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64 Cards in this Set

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  • Back
Define obesity.
An increase in adipose tissue beyond the requirements of the body.

It is indisputable that obesity results from a chronic excess of caloric intake relative to the expenditure of energy.
How many people in the US are obese?
If one defines obesity as beginning at 20% more than the mean adiposity, then 20% of middle-aged men and 40% of middle-aged women are obese.
Describe lifelong obesity.
Occurs in children and is lifelong.

Larger-than-normal number (hyperplasia) of adipocytes, a genetically determined phenomenon.

Weight gain distributed peripherally and measured as an increase in the skinfold thickness over the triceps muscle or in the subscapular area.
Describe obesity that begins in adult life.
Hypertrophied adipocytes, the # remains the same.

Fat deposited principally on the trunk (hips/buttocks in women, abdomen in men).
The most important consequence of obesity is....
Type II (maturity-onset) diabetes, which is associated with normal or high levels of circulating insulin and peripheral resistance to the action of insulin.
Effects of obesity.
Atherosclerosis & myocardial infarction.

Hypercholesterolemia --> gallstones; blood levels of uric acid are increased, gout.

Osteoarthritis, varicose veins, deep venous thrombosis.

Oligomenorrhea & amenorrhea
Define protein-calorie malnutrition.
A direct result of inadequate dietary protein coupled with a deficient intake of the carbohydrates and lipids necessary to provide an adequate energy source.
Caused by global starvation-- a deficiency in ALL elements of the diet.

Decreased body weight, diminished subcutaneous fat, protuberant abdomen, muscle wasting, wrinkled face. "shrunken old person"

low pulse, BP, temperature; diarrhea common, numerous infections.

Growth failure
A syndrome that results from a deficiency of protein in a diet that is relatively high in carbohydrates.

Growth failure and muscle wasting, but subcutaneous fat is normal.

EXTREME APATHY; severe edema, hepatomegaly, depigmentation of skin, dermatoses. Sandy/reddish hair with linear depigmentation.

Diarrhea, anemia.

Liver is conspicuously FATTY.
A general term for a # of unrelated organic catalysts that are not endogenously synthesized but that are necessary in tract amounts for normal metabolic functions.
Fat-soluble vitamins.
Water-soluble vitamins
Vitamin A important for....
Important for maintenance of many specialized epithelial linings, skeletal maturation, structure of membranes, enhancement of immunity.

Important constituent of the photosensitive pigments in the retina.
Deficiency of vitamin A results in.....
Squamous metaplasia, especially glandular epithelium. ACommon in trachea/bronchi --> bronchopneumonia.

xerophthalmia: dryness of cornea and conjunctiva.

Keratomalacia: cornea becomes softened.

Follicular hyperkeratosis from occluded sebaceous glands.
Earlist sign of vit A deficiency is....
diminished vision in dim light, due to decreased rhodopsin regeneration.
Acute vs. Chronic Vitamin A toxicity
Acute: headache, vomiting, stupor, papilledema

Chronic: weight loss, nausea, vomiting, dryness of lips, bone/joint pain, hyperostosis, enlarged liver and spleen, cirrhosis
Source of vitamin A; source of precursor of Vitamin A
fish liver oils

precusor is beta-carotene; source of it is carotene, found in green leafy vegetables.
Thiamine is essential for...

normal function of peripheral nervous system and myocardium.
Thiamine comes from where....
leafy green vegetables, milk, liver.
Who is susceptible to thiamine deficiency?
Classically seen in Orient-polished rice.

Western countries: alcoholics, neglected people with poor overall nutrition, food faddists.
What are the cardinal symptoms of thiamine deficiency?


cardiac failure
Dry beri-beri
(thiamine deficiency)

symptoms referable to the neuromuscular system:

paresthesias, depressed reflexes, weakness and atrophy of muscles of extrrmities.
wet beri-beri
(thiamine deficiency)

peripheral vasodilation, generalized edema (severe congestive failure), other manifestations of cardiac failure.

heart is flabby, dilated, increased in weight.
Wernicke Syndrome
(thiamine deficiency)

Alcoholics; involvement of brain;

progressive dementia, ataxia, ophthalmoplegia (paralysis of the extraocular muscles)
Riboflavin derived from where?

plant and animal sources.
Riboflavin important for what....
synthesis of flavin nucleotides, which play an important role in electron transport and other reactions in which the transfer of energy is crucial.
Deficiency of riboflavin occurs in....
debilitation due to other disease, malnutrition in alcoholism.
Effects of riboflavin deficiency
lesions of the facial skin and corneal epithelium

Cheilosis: fissures in the skin at the angles of mouth


Seborrheic dermatitis: inflammation of skin that exhibits a greasy, scaling appearance, involves cheeks and areas behind ears.

Interstitial keratitis of the cornea.
Niacin important for what....
plays a major role in the formation of NAD and NADP, which are compounds important in intermediary metabolism and a wide variety of oxidation-reduction reactions.
Source of niacin
available in grains

animal proteins found in meat, eggs, and milk contain TRYPTOPHAN that can be transformed into niacin.
Clinical niacin deficiency called what...?
Pellagra; occurs in weakness due to other diseases, malnutrition in alcoholism.

Prevalent in areas where corn is the staple food.

3 D's: dermatitis, diarrhea, dementia

Degerative changes in spinal cord, glossitis (red, raw fissured large tongue), stomatitis, cheilitis (burning mouth/tongue)
Source of pyridoxine

a variety of vegetable and animal foods.
Deficiency of pyridoxine is seen in who?


patient treated with certain drugs (isoniazide)


rarely caused by an inadequate diet.
Primary expression of pyridoxine deficiency:
CNS - hyperirritability and convulsions in infants.

Pyridoxine-responsive anemia is hypochromic and microcytic.

Cheilitis and glossitis.
Causes of vitamin B12 deficiency
-pernicious anemia and result from the lack of secretion of intrinsic factor in the stomach
-found in all animal protein so rare cases of extreme vegetarianism
-surgical removal of terminal ileum
-overgrowth of vit B12 consuming microorganisms
-parasitization of SI by fish tapeworm Diphyllobothrium latum
-inflammatory and neoplastic disorders of the ileum
Sources of folic acid
leafy vegetables, liver, kidney yeast
Causes of folic acid deficiency
-excessive cooking destoryed much of the folic acid in foods
-inadequate dietary intake- alcoholism and malnutrition
-diseases of malabsorption (nontropical and tropical sprue)
Deficiencies of both vitamin B12 adn folic acid are associated with.....
megaloblastic anemia, caused by impaired DNA synthesis.

Large, nucleated progenitors of RBC's in bone marrow.

Anemia, neutropenia, thrombocytopenia.
Pernicious anemia is complicated by....
a neurologic condition called

subacute combined degeneration of the spinal cord.
Oral manifestations of vitaminb12/folic acid deficiency
-atrophic glossitis (mucosal atrophy and erythema)
-burning mouth
-angular cheilitis
-aphthous ulcers
source of vit C
citric fruits
Ascorbic acid is important for....
it is a biologic reducing agent that is involved in numerous oxidation-reduction reactions and in the transfer of protons.

Essential for the synthesis of hydroxyproline and formation of collagen.
Vit C deficiency occurs in who?
-malnourished patients
-neglected elderly people
clinical vit C deficiency state:

Caused by formation of abnormal collagen that lacks tensile strength.

Subperiosteal hemorrhages lead to pain in bones/joints.

Petechial hemorrhages, ecchymoses, purpura.

Gingival swelling and hemorrhage; alveolar bone resorption results in the loss of teeth (periodontitis).

Poor wound healing and compromised skeletal development.
What are the 2 forms of vitamin D?
vitamin D3 = cholecalciferol, produced in the skin.

vitamin D2 = ergocalciferol, derived from plant ergosterol
Vitamin D important for....
Plays essential role in absorption of calcium and phosphate from the intestinal tract and in bone resorption (mobilization of calcium from bone). Also reabsorption of calcium in the distal renal tubules.

Maintains the appropriate concentration of calcium and phosphate in the blood that are required for proper bone mineralization.
Vitamin D deficiency results from:
Decreased endogenous synthesis: limited sunlight exposure

Deficient dietary intake

Inadequate intestinal absorption: small intestinal diseases (Celiac & Crohn disease), cholestatic disorders of the liver and biliary obstruction, chronic pancreatic insufficiency

Abnormal conversion to active metabolites: diffuse liver disease, chronic renal failure, vitamin D-dependent rickets type I (inherited deficiency of renal a1-hydroxylase)

Target organ resistance: vitamin D-dependent rickets type II (congenital lack or deficiency of receptors)
a disorder of adults that is characterized by inadequate mineralization of newly formed bone matrix

-Diffuse skeletal pain
-Susceptibility to fracture
-Generalized loss of lamina dura
disorder in children, in whom the epiphyses are open.

-Apathetic and irritable children
-Short stature
-Skull deformities (e.g. frontal bossing)
-Rachitic rosary and “pigeon breast”
-Lumbar lordosis
-Bowing of the legs
-Delayed dentition, dental caries and enamel defects
Can also cause rickets and osteomalacia.

-Poor intestinal absorption - long-term use of antacids
-Increased renal excretion - renal tubular disorders
-X-linked hypophosphatemia (Vit D Resistant Rickets)
-Fanconi syndromes
Consequences of hypercalcemia (hypervitaminosis C)
weakness and headaches

calcium salt deposits (nephrolithiasis, nephrocalcinosis, ectopic calcification)
Vitamin E is important for...
an antioxidant that protects membrane phospholipids against lipid peroxidation by free radicals formed via cellular metabolism.
Sources of vitamin E
corn and soybeans

other plants
Vitamin E deficiency
Is rare excpet among patients receiving parenteral nutrition and patients with disorders of fat absorption from the intestine.

No definable syndrome associated.
What are the 2 forms of vitamin K?
vitamin K1: from plants/green leafy vegetables

vitamin K2: synthesized by the normal intestinal bacteria.
Causes of vitamin K deficiency.....
common in severe fat malabsorption

destruction of intestinal flora by antibiotics

newborn infants exhibit deficiency because the vitamin is not transported well across the placenta.
Vitamin K important for....
the activity of 4 clotting factors:

factor VII
factor IX
factor X

deficiency can lead to catastrophic bleeding, hypoprothrombenemia, hemorrhages.
Minerals are....
components of enzymes and cofactors necessary for metabolic functions.
Iodine deficiency
Thyroid enlargement (goiter), hypothyroidism (cretinism and myxedema)
Zinc deficiency
growth retardation, infertility, acrodermatitis enteropathica, taste alterations
copper deficiency
microcytic anemia
manganese deficiency
poor growth, skeletal abnormalities, reproductive impairment, ataxia, convulsions
iron deficiency
microcytic hypochromic erythrocytes that exhibit poikilocytosis and anisocytosis.

most common cause of anemia

angular cheilitis, atrophic glossitis (generalized mucosal atrophy), burning mouth, aphthous ulcers.
Plummer-Vinson Syndrome
iron-deficiency anemia

oral burning sensation, angular cheilitis, atrophic glossitis

dysphagia and esophageal webs

koilonychia (nails)

premalignant condition for both oral and esophageal SCCa