LMBR3: P1. p 67-74 Flashcards
Eight things
What are the lifestyle medicine vital signs ?
Which of these are tested/validated ?
How often should be they be checked ?
BR 67
Feet - exercise ** \
Fingers - smoking, EtOH (AUDIT-C**) > BMI **
Forks - diet /
Sleep - sleep
Stress - stress
Love - emotional well-being
** Tested & validated
++ Assess at every visit ++
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What are the main components of daily total energy expenditure ?
What percentage does each contribute ?
BR 67
Resting energy expenditure 60-75% of total => 70%
Physical Activity 15 to > 30% of total => 20%
Thermic (effect of food) = 10% => 10%
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Mnemonic - ‘RAT’ (on a wheel)
How to assess the physical activity vital sign ?
What is/ is not adquately assessed by this method ?
BR 67
Easily & quickly measured using the two-item exercise vital sign:
1) “How many days a week do you engage in moderate to strenuous exercise such as a brisk walk?”
2) “On average, how many minutes per day do you exercise at this level ?”
While this provides general information about CV exercise, it does not address strength & resistance exercises, balance or flexibility exercises (BR 68)
BR 67
Why is it important to also assess strength training ?
What is an easy way to assess this ?
BR 68
Strength training should also be assessed because:
1) It can increase Basal metabolic expenditure
2) It improves Activities of daily living
3) It reduces the risk for falls (esp in elderly)(Tumbles)
Ask: “How many days a week do you engage in strength training or resistance exercises?”
BR 68
Mn: BAT (Humberto)
Give an example of a mini sleep assessment
BR 69
Questions for a mini sleep assessment:
1) Typical weekday hours of sleep
2) Typical weekend hours of sleep
3) Perceived sleep quality
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What is a simple way to assess a patient’s emotional well being ?
BR 69
To assess a patients emotional well-being ask them to rate the following on a scale of 1 (lowest) to 5 (highest):
1) I am Satisfied with my life
2) In most ways my life is Close to my IDeal
BR 69
Mn: SCID (Skid - Mary Ann J)
AUDIT-C brief alcohol screen for hazardous drinkers & active alcohol use disorders.
- Three questions, each yielding 0 to 4 points
- Positive Men 4 or more, women 3 or more
Q1: “How often do you have a drink containing alcohol ?”
Q2: How many standard drinks containing alcohol do you have on a typical day
Q3: How often do you have 6 or more drinks on one occasion ?
BR 70
Why is BMI important ?
How is it calculated ?
What are the categories of BMI ?
BR 70
BMI is associated with at least 20 health conditions including MSk disorders, CV disease, diabetes, chronic kidney disease, and several cancers.
BMI = weight (kg)/ height (m)^2
BMI = [weight (pounds) / height (inches)^2] x 703
Categories:
< 18.5 - underweight
18.5-24.9 Normal (lowest risk ~ 19 to 22)
25-29.9 Overweight
>30 Obese:
- 30-34.9 Class 1
- 35.0-39.9 Class 2
>40 Class 3 (extreme obesity)
What are diseases increased with high waist circumference ?
What are the cutoff values for men & women ?
BR 71
Higher risk of NIDDM, hypertension, and CV disease
Cutoff for ‘increased’:
Men >= 40 inches (102 cm)
Women >= 35 inches (>= 88cm)
What are the cutoff values for waist/hip ratio ?
BR 71
Normal waist:hip standards:
Men ratio <= 0.90
Women ratio <= 0.85
What are the 2017 standards for BP & hypertension ?
What is the prevalence of hypertension in adults > 60 yrs
How often should one screen for hypertension ?
BR 72, UpToDate
Seventh Report of Joints National Committee on Prevention/ Detection / Evaluation & Rx of High Blood Pressure
Normal BP < 120 / < 80 mmHg
Elevated BP: systolic 120-129 / < 80 mmHg
Stage 1: systolic 130-139 OR 80-89 mmHg
Stage 2: systolic > 140 OR > 90 mmHg
If there is a disparity in category between the systolic and diastolic pressures, the higher value determines the stage.
Prevalence - greater than 50% of those > 60 yrs old
Screen at each periodic visit (q 6-12 mos)
Name a fitness testing option to assess each of the following:
1) Cardiorespiratory fitness (2)
2) Muscular endurance
3) Flexibility
4) Body composition (avoid …)
5) Muscular strength
BR 73
Tests for each of the following:
Step testing, 6 min walk test for cardiorespiratory fitness
Squats, pushups & sit-ups for muscular endurance
Sit & reach test for flexibility (like a step)
Skin calipers for body composition (avoid bioimpedance - affected by hydration etc)
Strength - difficult unless weights or ability to apply a load (eg bench or squat press)
BR 73
Renal: Cr, BUN, Na K, CO2, Cl
Glucose
Calcium
Albumin + Total Protein
LFT’s: ALP, ALT, AST, Bili
Total of 14 tests - K (6), L (4), Prot (2), Ca, Glu
What screening/diagnostic BLOOD tests are part of a lifestyle-related assessment ?
BR 73
1) Complete metabolic panel (14 blood tests)
2) Fasting lipids: T-chol, LDL, HDL, TG, +/- particle size
3) hsCRP
4) HbA1c, fasting [Glucose] +/- OGT, fasting [insulin], possible C-peptide & HOMA-IR.
5) Vitamin D
6) TSH
- I also think a ferritin, B12 should be checked as a baseline, +/- Magnesium.
List 4 different diagnostic criteria for diabetes
BR 74 & UpToDate
1) HbA1c > 6.5%*
2) FPB > 126 mg/dL (7.0 mmol)*
- fasting means NPO for at least 8 hours
3) 2Hr [glucose] > 200 mg/dL (11.1 mmol/L) during 75g OGTT*
4) RND [Glu] > 200 mg/dL (11.1 mmol/L) plus classic symptoms (polyuria, polyphagia, polydypsia)
*= in the absence of unequivocal hyperglycemic, Dx required TWO abnormal test results from the same sample, or in two separate test samples.
List 10 settings in which one should screen for NIDDM
First step to suspect is if …
BR 74
Screen for NIDDM in all adults with BMI > 25 plus any of:
PMH: CV disease, PCO, prediabetes, Htn (>140/90)(or Htn meds)
Women: Baby > 9 lbs (4 kg) or Hx gestational diabetes
FH: FDR with NIDDM
Social: Ethnicity (Asian, Black, Latino, Native, Pacific Islander)
Lifestyle: Physical inactivity
O/E: signs insulin resistance (acanthus nigricans)
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If a patient has no risk factors, should one screen for NIDDM ?
If ‘yes’ - how often
BR 74
In someone with no risk factors, start screening at age 45 and repeat every 3 years.
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