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clinical nutrition > chapter 23 book notes > Flashcards

chapter 23 book notes Flashcards

1
Q

cancers:

A

-diseases characterized by the uncontrolled growth of a group of abnormal cells
-destroy adjacent tissues and spread to other areas of the body via the lymph or blood.

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2
Q

The growth of what kind of tissue causes cancer?

A

-malignant (cancerous cell or tumor)

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3
Q

Cancer is the ?? most common cause of death in the U.S.

A

-2nd

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4
Q

The various types of cancer have different characteristics such as..

A

-occur in different locations in the body, take different courses, and require different treatments.

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5
Q

In the United States, the most common cancers are:

A

-breast cancer (in women),
-prostate cancer (in men),
-lung cancer
-colorectal cancers

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6
Q

carcinogenesis:

A

-the process of cancer development.
-proceeds slowly and for several decades

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7
Q

A cancer usually arises from ?? mutations that alter gene expression
in a single cell

A

-genetic

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8
Q

These alterations may promote

A

-cellular growth,
-interfere with growth restraint, or
-prevent cellular death

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9
Q

tumor:

A

-an abnormal tissue mass that has no physiological function;
-also called a neoplasm.
-Tumors may be malignant (cancerous) or benign (noncancerous)

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10
Q

metastasize:

A

-to spread from one part of the body to another; refers to cancer cells.

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11
Q

In leukemia (cancer affecting the white blood cells), the abnormal cells do not form a ?? ; they accumulate in the ?? and other tissues

A

-tumor
-blood

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12
Q

Some metabolic processes may initiate carcinogenesis, as when ?? (immune cells) produce ?? that cause DNA damage, or when chronic ?? increases the rate of cell division and the risk of a damaging mutation

A

-phagocytes
-oxidants
-inflammation

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13
Q

More often, cancers are caused by interactions between a person’s ??
and the ?? .

A

-genes
-environment

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14
Q

Various food components may alter processes of ??/, ?? , or ?? in ways that affect cancer development

A

-DNA repair, gene expression, or cell differentiation

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15
Q

obesity is a risk factor for a number of different cancers, including some relatively common cancers such as ?? cancer and ??? cancer

A

-colon
-postmenopausal breast

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16
Q

Obesity increases cancer risk, in part, by altering the levels of hormones that influence cell growth, such as /??, the ??? , and several kinds of ??? .

A

-insulin
-sex hormones
-growth factors

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17
Q

What hormone is involved in postmenopausal breast cancer in women? Why?

A

-estrogen
-obese women have higher estrogen levels than lean women do because adipose tissue is the
primary source of estrogen after menopause

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18
Q

The increase in circulating estrogen may create an environment that encourages ??? in breast tissue

A

-carcinogenesis

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19
Q

About 5 percent of cancers worldwide can be attributed to ?? consumption,

A

-alcohol

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20
Q

Although the ways in which alcohol affects cancer development are
not fully understood, some evidence suggests that ?? —the principal metabolite of alcohol—upsets DNA synthesis and repair, promoting carcinogenesis

A

-acetaldehyde

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21
Q

Food ?? methods can influence the production of carcinogens,,, like…

A

-preparation
-cooking meat, poultry, and fish at high temperatures (broiling & frying) or
-foods adhere to smoke present during grilling

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22
Q

However, the cancer risk from eating such foods is
?/ because the biological effects of these carcinogens are modulated by
other dietary components, including compounds in ??? and other ??
foods.

A

-unclear
-vegetables
-plant

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23
Q

Consuming fruits and vegetables may reduce the risks of some ??

A

-cancers

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24
Q

Possiblebenefit has been attributed, in part, to nutrients and phytochemicals that have
?? activity, as these substances may prevent or reduce the oxidative
reactions in cells that cause DNA damage

A

-antioxidant

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25
Q

The B vitamin folate (provided by certain fruits and
vegetables) functions in ??? and ?? ;

A

-DNA synthesis
-repair

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26
Q

thus, inadequate folate intakes may allow DNA ?? to accumulate.

A

-damage

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27
Q

Fruits and vegetables also contribute dietary fiber, which may help to protect against ?? and ?? cancers by diluting potential carcinogens in fecal matter and accelerating their
removal from the GI tract

A

-colon
-rectal

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28
Q

Components of ?? vegetables may
inhibit several types of cancer, including….

A

-nonstarchy
-head and neck cancers,
-lung cancer, and
-breast cancer

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29
Q

The complications that develop are often due to the
tumor’s ?? on surrounding tissues.

A

-impingement

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30
Q

?? is a major contributor to the weight loss often associated with cancer

A

-Anorexia

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31
Q

The ?? changes that arise in cancer contribute to weight
loss and nutrient depletion.

A

-metabolic

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32
Q

Cytokines:

A

-signaling proteins
-released by both tumor and immune cells to induce an inflammatory and catabolic state

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33
Q

Patients with cancer exhibit an increase in… and a decrease in…

A

-protein turnover rate
-muscle protein synthesis

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34
Q

Muscle contributes amino acids for ??? further depleting the body’s supply of protein.

A

gluconeogenesis (glucose production),

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35
Q

?? breakdown increases, elevating serum lipids
many patients with cancer develop…

A

Triglyceride
-insulin resistance

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36
Q

cancer cachexia:

A

-a wasting syndrome associated with cancer that is characterized by anorexia, muscle wasting, weight loss, and fatigue.

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37
Q

Cancer cachexia develops in about ?? percent of patients with cancer and is responsible for as many as ?? percent of cancer deaths

A

-50%
-30%

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38
Q

Cachexia may be indicated by an involuntary weight
loss of more than ?? percent of body weight over the preceding 6 months

A

-5

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39
Q

Unlike in starvation, nutrition intervention alone is ?? to reverse cachexia.

A

-unable

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40
Q

The primary medical treatments for cancer are:

A

-surgery,
-chemotherapy,
-radiation therapy,
or any combination of the three

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41
Q

The primary medical treatments for cancer aim to help…

A

-remove cancer cells
-prevent further tumor growth
-alleviate symptoms

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42
Q

Surgery is performed to…

A

-remove tumors,
-determine the extent of cancer,
-protect nearby tissues

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43
Q

surgery must be followed by other cancer ?? to prevent the growth of new tumors

A

-treatments

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44
Q

chemotherapy:

A
  • the use of drugs to destroy cancer cells;
    -“antineoplastic agents.”
    -used to inhibit tumor growth, shrink tumors before surgery, and prevent or suppress metastasis
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45
Q

methotrexate:

A

-an anticancer drug that prevents cell division.
-Methotrexate closely resembles the B vitamin folate, which is needed
for DNA synthesis;
-the drug works by blocking activity of the enzyme that converts folate to its active
form

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46
Q

some cancer drugs have toxic effects on normal cells as well and are especially damaging to rapidly dividing cells, such as those cells in the… of the human body (3)

A

-GI tract, skin, and bone marrow.

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47
Q

The bone marrow damage can impair the production of ?? (causing anemia) and ?? (causing neutropenia)

A

-red blood cells
-white blood cells

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48
Q

neutropenia:

A

-a low white blood cell (neutrophil) count, which increases susceptibility to infection.

49
Q

radiation therapy:

A

-the use of X-rays, gamma rays, or atomic particles to destroy cancer cells.

50
Q

Radiation therapy generate reactive forms of oxygen, such as ?? and ?? , which can damage cellular DNA and cause cell death.

A

-superoxide
-hydroxyl radicals

51
Q

Newer techniques can focus the radiation ?? at tumors
and ?? damage to nearby tissues

A

-directly
-minimize

52
Q

An advantage of radiation therapy over surgery is that it can shrink tumors while ?? organ structure and function

A

-preserving

53
Q

Radiation treatment in the lower abdomen can
cause radiation enteritis,, which is…

A

-inflammatory condition of the small intestine that causes nausea, vomiting, diarrhea,
-the condition may persist for months or years and lead to chronic malabsorption

54
Q

hematopoietic stem cell transplantation:

A

-replaces the blood forming stem cells that have been destroyed by high dose chemotherapy or radiation therapy.
-the stem cells are obtained from bone marrow
(bone marrow transplantation) or circulating blood before therapy starts

55
Q

These procedures may be used to treat ??, ?? , /?? , and a number of noncancerous conditions

A

-leukemias, lymphomas, multiple
myeloma

56
Q

If another person’s stem cells are
used, the patient must take immunosuppressive drugs to prevent

A

-graft-versus-host disease
-graft rejection

57
Q

graft-versus-host disease:

A

-a condition in which the immune cells in transplanted tissue (the graft)
attack recipient (host) cells, leading to widespread tissue damage

58
Q

Graft-versus-host disease
often damages tissues of the ?? , leading to severe intestinal inflammation, profuse
diarrhea, and bleeding.

A

-GI tract

59
Q

Patients are often ?? to consume adequate food during or after the
procedures and usually require ??

A

-unable
-nutrition support.

60
Q

cancer immunotherapy:

A

-involves the use of medications that enhance the cancer fighting abilities of the immune system

61
Q

What is usually prescribed in cancer immunotherapy in order to stimulate natural immune processes that fight cancer

A

-cytokines
-interleukin-2
-interferon alfa proteins
(PROTEINS MADE FROM WHITE BLOOD CELLS)

62
Q

Drugs known as?? are used to block the actions of proteins that suppress immune responses.

A
  • immune checkpoint inhibitors
63
Q

drugs composed of monoclonal antibodies do what??

A

-target particular proteins on cancer cells

64
Q

some drugs used in immunotherapy treatments may cause symptoms such as… that reduce
a person’s ability or desire to consume adequate amounts of food

A

-fever, nausea, vomiting, GI symptoms, pain, headache, and fatigue)

65
Q

Medications prescribed to stimulate the
appetite and promote weight gain include

A

-megestrol acetate (Megace): a synthetic compound similar in structure to the hormone progesterone
-Dronabinol (Marinol): resembles the psychoactive ingredient in marijiuana and stimulates the appetite at doses that have minimal mental affects

66
Q

Antiemetic drugs help..

A

-control nausea and vomiting, are typically coadministered with chemotherapeutic drugs to improve appetite and food intake.

67
Q

Most frequently used CAM therapies:

A

-multivitamin and herbal supplements

68
Q

Use of the herb ?? , for example, can reduce the effectiveness of some anticancer drugs

A

-St. John’s wort

69
Q

some studies have suggested that certain ?? supplements may interfere with
chemotherapy or radiation treatments or worsen cancer outcomes

A

-antioxidant

70
Q

Patients should be screened for ?? when
cancer is diagnosed and be reassessed during the treatment and recovery periods

A

-malnutrition

71
Q

Protein recommendations typically range from ?? to ?? grams per kilogram of body weight per day, but may be higher if protein depletion is severe or if patients are older or chronically
ill.

A

-1 TO 1.5

72
Q

Although weight loss is a problem for many patients with cancer, those with ??
cancer often gain weight

A

-breast
-e weight gain occurs during the first five years after breast cancer diagnosis

73
Q

patients with suppressed immunity or ?? (due to hematopoietic
stem cell transplants or use of immunosuppressive drugs) are advised to carefully follow.., in order to minimize foodborne illness and other infectiions

A

-neutropenia
-safe food-handling practices.

74
Q

Foods to avoid include:

A

-unpasteurized juices
-dairy products
-unwashed raw fruits and vegetables.

75
Q

In addition to instructing immunosuppressed patients about food safety, many institutions prescribe what kind of diet??

A
  • low-microbial diets
    -more stringent recommendations for avoiding microbial contamination
76
Q

many patients who undergo radiation therapy for head and neck cancers develop ?? or ?? and may benefit from ?? feeding

A

-dysphagia
-oral mucositis
-tube

77
Q

Parenteral nutrition is reserved for patients who have inadequate GI function, such as those with severe ??

A

-radiation enteritis.

78
Q

acquired immunodeficiency
syndrome (AIDS):

A

-the late stage of illness caused by infection with the human immunodeficiency virus (HIV); attacks the immune system and disables a person defenses against other diseases

79
Q

In the more than 40 years since AIDS has been identified, it has caused about
?? million deaths worldwide

A

-33

80
Q

Although the global incidence of HIV infection has been declining in recent years,
its prevalence continues to be high in eastern and southern ??

A

-Africa

81
Q

As there is still no cure for AIDS, the best course is ??

A

-prevention

82
Q

HIV is most often sexually transmitted and can be spread by direct contact with contaminated:

A

-body fluids, such as blood, semen, vaginal secretions, and breast milk.

83
Q

Because many people remain ?? during the early stages of infection, they may not realize that they can pass the infection to others.

A

-symptom-free

84
Q

A blood test can usually detect HIV antibodies within several ??after exposure and, often, after just two or three weeks.

A

-months

85
Q

An estimated ?? percent of persons who have HIV infection are unaware
that they are infected

A

-19%

86
Q

HIV infection destroys immune cells that have a protein called ?? on their surfaces

A

-CD4

87
Q

The cells most affected are the?? , also called CD41 T cells because the presence of CD4 is a primary characteristic

A
  • helper T cells
88
Q

HIV is able to enter helper T cells and induce them to
produce additional copies of the virus, thus

A

-spreading the infection

89
Q

Early symptoms of HIV infection
are nonspecific and may include

A

-fever, sore throat, malaise, swollen lymph nodes,
skin rashes, muscle and joint pain, and diarrhea

90
Q

After these symptoms subside, many
people remain symptom-free for ?? to ?? years or even longer

A

-5 to 10

91
Q

the depletion of T cells eventually increases the person’s susceptibility
to opportunistic infections— which are infections caused by…

A

-microorganisms that normally do not cause disease in healthy individuals

92
Q

The term ?? applies to the advanced stages of HIV infection, in which the inability to fight illness allows a number of serious diseases and complications to develop

A

-AIDS

93
Q

AIDS-defining illnesses: (4)

A

-recurrent bacterial pneumonia,
-opportunistic infections,
-certain cancers,
-wasting of muscle tissue.

94
Q

Health practitioners evaluate disease progression of HIV to AIDS by measuring the concentrations of:

A

-helper T cells and circulating virus (called the viral load) and by monitoring clinical
symptoms.

95
Q

In the later stages of AIDS, the wasting is severe and increases the risk of ??.

A

-death

96
Q

The HIV-wasting syndrome (also known as AIDS-wasting syndrome) is diagnosed when a patient has an involuntary weight loss greater than ?? percent of initial body weight plus either chronic diarrhea or chronic weakness and fever for more than ?? days

A

-10%
-30

97
Q

Poor food intake from HIV/AIDS may result from various factors, including
the following: (5)

A

-oral infections: candidiasis and herpes simplex virus
-cancer: Kaposis sarcoma
-medications: medications that treat HIV can interfere with food intake
-respiratory disorders: pneumonia & tuberculosis
-emotional distress:fear, anxiety, depression

98
Q

candidiasis:

A

-a fungal infection on the mucous membranes of the oral cavity and
-THRUSH; milky white coating

99
Q

herpes simplex virus:

A

-virus that causes blisterlike lesions on the lips and in the mouth.

100
Q

Kaposi’s sarcoma:

A

-a common cancer in persons with HIV infections;
-characterized by lesions in the skin, lungs, and GI tract

101
Q

GI complications in patients with HIV infections may result
from

A
  • opportunistic infections, medications, or the HIV infection itself
102
Q

Patients in the advanced stages of HIV infection may develop pathological
changes in the small intestine, referred to as HIV enteropathy (also called AIDS
enteropathy) define this

A

-condition is characterized by villus atrophy and blunting, intestinal cell losses, and inflammation.
- result is a substantial reduction in the intestinal absorptive area, causing malabsorption, diarrhea, and weight loss.

103
Q

Many patients who use drug therapies to suppress HIV
infection develop abnormalities in body fat and fat metabolism known
as

A

-lipodystrophy

104
Q

types of lipodystrophy seen in patients

A

-breast enlargement (in men & women)
-fat accumulation in base of neck (buffalo hump)
-benign growths composed of fat tissue (lipomas)

105
Q

These changes in body composition are often
?? and may cause physical discomfort

A

-disfiguring

106
Q

patients with lipodystrophy often also develop:

A

-hypertriglyceridemia, elevated low-density lipoprotein (LDL)
cholesterol levels, insulin resistance

107
Q

neurological complications due to HIV infection, immunosuppression or medications used to treat HIV:

A

-mild to severe dementia
-gait disturbances
-pain and numbness in feet and legs

108
Q

Neurological impairments are usually more
pronounced in the advanced stages of ??? .

A

-AIDS

109
Q

The standard drug treatment for suppressing
HIV infection is usually a combination of three ?? drugs, which should be initiated immediately after an individual is diagnosed

A

-antiretroviral

110
Q

What has been successful in reversing unintentional weight loss and increasing muscle mass in patients who have HIV?

A

-anabolic hormones
-appetite stimulants
-regular physical activity

111
Q

herbal preparations that contain
?? or ?? may reduce the effectiveness of some antiretroviral drugs.

A

-St. John’s wort
-garlic

112
Q

Individuals who experience weight loss and wasting with HIV or AIDS may benefit from what kind of diet?

A
  • high-kcalorie high-protein diet.
113
Q

individuals who use antiretroviral drugs
frequently develop:

A

-insulin resistance and elevated triglyceride and LDL cholesterol
levels.

114
Q

?? supplementation has been shown to
be effective for reducing blood triglyceride levels in patients with HIV infection

A

-Fish oil

115
Q

The depressed immunity of people with HIV infections places
them at extremely high risk of developing ?? infections

A

-foodborne

116
Q

?? can also be a source of foodborne illness and is a common cause
of ?? in individuals with HIV infection

A

-Water
-cryptosporidiosis

117
Q

take additional safety measures,
water used for drinking and making ice cubes should be boiled for ?? minute.

A

-one

118
Q

For individuals with severe malabsorption, orally administered ?? containing ?? are well tolerated and may be as effective as parenteral nutrition for reversing weight loss and wasting

A

-hydrolyzed formulas
-medium-chain triglycerides

clinical nutrition (26 decks)

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