Intro to Nutrition Flashcards
top 3 leading causes of death in US
heart disease
cancer
stroke
Name 3 applications of nutrition in medicine
- public health issues: Chronic diseases - heart disease, cancer, obesity, hypertension, stroke, diabetes; international nutrition issues
- Ambulatory medicine: Pregnancy; lactation & breastfeeding; healthy, growing children; obesity, hypertension; hyperlipidemia; Type 2 diabetes mellitus; elderly; chronic diseases (Type 1 DM), cystic fibrosis, chronic obstructive pulmonary disease; celiac disease; micronutrient deficiencies.
- Nutrition support/in-patients
Components of assessment of nutritional status
- History (intake relative to needs and risks; + medical hx)
- Antrhopometrics (length/ht, wt, waist)
- exam
- labs
Factors/conditions in HPI that place pts at risk for nutritional depletion or excesses
• Impaired absorption (CF, celiac)
• Decreased utilization
• Increased losses (blood loss, diarrhea)
• Increased requirements (growth, high metabolic rate, work of breathing, pregnancy, lactation, growth etc)
-Limited intake
• High/low level of physical activity
High risk patient
- Very young or very old
- Underweight or recent loss of > 10% of usual body weight, or both
- Obese w/ central adiposity/insulin resistance
- One consuming limited variety: inadequate or excessive intake of certain foods
- Protracted nutrient losses: malabsorption, enteric fistulae, draining abscesses or wounds, renal dialysis, chronic bleeding or rbc destruction, s/p bariatric surgery
- Hyper-metabolic states: sepsis, protracted fever, extensive trauma, burns
- Chronic use of alcohol or meds with anti-nutrient or catabolic properties: steroids, antimetabolites (e.g. methotrexate), immune-suppressants, antitumor agents
- Marginalized circumstances: Impoverishment, isolation, advanced age, altered mental status (incl mental retardation)
Qualitative and Semi Qualitative dietary assessment
Qualitative: screening questions/comment -"Tell me about your diet" -"tell me what you ate yesterday" -"Where do you eat most of your meals?"
-Listen for variety, excess/inadequacy, issues relevant to the patient: sat fat, calories, Na, Ca, Fe
SemiQualitative:
Actual estimates of intakes of foods and/or nutrients
-Diet record (1 day, multiple days)
-Compare nutrient intakes to recommendations
Examples of Food Guides
- My plate (visual aid)
- 2010 dietary guidelines for Americans:
1) balancing caloric intake, 2) foods to reduce (e.g. saturated fats, high sodium and high sugar foods/beverages), 3) foods to increase (fiber/whole grain, low-fat or nonfat dairy, fruits, vegetables), and 4) be active your way.
Dietary Reference Intakes
present a shift in emphasis from preventing deficiency to decreasing the risk of chronic disease through nutrition
-Current DRI includes “upper limits for nutrients”
-“EAR”: Estimated Average Requirement: intake estimated to meet requirement defined by a specified indicator of adequacy in 50% of population
-Recommended Dietary Allowance: goal for healthy individuals;
average daily dietary intake level sufficient to meet the nutrient requirements of nearly all (95-97%) individuals in a life stage and gender group; RDA applies to individuals, not to groups; EAR is foundation of setting RDA; should be used as a goal for dietary intake by healthy individuals, not to assess/plan diets of groups
-So could be fine with 70% of RDI, but NOT EAR
Anthropometrics
• Information non-specific but quite sensitive (small changes detectable, but can be multiple causes)
• Major limitation is inaccuracy of measurement, recording
• Height , weight (head circumference, weight circumference) compared to standards based on age, sex:
-Pediatrics: WHO/ CDC growth charts (0-24 mo); NCHS/CDC w/ BMI: 2-20 yr, 2000
-Adults: Body Mass Index (BMI) weight in kg divided by height in m2
Interpretation of BMI
Underweight: 40
Clinical/physical exam
- Particular attention to skin (rash, petechiae, bruising, pallor), hair (pluckability, color changes, texture), mouth (sores, cracked lips, tongue), eyes
- Loss/gain of subcutaneous fat
- Muscle wasting
- Edema - extremities, sacral
- Neurologic exam (reflexes, vibratory sense, balance, gait/ataxia, Romberg, mental status )
Lab tests
-specific but not sensitive
Commonly used tests:
a) albumin - reflects protein synthesis, but levels decrease w/ stress/inflammation
b) prealbumin - shorter half-life compared to albumin; reflects more acute status but also decreases w/ stress
c) transferrin - iron and protein status
d) complete blood count and total lymphocyte count
e) Specific nutrient levels (e.g. retinol, 25-OH-Vit D, ferritin, etc)
Readiness to change
-related to 2 key concepts:
importance (is change worthwhile?)
confidence (whether pt believes he/she can achieve the change)
US Dietary Guidelines
1940s basic 7
1956-70s: 4 food groups
1979: hassle free daily food guide (limiting fats, sugar, alcohol)
1984: food wheel (5 food groups, 3 calorie levels)
1992-2005: food guide pyramid (goals for nutrient adequacy and moderation, 3cal levels)
05-11: my pyramid (variety, moderation, proportion) 1st physical activity; 12 calorie levels, 41 recs
Now: My Plate
DGA New Aspects
- mjority of pop overweight or oese and undernourished in key nutrients
- Consideration of “total diet” and how to integrate recs into practical terms–> nutrient dense and calorie balanced choices
- Addressing broader environmental and societal aspects
- increased plant based diets
- decreased solid fats and added sugars as well as sodium and refined grains
- Meet physical activity guidelines
