nclex nutrition and obesity
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Learning Outcome 10
What is the difference between fat soluble and water soluble vitamins?
Fat Soluble (A,D,E,K) stored in fatty compartments of the body. Most come from food sources.
Hypervitaminosis results from mega doses (intentional or not)
Water soluble (C and B complex (8 vitamins)).
Not stored, needed in daily food intake. Toxicity can occur.
Learning Outcome 11
The use of vitamin supplements:
Vitamins and minerals should come from food sources 1st Vitamin supplements 2nd.
Should evaluate diet 1st.
Can supplement what is missing
Vitamin C and D
Individuals who take vitamins should limit to 100% of RDA to avoid toxicity (multivitamin)
Best to get from food sources.
Use if nec.
Learning Outcome 12
Functions of vitamins discussed:
Food sources
http://ods.od.nih.gov/factsheets/list-VitaminsMinerals/?print=1
Fat Soluble Vitamins
Vitamin A Retinol up to a years supply is stored in the liver. Need protein to synthesize.
Food sources of Vitamin A? (liver, egg yolk, carrots, sweet potatoes, apricots)
Body Functions Dim light vison, Differentiation of epithelial cells (esp. eyes).
Deficiency Night blindness, Xeropthalmia (abnormal thickening and drying of the outer eye, can lead to blindness)
Fat Soluble Vitamins
Vitamin D ergocalciferol (D2-SUNLIGHT) and cholecalciferol (D3-SUPPLEMENT)
Essential for proper bone metabolism. (Rickets) (Cod liver oil)-vit d creates bridge for calcium and phosphorus to get into bone; bones become soft and malformed; lack of sunlight
Osteomalacia - adults
Recent research has found it may be essential in preventing many other chronic diseases including breast cancer.
Converted by both the liver and Kidneys (protein bound to the liver)
D2 formed when plants are irradiated by the sun
Liver converts to calcidiol
Kidney to calcitriol the active form of vitamin D
D3 formed when skin is irradiated by ultraviolet or sun light
Rickets children- soft fragile bones (bowlegs, knock knees, mishapen skulls)
Breastfeeding does not provide sufficient amounts of vitamin D.
Osteomalacia - vitamin D deficiency in adults low exposure to sunlight high risk. Soft bones esp. pelvis, spine and lower extremeties.
Vitamin D Continued
Absorbed in the duodenum and distal small intestine.-gastric bypass pts, resection
Intestinal absorption decreases with age.
Obesity (BMI > 30) may cause deficiency due to absorption into subcutaneous fat.
What surgical treatment for obesity may cause Vitamin D deficiency? gastric bypass
No RDA why? every individual is different (diet, exercise, exposure)
recommendation for sun exposure is 15 minutes per day
No RDA Multiple sources of the vitamin. Multiple reasons for deficiency
Vitamin D Continued
For individuals with low sunlight exposure, diet is critical.
Food sources: highest level to lowest
Fish (salmon, swordfish, tuna-all can be canned) 3 oz serving; Cod liver oil (453 IU per tsp)
Fortified Milk (good source of calcium)
Liver and beef
Egg yolk
Shitake mushrooms
Cod liver oil most bang for the buck
Swordfish is 566 is for 3 oz.
Fat soluble vitamins
Vitamin E
Protects integrity of cell membranes. Antioxidant,
Absorbed in the jejunum (fat and bile required for maximum absorption)
Deficiency is rare due to diet, usually related to lipid metabolism disorders.
Supplementing vitamin E is not recommended due to increase risk of stroke, prostate cancer.
Vitamin E continued
Food sources for vitamin E
Vegetable oils (wheat germ oil, 1 tbsp, 20.3 mg)
Nuts (almonds, hazelnuts, peanuts)
Sunflower seeds
Peanut butter
Fat soluble vitamins
Vitamin K
Blood clotting
Necessary for the liver to make clotting factors II (prothrombin), VII, IX, and X
Bone metabolism
2 types of vitamin K
Phylloquinone found in plant foods
Menaquinone synthesized by intestinal bacteria; antibiotic use effects blood clotting b/c of K deficiency (effects absorption)
Vitamin K continued
Food sources:
Green leafy vegetable (cooked is higher in vitamin K)
Cabbage
Pharmaceutical source (phytonadione) oral or injection. Oral water soluble solution available for those with malabsorption disorders
Overconsumption of vitamin E and A can interfere with absorption of Vitamin K
Warfarin (Coumadin) and Vitamin K-keep the limit the amounts of green leafy vegetables the samedon't decrease but definitely don't increase; will have to take higher levels of coumadin if Vit K is present, consult dietician for any dietary changes
Infants and vitamin K deficiencies- infants are not born with gut flora, will need shot of Vit K after birth
The anticoagulant warfarin interferes with the livers use of vitamin K (intended effect)
Infants born with sterile bowel. May have had inadequate vitamin K via the placenta. Takes about 24 hours for bacteria to colonize in the intestines. An IM dose of vitamin K recommended immediately after birth to prevent bleeding.
Fat Soluble vitamins
Water and fat do not mix
Fats are circulated in the water-based blood.
The liver attaches fat-soluble vitamins to protein carriers
Protein deficiency can hinder the use of fat soluble vitamins
Water Soluble vitamins
Vitamin C (Ascorbic acid)
Diverse functions
Wound, burn and fracture healing
Antioxidant
Enhances absorption of iron
Assists in the synthesis of hormones and neurotransmitters (adrenals) (serotonin)
Necessary for the formation of collagen
Vitamin C continued
Deficiency
Scurvy
Signs and symptoms:
Tender sore gums that easily bleed
Weakened blood vessels (Petechiae)
Breakdown of collagen
Delayed wound healing
Separation of scar tissue
Ends of long bones soften, leading to malformation and pain.
Fracturing occurs
Teeth loosen and fall out
Sudden death due to internal bleeding
Limey
Vitamin C Continued
Scurvy still exist today with certain populations.
Elderly
Neurodevelopmental disabilities
Psychiatric illnesses
Unusual dietary habits
In America, often times dietary deficiencies are not included in differential diagnosis.
Food sources for vitamin C
Fruits with the highest sources of vitamin C include:
Cantaloupe
Citrus fruits and juices, such as orange and grapefruit
Kiwi fruit
Mango
Papaya
Pineapple
Strawberries, raspberries, blueberries, cranberries
Watermelon
Vegetables with the highest sources of vitamin C include:
Broccoli, Brussels sprouts, cauliflower
Green and red peppers
Spinach, cabbage, turnip greens, and other leafy greens
Sweet and white potatoes
Tomatoes and tomato juice
Winter squash
Increased needs of Vitamin C
Smokers
Exposed to second hand smoke (esp. children)
Critically ill individuals
Vitamin C levels fall after uncomplicated surgery and fall even more in patients in the SICU.
Supplementation is recommended in those post gastrointestinal surgery.
Water Soluble Vitamins
B-Complex Vitamins
Thiamin
Riboflavin
Niacin
Vitamin B6
Folate
Vitamin B12
B-Complex Vitamins
Thiamin
Essential coenzyme in metabolism of glucose and certain amino acids.
Located primarily in the skeletal muscles. Also located in the liver, heart, kidneys and brain.
Absorbed in the small intestine, primarily jejunum and ileum.
As energy expenditure increases, need for thiamin increases.
Mainly excreted in urine
B-Complex Vitamins
Thiamin deficiencies:
Dry Beriberi:
Muscle weakness and wasting, primarily lower extremeties.
Symmetrical sensory and motor conduction problems affecting limbs
Wet Beriberi:
Progression to right sided heart failure.(cor pulmonale)
Occurs in infants 2 to 6 months old who do not get enough thiamin.
Alcoholism: liver dysfunction effects the usage of the vitamins due to storage problems (of the vitamins)
food sources: pasta, breads, liver, nuts, seeds
In Israel there was a soy based infant formula that did not have detectable levels of thiamin.
Thiamin deficiency common in alcoholism.
B-Complex Vitamins
Vitamin B2 Riboflavin
Coenzyme in the metabolism of protein and other vitamins.
Clients undergoing major healing processes such as burns require more than the average person.
Turns urine yellow/orange color
B-Complex Vitamins
Riboflavin (B2) deficiencies
Signs and symptoms (usually occur after 4 months)
Painful lesions on outside of lips and corners of the mouth
Redness and swelling in the mouth
Inflammation of the skin
Anemia
Peripheral nerve dysfunction
B-Complex Vitamins
Riboflavin deficiencies cont.
Clients at risk:
Those who avoid dairy products
Congenital heart disease
Some cancers
Alcoholism
Hypothyroidism
Adrenal insufficiency
B-Complex Vitamin
Food sources for Riboflavin
Dairy products.
Eggs.
Green leafy vegetables.
Lean meats.
Legumes.
Milk.
Nuts.
B-Complex Vitamins
Niacin (vitamin B3)
Coenzyme required for energy metabolism.
Participates in the synthesis of steroid hormones and fatty acids.
Requisite for more than 200 enzymes
Liver can convert Tryptophan to Niacin (requires riboflavin, B6, and iron). When Tryptophan levels are low protein synthesis takes precedence.
B-Complex Vitamins
Niacin Deficiency
Pellegra
Signs and symptoms
Symptoms can present as soon as 60 days
diarrhea, dermatitis, dementia, and death
High risk population
Alcoholism
Aids
Homelessness
Absorption problems
Aneroxia nervosa
B-Complex Vitamins
Food sources for Niacin
Fish (Cooked Yellowfin Tuna)
Chicken & Turkey (Cooked Chicken Breast)
Pork (Cooked Lean Chop)
Liver (Cooked Lamb Liver)
Peanuts (Oil Roasted)
Beef (Cooked Lean Rib)
Coffee (small amount)
B-Complex Vitamins
Vitamin B6
Coenzyme in the metabolism of amino acids
Involved in the metabolism of over 100 enzymes
Including those that convert tryptophan to niacin and heme for hemoglobin
Proper immune funtion
B-Complex Vitamins
Vitamin B6 cont.
High risk for deficiency
Women of childbearing age
Current and former oral contraceptive users
Smokers
Non-Hispanic Black
Elderly
High heat during commercial processing of foods
B-Complex Vitamins
Vitamin B6 deficiencies:
Signs and symptoms:
Rash on face, neck, shoulders and buttocks
Mouth lesions
Fatigue and weakness
Confusion
Peripheral neuropathy
anemia
B-Complex Vitamins
Vitamin B6 food sources
richest sources of vitamin B6 include fish, beef liver and other organ meats (any animal source)
Whole grains
Vegetables (potatoes and other starchy vegetables)
Fruit (non-citrus)
Fortified Cereals
B-Complex Vitamins
Folate
Involved in protein synthesis, including amino acids, DNA, RNA and Heme.
Folate participates in the reproduction of every cell.
Particularly for rapidly growing cells (GI tract, blood and fetal tissue)
Absence of adequate folate can be catastrophic. Birth defects occur 1st 3-4 weeks. Effects fetuses brain and spinal cord.
B-Complex Vitamins
Folate deficiency
Poor dietary intake most common cause.
Results in impaired cell division and protein synthesis, including red blood cells (anemia).
Signs and Symptoms:
Bright red tongue
Fatigue and weakness
Headaches, irritability
Shortness of Breath
Heart palpitations
B-Complex Vitamins
Folate food sources;
Beef liver, braised, 3 ounces
Green leafy vegetable (spinach), cooked
Black-eyed peas
Breakfast cereals, fortified with 25% of the DRV
Rice, white, medium-grain cooked
Asparagus cooked
Spaghetti, cooked, enriched
Brussels sprouts
B-Complex Vitamins
Vitamin B12
A coenzyme involved in the synthesis of DNA, RNA and the metabolism of fatty and amino acids.
Involved in the synthesis and maintenance of myelin (the fatty insulation that permits speedy transmission of impulses along the nerves)
Excessive intake of alcohol or vitamin C interfere with absorption.
B-Complex Vitamins
Vitamin B12 deficiency:
Common cause of neuropsychiatric problems in the elderly
Pernicious anemia
Signs and Symptoms:
Fatigue
Pallor
Shortness of breath
Heart palpitations
Numbness and tingling in the extremeties
Abnormal gait, poor coordination of movement
Memory loss, disorientation
Psychosis, dementia
Pernicious Anemia - Pernicious anemia is a type of vitamin B12 anemia. The body needs vitamin B12 to make red blood cells. n adults, symptoms of pernicious anemia are usually not seen until after age 30. The average age of diagnosis is age 60. You are more likely to get this disease if you:Are Scandinavian or Northern EuropeanHave a family history of the condition
B-Complex Vitamins
Vitamin B12 Food sources:
meat
poultry
Shellfish
eggs
dairy products
Learning Outcome 13
What is the importance of minerals to the body?
Necessary for biochemical reactions in the body
Obtained from the Earths crust, absorbed by plants, animals eat plants, humans eat animals and plants.
Water is the medium of absorption of nutrients for plants and the basis of the bodys nutrient delivery system.
Learning Outcome 14
How are minerals classified?
Macrominerals DR is >100 mg, help to balance pH. (calcium, chlorine, magnesium, phosphorus, potassium, sodium, and sulfur).
Microminerals DR is < 100mg (chromium, cobalt, copper, fluorine, iodine, iron, manganese, molybdenum, selenium, and zinc).
Healthy People 2020
Weight and growth
Food and nutrient consumption
Iron deficiency and anemia
Schools, worksites, and nutrition counseling
Food security
10/28/14
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