MNT — Exam #2 : Part 2 Flashcards
What is the purpose of nutrition INTERVENTION?
- Resolve or improve the nutrition problem;
- Done by determining and implementing the correct and most appropriate nutrition interventions;
- Must be tailored to the patient’s needs
What are the IDNT intervention terminologies?
-Use that terminology to “structure” documentation;
-Choose the most appropriate strategy
→ The intervention strategy is determined by the nutrition diagnosis and its etiology and often helps to resolve the signs and symptoms
What are intervention strategies chosen to CHANGE?
- Nutritional intake;
- Nutrition-related knowledge or behavior;
- Environmental conditions;
- Access to supportive care and services
What are Nutrition Intervention goals?
- Nutrition intervention GOALS determine how the patient’s progress is MONITORED and EVALUATED;
- Two sets of goals → Clinical (long-term) and Personal (short-term)
What are the 2 components of intervention?
- Planning;
2. Implementation
What is involved in PLANNING?
- Prioritize nutrition dx;
- Consult AND’s EAL practice guidelines and other practice guides;
- Determine expected outcomes for each Nutr dx;
- Work with patient and/or caregivers (setting is very important!);
- Define a nutrition intervention plan and strategies;
- Define time and frequency of care;
- Identify resources needed (educational tools, handouts, videos, etc - document)
What is included in IMPLEMENTATION of intervention?
- Action portion of intervention
- RD carries out the plan of care
- Communicates the nutrition care plan
- Continues with data collection
- Revises the nutrition intervention based on the patient’s response
How do you PRIORITIZE the nutrition diagnosis?
(PLANNING)
- Based on severity of problem, safety, patient needs, likelihood that the intervention will impact the problem, and the patient’s perception of importance;
- Determine which Nutr Dx will be affected most and give best outcome
How do you know what intervention strategy/strategies to choose?
(PLANNING)
- Use evidence-based guidelines = DGA, RDA, EAL practice guidelines, Specialized organizations- American Diabetes Association, ASPEN, AND…;
- Use institutional policies and procedures
What is the first part of “planning” for intervention?
- Plan the nutrition prescription!!;
- Rx states the patient/client’s individualized plan for best meeting nutritional needs;
- Will be the FIRST intervention done
What might be included in the nutrition prescription?
-Consistency needed;
-Schedule of food/fluids;
-Specific foods/ beverages;
-Other
(see IDNT)
What is the nutrition prescription NOT?
NOT the current diet order;
- Current would be what the pt was doing at home or what the dr. prescribed upon admission;
- Rx should CHANGE something
What is the nutrition prescription?
- It IS an individualized statement of NEEDS of a patient at that moment;
- Purpose of Nutrition Rx: “to communicate the RD’s diet/nutrition recommendation based on a thorough nutrition assessment.”
- Prescription is AFTER assessment!!!;
- Based on evidence-based dietetics practice
What does the prescription have to be related to?
- The the nutrition DIAGNOSIS;
- Ex: If PES is related to inadequate energy intake then Nutrition Rx should include method to increase energy and to what level (may also include meal schedule)
What is included in the prescription?
- If any part of the order is standard, do NOT include it in the order;
- If it is SPECIAL to the patient then MUST be as SPECIFIC as possible!;
- Include PROTEIN in all assessments and orders ;
- ** Don’t forget to put in ( ) what factors you used to calculate needs. Example: (AF=1.3, IF= 1.5), protein(1.3 g/kg)
When might a change in energy intake require a dictation?
- A change in “consistency” might not require a dictation in a change in energy intake;
- Only changing the form of the food, not the amount of energy provided by the food
Examples of Nutrition Prescription Components
- Calories (specify calories/d)
- Carbohydrate (specify grams/d, percent of kcal)
- Protein (specify g/d, g/kg/d, percent of kcal)
- Fat (specify g/d, percent of kcal)
- Recommended saturated fat level (specify g/d, % of kcal)
- Recommended unsaturated fat level (specify g/d, % of kcal)
- Recommended vitamin intake (ex: amt. of vitamin D/d)
- Recommended mineral intake (ex: amt. of calcium/d)
- Recommended fluid intake (specify ml/day)
- Recommended fiber intake (specify type and g/d, g/1000 kcals/d)
- Recommended level of bioactive substances (specify substance and amount)
What are Bioactive Substances?
- Any component of food that is thought to have health benefits beyond typical micro and macro nutrient requirements.;
- Examples: soy protein, soluble fiber, plant sterols (Benacol that is prescribed for treating cholesterol)
Examples of altered diets components that might be int the Nutrition Prescription?
- Recommended enteral nutrition order (specify formula, rate/schedule);
- Recommended parenteral nutrition order (specify solution, rate, access);
- Recommended liquid diet (Clear liquid, full liquid);
- Recommended texture modification (ex: mechanical soft, puree…);
- Recommended liquid consistency modification (ex: thin, nectar, honey, pudding)
What might be recommended food intakes for the Nutrition Prescription?
- Grains (Ex: servings, exchanges, amounts…);
- Fruit and vegetables;
- Meat, poultry, fish, eggs, beans, nuts…;
- Milk and milk product intake;
- Fat foods (specify types, servings, exchanges amounts)
What is the first step in prevention and treatment of malnutrition?
First step in prevention and treatment of malnutrition is adequate supply of acceptable food composing a diet that has been individualized to age, height, weight, activity level, and medical condition
What causes malnutrition seen in acute care?
Malnutrition in ACUTE care (short-term hospital/clinic) is due to chronic illness before admission, but heightened by pain, anxiety, depression and unfamiliar foods or meal schedules with admission to a health care setting
Who writes hospital diet orders?
- Dr’s or nurses write diet orders;
- RDs write and approve the menus that are used in each scenario of prescriptive diets;
- All patients must have diet order!
What is the Regular or “House” Diet?
- Standard diet served;
- General-purpose or “house diet” supplies a minimum of three meals each day with regulations dictating timing, frequency and nutrient content of the meals
What is NPO?
Nil per os = nothing by mouth (latin)
What is a Therapeutic Diet Order?
- Modification made to the general diet that are recommended as part of the nutrition prescription for the patients care under an RD;
- Used to maintain and restore health;
- Modifications can be made to accommodate change sin absorption , digestion, and organ function;
- Can provide specific support to gain or lose weight or to assist with diagnosis through nutrient content changes
What is a Nutrition Support Order?
Needs other forms of nutritional support or supplementation to supply needs; Extras added to a therapeutic diet
What are Oral Diets?
- “House” or regular diet;
- Therapeutic diets- Part of the NUTRITION PRESCRIPTION
What changes can be made to the House diet?
- Caloric level
- Consistency = Clear liquid and full liquid diets, Mechanical soft, Puree;
- Single nutrient manipulation = Low fat, High protein, Low sodium;
- Food restriction;
- Number, size, frequency of meals;
- Addition of supplements
How are modifications to meals and snacks made?
- RD recommends, implements, or orders nutrition interventions;
- Actions: to initiate, modify or discontinue a nutrition intervention =
- General/ healthful diet;
- Composition of meals/snacks or groups;
- Schedule of food/fluids;
- Specific food/beverages
- Other, specify
What are the compositions of the meals and snacks?
- Texture modified diet;
- Energy modified diet;
- Protein, CHO, or Fat modified diet;
- Fiber modified diet;
- Fluid modified diet;
- Vitamin/ mineral modified diet
What are the types of Liquid diets?
- Clear Liquid;
2. Full Liquid
When are pts put on a CLEAR liquid diet?
- Intended to provide fluid, electrolytes, and energy;
- In a form that does requires MINIMAL digestion and stimulation of GI tract;
- **Inadequate nutritionally;
- Only used for a few meals → Not to exceed 3 days;
- Typically used pre or post-operatively, during acute illnesses;
- Recommendation: → serve 5-6 small feedings/day
When are pts put on a FULL liquid diet?
- Transition between clear liquids and solid food;
- Intended for short periods =
— Post-operatively
— Acute illness
— The ability to chew or swallow is severely limited; - Limited to foods that are liquid at body temperature
Clear Liquid Foods
- Clear fruit juices (apple, grape, cranberry);
- Clear broths, bouillon;
- Gelatin, fruit ice, plain hard candy, sugar, honey, syrup;
- High PRO, high energy, clear liquid sups;
- Tea, fruit-flavored drink mixes with water
Full Liquid Foods
- Cooked refined grain cereals (great, cream of wheat);
- All veggie juice, strained juices, strain or pureed vegetables in coups;
- Cream soups;
- Milk, ice cream, pudding, yogurt,
- Butter, margarine, veggie oils, cream;
- All clear liquids
What is the purpose of a High Calorie and High Protein diet?
- Purpose → to increase nutrient or energy intake without increased volume;
- Patients with decrease appetite;
- And increased protein needs;
- Used to prevent weight loss, tissue wasting and promote healing.;
- Could provide 100-120 grams of protein/d and 3000-4000 kcal/d
What are the Indications for prescribing a High Cal/High Pro diet?
- Fever;
- Severe burns;
- Excessive weight loss;
- Decubitus ulcers;
- Malnutrition;
- Infections;
- Severe fractures;
- Cancer or cancer therapy
What are Decubitus Ulcers?
- Bed ridden patients develop ulcers and sores from lying on the same body part for too long;
- Very problematic and extremely hard to heal
Ways to add Protein AND Energy
- Use fortified milk (2 T dry milk powder/cup of fluid milk) for drinking, cooking, replacing water in prep;
- Snacks should be available ;
- Serve double portions of foods well-liked;
- Add melted margarine, butter or gravy to hot foods;
- Drink fluids away from meals;
- House supplements can be offered → Clear liquid supplements may be better tolerated;
- Add corn syrup to fruit ices;
- Add whipped cream to desserts;
- Add cheese to vegetables, grits, and starches;
- Offer higher energy options in every food group → Example: peas instead of green beans, cream soups instead of clear;
* *Honor food preferences
What snacks can be used to increased Protein AND Energy?
- Milk, whole or 2% preferred;
- Ice cream, yogurt, sherbet;
- Sandwiches;
- Cheese and crackers;
- Peanut butter and crackers;
- Pudding;
- 100% fruit juice;
- Malt, milkshake;
- Commercial medical nutritional product
Ways to add Protein ONLY
- Dry milk powder
- Evaporated milk → More condensed; Use fat-free evaporated if the goal is protein only ;
- Liquid egg substitutes;
- Nuts, nut butters;
- Chopped meats, cooked eggs, cheese, yogurt;
- Tofu or soy crumbles
→ ** Add items to appropriate foods
What are Medical Food Supps?
- Modified Foods and Beverages;
- Goal = Increase nutrient density without increasing volume; - Commercial Beverages =
- 250-350 Kcal 250 mL and approximately 7-15 g of protein → STANDARD formulas;
- Taste fatigue;
- Type depends on the patient’s needs and medical condition
What are some other hospital diets?
- Low Sodium → Reduce sodium to 1500 mg/d or less;
- Low Fat;
- Finger Food;
- Low vitamin K;
- Each hospital has own set of therapeutic diets.;
- Based on regular menu and modified as needed
What are the 4 Categories (domains) of Intervention Strategies?
- Food and/or Nutrient Delivery → Diet order
- Nutrition Education
- Nutrition Counseling
- Coordination of Nutrition Care
* *Use the reference sheets in the IDNT manual to write your nutrition prescription
- Definition of strategy (IDNT)
- Details of the intervention
What is included in the Diet Order?
- *Diet order will ONLY have what the pt. will be fed → Justification and reasoning will only be found the in the medical record ;
- Order is for the KITCHEN!! So must be super simple and straight forward with no excess or confusing details ;
- Codes are NOT actually included in real diet orders, but put them for now so she knows we used the IDNT
What are some IDNT Nutrient Delivery Categories?
- Energy Modification;
- Schedule Modification;
- Food Group;
- Feeding Assistance;
- Feeding Environment;
- Nutrition Related Medical Mgt
What should be consider for intervention in an OUTpatient setting?
- Patient compliance skills and abilities;
- Economic concerns with purchasing special food items;
- Willingness/ ability to change behavior to comply with diet;
- Availability/ access to a qualified practitioner for follow up and monitoring
What are the Interventions related to Education, Counseling, Coordination of Nutrition Care?
- Nutrition Education - Content;
- Education Application;
- Counseling Approach;
- Counseling Strategy;
What does the IDNT say about counseling style and approach?
“An intervention typically incorporates tools and strategies derived from a variety of behavior change theories and models. The practitioner is asked to indicate which Strategies (C-2) he/she used in a particular intervention session along with the Theories (C-1) that most influence the intervention being documented.”
What is the definition of STRATEGY?
– an evidence-based method or plan of action designed to achieve a particular goal.
What are the Strategies?
- Motivational interviewing;
- Goal setting;
- Self-monitoring;
- Problem solving;
- Social Support;
- Stress management = (Environmental strategies, Emotion focused strategies);
- Stimulus control;
- Cognitive restructuring;
- Relapse prevention;
- Rewards/ contingency management
What is Goal Setting?
Engage in goal setting with client: probe client about pros and cons of proposed goals and assist client in gaining the knowledge and skills necessary to succeed.
What is Self-Monitoring?
- Provide rationale and instructions for self-monitoring diet and exercise.;
- Review self-monitoring logs to identify patterns that contribute to undesirable food &/or exercise choices and assist with problem solving and goal setting.
What is Stimulus Control?
-Assisted client in identifying ways to modify the environment to eliminate triggers.;
EX: Targeted areas included: 1. keeping food out of sight, and 2. avoidance of the vending area at work.
What is Stress Mgt (Environmental Focused)?
Implement environmental-focused stress management strategies: guidance on planning meals ahead and use of time-management skills, to support healthy eating behaviors.
What is Problem Solving?
-Work collaboratively with client to define the problem, brainstorm solutions, and select 2 strategies to implement. (could identify the specific strategies).
What is the Intervention related to Collaboration and Referral of Nutrition Care (RC-1)?
“facilitating services or intervention with other professionals, institutions, or agencies on behalf of the patient/client prior to discharge from nutrition care.”
EX of Collaboration of Care
- Example → Recommend referral to Speech pathologist for evaluation of swallowing and recommendations re: possible need for modification of texture &/or liquid consistency of food/beverage.;
- Example → Recommend referral to Social Services for assistance with food assistance programs available to this patient/client
What is the Intervention related to Discharge & Transfer of Nutrition Care to a New Setting or Provider (RC-2)?
“Discharge planning and transfer of nutrition care from one level or location of care to another.”
Transfer to Another Location of Care
EX:Discharge and transfer of nutrition care: recommend patient follow up with Dudley Doright, RD, LDN at the Baton Rouge Clinic. Patient provided with phone number for BR Clinic and encouraged/instructed to schedule RD appointment for the week of ______ (or within ____days/weeks/months of hospital discharge).
Transfer to community agencies/ programs (and collaboration of care):
EX: Discharge and transfer to community agencies/programs: collaborate with social services/ social worker regarding referral of patient to food pantry, and food stamps programs.
What do Measurable Goals Focus on?
- Change in behavior (e.g. increasing fruit and vegetable intake);
- Change in knowledge/ awareness?;
- Change in environment/continuum of care?;
- Change in provision of nutrient intake (ie: enteral/parenteral feedings/ change in diet order)?
What Indicators for Monitoring/Eval?
- Weight gain/loss (specify amt/time frame);
- Protein status indicators;
- Biochemical Assessment(LDL C, serum glu, Hgb A1C);
- Hydration status indicators;
- Eating/ Medication/ Monitoring Behaviors;
- Food/ Beverage/ Supplement Intake
What is Involved in Goal Setting?
- Establish patient goals that are clear, measurable, achievable, and w/in a defined time frame;
- Best to NEGOTIATE goals with client (especially behavioral) → Not always possible- Example- patients that are receiving TF;
- Can have SHORT term goals (by the next visit) and LONG term goals (overall goal of nutrition intervention)
How many BEHAVIORAL goals should be chosen?
One to THREE BEHAVIORAL goals =
- Consider needs and skills of the patient/client;
- Consider problem;
- Prioritize so as not to overwhelm patient/client;
- Consider self efficacy, motivation
What should one behavioral goal be?
Challenging! =
- One that can be achieved (realistic);
- Not too difficult to achieve or too long term;
- Not one that is so easy that it does not provide a sense of accomplishment, or that does not make much impact on problem.
What is included in the Action Phase of the Intervention?
- Communicate plan of care;
- Carry out plan;
- Continue data collection
What else is included in Implementing the Intervention?
- Individualize nutrition intervention;
- Collaborate with colleagues or health care team;
- Follow up and verify that interventions are occurring;
- Adjust intervention strategies if needed
What is Obesity?
A condition of excessive fatness, either generalized or localized.
o It is possible to be overweight but not over-fat, and over-fat, but not overweight.
What is the NIH difference in Overwt and Obese?
- Individuals with BMI of 25-29 are classified as OVERWT;
- Individuals with BMI of 30 or greater are classified as OBESE
What are the BMI Classifications?
- < 18.5 = underweight;
- 18.5-24.9 =acceptable;
- 25-29.9 = overweight;
- 30-34.9 = Obesity Grade I;
- 35-39.9 = obesity Grade II;
- > or = 40 = extreme obesity Grade III
What is the obesity paradox?
- eating is voluntary/ food is accessible;
- -eating is necessary/ cannot “quit;
- -caveman body living in 2014
- PROBLEM/ETIOLOGY/ SOLUTION → all are complicated
What is the prevalence of obesity is the US?
- 68% of U.S. adults are overweight or obese;
- HIGHER average incidence in African American and Hispanic American, and Native American populations;
- Medical-care costs of obesity in U.S. estimated @ about $147 billion!!
How has obesity increased?
- 1960: 13.4% of adults were obese
- 1990: 23% of adults were obese
- 2010: almost 36% of adults were obese
- 2010: almost 17% of children & adolescents (2-19 yrs of age) were obese
How does obesity in LA compare to the US overall?
LA percentages are HIGHER than the US totals
What are the general consequences of obesity?
- Medical/ Physical Health
- Social/ Behavioral effects
- Psychological health
What are the health consequences of obesity?
- Mortality risk begins to increase with BMI >25;
- This increase is modest until a BMI > 30;
- For persons with a BMI > 30, all cause mortality is generally increased by 50 to 100% above persons with a BMI of 20-25
What are the Diet-Related Diseases?
- Obesity
- Type 2 Diabetes
- Heart disease
- Hypertension
- Stroke
- Colon cancer
- Breast cancer
- Prostate cancer
- Kidney failure
What are the Obesity-Related Diseases?
- Psychiatric/psychological (depression, self-esteem);
- CVD (high BP, cholesterol, HTN, stroke);
- Gallbladder dz and gallstones;
- HIgh blood glucose, T2DM;
- Gynecological abns;
- Gastro reflux;
- Increased risk of cancer
How does Obesity Relate to DM?
- Excess body fat = elevated plasma FFA;
- Elevated FFA = increased insulin secretion = insulin resistance = reduced glycogen storage = increased hepatic glucose production
- These = hyperglycemia, hyperinsulinemia, impaired GTT, eventual DM2
What would be the effect of a small wt. loss of DM risk/development?
–
What are some other health related problems with obesity?
- Cannot fit in scanners;
- X-rays/ sonograms cannot pass through excess fat tissue;
- Cannot be weighed on conventional/ medical scales
What are the Social/Behavioral Consequences of Obesity?
–
What are the Psychological Consequences of Obesity?
- Effect on self esteem
- Depression and related problems
- Disordered eating
What is included in the Two Compartment Model of body composition?
Fat vs. Fat-Free Mass
- Fat = Fat + Lean Body Mass;
- Fat-Freee Mass
What is Fat Mass?
fat from all sources/ includes brain, skeleton
What is Lean Body Mass (LBM)?
- Contains small amount of essential fat in internal organs, bone marrow, nerve tissue;
- Higher in men than women;
- Increases with exercise;
- Lower in older adults;
- Major determinant of RMR;
- Important to maintain LBM during fat loss;
- Pattern of weight loss important;
- Muscle and skeleton adjust to obese state, so as much as 29% of excess weight in obese due to increase in LBM
What is Fat-Free Mass (FFM)?
water, protein, mineral
What is Essential Fat?
ESSENTIAL for NORMAL physiologic functioning (small amount in bone marrow, heart, lung, liver, spleen, kidneys, muscles, nervous system)
What is the Essential Fat amount for MEN?
Men: min. of 3% body fat = essential → Healthy level of body fat for young adult men: 8-19% of total weight
What is the Essential Fat amount for WOMEN?
Women: min. of 12% body fat = essential → Healthy level of body fat for young adult women: 21-32% of total weight
What is Storage Fat?
- Primary energy RESERVE of body;
- Under skin and around organs- most considered expendable)
What are the evaluations of Body Fat distribution?
- Important predictor of health status =
1. Abdominal/central body fat → Apple, android
2. Lower body fat → Hips and thighs, pear, gynoid
3. Measured by waist circumference and waist to hip ratio
4. Unalterable factors that increase visceral fat: race, age in women, genetics
5. Alterable factors: tobacco use, alcohol intake, stress
How does Waist Circumference indicate Body Fat?
- Correlates well with CT/ MRI to quantify abdominal fat;
- Better indicator of disease risk for ASIAN descent/ older individuals
- “HIGH RISK” = > 40 in. males, > 35 in. females ;
- Reflects increased risk type 2 DM, HTN, dyslipidemia, CHD, metabolic syndrome;
- NO further value for disease risk assessment for people with BMI> 35
How does Waist to Hip Ratio indicate Body Fat?
- Alternate method to evaluate impact of body fat distribution on disease risk (use with BMI);
- Waist circumference/hip circumference;
- Disease risk increased = > 0.95 in males and >0.8 in females;
- Key concept = fat deep within abdomen and around intestines and liver increases disease risk
What factors contribute to obesity?
- Adaptive Thermogenesis;
- Futile;
- Brown adipose tissue (vs. white)
What is Adaptive Thermo?
changes in energy expenditure induced by factors such as food intake (i.e.- starvation)
What is Brown Adipose?
- Can waste energy as heat;
- -Tissue contains more mitochondria than white adipose tissue;
- -Mitochondria uncoupled from electron transport chain energy lost as heat instead of used to produce ATP;
- Found in infants → Helps to maintain their body temp ;
- Recent evidence: brown adipose tissue may also be present in adults in varying levels
What is Hypertrophy?
- Can increase CELL SIZE up to 1000 times;
- Occurs in overweight – moderate obesity
What happens to cell size during weight loss?
Cell size DECREASES
What is Hyperplasia?
- Occurs primarily during GROWTH process → Increase in Cell NUMBER;
- Can occur in adults once cell size at max. (morbid obesity)
What happens to cell number during weight loss?
-DO NOT lose number of cells, just shrink in size
What is ATGL (Adipose Triglyceride Lipase)?
- Hydrolyses ester links between triglycerides;
- uptake, synthesis, storage, mobilization
What do Adipocytes release first?
Release of ADIPOCYTOKINES = 1. Adiponectin;
- Leptin (
- Involved in appetite regulation, energy balance, glucose regulation, fatty acid catabolism
What else do Adipocytes release?
- Release of substances effecting BP, serum lipid levels;
- In ANDROID obesity, increased release of proinflammatory cytokines by fat cells is association w/ chronic low grade inflammatory state = increased health risks
What type of organ is Adipose tissue?
largest ENDOCRINE organ in the body and secretes hormones and cytokines, which are largely proinflammatory
What is Adiponectin?
- The antiinflammatory, proinsulin-sensitizing hormone from fat;
- DECREASED with excess visceral adiposity, which further contributes to the proinflammatory state.
How are the adipocyte secretions controlled?
-Secretion of hormones and cytokines from adipocytes is primarily regulated by adipose tissue macrophages in a paracrine fashion
What is Paracrine?
- A type of hormone function in which hormone synthesized in and released from endocrine cells binds to its receptor in nearby cells and affects their function;
- The secretion of a hormone by an organ other than an endocrine gland
What do inflammatory adipokines and free fatty acids lead to?
Inflammatory adipokines and free fatty acids lead to every component of the metabolic syndrome.
What does LOW Adiponectin predict?
-Anti-inflammatory from adipocytes! ;
-Hypertension;
-Myocardial infarction;
-Coronary dysfunction
→ In obesity, however, it circulates at LOW levels;
→ At such levels, adiponectin is a predictor of hypertension and vascular injury
What are the targets of Visceral Adipose?
- Endothelial dysfunction;
- Increased inflammatory gene expression in circulating monocytes;
- Nonalcoholic steatohepatitis;
- Skeletal muscle insulin resistance and mitochondrial dysfunction;
- Cardiac insulin resistance leading to the cardiomyopathy of obesity;
- β-cell apoptosis leading to loss of insulin secretion; and Alzheimer’s disease → which is 3 times more common in obese than in nonobese patients
What are the theories for Regulation of Energy Balance?
- Short-Term;
- Long-Term;
- Set Point Theory
What is the Short Term Theory?
Controlled by signals from GI tract, brain, and psychological factors physical triggers for hunger → triggers for satiety
How does the Short Term Theory work?
-Short term regulation of energy balance affects APPETITE;
-Secretion of pancreatic hormones;
-Stretch receptors in STOMACH signal hypothalamus to DECREASE appetite;
Release hormones by intestinal tract
What hormones are released by the intestine during Short Term Reg?
- GLP1: Stimulates insulin & amylin secretionà satiety
- CCK: in response to fats/proteins in chyme: àGB contraction, àpancreas to secrete enzymes à satiety in brain
- Ghrelin: from stomach in response to low food intake/ fasting. Acts on hypothalamus to stimulate hunger
What is the Long Term Theory?
- Involves feedback from adipose mass when “normal” body composition is disturbed;
- Leptin and adiponectin are involved.
How does Long Term Regulation work?
- Long-term Energy Balance: regulates AMOUNT of body fat=
1. Leptin — increased with increased fat stores;
2. Adiponectin — increased when fat stores decrease
What is the role of Leptin in Long Term Regulation?
- Acts on hypothalmus (interacts with many other peptides in the brain);
- Production may be related to levels of circulating insulin;
- Inhibits food intake;
- Increases energy expenditure;
- LEPTIN regulation better at preventing weight loss than preventing excessive weight gain
What is the role of Adiponectin in Long Term Regulation?
- Stimulates food intake;
- Increases insulin sensitivity;
- Decreases inflammation
What is the Set Point Theory?
body’s efforts to preserve SPECIFIC body weight (controversial)
How is energy EXPENDED?
- REE (RMR) = 60-70% of total energy expenditure;
- Thermic effect of food/ Diet induced thermogenesis/ Specific dynamic action;
- Activity thermogenesis: energy expended in voluntary activity
What are the methods for measuring energy expenditure?
- Direct Calorimetry;
- Indirect Calorimetry;
- Double Labeled Water;
- Electrical Impedance
What is Direct Calorimetry?
- Does not provide information on type of fuel oxidized;
- Does not reflect energy used in “free living” situation;
- High cost, rarely available
What is Indirect Calorimetry?
- Measures oxygen consumption & CO2 production;
- Equation used to convert to REE;
- Metabolic cart or monitor;
- Hand held indirect calorimeters
What is Double Labeled Water?
- GOLD standard for measuring energy requirements in humans;
- Benefits = easily administered, individual can go on with daily activities;
- Accurate = has precision of 2% - 8%;
- Impractical for clinical use = isotopes are expensive/ equipment requires expertise to use
What is Electrical Impedance?
- Sending electrical current through the body that distinguishes from fat and fat-free mass;
- Tanita scale = provides %body fat and FFM)
What are the etiologies of Obesity (causes)?
- Genetics: influence taste, appetite, storage;
- Medical Conditions and Pharmacologic Agents;
- Psychological;
- Environmental/ Lifestyle
Genetics vs. Environment
Is there only one gene associated with body weight regulation?;
Research =
-75% of the variation in BMI is due to genes and
- 25% of the variation is due to environment
How does family history relate to obesity?
- Individuals with family hx of obesity are 2-3 times more likely to become obese;
- Many studies regarding genes vs. environment involved twins
Is it possible for someone with no genetic tendency toward obesity to become overweight or obese?
??
-“When it comes to health and fitness, your genetics may load the gun, but your environment pulls the trigger” -Chris Freytag
What psychological factors of the environment and diet affect obesity?
- Cues to signal inappropriate eating (sight, smell, time, variety, advertising);
- Availability (lack of $, excess of unhealthy choices, access to groceries, cooking facilities);
- Experience (purchasing, preparing, tasting);
- Time (shop, prepare, clean up)
What psychological factors of the environment related to physical activity affect obesity?
Limited access to outdoors/ equipment
What psychological factors of the environment related to culture affect obesity?
- Social activity = food;
- Food = reward, love…;
- Influence of peers, family: food choices & portions/ activity choices
What lifestyle factors affect obesity?
- Sedentary vs active @ work & leisure;
- Dining out/ portions;
- Increase in snacking – poor choices;
- Physical Activity: availability/ safely/ time
How does CHOICE affect obesity?
–
How have portion sizes changed over the years?
- Soft drinks = increase 62%;
- French frieda = increase 57%;
- Cheeseburgers = increase 24%
What are our nutrition messages?
- All foods can fit?;
- Is there bad food?;
- Eat more fruit and vegetables?
