Intro to Nutrition and Dietary Guidelines Flashcards
Name situations that place a patient at risk for nutritional problems
Very young or very old
Underweight or recent loss of >10% body weight
Obese w/ central adiposity/insulin resistance
Limited variety of foods, very high/low intake of some foods
Protracted nutrient loss (malabsorption, renal dialysis, chronic bleeding/RBC destruction)
Hyper-metabolic states (burns, sepsis, extensive trauma/fever)
Chronic Alcohol use
Meds with anti-nutrient or catabolic properties (steroids, antimetabolites - methotrexate, immune suppressants)
Marginalized circumstances (impoverished, isolation, advanced age, altered mental status incl. retardation)
What are four methods for obtaining diet intake information
History: Patient reported dietary habits
Metrics: Height, weight, head circumference in infants, waist circumference
Exam: Clinical signs of malnutrition
Labs: Biochemical changes/levels
What is the Estimated Average Requirement of a nutrient?
The EAR is the intake estimated to meet the needs of 50% of the people in a specific group based on life stage and gender. Incorporates the assumed bioavailability of the nutrient. Used to assess inadequate intakes and to set goals for the mean intake of a GROUP.
What is the Recommended Daily Allowance?
The RDA is the average intake level estimated to meet the dietary requirements of 95-97% of those in a specific group based on life stage and gender. Used as a goal for dietary intake by HEALTHY INDIVIDUALS.
Name three or more medical conditions where nutrition is of particular concern
Public health issues:
Chronic diseases - heart disease, cancer, obesity, hypertension, stroke, diabetes; international nutrition issues (societies in transition with both over- and under- nutrition).
Ambulatory Health issues: 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
In-patient medicine:
ICU
surgical (esp. trauma, burns, transplant)
short gut syndrome/feeding intolerance, premature infants enteral (using the gut) or parenteral (by-passing gut: intravenous)
specialized, immune-modulating formulas
micronutrient deficiencies
What are the components of nutrition assessment?
History: Intake (food/nutrient) relative to needs and risks + medical hx
Anthropometrics: length/height, weight, (head circumference in infants), waist circumference, etc
Exam: Clinical signs
Labs: Biochemical changes/levels
Need införmation from 2+ of these categories, any one is not enough.
What are some strategies for addressing dietary and lifestyle changes with a patient?
Traditional dietary counseling relies on what patients should eat. The concept of why patients eat what they do and what impediments they have to change is less understood and emphasized. Failure to change is usually not a lack of desire to change but the presence of significant barriers to change. Thus, counseling should both increase motivation and attempt to decrease barriers.
What are two key concepts for a patient’s “readiness to change”?
Importance - Is the change worthwhile?
Confidence - Whether patient believes they are capable of changing
A person who is overweight may want to change & believes it is important, but may not have confidence to do so (e.g. may have failed in past), or many factors may get in the way of making change. An alcoholic or smoker may feel confident that they could quit anytime, but may not believe it is important to do so.
What are the goals of the US Dietary Guidelines?
Four goals:
1 - Balancing caloric intake
2 - Foods to reduce (saturated fats, high sodium/sugar)
3 - Foods to increase (fiber/whole grains, dairy, fruits, veg)
4 - Be active in your way
How does the USDA Food Guide (My Plate) complement the US dietary guidelines?
My Plate offers simple visual aids and tools for for individualized approaches to healthier eating.
What are the source of data for the EAR and RDA guidelines?
Nutrient intake data/Epidemiological observations
Biochemical measurements relative to intake
Experimental depletion/repletion studies
Effects of intervention trials
What are some advantages and disadvantages of anthropometric nutritional data?
Easy to obtain - height, weight, BMI
Reflect overall growth or decrease in body fat and muscle
Very sensitive - small changes can be detected
Not specific - Changes may be due to many, many factors
Limited by inaccurate measurements or recoding
What are some advantages and disadvantages of biochemical nutritional data and what are some common tests?
Measurements reflect status and body stores of nutrient
Very specific - abnormality in a specific nutrient is known
Not sensitive - blood/urine changes may not occur until nutrient level is significantly altered
Common tests:
Albumin
Pre-albumin
Transferrin
CBC
Specific nutrient levels
What are some physical exam findings that indicate nutritional deficiencies?
Skin: rash, petechiae, bruising, pallor Hair: pluck ability, color changes, texture Mouth: sores, cracked lips, tongue Eyes: Loss/gain of subcutaneous fat Muscle wasting Edema: extremities, sacral Neurological exam: reflexes, vibratory sense, balance, gait/ataxia, Romberg, mental status
