food is medicine: nutritional disorders - lecture 33 LAST LECTURE EVER

essential macronutrients

-- essential - you need to get them from your diet

-- nonessential - you dont have to get them from your diet

essential micronutrients

-- essential - you need to get them from your diet

-- nonessential - you dont have to get them from your diet

Nutrition

the study of the food we eat and its effects on our body's physiological and biochemical processes

Nutrients

embedded in the food we eat and are essential chemicals that are critical to human growth and function

-- Must get from diet

Phytochemicals

Phytochemicals are compounds in plants (phyto) that are believed to provide health benefits beyond the traditional nutrients (ex. Lycopene)

Zoochemicals

the animal equivalent of phytochemicals in plants. They are compounds in animals that are believed to provide health benefits beyond the traditional nutrients that food contains. (ex. Conjugated linoleic acid)

nutritional disorders

Inappropriate intake of food that negatively impacts physiological processes and thus healthspan

Caused by a deficiency or excess of one or more nutrients that alters the structure and/or function of cells, tissues, and organs to cause disease

Most are chronic, not acute

Suboptimal nutrition and/or marginal deficiencies

occurs when the diet doesn't provide recommended amounts of nutrients

Chronic and long-term --> malnutrition.

Malnutrition

Undernutrition, which includes wasting (low weight-for-height), stunting (low height-for-age) and underweight (low weight-for-age)

Micronutrient-related malnutrition, which includes micronutrient deficiencies (a lack of important vitamins and minerals) or micronutrient excesses

Overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes, and some cancers)

Non-essential Compounds Critical for Health

healthspan

Period of life spent in good health

lifespan

the length of time a person lives

Current treatment

From: Leading Causes of Death in the US, 2019-2023. All are associated with diet.

Functionality of dietary interventions on human tissues under health and diverse disease states. _________ ______________ exert beneficial effects across varying aspects, including nervous system, cardiovascular system, respiratory system, metabolic system, renal system, endocrine system, and digestive system as well as cancer

Dietary interventions

Suboptimal Nutrition (Marginal Deficiency) (2)

Deficiency syndrome/disease develops slowly

Sometimes individual does not recognize

2017: ≈11 million people worldwide died from suboptimal nutrition while 255 million have a disability associated with diet

Examples - in photo

Inappropriate food intake- leads to nutrient disorders....

what are the Nutrients of Concern:

Calcium

Vitamin A

Vitamin C

Iron

Folate

Iodine

Magnesium

Dietary Reference Intake (DRI)

refers to set of reference values that include RDA, AI, EAR, UL.

All nutrients now have an RDA and EAR, or AI.

increasing nutrient intake

Causes and Risk Factors

Mother of two children wanted to take her children to Disney World and ride the roller coaster with them. She was morbidly obese and weighed 250 lbs. She had tried numerous diets without success and decided to have a gastric bypass. The surgery went as planned at a well-known bariatric unit and she was discharged three days later. Within a few days of leaving the hospital, she developed abdominal pain and began vomiting. She went to the emergency room of a local hospital and five days later the surgeons drained abdominal fluid from her side. Several days later a hole was found in her stomach lining. She never recovered from this and died. At autopsy, several other wounds were found, and most were only partially healed.

What caused her death?

a)Inadequate protein intake

b)Suboptimal nutrition

c)Lack of vitamin C

d)Excess fluid intake

b)Suboptimal nutrition

How prevalent is it in hospitals?

Factors contributing to malnutrition in acute care patients

Nutritional Disorder Treatment

Treatment

1. Usually consists of replacing missing nutrients or removing excess nutrients

2. Treating symptoms as needed

3. Treating any underlying medical condition

Expectations (prognosis)

1. Depends on the cause of the malnutrition

2. Most can be corrected

3. Treat medical condition to reverse the nutritional deficiency/excess

Complications

1. Untreated - mental or physical disability, illness, and possibly death

Prevention

1. Eating a good, well-balanced diet

iodine

goiter

on the rise in higher social economic countries, particularly women

vitamin D

adults: increased fractures, muscle weakness, bone loss which can lead to osteomalacia, osteoporosis

children: growth delay, soft bones, rickets

about 42% of americans deficient in this vitamin. 3 out of 4 older people may be deficient

calcium

adults: osteoporosis, osteomalacia

children: soft bones, rickets

many americans do not consume enough calcium

vitamin A (retinol vs beta carotene)

excess amount of retinol in pregnancy - teratogen that causes congenital anomalies

too little - night blindness

retinol is found in animal products

beta carotene is found in plants

vitamin C

scurvy

symptoms: bruising, swollen, and/or bleeding gums, weakness, fatigue, rash, coiled hair, failure to thrive, irritability, muscle weakness, or weight loss

sailor's disease (greenbacks)

iron

microcytic anemia - small red blood cells

anyone, 30% of the population

folate

megaloblastic anemia

pregnancy: congenital anomalies - neural tube defects

specific foods now fortified with folate

vitamin B12

megaloblastic anemia

vegans, vegetarians, >20% of older adults (absorption decreases with age)

niacin

pellagra

4 Ds (dementia, diarrhea, dermatitis, death)

disease that killed many southerners

thiamin

beriberi

wet and dry form which affects nerves leading to wernicke encephalopathy and korsakoff syndrome

A 9-year-old girl with autism comes to the hospital with severe bone pain that keeps her from walking for 2 months. She also has a petechial rash and gingival swelling. An orthopedic workup, including extremity and back MRI, is negative. When asked specifically, her mother reports that her diet consists of frozen pancakes and chocolate milk. Which of the following deficiencies is most likely the cause of her symptoms?

a.Folate

b.Iron

c.Vitamin A

d.Vitamin C

e.Vitamin D

d.Vitamin C

Protein Calorie Malnutrition - Kwashiorkor

Characterized as a protein deficit that is relatively greater than the reduction in total calories

In Westernized countries, see with alcohol use disorder.

Protein Calorie Malnutrition - Marasmus

Undernourishment resulting from energy deficit and reduction in all nutrients

-- Loss of muscle and fat stores

-- Diarrhea is common

-- Children - growth failure

Eating Disorders

Serious disturbance in eating with excessive concern over body shape and/or body weight

Examples: Anorexia nervosa, Bulimia nervosa, Binge-eating disorder

Disordered eating

abnormal eating patterns that do not meet the criteria for an eating disorder diagnosis

-- ARFID (Avoidant/Restrictive Food Intake Disorder) avoid certain foods or restrict their diets; often seen in children

-- Night eating syndrome (NES) - eat more than 25% of calories at night, have trouble sleeping, wake up at night to eat

Relative Energy Deficiency in Sports (RED - S) (aka Female Athlete Triad)

seen in male and female athletes

A woman aged 48 years, diagnosed with anorexia nervosa (AN) at the age of 12 was admitted to a highly specialized eating disorder facility in the UK with distended abdomen, muscular atrophy, ulcerative dermatitis, electrolyte derangements and low serum albumin. Her weight was 53.1 kg, corresponding to a body mass index (BMI) of 17.9 kg/m2. After initial stabilization, a therapeutic ascites puncture relieved the patient from 6500 mL of ascites. After 6 weeks of nutritional and diuretic treatment, the patient was discharged with a weight of 46.8 kg (BMI 15.7 kg/m2), without ascites and with healed ulcerations. What is the patient’s nutritional problem?

a)Obesity

b)Kwashiorkor

c)Vitamin B12

d)Marasmus

e)Vitamin D

b)Kwashiorkor

Excess Adipose Tissue - Obesity

Root cause still unknown

Eating too many calories from energy dense, nutrient poor foods seems to contribute to obesity

Too many calories does not mean you are getting all the nutrients you need every day

Examples of nutrient deficiency/malnutrition seen in obese people:

Treatment:

- Surgery

- Drugs

- Diet

All treatments involve losing weight, focus is adipose tissue

Treatment can lead to nutritional disorders

Surgery: Nutrient Deficiencies/Malnutrition with Bariatric Surgery

Micro-nutrient deficiencies are common in people who are obese before and after by-pass surgery

Bypass alters the GI tract, so changes nutrient absorption

Common nutrient problems with RYGB - iron, vitamin B12, folic acid, vitamin D, and calcium

Protein and vitamin B12 are a problem if the stomach is altered

FDA-approved meds for weight loss

dont need to memorize

1. Orlistat (Xenical)

2. Orlistat (Alli)--over the counter

3. Phenteramine-topiramate (Qsymia)

4. Naltrexone-bupropion (Contrave)

5. Liraglutide (Saxenda)*

6. Semaglutide (Wegovy)*

7. Setmelanotide (Imcivree) for rare genetic conditions

*GLP-1 agonists for weight loss require _______ doses than for DM treatment

higher

what are some Observed nutrient deficiencies r/t GLP-1 use?

vitamin B12, vitamin D, iron, calcium

Diets: Nutrient Deficiencies/Malnutrition with Weight Loss Diet

Tips for Evaluating Diets - Red Flags that signal bad advice

Short List of Drugs That Can Cause Nutrient Disorders/Malnutrition

Protein pump inhibitors (used to treat GERD)

-- increase risk of hypocalcemia and hypomagnesemia

Antacids – long term use

-- Vitamin B12 deficiency

Antihypertensives

-- Affect body levels of potassium, calcium and zinc

Diuretics

-- Some increase loss of potassium, magnesium, and calcium

Cholestyramine

-- Decrease absorption of fat-soluble vitamins as well as vitamin B12, folic acid and calcium

Hydralazine

-- antihypertensive drug that depletes vitamin B6

A sixty-eight-year-old man with atherosclerosis and high blood pressure reports to the ER with complaints of “swimming in my head”. His BP is so low it’s difficult to measure. He is severely dehydrated, lips that are dry and cracked, and a dry tongue. His hands are covered by dark, thick, rough, scaly, skin from the knuckles to the tip of the fingers, which they’ve had for months. The rash is on his back, chest, and feet. His partner indicates he has had severe diarrhea for the past several months, going to the bathroom five to ten times a day and at night. His current medications are atorvastatin (a statin for high cholesterol), hydralazine (for high blood pressure), and metformin (for diabetes), all of which he has taken for several years. He eats a well-balanced meals with a good combination of fresh fruits, vegetables, grains, and chicken. Based on this information, which of the following do you think this individual may be deficient for:

A. Thiamine

B. Niacin

C. Pyridoxine

D. Folate

E. Cobalamin

C. Pyridoxine

Diets Experts Are Recommending: US News & World News

What should you eat? Resources to eat right

fruits

potassium, dietary fiber, vitamin c, and folate (folic acid)

vegetables

many nutrients, including potassium, dietary fiber, folate (folic acid), vitamin a, and vitamin c

grains

dietary fiber, several b vitamins (thiamin, riboflavin, niacin, and folate), and minerals (iron, magnesium, and selenium)

dairy

calcium, potassium, vitamin D, vitamin B12, and protein

protein

protein, b vitamins (niacin, thiamin, riboflavin, and b6), vitamin E, vitamin B12, iron, zinc, and magnesium

MyPlate

https://www.choosemyplate.gov/MyPlate (app available)

Breaks food we eat into five groups plus oil

Stresses importance of your plate consisting of mostly plant foods from three groups:

-- Vegetables

-- Fruits

-- Whole grains

Includes dairy which many people cannot eat - substitute soy or almond milk

Stresses importance of a colorful plate (only get if include lots of plant foods)

MyPlate Daily Checklist

summary

our job

to assist in identifying potential nutritional disorders/malnutrition and bring to the attention of the medical team, doctor, and/or dietitian