Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FPH exam > 2E health and social behaviour > Flashcards

2E health and social behaviour Flashcards

1
Q

Nutrition

A

The process of securing the dietary requirements for individuals or a population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Macronutrients

A

Things required in diet in relatively large amounts (ie carbohydrate, protein, fat, water)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Micronutrients

A

Things required in diet in relatively small amount (ie vitamins and minerals)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hunter Gatherer diet Vs Western diet

A

Hunter gatherer diet contained more protein, carbohydrate and fibre and considerably less fat than the western diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Population nutritional surveillance: Study designs to assess population nutrition- list 5

A
  1. ecological
  2. retrospective case control
  3. cohort
  4. RCT
  5. nutritional surveys
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Study designs to assess population nutrition: ecological studies

A
  • compare disease outcomes with diets of different nations (or disease outcomes and diet of a country over time)
  • potential for confounding means conclusions are hard to draw
  • can be a fruitful source of hypotheses

eg ‘french paradox’ it was noted that France had a relatively low prevalence of CHD and a relatively high intake of saturated fat. Studies considered various candidate protective factors such as red wine, fish and lack of snacking. However a larger, carefully conducted study into CHD showed the french paradox did not exist.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Study designs to assess population nutrition: retrospective case control

A

Individuals with disease and health controls are asked about a range of dietary influences

  • Has the potential for recall bias and that the onset of disease may have altered diet (difficult for participants to be sure when diet changed)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Study designs to assess population nutrition: cohort study

A
  • Health cohort, follow up and see who develops disease
  • adjustments are made for confounding factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Study designs to assess population nutrition: RCT

A
  • nutrient or food constituent is given to one group only
  • expensive
  • effect sizes are often small so large study/ meta analysis needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Study designs to assess population nutrition: nutritional surveys

A
  • Food expenditure surveys (ie UK ONS living cost and food survey - part of Integrated Household Survey)
  • Diet and nutrition surveys (eg UK National diet and Nutrition Survey)
  • Breastfeeding surveys (eg UK Infant feeding Survey)
    -school meal surveys
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sources of Nutritional Surveillance data (4 categories)

A
  • Food supply data
  • food expenditure data
  • data and nutrition surveys
  • nutritional surveillance in children
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Sources of Nutritional Surveillance data: food supply data

A
  • Data is available on agricultural food production and food imports/ exports
  • for most countries this is collated nationally by the UN food and agriculture organization
  • Ad hoc food mapping exercises often form part of needs assessment. These establish where people can buy/eat food. They often identify ‘food deserts’ often inner city areas where people cannot access fresh food without a car
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sources of Nutritional Surveillance data: food expenditure data

A
  • most European countries conduct a household income and expenditure survey every 1-5 years
  • UK has Living Cost and Food Expenditure survey as part of the Integrated Household Survey
  • collects food expenditure data via self reported diaries annually
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Sources of Nutritional Surveillance data: diet and nutrition surveys

A
  • may involve food diaries, physical measurements (ie BMI, blood analysis), interviews etc

-Food diaries are often unreliable as people tend to underestimate their intake. There is also bias as obese people tend to underestimate by more than non-obese

  • UK has National Diet and Nutrition survey. Surveys adults age 19-64years, continuous, cross sectional survey
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Sources of Nutritional Surveillance data: nutritional surveillance in children

A
  1. Breastfeeding surveys: Uk has Infant feeding survey which surveys around 15000 mums on nutrition over the first year of life. Was 5 yearly but 13 year gap between last 2 (2010 and 2023)
  2. School meals- data is available on number of children having school meals but only for schools using local authority caterers (not available for private caterers)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Short term nutritional impacts: too much sugar

A

dental caries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Short term nutritional impacts: too much salt

A

hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Short term nutritional impacts: lack of protein

A

Kwashiorkor

muscle wasting, protruding belly, diarrhoea, fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Short term nutritional impacts: lack of calories, fat and protein

A

Marasmus (emaciation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Short term nutritional impacts: lack of B vitamins

A

Beri beri
- heart failure, generalised oedema and neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Short term nutritional impacts: lack vitamin C

A

Scurvey
- gum disease, bleeding, listlessness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Long term nutritional impacts: central obesity

A

type 2 diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Long term nutritional impacts: lack of fruit and veg

A

CHD
many cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Long term nutritional impacts: lack of calcium

A

osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Long term nutritional impacts: lack of vitamin B12

A

clinical features: pernicious anaemia, neuropsychiatric symptoms
high risk groups: alcohol dependency, strict vegetarians and vegans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Long term nutritional impacts: Vitamin D deficiency

A

clinical features: children –> osteomalacia, ricketts
adults–> osteoporosis

high risk groups: dark skin, keep skin covered for religious reasons, elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Long term nutritional impacts: folate deficiency

A

clinical effects: anaemia, birth defects

high risk groups: alcohol dependency, pregnancy and lactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Long term nutritional impacts: iron deficiency

A

clinical effects: anaemia
High risk groups: pregnancy, strict vegetarians/ vegans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Acute malnutrition: pathophysiological pathway

A

Acute lack of nutrution–> inflammatory response and cytokine release –>:
1. infection
2. impaired healing
3. organ failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

chronic malnutrition: pathophysiological pathway

A

chronic overnutrition–> obesity –> insulin and leptin resistance +/- diabetes (this leads to increased obesity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

malnutrition in disease states: pathophysiological pathway

A

Disease –> anorexia–> reduced food intake –> malnutrition–> disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Protein energy malnutrition

A
  • accounts for > 5million deaths per year
  • definitions of kwashiokor and marasmus and not universally agreed on
  • broadly:

kwashiokor= lack of protein –> odema, protruding belly, muscle wasiting

Marasmus = lack of calories, fat and protein –> emaciation, stunted growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

malnutrition in pregnancy: UK dietary and supplement recommendations

A
  • avoid alcohol, soft cheese, unpasteurised milk, some fish
  • take 400 micrograms folic acid for first 12 weeks pregnancy. take 10 microgram vit D daily throughout
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

malnutrition in pregnancy: IUGR

A

IUGR= est foetal weight < 10th centile
low birth weight = >37 weeks and < 2500g

-inadequate nutrition in pregnancy can lead to foetus not reaching full growth potential (this is one cause of IUGR)
- IUGR is a strong predictor of complication during pregnancy ie still birth, hypoxic brain injury, chronic lung disease
- also evidence that IUGR can increase risk of some adulthood disease ie cardiovascular disease, renal disease

IUGR is a serious public health problem in developing countries but only effects about 2% in developed countries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

malnutrition in pregnancy: Iron deficiency anaemia

A
  • IDA is the most common nutritional deficiency in the world
  • affects > 2 billion people worldwide across all ages
    -most common in infancy, children, teens, women of childbearing age
  • predominantly caused by deficiency in dietary iron
  • maternal iron deficiency anaemia increases risk of maternal morbidity and mortality and risk of foetal morbidity and mortality and low birth weight
36
Q

malnutrition in pregnancy: iodine deficiency

A
  • iodine is needed for the production of thyroid hormones
  • extreme iodine deficiency pregnancy or infancy can lead to cretinism
  • some food interfere with iodine uptake (ie cassava and brassica vegetables), cassava is a staple in many areas
  • serious issue in many developing countries
  • public health programmes ie salt iodization can prevent
37
Q

Malnutrition in growth and development: general

A
  • nutrition in early childhood can impact long term cognitive development, behaviour and physical health
  • height, weight, OFC, BMI are monitored in many developed countries
  • severe malnutrition can lead to kwashiokor or marasmus
38
Q

Malnutrition in growth and development: Vitamin A deficiency

A
  • leading cause of preventable blindness in children
  • causes xeropthalmia, severe dryness of the eye which can lead to corneal damage and blindness
  • increasing evidence that , in vit A deficient populations, vitamin A supplementation reduces mortality, morbidity and blindness
39
Q

list 6 ways of measuring nutritional status

A
  1. Anthropometry
  2. Indices of malnutrition
  3. Biochemical tests
  4. Bioelectrical impedance analysis
  5. Imaging
  6. Food consumption questionnaires
40
Q

Ways of measuring nutritional status: anthropometry

A
  • height and weight for BMI
  • head circumference
  • plotted on growth charts
  • skin fold thickness
41
Q

ways of measuring nutritional status: Indices of malnutrition

A

ie MUST scoring
- 5 point scoing system indicating likelihood of current malnutrition or risk of developing malnutrition
- considers: BMI, unplanned weight loss and acute illness affecting nutrition
- score indicates risk and advises on management and monitoring

42
Q

ways of measuring nutritional status: Biochemical tests

A

ie 24 hour urinary nitrogen as a marker of protein intake
- biochemical tests are a poor marker of nutrition as changes compensated for by homeostatic mechanisms and affected by other diseases

43
Q

ways of measuring nutritional status: bioelectrical impedance analysis

A
  • used to measure body composition
  • accuracy limited
44
Q

ways of measuring nutritional status: Imaging

A

ie near infrared interactance may be used to measure body composition

45
Q

ways of measuring nutritional status: Food consumption surveys

A
  • maybe prospective or retrospective
  • different types:
    1. food frequency and amounts questionnaire
    2. food diaries (2 main types weighed inventory and household measures)
    3. duplicate diet mehtod
46
Q

ways of measuring nutritional status: Food consumption surveys - food frequency and amounts questionnaire

A
  • contains pre printed list of foods
  • people are asked to indicate how often they eat and average amount (ie cup, bowl, spoonful)for each food type
47
Q

ways of measuring nutritional status: Food consumption surveys- food diaries

A

WEIGHTED INVENTORY
- people are asked to weigh all food and drink they consume and record
- most commonly used food diary technique

HOUSEHOLD MEASURES
- as above but people instead record portion size in household measures ie cup, bowl, spoonful
- photos can help improve estimate accuracy

48
Q

ways of measuring nutritional status: Food consumption surveys- duplicate diet method

A
  • subject has to weight and record all food but also has to weight second identical portion which is then chemically analysed
49
Q

List nutritional interventions examples (6)

A
  1. fluoridation of water
  2. fortification of food (ie flour fortified with folic acid to reduce neural tube defects)
  3. workplace campaigns (ie healthier food in the canteen)
  4. tv series promoting healthier diets (ie jamie oliver school meals)
  5. Collaboration with food and drink industry
  6. legislation ie sugar tax
50
Q

list 5 ways of assessing the impact of nutritional interventions

A
  1. sales data (ie sales of full fat vs skimmed milk)
  2. dietary surveys
  3. clinical measures (ie BMI, dental caries)
  4. biochemical measures (ie serum cholesterol
  5. morbidity and mortality end points (eg MI, death)
51
Q

Factors influencing choice of diet (7)

A
  1. Personal preference
  2. Financial resources
  3. Culture (ethnicity, religion)
  4. Education
  5. Time resource
  6. Food environment
  7. Psychological (stress, mood)
52
Q

Social determinants of diet: Poverty

A
  • traditionally poverty has impacted the diet of adults more than children as adults often protect children’s diets and school meals have provided some nutrition
  • more recently there has been concern over the nutrient value of school meals

Particular issues with poverty include:
- discount stores are less likely to stock fresh food
- tinned and frozen food is often cheaper
- lack of car access can make getting to a supermarket difficult (food deserts)
- less able to try new recipes as failure may mean going hungry
- lean cuts of meat are often more expensive than fatty ones

53
Q

Social determinants of diet: ethnicity, culture and religion

A

Eating patterns may be influenced by:
- traditional cuisines
- fasting and festivals
- prohibited foods

54
Q

Social determinants of diet: education

A
  • more highly educated individuals are more likely to be knowledgeable of healthy eating and more likely to have a healthy diet
55
Q

Social determinants of diet: time resource

A
  • cooking fresh food can be a time consuming process
  • time poor individuals may find this challenging (ie working single parents)
56
Q

Behavioural determinants of diet: attitudes and beliefs

A
  • beliefs around importance of healthy diet differ between different groups
  • women and older people often prioritise healthy eating more
57
Q

behavioural determinants of diet: psychological determinants

A
  • mood and stress can impact dietary choices alongside capability to engage in healthy eating and appetite
58
Q

3 main types of dietary recommendations produced by public health agencies

A
  1. dietary reference values
  2. Dietary goals
  3. Dietary guidelines
59
Q

3 main types of dietary recommendations produced by public health agencies: dietary reference values

A

Quantitative guidelines for different population subgroups on the essential macro and micro nutrients needed to prevent nutritional deficiencies

eg PHE government dietary recommendations

Dietary reference values should be used to assess the nutrient requirements for large groups of people and populations but not applied to individuals as there is large variation between the needs of individuals

60
Q

3 main types of dietary recommendations produced by public health agencies: dietary goals

A
  • quantitative guidelines for selected macro and micro nutrients aimed at preventing long term disease

eg PHE government dietary recommendations

61
Q

3 main types of dietary recommendations produced by public health agencies: dietary guidelines

A

Broad targets aimed at individuals to promote nutritional wellbeing
eg the eatwell guide

can be quantitative ie eat 5 portions of fruit and veg a day or qualitative eg eat more fruit and veg

62
Q

Evidence for the dietary reference values and dietary goals in the PHE ‘government dietary recommendations’ (2016)

A

Based on recommendations from the:
-Scientific advisory committee on nutrition (SACN)
-Committee on medical aspects of food policy (COMA)

  • SACN produced a report in 2011 on the dietary reference values for energy based on updated evidence on total energy expenditure from studies using doubly labelled water
    -COMA report in 1991 provided dietary recommendations for total fat, saturated fat, total carbohydrate, sugars and dietary fibre
63
Q

4 types of reference value

A
  1. Estimated average requirement
  2. Reference nutrient intake
  3. Lower reference nutrient intake
  4. safe intake
64
Q

4 types of reference value: estimated average requirements

A

the average amount needed by a group of people (ie 50% of the groups requirements are met)

EARs are used in the SACN 2011 report on dietary reference values for energy

65
Q

4 types of reference value: reference nutrient intake

A

amount that is sufficient to meet the needs of 97.5% of population (ie most will need less)

66
Q

4 types of reference value: lower reference nutrient intake

A

amount that is sufficient to meet the needs of 2.5% of population with the smallest needs (ie most will need more)

67
Q

4 types of reference value: safe intake

A

used when evidence is not strong enough to give EARs or RNIs

68
Q

Evidence for dietary goals

A
  • Department of health estimate that eating 5 portions of fruit and veg a day can reduce your risk of death from chronic diseases (ie stroke, MI, cancer) by 20%
69
Q

What contains England’s Dietary guidelines and give some key features

A
  • the Eatwell guide
  • contains pictorial diagram of food groups that should make a healthy diet and their proportions
  • also includes 8 tips for eating well:
    1. base your meals on STARCHY foods
    2. Eat lots of FRUIT and veg
    3 Eat more FISH-including one portion of oily fish per week
    4. cut down on SATURATED fat and sugar
    5. eat less SALT, no more than 6g per day for adults
    6. Get ACTIVE and be a healthy weight
    7. Don’t get THIRSTY
    8. Don’t skip BREAKFAST

(silly french frogs sip sweet tea after breakfast)

70
Q

Challenges in obtaining evidence for nutritional recommendations

A
  • Signficant ethical and practical limitations to RCTs
  • many outcomes of interest occur over long time periods ie CV events making trials impracticable and prohibitively expensive
    -International ecological studies (ie intersalt) have capitalised on dietary differences between cultures and have been useful for indicating which factors effect health
  • however they are vulnerable to ecological fallacy and confounding (ie differing genetic susceptibility to disease and unobserved lifestyle variations which may be responsible for differences)
71
Q

what was intersalt

A
  • large cross sectional ecological study
    -1988
  • investigated relationship between salt intake (measured by 24 urinary sodium excretion) and BP
  • regression analysis found that urinary sodium excretion was related to BP at the ecological level
72
Q

The impact of lifestyle: types of diet

A
  • different diets can have different health effects

WESTERN DIET
- high in total energy, saturated fat (butter and red meat), salt and low in fibre
- associated with obesity, breast cancer, hypertension/CHD, colorectal cancer

MEDITERRANEAN DIET
- high in unsaturated fats (olive oil), fruit and veg, low red meat
- associated with lower obesity, lower cholesterol/heart disease, lower cancer risk

SOUTH ASIAN DIET IN UK
- high in saturated fat (ghee), high in fruit and veg
- associated with obesity, CHD, stroke, T2DM

73
Q

The impact of lifestyle: obesity

A
  • obesity prevalence has been rising in UK since 1980s
  • Associated with several cancers, CHD, hypertension, stroke, T2DM, osteoarthritis
  • estimated to cost NHS £6.5 billion annually
74
Q

The impact of lifestyle: Physical activity

A
  • physical activity is associated with reduced obesity, reduce cancer risk, reduce CHD, reduced stroke, reduce hypertension, reduced mental ill health and reduced MSK conditions

UK recommendations
- adults 150 mins mod activity or 75 mins vigorous activity per week
- under 5 years - 180 mins physical activity a day

In 2021 (health survey for England) 64% of England’s adults met the physical activity guidelines

75
Q

The impact of lifestyle: alcohol

A
  • Alcohol can have acute effects (injury, RTA, violence, liver disease, STIs), chronic effects (pancreatitis, liver disease, dementia, CHD, stroke), and effects in pregnancy (foetal alcohol syndrome)
  • England recommendations: no more than 14 units of alcohol per week, spread evenly across at least 3 days
76
Q

The impact of lifestyle: drugs

A

The effects of drug use include:
- psychological: addicition, depression, anxiety, psychosis
- mortality
- BBV: Hep C , HEpB , HIV
-Social effects: unemployment, homelessness

76
Q

The impact of lifestyle: smoking

A

Smoking is the leading cause of preventable mortality worldwide

Smoking is associated with:
- cardiovascular disease (CHD, stroke)
- Addiction
-lung disease (lung cancer, COPD)
-other cancers (head and neck)
- pregnancy effects (IUGR)

77
Q

The impact of lifestyle: unprotected sex

A

-unprotected sex can lead to:
1. STIs
2. Unintended pregnancy

STIs can lead to chronic/serious disease:
- pelvic inflammatory disease
- HPV–> cervical cancer
- HIV

78
Q
A
79
Q

The impact of lifestyle: sun exposure

A
  • sun exposure is associated with malignant melanoma and other non melanoma skin cancers (squamous cell and basal cell carcinoma)
  • incidence of malignant melanoma has risen significantly in the UK over the past decade.
80
Q

Complex problems

A

Problems which may have multiple components, interacting elements and multiple causes. There is no simple cause and effect solution.

81
Q

Complex interventions

A

Many things can make an intervention complex.

They are often hallmarked by the number of interacting components, the number/difficulty of the behaviours required by those delivering the intervention, the variability of outcomes and the flexibility/tailoring of the intervention required.

82
Q

Give 3 broad methods of intervening in complex problems

A
  1. Medical
  2. Socioenvironmental
  3. behvaioural
83
Q

Methods of intervening in complex problems: medical

A
  • focuses on the disease
  • narrow view of the cause of disease (ie physiological or biological causes rather than the wider determinants
  • risk reduction often focuses on pharmaceutical intervention (ie statins, antihypertensives)
84
Q

Methods of intervening in complex problems: socioenvironmental

A
  • aims to improve health by modifying the social, economic and political environment through government and community actions

Advantages:
- there is evidence of effectiveness (ie sugar tax to reduce sugar intake)
- can reduce health inequalities (as can remove structural barriers to healthy choices)

Disadvantages:
- can be seen as limiting free will
- can lead to unpopular policies

85
Q

methods of intervening in complex problems: behavioural

A
  • promotes education and free choice rather than legal or fiscal coercion
  • may use:
    health information
    social marketing (takes into account perspective and priorities of particular sectors of a target group for health messages)

Disadvantages
- disregards sociocultural influences on behaviour (ie health information may have no impact on diet of poor if they cannot afford healthier food)
- can lead to individual blaming

86
Q

What are nudge techniques

A
  • a type of behavioural intervention
  • published by Thaler and Sunstein
  • individuals are given freedom to make their own choices but a paternalistic organization (ie government) modify the choice architecture to favour the healthiest option (ie put fruit near the checkouts)

FPH exam (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions