Nutrition Flashcards
1
Q
Factors determining state of nutrition?
A
- biological
- genotype (sex)
- age
- phase of life cycle
- metabolism
- genes - physiological
- desire to eat
- appetite
- palatibility of food - social
- cultural eating
- habits
- availability of food - pathophysiological
- presence of disease
- look at whole picture
2
Q
things to consider to make Nutritional guidelines?
A
- should be population specific
- diet influences gene expression (nutrigenomics)
- 50% of individual variation in plasma cholesterol is genetically determined
- over 50% of variation in weight is associated with genetic background
- 30-60% of blood pressure variation if genotype related
3
Q
Dietary reference values (DRVs)? (8)
A
- DRVs are quantitative reference nutritional intake in different population on the estimated quantities of adequate growth, development and health, while reducing the risk of deficiencies and diseases
1. estimated average requirement (EAR) - average daily dietary intake level that is sufficient to meet 1/2 of the nutrient requirements for healthy individuals in a particular life stage/gender (50% risk of inadequacy)
2. recommended dietary allowance (RDA) - average daily dietary intake level that is sufficient to meet the nutrient requirements (97-98%) for most healthy individuals in a particular life stage/gender
3. tolerable upper intake level (UL) - highest average daily nutrient intake level with adverse effects to most individuals
- useful in use of fortified foods and dietary supplements
4. adequate intake (AI) - used when EAR or RDA is unavailable
- average daily dietary intake level that is based on an estimate of nutrient intake of healthy people
- unrelated to UL
4
Q
metabolic syndrome as secondary target of therapy?
A
- abdominal or central obesity
- elevated blood pressure
- elevated fasting blood glucose levels
- elevated serum TGs
- low high density lipoproteins (HDL) levels
- metabolic syndrome is associated with the risk of developing CVD and diabetes
5
Q
obesity?
A
- the most common nutrition related disorder in affluent countries
- associated with an increased risk of several disease such as type 2 diabetes, hypertension, stoke, dyslipidemia, gall stones (female), cancers (breast, endometrial, ovarian, gallbladder, colon), psychological disorders
- 2/3 adult americans overweight
- 36% obese
- mortality risk increases as BMI increases
6
Q
apple vs pear?
A
- pear- small amounts of visceral fat, most fat in hip, lower body obesity
- apple- large amounts of visceral fat, upper body obesity, contributes more to CVD
7
Q
Body mass index (BMI)?
A
- BMI= weight/height^2
- Kg/m^2
- lbs/inches^2 * 703
- under 18.5 is malnourished
- 18.5-20 is underweight
- 20-25 is healthy
- 26-30 is overweight
- 30+ is obese
- people have different body types but only one BMI, so BMI does not work for everybody, it is a general measurement, fat could be stored in different parts of the body
8
Q
Measurements important in nutritional assessment? (21)
A
- waist to hip ratio
- over 0.9 for men and over 0.85 for women - mid arm circumference
- if MAC is less than 23.5 cm, BMI is likely to less than 20
- if MAC is more than 32 cm, BMI is likely to be over 30 - skin fold thickness
- measurements of lean body mass
- dual energy X-ray absorptiometry (DXA)
- differentiates between bone minerals, fat tissue, and lean tissue (% body fat) - grip strength
- loss of lean body mass - peak expiratory flow (PEF)
- persons max speed of expiration, as measured with peak flow meter, a small handheld device used to monitor a persons ability to breathe out air - assessment of body fat and total body water by bioelectrical impedance analysis (BIA)
- uses resistance of electrical flow through body to estimate body fat
- when set against person height, weight, gender, the scales can then compute body fat % - air displacement plethysmography (ADP)
- body volume is combined with body weight (mass) in order to determine body density
- technique then estimates the % of body fat and lean body mass (LBM) through known equations (density of fat and fat free mass) - measurement of lean body mass using CT scans
- gold standard for measuring body composition
9
Q
WAVE?
A
- a quick tool for providers to assess and discuss weight, physical activity and eating habits
- identify weight, nutrition, physical activity issues to be addressed
- reinforce the importance of nutrition and physical activity in health promotion and disease prevention
- WAVE
- W= weight
- A= activity
- V= variety
- E= excess
- provider can choose to discuss this issues in any order
- 5-10 minutes
10
Q
current dietary recommendations?
A
- recommendations for general population focus on:
- weight reduction
- level of physical activity
- balanced eating
- portion control
11
Q
acceptable ranges for adults of macronutrients?
A
- fat 20-35%
- 45-65%
- protein 10-35%
- fiber
- men 38g
- women 25g
- american diet is 11g/day
12
Q
common causes of death?
A
- heart disease and cancer are the highest
- stroke is high
- diabetes not as high
- diet plays a significant role in prevention of heart disease
- diet plays a role in some forms of cancer
13
Q
Dietary fats?
A
- type of fat in diet is more important than total amount consumed
- dietary fats strongly influenced the incidence of CHD
- evidence linked dietary fat and risk of cancer or obesity is much weaker
14
Q
Plasma lipids and CHD?
A
- increased plasma cholesterol increases risk of CHD
- increased LDL
- decreased HDL
- free radicals risk very high
- increasing HDL and decreasing LDL lowers risk of CHD
15
Q
classification of fatty acids? (36)
A
pic
16
Q
what is a balanced fat intake?
A
- 30% saturated
- 33% PUFA
- 37% MUFA
- composition of dietary lipids have a mixture of different types of fats
17
Q
saturated fats effect on body?
A
- high levels correlate to high levels of total cholesterol
- increases LDL and risk of CHD
- little effect on HDL
- most hypercholesterolemia saturated fats are lauric (12 C), myristic (14C), palmitic (16C)
- stearic (18C) is neutral
18
Q
monounsaturated fatty acids (MUFA)?
A
- increased MUFA, decreases total cholesterol
- decreases LDL and risk of CHD
- HDL is maintained or increased
- cis conformation
- mediterranenan diet, a lot of olive oil, decreases risk of CHD
19
Q
polyunsaturated fats (PUFA)?
A
- eliminating saturated fats is twice as effective in lowering total cholesterol as increasing PUFA
1. omega 6 - decreases total levels of cholesterol
- decreases LDL and risk of CHD
- also decreases HDL
2. omega 3 - little effect on LDL or HDL
- improves overall heart health
- DHA, EPA
20
Q
fish oil intake? (42)
A
- 2-4g of EPA and DHA per day is recommended for persons with hypertriglyceridemia
- decreases cardiac arrhythmias
- decreases serum TGs
- decreases blood pressure
- decreases cardio mortality, anticoagulant effects
- improves endothelial dysfunction
- reduces inflammation
- 2 fish meals per week recommended
21
Q
trans fatty acids?
A
- chemically classified as UFAs but behave like saturated fats
- increased levels of transfat increases total cholesterol
- increases LDL and CHD
- decreases HDL
22
Q
dietary cholesterol?
A
- acts synergistically with saturated fats, positively related to CHD risk
- raises total and LDL cholesterol
- hyper responders may convert cholesterol to bile acids poorly
- found in animal products
- type of fat is more important than total amount consumed
23
Q
summary of dietary fats effects? (45)
A
pic
24
Q
nutrition tips for fats?
A
- fats are calorie dense
1. limit saturated and trans fat
2. more vegetable oil (high PUFA, MUFA)
3. other dietary factors with cardio protective efforts - polyphenol antioxidant compounds- inhibits oxidation, present in grapes (reservatrol), raisins, red wine
- soy protein decreases LDL
25
dietary carbs?
1. simple sugars
- monosaccharides (glucose, fructose) found in corn syrup, honey
- disaccharides (sucrose, lactose, maltose) maple syrup, molasses, table sugar, milk
2. complex carbs
- polysaccharides (starch, wheat, whole grains, potatoes, peas, beans, veggies)
3. non digestible carbs
- fibers
- soluble fiber- viscous gel when mixed with liquid
- insoluble fiber- passes through digestive system intact
- functional fiber- extracted or synthetic fiber and proven health benefits
26
examples of soluble fibers? effects?
- effects:
1. decreases absorption of dietary fat and cholesterol
- increases fecal loss of cholesterol
2. delays gastric emptying
- generates sensation of fullness
- reduces postprandial blood and glucose concentration
- examples:
1. pectin
- ingredient in gelling sugar
- used to make jam
2. hemicellulose
- contains many sugars, branched monomers
- metamucil
27
examples of insoluble fiber? effects?
- effects:
1. reduces constipation and hemorrhoid formation, softens stool
2. increases bowel motility, thus reducing exposure of gut to carcinogens
- examples:
1. lignin
- strengthens wood plants
2. cellulose
- primary structure in cell wall
- whole grains
28
Prebiotic foods?
1. non digestible carbs
- alliums:
- raw or cooked onions
- raw garlic
- raw leek
- raw asparagus
- raw dandelion greens
2. nourish the good bacteria already in colon
3. act as fertilizer for good bacteria, helping them grow
4. improve ratio of good to bad bacteria
5. maybe effective in decreasing number of infectious episodes needing antibiotics and total number of infections in children under 2 years old
6. maybe beneficial to IBD (irritable bowel) and lead to increased production of SCFA
29
Probiotic foods?
1. fermented food can keep digestive system healthy and controlling growth of harmful bacteria
2. fermented dairy products that are high in lactobacilli and bifidobacterium (culture yogurt)
3. tempeh (fermented soy bean)
- substitute for meat
- complete protein with all AAs
- great source of Vit B12
- tempeh can be cooked or crumbled over salads
4. Kimchi, sauerkraut, pickles, fermented meat, fish, eggs
30
added sugars in US diet?
- soft drinks are major problem
- substitute with water, would significantly help diet
- relative price of produce has increased over the years
- high sugar foods are much cheaper
31
Glycemic index? (60)
- some carbs which produce a rapid rise followed with steep fall in blood glucose are considered to have high glycemic index
- low glycemic index carbs create sense of satiety over a longer period of time and may be helpful in limiting caloric intake
- calculating GI= (% total CHO)\*(GI value)
- GI value of various foods is determined based on blood glucose measurements after consumption of 1g of a particular food compared to 1g of white bread
32
Classification of glycemic index?
1. low GI less than 55
- most fruit (except watermelon), veggies, whole grains
2. medium 56-69
- sucrose, candy, sweet potato, brown rice
3. high over 70
- glucose, corn flakes, baked potato, white rice, watermelon, white bread
33
glycemic load?
GL = GI \* CHO (g)
-consider mass and multiply by GI value
34
impact of consuming high GI and GL foods early postprandial period (up to 2 hours) then (2-4 hours later) then (4-6 hours later)?
1. increase in blood glucose levels
2. increased insulin secreted
3. increased anabolism (glycogenesis, lipogenesis)
4. decreased blood glucose due to enhanced insulin action
5. hunger
6. most nutrients are completely absorbed from intestinal tract
7. high insulin/glucagon ratio
8. decreased blood glucose (hypoglycemia)
9. increased hunger
10. low glucose levels create state similar to fasting condition
11. normally low levels of glucose and fatty acids stimulate release of glucagon and epinephrine to increase free fatty acids
- but this is blocked by high insulin levels
35
How does glycemic index affect us?
- low GI maintain healthy levels of blood sugar and insulin and enhance physical and mental health and function
- high GI foods cause more rapid rise in blood glucose levels and is suitable for energy recovery after endurance exercise or for a person with diabetes experiencing hypoglycemia
36
Nutrition tips for carbs?
- starches are good source of B vitamins
- products made with whole grains (wheat, oats, brown rice) typically contain antioxidants, phytoestrogens (high quality carbs and proteins), fiber, Vit E, minerals like iron
- starchy veggies have an average of 3g of fiber
- beans, peas, lentils are an excellent source of fiber and protein, low in fat
37
Nutrition tips for protein?
- animal proteins can carry high saturated fats
- poultry, fish, nuts and legumes are better sources of proteins
- choose leanest cuts of red meat
- excess protein is eliminated as urinary nitrogen along with calcium, increasing the risk of nephrolithiasis and osteoporosis
38
antioxidants defense system?
- antioxidants act as radical scavenger, H+ donor, electron donor, peroxide decomposer, singlet oxygen quencher, enzyme inhibitor, synergist, metal chelating agents, prevent reactive oxygen species
- both enzymatic and non enzymatic antioxidants exist in the intracellular and extracellular environment to detoxify ROS
- free radicals affect DNA, oxidative stress
- fruits and veggies high in antioxidants
