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Clinical Nutrition > Final > Flashcards

Final Flashcards

1
Q

What are the recommendations for patients with hypothyroidism

A
  • fasting/carb restrictive diets
  • goitrogens: broccoli, cauliflower
  • Iodine
  • selenium
  • Iron
  • Zinc
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2
Q

Managing imbalances of thyroid function

A
  • get precursors for T4 (protein, I, Zn)
  • reduce anti thyroidal antibodies (undiagnosed celiac)
  • improve conversation of T4 to T3 (selenium, Zn)
  • enhance T3 influence on mitochondria (selenium)
  • monitor use of botanicals (guggul extract and ashwagandha)
  • avoid thyroid hormone metabolism disruption (avoid flavonoids—celery, thyme, chamomile tea etc)
  • caution with supplements (alpha lipoid acid reduces conversion of T4 to T3)
  • get adequate vitamin D
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3
Q

Nutritional suggestions for managing thyroid imbalance

A 
Increase protein
I
Se
Zn
Fe
Vitamin D 
Caution a-lipoic acid
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4
Q

How is adrenal fatigue measured

A

ATCH stimulatory test

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5
Q

Diagnosing diabetes. And how often do the tests need to be done to confirm

A

Oral glucose tolerance test
Fasting blood glucose
Long term: HbA1C (6.5% +)

Must be done 2 weeks later to confirm

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6
Q

Nutritional recommendations to a pre or diabetic patient

A 
Weight loss
Mediterranean diet
Increase fiber and whole grain
Limit sugar sweetened beverages
Replace saturated fat with MUFA/PUFA
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7
Q

Carb counting in diabetic patient

A

Total intake of CHO intake

Count starches, fruits, dairy, sweets

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8
Q

Should diabetic patient exercises? Any precautions?

A

type 1: check levels before, during and after. Consume 15g of carbs per 30-60min (prior)

Type 2: exercise can improve glycemic response. Often have a lower V02 max so they need to ease into training

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9
Q

Exercise recommendations for diabetics

A

Min of 150 min

No more than 2 consecutive days without activity
Type 2 encouraged to do resistance at least 2x/wk

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10
Q

What are the long term complications of uncontrolled blood glucose

A

CVD (due to high TG)
Nephropathy
Retinopathy
Neuropathy

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11
Q

How is hypoglycemia diagnosed

A
  • low blood glucose <50mg/dL
  • weakness, fatigue, sweating, palpitations
  • symptoms disappear with carb ingestion and blood glucose returns to normal

“Whipped triad”

**if don’t disappear might be pancreatic insufficiency

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12
Q

Causes of microcytic anemia

A

Iron deficiency

Potentially copper

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13
Q

Causes of macrocytic anemia

A

Folate or B12 deficiency

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14
Q

Plasma ferritin and iron deficiency

A

Normal 100+- 60

Iron depletion = 20
Iron deficiency <10

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15
Q

S.s of microcytic anemia

A

Pallor
Glossitis
Spooning of nails
Pale conjunctiva

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16
Q

What supplementation should be used for microcytic anemia

A

50-100mg of elemental iron. Add zinc supplement if not responding

vitamin C

Limit binders: oxalate, phytate, tea, coffee

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17
Q

Nutritional therapy for macrocytic megaloblastic anemia

A

1000mcg folic acid
1000mcg B12

High protein (1.5g/kg)

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18
Q

What is the best biomarkers for macrocytic deficiency

A

MMA

Methylmalonic acid

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19
Q

When should dietary changes be used and when should dietary and supplement changes be used in hypochromic microcytic anemia?

A

Stage 4: supplement & dietary changes
(<10 plasma ferritin)

Stage 3: dietary changes
(10 plasma ferritin)

Supplement 50-100mcg Fe + Vit C + Zn

Diet: protein, omegas (decrease inflammation), limit binders: oxalate, phytate, tannins etc.

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20
Q

What nutrients are important for brain function?

A

Protien
Lipids (3-DHA, 6-ARA)
Iron (myelination/neurotransmitter synthesis)
Iodine
Zinc
Methyl donors (folate B6, betaine choline)

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21
Q

Iron supplements for fullterm breastfed infants and preteen breastfed infants

A

Fullterm: @ 4 months 1mg/kg/day

Preterm: @ 1 month 2mg/kg/d

Formula fed: none

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22
Q

Zinc functions and results if deficient

A

Myelination, neurotransmitter release

Poor learning, attention, memory and mood. 
Altered immune 
Increased cytokine 
Increased intestinal permeability 
Food allergy
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23
Q

What are the methyl donors

A

Folate
B6
B12
Betaine choline

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24
Q

How is the gut involved in brain development and psychiatric manifestations?

A

Lactobacillus: GABA and Ach
Streptococcus: serotonin
Bifidobacterium: GABA
Escherichia: serotonin, norepinephrine

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25
Q

More adipocytes= more inflammation. Gut inflammation precedes weight gain and adipocytes inflammation. M___ —> M __

A

M2 (heal)—> M1 (kill)

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26
Q

Diet stress—> gut changes—> immune cell activation = chronic inflammation

Explain

A

Diet and stress: causes change in the gut microbiome

Gut changes: inflammation. Increased LPS absorption —> + NF-kB—> + cytokines—> + ROS —> + NFkB etc.

Immune: systemic inflammation

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27
Q

Biomarkers of systemic inflammation

A

CRP: 3+ is high
IL6
Fibrinogen

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28
Q

Maternal ____ production is associated with fetal neuroinflammation. _____ is an indicator of systemic inflammation. What does it cause?

A

Cytokine
IL6
Alters brain areas associated with working memory and causes abnormal network connections

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29
Q

Microglia and neuroinflammation

A

Need for synaptic plasticity and clearance of debris

peaks at 14 days old

Excessive activation from cytokines and LPS may cause brain lesions, sequester iron, secrete: IL1, TNF, ROS, MMP, amyloid precursor

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30
Q

How do microglia become activated and what do they do when they are

A

Cytokines and LPS

Sequester iron, secrete IL1, TNF, ROS, MMP, and amyloid precursor

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31
Q

How are microglia deactivated

A

Anti-inflammatory cytokines IL4, 10, 13

Increased oxidative metabolism in microglia drive pro-regenerative phenotype

SIRT1 prevent excessive activation through deacetylation of NFkB
(Berries)

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32
Q

What prevents excessive microglia activation

A

SIRT1 (deactivates NF-kB)

Eating berries activates more

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33
Q

What dietary recommendations and supplements may be useful for depression?

A 
Omega 3
Folate
B12
Mg
Zn
Probiotics (bifidobact/lactobacillus)
Phytochemicals (cocoa/coffee/green tea/honey/blueberries)
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34
Q

Fat type of recommendation and mood disorders

A

Increase SCFA= improved mood disorders

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35
Q

Nutrient and supplement recommendation for bipolar disorder

A

Na (moderate and stable intake)
CoQ10
N-acetylcycteine
SAMe

Supplement: fish oil 9g/d
N-acetylcysteine
Mg (300-600)

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36
Q

Anxiety and the gut

A

Gut inflammation stimulated anxiety behavior

Fermentation products are protective (lactobacillus MC)

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37
Q

Nutrient and supplement recommendation for anxiety

A 
Carbs (reactive hypoglycemia common)
Omega 3
Mg (100)
B and D vitamins
Ashwagandha

Zinc found to be low (but supplements didn’t help)

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38
Q

Dementia and Alzheimer’s prevention

A

MIND diet
Folate and B12

Mind diet: 
Veggie 1/d
Nuts 1/d
Fish 1/wk
Poultry 2/wk
Berries 2/wk
Beans 3/wk
Green leafy 6/wk
Whole grain 3/d
Cheese/fried food 1/wk

Dash diet: low fat, plants, moderate protein
(Mediterranean: moderate fat, olive oil, plants, legumes)

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39
Q

Anti inflammatory diet

A 
Turmeric
Fiber
Flavones
Isoflavones
Tea
Beta carotene
Mg
Omega 3
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40
Q

High inflammation and mental health relation

A

High inflammation= high mental health issues

70% increased risk of depression, 60% anxiety

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41
Q

What are some anti-inflammatory diets

A

Mediterranean (moderate fat, olive oil, plants, legumes)

DASH (low fat, plants, moderate protein)

MIND Plant based

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42
Q

What nutrients are depleted in NSAID use

A

Iron and folate

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43
Q

What nutrients are depleted in aspirin use

A

Folate, iron, Vit C

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44
Q

What are some biomarkers for rheumatic diseases inflammation

A 
CRP (3+)
TNF
ESR 
Liver: ALT/AST
Eosinophils (4+%)
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45
Q

Nutritional therapy for OA

A 
Anti-inflammatory diet 
Vitamin D
Glucosamine sulfate (1500mg)
Chondroitin sulfate (1200mg)
Omega 3 3g/d
Weight loss/exercise

(SAMe/capsaicin gel)

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46
Q

Nutritional concerns with RA patients

A

Low vitamin D
Increased metabolic rate due to increased inflammation
Taste alterations
Fasting—potential benefit to decrease inflammation

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47
Q

RA nutritional therapy

A 
Anti-inflammatory diet
Increased protein (1.5-2.0g/kg/d)
Omega 3 3g/d
Vitamin E (nuts/seeds)
folate 
B6,12
vitamin D

Evening primose or black currant herbs

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48
Q

What herbs do you NOT give RA pateints

A

Thunder god vine

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49
Q

Nutritional therapy for gout

A 
Decrease: 
Red meat/organ meat
Seafood
Alcohol-beer**
High Purine foods (anchovies, gravy, broth, yeast, seafood)
Increase: 
Dairy
Vitamin C
Coffee
Tart cherry juice 
Water
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50
Q

What are dietary strategies that may protect against stroke?

A

Healthy BMI
Monitor for HTN and Diabetes

Flavonoids (green tea 5cups/d)
Omega 3 from fish
DASH diet (low fat, plants, moderate protein)
Na:K <1
Long term coffee
51
Q

What recommendations may be useful for patients with TBI

A

100-140% intake of expenditure
15-20% energy from protein

Omega 3
Mg
Zn
Ketogenic diet

52
Q

What diet is often used in patients with epilepsy?

A

High fat/low carb
(Ketogenic)

4:1 (fat: carb+ protein)

53
Q

What is involved with diet recommended for epilepsy

A

Ketopancakes with blueberries

Cream, celery, chicken, avacado, olive oil

Cream and strawberries

Cream, tomato sauce, ground beer, spaghetti squash, olive oil

4:1 ratio (fat: carb+protein)

54
Q

What nutritional recommendations may be made for patients with MS-prevention

A

Vitamin D adequate intake

Don’t smoke

55
Q

What nutritional recommendations may be made for patients with MS-treatment

A

Vitamin D
Anti-inflammatory diet
Keto diet?

56
Q

Nutritional recommendations for people with Parkinson’s

A

If on L-Dopa: low protein diet spread throughout day and NO B6 supplements

Adequate fiber and fluid 
Plant rich—> neuroprotective
Vitamin D
Omega 3
Keto?
57
Q

Recommendations for dementia and Alzheimer’s prevention

A

MIND diet
Prevent type 2 diabetes and monitor HbA1C

Folate B12

58
Q

For chronic daily HA and migraine: what are the main dietary strategies that would be most useful? And what supplements?

A

Avoid alcohol
Don’t smoke
Healthy BMI

Regulate blood sugar (reactive hypoglycemia) carb counting
Decrease overall at intake
Increase w-3, decrease w-6
Decrease folate
Increase methyl donors
Decrease tyramine foods (cheese, sausage, soy)
Avoid histamine (sausage, preserved fish, cheese, eggplant, avacado, spinach, tomato, alcohol)
Mg, Riboflavin, CoQ10

59
Q

Headache comorbidities

A

IBS
Gastroparesis
Celiac
Chrohns

All more likely to have HA

60
Q

What is the most common headache trigger

A

Alcohol

61
Q

What are headache chemical triggers

A

Tyramine (cheese, sausage, soy sauce)

Phenyl ethlamine- chocolate

Histamine

62
Q

What reduces the bodies ability to metabolize histamine (increasing headaches)

A

NSAIDS
Tricyclics antidepressants
Tagamet

63
Q

What are things to avoid when on a low histamine diet

A 
Sausage
Dried/preserved fish/sauces
Cheese
Eggplant
Avacado
Spinach
Tomatoes/products
Alcohol
64
Q

What supplements and dose are used to treat headaches/migraines

A

-Mg: 360-600mg
-Riboflavin: 400mg/d
-CoQ10: 150-300mg/d (100mg 3x/d)
Pediatric: 1-3mg/mg/d

Butterbur:75mg 2x/d
Feverfew—NOT if ragweed allergy

65
Q

What studies are used to determine the influence of dietary components on cancer risk? Ex: dairy & prostate?

A

Cohort

Case control

66
Q

What types of studies are used to determine the influence of dietary components on pathways? W-3 and angiogenesis?

A

Animal data

In vitro

67
Q

Estimated that 1/3 of all cancers in higher income countries due to what?

A

Poor nutrition
Sedentary lifestyle
Excess weight

68
Q

What things stimulate NF-kB inflammation in regards to cancer

A

High fat diet with saturated fat and excess w-6

Hyperglycemia

69
Q

What things increase and decrease apoptosis of cancer?

A

Decrease:
ROS
Obesity

Increase: w-3
Olive oil
Berries
Circumcised
Cruciferous veggies 
Garlic
70
Q

What things increase and decrease metastasis

A

Increase: glucose (increased invasion of colon CA cells)

Decrease:
W-3
Ketogenic
Milk thistle/silbinin

71
Q

What is the Warburg effect?

A
  • Decrease in Krebs cycle and electron transport system—> allows tumors to grow anaerobically
  • increase in glycolysis—> lactate production created favorable acidic environment
72
Q

What diets may possibly decrease tumor growth?

A

Calorie restriction

Ketogenic

73
Q

How is cachexia diagnosed?

A

All 3:

  • weight loss more than 10%
  • caloric intake <1500cal/d
  • CRP>10mg/L
74
Q

What are nutritional recommendations for patients with cachexia?

A

High fat, high protein

Whatever calories they can get down, let them eat it
Early interventions with nutritional beverages

75
Q

Protein and energy requirements for maintaining body weight and for regaining weight

A

Maintaining:

Protein 1-1.5g/kg
Calories= 25-30kcal/kg

Gaining:
Protein 1.5-2
Cal=30-35

76
Q

Fluid recommendations in cancer patient

A

20-40mL/kg

1 cup= 250mL

77
Q

Are supplements recommended for pateints undergoing cancer treatment?

A

Supplements only considered if deficiency is biochemically or clinically demonstrated

<67%RDA

Avoid use if possible

78
Q

Recommendations to treat anorexia/poor diet with cancer

A

Small frequent nutrient dense meals/snacks
Add protein/cal to favorite foods
Eat when feeling best and in a present atmosphere

79
Q

Recommendations to treat nausea

A

Small, low-fat meal
Bland food
Easy digestible—> crackers/green grapes

80
Q

Recommendations for diarrhea in cancer

A

CRAM

Cereal, rice, applesauce, milk

Small amounts of electrolyte fluid
Avoid fruit juices
Probiotic

81
Q

Recommendations for constipation in cancer

A

Increase fiber and fluid

Increase physical activity

82
Q

Recommendations for sore throat in cancer

A

Soft moist foods with extra sauce

Avoid alcohol, citrus, caffeine, tomatoes, vinegar, spice

83
Q

Recommendations for mucousitis in cancer

A

Maintain good oral hygiene
Only soft, non-fibrous, non-acidic foods

20ml swish and swallow -buckwheat

84
Q

Recommendations for xerostomia—dry mouth in cancer?

A

Increase liquids
Avoid alcohol
Increase sour foods (if none present such as frozen pineapple)

85
Q

Recommendations for altered taste in cancer

A

Good oral hygiene
Use plastic utensils
Try marinades or spices

86
Q

Recommendations for thickened saliva in cancer patient

A

Increase fluids
Try fizzy water
Mucinex
Cool mist humidifier when sleeping

87
Q

What treatments may lead to neuropathy?

A

Surgery

Chemotherapy

88
Q

What increases risk of breast cancer

A 
Heavier
Smoking
BRCA1/2
Dense breast tissue
Years of estrogen exposure (earlier period)
Alcohol
89
Q

What decrease risk of breast cancer

A 
First pregnancy before 35
Breastfeeding
Mastectomy
Ovarian ablation
Exercise
Plant based diet + fish
90
Q

ER+ subtype what increase/decrease risk

A

Increase: alcohol
Fat
Saturated fat

Decrease: w-3

91
Q

What decrease risk in ER- subtype

A 
Decrease: 
Veggies
Coffee
Mediterranean diet
W-3
92
Q

What increase risk in PR+

A

Increase:
Total fat
Saturated fat

93
Q

What decreases risk in PR-

A

Decrease:

Coffee
Mediterranean

94
Q

What increase/decrease risk in HER2-

A

Increase:
Alcohol
Sat fat

Decrease:
Soybeans

95
Q

What increase/decrease risk in HER2+

A

Increase:
Western diet
Soybeans

Decrease:
Mediterranean
Breastfeeding
Alpha-linolenic acid

96
Q

What decrease risk in ER-/PR-/HER2-

A

Mediterranean

Breastfeeding

97
Q

What increase risk of prostate CA

A 
Age
Genetics
Smoking
Weight
Sedentary
Red meat
High fat diet
Dairy calcium
98
Q

What decrease risk of prostate

A

Plants

Cruciferous veggies—broccoli/cauliflower

99
Q

What increase risk of colorectal ca

A 
Family history
History of IBD
Alcohol
Smoking
AA
Weight
Red meat
100
Q

What decrease risk of colorectal CA

A

Healthy weight
Fruits/veggies
Fiber, SE
Increase dairy

Limit red meat, alcohol

101
Q

What CA is dairy good for prevention and what is it bad for?

A

Dairy increases risk of prostate but decreases risk for colorectal

102
Q

Grilling/roasting produce?

A

Heterocyclic amines HCA

103
Q

Grilling with charcoal produces

A 
Polyaromatic hydrocarbons (PAH)
More flames due to temp, fat content = more PAH
104
Q

Grilling recommendations to reduce PAH and HCA

A 
Whole cuts
Marinate—lemon juice, beer, honey, herbs
Cover grill with foil
375-450
Cut off black bits
105
Q

What decreases risk of lung CA

A 
Dont smoke
Healthy BMI
Limit red meat
Eat veggies
SE
Quercetin foods (fruit, tea, onion, cocoa, red wine, olive oil)
Mediterranean diet (decrease risk of lung CA in 90% smokers) 
Limit beta carotene
106
Q

Overall CA prevention recommendations

A 
Healthy weight
Exercise
Dont smoke
Limit red meat
Limit alcohol
Plants and fish
Green tea
107
Q

What diet is recommended for CA survivors?

A

Veggies
Fruits
Whole grains
Legumes

Decrease:
Sat fat
Alcohol

108
Q

Breast cancer prevention guideline

A 
Rich colored plants
Salmon w-3
Decrease sat fat 
First pregnancy before 35 
Breastfeed
Dont smoke
Decrease alcohol
109
Q

Prostate cancer prevention guideline

A 
Rich colored plants
Limit red meat
NO ca supplements
No smoking
Increase green tea
Decrease dairy
110
Q

Colorectal cancer prevention

A 
Rich colored plants
Salmon for n-3
Limit red meat
Vitamin D
Ca
Dont smoke
Decrease alcohol
Increase dairy
111
Q

Lung cancer prevention guidelines

A 
Rich colored plants
Limit red meat
Limit beta carotene
High intensity exercise
Don’t smoke
Increase nuts/seeds/veggies
112
Q

What are the 4 steps of motivational interviewing

A

Engage
Focus
Evoke
Planning

113
Q

What are the four micro skills in motivational interviewing

A

Open ended Q’s
Affirmation/validation
Reflection
Summary

114
Q

Motivational interviewing is a helpful communication took most useful for people in what stages?

A

Precontemplation

Contemplation

115
Q

Autonomy

A

Avoid directives “ you should etc..”

Instead “how would that work for you?”

116
Q

Sustain talk

A

Shows ambivalence
“But”
“I want to do ___ but ____”

117
Q

Change talk

A

Ready to make a change

“I need to ___.”

118
Q

Acronym for micro skills of motivational interviewing

A

OARS

119
Q

When talking about open ended questions vs reflection what is the ratio and the motified acronym

A

ROAS

Twice as many reflections and open ended questions

120
Q

Moving through ambivalence—preparing

A

DARN

Desire
Abilities
Reason
Need

121
Q

Moving through ambivalence-mobilizing

A

CAT

Commitment
Activation
Taking steps

122
Q

Parts of planning fr change

A

Smart goals
VAS confidence scales
Change plan worksheet

123
Q

Before patient leaves for motivational interveiewing

A

GAB

Goals
Assessment of confidence
Barriers

Clinical Nutrition (5 decks)

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