9. Medical nutrition therapy in obesity management Flashcards
what can be used as a
foundation for nutrition and food-related education
Canada’s Food Guide for Healthy Eating
Nutrition interventions for obesity management should
emphasize which 3 things?
- individualized eating patterns, 2. food quality
- a healthy relationship with food
waht can mindfulness-based eating practices help?
help lower food cravings, reduce reward-driven eating, improve body satisfaction
and improve awareness of hunger and satiety.
Caloric restriction may
affect neurobiological pathways that control appetite, hunger, cravings and body weight regulation that may result in
increased food intake and weight gain. T/F
T
People living with obesity are at increased risk for micronutrient deficiencies including but not limited to ?
vitamin D, vitamin B12 and iron deficiencies
what does Mediterranean dietary pattern improve?
glycemic control, HDL-cholesterol and triglycerides;
reduce cardiovascular events,
reduce risk of type 2 diabetes;
and increase reversion of metabolic syndrome with little effect on body weight and waist
circumference
what does vegetarian dietary pattern improve?
glycemic control,
established blood lipid targets, including LDL-C, and reduce body weight, (Level 2a, Grade B),16 risk of type 2
diabetes (Level 3, Grade C)17 and coronary heart disease
incidence and mortality (Level 3, Grade C).18
Portfolio dietary pattern to improve ?
established blood
lipid targets, including LDL-C, apo B, and non-HDL-C
(Level 1a, Grade B),19 CRP, blood pressure, and estimated
10-year coronary heart disease risk (Level 2a, Grade B).19
Low-glycemic index dietary pattern to reduce?
body weight (Level 2a, Grade B)20 glycemic control, (Level 2a,
Grade B),21 established blood lipid targets, including
LDL-C (Level 2a, Grade B),22 and blood pressure, the risk of type 2 diabetes (Level 3, Grade
C)24 and coronary heart disease (Level 3, Grade C).25
Dietary Approaches to Stop Hypertension (DASH) dietary
pattern to reduce?
body weight and waist circumference;
(Level 1a, Grade B),26 improve blood pressure (Level 2a,
Grade B),27 established lipid targets, including LDL-C
(Level 2a, Grade B),27 CRP (Level 2b, Grade B),28 glycemic control; (Level 2a, Grade B),27 and reduce the risk of
diabetes, cardiovascular disease, coronary heart disease,
and stroke (Level 3, Grade C).27
Nutrition interventions should use a shared decision-making approach to improve overall health, promote a healthy relationship with food, consider the social context of eating and promote eating behaviours that are sustainable and realistic for the individual. T/F
T
The Canadian Adult Obesity Clinical Practice
Guidelines define obesity as ?
“a complex chronic disease
in which abnormal or excess body fat (adiposity) impairs
health, increases the risk of long-term medical complications and reduces lifespan.”
what term is used to describe health-related improvements
beyond weight-loss outcomes alone?
Obesity management
what is an evidence-based approach used in the nutrition care process (NCP) of treating and/or managing
chronic diseases, often used in clinical and community
settings, that focuses on nutrition assessment, diagnostics, therapy and counselling.
Medical Nutrition Therapy
what is the term used for an evidence-based, nutrition-related approaches for improving health outcomes instead of
weight-loss focused ideals that are often associated with
the term “diet.”
Nutrition interventions
what is moderate, low and very low caloric restriction?
(1300–1500 kcal/day)
(900–1200 kcal/day)
(< 900 kcal/day)
1000 vs 1500 kcal/day diet with behavioural treatment, which group regained more at 12 months?
1000 group
Although MNT that achieves a caloric deficit can result in weight
loss in the short-term (6–12 months), the weight change is often
not sustained over time. T/F
T
appetite increased by how much kcal/day for every kilogram of weight lost, contributing to weight gain over time?
100
caloric restrictions
may have negative consequences for
skeletal health75 and muscle
strength
The dietary reference intakes permit wide acceptable macronutrient distribution ranges. what is the range of calories from carbohydrate?
45-65%
what is the range of calories from protein? fat?
10% to 35% of calories from protein and 20% to 35% of calories from fat (with 5% to 10% of calories
derived from linoleic acid and 0.6% to 1.2% of calories derived
from alpha linolenic acid).
for macronutrient-based approaches, The data suggest that what may be a more important focus than quantity in the evaluation of the relationship between macronutrient distributions and cardiometabolic outcomes?
quality
what is the recommendation of fiber from the DRIs for 19-50 years and 51 years and older group?
25 g/day and 38 g/day for women and men 19–50 years of age, respectively;
21 g/day and 30 g/day for women and men ≥51 years of age, respectively
The evidence showed that higher intakes
of total dietary fibre were associated with decreased incidence of ?
diabetes, coronary heart disease and mortality, stroke and mortality, colorectal cancer, and total cancer and mortality;
The authors did not observe differences in risk reduction by fibre type
(insoluble, soluble or soluble viscous) or fibre source (cereals, fruit,
vegetables or pulses).
Meta-regression dose response analyses
showed that benefits of fiber were associated with intakes greater than how much per day?
25 g–29 g per day
Despite the lack of interaction by fibre type and source in the
prospective cohort studies, the evidence from randomized controlled trials differs. This data supports the benefits of dietary fibre
on intermediate cardiometabolic risk factors and suggests these
are restricted largely to fibre from a what type of fiber?
soluble viscous fiber
what are soluble viscous fibres that lowers cholesterol?
oats, barley, psyllium and polysaccharide complex (glucomannan, xanthan
gum, sodium alginate)
what are soluble viscous fibres that lowers postprandial glycemia?
polysaccharide complex (glucomannan, xanthan gum, sodium alginate)
The studies also highlighted that which type of fibre, other than contributing to stool bulking, has not
shown cardiometabolic advantages in comparison with low-fibre controls or in direct comparisons with viscous soluble fibre, where it
is often used as a neutral comparator of soluble viscous fibre.
insoluble fibre
The evidence from oats (beta-glucan), barley (beta-glucan),psyllium, konjac mannan (glucomannan) and fruit and vegetables
(pectin) shows improved in what?
glycemic control by HbA1c and fasting
blood glucose, insulin resistance by HOMA-IR, blood pressure,
and blood lipids, including the established therapeutic lipid targets
LDL-C, non-HDL-C and apo B.
does mixed fibre interventions emphasizing high intakes of dietary fibre from a combination of types (insoluble, soluble, and soluble viscous)
and sources (cereals, fruit, vegetables and/or pulses), have shown cardiometabolic advantages?
yes
mixed fibre interventions result in ?
reduction in body weight and improvements in HbA1C, postprandial glycemia,
blood pressure and blood lipids.
Dose thresholds for mixed fibre benefit are
unclear but generally support optimal benefits at intakes of ..?
25 and more g/day total fiber (10-20 g/day of soluble viscous fibre)
low-calorie
sweeteners in substitution for sugars or other caloric sweeteners,
especially in the form of sugar-sweetened beverages, may have
advantages like those of water or other strategies intended to displace excess calories from added sugars - t/f
t
what is the Mediterranean dietary pattern?
a plant-based dietary pattern that emphasizes a high intake
of extra virgin olive oil, nuts, fruit and vegetables, whole grains
and pulses; a moderate intake of wine, fish and dairy; and a low
intake of red meats
which dietary pattern has shown weight loss
and improvements in glycemic control and blood lipids compared
with other dietary patterns in people with type 2 diabetes
mediterranean
PREDIMED investigated a
calorie-unrestricted Mediterranean dietary pattern, supplemented
with either extra virgin olive oil or mixed nuts, compared with a control diet (calorie-unrestricted low-fat American Heart Association) in 7447 participants at high cardiovascular risk - what was the result?
the Mediterranean dietary pattern reduced major cardiovascular events by ~30%, diabetes incidence by 53%
(single-centre finding), and increased reversion of metabolic syndrome by ~30%, with little effect on body weight over a median
follow-up of 4.8 years
A dietary pattern emphasizing a high intake of fruit, low-fat dairy, vegetables, grains, nuts, and dietary pulses and a low intake of red
meat, processed meat, and sweets
Dietary approaches to stop hypertension (DASH)
A dietary pattern that emphasizes the exchange of low-glycemic index foods (temperate fruit, dietary
pulses, heavy mixed grain breads, pasta, milk, yogurt, etc.) for
high-glycemic index foods.
Low-glycemic index
A plant-based dietary pattern emphasizing the intake
of a portfolio of cholesterol-lowering foods (e.g. nuts; plantbased protein from soy and pulses; viscous fibre from oats, barley and psyllium; and plant sterols, plus MUFAs from extra virgin
olive oil or canola oil), all of which have Food and Drug Administration (FDA), Health Canada and/or European Food Safety Authority approved health claims for cholesterol-lowering or
cardiovascular disease risk reduction
Portfolio
translation of the Mediterranean,
Portfolio, DASH and National Cholesterol Education Program
dietary patterns. - emphasizes foods typically consumed
as part of a traditional diet in Nordic countries
Nordic
A plant-based dietary pattern that includes four
main variants (lacto-ovo vegetarian, lacto vegetarian, vegetarian and vegan)
Vegetarian
all the dietary pattern studied are associated with decreased
incidence of what?
diabetes and cardiovascular disease in large prospective cohort studies inclusive of people with a BMI ≥25 kg/m2.
what is the effect of meal replacements?
shown to reduce body
weight, waist circumference, blood pressure and glycemic control
compared with conventional, calorie-restricted weight loss diets in
a systematic review and meta-analysis of nine randomized control
trials in people with a BMI ≥25 kg/m2
and type 2 diabetes over a
median follow-up of six months.
at 1 year, which one is better - partial meal replacement or calorie-restricted group?
better for the partial meal replacement group compared with the calorie-restricted
group (47% vs. 64%, respectively) with no adverse effects
