable vomiting; or 4)tendency to aspiration.

Front 101

How is Parenteral Nutrition delivered?

Back 101

via intravenousinfusion

indicated in patients who are unable to ingest, digest, or absorb sufficientamounts of nutrients through the gGI tract.

Central venous infusion is indicated inpatients with severe GI disease, chronic hypermetabolism, or other chronicconditions.

Peripheral parenteral nutrition is adequate when oral or enteral intake is insufficientand central venous infusion is not feasible or advisable.

Major complications are catheter-related sepsis, metabolic sequelae to use of inappropriate formulas andmechanical problems of the catheter and infusion apparatus.

Front 102

The infusion of a hypertonic nutrient solution through the jugular or saphenous vein iscalled:

a. enteral alimentation.

b. central parenteral alimentation.

c. peripheral parenteral alimentation.

d. peridialytic alimentation

Back 102

b. central parenteral alimentation.