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1
Q

What is NF-kB

A

(osteoarthritis) associated with inflammation (direct relationship)
Transcription factor. when activated increases the risk of Cancer, MI, diabetes, alzheimers, crohns, allergy/asthma, and atherosclerosis

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2
Q

What supplements are recommended for OA patients and how do they work

A

omega-3 synergistic with glucosamine sulfate

adequate vit-D

glucosamine sulfate and chodroitin sulfate-will inhibit the expression of iNOS, COX-2, mPGEs, and NF-kB

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3
Q

Would you reccommend anti oxidants for a patient with OA or would you reccommend Vit-D

A

Anti-oxidants No there is no evidence that they will help

Vit-D has been shown to be beneficial for younger patients

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4
Q

What is the anti-inflammatory diet low in

A

Low

sat/trans fat, n-6 fatty acids, refined carbs, red meat butter processed foods and alcohol

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5
Q

what is the anti-inflammatory diet high in

A

fruits/veggies, n-3 fatty foods (fish walnut, or grapeseed oil)

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6
Q

What is the anti-inflammatory diet moderate in

A

EVOO, low fat dairy, whole grains, spices, lean meat, tea, dark choc, unsalted nuts

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7
Q

OA resistance training

A

30 mins 3 days per week Isometric contraindicated for elderly

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8
Q

OA aerobic

A

30 mins 3 days per week moderate intensity

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9
Q

Tai Chi OA

A

Yang Style 20-60 mins 1-5 days per week

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10
Q

water therapy OA

A

60 min 1 day per week

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11
Q

yoga therapy OA

A

90 min 1 day per week

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12
Q

What impact does supplementation with glucosamine and chondroitin have on inflammatory compounds

A

inhibits expression of iNOS, COX-2,mPGEs, and NFkB

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13
Q

What are the most common nutritional deficiencies in RA patients

A

B vitamins, Calcium, VIt-D and E, zinc and selinium

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14
Q

what nutritional malabsorption can you have with RA

A

Ca and Vit-D

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15
Q

what nutritional depletions can you have with RA drugs

A

folate, B6, Ca and Vit-D

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16
Q

What daily intake of protein should a patient with RA be consuming

A

increase protein to 1.5-2 g/kg

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17
Q

what probiotics may be beneficial for RA

A

bacillus coagulans or lactobacillus GG

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18
Q

What dose of fish oil may be helpful for RA

A

3 g/day

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19
Q

What diet should RA patients follow

A

Anti-inflammatory

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20
Q

What are some recommended treatments for Gout

A

NSAID, anti-gout meds, low PURINE DIET, limit animal protein, alcohol, and fructose

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21
Q

What should a patient with gout increase with their nutrition

A

dairy, eggs, cherries, coffee, and vegetable protein

increase fluid intake and maintain healthy BW

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22
Q

What food should be eliminated in patients with gout

A

Purine containing foods

sardines, anchovies, gravy, kidney, liver, sweetbreads, yeast, broth, scallops, mackerel, and mussles

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23
Q

What are risk factors associated with stroke

A

age, htn, smoking, obesity, diabetes and physical activity

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24
Q

What are some nutritional factors that may increase the risk of stroke

A

high sodium intake, meat intake, processed meat, western diet

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25
What are some nutritional factors that may decrease the risk of stroke
high potassium diet, n-3 intake, 5+ servings of fruits and veggies, low fat dairy, chocolate, tea, coffee, whole grains
26
what diets can decrease the risk of stroke
DASH and Mediterranean diets
27
What are the protein and energy requirements for Traumatic Brain injury
2g/kg for protein hypermetabolism form inflammation 100-140% REE sedatives reduce metabolism 100-120% REE
28
With traumatic brain injury what nutrient may be helpful
N-3
29
What are some risk factors for alzhiemers
age, HTN, obesiety, dyslipidemia, insulin resistance, inflammation, down syndrome, TBI, and genetics (Apo-E4)
30
What nutritional factors are important for prevention of Alzheimers
AOX Vit-E and C, essential fatty acids (EPA and DHA from fish) decrease omega-6, B vitamins, medium chain triglycerides, caloric restriction
31
What diet may be helpful for Alzheimers prevention
Mediterranean
32
What supplements may benefit a patient with alzhiemers
Resveratrol (skin of grapes, raspberries, and mulberries) and curcumin (turmeric
33
what supplements should be avoided by patients with alzhiemers
MV containing iron and copper
34
What are some feeding strategies that may improve quality of life with Alzheimer's
offer 1 food at a time simple place setting, plate different color, add condiments, finger foods, minimize noise, and eat a big lunch
35
what nutritional therapy is recommended for epilepsy
fasting (trigger foods) ethically Keto diet
36
what macro ratios do you recommend for a keto diet
4:1 fat to carbs and protein 4 grams fat for every 1 gram protein and carb approx 10-20 carbs per day
37
how do you monitor adherence to the keto diet
seizure frequency, monitor vitamin and mineral deficiencies and proper growth and ketone in blood
38
What are the energy and protein requirements in a person with acute Spinal cord injury
90% energy intake and 2g/kg protein
39
what are the protein req for rehab spinal cord injury
.8-1 g/kg
40
What is the fluid intake recommendation for a patient with rehab spinal cord inury
40ml/kg + 500 ml
41
what nutritional interventions may be helpful for MS
limit sat fat to <20 g/day, increase PUFA, Vit D (1000-2000 iu/d) acetyl-l-carnitine (fatigue) and L-theronine (spasticity)
42
What drug-nutrient interactions may occur in patients with Parkinsons disease
L-dopa (levodopa)- limit protein intake to .5-1g/kg bw | supplement with B-6 to convert L-dopa to dopamine before it reaches the brain.
43
how do you treat gastroparesis, GERD, and constipation in patients with parkinsons
smaller more frequent meals. low in fat and fiber. increase fluid, maintain vit-D and n-3 intake along with a diet high in AOX
44
what factors increase the likelyhood of migraine
obesity, low blood sugar, inflammatory disorders, and gut dysbiosis
45
what are some food sensitivities that are migraine triggers
alcohol, high tyramine foods, nitrates, sulfites, and histamines low blood sugar is a trigger in 60% of migraine patients
46
what diet may be helpful for patients suffering from migraines
ketogenic diet
47
how can lipid intake be modified to decrease the number of headache days
low fat diets DEC intensity and duration | increasing omega-3 must be combined with decreasing omega-6 to decrease headache days
48
which micronutrient disturbances are most common in migraine patients
low folate, low magnesium, and HIGH IRON
49
is dehydration an issue with migraine patient
yes dehydration significantly increases headache days er month
50
what is the fluid intake recommendation for migraine patients
8-10 8oz glasses per day
51
what supplements may be beneficial for patients with migraines
MG (women with menstrual migraine) Riboflavin and CoQ10 (mitochondrial dysfxn) CoQ10 peds buterbur
52
What are the protein requirements for thyroid fxn
min .8g/kg
53
what micro and macro nutrients are imp for thyroid fxn
iodine, iron, selenium (less than 500mcg/day), zinc, Vit-A and D,
54
If a patient has hypothyroidism what should they avoid
ALA (alpha-lipoic acid) decreases conversion of T4-T3
55
What macro and micro nutrients are imp for bone synthesis
Protein calcium, phosphate, Vit A, D, C, K, Mg and potassium | also co enzyme Q10
56
What are some etiologies involved in cancer
Genetics, excess energy, viruses (HPV and Hep) chemical carcinogens, limitied fruits and veggie, sedentary lifestyle, radiation, and tobacco
57
what are some dietary strategies that increase risk of cancer
red meat, salt, sat fat, trans fat, alcohol, high temp cooking, and obesity
58
what are some dietary strategies that decrease the risk of cancer
fruits/veggies, whole grains, fish fiber, Vit-D coffee and tea
59
ACA guidelines for cancer prevention in terms of exercise and weight
be as lean as possible limit high cal foods and beverages exercise 150 min/week moderate 75 mins/week vigorous kids 60 mins/day moderate or vigorous
60
ACA guidelines for cancer prevention in terms of Diet
limit red meat, choose plants, watch portions, limit alcohol, 2.5 cups fruits/veggies daily, whole grains
61
what nutritional assessment could you do in practice for a patient with cancer.
use patient generated subjective global assessment for malnutrition (SGA)
62
how do you monitor for malnutrition in cancer patient
anthropometric data with every visit. mid arm muscle circumference
63
what types of cancer usually present with malnutrition
head/neck, esophageal gastric, pancreatic, lung
64
which types of cancer are usually found in patients with over nutrition
breast prostate colon (all others)
65
What diets can help in cancer patients
Ketogenic diet- glucose deprivation increases oxidative stress in cancer cells Calorie restriction- decrease tumor initiation promotion and progression
66
What are the energy requirements for an obese cancer patient
21-25 cal/kg bw
67
what are the energy requirements to maintain weight in cancer patient
25-35 cal/kg bw
68
what are the energy requirements to gain weight in cancer patients
30-40 cal/kg
69
What are the protein requirements in cancer patients. Stressed vs non stressed
Stressed 1.5-2.5 g/kg | non-stressed 1-1.5 g/kg
70
do you reccommend multi vitamins in cancer patients
no get nutrients from food, not supplements. only if supplemental deficiency is biochemically or clinically demonstrated or if intake is consistently
71
When should supplementation be considered with cancer patients
with cachexia
72
how is cancer cachexia diagnosed
weight loss >10% caloric intake <1500 cal/day CRP >10ml/L
73
What are some strategies used to increase energy intake in your cachectic patient
high fat, high protein diet. Drink fluids with calories, phytochemicals
74
what dietary strategies can be helpful to patients with nausea/vomiting
small low fat meal morning of treatment. clear liquid diet for days after. avoid high fat, spicy or sweet foods. Eat bland, soft easy to digest
75
what dietary strategies can be helpful to patients with constipation
increase fiber and fluid. eat and snack throughout the day. increase physical activity
76
what dietary strategies can be helpful to patients with diarrhea
small amounts of electrolyte containing fluid. avoid fruit juices, sugar alcohol. CRAM (cereal rice applesauce milk) probiotic (Lacto and bifido), glutamine, and decrease high soluble fiber foods
77
what dietary strategies can be helpful to patients with sore throat
eat soft moist foods, avoid dry coarse foods. avoid alcohol, citrus caffeine, tomatoes, vinegar, and hot pepers
78
what dietary strategies can be helpful to patients with mucositis (inflammation of epithelial cells lining GI)
maintain oral hygeine, maintain minimum protein levels (1.5 g/kg) eat soft non fibrous non-acidic foods. avoid fizzy drinks honey (20 ml swish and swallow) supplement with zn, glutamine, epicatechin, and DGL (heals ulcers)
79
what dietary strategies can be helpful to patients with dysguisia (alt taste)
avoid metal utensils, pour into glass first, high protein foods, cooler foods, marinades or spices, supplement with zn and Vit-D
80
what dietary strategies can be helpful to patients with xerostomia (extreme dry mouth)
avoid coffee, tea, soda, and alcohol containing mouth wash. | sip on liquids use sugar free gum. suck on frozen fruits. use good oral hygiene, mouth moisturizers, and accupuncture
81
What is the fluid intake recommendation for cancer patients
1 ml/calorie
82
is exercise recommended during cancer treatment
150 min mod per week or 75 vigorous per week. can be in 10 min intervals resistance training 2 days per week
83
what are some etiologies associated with breast cancer
age, history, ovarian cancer, personal history, BRCA 1/ BRCA 2, early menarche, late menopause, later pregnancy
84
what are some etiologies associate with prostate cancer
older than 50, genetics, obesity, sedentary lifestyle, prostate infection, not circumcised, precessed carbs, dairy
85
what are some etiologies associated with colon cancer
over 50, genetics, obesity, sedentary lifestyle, tobacco, alcohol, height (short), and red meat
86
what are some etiologies associated with lung cancer
smoking, radon, air pollution, asbestosis, race, radiation, high dose beta carotene/ Vit A, red meat
87
what are some dietary strategies that may decrease the risk of the above cancers
maintain healthy weight, exercise, dont smoke, limit red meat and processed meat, limit alcohol, eat plants and fish, drink green tea, grill responsibly
88
what are some nutritional strategies for breast cancer survivors
3-5 cups green tea daily, avoid alcohol, MVM with no more than 100% RDA except Vit D, get nutrients from food not supp, avoid soy supp, and ER/PR cancers limit fat to 15-20% of energy

Clinical nutrition Final (1 decks)

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