Exam 2 Flashcards
REE vs BEE
Resting energy expenditure (includes ADLs) vs basal energy expenditure (Straight metabolism)
REE needs decrease by what percent every how many years after age what?
by 2% every decade after age 30
Components of Energy expenditure are what?
TEE (thermal effect of food), PEE (Physical Activity) and REE (resting)
What is the syndrome that increases ghrelin levels 3-4x mostly in children…treatment?
Prader-Willi Syndrome
treatment would be the use of hormones (growth or sex) and increasing muscle mass
What regulates food intake and energy balance? (Hormones and parts of the body)
The hypothalamus tells us we are full when stomach receptors stretch
GI/pancreatic secretions (insulin, glucagon, glucagon-peptide-1)
Leptin= satiety hormone from adipose tissue
Ghrelin= hunger hormone from the stomach
Describe the two types of adipose tissue, their composition, and the difference between hypertrophy and hyperplasia
White adipose tissue is most of our fat tissue and is mostly triglycerides
Brown fat is less and helps regulate body temperature (more BAT is in newborns)
Adipose tissue is metabolically active and release hormones that influence BP, insulin, other bodily secretions, and releases pro-inflammatory cytokines (PG-1&3) resistance
Hyperplasia = growth in number
Hypertrophy = growth in size
Android vs Gynoid fat distribution
Android is higher risk for chronic diseases like TTD, HTN, dyslipidemia, CVD
Gynoid is lower risk from lower fat distribution
List the different BMI categories
Underweight: <18.5
Normal: 18.5-24.9
Overweight: 25-29.9
Obese (class 1): 30-34.9
Obese (class 2): 35-39.9
Extreme Obesity: > or = 40
What makes an environment Obesogenic?
Holidays centered around eating lots of food, plate sizes, accessibility to grocery stores, sidewalks, bike lanes, physical activity availability, work and school environment, etc
What are the qualifications for bariatric surgery?
BMI >40 or >35 with other comorbidities
Prior education and post-operation care\
Must have met with a dietitian and tried a weight-loss program before surgery
Assessment of the patient’s ability to follow post-op guidelines
List and understand the 4 types of bariatric surgeries
Gastric sleeve = adjustable band that shrinks top of stomach slowing digestion
Roux-en-Y = bypasses bottom of stomach and duodenum
Sleeve gastronomy = cuts the stomach vertically down the middle
Duodenal Switch with biliopancreatic diversion = sleeve gastronomy paired with cut off the top of duodenum and attach to bottom of ileum
Long terms vs short-term weight loss medications and their names
Long-term= Orlistat (lipase-inhibitor…blocks breakdown and absorption of lipids)
Short-term appetite suppressants (Belviq and lorcaserin)
Most common bariatric surgery?
Roux-en-Y
Types of Bariatric surgeries? only 3 major categories
Restrictive or Malabsorptive or both
List the types of eating disorders and explain differences
- Anorexia Nervosa (AN) - can be restrictive or binge/purge
- Bulimia Nervosa (BN) - can be non-purging or purging
Purging = vomiting or use of laxatives/enemas
Non-purging = may compensate with over-exercising or fasting - Bine-Eating Disorder (BED) = does not have any compensating behaviors
List complications that arise with ED and why
- Laxative abuse is a huge driver of hospitalization (electrolyte imbalances)
- Atrophied GI tract may produce no bowel sounds when listening to GI tract (no food)
- Atrophied muscle layer in the stomach may cause uncontrolled vomiting due to a weakened stomach
- Acidic contents from purging can weaken the enamel of teeth, enlarge salivary glands
- Purging can cause calluses on knuckles ( called Russell sign)
- Constipation, bloating, and fullness from delayed gastric emptying and atrophied GI tract
- Lanugo (very fine soft hairs that grow on the skin, like the face, in order for the body to compensate for lack of nutrients and protection)
- Amenorrhea (loss of period)
- Hypoglycemia and low sodium/potassium (Hyponatremia and Hypokalemia)
What three ID teams are needed for ED treatment (need at least these 3)
Dietitian, behavior therapist (BT), and MD to write prescriptions
Possible nutrition diagnoses for Obesity (PES)
- Excessive fat (energy, or alcohol) intake
– Food and nutrition-related knowledge deficit
– Disordered eating pattern
– Undesirable food choices
– Overweight/obesity
– Involuntary weight gain
Nutrition Interventions for Obesity
- diet changes
- weight loss goals (lower kcal/day)
- nutrition counseling
- physical activity
What is the syrup that is used to induce vomiting that ED patients misuse?
IPECAC
FTT meaning and most common factor?
Failure to thrive (is a medical dx)
inadequate caloric intake
effects cognitive and physiological development
Name 3 resources for Malnutrition
ASPEN, Abbott, and Nestle
These are the underlined ED complications from PPTX for AN
Bradycardia (low heart rate)
Lanugo (body hairs)
Hypotension (low SBP)
Russell sign (calluses on knuckles…more so BN)
Amenorrhea
Infertility
Decreased bone mineral density
PES Diagnosis examples for ED
- inadequate energy, fat, or vit/min intake
- predicted suboptimal energy intake
- limited food acceptance
- inadequate or excessive fluid intake
- malnutrition
- underweight
- unsupported beliefs/attitudes about food-or nutrition-
related topics - disordered eating patterns
Common medication used and treatment for BED/BN
Antidepressants
CBT (cognitive behavior therapy)
Primary treatments for AN, BN, and BED
AN - restore body weight
BN - normalize eating patterns
BED - depends on the individuals specific issues
EN is used as last resort (at risk for refeeding syndrome)
List the interrelated diseases for CVD and their acronyms
- CHD- Coronary Heart Disease is the narrowing of vessels supplying the heart and decreased blood flow… also could be CAD (Coronary artery disease) OR IHD (Ischemic heart disease)
- Atherosclerosis ( plaque build-up)
- Peripheral Artery Disease (PAD) or Peripheral Vascular Disease (PVD) is the narrowing of blood vessels that do not directly supply the heart and is caused by atherosclerosis
- HF OR CHF - the heart does not pump out blood as efficiently. This is irreversible
- Hypertension (HTN)
List the Hypertension levels
normal: <120/<80 (and)
Elevated: 120-129/<80 (and)
Stage 1 hypertension: 130-139/80-89 (or)
Stage 2 hypertension: >/=140/>/=90 (or)
Crisis: >180/>120 (and/or)
mm/Hg
Arterial blood pressure is regulated by (short vs long term)
Sympathetic nervous system (short)
Renin-Angiotensin-Aldosterone-System (long)
- also renal function
Primary/essential HTN vs secondary
Primary: idiopathic yet influenced by inflammatory response, lifestyle factors, and genetics play a role
Secondary: the result of another chronic condition
HTN PES Diagnosis examples
- Excessive energy, fat, or sodium intake
- Inadequate calcium, fiber, potassium, or
magnesium intake - Overweight/obesity
- Food and nutrition knowledge deficit
Lifestyle modifications for HTN intervention
DASH
low sodium
physical activity
weight loss
alcohol intake
Describe the process of plaque build up in arterial walls
monocytes get activated by LDL then become macrophages and engulf the LDL, then get stuck in the LDL and foam cells form, foam cells become fatty streaks, and fatty streaks keep growing as the process continues and that is “plaque” Fatty streaks also contain other lipids, cellular debris and connective tissue.
Lipid Panel Numbers
<199 Chol … >200 Chol is risk
<150 Trig
< 70 at risk, <100 normal, <130 low risk LDL
40-59 normal >60 HDL
Statin Therapy
Statins = group of medications to help lower LDL
NCEP
National Cholesterol Education Program
Atherosclerosis medical treatment
Catheters (narrow rod with balloon) (Angioplasty)
Stents (like a Chinese finger trap)
^ both are PCI’s (percutaneous coronary interventions)
CABG (Coronary artery bypass graft)
Medications for CVD
Statin drugs, ACE inhibitors, diuretics, anticoagulants (Warfarin … watch Vit K intake)
Angia means
pain from reduced blood flow to the heart
Coronary means
heart
TLC meaning, what it targets, and other assessment tools
Therapeutic lifestyle changes
targets diet and lifestyle
CAGE and REAP
Nutrition diagnosis for Atherosclerosis
fat, fiber, weight, physical activity, and food choices
Atherosclerosis Intervention
- healthy fats (omega 3s)
- limit sat/trans fat
- fiber about 30g/day… increase slowly
- physical activity
- weight loss
- cholesterol
Atherosclerosis Monitoring/Evaluation
Blood lipid panels
SMART goals
Types of tests for CHD/IHD/CAD
Angiography (catheter), treadmill test (stress test), and a EKG/ECG electrocardiogram
MI/IHD intervention
small meals more frequently.
Heart Failure Treatment
treat underlying cause
pharmaceutic
often patients are malnourished
HF Assessment
accurate sodium and fluid intake
problems with early satiety and nutrient-drug interactions
any other underlying conditions
HF nutritional diagnosis
Excessive sodium and/or fluid intake
– Less than optimal intake of saturated fat,
trans fatty acids, and cholesterol
– Inadequate oral food/beverage intake
– Inadequate protein and/or energy intake
– Food-medication interactions
– Impaired ability to prepare foods/meals
Why is food safety so important for heart failure patients?
From immunosuppressant therapy
