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Nutrition Flashcards

1
Q

EAR / AR def
(USDA)

A

EAR = Estimated Avg Requirement
AR = Avg Req

-amt to meet requirements for 50% healthy ppl in a pop

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2
Q

RDA / RNI
(USDA)

A

= Rec’d Daily Allowance
= Rec’d Nutrient Intake (?derived from AR)

-avg daily amt to meet reqs of 97-98% of pop

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3
Q

AI
(USDA)

A

= adequate intake
*used when insufficient data for AR

-rec’d avg intake based on observed or experimentally-determined estimates in healthy pop

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4
Q

UL
(USDA)

A

= upper level of intake

highest daily amt likely to post no adverse effects to most ppl

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5
Q

Order of increasing intake

A

EAR / AR
RDA / RNI
RDA <– AI –> UL

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6
Q

AMDR and %’s

A

= Acceptable Macronutrient Distribution Range (% total cals)

P: 10-35%
C: 45-65
F: 20-35

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7
Q

Fat #’s

A

RDA / AI: (?infants only)
31 g/d in 0-6 mo
30 g/d in 7-12

AMDR:
30-40% in 1-3 yo
20-35% in 4+ yo (adults)

UL:
not defined (low sat fat)

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8
Q

EFA types (2)

A

-o6 (linoleic)
-o3 (a-linoleic –> EPA & DHA)

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9
Q

o6
-roles
-health benefits
-AHA

A

-roles:
clotting, CM in brain

-benefits:
↓ LDL
↓ infl
cardioprotective
possibly ↓ stroke
?benefits in CA, IBD, AI dz like RA

*AHA: 5-10% of E to ↓ risk CHD

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10
Q

o3
-eg
-roles
-health benefits
-AHA

A

-oils & some veg: ALA
-fish: EPA, DHA
(ALA can be partially converted to EPA or DHA)

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11
Q

o-6 to o-3 ratio

A

typical american diet 20:1
ideal may be 4:1

achieve by ↑ o-3 intake

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12
Q

Omega-3 PUFA #’s

A

(a-linoleic, fish oil, some veg, etc)

RDA / AI:
0.5-1.6 g/d
(men- 1.6, women 1.5)

AMDR:
0.6-1.2% (>1 yo)
… but AHA recs 5-10% to ↓ risk of CVD

UL:
not determined

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13
Q

Saturated fat, Trans fat, and Cholesterol #’s

A

RDA / AI:
Not defined!

AMDR:
Not defined!

UL:
“minimized”

*no required role
*AHA rec’s sub polys for sat fat ↓ risk of CVD 30%!

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14
Q

Carb #’s

A

EAR:
-100 g/d

RDA / AI: (?1o source of energy for brain)
-130 g/d

AMDR: (to maint wt)
45-65%

UL:
Not established
(sugars <25% E intake)

?
Preg: 175 g
Lact: 210 g

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15
Q

Are carbs essential

A

-Generally not essential!
…Except w some genetic defects in glucose metab

*No know carbohydrate deficiencies

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16
Q

Sugar limits

A

<25% total E intake (source?)

<50 g/d (12t)

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17
Q

Protein #’s

A

EAR:
.66 g/kg/d

RDA / AI:
56 g/d men
46 g/d women

AMDR:
10-35%

UL:
not defined!

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18
Q

Protein deficiencies

A

Kwashioror- protein only
Marasmus- pro & carbs

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19
Q

Protein and weight loss & maint

A

Loss:
1.2-1.5 g/kg daily
(about 90-120 lbs)

Maint:
0.7-1 g/kg daily

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20
Q

Fiber

A

38 g men (14-50y)
25 g women (19-50y)

(28 preg)
(29 lact)

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21
Q

Water AI

A

-includes all sources (food too)
-no RDA or UL

AI (L/d):
3.7 men ~1 gal
2.7 women

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22
Q

Vit D def & xs

A

def: osteomalacia (Rickets in kids)

xs: hyperCa+ complications

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23
Q

Vit D supp in babies

A

400 IU/d if breastfed only

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24
Q

Vit D def in obesity

A

-very common
-obesity causes vit D def bc diluted throughout body

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25
Q

Ca & obesity, effects on adipocytes

A

↑ Ca –> ↓ obesity

Adipocytes:

↓ PTH, vitD, intracellular Ca, lipogenesis, fat stores

↑ lipolysis

*opposite effects above with low Ca intake

26
Q

Fe def

A

-common after bariatric surg, all need MVI to prevent
-ucytic anemia (MCV<80)

** serum ferritin most sensitive

27
Q

GI sites of nutrient absorption

A

Stom: H2o, EtOH

Duod: Fe, Ca (FA, AA, other vits & mins)

Jeju: Fe, Ca proximally; also K, vits & min, carbs, AA, ?fats

Ileum: K, min, salts
**WATER
**FATS & vits ADEK
B12
& remain nutrients
bile salts & acids

Colon:
**WATER
Vit K
Biotin
B12
Thiamine
Riboflavin
NaCl
–> secretes K, HCO3

28
Q

Most important parts of diet for wt loss

A

-LOW ENERGY

-ADHERENCE

29
Q

LCD
-cals
-types

A

800-1500 cal/d

many types:
-exchange system/points
-portion controlled +/- MR
-low F
-low carb
-paleo, SB, Medit, etc

30
Q

Low fat diet def (%)

A

<20% fat
??20-30% fat (AMDR 20-35)

55-65 carb
15 pro

<10% sat fat
↓ LDL & total chol

31
Q

AHA recs & sat fat

A

?low fat diets only

-replace w polyuns veg oil ↓ CVD risk 30% (~statins!)
-if replaced w whole grain carbs ↓ CVD risk 9%

XXX do not replace with refined carbs (↑ CVD risk 1%)

32
Q

Low carb diet def (%)

A

<45% (AMDR 45-65%)

Carbs: 50-150 g/d
-eliminate refined carbs

e.g. Zone, South beach, diabetic diet, VLCD

> =25% protein considered “high”

33
Q

Ketogenic def

A

<50 g/d

34
Q

Joslin new guidelines for T2DM

A

Low carb:

40% carbs (AMDR 45-65%)
-low GI, high fiber

20-30% protein

30% fat
-no trans
-7-10% sat
-20% mono & poly

35
Q

VLCD

A

<800 cal/d

-MR plans typically:
-75-105 g protein
(1.5 g/kg IDEAL bw men)
(1.2 “ women)

-50-100g carbs

-10-20g fats (incl. EFA’s)

*can also be done w store-bought foods (PSMF)

36
Q

VLCD’s more effective than LCD’s?

A

-VLCD’s did not produce greater weight losses than LCD’s
-MR plus LCD may be effective and less $ alternative

37
Q

VLCD complications

A

GI: n/v/change in BMs
Cold intol
Dizziness
Fatigue
Derm: skin, hair, nail changes
Amenorrhea
Psych
Electrolytes: K, Na, cramps, arrhythmias
EFA def
Gout (pre-tx w allo)
Gallstones

38
Q

Keto

A

Induction 20 g/d carbs
Maint 60-90 g/d

-20% protein
-75% fat

↓ HbA1c
-rapid weight loss
-may ↑ LDL, if ↑↑ possibly familial

39
Q

Medit

A

35-40% fat = Moderate fat (AMDR 20-35%)

-high o-3, olive oil
-whole grains, fruits, veg, legumes
-fish, seafood
-limited poultry, rare red meat
-moderate EtOH

PREDIMED:
30% ↓ 1st CV event
40% ↓ onset of T2DM

50% ↓ recurrent CHD (Lyon)

40
Q

Vegetarian diets
-protein sources
-vegan risks
-health benefits

A

-proteins: low-fat dairy, soy, legumes, whole grains, nuts, seeds

-vegans ↑ risk of deficiencies:
…B12, Fe, Zn, Ca, Vit D, o-3*
*may need to supp
…often in Lys as well

-health benefits of vegetarian diets:
…may ↓ CA risk (colon)
…cardioprotective
…↓ LDL
…↓ DM risk, ↑ glycemic control

41
Q

MR

A

** best evidence for wt loss & MAINT

-loss: 2 MR/d better wt loss than diets w food
-maint: 1 MR/d

-can be used with any dietary approach

** partial MR plans produce ↑ wt loss vs. equivalent calorie diets

42
Q

DASH diet

A

-↓ HTN, 8-14 pts in 2 wks
-not intended for wt loss

<1500 Na mg/d
whole grains
fruit & veg
dairy
lean meats, fish, poultry
nuts, seeds, legumes

43
Q

E density

A

Dietary tx can also focus on low-E density foods like fruits & veg

-allows for ↑ volume & satiety

44
Q

Diet effects on lipids

A

Wt loss in general:
↓ LDL and total chol

Low C (vs. low fat):
↓ TG & VLDL
↑ HDL
dz: ↓ DM2

Low fat:
↓ total chol
may ↓ LDL more than low carb

45
Q

Health benefits of other diets

A

Med:
↓ CV mortality
↓ DM2

Veg:
↓ CV mortality
↓ DM2
also ↓ LDL

DASH:
↓ BP

VLCD:
↓ DM2

Low GI, High protein:
Weight maintenance

46
Q

IF

A

-many different types

Study:
-IF w 70% calc EE
↓ wt, fat mass, LDL
… as compared to 70% red without fast
-if no E deficit, IF lost some weight but not improve health compared to other groups

47
Q

Dietary effects on metabolism?

A

Resting EE decreases:
low fat > low GI > low carb

i.e. lower carb diets result in less metabolic slowing

*But POUNDS lost shows similar slowing across diets

48
Q

Metabolic adaptation

A

> 10% wt loss leads to

↓ TDEE greater than expected from wt loss alone
…300-400 less calories to maintain body weight as someone who hasn’t lost 10% bw

-may last 6 mo - 7 yrs

(↑ muscle efficiency as well)

49
Q

What is a calorie

A

1 _c_al = amt of heat to raise temp of 1 g of h2o by 1C

1 Cal = 1 kcal = 1000 calories

50
Q

Essential AA

A

9(11): HILLMPTTV
His
Isoleu
Leu
Lys
*Meth & Cys
*Phenylala & Tyr
Threo
Trypto
Val

51
Q

Conditonally essential AA’s

A

can convert to the other:

*Meth & Cys
*Phenylala & Tyr

52
Q

RQ def & macros

A

-ratio Co2 produced : O2 burned (“C:Otient”), 20 min breath into tube
-unique to individ.
-used to calc BMR

Which macros metabolized:
0.7 fats
0.81 proteins / mixed diet
1.0 carbs*

*stupid mnemonic, high carbs = high co2

53
Q

Micronutrient deficiencies after bariatric surgery (4)

A

Thiamine (B1)
Cyanocobalamin (B12)
Fe
Vit D

54
Q

Thiamine (B1) def, sx & tx

A

-can become acutely deficient post-op, esp if lots of vomiting

Sx:
diplopia
nystagmus
facial weakness
polyneuropathy
ataxia
confusion
Wernicke’s encephalopathy (confusion, ophthalmoplegia, gait ataxia)

B_eriber_1:
wet- high output CHF
dry- symm polyneuropathy

Tx:
100 mg IV/IM QD x1-2wks
…then, 10 mg/d until recovered

55
Q

Fe def

A

-p-bariatric surgery, all pts need MVI!

-routine monitoring to catch early (MCV <80)
-ferritin most sens test

Tx:
-oral replacement
-20-30% may need parenteral

56
Q

B12 def causes (5)

A
  1. Pernicious anemia:
    AI dz, gastric atrophy w ↓ IF
  2. Gastric bypass:
    -loss of parietal cells, ↓ IF
    -30% @ 1 yr, 50% @ 5y if not suppl
  3. Metformin:
    –| ileum abs of B12
    Tx: w Ca supp
  4. Kids w obesity have 4x risk B12 def
  5. Vegans: inadequate B12 intake from animal products

Others:
-low intake of meat and dairy
-poor digestion of meats ↓ B12 release
-low acid e.g PPI
-low IF (as above)

57
Q

B12 def sx

A

weakness / tired
palps
smooth tongue
angular cheilitis
change BM
nerves (numbness, gait, vision)
depression
memory loss

58
Q

B12 dx

A

-B12 levels detect def but dont tell cause
-85% pern an have parietal cell abs, but IF abs less sens & more spec
-↑ MMA (bc B12 converts to succCoA)
-↑ homocysteine

59
Q

Vit D def
-role
-def
-xs
-obesity

A

role:
-fight infxn, support healthy immune system
-bone formation, abs Ca

def:
-osteomalacia (Rickets in kids)
-post-bariatric bc ↓ Ca, vit D intake in food and ↓ absorption
…leads to 2o hyperPTH & osteoporosis
-exclusively breastfed babies need 400 IU/d

xs:
-rare, hyperCa & assoc complications

common in obesity:
-diluted
-↓ skin:volume ratio
-obesity causes vit D def, but NOT other way around
-30-40% prior to bariatric surg –> replace pre-op (50K u/wk x 2 mo)
-need to supp post-op & monitor q3mo, ?DEXA

60
Q

Folic acid (B9) def

-causes (5 + 5 meds)
-sx
-dx
-tx

A

-aka pteroylglutamate / -ic acid
-suppl in preg to prevent neural tube defects

causes:
-unhealthy diets without fruit & veg
-abs probs: Crohn’s, celiac
-genetic do
-EtOH smoking
-MEDS: phenytoin, sulfasal, TMP-SMX, triamterene, OCP)

Sx:
-loss of app
-wt loss
-weakness
-sore tongue
-HA
-palps
-irrit
-macro, megalo anemia

Dx:
CBC, B12, folate (RBC folate leves better)
MMA nL w folate def (↑ w B12 def)

61
Q

Biggest loser study @ 6 yrs

A

Metabolic adaptation:
-after 6 yrs, TEE increased but but remained below baseline
-those w ↑ persistent wt loss has ↑ metabolic slowing
-BUT those who regained also still had metabolic slowing ~500 cal
-physical activity maintained since competition

↓ leptin, T4, TG
↑ HDL, adiponectin
no change in ins sens

62
Q

Estimating energy needs

A
  1. Need BMR:
    -direct or indirect calorimetry
    -calcuated
  2. Maint cals = BMR x activity factor (1.2 sed - 1.9)

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