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FNN 301 > Midterm > Flashcards

Midterm Flashcards

1
Q

What are the 3 components of evidence based practice?

A
  1. best research evidence
  2. clinical expertise
  3. patient values and preferences
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2
Q

Which terms are protected by law?

A

registered dietitian
professional dietitian
dietitian

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3
Q

What are the 3 types of malnutrition?

A
  1. starvation related malnutrition (no inflammation)
  2. chronic-disease related malnutrition (mild to moderate malnutrition, yes inflammation)
  3. acute disease or injury-related malnutrition (yes inflammation)
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4
Q

what type of malnutrition does not have inflammation?

A

starvation related malnutrition

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5
Q

what is the canadian nutrition screening tool used for?

A

to identify those at risk of malnutrition

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6
Q

what are the benefits of the canadian nutrition screening tool to assess malnutrition?

A
  1. short
  2. easy to use
  3. valid
  4. reliable (especially in acute and primary care settings)
  5. can ask family and friends questions
  6. doesnt need to be completed by a nutrition professional
  7. easy to include in nurse admission assessment
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7
Q

what are the 3 classifications in the subjective global assessment form?

A
  1. well nourished
  2. mildly/moderately malnourished
  3. severely malnourished
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8
Q

according to the subjective global assessment, what are the 5 features of patient history?

A
  1. weight change
  2. dietary intake change
  3. gi symptoms
  4. functional capacity
  5. disease and its relation to nutrition requirements
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9
Q

according to the subjective global assessment, what are the 5 features of physical exam?

A
  1. loss of subcutaneous fat in triceps
  2. muscle wasting in quads and deltoids
  3. ankle edema
  4. sacral edema
  5. ascites
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10
Q

what are the 5 steps of the malnutrition universal screening tool?

A
  1. BMI score
  2. weight loss score
  3. acute disease effect score
  4. risk of malnutrition
  5. management guidelines
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11
Q

this questionnaire has 17 questions. it asks parents about eating and other habits that influence their childs nutritional status.

it is given when you go for. well baby check

A

Nutristep questionnaire

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12
Q

this questionnaure is 100% sensitive for anorexia and bulimia when there are 2 or more yes answers to 5 questions

A

SCOFF questionnaire

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13
Q

what ages do you use a lenbth boar dor to measure length?

A

0-2

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14
Q

what is considered overweight bmi

A

85th - 95th percentile of bmi for age

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15
Q

what is considered obese for bmi

A

greater than 95th percentile of bmi for age

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16
Q

what is considered underweight for bmi

A

less than 5th percentile

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17
Q

what measures does WHO growth charts look at from 0-2?

A

length for age
weight for age

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18
Q

what measures does WHO growth charts look at from 2-19?

A

BMI
weight for age

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19
Q

true or false: cutt of points for anhtropometric measurements are intended to give guidance for further assessment, referral, or intervention.

they should be used as diagnostic criteria

A

false - cut off points should not be used for diagnostic criteria

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20
Q

what is the recommended nutritional indicator for screening children 2 years and older to identify people who are wasted, overweight, or obese?

A

BMI for age

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21
Q

what is the underweight cut off for weight for age

A

< 3rd percentile

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22
Q

what is the severely underweight cut off for weight for age

A

< 0.1st

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23
Q

what is the overweight cut off for weight for length?

A

> 97th percentile

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24
Q

what is the stunted cut off for length for age

A

< 3rd percentile

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25
Q

what is the severely stunted cut off for length for age

A

< 0.1st perecntile

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26
Q

what is the risk of overweight cut off for weight for length?

A

<0.1st percentile

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27
Q

what is the obese cut off for weight for length?

A

> 99.9th percentile

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28
Q

what is the most important predictor of protein-calorie malnutrition?

A

assessing weight change / unintentional weight loss is the best way to screen for malnutrition

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29
Q

how do you calculate % usual body weight?

A

current body weight / usual body weight x 100

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30
Q

how do you calculate % weight change?

A

(usual body weight - current body weight) / usual body weight

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31
Q

what % of UBW puts you at risk of mild malnutrition

A

85-95

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32
Q

what % of UBW puts you at risk of moderate malnutrition

A

75-84

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33
Q

what % of UBW puts you at risk of severe malnutrition

A

<74

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34
Q

what is considered significant unintentional weight loss at 1 week?

A

> 2% of weight loss

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35
Q

what is considered significant unintentional weight loss at 1 month?

A

> 5%

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36
Q

what is considered significant unintentional weight loss at 3 months?

A

<7.5%

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37
Q

what is considered significant unintentional weight loss at 6 months?

A

> 10%

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38
Q

how do you calculate BMI?

A

weight kg / height in metres squared

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39
Q

How do you measure waist circumference?

A

On torso
Between lowest rib and pelvic bone or over umbilical

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40
Q

body composition refers to:

A

fat mass and fat free amss

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41
Q

what are the 2 most common tools used to assess body composition in nutritional assessments?

A

skinfold test
bioelectrical impedance (BIA)

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42
Q

_____ estimates energy reserves in subcutaneous tissue

A

skinfold measurement

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43
Q

what are advantages and disadvantages of using skinfold mesurement as a nutrition care indicator?

A

advantages: not invasive, minimal equipment

disadvamtages: needs repetition and experience

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44
Q

Which indicators do we look at for hematological assessment?

A
  1. hemoglobin
  2. hematocrit (ratio of rbcs to total blood volume)
  3. mean corpuscle volume (average size of RBCS)
  4. mean corpuscual hemoglobin - average quantity of hemoglobin in RBC
  5. mean corpuscular hemoglobin concentration
  6. ferritin , transferin saturaiton, iron
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45
Q

low mean corpuscular hemoglobin is a sign of:

A

iron deficiency anemia

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46
Q

high mean corpuscular hemoglobin is a sign of:

A

B12 folate deficiency

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47
Q

dark circles under the eyes, with some hollowing, indicates

A

mild-moderate nutrition

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48
Q

What are the 3 different components of energy expenditure per day, along with their %?

A

Thermic effect of food: 10%
physical activity: 23%
REE: 67%

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49
Q

what is daily resting energy expenditure?

A

67%

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50
Q

what is daily activity expenditure?

A

23%

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51
Q

what is daily expenditure from thermic effect of food

A

10%

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52
Q

Physical activity energy expenditure, which is about 23% of daily expenditure, is influenced by 5 things:

A
  1. body weight
  2. # of muscle groups used in the activity
  3. intensity of activity
  4. duration of activity
  5. frequency of activity
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53
Q

when does the thermic efffect of food peak?

A

60-120 minutes after a meal

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54
Q

What are the PA coefficients?

A

1.0
1.12
1.27
1.48

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55
Q

how long can the thermic effect of food last after a meal?

A

4-6 hours

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56
Q

when there is a decreased intake and loss of body fat leads to increased appetitite and decreased energy expenditure. this is cualled

A

orexigenic stimuli

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57
Q

Ghrelin is an example of ____ stimuli

A

orexigenix stimuli

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58
Q

when there is increased intake and increased body fat, it leads to decreased appetite and increased energy expenditure (known as adaptive thermogenesis). this is called

A

anorexigenic stimuli

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59
Q

What are examples of anorexigenic stimuli?

A

leptin
insulin

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60
Q

when one is hungry and appetite is stimulated, the body produces:

A

ghrelin

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61
Q

when one is full and brain receives signal to reduce appetite and release:

A

CCK, glu-like peptide 1, peptide YY

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62
Q

when blood sugar levels rise following a meal, it leads to the release of

A

insulin
amylin

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63
Q

which neurochemicals are important for short term regulation of appetite and food?

A

ghrelin - influence food intake at meals
GLP1 - influence food intake at meals
Insulin
gut peptides

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64
Q

which neurochemicals are important for long term regulation of % body fat

A

leptin

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65
Q

which hormone suppresses hunger?

A

GLP1

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66
Q

which hormone stimulates hunger?

A

ghrelin

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67
Q

after eating, ghrelin levels dont decrease as much in obese people as they do in thin people.

GLP-1, which suppresses hunger, is lower in obese people than thin peopel

A
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68
Q

what is the difference between satiety and satiation

A

satiety develops after a meal, whereas satiation occurs during a meal

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69
Q

we are all born with a stable # of adipocytes. they dont increase in #, they increase in size.

A
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70
Q

which organ regulates weight?

A

the hypothalamus

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71
Q

the hypothalamus’s regulation of weight is affected by:

A

genetics (75% of our weight is determined by genetics)
microbiome
gut hormones
adipose tissue hormones
environment
medications
chronic stress

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72
Q

how many genes are strongly associated with weight gain?

A

50

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73
Q

Genes account for ___ % variability in weight gain

A

40-70%

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74
Q

what is POMC deficiency?

A

it is characterized by early onset obesity, adrenal insufficiency, severe hyperphagia (extreme, insatiable hunger)

75
Q

What is LepR deficiency?

A

rare, inherited condition that affects how the body processes energy, responds to food and stores fat.

characterized by hyperphagy

76
Q

what is mc4r deficiency

A

also early onset obesity, taller than average height

77
Q

what congenital conditions are known to cause obesity?

A
  1. prader-willi syndrome
  2. down syndrome
  3. bardet biedel syndrone
  4. alstrom syndrome
  5. cohen syndrome
  6. carpenter syndrome
78
Q

what neuroendocrine disorders are known to cause obesity?

A

cushing’s syndrome
hypothalamic disorders
hypothyroidism
PCOS
growth hormone deficiency

79
Q

which pharmacological agents are known to cause obesity?

A
  1. antidepressants
  2. antidiabetic medications (insulin, metformin)
  3. anyihypertensive medications (alpha blocker, beta-blocker, ace inhibitors, calcium channel blockers
  4. antipsychotics
  5. anticonvulsants
  6. contraceptives
  7. chronic inflammatory conditions
  8. AIDS treatment
80
Q

what % of bipolar people are overweight?

A

25-60%

81
Q

what % of schizofrenic people are overweight?

A

30-70%

82
Q

what % of depressed people are overweight?

A

20-50%

83
Q

links have been made between binging and adhd, ptsd

A
84
Q

which hormone suppresses appetite, stimulates release of insulin, and is secreted in the small intestine?

A

GLP1

85
Q

which hormone stimulates appetite, and stimulates hunger?

A

ghrelin

86
Q

what is the old definition of obesity?

A

BMI of > 30 kg /m2

87
Q

what is the new definition of obesity?

A

a chronic, progressive, relapsing disease.

Characterized by abnormal or excess adiposity that impairs health and social well-being

88
Q

what are the 4 Ms of obesity?

A
  1. mental health
  2. mechanical health
  3. metabolic health
  4. monetary health
89
Q

____ refers to negative personal attitudes and views about obesity and people with obesity

A

weight bias

90
Q

_____ refers to labelling of people living with obesity based on on deeply rooted social stereotypes

A

weight stigma

91
Q

_____ refers to when we treat people with obesity differently or unfairly, and can include verbal, physical, or relational discrimination

A

weight-based discrimination

92
Q

what are the 5 As of treating obesity?

A

Ask for permission to discuss weight
Assess obesity related risks
Advise on risks /options
Agree on outcomes
assist in access

93
Q

when should you measure waist circumference?

A

if BMI is between 25-35 kg/m2

94
Q

What are some recommended measurements for assessing people living with obesity?

A
  1. blood pressure in both arms
  2. fasting glucose
  3. lipid profile
  4. ALT for non-alcoholic fatty liver disease
  5. edmonton obesity staging system
95
Q

what is the edmonton obesity staging system used for?

A

to determine the severity of obesity

to guide clinical decision making

96
Q

how many stages are there in the EOSS (edmonton obesity staging system)?

A

4

97
Q

medical management of obesity may include the following 4 items:

A
  1. medical nutriton therapy
  2. physical activity/ behaviour therapy
  3. psychological/behavioural interventions
  4. pharmacotherapy
98
Q

calorie restriction can achieve short term reduction in weight, but not long term (over 12 months). In fact, calorie restriction may increase food intake and weight gain!!

A
99
Q

people living with obesity are at increased risk for these 3 vitamin deficiencies:

A
  1. vitamin D
  2. vitamin B12
  3. iron
100
Q

obesity management should emphasize the following 3 areas:

A
  1. individualized eating patterns
  2. food quality/healthy relationship with food
  3. mindfulness-based eating ptactices
101
Q

an activity factor of 1 for men is

A

sedentary

102
Q

an activity factor of 1.12 for men is

A

low active

103
Q

an activity factor of 1.29 for men

A

active

104
Q

if a man is very active, use an activity factor of:

A

1.59

105
Q

if a man is low active, us an activity level of

A

1.12

106
Q

if a man is active, use an activity level of

A

1.29

107
Q

if a women is low active, her activity factor is

A

1.16

108
Q

if a woman is active, her activity level is

A

1.27

109
Q

if a women is very active, her activity level is

A

1.44

110
Q

what are the 2016 aspen guidelines?

A

they are clinical guidelines on protein and energy

111
Q

what 6 things are involved in anthropmetric nutrition assessment for overweight patients

A
  1. height
  2. current weight
  3. weight history (highest adult weight, usual body weight)
  4. BMI
  5. waist circumferences
  6. nutrition-focused physical exam
112
Q

what 6 lab measurements are needed to assess metabolic syndrome in obese patients?

A
  1. serum glucose
  2. A1C
  3. total cholesterol
  4. LDL
  5. HDL
  6. triglycerides
113
Q

the DASH diet emphasizes the following dietary patterns:

A
  • lots of fruits and veggies
  • low fat dairy
  • whole grains
  • fish, poultry, nuts
114
Q

what are the sodium recommendations on the DASH diet?

A

under 2300 mg sodium

115
Q

the DASH diet recommends low (4 things):

A
  1. saturated fat
  2. cholesterol
  3. total fat
  4. sodium
116
Q

what is the glycemic index?

A

it ranks carbs based on how much they increase blood gludocse

117
Q

what foods are considered low on the glycemic index

A

< 55 mg/dl

118
Q

what foods are considered medium on the glycemic index

A

56-69 GI

119
Q

what is the portfolio diet?

A

less animal protein, more plant protein, more sticky fibre, nuts, plant sterols

120
Q

what does a nordic dietary pattern look like?

A

natural sources and seasonal foods

121
Q

which foods have proven benefit on glycemic ocntrol, lipid profile, chronic disease?

A
  1. pulses (beans, peas, chickpeas)
  2. fruits and veggies
  3. fish
  4. olive oil
  5. whole grains
  6. nuts
  7. some dairy foods
122
Q

adults living with obesity ad PREDIABETES should do lifestyle interventions that target ____ % of body weight

A

5-7 %

123
Q

adults living with obesity and TYPE 2 DIABETES should do lifestyle interventions that target ____ % of body weight

A

7-15%

124
Q

___ % decrease in body weight results in a reduction in 24 hour energy expenditure

A

10%

125
Q

REE declines within 1 day of starting a calorie restricted diet

A
126
Q

when would bariatric surgery be suggested?

A

BMI > 40
BMI > 35 with comorbitidites

127
Q

what type of diet should you have before bariatric surgery?

A

optifast diet (low carb, very low fat, high protein)

128
Q

can you eat other food on the optifast diet?

A

max 2 cups of lettuce, green pepper, celery, cucumber, broccoli, vinegar, lemon juice

129
Q

what are protein requirements after surgery?

A

1.5 g/kg of ideal body weight (minimum 60 g per day)

130
Q

after weight surfgery, which vitamins do you have to take for the rest of your life?

A
  1. multivitamin
  2. calcium citrate
  3. b12
  4. vitamin d
131
Q

what is dumping syndrome?

A

when food with a high sugar content is quickly released into the small bowel due to the absence of the pyloric sphincter

132
Q

the hematological system constitutes which 5 items:

A

blood
blood vessels
bone marrow
spleen
other tissue

133
Q

RBCs account for what % of whole blood?

A

45%

134
Q

what is the breakdown of blood

A

RBCs = 45%
Plasma = 55%
Buffy coat = 1%

135
Q

What is the buffy coat of the whole blood made out of?

A

platelets
white blood cells

136
Q

four subunit metalloprotein containing iron at the center of each heme, is called

A

hemoglobin

137
Q

what is the difference between the akpha and beta globin chains of hemoglobin?

A

they differ in:
1) ability to carry oxygen
2) resistance to binding

138
Q

nutritional anemia results from 1 of 3 things:

A
  1. deficiency in size of rbcs
  2. deficiency in # of rbcs
  3. amount of hemoglobin rbcs contain
139
Q

what are the 3 categories of nutritional anemia?

A
  1. microcytic
  2. macrocytic
  3. hemolytic
140
Q

what is the difference between the 3 types of nutritional anemia - microcytic, macrocytic, hemolyitc

A

microcytic - cant store or utulize iron
macrocytic - not enough b12 or folate. dietary or genetic
hemolytic - vitamin E deficiency or excess

141
Q

what are signs of anemia

A

fatigue
lethargy
pallor
cold extremities
muscle aches
difficulty concentrating
sleepiness
irritability

142
Q

microcytic anemia is also known as

A

iron deficiency anemia

143
Q

What is iron deficiency anemia? it is a condition where there is decreased:

A

1) # of circulating RBCs
2) hemoglobin level
3) volue of packed RBCs

144
Q

what are the 3 stages of iron deficiency anemia?

A

1) subclinical - no symptoms but there is a negative iron balance
2) clinical. lab value alterations. iron-deficiency or iron deficiency arythropoiesis
3) overt clinical iron deficiency anemia. signs and symptoms

145
Q

what is the recommended initial test/tests to determine iron status?

A

serum ferritin
complete blood count

146
Q

What are 6 diagnostic indices used to measure iron?

A
  1. serum ferritin level
  2. serum iron
  3. mean corpuscular volume
  4. mean corpuscular hemoglobin
  5. hemoglobin / hematocrit
  6. total iron binding capacity
147
Q

what do low hemoglobin and hematocrit levels reflect

A

they reflect SEVERITY of anemia, but do not reflect iron deficiency anemia

148
Q

what test would you use if you want to see if you have microcytic or macrocytic anemia, and want to see size of RBC

A

mean corpuscular volume

149
Q

which test would you use if you want to reflect iron tissue stores?

A

serum ferritin

150
Q

if you have iron deficiency, this might be low

A

serum iron levels

151
Q

which iron test is an indirect measure of transferrin levels?

A

total iron binding capacity

152
Q

which measure tells you the amount of hemoglobin in RBCs?

A

mean corpuscal hemoglobin

153
Q

for children, how many ug/L of serum ferritin is indicates iron deficiency?

A

<12 ug/L

154
Q

for children, how many ug/L of serum ferritin is indicates possibility of iron deficiency?

A

12-30 ug/L

155
Q

for adults, how many ug/L of serum ferritin indicates iron deficiency

A

<15 ug/L

156
Q

for adults, how many ug/L of serum ferritin indicates possible iron deficiency

A

15-30 ug/L

157
Q

for adults, how many ug/L of serum ferritin indicates normal iron stores

A

> 100 ug/L

158
Q

what is the worldwide incidience of anemia?

A

25%

159
Q

what % of acanadian preschoolers have anemia?

A

30%

160
Q

who is most vulnerable for getting nutritional anemia?

A
  1. menstruating females
  2. pregnant women
  3. kids under 2
  4. frail elderly
161
Q

which races are most at risk of getting nutritional anemia?

A
  1. mexican american females
  2. non-hispanic black females
162
Q

If you are going to eat plant sources of iron, then what should you eat them with?

A

Vitamin C

163
Q

breast milk contains _____ which increases the bioavailability and absorption of iron from milk

A

lactoferrin

164
Q

Prolonged bottle use is considered a risk factor for:

A

milk anemia

165
Q

restless leg syndrom is an overt sign of:

A

iron deficiency anemia

166
Q

What are 5 interventions for iron deficiency?

A

Increase iron + vitamin C in diet

Provide iron supplement of 100-200 mg

education

use cast iron skillet

increase consumption of meat

167
Q

What are 3 tips for taking iron supplements?

A
  1. take on empty stomach 1-2 gours before eating
  2. take with 600-1200 mg of vitamin C
  3. take 2 hours apart from other multivitamins, incuding calcium
168
Q

What is the adult RDA for iron (ages 19-49) for men and women:

A

Men: 8 mg/day
Women: 18 mg/day

169
Q

What is the adult RDA for iron for pregnant women:

A

27 mg/day

170
Q

What is the RDA for iron for vegetarians adults?

A

Men: 14 mg/day
Women: 33 mg/day

171
Q

What is the RDA for iron for vegetarians pregnant women?

A

49 mg/day

172
Q

when you are trying to replenish iron stores (ferritin), what are the target ferritin levels you are trying to hit?

A

50-100 ug/L

(can take up to 6 months to replenish)

173
Q

what are 3 characteristics of RBCS in macrocytic anemia?

A
  1. large
  2. irregular
  3. immature
174
Q

why do people get macrocytic anemia?

A

due to folate or b12 deficiency

175
Q

when one has macrocytic anemia, what is going on with their RBCS?

A

THEY HAVE DECREASED CAPACITY FOR OXYGEN TRANSPORT

176
Q

If you want to assess average nutrient intake of a group, what dietary measure would you use?

A
  1. 1 24 hr recall
  2. 3 day food record
177
Q

If you want to assess % of population at risk, what dietary measure would you use?

A
  1. many 24 hr recalls
  2. 1 day food record
178
Q

If you want to assess usual nutrient intake to rank individuals within a group, what dietary measure would you use?

A
  1. many 24 hr recalls
  2. semi-quantitative FFQ
179
Q

If you want to assess usual food/nutrient intake of an individual, what dietary measure would you use?

A
  1. many 24 hr recalls
  2. 1 semi-quantitative FFQ
180
Q

what is the gold standard for measuring energy requirements?

A

indirect calorimetry

the total amount of energy that a person needs is the sum of 3 basic components: BEE + PA + TEF

181
Q

Basal energy expenditure is approximately ___ % of energy requirement

A

60%

182
Q

How do you do the simplifed formula for range of EER

A

age x 25 = low range
age x 30 = high range

183
Q

what are the 3 components of. thenutrition diagnosis?

A

intake
clinical
behavioural

184
Q

What are the 4 components of nutrition intervention?

A
  1. nutrient delivery
  2. nutrient education
  3. nutrient counselling
  4. coordination of nutritional care

FNN 301 (10 decks)

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