Natural Health Products and Clinical Nutrition Flashcards
What are Nutrceuticals?
Food, Drug or Natural Health product
A nutrient compound that has health benefits in addition to the basic nutritional value contained in food.
What are the “health benefits” of a nutracetical?
Major physiological endpoint like skeletal muscle mass or cholesterol levels
Examples of NHP?
-Probiotics
-Herb remedies
-Vit and Minerals
-Homeopathic Medicines
-Traditional medicines such a traditional chinese med
-AA and Essential Fatty Acids
Do NHPs need a perscription?
No, NHPs must be safe to use as over-the-counter products
Who decides of a NHP is allowed on the shelves?
Health Canada
What does it take for NHP to get on the shelves?
NHP license applications
-Evidence supporting the safety and efficacy of the NHP according to its recommended conditions of use must be submitted to health Canada
What are health claims?
Statements that indicate the intended beneficial effect of a product when used in accordance with its RECOMMENDED conditions of use
What is NHP licensing based on?
Based on at least one health claim to support at least one of the medicinal ingredients in the product
Health claims can be related to what 3 outcomes?
Functional
Therapeutic
Preventative
Health Canada uses a risk-based assessment approach. What does that mean?
Standard evidence required to support the safety and efficacy of the product is proportionate to health risk
Requirement for the legal sale of NHPs in Canada x3
1)Natural Product Number (NHP): Shows Health Canada has reviewed and approved the product for sale
2)NHP complaint label: Shows NPN, ingredients, directions for use and warnings
3)Licensed importer of record: NHP manufactured outside of Canada must be a licensed importer of record with health canada. NHPs manufactured in Canada need to be manufactured, packaged and labelled in a licensed facility.
What is included on a NHP compliant label? x4
Shows NPN
ingredients
directions for use
warnings
What is on a NHP product monograph x7
1)Branding name consisting of trade name and product name in English and French
2)Health claim authorized by Health Canada
3)Potency
4)Quantity per dosage unit
5)MPN
6)Net amount, dosage form
What is included on a product label x7
1)Medicinal Ingredients
2)Uses
3)Warnings
-Allergens
-Ask health care prof before use f
-When using this product consult a health care prof. if
-Keep out of research of children
4)Directions
5)Other info
6)Non-medical ingredients
7)Questions
What is B-Hydroxy-B-Methylbutyrate (HMB)
HMB is a product of leucine breakdown but only 5% of leucine is converted to HMB
True or False: HMB + Vit D supplementation may improve muscle function in older adults deficient in vit D
True, sig difference in handgrip strength, with or without exercise
Exercise showed same benefit
Exercise perscription for HMB and Vit D supplementation to improve muscle function in older adults Vit D deficnet
60 minutes full body resistance exercise 4x/week
Benefits of HMB?
1)Proposed mechanism of action is enhancement of muscle protein synthesis
2)HMB may also help reduce muscle damage and promote muscle recovery following exercise while also attenuating muscle disuse atrophy
Supplementation for HMB and Vit D supplementation to improve muscle function in older adults Vit D deficient
HMB 3g/day
Vit D 2000IU/Day
Main takeaway of Supplementation for HMB and Vit D supplementation to improve muscle function in older adults Vit D deficient
If you are not exercising taking HMB+D supplementation is beneficial in improving muscle function over time
BUT if you are exercising it makes no difference
What are some key considerations when studying the effects of a NHP?
-Minimial effective dose
-Formulation + Active Ingridents
-Pop: quality of the tsudy/who was tested
-Interactions with meds
-Immediate versus chronic effects (potency over time)
True or False HMB +D inreases weight gain?
True in a positive way
T or F: Hypercaloric HMB and Vit D ONS may improve clinical outcomes in older adults.
True, however it was difficult to tell because the supplement and placebo had very different amounts of calories, protein, Fat, and CHO
T or F: Reactive oxygen species are always bad
False too much results in cell damage, but a little is good for cell signaling
What are antioxidants
Substances that inhibit or reduce oxidative damaged caused by ROS
When may ROS damage proteins and cellular membranes?
Only when they get too high enough levels
What are polyohenols
ANTIOXIDANT
-Naturally occur compounds found in plants, fruits (grapes, perars, berries, apples)
Why are polyphenols important
Antioxidant that may protect cells from oxidative damage and limit risk of various diseases
What are the 4 classes of polyphenols
Flavonoids (most abundant in human diet)
Phenolic Acids
Stilbenes
Lignans
True or False Flavonoid intake decreased risk of all cause mortality in older women
True reduced risk of CVD, Cancer mortalityb
What is malnutrition
Deficiencies, excess or imbalance in a persons intake of energy or nutrients
True or False the definition of manutrition has evolved over time
True, grows and includes more research and resources
Why should we care about malnutriment in clinical populations and settings as a public health concern
1)Malnourished surgical patients experience poor postoperative outcomes including increased hospital length of stay and readmission
2)Malnutrition is often a precursor to sarcopenia
What defines preoperative nutritional supplementation
Carbs, Fats, Protein
True or False: Preoperative nutritional supplementation and other nutritional considerations can decrease infection risk, hospital length of stay, and other negative postoperative outcomes
True
What is prehabilitation
Supplementation of nutrient containing or immune-enhancing nutrition in preop period
Trauma and Critical Care Considerations
-Patients may require serial procedures or surgeries that interrupt or alter nutrient delivery and requirements
-After a traumatic injury tissue damage triggers an acute response characterized by protein catabolism, insulin resistance, and increased energy expenditure (20-50% higher in trauma patients compared to those undergoing elective surgery)
-State of hyper-metabolism where your body is trying to make sure it gets enough nutrients. This leads to increased energy expentiture and is more severe in traumatic surgey than scheduked
What are Oral Nutritional Supplements (ONS)
Sterile liquids, semi-solids or powders that contain additional protein, engery, and micronutrients and potentially other specialized nutrients to improve nutritional status
Situations where ONS are used?
Acute or Chronic
Preparation of undernourished patients
Dysphagia
Disease related metabolism
Enteral Nutrition
Delivery of a nutritionally complete feed via a tube into the stomach, duodenum, or jejunum
Enteral Nutrition is used for
People who have inadequate oral intake but functional GI tract
Parenteral Nutrition
Delivery of a nutritionally complete feed via a central or peripheral venous catheter
Bypass the GI tract and portal venous systems
EFFORT Study: Early nutritional support on fraility functional outcomes and recovery
Length of stay greater than 4 days with nutritional support initiated no later than 48 hours after admission
Early use of individualized nutritional support in medical inpatients at nutritional risk lowers risk of mortality and functional decline within 30 days
High score = worse outcome
What is the ERAS Enhanced Recovery After surgery knowledge translation
Aims to develop peri-op care and to improve patient recovery
Gudelines used in many surgical procdures and incuded guidance on nutritoon, wound healing, etc.
