Midterm Flashcards
What are the 3 components of evidence based practice?
- best research evidence
- clinical expertise
- patient values and preferences
Which terms are protected by law?
registered dietitian
professional dietitian
dietitian
What are the 3 types of malnutrition?
- starvation related malnutrition (no inflammation)
- chronic-disease related malnutrition (mild to moderate malnutrition, yes inflammation)
- acute disease or injury-related malnutrition (yes inflammation)
what type of malnutrition does not have inflammation?
starvation related malnutrition
what is the canadian nutrition screening tool used for?
to identify those at risk of malnutrition
what are the benefits of the canadian nutrition screening tool to assess malnutrition?
- short
- easy to use
- valid
- reliable (especially in acute and primary care settings)
- can ask family and friends questions
- doesnt need to be completed by a nutrition professional
- easy to include in nurse admission assessment
what are the 3 classifications in the subjective global assessment form?
- well nourished
- mildly/moderately malnourished
- severely malnourished
according to the subjective global assessment, what are the 5 features of patient history?
- weight change
- dietary intake change
- gi symptoms
- functional capacity
- disease and its relation to nutrition requirements
according to the subjective global assessment, what are the 5 features of physical exam?
- loss of subcutaneous fat in triceps
- muscle wasting in quads and deltoids
- ankle edema
- sacral edema
- ascites
what are the 5 steps of the malnutrition universal screening tool?
- BMI score
- weight loss score
- acute disease effect score
- risk of malnutrition
- management guidelines
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
Nutristep questionnaire
this questionnaure is 100% sensitive for anorexia and bulimia when there are 2 or more yes answers to 5 questions
SCOFF questionnaire
what ages do you use a lenbth boar dor to measure length?
0-2
what is considered overweight bmi
85th - 95th percentile of bmi for age
what is considered obese for bmi
greater than 95th percentile of bmi for age
what is considered underweight for bmi
less than 5th percentile
what measures does WHO growth charts look at from 0-2?
length for age
weight for age
what measures does WHO growth charts look at from 2-19?
BMI
weight for age
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
false - cut off points should not be used for diagnostic criteria
what is the recommended nutritional indicator for screening children 2 years and older to identify people who are wasted, overweight, or obese?
BMI for age
what is the underweight cut off for weight for age
< 3rd percentile
what is the severely underweight cut off for weight for age
< 0.1st
what is the overweight cut off for weight for length?
> 97th percentile
what is the stunted cut off for length for age
< 3rd percentile
what is the severely stunted cut off for length for age
< 0.1st perecntile
what is the risk of overweight cut off for weight for length?
<0.1st percentile
what is the obese cut off for weight for length?
> 99.9th percentile
what is the most important predictor of protein-calorie malnutrition?
assessing weight change / unintentional weight loss is the best way to screen for malnutrition
how do you calculate % usual body weight?
current body weight / usual body weight x 100
how do you calculate % weight change?
(usual body weight - current body weight) / usual body weight
what % of UBW puts you at risk of mild malnutrition
85-95
what % of UBW puts you at risk of moderate malnutrition
75-84
what % of UBW puts you at risk of severe malnutrition
<74
what is considered significant unintentional weight loss at 1 week?
> 2% of weight loss
what is considered significant unintentional weight loss at 1 month?
> 5%
what is considered significant unintentional weight loss at 3 months?
<7.5%
what is considered significant unintentional weight loss at 6 months?
> 10%
how do you calculate BMI?
weight kg / height in metres squared
How do you measure waist circumference?
On torso
Between lowest rib and pelvic bone or over umbilical
body composition refers to:
fat mass and fat free amss
what are the 2 most common tools used to assess body composition in nutritional assessments?
skinfold test
bioelectrical impedance (BIA)
_____ estimates energy reserves in subcutaneous tissue
skinfold measurement
what are advantages and disadvantages of using skinfold mesurement as a nutrition care indicator?
advantages: not invasive, minimal equipment
disadvamtages: needs repetition and experience
Which indicators do we look at for hematological assessment?
- hemoglobin
- hematocrit (ratio of rbcs to total blood volume)
- mean corpuscle volume (average size of RBCS)
- mean corpuscual hemoglobin - average quantity of hemoglobin in RBC
- mean corpuscular hemoglobin concentration
- ferritin , transferin saturaiton, iron
low mean corpuscular hemoglobin is a sign of:
iron deficiency anemia
high mean corpuscular hemoglobin is a sign of:
B12 folate deficiency
dark circles under the eyes, with some hollowing, indicates
mild-moderate nutrition
What are the 3 different components of energy expenditure per day, along with their %?
Thermic effect of food: 10%
physical activity: 23%
REE: 67%
what is daily resting energy expenditure?
67%
what is daily activity expenditure?
23%
what is daily expenditure from thermic effect of food
10%
Physical activity energy expenditure, which is about 23% of daily expenditure, is influenced by 5 things:
- body weight
- # of muscle groups used in the activity
- intensity of activity
- duration of activity
- frequency of activity
when does the thermic efffect of food peak?
60-120 minutes after a meal
What are the PA coefficients?
1.0
1.12
1.27
1.48
how long can the thermic effect of food last after a meal?
4-6 hours
when there is a decreased intake and loss of body fat leads to increased appetitite and decreased energy expenditure. this is cualled
orexigenic stimuli
Ghrelin is an example of ____ stimuli
orexigenix stimuli
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
anorexigenic stimuli
What are examples of anorexigenic stimuli?
leptin
insulin
when one is hungry and appetite is stimulated, the body produces:
ghrelin
when one is full and brain receives signal to reduce appetite and release:
CCK, glu-like peptide 1, peptide YY
when blood sugar levels rise following a meal, it leads to the release of
insulin
amylin
which neurochemicals are important for short term regulation of appetite and food?
ghrelin - influence food intake at meals
GLP1 - influence food intake at meals
Insulin
gut peptides
which neurochemicals are important for long term regulation of % body fat
leptin
which hormone suppresses hunger?
GLP1
which hormone stimulates hunger?
ghrelin
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
what is the difference between satiety and satiation
satiety develops after a meal, whereas satiation occurs during a meal
we are all born with a stable # of adipocytes. they dont increase in #, they increase in size.
which organ regulates weight?
the hypothalamus
the hypothalamus’s regulation of weight is affected by:
genetics (75% of our weight is determined by genetics)
microbiome
gut hormones
adipose tissue hormones
environment
medications
chronic stress
how many genes are strongly associated with weight gain?
50
Genes account for ___ % variability in weight gain
40-70%
what is POMC deficiency?
it is characterized by early onset obesity, adrenal insufficiency, severe hyperphagia (extreme, insatiable hunger)
What is LepR deficiency?
rare, inherited condition that affects how the body processes energy, responds to food and stores fat.
characterized by hyperphagy
what is mc4r deficiency
also early onset obesity, taller than average height
what congenital conditions are known to cause obesity?
- prader-willi syndrome
- down syndrome
- bardet biedel syndrone
- alstrom syndrome
- cohen syndrome
- carpenter syndrome
what neuroendocrine disorders are known to cause obesity?
cushing’s syndrome
hypothalamic disorders
hypothyroidism
PCOS
growth hormone deficiency
which pharmacological agents are known to cause obesity?
- antidepressants
- antidiabetic medications (insulin, metformin)
- anyihypertensive medications (alpha blocker, beta-blocker, ace inhibitors, calcium channel blockers
- antipsychotics
- anticonvulsants
- contraceptives
- chronic inflammatory conditions
- AIDS treatment
what % of bipolar people are overweight?
25-60%
what % of schizofrenic people are overweight?
30-70%
what % of depressed people are overweight?
20-50%
links have been made between binging and adhd, ptsd
which hormone suppresses appetite, stimulates release of insulin, and is secreted in the small intestine?
GLP1
which hormone stimulates appetite, and stimulates hunger?
ghrelin
what is the old definition of obesity?
BMI of > 30 kg /m2
what is the new definition of obesity?
a chronic, progressive, relapsing disease.
Characterized by abnormal or excess adiposity that impairs health and social well-being
what are the 4 Ms of obesity?
- mental health
- mechanical health
- metabolic health
- monetary health
____ refers to negative personal attitudes and views about obesity and people with obesity
weight bias
_____ refers to labelling of people living with obesity based on on deeply rooted social stereotypes
weight stigma
_____ refers to when we treat people with obesity differently or unfairly, and can include verbal, physical, or relational discrimination
weight-based discrimination
what are the 5 As of treating obesity?
Ask for permission to discuss weight
Assess obesity related risks
Advise on risks /options
Agree on outcomes
assist in access
when should you measure waist circumference?
if BMI is between 25-35 kg/m2
What are some recommended measurements for assessing people living with obesity?
- blood pressure in both arms
- fasting glucose
- lipid profile
- ALT for non-alcoholic fatty liver disease
- edmonton obesity staging system
what is the edmonton obesity staging system used for?
to determine the severity of obesity
to guide clinical decision making
how many stages are there in the EOSS (edmonton obesity staging system)?
4
medical management of obesity may include the following 4 items:
- medical nutriton therapy
- physical activity/ behaviour therapy
- psychological/behavioural interventions
- pharmacotherapy
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!!
people living with obesity are at increased risk for these 3 vitamin deficiencies:
- vitamin D
- vitamin B12
- iron
obesity management should emphasize the following 3 areas:
- individualized eating patterns
- food quality/healthy relationship with food
- mindfulness-based eating ptactices
an activity factor of 1 for men is
sedentary
an activity factor of 1.12 for men is
low active
an activity factor of 1.29 for men
active
if a man is very active, use an activity factor of:
1.59
if a man is low active, us an activity level of
1.12
if a man is active, use an activity level of
1.29
if a women is low active, her activity factor is
1.16
if a woman is active, her activity level is
1.27
if a women is very active, her activity level is
1.44
what are the 2016 aspen guidelines?
they are clinical guidelines on protein and energy
what 6 things are involved in anthropmetric nutrition assessment for overweight patients
- height
- current weight
- weight history (highest adult weight, usual body weight)
- BMI
- waist circumferences
- nutrition-focused physical exam
what 6 lab measurements are needed to assess metabolic syndrome in obese patients?
- serum glucose
- A1C
- total cholesterol
- LDL
- HDL
- triglycerides
the DASH diet emphasizes the following dietary patterns:
- lots of fruits and veggies
- low fat dairy
- whole grains
- fish, poultry, nuts
what are the sodium recommendations on the DASH diet?
under 2300 mg sodium
the DASH diet recommends low (4 things):
- saturated fat
- cholesterol
- total fat
- sodium
what is the glycemic index?
it ranks carbs based on how much they increase blood gludocse
what foods are considered low on the glycemic index
< 55 mg/dl
what foods are considered medium on the glycemic index
56-69 GI
what is the portfolio diet?
less animal protein, more plant protein, more sticky fibre, nuts, plant sterols
what does a nordic dietary pattern look like?
natural sources and seasonal foods
which foods have proven benefit on glycemic ocntrol, lipid profile, chronic disease?
- pulses (beans, peas, chickpeas)
- fruits and veggies
- fish
- olive oil
- whole grains
- nuts
- some dairy foods
adults living with obesity ad PREDIABETES should do lifestyle interventions that target ____ % of body weight
5-7 %
adults living with obesity and TYPE 2 DIABETES should do lifestyle interventions that target ____ % of body weight
7-15%
___ % decrease in body weight results in a reduction in 24 hour energy expenditure
10%
REE declines within 1 day of starting a calorie restricted diet
when would bariatric surgery be suggested?
BMI > 40
BMI > 35 with comorbitidites
what type of diet should you have before bariatric surgery?
optifast diet (low carb, very low fat, high protein)
can you eat other food on the optifast diet?
max 2 cups of lettuce, green pepper, celery, cucumber, broccoli, vinegar, lemon juice
what are protein requirements after surgery?
1.5 g/kg of ideal body weight (minimum 60 g per day)
after weight surfgery, which vitamins do you have to take for the rest of your life?
- multivitamin
- calcium citrate
- b12
- vitamin d
what is dumping syndrome?
when food with a high sugar content is quickly released into the small bowel due to the absence of the pyloric sphincter
the hematological system constitutes which 5 items:
blood
blood vessels
bone marrow
spleen
other tissue
RBCs account for what % of whole blood?
45%
what is the breakdown of blood
RBCs = 45%
Plasma = 55%
Buffy coat = 1%
What is the buffy coat of the whole blood made out of?
platelets
white blood cells
four subunit metalloprotein containing iron at the center of each heme, is called
hemoglobin
what is the difference between the akpha and beta globin chains of hemoglobin?
they differ in:
1) ability to carry oxygen
2) resistance to binding
nutritional anemia results from 1 of 3 things:
- deficiency in size of rbcs
- deficiency in # of rbcs
- amount of hemoglobin rbcs contain
what are the 3 categories of nutritional anemia?
- microcytic
- macrocytic
- hemolytic
what is the difference between the 3 types of nutritional anemia - microcytic, macrocytic, hemolyitc
microcytic - cant store or utulize iron
macrocytic - not enough b12 or folate. dietary or genetic
hemolytic - vitamin E deficiency or excess
what are signs of anemia
fatigue
lethargy
pallor
cold extremities
muscle aches
difficulty concentrating
sleepiness
irritability
microcytic anemia is also known as
iron deficiency anemia
What is iron deficiency anemia? it is a condition where there is decreased:
1) # of circulating RBCs
2) hemoglobin level
3) volue of packed RBCs
what are the 3 stages of iron deficiency anemia?
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
what is the recommended initial test/tests to determine iron status?
serum ferritin
complete blood count
What are 6 diagnostic indices used to measure iron?
- serum ferritin level
- serum iron
- mean corpuscular volume
- mean corpuscular hemoglobin
- hemoglobin / hematocrit
- total iron binding capacity
what do low hemoglobin and hematocrit levels reflect
they reflect SEVERITY of anemia, but do not reflect iron deficiency anemia
what test would you use if you want to see if you have microcytic or macrocytic anemia, and want to see size of RBC
mean corpuscular volume
which test would you use if you want to reflect iron tissue stores?
serum ferritin
if you have iron deficiency, this might be low
serum iron levels
which iron test is an indirect measure of transferrin levels?
total iron binding capacity
which measure tells you the amount of hemoglobin in RBCs?
mean corpuscal hemoglobin
for children, how many ug/L of serum ferritin is indicates iron deficiency?
<12 ug/L
for children, how many ug/L of serum ferritin is indicates possibility of iron deficiency?
12-30 ug/L
for adults, how many ug/L of serum ferritin indicates iron deficiency
<15 ug/L
for adults, how many ug/L of serum ferritin indicates possible iron deficiency
15-30 ug/L
for adults, how many ug/L of serum ferritin indicates normal iron stores
> 100 ug/L
what is the worldwide incidience of anemia?
25%
what % of acanadian preschoolers have anemia?
30%
who is most vulnerable for getting nutritional anemia?
- menstruating females
- pregnant women
- kids under 2
- frail elderly
which races are most at risk of getting nutritional anemia?
- mexican american females
- non-hispanic black females
If you are going to eat plant sources of iron, then what should you eat them with?
Vitamin C
breast milk contains _____ which increases the bioavailability and absorption of iron from milk
lactoferrin
Prolonged bottle use is considered a risk factor for:
milk anemia
restless leg syndrom is an overt sign of:
iron deficiency anemia
What are 5 interventions for iron deficiency?
Increase iron + vitamin C in diet
Provide iron supplement of 100-200 mg
education
use cast iron skillet
increase consumption of meat
What are 3 tips for taking iron supplements?
- take on empty stomach 1-2 gours before eating
- take with 600-1200 mg of vitamin C
- take 2 hours apart from other multivitamins, incuding calcium
What is the adult RDA for iron (ages 19-49) for men and women:
Men: 8 mg/day
Women: 18 mg/day
What is the adult RDA for iron for pregnant women:
27 mg/day
What is the RDA for iron for vegetarians adults?
Men: 14 mg/day
Women: 33 mg/day
What is the RDA for iron for vegetarians pregnant women?
49 mg/day
when you are trying to replenish iron stores (ferritin), what are the target ferritin levels you are trying to hit?
50-100 ug/L
(can take up to 6 months to replenish)
what are 3 characteristics of RBCS in macrocytic anemia?
- large
- irregular
- immature
why do people get macrocytic anemia?
due to folate or b12 deficiency
when one has macrocytic anemia, what is going on with their RBCS?
THEY HAVE DECREASED CAPACITY FOR OXYGEN TRANSPORT
If you want to assess average nutrient intake of a group, what dietary measure would you use?
- 1 24 hr recall
- 3 day food record
If you want to assess % of population at risk, what dietary measure would you use?
- many 24 hr recalls
- 1 day food record
If you want to assess usual nutrient intake to rank individuals within a group, what dietary measure would you use?
- many 24 hr recalls
- semi-quantitative FFQ
If you want to assess usual food/nutrient intake of an individual, what dietary measure would you use?
- many 24 hr recalls
- 1 semi-quantitative FFQ
what is the gold standard for measuring energy requirements?
indirect calorimetry
the total amount of energy that a person needs is the sum of 3 basic components: BEE + PA + TEF
Basal energy expenditure is approximately ___ % of energy requirement
60%
How do you do the simplifed formula for range of EER
age x 25 = low range
age x 30 = high range
what are the 3 components of. thenutrition diagnosis?
intake
clinical
behavioural
What are the 4 components of nutrition intervention?
- nutrient delivery
- nutrient education
- nutrient counselling
- coordination of nutritional care
