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Common complications of malnutrition
  • chronic diseases
  • infection
  • complications from surgery and chemotherapy
  • wound-healing time and mortality
  • pediatric populations (factors that may be compromised/affected ie. growth, development, learning)
USP Certification
dietary supplements do not need proof of safety, efficacy, or production under good manufacturing practices...
therefore: USP mark is important because it verifies the product ingredients and amounts, effective disintegration and dissolution, absence of harmful contaminants, safe, sanitary, and well-controlled manufacturing
Celiac Disease causes what type of malnutrition
Cholestryamine - binds bile acids, thereby hindering lipid emulsification
Cystic fibrosis causes what type of malnutrition
Orlistat - inhibit gastric and pancreatic pilases in the intestinal lumen
Obstructive jaundice causes what type of malnutrition
Mineral Oil - an unabsorbed oil that increase the fecal loss of fat-soluble vitamins
Cirrhosis of the liver causes what type of malnutrition
Olestra - decreases absorption of fat-soluble vitamins
Vitamin A
growth and reproduction (especially skeletal/tooth), organ functions (especially eye)
Vitamin D
bone formation and mineral homeostasis
Vitamin E
antioxidant, protects cell membranes from damage/destruction
Vitamin K
Promotes synthesis of and activates clotting factors
Vitamin C
Synthesis of hydroxyproline (precursor to collagen, osteoid, dentin), absorption of Fe2+

Folic Acid (Vitamin B9)
Synthesis of purines/pyrimidines, DNA synthesis, RBC maturation
Niacin (Vitamin B3)
Electron transfer during respiration
Pyridoxine (Vitamin B6)
Co-factor for many enzymes, heme production, metabolism of homocysteine
Riboflavin (Vitamin B2)
Oxidation/reduction rxns (CYP450), part of FAD and flavin mononucleotide
Thiamine (Vitamin B1)
Oxidative decarboxylation of pyruvic acid (Kreb’s cycle), myocardial and nerve cell function, carbohydrate metabolism
Calcium
*note max body can absorb at a time is 500 mg --> taken TID
Activates enzymes, acetylcholine synthesis, cell membrane permeability, B12 absorption, muscle contraction/relaxation, activation of plasma clotting factors, cell functions (Ca2+ carbonate: needs acidic environment to be better absorbed; Ca2+ citrate: has acidic component => better absorption)
Iron
Oxygen and electron transport
Magnesium
Bone structure formation, enzyme functions, maintenance of electrical potentials, transmission of impulses
Phosphorus
Component of bone matrix, phospholipids, carbohydrates, nucleoproteins, nucleotides, DNA/RNA, ADP/ATP, buffer
Chromium
Component of glucose tolerance factor
Selenium
Antioxidant that protects cell from damage
Zinc
Cofactor in DNA/RNA synthesis, mobilizes vitamin A, cellular immune functions
Vitamin A Toxicity
Toxicity
  • Main Side Effect: HA
  • May be accompanied by: diplopia (double vision), N/V, vertigo, fatigue, or drowsiness
Pregnant women or women of childbearing age: Teratogenic risk
Vitamin D (calciferol) Toxicity
Anorexia, hypercalcemia, soft tissue calcification, kidney stones, renal failure
Vitamin E Toxicity
None
Vitamin K Toxicity
None
Vitamin C Toxicity
Nausea, stomach cramps, diarrhea, nephrolithiasis (kidney stones), hemolysis, + more w/ pregnant, DM, renal dysfunction
Folic Acid (Vitamin B9) Toxicity
excreted
Niacin (Vitamin B3) Toxicity
Most common: GI symptoms, flushing/warmth—therefore take w/ ASA ½ hr before Others: hepatotoxicity, skin lesions, tachycardia, HTN
Vitamin B6 (pyridoxine) Toxicity
Sensory neuropathy, anti-prolactin effect
Riboflavin (Vitamin B2) Toxicity
Discolored urine as excreted
Thiamin (Vitamin B1) Toxicity
Excreted; changes color of stool
Calcium Toxicity
Main Side Effect: Constipation Others: Higher risk of renal stones/damage, anorexia, n/v, polyuria, black/tarry stools (refer)
Iron Toxicity
Main Side Effects: Constipation, GI symptoms Others: Acute poisoning (shock → cardiovascular collapse, electrolyte imbalance)
Magnesium Toxcity
Diarrhea, hypermagnesemia (muscle weakness, HTN, lethargy, sedation, coma)
Phosphorus Toxicity
GI Effects
Chromium Toxicity
Usually none, hexavalent: carcinogenic
Selenium Toxicity
Loss of hair/nails, skin lesions, muscle weakness, fatigue, CNS abnormalities
Zinc Toxicity
GI irritation and vomiting
The Food and Nutrition Board (FNB) of the Institute of Medicine created a new framework of 4 values for each nutrient
  • Estimated average requirement (EAR) which is an average daily intake level that could meet the requirements of 50% of healthy individuals in that life stage/gender group
  • Recommended dietary allowance (RDA) which is an average daily nutrient intake level to meet the requirements of 97-98% of healthy individuals in that life stage/gender group
  • Adequate intake (AI) which is a recommended average daily intake level assumed to be adequate when RDA cannot be determined—this is based on observed or experimentally determined approximations or estimations.
  • Tolerable upper intake level (UL) which is the highest average daily nutrient intake level that would be free of adverse effects for most individuals
A once daily multivitamin with 100% of the DRI is usually sufficient for most patients.  Many patients want to megadose on vitamins, as they think that vitamins are safe.  Which vitamins are stored in body tissues that can be toxic at high doses if megadoses are taken?
  • Vitamin A, D
  • Niacin (Vitamin B3)
  • Pyridoxone (Vitamin B6)
Pregnant
folate/folic acid is needed to prevent neural tubal defects of the fetus.  An intake of 400 mg-800 mg daily is recommended for most patients—some physicians may prescribe a prenatal vitamin that contains 1000 mg, but this is prescription only.  An additional 20-30 g of calcium is also needed during pregnancy to aid in the skeletal formation of the fetus—so intake should include at least 1000 mg daily.  Additional iron is also needed in pregnancy—so intake should include at least 27 mg daily
Women over the age of 30
1200 mg of calcium is recommended
Women with osteoporosis
1500 mg of calcium is recommended and 800-1200 mg of vitamin D
Women who have heavy menses
Iron supplementation may be required to prevent anemia.  At least 18 mg daily intake is recommended compared to the 8-10 mg elemental iron daily for the general patient population
Children and adults
previous recommendations for vitamin D was 200 IU daily and 400 to 600 IU daily for adults. Experts are now recommending 1000 IU daily for kids and 1000 to 2000 IU daily for adults.  15 minutes, 2-3 times per day provides sufficient vitamin D for most patients who do not have sunscreen
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