Adult Nutrition 2

Question 1

Aetiology of overweight and obese

Answer 1

35% overweight, 28% obese
Can result from long term energy in/ energy output imbalance
Vary across age, gender, race and income categories

Thyroid hormones- decreased metabolism by hypothyroidism
Insulin- increased synthesis and storage of fat
Leptin- increased satiety
Ghrelin- increased intake and decreased metabolism and fat use
Obese 1- 30-34.9
Obese 2 35-39.9
Obese 3 40+

Question 2

Five a approach to obese patients

Answer 2

Ask
Assess- exercise? Normal consumption?
Advise- explanation of motivation for change
Assist- weight management program specific for individual
Arrange- follow up

Question 3

Interventions for weight management

Answer 3

Reasons for motivation for weight loss, previous attempts, understanding obesity, attitude and capacity to perform phys activity, time available, financial consideration

Reason and motivation for weight loss, successful plans, eating plan reducing caloric intake

Dietary therapy, behavioural modification techniques, altering physical activity patterns, pharmacotherapy, surgery, combination of above

Question 4

Goals of weight management

Answer 4

Small amounts can reduce or present health risks associated with obesity (5-10%). Prevents further weight gain, reduces body weight, maintain a lower body weight for the long term.

Eating plan in deficit in calories
Meets guidelines for healthy eating 
Balanced vitamin/ mineral supplements 
Programs most successful that utilise CBT- recognise and replace automatic and irrational thoughts and beliefs. Increase awareness and control of cues associated with eating (stimulus control). 
Programs typically 12-16wks long

Question 5

Challenge of weight management

Answer 5

Rate of weight loss declines and plateaus 
Metabolic compensation- energy gap 
Successful weight loss and maintenance 
Use more behavioural strategies
- consistently control calorie intake
- exercise more often and strenuously 
- tracking weight 
- eating breakfast

Question 6

Pharmacotherapy for weight loss

Answer 6

Comorbidities and risk factors may warrant use of weight loss drugs
Medications combined with lifestyle medication is most effective
Over the counter and herbal weight loss preparation have not been tested for efficacy and safety- not recomnended

Bariatric surgery- BMI>40, BMI >35 with comorbidities, APDs counsel on adherence to strict eating guidelines, supplement prescription, reduction In portion sizes, eating instructions

Question 7

Cardiovascular disease

Answer 7

CHD- atherosclerosis, hardening of arteries due to plaque buildup. Arteries narrow increasing risk of myocardial infarction (shut off blood to heart) or stroke (shut off blood to cerebral artery of brains

Cerebral vascular disease- blood vessels in the legs, hyperlipidaemia and hypertension - important factors in the progression of CBD

Men develop at younger age, IHD number one cause of death in Aus

Question 8

Effects of cardiovascular disease

Answer 8

Behinds with cholesterol, fatty acids and calcium
Increased levels of homocysteine, inflammatory disease, abnormal blood clotting factors
Build up of plaque and lesion leave less room for blood flow - decreased flow to heart, reduced energy, decline in organ function, inability to perform ADL, shortness of breath, chest pain

Risk from dyslipidaemia- increased LDL and decreased HDL and triglycerides
High bp, diet etc, diabetes, infection and inflammation

Question 9

Diabetes Mellitus

Answer 9

Fasting bgl >8mmol/L
Type 1 - pancreatic beta cell destroyed, insulin required
Type 2- insulin resistance related to obesity, most common type
Prevalence of diabetes- 80 mill worldwide, most often over 40yo,

Causes high BGL leading to increased TGs, BP, macrovascular and microvascular damage

Question 10

Diabetes effects

Answer 10

Short term 
Hunger and thirst
Fatigue
Increased urination 
Increased weight 
Blurred vision 

Long term 
Heart disease
Hypertension 
Blindness
Kidney failure 
Stroke 

Intervention
Normalise BGL and glucose metabolism
Prevent or slow the progression of diabetes complications
Treatment focus is to empower the person with diabetes to self manage

Question 11

Screening and assessment of diabetes

Answer 11

Genetics, history of GDM, sedentary lifestyle, high BP? High LDL cholesterol, low HDL cholesterol

Weight status, eating pattern, knowledge about diabetes, physical activity, lab values etc

Clinical goals:
Normalise BGL and glucose metabolism
Prevent or slow the progression of diabetes complications
Treatment focus is to empower the person with diabetes to self manage

Question 12

Medical nutrition therapy for diabetes

Answer 12

Diet flexibility and individualisation: 
Diet plan 
Calorie level 
Calorie and carb distribution 
Consistent eating pattern 
GI
Carb counting
Self monitored blood glucose 

Diet should be:
Healthy and balanced, carb at every meal, unsay fat, CHO counting

Question 13

Metformin

Answer 13

Acts by increasing insulin sensitivity of liver, muscle, adipose and other tissues
Sulphhonylureases (increased insulting production by the pancreas)
Gliptins (DOO-4- inhibitors)
Insulin
Statins- slow or block the HMG CoA- main scums in cholesterol synthesis by the liver. Lower LDL but don’t change HDL

Question 14

Carcinogenesis

Answer 14

Connective tissue- sarcomas and leukaemia
Muscular- myosarcomas
Nervous- gliomas
Epithelial- the main skin, GI, urogenital, secretory and respiratory

Question 15

Stages of cancer

Answer 15

Activation 
Initiation (injury or insult to DNA by a carcinogen such as free radicals, toxin, or radiation) 
Promotion (damaged DNA divides) 
Progression (uncontrolled growth) 
Invasion 
Metastasis

Question 16

Osteoporosis

Answer 16

Bone loss greater than remodelling
Most common in hip, pelvis, wrist and spine
Painful, low of function, loss of independence, prematurity and mortality