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NMT200 wk 9 onwards > nutrition > Flashcards

nutrition Flashcards

1
Q

modifiable risk factors in cardiovascular disease

A

High blood glucose Hypertension
High dietary salt intake Low fruit/vegetable intake
Trans fat intake
Oxidized LDL
Excess weight/obesity
Low dietary EPA/DHA intake
Alcohol use
Smoking

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2
Q

sodium importance

A

water balance/distribution, maintaining acid-base balance, cellular transport mechanisms, muscle and nerve function

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3
Q

____ is not sodium

A

salt

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4
Q

1 gram of salt (sodium chloride) = xx mg of sodium

A

1 gram of salt (sodium chloride) = 387 mg of sodium

(approximately 40% sodium by weight)

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5
Q

need for sodium is related to

A

loss (sweating)

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6
Q

tolerable upper limit for sodium

A

2.5g

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7
Q

adequate intake for sodium

A

1500 mg for younger adults, and this decreases with advanced age (1300 for those aged 51 – 70, 1200 for those 70 and older)

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8
Q

potassium is ____ a plentiful as sodium

A

twice

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9
Q

where is potassium found in the body

A

Most is found intracellularly, however, the small amount that exists in the extracellular fluid is very important for muscle function and is tightly regulated by the body

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10
Q

importance of potassium

A

water balance, acid-base balance, and muscle/neuron activity, it is also important in carbohydrate metabolism (stored in glycogen) and protein synthesis

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11
Q

food sources of potassium

A

Avocado, potato, squash, mushrooms, banana, tomato Legumes, particularly white beans
Seafood (highest in salmon)
Leafy greens, particularly beet greens
Dairy

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12
Q

vitamin C and CVD

A

Plays a role in cholesterol metabolism

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13
Q

vitamin K and CVD

A

plays a role in vascular health and calcium homeostasis

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14
Q

vitamin E and CVD

A

Reduces lipid peroxidation and platelet aggregation

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15
Q

therapeutic considerations for CVD

A

Reduce calorie intake and maintain appropriate portion control

Increase intakes of monounsaturated and omega-3 fatty acids

Increase dietary fibre from fruits, whole grains, and vegetables

Increase micronutrients from food (vitamins A, E, B6, B12 and folate)

Consume plant proteins over animal proteins

Reduce use of highly processed foods and opt for whole foods as much as possible

Adopt a Mediterranean diet

Add physical activity

Stop smoking

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16
Q

___% of total cholesterol in the bloodstream comes from diet (remainder is synthesized in the body)

A

20%

Reducing intake only accounts for a small amount

Enhancing elimination may be a more efficient option

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17
Q

Isocaloric replacement of saturated fatty acids with monounsaturated and polyunsaturated fatty acids helps to reduce

A

LDL

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18
Q

saturated fat sources

A

Fats solid at room temperature (butter, lard, coconut oil, palm oil), fatty meats, cured meat, full-fat dairy

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19
Q

finer can help reduce

A

LDL choelsterol

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20
Q

total fiber intake vs soluble fibre intake goals

A

Total fibre intake of at least 17 g per day with a goal of 30 g per day

Soluble fibre intake of at least 7 g per day with a goal of 13 g per day

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21
Q

nutrition supplementation and CVD?

A

In many instances, the evidence base for nutrient supplementation does not show reductions in risk for cardiovascular disease

True for most antioxidants including beta-carotene, omega-3 fatty acids, vitamins C, E

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22
Q

sodium and potassium intake in hypertesntion

A

reduce sodium intake and increase potassium intake through diet

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23
Q

increased blood pressure/ hypertension, 20-50% of people are

A

salt sensitive

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24
Q

salt sensitivity is associated with with genes

A

genetic variations in ACE, angiotensinogen, and nitric oxide synthase

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25
Q

DASH diet

A

Dietary Approaches to Stop Hypertension

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26
Q

DASH diet limits sodium too? what is the lower sodium version too?

A

2300mg / day

A lower sodium version exists limiting to 1500 mg per day

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27
Q

macro breakdown in DASH diet

A

27% fat (no more than 6% saturated fat), 18% protein, 55% carbohydrates

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28
Q

DASH diet; potassium ,calcium, magnesium, fiber, cholesterol intake

A

Based on a 2100 calorie day: potassium intake of 4700 mg per day, calcium 1250 mg, magnesium 500 mg, fibre 30 g, cholesterol intake limit of 150 mg per day

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29
Q

daily servings of foods in a dash diet (based on 2100 cal diet)

A

Fats and oils: 2 - 3

Sweets/added sugars: 5 or less per week

Nuts, seeds, legumes: 4 – 5 per week

Grains: 6 – 8

Vegetables: 4 – 5

Fruits: 4 – 5

Fat-free or low-fat dairy: 2 – 3

Lean meat, poultry, fish: 6 or less

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30
Q

STUDY on DASH diet slide 22

what did they evaluate

A

Evaluated the relationship between the long-term consumption of 10 food groups and cardiovascular mortality

Whole grains, vegetables, fruits, nuts, legumes, eggs, poultry, dairy products, fish/seafood, red/processed meat

There were no studies to be included for fish/seafood and poultry

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31
Q

study found that each 10 gram increase in whole grain intake per day was associated with

A

4% reduction in the risk of cardiovascular mortality

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32
Q

study: lowest vs highest intake of whole grain people what CVD mortality risk

A

Compared with the lowest intake of whole grain intake, people with the highest whole grain intake had a 13% lower risk of cardiovascular mortality

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33
Q

each 10 gram increase in red/procesed meat is associated with

A

with a 1.8% increased risk of cardiovascular mortality, with individuals consuming the highest intakes having a 23% increased risk of cardiovascular mortality compared with those consuming the lowest amount

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34
Q

dairy products and CVD?

A

Neither our meta- nor dose-response analysis showed effects of dairy intake on the risk of cardiovascular mortality

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35
Q

nuts and CVD risk

A

a 27% lower risk of cardiovascular mortality in individuals with the highest nut intake compared with the lowest intake

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36
Q

legumes and CVD mortality?

A

No associations of legume intake with the risk of cardiovascular mortality from the meta-analysis data

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37
Q

dose response analysis found that a 10gram increase in legumes per week is associated with

A

with a negligible 0.5% reduction in the risk of cardiovascular mortality

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38
Q

higher fruit and vegetable intake is associated with lower cardiovascular mortality by

A

by 28%, where a larger (36%) risk reduction was found with only higher fruit intake

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39
Q

when do the benefits of fruits and vegetables plateau

A

at 5 servings per day

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40
Q

what can headaches be a symptoms of what deficiency

A

iron deficiency anemia

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41
Q

inverse relationship between what mineral and headaches

A

inverse relationship between serum ferritin levels and experiencing severe headaches or migraines in people who menstruate

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42
Q

in post menopausal Womens high levels of what are protective

A

ferritin

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43
Q

iron and headaches for males?

A

No relationship exists between iron and the experience of headaches and migraines in those assigned male at birth.

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44
Q

forms of iron

A
  1. hemoglobin and myoglobin
  2. storage iron (ferritin)
  3. transport iron (transferrin)
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45
Q

hemoglobin and myoglobin

A
  • Most of the body iron found here
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46
Q

storage iron; stored as what? where? excess iron is held as?

A

Iron stored as ferritin in the liver, spleen, and bone marrow
- Excess iron is held as hemosiderin

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47
Q

transport iron found where? what transport protein?

A

Found in blood plasma bound to the transport protein transferrin

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48
Q

what is iron absrotpiton influenced by

A

by iron form (heme vs non-heme) and chemical state (Fe3+ - ferric vs Fe 2+ - ferrous)

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49
Q

larger portion of dietary iron is

A

non heme

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50
Q

non heme

A

Includes all plant sources of iron and 60% of animal sources

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51
Q

heme absorption and size

A

Heme iron is smaller than non-heme and absorbed much more quickly

52
Q

non heme aborsption? bound to?

A

Non-heme iron is bound to organic components and must be separated to absorb it

53
Q

ferric vs ferrous

A

ferric = fe3+
ferrous= fe2+

54
Q

what is non heme iron exist as (ferrous or ferric) what must change

A

Non-heme iron exists as ferric iron (Fe3+) and must be reduced to ferrous iron to be absorbed

55
Q

what substance helps non heme iron turn from ferric to ferrous iron

A

Gastric acid helps separate ferric iron from the organic compounds it is bound to and reduces it to ferrous iron

56
Q

what happens to the non heme iron that is not reduced

A

Any iron that remains bound to organic compounds or is not reduced to ferrous iron is lost in the feces

57
Q

% absorption of heme and non heme iron

A

Approximately 17% of nonheme iron and 25% of heme iron is absorbed

58
Q

iron deficiency affects absorption?

A

Iron deficiency seems to enhance absorption of heme iron, but not nonheme iron

59
Q

where is iron absorbed

A

upper small intestine

60
Q

proportion of dietary iron absorbed is determined by

A

the amount of ferritin already present in the intestinal mucosal cells

61
Q

how is iron absorbed in the intestine

A

Intestinal mucosal cells bind iron to apoferritin or apotransferrin to form ferritin and transferrin, respectively

Once these protein binding sites are saturated iron absorption halts and any excess is returned to the lumen of the small intestine

62
Q

absorption factors of iron

A
  1. body need
  2. vitamin c and other acids
  3. animal proteins
  4. infection
  5. binding agent
  6. calcium
63
Q

body need for iron affects absorption

A

Deficiency or increased demand increases absorption

64
Q

vitamin c and other acids effect iron absorption

A
  • An acidic environment enhances absorption by reducing ferric iron to ferrous iron
65
Q

animal proteins and iron absorption

A
  • Heme iron improves absorption of nonheme iron eaten at the same meal
  • Peptides released during digestion of meat and fish enhance absorption of iron from other food sources
66
Q

infections affecting iron absorption

A
  • Depresses iron absorption to limit iron supply to infectious microorganisms
67
Q

binding agents and iron absorption

A
  • Phosphates, phytates, and oxalates prevent absorption
  • Some vegetable proteins (like soy) decrease absorption
  • Polyphenols (tea and coffee) decrease nonheme iron absorption
68
Q

calcium affecting iron absorption

A
  • Large amounts inhibit absorption of heme and nonheme iron consumed in the same meal
  • Typical amounts consumed with food not usually the problem, but more so with supplemental calcium taken with meals
69
Q

where does iron regulation occur

A

at the point of absorption

70
Q

how does body excrete iron

A

The body has no system for actively excreting iron

The majority of iron filtered by the kidneys is reabsorbed, although some is lost in the urine

Some lost through normal cellular turnover (skin, GI lining)

Blood loss

71
Q

heme iron sources

A

animal protein

72
Q

non heme iron sources

A

Spinach, sweet potatoes, peas, broccoli, leafy greens
Enriched cereals and whole grains
Legumes
Dried fruit

73
Q

food triggers fro migraine headaches

A

caffeine, milk, cheese, citrus, processed meats, MSG, aspartame, and alcohol

74
Q

fasting and headaches?

A

Fasting has been associated with triggering migraine headache

75
Q

omega 3 and headaches?

A

Dietary intake of omega-3 fatty acids associated with lower prevalence of severe headache or migraine

76
Q

therapeutic considerations for headaches

A

Consider headaches as a symptom of other disorders (like iron deficiency anemia, other anemias, etc.)

Optimize dietary intake and consider supplemental iron
- Especially when the patient consumes a restricted diet

Ask the patient to reflect on possible dietary triggers

77
Q

reasons for iron deficiency

A

Usually, a result of decreased intake or increased loss

Can also occur due to malabsorption, chronic disease, and obesity

Clinically results in insufficient iron for hemoglobin synthesis

78
Q

common symptom for iron deficiency? what gender?

A

Headache is a common symptom of iron deficiency anemia with the severity of iron deficiency anemia correlating with the severity of headache

This seems to hold true more for those assigned female at birth compared to those assigned male at birth

79
Q

PICA

A

Persistent and compulsive cravings to eat non-food items

Can be present at all age ranges

Items eaten can include ice, soil, hair, pebbles, ash, chalk, paint chips

80
Q

how much iron supplementation if deficient

A

iron deficiency need 150 – 200 mg elemental iron per day (2 – 5 mg/kg body weight)

81
Q

do all iron salts yield the same amount of elemental iron?

A

Not all iron salts yield the same amount of elemental iron

For example, ferrous gluconate is 12% elemental iron by weight vs ferrous fumarate which is 33% elemental iron by weight

Iron bisglycinate is 17% elemental iron by weight

82
Q

when to take heme vs non heme iron

A

Heme iron supplements can be taken with meals

Iron salts (nonheme iron) should be taken on an empty stomach

83
Q

hemoglobin levels improve in how many days of therapy

A

30 days

84
Q

how long to continue iron therapy for after hemoglobin levels return to normal

A

Iron therapy should continue for at least 2 months after hemoglobin levels return to normal to replenish iron stores

85
Q

what to avoid with iron supplementation

A

Avoid taking iron with other minerals (magnesium, calcium, zinc, etc.)

Do not take antacids at the same time as iron supplements

To minimize the effects of meals/other supplements, take iron at least 2 hours after

86
Q

common side effect of iron supplementation

A

constipation

87
Q

therapeutic diets for migraine headaches

A

A low glycemic index may reduce the frequency and severity of migraine attacks

Low-fat diets may also reduce frequency and severity

Ketogenic diets also significantly reduce attack frequency and duration

DASH diet – 30% lower prevalence in highest adherence vs lowest

Some evidence to support dietary elimination based on the results of IgG food sensitivity tests

88
Q

How long should iron therapy be continued after hemoglobin levels normalize in a patient with a history of iron-deficiency anemia?
A. 1 week
B. 4 weeks
C. 8 weeks
D. 24 weeks

A

C. 8 weeks

89
Q

when does cognition peak

A

Cognition peaks around 30 years of age and slowly declines with age

Mild changes in cognition are a normal part of aging

Separating normal aging from abnormal aging can be difficult

90
Q

dementia is part of another diagnosis

A

Parkinson’s disease, Alzheimer’s disease, chronic traumatic encephalopathy (traumatic brain injury), vascular dementia, etc.

91
Q

mild cogntiive impairment

A

cognitive decline is greater than expected for age, education, or development but do not affect the ability to carry out activities of daily living (ADL).

92
Q

dementia

A

Dementia – same as with MCI but ADLs are affected

Mild cognitive impairment (MCI) – cognitive decline is greater than expected for age, education, or development but do not affect the ability to carry out activities of daily living (ADL).

93
Q

risk factors for dementia

A

Depression
Insufficient mental activity Insufficient exercise
Type 2 diabetes Hypertension Obesity Smoking
Depression
Insufficient mental activity Insufficient exercise

94
Q

changes in age with body ? muscle decerase?

A

Muscle loss, bone loss, increase in body fat are very common

Muscle mass decreases approximately 3 – 8% per decade after the age of 30 with the rate of decline higher after the age of 60

95
Q

cardio and aging? renal? respiratory?

A

Cardiovascular changes including reduced cardiovascular fitness and arteriosclerosis

Renal changes resulting in reduced function and difficulty maintaining fluid balance

Reduced respiratory elasticity

96
Q

GI and aging? which acid do you lose? what vitamin absorption is effected? neural?

A

Gastrointestinal changes resulting in reduced digestive secretions

Loss of gastric acid interferes with the absorption of vitamin B12 and reduces uptake of thiamine, folate, calcium, and iron

Neural changes result in increased transit time (constipation) and early satiety

97
Q

loss of gastric acid with aging affects absorption of

A

absorption of vitamin B12 and reduces uptake of thiamine, folate, calcium, and iron

98
Q

age groups for nutritional requirement

A

Age-related nutritional requirements are often divided by age: 51 – 70, and 71 and older

99
Q

calories in old people

A

Caloric requirements generally decrease but are still dependent on activity

100
Q

macros in old people (carbs and fats)

A

Emphasis on complex carbohydrates with high fibre content comprising 45 – 65% of total energy intake

Fat intake of 20 – 35% of total energy intake with an emphasis on healthy fats.

Fats are generally well digested but should be divided up within the day to enhance utilization

101
Q

protein requirements in old people

A

Protein requirements are debated

The RDA suggests 0.8 g/kg body weight

Protein consumption to reduce muscle loss suggests intakes of 1 – 1.25 g/kg body weight

Surgery or acute illness recovery 1.2 – 1.5 g/kg

Ultimately, existing comorbidities, activity levels, and kidney function should guide protein targets for individuals

102
Q

what mineral requriemnt increases with aging to help reduce bone loss and risk fracture

A

calcium

103
Q

what mineral requreimtn drops if old, what not to supplement with

A

Post menopausal iron requirements drop. Iron supplementation is not recommended for older adults

104
Q

potassium equipment for old people

A

Potassium requirements change depending on diuretic use

105
Q

sodium intake in old people

A

Sodium intake should be limited to 2300 mg to avoid fluid retention and increases in blood pressure

106
Q

folate in old peopl

A

Folate optimization is recommended to prevent increased homocysteine and acceleration of atherosclerosis

107
Q

b6 in old people to preserve

A

muscle mass

108
Q

b12 in old people

A

based on reductions in gastric acid and difficulties with absorption

109
Q

vitamin D in old people

A

to account for increased calcium requirements and reduced time outdoors

110
Q

are old people more or less thirsty

A

Hypothalamic changes alter the thirst mechanism resulting in less drive for fluid intake

111
Q

what affects fluid requirements in old people

A

Medications, comorbidities, and age-related system changes also affect fluid requirements

Aging kidneys are less capable of conserving water

Risk of dehydration and overhydration so fluid intake should be monitored more closely

112
Q

general fluid requirements in old people

A

1.2 L to 2 or 3 L depending on body size and activity levels

113
Q

therapeutic considerations for dementia

A

Nutritional support to a patient with dementia will ultimately depend on the cause of the dementia

Alzheimer’s dementia is the most common cause (up to half of all cases) and will be the focus of therapeutic options

Always keep comorbidities and medications in mind, as well as changes to nutritional recommendations for aging patients

114
Q

prevention of dementia

A

Many risk factors associated with dementia are preventable

Need to recognize the impact a lifetime of these effects cause

Treatment after an established diagnosis then becomes quite challenging

115
Q

neuroprotection in dementia

A

Antioxidants to reduce oxidative damage

Promotion of neurotrophic signalling

116
Q

what antioxidants for neuroprotection

A

Pinocembrin (honey, propolis, ginger)
Naringenin (citrus) Genistein (soy)
Orientin (tea)
Eriodictyol (citrus, peppermint)
Luteolin (radicchio, peppers) Apigenin (parsley, celery)

117
Q

what polyphenols for neuroprotection

A

Curcuminoids
Taurine (meat, dairy, fish)
Allicin (garlic)
Harpagoside
Alpha lipoic acid (spinach, broccoli, tomato, organ meats)

118
Q

which edits for lower alzheimers risk

A

Mediterranean diets and healthy Japanese diets are associated with a lower risk of Alzheimer’s disease

A combination of the Mediterranean and DASH diets was created specifically to promote brain health – Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND)

119
Q

MIND diet

A

A combination of the Mediterranean and DASH diets was created specifically to promote brain health – Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND)

120
Q

MIND diet recommednations f

A

3+ servings a day of whole grains
1+ servings a day of vegetables (other than green leafy)
6+ servings a week of green leafy vegetables
5+ servings a week of nuts
4+ meals a week of beans
2+ servings a week of berries 2+ meals a week of poultry 1+ meals a week of fish
Mainly olive oil if added fat is used

121
Q

MIND diet recommends LESS THAN….

A

Less than 5 servings a week of pastries and sweets

Less than 4 servings a week of red meat (including beef, pork, lamb, and products made from these meats)

Less than one serving a week of cheese and fried foods

Less than 1 tablespoon a day of butter/stick margarine

122
Q

alcohol and MIND diet

A

Alcohol was originally part of the dietary recommendations but was removed for safety reasons

Considered an “add on” based on personal health history, risk factors, medications, etc.

123
Q

MIND diet reduced alzheimers by

A

Those with the highest engagement with dietary recommendations saw a 53% lower rate of
Alzheimer’s disease

Those with moderate engagement saw a 35% lower rate of Alzheimer’s disease

Participants with higher MIND diet scores, compared with those with the lowest scores, had better cognitive functioning, larger total brain volume, higher memory scores, lower risk of dementia, and slower cognitive decline, even when including participants with Alzheimer’s disease and history of stroke

124
Q

feeding assistance in dementia

A

Comorbidities and advanced dementia may make eating difficult

Consider using modified utensils and dishes to make eating easier and reduce mealtime frustration

Finger foods

Leave adequate time, protect mealtimes, reduce distractions

125
Q

calorie target in dementia

A

Depends on overall health

Weight loss from altered activity levels, inadequate intake, depression, impaired memory, and self-feeding difficulty should be prevented

May need to increase calorie targets for those who pace or wander throughout the day

126
Q

other dietary suggestions in dementia

A

Consider the nutrient density of foods for those with early satiety

Oily fish consumption for omega-3 fatty acid intake

Ensure potassium intake to prevent loss of muscle mass

Vary fruit and vegetable intake to maximize antioxidant content

127
Q

The MIND diet is a combination of what two therapeutic diets? A. Low GI diet and Mediterranean diet
B. Mediterranean diet and DASH diet
C. DASH diet and ketogenic diet
D. Ketogenic diet and low GI diet

A

B. Mediterranean diet and DASH diet

NMT200 wk 9 onwards (4 decks)

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