UC San Diego Independent Study Projects Title Supplemental Study Resources and Assessment Questions for MS1 Nutrition Thread Permalink https://escholarship.org/uc/item/7hk9b4fs Author Diggs, Jenna Elizabeth Publication Date 2016 eScholarship.org Powered by the California Digital Library University of California Supplemental Study Materials for MSI Nutrition Thread ISP completed by Jenna Diggs, class of 2016 Micronutrient Index Overview of supplemental modules provided for additional study The Behavioral and Social Science Foundations for Future Physicians reports, “Over 50 percent of premature morbidity and mortality is caused by behavioral and social determinants of health such as smoking, diet, exercise, and socioeconomic status.” Schlair and colleagues (2012) share another statistic that 70% of adults in America are overweight or obese. What people eat plays a major role in their predicted health outcomes. Doctors have an obligation to educate their patients on lifestyle changes, even if it is only a few words or suggestions each visit. Unfortunately, many physicians today do not offer advice on nutrition to patients because they either do not have the know-how or they are not confident to do so (Schlair et al, 2012). In a survey that Schlair and colleagues conducted, doctors felt more confident counseling their patients on nutrition once they were offered an education course about the basics of diet improvement. Studies have also shown that improving one’s own health and habits improves counseling to a patient (Schlair et al, 2012). Certainly, doctors should practice what they preach (Kushner et al, 2013). If they live the healthy lifestyles that they tell their patients to endorse, physicians will undoubtedly gain more credibility in the eyes of their patients and strengthen their relationships with them. The study modules that follow were designed to enhance medical student learning in the first year Nutrition Thread. As expressed above, nutrition education is integral to creating well-rounded physicians especially with the obesity epidemic running rampant in this nation. These modules provide a condensed overview of the most valuable vitamins and minerals that the human body requires to function adequately and thrive. They should serve as supplemental study resources to the course material taught in lectures throughout the Nutrition Thread. Salient points listed in these modules will also appear on assessments (both weekly quizzes and exams), so it is recommended that students use them as a reference throughout the year. Listed below is an abbreviated outline of the vitamins and minerals included in the modules. Vitamins Minerals = essential, organic substances needed in small = inorganic substances critical to many body amounts in the diet; they are not a source of functions, including cell metabolism, nerve impulse energy, but instead aid in growth, development, transmission, growth and development and maintenance of body tissues Fat soluble vitamins: So named because they Major minerals: reasonably large quantities in food, dissolve in organic solvents present in large amounts in body • Vitamins A, D, E, K • Electrolytes: sodium, chloride, potassium • Calcium, phosphorus, magnesium Water soluble vitamins: So named because they dissolve in water Trace minerals: small quantities in food, minute • Vitamin C, thiamin, folate, vitamin B12, stores in body vitamin B6, niacin, biotin, pantothenic acid, • Iron, copper, zinc, iodine, manganese, riboflavin selenium, fluoride, chromium, molybdenum Supplemental Study Materials for MSI Nutrition Thread ISP completed by Jenna Diggs, class of 2016 Other helpful definitions when studying from these modules: • Recommended Dietary Allowance (RDA): average daily level of intake sufficient to meet the nutrient requirements of nearly all (97-98%) healthy individuals • Adequate intake (AI): established when evidence is insufficient to develop and RDA and is set at a level assumed to ensure nutritional adequacy • Upper Limit (UL): maximum daily intake unlikely to cause adverse health effects Resources ods.od.nih.gov The NIH provides a comprehensive database of major vitamins and minerals. Much of the information provided in the study modules was drawn from this resource. “Report of the Behavioral and Social Science Expert Panel.” Behavioral and Social Science Foundations for Future Physicians. Association of American Medical Colleges. 2011. www.aamc.org/socialsciencesfoundation Schlair S, Hanley K, gillespie C, Disney L, Kalet A, Darby P, Frank E, Spencer E, Harris J, Jay M. Medical students’ behaviors and attitudes affect the impact of a brief curriculum on nutrition counseling. J Nutr Educ and Behav; 2012; 44 (6); 633-637. Kushner RF, Van Horn L, Rock CL, Edwards M, Bales CW, Kohlmeier M, Akabas SR. Nutrition education in medical school: A time of opportunity. American Journal of Clinical Nutrition, in press. Supplemental Study Materials for MS1 Nutrition Thread ISP completed by Jenna Diggs, class of 2016 Nutrient Summary Sheet **Disclaimer—The facts on this page are by no means comprehensive as compared to the Supplemental Study Materials from which they originate. You may be tested on material presented in the complete modules that is not found within the summary pages of this document. FAT SOLUBLE VITAMINS Nutrient Major function RDA in adult UL in adult Clinical significance Vitamin A Vision and 700-900 mcg 3000 mcg -Main source of retinoic acid and retinaldehyde, active forms of the vitamin regulation of cell -Deficiency causes corneal ulceration (keratomalacia), Bitot’s spots, proliferation and follicular hyperkeratosis, impaired immune function, and night blindness differentiation Vitamin D Calcium 15 mcg or 600 100 mcg or -UV rays from sun help convert precursor to vitamin D in skin, but absorption and IU 1500 IU exogenous source is also necessary to meet requirements resorption -It should be supplemented to breastfeeding infants and is added as a fortificant to infant formula -Deficiency causes rickets in children and osteomalacia in adults Vitamin E Antioxidant 15 mg 1000 mg -Deficiency causes hemolytic anemia and impaired immune function Vitamin K Coagulation and 75 mcg N/A -Newborns at risk of deficiency and consequently hemorrhagic disease of bone health the newborn, so AAP recommends all neonates receive parenteral supplement at birth -Deficiency causes impaired coagulation, resulting in bruising, mucosal bleeding, splinter hemorrhages, melena, and hematuria WATER SOLUBLE VITAMINS Nutrient Major functions RDA in adult UL in adult Clinical significance Vitamin C Collagen synthesis, 75-90 mg 2000 mg -Deficiency results in clinical syndrome of scurvy – starts as gum protein and fatty acid inflammation and progresses to petechiae, ecchymosis, purpura, joint metabolism, pain, poor wound healing immunity, non-heme iron absorption Thiamin Branched chain 1.1-1.2 mg N/A Clinical deficiency can manifest as: amino acid and 1. Beriberi syndrome: peripheral polyneuropathy sometimes involving carbohydrate development of heart failure metabolism 2. Wernicke-Korsakoff syndrome: triad of ophthalmoplegia/nystagmus, ataxia with wide base, and mental status disturbances – usually Supplemental Study Materials for MS1 Nutrition Thread ISP completed by Jenna Diggs, class of 2016 alcoholics 3. Leigh syndrome: rare, causes infant encephalopathy Folate Nucleic acid 400 mcg 1000 mcg -Deficiency results in megaloblastic anemia, which is clinically similar to synthesis vitamin B12 deficiency; however, folate stores are depleted within months while B12 deficiency takes years to develop -Folate supplementation during pregnancy reduces the risk of preterm delivery and neural tube defects Vitamin B12 Nucleic acid 2.4 mcg N/A -Good stores in liver and small requirements, so takes years to deplete synthesis and (vs. folate) neurologic function -Vegans at risk of deficiency due to lack of animal products in diet -Clinical deficiency manifests as megaloblastic anemia; more severely, subacute combined degeneration -Patients taking long term PPI’s should have periodic B12 monitoring Vitamin B6 100s of coenzyme 1.3 mg 100 mg -Deficiency usually occurs with other vitamin deficiencies, including B12 reactions and folate; symptoms include neuropathy, seizure, dermatitis, anemia -Toxicity can occur from excess supplementation; results in irreversible nervous system damage Niacin Oxidation/reduction 14-16 mg 35 mg -Deficiency causes pellagra, a clinically syndrome involving the triad of reactions involved in dementia, dermatitis, and diarrhea energy metabolism -Toxicity causes flushing, GI upset, liver damage Biotin Coenzyme for 30 mcg N/A -Excessive consumption of raw eggs can lead to deficiency; symptoms carboxylation include rash, alopecia, and neurologic deficits reactions in energy -Inherited biotinidase deficiency occurs in 1 in 100,000 infants, which metabolism subsequently causes biotin deficiency Pantothenic Energy and fatty acid 5 mg N/A -Ubiquitous in foods, so deficiency very rare acid metabolism Riboflavin Coenzyme in energy 1.1-1.3 N/A -Deficiency usually occurs with other vitamin deficiencies; clinically metabolism manifests as ariboflavinosis, which causes mouth and skin lesions, anemia, and constitutional symptoms ELECTROLYTES Nutrient Major functions RDA in adult UL in adult Clinical significance Sodium Body water balance, 1500 mg 2300 -Hyponatremia: caused by volume loss or overload and SIADH; muscle contraction asymptomatic if slow developing; rapid development causes and nerve nausea/vomiting