Mid Term 1 Flashcards
1
Q
What is screening?
A
process of identifying characteristics known to be associated with nutritional problems
2
Q
What is the purpose of screening?
A
quickly identify individuals with nutrition risks
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
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
5
Q
What are the goals of nutritional assessment?
A
identify monitor evaluate disease prevention specific deficiencies overall malnutrition
6
Q
What is morbidity?
A
the condition of being diseased
7
Q
malnutrition is associated with increased
A
morbidity
mortality
hospital length of stay
healthcare costs
8
Q
Initial nutritional screening includes
A
pre-existing conditions causing nutrient loss
conditions that increase nutrient requirements
dietary intake
9
Q
What are the components of assessment?
A
Anthropometrics Biochemical Clinical Dietary Functional
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
11
Q
What is anthropometrics composed of
A
body size
weight
proportions
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
13
Q
Anthropometrics allow to assess body size and estimate composition using
A
height weight circumferences skinfolds ratios
14
Q
What is the tool used to measure height standing?
A
stadiometer
15
Q
What is frankfort plane?
A
line from eye to middle ear
16
Q
What is the tool used to measure knee height?
A
caliper
17
Q
What are the different ways of measuring height?
A
standing
knee height
arm span
18
Q
why is arm span not recommended
A
not for asians, african americans. spinal deformities
19
Q
How is frame size measured?
A
wrist circumference
r = height (cm)/wrist circumference (cm)
not used anymore, it was valid before BMI
20
Q
What is weight?
A
sum of all components at each level of body composition - measure of body stores
21
Q
How is weight measured?
A
scale
bed scale
chair scale
22
Q
When should the weight be measured?
A
in the morning, fasting state, no clothes or shoes
23
Q
How is BMI calculated?
A
weight (g)/ height ˆ2 (m)
24
Q
What is the range of the normal BMI
A
18.9-24.9
25
What is the BMI of someone who is overweight
25-29.9
26
What BMI is considered obese?
more than 30
27
What is the healthy BMI for elderly
24-29
28
What are the limitations of BMI measurements?
does not measure body composition
differences in sex, age, ethnicity
limitations in athletes
must be accompanied with other measurements
29
How is % usual body weight calculated?
current weight/usual body weight x 100
30
What does it indicate if the %UBW is 85-95%
may indicate MILD malnutrition
31
What does it indicate if the %UBW is 74-84%
may indicate MODERATE malnutrition
32
What does it indicate if the %UBW is <74%
may indicate SEVERE malnutrition
33
How to calculate % weight change?
(UBW-current weight)/UBW x 100
34
What is considered a significant loss in % weight change?
```
%2 - 1 week
%5 - 1 month
%7.5 - 3 months
%10 - 6 months
%20 - unlimited
```
35
Unwanted weight loss can predict:
mortality
surgical outcomes/post op complications
risk of functional assessment
36
What are the measurements that can be done for body circumference and areas?
```
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
```
37
What is the tool used to measure skinfold thickness?
caliper
38
skinfold thicknessis an indicative of _____
subcutaneous adipose tissue
39
Which body areas can we measure the skinfold thickness
triceps
subscapular
biceps
suprailiac
40
What is the princple behind skinfold thickness
assumes that each site is representative of total body stores
41
What does MAC indicate?
reflects muscle, bone, subcutaneous fat
| -- not sensitive to changes in muscle
42
What does MAMC indicate?
corrects for subcutaneous fat
| -- not sensitive to changes in muscle
43
What does MAMA indicate?
reflects muscle and bone
more sensitive to changes in muscle than MAMC
more adequately reflects total body muscle mass
44
What does cMAMA indicate?
reflects only muscle without bone
not valid in elderly or obese
-- not sensitive to changes in muscle
45
What does MAFA indicate?
reflects the adipose tissue stores
| better indicator of total body fat than a single skinfold measurement
46
What does waist circumference indicate?
reflective of visceral fat stores and abdominal obesity
47
How is waist circumference measured?
at level of iliac crest/navel
48
What are the ideal numbers of waist circumference in men and women?
<102cm in men
| <88cm in women
49
What does waist:hip ratio indicate?
estimates distribution of subcutaneous and intraabdominal adipose and muscle tissue
-- not used anymore
50
What are other technological techniques to measure body compositions?
```
BIA
DXA
BOD POD
Underwater weighing
MRI
```
51
What is the gold standard in measuring body composition?
MRI
52
How does Bioelectrical Impedance work?
measures impedance to a low frequency electrical current (mainly from fat)
estimates fat mass, fat free mass, total body water
53
What are the limitations of BIA?
influenced by hydration status
less precise in atypical bodies (obese)
reference data is limited
54
How does Dual X-ray Absorptiometry work?
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
55
What are the limitations of DXA?
expensive
radiation
assumes normal hydration status
56
How does Air displacement (BOD POD) work?
total body volume measured by air displacement in a chamber
| based on fat and lean tissue density
57
What are the limitations of BOD POD?
access to instruments
| residual lung volume must be measured
58
What is biochemical assessment?
measurement of nutritional markers in blood, urine, etc.
| detects subclinical nutrient deficiencies
59
What are the components that can be assessed by biochemical assessment?
```
visceral and somatic proteins
hematological assessment
lipid profile
micronutrient assessment
immunocompetence assessment
```
60
Biochemical assessment can be affected by:
nutritional status
medications
illness
physiological state
61
What is the ideal level of albumin
40-60g/L or 4.0-6.0g/dL
62
What is the ideal level of glucose
3.9-6.1 mmol/L
63
What is the ideal level of iron
11-32 umol/L
64
Visceral protein status is assessed by the measurement of
serum proteins
RBC
WBC
65
What is the composition of serum proteins
albumin
fibronectin
transferrin
66
Transferrin is composed of:
prealbumin
| retinol binding protein
67
In what condition does biochemical assessment has low sensitivity and specificity for nutritional status?
```
poor protein intake
altered metabolism and synthesis
hydration
inflammation
pregnancy
madications
exercise
```
68
What is the half life of albumin
17-21 days
69
What is the function of albumin
maintain osmotic pressure
| transport of large insoluble molecules, drugs, calcium, zinc
70
What is the function of transferrin
iron transport
71
What is the function of TTR
transports T3-T4
| carrier for RBP
72
What is the function of RBP
retinol transport from liver to periphery
| circulates with TTR
73
In what condition is albumin high and low?
high during dehydration
low during low protein intake, poor synthesis, overhydration, edema, acute illness, aging
74
In what condition is Transferrin high and low?
high during Fe deficiency, pregnancy, chronic loss
low during acute illness, chronic infection, PEM, systemic disease
75
In what condition is TTR high and low?
high during renal disease, Hodgkins disease
low during liver disease, PEM, chronic loss, malabsorption, hyperthyroidism
76
In what condition is RBP high and low?
high during renal disease
low during vitamin A def., zinc def, hyperthyroidism, liver disease
77
What are acute phase proteins?
are a class of proteins whose plasma concentrations increase (positive acute-phase proteins) or decrease (negative acute-phase proteins) in response to inflammation.
78
Give examples of + acute phase proteins
C-reactive protein (CRP)
| Ferritin
79
Give examples of - acute phase proteins
albumin, transferrin, TTR, and RBP
80
How is somatic protein status assessed?
nitrogen balance
creatinine excretion
immune function
81
How is positive N balance expressed in terms of anabolism and catabolism?
anabolism>catabolism
82
How is 0 N balance expressed in terms of anabolism and catabolism?
anabolism=catabolism
83
How is negative N balance expressed in terms of anabolism and catabolism?
anabolism
84
How is N balance calculated?
N balance (g/day) = (protein intake g/6.25) - (UUN + 4)
85
1 mmol of UUN equals to
0.028g of UUN
86
What are the limitations of N balance
time consuming
prone to errors
missed or incomplete urine collections
does not account for losses due to diarrhea, vomiting, wound leaks
-- tend to overestimate
87
Why is creatinine excretion measured?
excretion is proportional to skeletal muscle
88
creatinine excretion increases with ----
exercise, meat intake, menstruation, infection, fever, trauma
89
creatinine excretion decreases with ----
renal failure and age
90
How is creatinine height index measured?
observed 24h creatinine (mg) excreted/expected 24h creatinine excretion
91
Hematological assessment is done with
complete blood count
92
complete blood count includes
erythrocytes (shape, size, color, number) to diagnose anemia
93
What is anemia?
reduction in the quantity of hemoglobin or in the number of RBC in the blood
leads to decreased oxygen carrying capacity
94
How are RBC classified in terms of their color?
hypochromic (pale color)
normochromic
hyperchromic (darker color)
95
How are RBC classified in terms of their shape?
microcytic (small cells)
normocytic
macrocytic (large cells)
96
Anemia maybe due to deficiencies of
```
iron
folate
vitamin B12
other nutrients (vitamin C, E)
chronic diseases
```
97
What is the shape and the color of the RBC in case of iron deficiency anemia
microcytic and hypochromic
98
What is the shape and the color of the RBC in case of folate deficiency anemia
macrocytic and megaloblastic
99
What is the shape and the color of the RBC in case of vitamin B12 deficiency anemia
macrocytic and megaloblastic
100
What are the general test that can be done to diagnose anemia and its type?
```
hemoglobin
hematocrit
rbc count
mean corpuscular volume
mean corpuscular hemoglobin
mean corpuscular hemoglobin concentration
```
101
What are the ideal level for hemoglobin
Higher than
Men: 14 g/dL
Women: 12 g/dL
102
What are the ideal level for hematocrit
Men: 40%
Women: 37%
103
In what conditions does hemoglobin decrease
during PEM, hemorrhage, and other anemias
104
What is hematocrit
% of RBC in total blood volume
105
hematocrit increases during ___
dehydration
106
hematocrit decreases during ___
hemorrhage and water overload
107
What is the order of depletion during iron deficiency?
decrease in:
storage iron - liver, bone marrow, spleen
transport iron - transferrin saturation
essential iron - rbc, hemoglobin, enzymes
108
What are some specific test that can be done to for anemia diagnosis?
```
serum ferritin
serum iron
TIBC (Transferrin and Iron-binding Capacity)
Transferrin saturation
Erythrocyte Protoporphyrin
```
109
What are the lab tests that can be done to diagnose folate deficiency anemia?
serum folate
| rbc folate
110
The indicators of folate deficiency anemia are
low serum and rbc folate
megaloblastic and macrocytic rbc
normal B12 levels
111
What are the lab tests that can be done to diagnose vitamin B12 deficiency anemia?
serum B12
| Schilling test
112
What does it mean when the serum b12 levels are low in case of normal intake
malabsorption
113
What are the iron requirements for men, women, pregnant, and elderly
men 8mg/day
women 18mg/day
pregnant 27mg/day
elderly 8mg/day
114
What are excellent sources of heme iron
clams
oysters
liver
115
What are good sources of heme iron
beef cooked
| turkey
116
What are sources of heme iron
```
chicken
ham
lamb
pork
veal
salmon
```
117
What are excellent sources of non-heme iron
cooked legumes
seeds
fortified cereals
tofu
118
What are good sources of non-heme iron
canned legumes
enriched egg noodles
dried apricot
119
What are sources of non-heme iron
```
nuts
sunflower seeds
cooked pasta
bread
cooked oatmeal
wheat germ
```
120
What are the risk factors for poor iron status
```
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
How is iron supplementation done and what are the important things that the patients should be informed about?
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
To maximize iron absoprtion
take on an empty stomach with liquid (food decreases absorption 1/3)
123
What is clinical assessment
includes pt's medical, social, and psychological history
| physical examination for clinical signs and symptoms of malnutrition
124
sign vs. symptom
sign is something that you can visually see and symptom is subjective from patients eyes
125
Patient history includes
```
1st, 2nd diagnosis
past medical history
weight history
factors affecting nutrient intake
social history (religion, socioeconomic, shopping, cooking, family)
```
126
How is dietary assessment done?
24-hour recall
Food records
Food frequency questionnaire
Direct observation
127
What is 24h recall and what are the advantages and disadvantages?
```
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
What is food records and what are the advantages and disadvantages?
```
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
What is food frequency questionnaire and what are the advantages and disadvantages?
```
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
What is direct observation and what are the advantages and disadvantages?
```
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
What are the components of Total Energy Expenditure?
- Resting energy expenditure/Basal Metabolic rate
- Physical Activity
- Thermic effect of food
- injury/stress
132
What does indirect calorimetry measure?
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
Basal energy expenditure vs resting energy expenditure
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
What are the equations that can be used to calculate REE
```
harris-benedict
fao/who
mifflin st jeor
owen
rule of thumb
```
135
How is TEE calculated?
TEE = REE x Activity factor x Stress factor
136
What are the limitations of Harris-Benedict
tends to overestimate REE by 5-15% except in males >65 where it underestimates REE
DO NOT USE WITH OBESE
137
Which equation is most commonly used and most accurate in everyone?
Mifflin St Jeor
better predicts REE in non-obese and obese subjects
138
What is the simple calculation of REE in non-obese?
25kcal/kg --> low activity or overweight
30kcal/kg --> moderate activity, non-obese
35kcal/kg --> for higher active or higher needs
139
Which weight do we use in calculating the REE? "Ideal" or current?
If patients BMI = 16-29.9 use current weight
| If BMI >30 use the ideal or healthy body weight
140
What is the PA level for sedentary
1.3
141
What is the PA level for moderate
1.5
142
What is the PA level for active
1.8
143
What are the protein requirements?
for healthy adults - 1.0g/kg/d
| elderly - 1.0-1.2g/kg/d
144
What are the fluid requirements?
1ml/kcal
145
What are dehydration symptoms?
```
thirst
dry mouth
headache
tachycardia
rapid weight loss
increased Na, albumin, BUN, creatinine, Hb, Hct
```
146
What are overhydration symptoms?
```
increased BP
decreased pulse rate
edema
decreased Na, K, Albumin, BUN, creatinine, Hb, Hct
rapid weight gain
```
147
What is the requirement for calcium
1200mg
148
What is functional assessment
muscle strength correlates with muscle mass
handgrip strength measured with a dynamometer
repeated 3x on dominant hand
>23kg women, >35kg men
149
overweight vs adiposity
```
overweight = excess body fat (fat, muscle, bone, water-includes all components)
obesity = excess adiposity
```
150
Pear body shape is called
gynoid - related with women
151
Apple body shape is called
android - related with men
152
What is the ideal BMI and waist circumference of asian population
BMI >23 in women >27 in men
| waist >90 in men >80 in women
153
What are health consequences of obesity
```
CVD
HTN
Diabetes
Cancer
Breathing problems
arthritis
gallbladder diseases
reproductive problems
surgical risks
emotional consequences
healthcare cost
```
154
Cardiometric risks include
CVD
HTN
Diabetes
155
What kind of relationship does BMI and all-cause mortality have
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
What is Intra-abdominal fat and what is its significance in terms of mortality
it is visceral fat and it is more dangerous than subcut. fat
| waist circumference = subcut. fat + visceral fat
157
What are the type of cancers in women where the risk is increased by increased obesity
endometrium
ovary
cervix
breast (post-menopausal)
158
What are the type of cancers in men where the risk is increased by increased obesity
prostate
159
What are the type of cancers in both men and women where the risk is increased by increased obesity
colon, gallbladder, kidney, liver
160
What is the other name of gallstones
cholelithiasis
161
What are the hepatobiliary disorders that obesity causes
increases the risk of gallstones
| increases the risk of non alcoholic fatty liver disease (NAFLD)
162
How is the progression of liver failure in terms of NAFLD
steatosis --> steatohepatitis --> cirrhosis (irreversible) --> liver failure
163
What are the repsroductive disorders that obesity causes
men:
- reduced testosterone, increased estrogen levels
- gymnecomastia (breast enlargement)
women:
- PCOS
- gestational diabetes
- preclampsia
164
What is the etiology of obesity
```
energy balance
appetite and body weight regulation
genes
environmental conditions
medical conditions and medications
other factors
```
165
What is obesogenic environement?
environments that encourage people to eat unhealthily and not do enough exercise.
166
Why is the Physical activity energy is higher in sedentary obese people than active individuals?
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
Define hunger
physical sensation indicating need or intense desire for food
168
define satiety
feeling of fullness after eating
169
define satiation
state of being satisfactory full associated with length of time between meals
170
define appetite
desire to eat
| it is not the amount of food you eat, it is the desire to eat
171
what are the types of control in appetite
homeostatic
| hedonic
172
what is hedonic control of appetite
influence of environmental factors, emotional, social
| hedonic = pleasure
173
Where is the location of the homeostatic regulation of food intake
central: cerebral cortex, arcuate nucleus, paraventricular nucleus, lateral nucleus, brainstem
peripheral: stomach, gut, fat, pancreas, vagus
174
what are the two pathways of regulation of food intake
orexigenic - involves peptides
| anorexigenic - less food intake
175
what are the hormones that are secreted from hypothalamus
```
Oxytocin - inhibits
CRH - inhibits
MCH - increases
Orexin - increases
AgRP - increases
seretonin - inhibits
histamine - inhibits
```
176
what are the hormones that are secreted from stomach
ghrelin - increases appetite
177
what are the hormones that are secreted from the gut
CCK - inhibits
Oxyntomodulin - inhibits
GLP-1
PPY
178
what are the hormones that are secreted from fat tissue
leptin - decreases appetite
179
what are the hormones that are secreted from pancreas
insulin
glucagon
PP
180
Medical conditions and pharmacological agents that cause obesity
congenital causes (down syndrome, prader-willi)
neuroendocrine disorders (cushings, pcos, gh)
pharmacological agents (psychiatric meds)
steroid hormones
antidiabetic agents
181
Dietary assessment for obesity includes
```
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
Physical activity assessment for obesity includes
```
interviews, questionnaires, log sheets
does not capture fidgeting
pedometers
accelometers
apps on phones
```
183
Define physical activity
all leisure and non leisure body improvements resulting in a substantial increase in EE
184
define exercise
a form of leisure time PA that is planned, structured and repetitive. its main objective is to improve or maintain physical fitness
185
define physical fitness
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
define active living
when physical activities are an integral part of daily living
187
What are METs
Metabolic Equivalent Tasks
| energy cost of physical activities
188
1 MET = ?
3.5 ml O2 uptake/kg BW/min
| 1kcal/kg BW/hour (sitting or lying quitely)
189
What are behavioural aspects in treating obesity
```
readiness to change
long-term commitment
family, friend or social support
right timing
identification of barriers
stages of change theory
```
190
What are the stages of change theory
```
pre-contamplation
contemplation
preparation
action
maintenance/relapse
```
191
What is the distribution of percentage of energy expenditure at rest
liver is the most active organ
| brain also takes up huge amount of energy
192
How many grams of water are lost when 1g of glycogen or protein tissue is being lost
4g of water
193
Explain the fed signal
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
What happens to FFA levels in response to a meal
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
What do fad diets claim about CHO and insulin
carbs have the most profound effect on insulin release, therefore are the most likely to favour energy storage and weight gain
196
Why is insulin important?
besides blood glu regulation and fat storage, it also inhibits protein breakdown and promotes protein synthesis
197
Give examples of high GI food
beer, glucose, cooked carrots, white rice
198
give examples of low gi food
```
wheat bread
spaghetti (al dente)
raw carrots
dairy
beans
veggies
```
199
What are the 3 goals of adapting to fasting
1. meet energy needs
2. meet glucose requirements
3. spare protein (lean mass)
200
What are the 3 facts of energy paradox
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
What are the periods of glucose consumption
exogenous
glycogen stores
gluconeogenesis
ketogenesis
202
What are the types of ketoacids
acetoacetate
| b-hydroxybutyrate ***
203
Why are ketoacids produced
produced as a result f overwhelming FA oxidation
| used as fuel for brain; reduces needs for gluconeogenesis
204
How are ketoacids excreted in the urine
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
What is the condition called when too much K is excreted with ketoacids
hypokalemia
206
What is ketoacidosis
the concentration of B-OH needs to be higher than 10mM. It starts to become a problem at 6mM
207
Renal consequences of starvation
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
What is the recommended value of protein intake in case of weight reduction diets in order to have a positive N balance
1.5g/kg/d
209
What is Forbes predictions
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
What are the cardiovascular and renal changes to severe weight loss
decrease in CV output, heart rate and BP
increase in tachycardia
increase in stress on kidneys (acid-base balance)
211
What are the immune function changes to severe weight loss
decrease in T-cell function/lymphocytes
| decrease in cytokines
212
What are the GI function changes to severe weight loss
decrease in lipid absorption
decrease in gastric and pancreatic bile secretion
decrease in villous surface area
213
What is a ketogenic diet?
```
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
Side effects of ketogenic diets
```
hyperuricemia
hypocalcemia
irritability
lethargy
appetite suppressant
carnitine deficiency
elevated serum lipids (when isocaloric)
constipation
water soluble vitamin def.
renal stones
growth inhibition
```
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What is refeeding syndrome
shift back to glucose as the main fuel
216
what happens in refeeding syndrome
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
symptoms of refeeding syndrome
```
fatigue
lethargy
dizziness
muscle weakness
edema
arhythmia
hemolysis
```
218
physiological changes during repletion (refeeding syndrome)
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
What are the steps in refeeding
- 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
What are the 5As of obesity management
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
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What are 5As guiding pronciples
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
What are therapeutic objectives in treating obesity
```
individually tailored
changes in eating behaviour
weight loss/weight stabilization
prevention of weight regain
reduction in risk factors
eligibility for surgey
psychosocial adjustment
```
223
Cardiovascular benefits of weight loss
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normalizes TG levels
raises HDL
lowers LDL
improves CHD risk profile
reduces need for antihyperlipidemic medication
```
224
Diabetic benefits of weight loss
increased glucose tolerance
increased insulin sensitivity
decreased for glucose lowering medications
225
Benefits of weight loss in HTN
decrease in:
- systolic BP
- blood volume
- cardiac output
- sympathetic activity
- need for hypertension medication
226
What is the plateau phase?
hypocaloric diet becomes isocaloric as the body adjusts
227
What are the priorities in a weight loss diet?
create energy deficit
avoid nutritional deficiencies
preserve lean mass
promote long-term adherence (avoid hunger 3h)
228
What are endurance activities
large muscle group physical activities of a continuous nature
229
What does the international physical activity guidelines recommend?
approx. 1000kcal/week or 400-500kcal/day
230
Recommendations for fitness are
FITT
F frequency --> 3-5 times
I intensity
T time --> 20-60 minutes >10000 steps everyday
T type --> aerobic, resistance, flexibility
231
physical activity need to prevent weight gain
150-250 min/week
| 1200-2000 kcal/week
232
physical activity need for weight loss
<150 min/wk for minimal wl
| >250-400 min/wk results in 5-7kg wl
233
physical activity need for maintenance after weight loss
200-300 min/wk
234
What are the two main types of pharmacological treatment therapy adjunct to diet exercise and behavior
lipase inhibitors
| appetite suppressant
235
Give an example of lipase inhibitor and its mechanism
ORALISTAT
malabsorption of fat
50% efficacy
side effects include fatty stools, incontinence, fecal urgencies, losses in Vit ADEK
236
Give an example of appetite suppressant and its mechanism
SIBUTRAMINE
prescribed short term - may cause addiction
- seratonin agonists
- amphetamine derivatives
side effects include nausea, dizziness, headaches, difficulty sleeping, constipation
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How to change eating habits
enhance self-awareness
minimize exposure to food
interrupt behaviour chains (cookie story)
