350 exam 1 Flashcards
What are the implications of the Keyes research to population groups with cyclical food availability?
“Keys also stressed the dramatic effect that starvation had on mental attitude and personality, and argued that democracy and nation building would not be possible in a population that did not have access to sufficient food.”
What might happen to the capacity to work with undernutrition?
• Decrease drastically
4 types of malnutrition
Overnutrition
Secondary malnutrition
Micronutrient malnutrition
Protein calorie/energy malnutrition
Define overnutrition
Too many calories and not enough exercise
Define secondary malnutrition
Results from condition that prevents proper ingestion, digestion or absorption and metabolism
Define micronutrient malnutrition
dietary deficiencies of vitamin A, iodine, iron, and others
Define PEM
extremely deficient intake of protein and kcalories; made worse by accompanying illness
What is “environmental enteropathy” and what is its’ proposed mechanism?
- Small intestinal disorder triggered by constant ingestion of feces
- Results in “leak” of bacteria through intestinal walls into blood stream
- Results in low-grade infections that require large amounts of energy to fight (leaves fewer nutrients for growth)
What is the relationship between toilets and stunting?
Sanitary waste disposal is important in reducing secondary malnutrition
o Poor sanitation may cause more than half of the stunting issues worldwide
o “Children who grow up surrounded by feces - animal and human - ingest it constantly which can trigger a disorder of the small intestine called “environmental enteropathy”. The intestinal walls of children who have this condition constantly “leak” bacteria into the blood stream causing chronic low-grade infections that consume vast amounts of energy to fight, leaving less nutrients available for growth.”
What explains the difference in average height between Indian and African children?
• “A child raised in India is far more likely to be malnourished than one from the Democratic Republic of Congo, Zimbabwe or Somalia, the planet’s poorest countries. Stunting affects 65 million Indian children under the age of 5, including a third of children from the country’s richest families.”
What is a problem in both industrialized and developing countries and why?
• Overnutrition—parts of that country that are very rich like the industrialized middle-class families
How did the subjects in the Keyes study adapt to semistarvation?
- Loss of active tissue caused relatively high loss of lean body mass
- Reduced activity costs were main part of energy savings caused decreased BMR, less thermic effect of food, and reduced body weight
- Reduction in tissue metabolism and in physical activity
What were the physical symptoms exhibited during the semistarvation in the Keyes study?
o Body weight decreased about 25%
o Exhibited lack of ambition, self-discipline, and poor concentration
o Were often moody and depressed
o Became less able to laugh heartily, sneeze and tolerate heat
o Heart rate and muscle tone decreased
What were the psychological symptoms exhibited during the semistarvation in the Keyes study?
o Hunger subsides after 2-3 days o Defecation ceases after 3-4 days o Urine output drops after 1 week o Blood glucose levels drop o Nausea occurs in about 1/3 of people o Hormonal changes
How long did full recovery take in these study subjects?
• 3 months were given to them, but took as long as 2 years
How does the body adapt metabolically to malnutrition?
• Gradual shift in metabolic fluids
o Glucose is produced from protein breakdown to provide energy
• Then fat breakdown and metabolism provides ketones
• Serum fatty acid levels increase
• Serum albumin is normal until late in starvation
• Weight loss
• Basic metabolic rate and total energy expenditure decrease in prolonged starvation
o Decreased activity, increased sleep; decrease in body temperatures
• Negative nitrogen balanced
What nutrient is required for energy production and where does it come from when not in the diet?
• Calories, carbohydrates—protein is broken down if carbohydrates are not available
How does the body adapt physiologically to PEM?
- Low insulin levels
- Decreased secretion of non-vital hormones (i.e. sex hormones)
- Red blood cell production decreases due to decreased oxygen demands (from lower body mass)
- Heart muscles reduce in size
- Cardiovascular and kidney changes
What is the result of the changes in the immune system during protein energy malnutrition?
- Depletion of lymphocytes
* Phagocytosis, chemotaxis, and intracellular killings are impaired
What happens to the functional capacity of the heart during protein calorie malnutrition? The lungs?
o Smaller size of ventricles
What happens to the functional capacity of the lungs during protein calorie malnutrition?
o Decreased respiratory muscle strength, maximum voluntary ventilation, vital capacity
What is the effect of electrolyte changes on muscle tissue?
- Total body potassium is reduced
- Decreased amounts of ATP
- Increased intracellular sodium—water goes with sodium, so may be intracellular over-hydration
- Increased fatigability and reduced strength of skeletal muscle
Why is there diarrhea with severe PEM?
• Decrease in gastric, pancreatic, and bile productions
• Low blood protein levels lead to intestinal edema which decreases luminal absorption, leading to diarrhea
o Worsens malabsorption and can further decrease nutritional status
What is the major effect of early life PEM?
• Decreased brain growth (cell number and growth), nerve myelination, neurotransmitter production, velocity of nervous conduction
2 types of PEM
• Kwashiorkor and marasmus
Define kwashiorkor
o Increased fat production in liver from excess carbohydrate
o Lack of protein
Define marasmus
o Wasted appearance
o Lack of protein and calories (energy)
What has been linked to the microbiome?
- Kwashiorkor
* Gut microbiome influences growth and differentiation of gut epithelial cells
What are the major micronutrient deficiencies in the world?
Iron, iodine, and vitamin A
Symptoms of iron
Anemia
Symptoms of iodine
Goiter (enlargement of thyroid gland)
Symptoms of vitamin A
night blindness, impaired immune system, dry/hard skin, xerophthalmia (dry cornea and eventual blindness)
Who is most likely to be deficient of iron?
Women
Who is most likely to be deficient of iodine?
Adults
Who is most likely to be deficient in vitamin A?
Children
What foods contain iron?
heme iron is from meat; non-heme iron is from green, leafy veggies or grains
What foods contain iodine?
depends on soil concentrations; abundant in seawater (seafood and seaweed)
What foods contain vitamin A?
beef liver, carrots, mustard greens, egg yolk, apricots
What impact does iron deficiencies have on life?
cognitive defects in children, maternal deaths, decreased productivities
What impact does iodine deficiencies have on life?
increased rates of spontaneous abortion, stillbirths, congenital anomalies, cretinism, psychomotor deficits, neonatal mortality, impaired thyroid function
What impact does vitamin A deficiencies have on life?
decreased resistance to infection
What nutrient deficiencies are associated with decreased cognitive ability? How?
• Iron—thought to be due to not enough oxygen to brain or decreased amount of neurotransmitters which are iron dependent
What nutrient has been successfully supplemented in the diet via salt? Sugar?
- Salt = iodine (iodized salt)
* Sugar = vitamin A (in Zambia and Central America)
What nutrient deficiency has a decrease in immune function before the presentation of more obvious clinical signs?
Vitamin A
Why is obtaining iron and vitamin A different from animal versus plant sources?
• Different ways of absorption
o Vitamin A—fat soluble and is absorbed/transported with lipids
• Animal sources - preformed vitamin A; about 90% is absorbed
• Pro-vitamin A sources (carotenoids from plants)
• Dependent on type of plant source and fat content
o Iron
• Amount of iron in food and absorbability can be significantly different
• Concurrent intake of Vitamin C can enhance absorption non nonheme iron
• Meat factor also increases absorption of iron
What is key indicator of malnutrition?
• Infant mortality rate—number of children per 1,000 live births who die before their 1st birthday
What is the effect of maternal nutrition on the fetus?
- Intra Uterine Growth Retardation (IUGR)—small growth causing neurological dysfunctions and immune function impairment
- Low birth weight
What is the best way to feed an infant? Be able to give reasons.
BREASTFEEDING
• Usually have better nutritional status than those who do not
• Breast milk is clean food supply in a clean container
• Has immunologic benefits so decreases disease as well
• Extends length between children
o Strongly related to child survival
• Stronger intellectual development
• Reduced risk of cancer, obesity, and several chronic disease (i.e. diabetes)
Why is it important to frequently weigh and measure a child?
- Stunting at age 2 is associated significantly with later deficits in cognitive ability
- Birth weight contributes to about half of the growth failure at age 2
- Birth weight also influences mental development
What improves learning in children?
Breastfeeding–leads to stronger intellectual development
What happens in the adolescent period that challenges nutrition?
• Adolescent hormonal changes accelerate growth–Growth is faster than at any other postnatal time except the first year
What is a major issue with early pregnancy in undernourished girls?
- Linear growth of adolescent girls stops when girls get pregnant
- Food supplementation of the adolescent pregnant for the firs time does not improve birth weight
- Control of anemia can improve birth weight
- Best way to improve birth weight is to delay pregnancy until at least age 18
What problems may stunted women have during pregnancy and delivery?
• Higher maternal and infant mortality and preterm delivery with adolescent pregnancies
What decreases with malnutrition in adults?
• Body weight and work capacity and productivity are directly related
• Adults who have low body weight have fewer days that they are available for heavy labor b/c of illness or exhaustion
o Then decreases income to family, which causes malnutrition of the women and children
Why is good nutrition important for the elderly?
• Nutritional status is related to functional ability
• Undernutrition is associated with higher risk of impairments in
o Psychomotor speed and coordination
o Mobility
o Ability to carry out activities of daily living independently
• Causes sarcophenia (gradual loss of muscle mass with age)
Why should prevention focus on the life cycle and not just with fetal and early childhood malnutrition?
- Life cycle dynamics of cause and consequence demand a holistic inclusive approach
- Intervening at each point in the life cycle will accelerate and consolidate positive change
What are the major dangers of refeeding?
Congestive heart failure
Short of breath
Excess carbon dioxide production
Edema (excess water)
What happens metabolically when refeeding?
Insulin release is stimulated by presence of carbohydrate and protein in gut
• Stops sodium excretion, which cause fluid retention
What happens physiologically when refeeding?
Heart
• Increases heart rate, blood pressure, oxygen consumption, cardiac output, and expansion of plasma volume
• Congestive heart failure s quite common
Lungs
• Too much glucose and overfeeding from excess carbon dioxide production and increased oxygen consumption
• Short of breath
• Pulmonary edema from increased water load
Gastrointestinal system
• Diarrhea, nausea, and vomiting
• Requires period of readaptation to food
What is ORS and what is it used for?
- Oral rehydration salts solution
- Responsible for saving the lives of millions of children worldwide
- Inexpensive solution of sodium and glucose used to treat acute diarrhea
- Primary tool for treating diarrhea
What is RUTF, under what circumstances is it used, and what are the advantages of it?
• Ready-to-use therapeutic food
• Home based treatment for severe acute malnutrition in children who have no medical complications but still have an appetite
• Provides foods that are safe to use at home and ensure rapid weight gain
• Ready to use paste in packets that don’t need to be mixed with water
o Peanut butter mix with dried milk, vitamins, and minerals
What indicator is used to measure progress in breaking the intergenerational cycle of malnutrition?
• IUGR (intrauterine growth retardation)
What has been hypothesized regarding in utero malnutrition and health in later life?
- Neurologic dysfunctions (ADD) and immune function impairment also occur
- Increased risk of chronic illness
What is the nutrition transition?
A term used to describe the changes in diet, physical activity, health and nutrition
o Results from higher incomes, marketing, and changes in work and leisure activities
What dietary changes occur in the nutrition transition period?
• Indigenous diet, usually high in whole grains and starchy roots, is replaced by foods higher in fat, animal food sources and sugars
What are the good and bad parts of nutrition transition?
- Less undernutrition and communicable disease
* Higher risk of obesity and chronic disease
What are the common chronic diseases? What common condition have many been linked to?
- Cardiovascular disease
- Cancer
- Chronic respiratory diseases
- Diabetes
• Commonly linked to undernutrition!
What are modifiable risk factors for chronic disease?
- Unhealthy diet
- Physical inactivity
- Tobacco use
- Harmful use of alcohol
Who is affected by chronic disease?
Low- and middle-income families
What dietary recommendations have been made to decrease risk?
Eat less sugar and less red meat
What must people have to make good choices about diet?
Resources and knowledge
What is the link between poverty and obesity?
- Association between obesity and food insecurity
- “Feast and famine”; preoccupation with food and bringing when food is available
- Types of food eaten due to cost, availability, and marketing (energy dense, low nutrient foods are inexpensive)
- Fewer opportunities for physical activity
- High levels of stress
- Early poverty associated with obesity in young adults
