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6-Clinical Nutrition 1 > Mid Term 1 > Flashcards

Mid Term 1 Flashcards

1
Q

What is screening?

A

process of identifying characteristics known to be associated with nutritional problems

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2
Q

What is the purpose of screening?

A

quickly identify individuals with nutrition risks

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3
Q

What is assessment?

A

process of assessment of body compartments and analysis of structure and function of organ systems and their effects on metabolism

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4
Q

What is the definition of AND on screening?

A

process of identifying patients, clients of groups who may have nutrition diagnosis and benefit from nutrition assessment and intervention

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5
Q

What are the goals of nutritional assessment?

A 
identify
monitor
evaluate
disease prevention
specific deficiencies
overall malnutrition
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6
Q

What is morbidity?

A

the condition of being diseased

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7
Q

malnutrition is associated with increased

A

morbidity
mortality
hospital length of stay
healthcare costs

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8
Q

Initial nutritional screening includes

A

pre-existing conditions causing nutrient loss
conditions that increase nutrient requirements
dietary intake

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9
Q

What are the components of assessment?

A 
Anthropometrics
Biochemical
Clinical
Dietary
Functional
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10
Q

What are the stages of a nutrient depletion

A

diet inadequacy
tissue level - needs biopsy
bodily fluid level - urine, blood, etc.
function tissue
enzymatic activity - decreases ex. urea cycle enzymes
functional change - ex. vit A def, not able to see in dark
clinical symptoms - hair loss, dry skin, etc.
anatomical sign

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11
Q

What is anthropometrics composed of

A

body size
weight
proportions

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12
Q

What is body composition

A

the proportion of fat, muscle, and bone of an individual’s body, usu. expressed as percentage of body fat and percentage of lean body mass

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13
Q

Anthropometrics allow to assess body size and estimate composition using

A 
height
weight
circumferences
skinfolds
ratios
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14
Q

What is the tool used to measure height standing?

A

stadiometer

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15
Q

What is frankfort plane?

A

line from eye to middle ear

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16
Q

What is the tool used to measure knee height?

A

caliper

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17
Q

What are the different ways of measuring height?

A

standing
knee height
arm span

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18
Q

why is arm span not recommended

A

not for asians, african americans. spinal deformities

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19
Q

How is frame size measured?

A

wrist circumference
r = height (cm)/wrist circumference (cm)

not used anymore, it was valid before BMI

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20
Q

What is weight?

A

sum of all components at each level of body composition - measure of body stores

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21
Q

How is weight measured?

A

scale
bed scale
chair scale

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22
Q

When should the weight be measured?

A

in the morning, fasting state, no clothes or shoes

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23
Q

How is BMI calculated?

A

weight (g)/ height ˆ2 (m)

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24
Q

What is the range of the normal BMI

A

18.9-24.9

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25
Q

What is the BMI of someone who is overweight

A

25-29.9

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26
Q

What BMI is considered obese?

A

more than 30

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27
Q

What is the healthy BMI for elderly

A

24-29

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28
Q

What are the limitations of BMI measurements?

A

does not measure body composition
differences in sex, age, ethnicity
limitations in athletes
must be accompanied with other measurements

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29
Q

How is % usual body weight calculated?

A

current weight/usual body weight x 100

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30
Q

What does it indicate if the %UBW is 85-95%

A

may indicate MILD malnutrition

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31
Q

What does it indicate if the %UBW is 74-84%

A

may indicate MODERATE malnutrition

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32
Q

What does it indicate if the %UBW is <74%

A

may indicate SEVERE malnutrition

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33
Q

How to calculate % weight change?

A

(UBW-current weight)/UBW x 100

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34
Q

What is considered a significant loss in % weight change?

A 
%2 - 1 week
%5 - 1 month
%7.5 - 3 months
%10 - 6 months
%20 - unlimited
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35
Q

Unwanted weight loss can predict:

A

mortality
surgical outcomes/post op complications
risk of functional assessment

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36
Q

What are the measurements that can be done for body circumference and areas?

A 
Mid-upper arm circ. (MAC)
Mid-upper arm muscle circ. (MAMC)
Mid-upper arm muscle area (MAMA)
Corrected MAMA
Mid-upper Arm Fat Area (MAFA)
Waist circumference
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37
Q

What is the tool used to measure skinfold thickness?

A

caliper

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38
Q

skinfold thicknessis an indicative of _____

A

subcutaneous adipose tissue

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39
Q

Which body areas can we measure the skinfold thickness

A

triceps
subscapular
biceps
suprailiac

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40
Q

What is the princple behind skinfold thickness

A

assumes that each site is representative of total body stores

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41
Q

What does MAC indicate?

A

reflects muscle, bone, subcutaneous fat

– not sensitive to changes in muscle

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42
Q

What does MAMC indicate?

A

corrects for subcutaneous fat

– not sensitive to changes in muscle

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43
Q

What does MAMA indicate?

A

reflects muscle and bone
more sensitive to changes in muscle than MAMC
more adequately reflects total body muscle mass

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44
Q

What does cMAMA indicate?

A

reflects only muscle without bone
not valid in elderly or obese
– not sensitive to changes in muscle

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45
Q

What does MAFA indicate?

A

reflects the adipose tissue stores

better indicator of total body fat than a single skinfold measurement

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46
Q

What does waist circumference indicate?

A

reflective of visceral fat stores and abdominal obesity

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47
Q

How is waist circumference measured?

A

at level of iliac crest/navel

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48
Q

What are the ideal numbers of waist circumference in men and women?

A

<102cm in men

<88cm in women

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49
Q

What does waist:hip ratio indicate?

A

estimates distribution of subcutaneous and intraabdominal adipose and muscle tissue

– not used anymore

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50
Q

What are other technological techniques to measure body compositions?

A 
BIA
DXA
BOD POD
Underwater weighing 
MRI
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51
Q

What is the gold standard in measuring body composition?

A

MRI

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52
Q

How does Bioelectrical Impedance work?

A

measures impedance to a low frequency electrical current (mainly from fat)
estimates fat mass, fat free mass, total body water

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53
Q

What are the limitations of BIA?

A

influenced by hydration status
less precise in atypical bodies (obese)
reference data is limited

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54
Q

How does Dual X-ray Absorptiometry work?

A

imaging technique, based on attenuation of radiation from different tissue densities
measures bone, soft lean and fat tissues, whole-body and segments
sufficient precision to assess short and long term changes

– recognized as a reference method

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55
Q

What are the limitations of DXA?

A

expensive
radiation
assumes normal hydration status

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56
Q

How does Air displacement (BOD POD) work?

A

total body volume measured by air displacement in a chamber

based on fat and lean tissue density

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57
Q

What are the limitations of BOD POD?

A

access to instruments

residual lung volume must be measured

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58
Q

What is biochemical assessment?

A

measurement of nutritional markers in blood, urine, etc.

detects subclinical nutrient deficiencies

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59
Q

What are the components that can be assessed by biochemical assessment?

A 
visceral and somatic proteins
hematological assessment
lipid profile
micronutrient assessment 
immunocompetence assessment
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60
Q

Biochemical assessment can be affected by:

A

nutritional status
medications
illness
physiological state

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61
Q

What is the ideal level of albumin

A

40-60g/L or 4.0-6.0g/dL

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62
Q

What is the ideal level of glucose

A

3.9-6.1 mmol/L

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63
Q

What is the ideal level of iron

A

11-32 umol/L

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64
Q

Visceral protein status is assessed by the measurement of

A

serum proteins
RBC
WBC

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65
Q

What is the composition of serum proteins

A

albumin
fibronectin
transferrin

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66
Q

Transferrin is composed of:

A

prealbumin

retinol binding protein

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67
Q

In what condition does biochemical assessment has low sensitivity and specificity for nutritional status?

A 
poor protein intake
altered metabolism and synthesis
hydration
inflammation
pregnancy
madications
exercise
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68
Q

What is the half life of albumin

A

17-21 days

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69
Q

What is the function of albumin

A

maintain osmotic pressure

transport of large insoluble molecules, drugs, calcium, zinc

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70
Q

What is the function of transferrin

A

iron transport

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71
Q

What is the function of TTR

A

transports T3-T4

carrier for RBP

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72
Q

What is the function of RBP

A

retinol transport from liver to periphery

circulates with TTR

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73
Q

In what condition is albumin high and low?

A

high during dehydration

low during low protein intake, poor synthesis, overhydration, edema, acute illness, aging

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74
Q

In what condition is Transferrin high and low?

A

high during Fe deficiency, pregnancy, chronic loss

low during acute illness, chronic infection, PEM, systemic disease

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75
Q

In what condition is TTR high and low?

A

high during renal disease, Hodgkins disease

low during liver disease, PEM, chronic loss, malabsorption, hyperthyroidism

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76
Q

In what condition is RBP high and low?

A

high during renal disease

low during vitamin A def., zinc def, hyperthyroidism, liver disease

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77
Q

What are acute phase proteins?

A

are a class of proteins whose plasma concentrations increase (positive acute-phase proteins) or decrease (negative acute-phase proteins) in response to inflammation.

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78
Q

Give examples of + acute phase proteins

A

C-reactive protein (CRP)

Ferritin

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79
Q

Give examples of - acute phase proteins

A

albumin, transferrin, TTR, and RBP

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80
Q

How is somatic protein status assessed?

A

nitrogen balance
creatinine excretion
immune function

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81
Q

How is positive N balance expressed in terms of anabolism and catabolism?

A

anabolism>catabolism

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82
Q

How is 0 N balance expressed in terms of anabolism and catabolism?

A

anabolism=catabolism

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83
Q

How is negative N balance expressed in terms of anabolism and catabolism?

A

anabolism

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84
Q

How is N balance calculated?

A

N balance (g/day) = (protein intake g/6.25) - (UUN + 4)

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85
Q

1 mmol of UUN equals to

A

0.028g of UUN

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86
Q

What are the limitations of N balance

A

time consuming
prone to errors
missed or incomplete urine collections
does not account for losses due to diarrhea, vomiting, wound leaks

– tend to overestimate

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87
Q

Why is creatinine excretion measured?

A

excretion is proportional to skeletal muscle

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88
Q

creatinine excretion increases with —-

A

exercise, meat intake, menstruation, infection, fever, trauma

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89
Q

creatinine excretion decreases with —-

A

renal failure and age

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90
Q

How is creatinine height index measured?

A

observed 24h creatinine (mg) excreted/expected 24h creatinine excretion

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91
Q

Hematological assessment is done with

A

complete blood count

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92
Q

complete blood count includes

A

erythrocytes (shape, size, color, number) to diagnose anemia

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93
Q

What is anemia?

A

reduction in the quantity of hemoglobin or in the number of RBC in the blood
leads to decreased oxygen carrying capacity

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94
Q

How are RBC classified in terms of their color?

A

hypochromic (pale color)
normochromic
hyperchromic (darker color)

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95
Q

How are RBC classified in terms of their shape?

A

microcytic (small cells)
normocytic
macrocytic (large cells)

96
Q

Anemia maybe due to deficiencies of

A 
iron
folate
vitamin B12
other nutrients (vitamin C, E)
chronic diseases
97
Q

What is the shape and the color of the RBC in case of iron deficiency anemia

A

microcytic and hypochromic

98
Q

What is the shape and the color of the RBC in case of folate deficiency anemia

A

macrocytic and megaloblastic

99
Q

What is the shape and the color of the RBC in case of vitamin B12 deficiency anemia

A

macrocytic and megaloblastic

100
Q

What are the general test that can be done to diagnose anemia and its type?

A 
hemoglobin
hematocrit
rbc count
mean corpuscular volume
mean corpuscular hemoglobin
mean corpuscular hemoglobin concentration
101
Q

What are the ideal level for hemoglobin

A

Higher than
Men: 14 g/dL
Women: 12 g/dL

102
Q

What are the ideal level for hematocrit

A

Men: 40%
Women: 37%

103
Q

In what conditions does hemoglobin decrease

A

during PEM, hemorrhage, and other anemias

104
Q

What is hematocrit

A

% of RBC in total blood volume

105
Q

hematocrit increases during ___

A

dehydration

106
Q

hematocrit decreases during ___

A

hemorrhage and water overload

107
Q

What is the order of depletion during iron deficiency?

A

decrease in:
storage iron - liver, bone marrow, spleen
transport iron - transferrin saturation
essential iron - rbc, hemoglobin, enzymes

108
Q

What are some specific test that can be done to for anemia diagnosis?

A 
serum ferritin
serum iron
TIBC (Transferrin and Iron-binding Capacity)
Transferrin saturation
Erythrocyte Protoporphyrin
109
Q

What are the lab tests that can be done to diagnose folate deficiency anemia?

A

serum folate

rbc folate

110
Q

The indicators of folate deficiency anemia are

A

low serum and rbc folate
megaloblastic and macrocytic rbc
normal B12 levels

111
Q

What are the lab tests that can be done to diagnose vitamin B12 deficiency anemia?

A

serum B12

Schilling test

112
Q

What does it mean when the serum b12 levels are low in case of normal intake

A

malabsorption

113
Q

What are the iron requirements for men, women, pregnant, and elderly

A

men 8mg/day
women 18mg/day
pregnant 27mg/day
elderly 8mg/day

114
Q

What are excellent sources of heme iron

A

clams
oysters
liver

115
Q

What are good sources of heme iron

A

beef cooked

turkey

116
Q

What are sources of heme iron

A 
chicken
ham
lamb
pork
veal
salmon
117
Q

What are excellent sources of non-heme iron

A

cooked legumes
seeds
fortified cereals
tofu

118
Q

What are good sources of non-heme iron

A

canned legumes
enriched egg noodles
dried apricot

119
Q

What are sources of non-heme iron

A 
nuts
sunflower seeds
cooked pasta
bread
cooked oatmeal
wheat germ
120
Q

What are the risk factors for poor iron status

A 
diet low in animal products
diet low in vitamin c
diet low in fortified foods
consumption of coffee and tea with meals 
consumption of phytates and oxalates with meals
excessive menstrual losses
3+ annual blood donations
pregnancy >3
121
Q

How is iron supplementation done and what are the important things that the patients should be informed about?

A

ferrous sulfate (200mg TID X 6 months)
3 x better absorption
liquid tablet form
expect a rise in Hb of 1g/L per week

– side effects such as darker poop

122
Q

To maximize iron absoprtion

A

take on an empty stomach with liquid (food decreases absorption 1/3)

123
Q

What is clinical assessment

A

includes pt’s medical, social, and psychological history

physical examination for clinical signs and symptoms of malnutrition

124
Q

sign vs. symptom

A

sign is something that you can visually see and symptom is subjective from patients eyes

125
Q

Patient history includes

A 
1st, 2nd diagnosis
past medical history
weight history
factors affecting nutrient intake 
social history (religion, socioeconomic, shopping, cooking, family)
126
Q

How is dietary assessment done?

A

24-hour recall
Food records
Food frequency questionnaire
Direct observation

127
Q

What is 24h recall and what are the advantages and disadvantages?

A 
ask about intake during the previous 24h (must be done >3 times)
AD: 
- quick and inexpensive
- element of surprise
- low patient burden
- literacy independent
DISAD:
- memory dep.
- overestimation/underestimation
- higher inter-interviewer variability
128
Q

What is food records and what are the advantages and disadvantages?

A 
recorded or weighted for given period of time 
asses actual or usual intake 
AD: 
- greater precision than 24h recall
- not memory dependent
- considered actual intake
DISAD:
- time consuming
- may not reflect "normal" eating patterns
- pt must be literate and motivated
129
Q

What is food frequency questionnaire and what are the advantages and disadvantages?

A 
survey of intake over specified time 
includes food lists, consumption frequency 
AD:
- quick, inexpensive
- can examine specific nutrients
- can be used in large studies
- considered usual intake 
DISAD: 
- qualitative info and less accurate
- memory dependent
- difficult since not meal based
- pt must be literate and motivated
130
Q

What is direct observation and what are the advantages and disadvantages?

A 
used in controlled setting
AD: 
- not memory dependent
- pt unaware of assessment 
DISAD:
- does not represent usual intake 
- high staff burden
- may be intrusive
- difficult to attain and interpret
131
Q

What are the components of Total Energy Expenditure?

A
  • Resting energy expenditure/Basal Metabolic rate
  • Physical Activity
  • Thermic effect of food
  • injury/stress
132
Q

What does indirect calorimetry measure?

A

measure the quantity of O2 consumed and CO2 produed by energy processes.
from this, heat production is calculated
this method is used to measure basal energy expenditure or resting energy expenditure

133
Q

Basal energy expenditure vs resting energy expenditure

A

BEE is the energy needed to carry out fundamental metabolic functions, such as breathing, ion transport, normal turnover of enzymes and other body components, etc.
REE is metabolism during a time period of strict and steady resting conditions that are defined by a combination of assumptions of physiological homeostasis and biological equilibrium.

REE differs from basal metabolic rate (BEE) because BEE measurements must meet total physiological equilibrium whereas REE conditions of measurement can be altered and defined by the contextual limitations.
Therefore, BEE is measured in the elusive “perfect” steady state, whereas REE measurement is more accessible and thus, represents most, if not all measurements or estimates of daily energy expenditure.

134
Q

What are the equations that can be used to calculate REE

A 
harris-benedict
fao/who
mifflin st jeor
owen
rule of thumb
135
Q

How is TEE calculated?

A

TEE = REE x Activity factor x Stress factor

136
Q

What are the limitations of Harris-Benedict

A

tends to overestimate REE by 5-15% except in males >65 where it underestimates REE
DO NOT USE WITH OBESE

137
Q

Which equation is most commonly used and most accurate in everyone?

A

Mifflin St Jeor

better predicts REE in non-obese and obese subjects

138
Q

What is the simple calculation of REE in non-obese?

A

25kcal/kg –> low activity or overweight
30kcal/kg –> moderate activity, non-obese
35kcal/kg –> for higher active or higher needs

139
Q

Which weight do we use in calculating the REE? “Ideal” or current?

A

If patients BMI = 16-29.9 use current weight

If BMI >30 use the ideal or healthy body weight

140
Q

What is the PA level for sedentary

A

1.3

141
Q

What is the PA level for moderate

A

1.5

142
Q

What is the PA level for active

A

1.8

143
Q

What are the protein requirements?

A

for healthy adults - 1.0g/kg/d

elderly - 1.0-1.2g/kg/d

144
Q

What are the fluid requirements?

A

1ml/kcal

145
Q

What are dehydration symptoms?

A 
thirst
dry mouth
headache
tachycardia
rapid weight loss
increased Na, albumin, BUN, creatinine, Hb, Hct
146
Q

What are overhydration symptoms?

A 
increased BP
decreased pulse rate
edema
decreased Na, K, Albumin, BUN, creatinine, Hb, Hct
rapid weight gain
147
Q

What is the requirement for calcium

A

1200mg

148
Q

What is functional assessment

A

muscle strength correlates with muscle mass
handgrip strength measured with a dynamometer
repeated 3x on dominant hand
>23kg women, >35kg men

149
Q

overweight vs adiposity

A 
overweight = excess body fat (fat, muscle, bone, water-includes all components)
obesity = excess adiposity
150
Q

Pear body shape is called

A

gynoid - related with women

151
Q

Apple body shape is called

A

android - related with men

152
Q

What is the ideal BMI and waist circumference of asian population

A

BMI >23 in women >27 in men

waist >90 in men >80 in women

153
Q

What are health consequences of obesity

A 
CVD
HTN
Diabetes
Cancer
Breathing problems
arthritis
gallbladder diseases
reproductive problems
surgical risks
emotional consequences 
healthcare cost
154
Q

Cardiometric risks include

A

CVD
HTN
Diabetes

155
Q

What kind of relationship does BMI and all-cause mortality have

A

J-shaped relationship meaning lower risk and low mortality when you have a BMI between 20-25
Lower end of the bmi is also at risk and as you go over, the risk increases.
- not a linear but exponential relationship

156
Q

What is Intra-abdominal fat and what is its significance in terms of mortality

A

it is visceral fat and it is more dangerous than subcut. fat

waist circumference = subcut. fat + visceral fat

157
Q

What are the type of cancers in women where the risk is increased by increased obesity

A

endometrium
ovary
cervix
breast (post-menopausal)

158
Q

What are the type of cancers in men where the risk is increased by increased obesity

A

prostate

159
Q

What are the type of cancers in both men and women where the risk is increased by increased obesity

A

colon, gallbladder, kidney, liver

160
Q

What is the other name of gallstones

A

cholelithiasis

161
Q

What are the hepatobiliary disorders that obesity causes

A

increases the risk of gallstones

increases the risk of non alcoholic fatty liver disease (NAFLD)

162
Q

How is the progression of liver failure in terms of NAFLD

A

steatosis –> steatohepatitis –> cirrhosis (irreversible) –> liver failure

163
Q

What are the repsroductive disorders that obesity causes

A

men:
- reduced testosterone, increased estrogen levels
- gymnecomastia (breast enlargement)
women:
- PCOS
- gestational diabetes
- preclampsia

164
Q

What is the etiology of obesity

A 
energy balance
appetite and body weight regulation
genes
environmental conditions
medical conditions and medications
other factors
165
Q

What is obesogenic environement?

A

environments that encourage people to eat unhealthily and not do enough exercise.

166
Q

Why is the Physical activity energy is higher in sedentary obese people than active individuals?

A

in obese, it is not just excess fat, but here is also more lean mass to support the body but doesn’t actually come from physical exercise

167
Q

Define hunger

A

physical sensation indicating need or intense desire for food

168
Q

define satiety

A

feeling of fullness after eating

169
Q

define satiation

A

state of being satisfactory full associated with length of time between meals

170
Q

define appetite

A

desire to eat

it is not the amount of food you eat, it is the desire to eat

171
Q

what are the types of control in appetite

A

homeostatic

hedonic

172
Q

what is hedonic control of appetite

A

influence of environmental factors, emotional, social

hedonic = pleasure

173
Q

Where is the location of the homeostatic regulation of food intake

A

central: cerebral cortex, arcuate nucleus, paraventricular nucleus, lateral nucleus, brainstem
peripheral: stomach, gut, fat, pancreas, vagus

174
Q

what are the two pathways of regulation of food intake

A

orexigenic - involves peptides

anorexigenic - less food intake

175
Q

what are the hormones that are secreted from hypothalamus

A 
Oxytocin - inhibits
CRH - inhibits
MCH - increases 
Orexin - increases
AgRP - increases 
seretonin - inhibits
histamine - inhibits
176
Q

what are the hormones that are secreted from stomach

A

ghrelin - increases appetite

177
Q

what are the hormones that are secreted from the gut

A

CCK - inhibits
Oxyntomodulin - inhibits
GLP-1
PPY

178
Q

what are the hormones that are secreted from fat tissue

A

leptin - decreases appetite

179
Q

what are the hormones that are secreted from pancreas

A

insulin
glucagon
PP

180
Q

Medical conditions and pharmacological agents that cause obesity

A

congenital causes (down syndrome, prader-willi)
neuroendocrine disorders (cushings, pcos, gh)
pharmacological agents (psychiatric meds)
steroid hormones
antidiabetic agents

181
Q

Dietary assessment for obesity includes

A 
weight history, previous diets
food intake (24h recall)
patterns of meals
ability to cook, budget, access to food
allergies, intolerance
use of vitamins and minerals 
medications
182
Q

Physical activity assessment for obesity includes

A 
interviews, questionnaires, log sheets
does not capture fidgeting
pedometers
accelometers
apps on phones
183
Q

Define physical activity

A

all leisure and non leisure body improvements resulting in a substantial increase in EE

184
Q

define exercise

A

a form of leisure time PA that is planned, structured and repetitive. its main objective is to improve or maintain physical fitness

185
Q

define physical fitness

A

a set of attributes that are either health or performance related. the ability to carry out doily tasks with vigor and alertness, without fatigue, and with ample energy to energy leisure time pursuits and to meet unforeseen

186
Q

define active living

A

when physical activities are an integral part of daily living

187
Q

What are METs

A

Metabolic Equivalent Tasks

energy cost of physical activities

188
Q

1 MET = ?

A

3.5 ml O2 uptake/kg BW/min

1kcal/kg BW/hour (sitting or lying quitely)

189
Q

What are behavioural aspects in treating obesity

A 
readiness to change
long-term commitment
family, friend or social support
right timing
identification of barriers 
stages of change theory
190
Q

What are the stages of change theory

A 
pre-contamplation
contemplation
preparation
action
maintenance/relapse
191
Q

What is the distribution of percentage of energy expenditure at rest

A

liver is the most active organ

brain also takes up huge amount of energy

192
Q

How many grams of water are lost when 1g of glycogen or protein tissue is being lost

A

4g of water

193
Q

Explain the fed signal

A

when the meal is ingested, there is going to be a rise in glucose level in blood
insulin response is the main driver of the metabolism adaptation
muscle and adipose tissue require insulin for glucose uptake they are said to be insulin sensitive
liver + CNS + RBC –> dont require insulin for glucose uptake

194
Q

What happens to FFA levels in response to a meal

A

FFA decrease even if the meal contains FFA bc in the fasting state FFA increase and once the meal is ingested, the insulin levels rise and the FFA concentration will go down

195
Q

What do fad diets claim about CHO and insulin

A

carbs have the most profound effect on insulin release, therefore are the most likely to favour energy storage and weight gain

196
Q

Why is insulin important?

A

besides blood glu regulation and fat storage, it also inhibits protein breakdown and promotes protein synthesis

197
Q

Give examples of high GI food

A

beer, glucose, cooked carrots, white rice

198
Q

give examples of low gi food

A 
wheat bread 
spaghetti (al dente)
raw carrots
dairy
beans
veggies
199
Q

What are the 3 goals of adapting to fasting

A
  1. meet energy needs
  2. meet glucose requirements
  3. spare protein (lean mass)
200
Q

What are the 3 facts of energy paradox

A
  1. the brain needs 500kcal of water soluble fuels (glu)
  2. almost all energy is stored as FA and not as glycogen
  3. FA cannot be converted to glucose
201
Q

What are the periods of glucose consumption

A

exogenous
glycogen stores
gluconeogenesis
ketogenesis

202
Q

What are the types of ketoacids

A

acetoacetate

b-hydroxybutyrate ***

203
Q

Why are ketoacids produced

A

produced as a result f overwhelming FA oxidation

used as fuel for brain; reduces needs for gluconeogenesis

204
Q

How are ketoacids excreted in the urine

A

they must be “salted out” which involves loss of either Na, K, H, or NH4
ideally NH4 is excreted bc it is a waste product but K is the preferred ion to be excreted

205
Q

What is the condition called when too much K is excreted with ketoacids

A

hypokalemia

206
Q

What is ketoacidosis

A

the concentration of B-OH needs to be higher than 10mM. It starts to become a problem at 6mM

207
Q

Renal consequences of starvation

A

need normal kidney function
ammonia is toxic so need for more water
acid/base balance changes in response to starvation needs to be controlled by kidney

208
Q

What is the recommended value of protein intake in case of weight reduction diets in order to have a positive N balance

A

1.5g/kg/d

209
Q

What is Forbes predictions

A

Prediction1:
during fast, obese individuals will lose less N (LBM) than thin ppl

Prediction2:
the fatter the subject the less the less the contribution of LBM to total weight loss on energy restricted diets

210
Q

What are the cardiovascular and renal changes to severe weight loss

A

decrease in CV output, heart rate and BP
increase in tachycardia
increase in stress on kidneys (acid-base balance)

211
Q

What are the immune function changes to severe weight loss

A

decrease in T-cell function/lymphocytes

decrease in cytokines

212
Q

What are the GI function changes to severe weight loss

A

decrease in lipid absorption
decrease in gastric and pancreatic bile secretion
decrease in villous surface area

213
Q

What is a ketogenic diet?

A 
very low CHO(6-12%), high FAT (60-70%)
less than 50g of CHO to induce ketosis 
diet should not include: 
grains
fruits
starchy vegetables
added sugars

weight loss is due to water loss

214
Q

Side effects of ketogenic diets

A 
hyperuricemia 
hypocalcemia
irritability
lethargy
appetite suppressant
carnitine deficiency
elevated serum lipids (when isocaloric)
constipation
water soluble vitamin def. 
renal stones
growth inhibition
215
Q

What is refeeding syndrome

A

shift back to glucose as the main fuel

216
Q

what happens in refeeding syndrome

A

rapid shift of electrolytes and intracellular anions and cations to intracellular space
sodium and water retension
rapid refluxes of insulin due to CHO load

217
Q

symptoms of refeeding syndrome

A 
fatigue
lethargy
dizziness 
muscle weakness
edema
arhythmia
hemolysis
218
Q

physiological changes during repletion (refeeding syndrome)

A

ECF expnasion (edema from increased Na intake)
Glycogen Synthesis (may lower PO4, K concentration)
Increased BEE (reversal of starvtion and LBM building)
Increased insulin secretion (fed signal, glu uptake)
stimulates N retention
stimulate cell synthesis, growth and rehydration

219
Q

What are the steps in refeeding

A
  • normalize fluid and electrolytes imbalances
    (PO4, K and Mg by supplementation and limit Na and water in the first few days)
  • provide a mixed diet at maintenance energy level
    (to establish intolerence and avoid refeeding syndrome. aim for 100-500g glucose to stop LMB breakdown but start with 25% of dose)
  • provide PRO at 1.5-2g/kg/d
    (start with 20g/day due to adaptation in urea cycle enzymes)
  • monitor serum electrolytes, weight, intake, output
220
Q

What are the 5As of obesity management

A

ASK - permission to discuss weight, explore readiness
ASSESS - risks and root causes
ADVISE - health risks and treatment options
AGREE - health outcomes and behavioural goals
ASSIST - access to resources and providers

221
Q

What are 5As guiding pronciples

A

obesity a chronic condition
improving health and well-being, not just reducing weight
early intervention
success is different for everyone
a patients best weight may never be an ideal weight

222
Q

What are therapeutic objectives in treating obesity

A 
individually tailored
changes in eating behaviour
weight loss/weight stabilization
prevention of weight regain
reduction in risk factors
eligibility for surgey
psychosocial adjustment
223
Q

Cardiovascular benefits of weight loss

A 
normalizes TG levels
raises HDL 
lowers LDL
improves CHD risk profile
reduces need for antihyperlipidemic medication
224
Q

Diabetic benefits of weight loss

A

increased glucose tolerance
increased insulin sensitivity
decreased for glucose lowering medications

225
Q

Benefits of weight loss in HTN

A

decrease in:

  • systolic BP
  • blood volume
  • cardiac output
  • sympathetic activity
  • need for hypertension medication
226
Q

What is the plateau phase?

A

hypocaloric diet becomes isocaloric as the body adjusts

227
Q

What are the priorities in a weight loss diet?

A

create energy deficit
avoid nutritional deficiencies
preserve lean mass
promote long-term adherence (avoid hunger 3h)

228
Q

What are endurance activities

A

large muscle group physical activities of a continuous nature

229
Q

What does the international physical activity guidelines recommend?

A

approx. 1000kcal/week or 400-500kcal/day

230
Q

Recommendations for fitness are

A

FITT
F frequency –> 3-5 times
I intensity
T time –> 20-60 minutes >10000 steps everyday
T type –> aerobic, resistance, flexibility

231
Q

physical activity need to prevent weight gain

A

150-250 min/week

1200-2000 kcal/week

232
Q

physical activity need for weight loss

A

<150 min/wk for minimal wl

>250-400 min/wk results in 5-7kg wl

233
Q

physical activity need for maintenance after weight loss

A

200-300 min/wk

234
Q

What are the two main types of pharmacological treatment therapy adjunct to diet exercise and behavior

A

lipase inhibitors

appetite suppressant

235
Q

Give an example of lipase inhibitor and its mechanism

A

ORALISTAT
malabsorption of fat
50% efficacy
side effects include fatty stools, incontinence, fecal urgencies, losses in Vit ADEK

236
Q

Give an example of appetite suppressant and its mechanism

A

SIBUTRAMINE
prescribed short term - may cause addiction
- seratonin agonists
- amphetamine derivatives
side effects include nausea, dizziness, headaches, difficulty sleeping, constipation

237
Q

How to change eating habits

A

enhance self-awareness
minimize exposure to food
interrupt behaviour chains (cookie story)

6-Clinical Nutrition 1 (21 decks)

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