MT2 Flashcards
What does insulin do?
peptide hormone that promotes glucose transport into cells to control blood plasma glucose levels
What is the AMDR of carbohydrates?
45-65% of total daily calories
20-30g/day of dietary fibers
50g/day to prevent ketosis
what are some functions of carbohydrates?
-Energy source (glucose)
-Antiketogenic (glucose) - prevents high fat mobilization
-spare protein breakdown (glucose) - gluconeogenesis
-Fiber (polysaccharides) - healthy GI
When can Ketosis occur?
Non-diabetics with low carb intake
type 1 diabetic who isnt managing disease well
some type 2 diabetics (less common than type 1)
What organs use ketones as energy?
Brain and heart
What is ketosis?
Large amounts of fatty acids are mobilized from adipocytes for energy metabolism, however large amounts of fatty acids cant be fully metabolized and ketones build up in the body
what is hyperglycemia
abnormally high levels of glucose in blood
what is type 1 diabetes
no insulin production by pancreas (no beta cells), requires exogenous insulin therapy
what is type 2 diabetes
insufficient insulin production (beta-cell dysfunction), alongside resistance to insulin
90% of diabetics are type 2
What are the hyperglycemic values
> 125mg/dL glucose
2 hour plasma glucose after 75g glucose load = >200mg/dL
what is glycated hemoglobin (A1C)
Indicator of glucose control
diabetic levels = >6.5%
prediabetic levels = 6-6.4%
normal values = 4-5.9%
How does insulin function in the body?
Insulin secreted by the pancreas interacts with cell surface receptors and this promotes glucose transport into cells through glucose transport proteins
What is the anabolic function of insulin?
glucose to glycogen
amino acids to proteins
pyruvate to fatty acids
What is the anticatabolic function of insulin
Inhibits lipolysis
inhibits glycogen
inhibits protein breakdown
what are counter regulators of insulin?
cortisol
glucagon
adrenaline
noradrenaline
growth hormone
What are some co-morbidities of poor glucose control?
Hyperglycemia is a component of metabolic syndrome
can cause retinal degeration
heart disease/hypertension
kidney disease
what are some treatment options for type 2 diabetes
diet changes to control glucose/exercise to lose weight
if not effective then oral hypoglycemic agents added (metformin) - lowers nlood plasma glucose
if not effective then insulin injections for glucose control
what are some ways to manage type 2 diabetes
increase exercise
lower saturated fatty acid intake and increase omega 3 fats
lose weight
avoid simple sugars and choose complex carbs
low glycemic index foods
lower calorie intake by 300-400kcal
keep protein at 15-20% AMDR to avoid kidney stress and gluconeogenesis
what is the glycemic index/load
potential for food to increase blood glucose
<55 is low GI, >70 is high GI
Glycemic load is GI x amount of carbs
ex/ GI for bread is 70, amount of carbs is 15%
70 x 15/100
GL=10.5
<11 is low GL, >20 is high GL
what are some issues with the glycemic index
determined for single foods, not meals
distracts individual from other factors like calories or saturated fat
there is a high variability in GI among people
what are the 3 steps to a nutritional approach to managing diabetes
assessment by health care provider (ex A1C and FPG lab tests, dietary assessment, etc)
intervention to develop a strategy (ex dietary plan and food planning such as carb counting)
Monitoring and evaluation of results (EX seeing if plan is working, and if it isnt making changes to the plan or introducing OHA or insulin therapy)
What is the most common cancer for women
breast (1 in 8.9 women)
What is the most common cancer for men
prostate (1 in 7.1 men)
What influences cancerous gene expression
genetic and epigenetic changes, as well as diet and other environmental factors
what is a genoprotective diet
low in harmful dietary factors (carcinogens)
sufficient in protective dietary factors like vitamin b folate
delays age on cancer onset
what is cancer characterized by
dysregulated cell growth/death as well as loss of differentiation
what are the 3 stages of carcinogenesis
Initiation - DNA mutation
promotion - mutation established and passed on to promote mutant cells
progression - metastasis or spreading of cancer cells through inactivation of tumor suppressor genes
What is cancer metastasis
spreading of cancer to other areas, commonly occurring in the brain, respiratory regions, skeletal regions, liver, and lymph nodes
hard to treat with high mortality
What are some events that can promote cancerous growth
DNA damage through mutations causing oxidative or non-oxidative damage
expression of cancer-promoting genes
suppressed immunity
diet can have a role in all of these events as deficiencies in antioxidant vitamins, folate deficiency, and vitamin A deficiency can all increase risk of these events
essentially, more damage to DNA through lack of protection or increased exposure causes mutations that can raise cancer risk
How do environmental factors impact cancer
2/3 cancer caused by these, can be dietary or non dietary, proven as when humans migrate to new environments their risk of cancers changes based on where they live, while maintaining their own culture’s genetic background
What is the ACS grading system
system for estimating contribution of dietary factors to cancer prevention,
A1-best established evidence (limit alcohol for oral/esophageal cancer)
A2 - probable benefit (limit red meat for colorectal cancer)
What is the link between Beta-carotene supplements and Lung cancer
isolated beta carotene may increase the risk of lung cancer, however when in fruits and veggies it can lower risk
What are the cancer risks with obesity and increased exercise
bmi - higher breast, colon, and endometrial cancer
exercise - lower breast and colon cancer
What are the cancer risks with high dietary fat
higher colon, breast, and prostate cancer risk
What are the cancer risks with high dietary protein
higher colon cancer risk with high red meat intake
How do fruits and veggies lower cancer risk
higher fiber and other phytochemicals to increase GI microbiome health, eliminate carcinogens, prevent oxidative damage (flavonoids), and affect hormone action (phytoestrogens)
high nutrient density for vitamins and minerals
How does alcohol increase carcinogens
mouth throat esophagus cancer risk
malnutrition is common in drinkers, leading to folate deficiancy
How does your cooking method affect carcinogen content
smoking, grilling, or frying can cause polyaromatic hydrocarbons (PAH) - burned/smoked foods
heterocyclic amines (burned meats)
acrylamide (fried potatoes)
Nitrites (smoked/cured meats) - carcinogenic nitrosamines
What are diet recommendations to lower cancer risk
more fruits n veggies
less booze
less fats
less red/processed meat
less burned/smoked/fried meat
less calories with more exercise
What is cancer cachexia
Wasting disease
loss of weight and muscle mass due to muscle protien breakdown
anorexia due to low NPY and anemia
WHat is the goal of nutritional cancer care
correct nutritional deficiencies
slow rate of or prevent weight loss through enhanced nutritional support
what are some nutritional recommendations to the side effects of cancer therapy
low fat cold liquids for nausea
non acidic liquids for mouth inflammation
high moisture foods for xerostomia
caloric dense foods for early satiety
safe well cooked foods with A1 ACS rating for immunodeficiency
What foods should be given for entral and parentral nutrition
entral (tube into nose down to gut) - milk/soy/predigested foods
parentral (IV, used with nonfunctional gi tract) -glucose, amino acids, albumin, minerals
What are some neurological disorders chronic low intake of nutrients can cause
wernike-korsakoff syndrome -B1 defciency
peripheral neuropathy -vitamin B6 deficiency
What are some neurological disorders chronic excessive intake of nutrients can cause
peripheral neuropathy - B6 excess
What are some neurological disorders malabsorption can cause
fat malabsorption
vitamin binding deficiencies
what are some nutritional related assessments for neurological disorders
comparing rate of chewing
extent of dysphagia
cognitive funtion
ability to self feed
What is dysphagia
difficulty with swallowing, can cause lung infections, choking, and malabsorption
treated by mashing or liquifying solids, thickening liquids with starches/yogurt
micronutrient supplements
enteral nutrition
WHat are the 2 types of strokes
85% thromboembolic
plaque blocks vessel with clotting or clot travels to vessel in brain
15% intracranial hemorrhage
ruptured blood vessel
what are some stroke prevention techniques? what are some non-nutritional factors
preventing hypertension, obesity, diabetes, atherosclerosis, thrombosis
non nutritional factors include smoking, low exercise, age, and genetics
What are nutritional management goals of a post stroke patient
lower cholesterol, lower fat, and lower salt not an immediate priority
major task is to implement a balanced diet to manage dysphagia and aid recovery
What is epilepsy
different types of seizures that are characterized by abnormal neural activity
2 or more unprovoked seizures that occur more than 24 hours apart
How do anti-epileptic drugs work
influence hepatic vitamin D metabolism, causing vitamin D deficiency
folic acid can influence absorption of these drugs, and shouldnt be mixed with the drugs
What is a nutritional management method of epilepsy? How can the components of this strategy be measured?
Ketogenic diet is used when drugs cant control the seizures, and is an alternative to brain surgery
creates a state of ketosis, but requires very strict diet and only works in 1/3 people, can also raise risk of GI issues and CVD, medium chain triglycerides can facilitate the use and can cause rapid and efficient ketosis due to dast absorption (meat, eggs, fish, butter, etc)
may involve fasting period, followed by 9:1 ratio of fat to protein, with about 5kcal/kg/day of protein for a child (about 1.25g)
to calculate how much of each, do energy requirement/10 parts, then calculate protein by multiplying 5kcal/kg by weight of child
What is parkinsons disease
progressive loss of dopaminergic neurons, causing disorders with movement control (more movement inhibition)
L-dopa is used to control symptoms as it is converted to dopamine to make up for missing dopamine, high B6 and amino acids compete with absorption and lower availability to brain
what are some nutritional management approaches to parkinsons
minimize daytime protein, by intaking most of it during dinner
what is Alzheimers disease
most common form of dementia due to degeneration of cortical neurons
what are some nutritional consequences of alzheimers
increased dependancy on others for feeding and dysphagia causes weight loss
abnormal eating behaviours such as not recognizing foods and increased distraction during meals
frequent snacks and nutrient supplements recommended
What is the difference between life expectancy and life span
life expectancy is the average number of years people live
life span is the maximum time members of a population are to live
What is essential life span?
theory that maintenance and repair systems (MRS) of the body assure reproductive fitness, genes to next generation
MRS function deteriorates after ELS, and genetic factors influence the rates
WHat is oxidative stress
imbalance between free radicals (oxygen containing molecules with uneven electrons) and antioxidants in the body, the damage done and repairs results in aging and chronic diseases
free radicals cause chain reactions due to high reactivity, so when more free radicals than antioxidants exist, damage can be done to fatty tissue, DNA, and proteins causing hypertension, atherosclerosis, inflammation, and cancer
what factors increase oxidative stress
decreased dietary intake of antioxidants
decreased activity of endogenous antioxidants like glutathione
increased pro-oxidant exposure
decreased repair of damage (of DNA damage for example)
excessive levels of iron and copper
What are some examples of dietary antioxidants
vitamins, flavonoids, and phytochemicals
what are some examples of endogenous antioxidants
endogenous - made in body
glutathione, GPx (glutathione peroxidase - needs selenium), transferrin (has high levels of iron n copper - can cause oxidative damage)
what are some sources of pro-oxidants
incomplete reduction of oxygen (energy metabolism)
killing of microbes (immune system)
cytochrome P450 (detox and other chemical reactions
excessive levels of iron or copper
exposure to radiation, smoke, and pollutants
How does aging affect muscle function
decreased lean body mass (sarcopenia - age-associated skeletal muscle loss, usually due to lack of activity)
How does aging affect senses
decreased sense of taste/smell, associated with zinc deficiency and cancer treatments, impaired ability to detect spoiled foods and less pleasure from food
How does aging affect the mouth
causes xerostomia (dry mouth), tooth loss, which can lower intake of food as well as causing decreased saliva and dysphagia
How does aging affect the GI tract
causes gastritis and decreased intestinal absorption of nutrients such calcium, vitamin b12, lactose intolerance, and higher risk of constipation - higher fluid and fiber intake recommended
How does aging affect the kidneys
dehydration risk increases, and high protein intake can further compromise kidney function
How does aging affect nervous system
affected appetite, memory, attention, and increased risk of dysphagia due to decreased neurotransmitter production and increased oxidative stress
How does aging affect the immune system
more likely to be compromised in elderly, causing increased risk of infections and malignancies
How does aging affect the endocrine system
decreased insulin secretion capacity of pancreas and increased insulin resistance
How does aging affect the cardiovascular system
increased risk of hypertension, lower vascular elasticity, and increased atherosclerosis
WHat are the 6 main nutritional requirements for the elderly
lower energy requirements (300-600 less) due to lower BMR and less activity
no change in protein requirements to lower risk of sarcopenia, while also minimizing stress on kidneys
20% higher calcium requirement due to increased rates of bone loss/ lower intake and absorption of calcium
higher or altered requirements for vitamins due to lower absorption/altered metabolism (+25% vitamin D for lower sun exposure, +15-25% B6 for lower activation/absorption, +B12 for lower absorption)
higher fluid due to decreased thirst response and lower water conservation
maintain normal fat intake for energy and lower risk of deficiency of fat-soluble vitamins
What are some general points when preparing food for elderly
safe foods - pasturized/cooked (due to lower immune function and senses)
nutrient dense foods
appropriate consistency (dependent on levels of dysphagia
supplements if food groups are avoided (like dairy)
deal with external causes of under nutrition (depression, dementia, financial hardship, etc)
