Medical Nutrition I Flashcards
One of the most pressing and concerning public health problems in the US and other resource rich countries
Obesity
Adult obesity prevalence increased from 22.9% in 1988 to
35% in men and 40.4% in women
Equally as troublesome as these statistics is the trajectory of these findings. The projected prevalence of obesity is
50% by 2030
What is a good initial goal for weight loss?
Losing 5-7% of body weight
The rate of weight loss has the potential to reduce after
3-6 Months of weight loss
With weight loss, we see an increase in hunger stimulation by
Ghrelin
With weight loss, energy storage is increased by
GIP
Work to decrease appetite during weight loss
CCK and Leptin
If patients lose 10% of their weight, their energy expenditure goes
-makes it harder to continue to lose weight
Down
Diets that promise quick weight loss through what is usually an unhealthy, unbalance diet
Fad diets
Short-term, typically unsupported by data, and promise results without commitment or lifestyle changes
Fad diets
A common theme with many of these fad diets is
Weight cycing
An important determinant of short term (less than 2 weeks) weight loss
Carbohyrate content of diet
What is the classification for a
- ) Low carbohydrate diet
- ) Very low carbohydrate diet
- ) 60-130 g/day
2. ) 0-60 g/day
When no carbohydrates are ingested, body energy stores are mobilized, particularly
Glycogen
Glycogen is broken down and fluid loss is
Plentiful
Further reduction in carbohydrate ingestion results in break down of
TAGs
Begins at ingestion of less than 50 g of carbs per day
Ketosis
In the short-term, however, high-fat, low-CHO ketogenic diets cause a greater loss of body water than
Body Fat
What are two examples of popular low carb diets?
Paleo diet and Atkins diet
The body is taking in no nutrition. As a result, the body reaches to its own stores and tissues in order to provide substrate for energy production
Starvation
Muscle is broken down to feed amino acids into gluconeogenesis during
Starvation
This diet focuses on high fat and protein but minimal carbohydrate intake
Ketosis diet and low carb diet
In the ketosis and lo carb diets, the triglycerides consulted are shunted to production of acetyl coA as a substrate for the
TCA cycle
Also, the protein is broken down into amino acids, which shunted into
Gluconeogenesis and the TCA cycle
What are some of the benefits of a low carbohydrate diet?
Rapid weight loss, decread TAG, increased HDL
Low carbohydrate diets can cause deficiency in
B6, Folate, Ca, Mg, K, and fiber
Constipation and headaches are common with
Low carbohydrate diets
Focus on reducing fat intake and eating healthy carbohydrates like beans, vegetables, and fruits
High carb and low fat diets
In the high carb/low fat diet, what percentage of calories come from fat?
Less than 10%
What can not be eaten in the high carbohydrate/low fat diet?
Meat, avocado, nuts, seeds
What are the benefits of a high carbohydrate, low fat fad diet?
High fiber, plenty of vitamins and minerals
What are some of the potential risks of a high carbohydrate, low fat fad diet?
Increased TAGs, decreased HDL, difficult to sustain
Studies have shown that some people that adopt gluten-free diet actually might
Gain weight
Improvement of symptoms and growth issues, if patient has celiac disease of gluten-sensitivity
Benefit of GF diet
The GF diet could cause deficiency in
Iron, folate, niacin, and other vitamins
A gluten free diet can also reduce beneficial
Gut bacteria
Has been associated with improvement in dyslipidemia in individuals without celiac or gluten-sensitivity
Gluten
Have been reported to inhibit angiotensin converting enzyme (ACE)
Gliadin hydrosylates
Gluten may boost the
Immune system
Refers to a period of 3-10 days of mainly fruit and vegetable juices
Juice cleanse
Is there any scientific evidence to support juice cleanses?
No
For example, there is a case report of oxalate nephropathy requiring hemodialysis and reduction in GFR due to increased consumption of
Oxalate-containing fruits and veggies
The nutritional properties of whole foods and food patterns — rather than macronutrients and micronutrients — are an important focus of the
Mediterranean diet
Rather than restricting foods and calories or eating like a Mediterranean for several days, this is viewed as a
Lifestyle change
The diet focuses on vegetables and fruits, whole grains, lean proteins, nuts, with olive oil or fats with oils high in PUFA like olive oil
Mediterranean diet
An important part of the Mediterranean diet is the bottom row, which is the
Social component of the diet
In an older population, a Mediterranean diet supplemented with olive oil and nuts is associated with improved
Cognitive function
A Mediterranean diet was associated with reduced incidence of major
CVD
Was associated with reduced insulin resistance, endothelial dysfunction, inflammatory markers, and metabolic syndrome
Mediterranean Diet
Immediately starting the diet, there is a significant weight loss in patients with the
Low carb diet
However, this eventually turns into
Returned weight gain
A patient on this diet loses weight and then levels off at a new set point without regaining to initial weight or fluctuating significantly
Mediterranean Diet
Preferable and easier to maintain and adhere to leading to better long term outcomes for weight loss and other lipid and cholesterol levels
Meiterranean diet
What is stage one of hypertension?
Systolic 130-139 mm Hg OR diastolic 80-89 mm Hg
What is stage 2 of hypertension?
Systolic greater than 140 OR diastolic greater than 90
Causes are other general medical conditions that can lead to hypertension. For example, if your body has a tumor of the adrenal gland zona glomerulosa that is independently and inappropriately secreting aldosterone into the blood stream
Secondary hypertension
One of the diets recommended for people with high BP is the
DASH diet
Showed in an NEJM article to have a significantly lower systolic BP at every sodium level
DASH diet
The diet itself emphasizes fruits, vegetables, and low-fat dairy foods; includes whole grains, poultry, fish, and nuts; and contains smaller amounts of red meat, sweets, and sugar-containing beverages than the typical diet in the United States
DASH diet
Very similar to the Mediterranean diet
DASH diet
Also contains smaller amounts of total and saturated fat and cholesterol and larger amounts of potassium, calcium, magnesium, dietary fiber, and protein than the typical diet
DASH diet
What are the normal levels for total cholesterol?
Less than 200
High cholesterol is classified as total cholesterol greater than
240
Has been proven to improve reductions of LDL beyond changes in diet alone. These changes can be evident in 6-12 months
Exercise
In patients with poor baseline diets, it has been shown that changes in diet alone can lower LDL by as much as
30%
Have also been shown to reduce LDL levels
PUFAs
Lower LDL and TAGs without lowering HDL
MUFAs
Once diagnosed, the goal of diabetes management is
Glycemic control
In treating diabetes, we want HbA1c levels to be
Less than or equal to 7
A measure that indicates blood sugar control over the last 3 months
HbA1c
Tells you the percent of red blood cells that have had sugars attached to their membrane due to the high amounts of circulating sugars in a patient with diabetes
HbA1c
The following are the indications for?
BMI ≥ 40 without comorbid illness
BMI 35 – 39.9 with at least one serious comorbid illness BMI 30 – 34.9 and uncontrollable Type 2 DM or metabolic syndrome
Bariatric surgery
What are the 4 types of bariatric surgery?
Roux-en-Y, Sleeve, Lap Band, and Biliopancreatic diversion
Take a small pouch of the proximal stomach and connect it to the small bowel
Roux-en-Y
Results in restrictive weight loss but also a malabsorptive component
Roux-en-Y
With a Roux-en-Y, the connection between the small stomach pouch and the jejunum causes dumping syndrome if the patient eats too much
Sugar
Inhibited by a Roux-en-Y as it is released by the foregut and much of the foregut is bypassed
Ghrelin
Increased after a Roux-en-Y procedure
CCK and GLP-1
Most of the greater curvature of the stomach is removed and a tubular stomach is created
Sleeve
With the sleeve, there is restricted food intake as well as a
- ) Decrease in
- ) Increase in
- ) Ghrelin
2. ) GLP-1 and PYY
Insulin resistance improves with the
Sleeve
A soft silicone ring is connected to an infusion port in the subcutaneous tissue. The port allows for adjustment of the ring by infusing saline resulting in restrictive weight loss
Lap Band
This procedure divides the duodenum from the pylorus, removes the pylorus, and then divides the ileum
Bilopancreatic Diversion
Then, the surgeon anastomoses the distal ileum to the stomach and proximal ileum to the
Distal ileum
This procedure is not as well studied from a diabetes perspective and few centers actually do it
Bilopancreatic diversion
The result of a bilopancreatic diversion is essentially having two parallel circuits running and connecting to a
Common limb
Medical literature has shown that bariatric surgery can be the best option for severely obese patients with diabetes. Even without weight loss, patients who have bariatric surgery have improved
HbA1c
What is the minimum protein requirement per day for patients who have undergone bariatric surgery?
Minimum 60g protein per day
