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
2
Q
sodium importance
A
water balance/distribution, maintaining acid-base balance, cellular transport mechanisms, muscle and nerve function
3
Q
____ is not sodium
A
salt
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)
5
Q
need for sodium is related to
A
loss (sweating)
6
Q
tolerable upper limit for sodium
A
2.5g
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)
8
Q
potassium is ____ a plentiful as sodium
A
twice
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
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
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
12
Q
vitamin C and CVD
A
Plays a role in cholesterol metabolism
13
Q
vitamin K and CVD
A
plays a role in vascular health and calcium homeostasis
14
Q
vitamin E and CVD
A
Reduces lipid peroxidation and platelet aggregation
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
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
17
Q
Isocaloric replacement of saturated fatty acids with monounsaturated and polyunsaturated fatty acids helps to reduce
A
LDL
18
Q
saturated fat sources
A
Fats solid at room temperature (butter, lard, coconut oil, palm oil), fatty meats, cured meat, full-fat dairy
19
Q
finer can help reduce
A
LDL choelsterol
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
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
22
Q
sodium and potassium intake in hypertesntion
A
reduce sodium intake and increase potassium intake through diet
23
Q
increased blood pressure/ hypertension, 20-50% of people are
A
salt sensitive
24
Q
salt sensitivity is associated with with genes
A
genetic variations in ACE, angiotensinogen, and nitric oxide synthase
25
DASH diet
Dietary Approaches to Stop Hypertension
26
DASH diet limits sodium too? what is the lower sodium version too?
2300mg / day
A lower sodium version exists limiting to 1500 mg per day
27
macro breakdown in DASH diet
27% fat (no more than 6% saturated fat), 18% protein, 55% carbohydrates
28
DASH diet; potassium ,calcium, magnesium, fiber, cholesterol intake
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
29
daily servings of foods in a dash diet (based on 2100 cal diet)
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
30
STUDY on DASH diet slide 22
what did they evaluate
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
31
study found that each 10 gram increase in whole grain intake per day was associated with
4% reduction in the risk of cardiovascular mortality
32
study: lowest vs highest intake of whole grain people what CVD mortality risk
Compared with the lowest intake of whole grain intake, people with the highest whole grain intake had a 13% lower risk of cardiovascular mortality
33
each 10 gram increase in red/procesed meat is associated with
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
34
dairy products and CVD?
Neither our meta- nor dose-response analysis showed effects of dairy intake on the risk of cardiovascular mortality
35
nuts and CVD risk
a 27% lower risk of cardiovascular mortality in individuals with the highest nut intake compared with the lowest intake
36
legumes and CVD mortality?
No associations of legume intake with the risk of cardiovascular mortality from the meta-analysis data
37
dose response analysis found that a 10gram increase in legumes per week is associated with
with a negligible 0.5% reduction in the risk of cardiovascular mortality
38
higher fruit and vegetable intake is associated with lower cardiovascular mortality by
by 28%, where a larger (36%) risk reduction was found with only higher fruit intake
39
when do the benefits of fruits and vegetables plateau
at 5 servings per day
40
what can headaches be a symptoms of what deficiency
iron deficiency anemia
41
inverse relationship between what mineral and headaches
inverse relationship between serum ferritin levels and experiencing severe headaches or migraines in people who menstruate
42
in post menopausal Womens high levels of what are protective
ferritin
43
iron and headaches for males?
No relationship exists between iron and the experience of headaches and migraines in those assigned male at birth.
44
forms of iron
1. hemoglobin and myoglobin
2. storage iron (ferritin)
3. transport iron (transferrin)
45
hemoglobin and myoglobin
- Most of the body iron found here
46
storage iron; stored as what? where? excess iron is held as?
Iron stored as ferritin in the liver, spleen, and bone marrow
- Excess iron is held as hemosiderin
47
transport iron found where? what transport protein?
Found in blood plasma bound to the transport protein transferrin
48
what is iron absrotpiton influenced by
by iron form (heme vs non-heme) and chemical state (Fe3+ - ferric vs Fe 2+ - ferrous)
49
larger portion of dietary iron is
non heme
50
non heme
Includes all plant sources of iron and 60% of animal sources
51
heme absorption and size
Heme iron is smaller than non-heme and absorbed much more quickly
52
non heme aborsption? bound to?
Non-heme iron is bound to organic components and must be separated to absorb it
53
ferric vs ferrous
ferric = fe3+
ferrous= fe2+
54
what is non heme iron exist as (ferrous or ferric) what must change
Non-heme iron exists as ferric iron (Fe3+) and must be reduced to ferrous iron to be absorbed
55
what substance helps non heme iron turn from ferric to ferrous iron
Gastric acid helps separate ferric iron from the organic compounds it is bound to and reduces it to ferrous iron
56
what happens to the non heme iron that is not reduced
Any iron that remains bound to organic compounds or is not reduced to ferrous iron is lost in the feces
57
% absorption of heme and non heme iron
Approximately 17% of nonheme iron and 25% of heme iron is absorbed
58
iron deficiency affects absorption?
Iron deficiency seems to enhance absorption of heme iron, but not nonheme iron
59
where is iron absorbed
upper small intestine
60
proportion of dietary iron absorbed is determined by
the amount of ferritin already present in the intestinal mucosal cells
61
how is iron absorbed in the intestine
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
absorption factors of iron
1. body need
2. vitamin c and other acids
3. animal proteins
4. infection
5. binding agent
6. calcium
63
body need for iron affects absorption
Deficiency or increased demand increases absorption
64
vitamin c and other acids effect iron absorption
- An acidic environment enhances absorption by reducing ferric iron to ferrous iron
65
animal proteins and iron absorption
- 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
infections affecting iron absorption
- Depresses iron absorption to limit iron supply to infectious microorganisms
67
binding agents and iron absorption
- Phosphates, phytates, and oxalates prevent absorption
- Some vegetable proteins (like soy) decrease absorption
- Polyphenols (tea and coffee) decrease nonheme iron absorption
68
calcium affecting iron absorption
- 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
where does iron regulation occur
at the point of absorption
70
how does body excrete iron
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
heme iron sources
animal protein
72
non heme iron sources
Spinach, sweet potatoes, peas, broccoli, leafy greens
Enriched cereals and whole grains
Legumes
Dried fruit
73
food triggers fro migraine headaches
caffeine, milk, cheese, citrus, processed meats, MSG, aspartame, and alcohol
74
fasting and headaches?
Fasting has been associated with triggering migraine headache
75
omega 3 and headaches?
Dietary intake of omega-3 fatty acids associated with lower prevalence of severe headache or migraine
76
therapeutic considerations for headaches
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
reasons for iron deficiency
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
common symptom for iron deficiency? what gender?
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
PICA
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
how much iron supplementation if deficient
iron deficiency need 150 – 200 mg elemental iron per day (2 – 5 mg/kg body weight)
81
do all iron salts yield the same amount of elemental iron?
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
when to take heme vs non heme iron
Heme iron supplements can be taken with meals
Iron salts (nonheme iron) should be taken on an empty stomach
83
hemoglobin levels improve in how many days of therapy
30 days
84
how long to continue iron therapy for after hemoglobin levels return to normal
Iron therapy should continue for at least 2 months after hemoglobin levels return to normal to replenish iron stores
85
what to avoid with iron supplementation
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
common side effect of iron supplementation
constipation
87
therapeutic diets for migraine headaches
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
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
C. 8 weeks
89
when does cognition peak
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
dementia is part of another diagnosis
Parkinson’s disease, Alzheimer’s disease, chronic traumatic encephalopathy (traumatic brain injury), vascular dementia, etc.
91
mild cogntiive impairment
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
dementia
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
risk factors for dementia
Depression
Insufficient mental activity Insufficient exercise
Type 2 diabetes Hypertension Obesity Smoking
Depression
Insufficient mental activity Insufficient exercise
94
changes in age with body ? muscle decerase?
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
cardio and aging? renal? respiratory?
Cardiovascular changes including reduced cardiovascular fitness and arteriosclerosis
Renal changes resulting in reduced function and difficulty maintaining fluid balance
Reduced respiratory elasticity
96
GI and aging? which acid do you lose? what vitamin absorption is effected? neural?
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
loss of gastric acid with aging affects absorption of
absorption of vitamin B12 and reduces uptake of thiamine, folate, calcium, and iron
98
age groups for nutritional requirement
Age-related nutritional requirements are often divided by age: 51 – 70, and 71 and older
99
calories in old people
Caloric requirements generally decrease but are still dependent on activity
100
macros in old people (carbs and fats)
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
protein requirements in old people
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
what mineral requriemnt increases with aging to help reduce bone loss and risk fracture
calcium
103
what mineral requreimtn drops if old, what not to supplement with
Post menopausal iron requirements drop. Iron supplementation is not recommended for older adults
104
potassium equipment for old people
Potassium requirements change depending on diuretic use
105
sodium intake in old people
Sodium intake should be limited to 2300 mg to avoid fluid retention and increases in blood pressure
106
folate in old peopl
Folate optimization is recommended to prevent increased homocysteine and acceleration of atherosclerosis
107
b6 in old people to preserve
muscle mass
108
b12 in old people
based on reductions in gastric acid and difficulties with absorption
109
vitamin D in old people
to account for increased calcium requirements and reduced time outdoors
110
are old people more or less thirsty
Hypothalamic changes alter the thirst mechanism resulting in less drive for fluid intake
111
what affects fluid requirements in old people
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
general fluid requirements in old people
1.2 L to 2 or 3 L depending on body size and activity levels
113
therapeutic considerations for dementia
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
prevention of dementia
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
neuroprotection in dementia
Antioxidants to reduce oxidative damage
Promotion of neurotrophic signalling
116
what antioxidants for neuroprotection
Pinocembrin (honey, propolis, ginger)
Naringenin (citrus) Genistein (soy)
Orientin (tea)
Eriodictyol (citrus, peppermint)
Luteolin (radicchio, peppers) Apigenin (parsley, celery)
117
what polyphenols for neuroprotection
Curcuminoids
Taurine (meat, dairy, fish)
Allicin (garlic)
Harpagoside
Alpha lipoic acid (spinach, broccoli, tomato, organ meats)
118
which edits for lower alzheimers risk
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
MIND diet
A combination of the Mediterranean and DASH diets was created specifically to promote brain health – Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND)
120
MIND diet recommednations f
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
MIND diet recommends LESS THAN....
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
alcohol and MIND diet
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
MIND diet reduced alzheimers by
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
feeding assistance in dementia
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
calorie target in dementia
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
other dietary suggestions in dementia
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
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
B. Mediterranean diet and DASH diet
