Nutrition Flashcards
Which nutrients provide you energy
- Macronutrients (lipids, protein, carbohydrates)
- micronutrients (minerals and vitamins) DO NOT provide energy
essential amino acids
- Histidine
- Isoleucine
- Leucine
- Methionine
- Phenylalanine
- Thronine
- Tryptophan
- Valine
- Lysine
conditionally non-essential amino acids
Arginine Asparagine Glutamine Glycine Proline Serine Tyrosine
non-essential amino acids
Alanine
Aspartate
Cysteine
Glutamate
calculating energy requirements: estimation
Weight maintenance: 25-35 kcal/kg
Weight loss: 20-25kcal/kg
Weight gain: 35-45 kcal/kg
simple carbohydrates
- mono-/disaccharides
- maltos (glucose-glucose)
- sucrose (fructose-glucose)
- lactose (galactose-glucose)
complex carbohydrates
- starches (amylose, amylopectin)
- cellulose
- glycogen
essential fatty acids
-how derived: unsaturated –> polyunsaturated and monounsaturated –> omega 6, omega 3 from polyunsaturated, omega 9 from monounsaturated
energy scale for food
- carbs = 4 calories per gram
- protein = 4 calories per gram
- fats = 9 calories per gram
structural differences between saturated, unsaturated, and trans fats
- saturated is straight
- unsaturated has a cis double bond
- trans has a trans double bond
how are energy requirements calculated
-age, weight, hight
factors that require adjustment in energy requirements
-bed rest
-out of bed
-general surgery
-sepsis
-multiorgan failure
burns
-temperature
Nutrition: obesity
- promote weight loss through calorie restriction
- meds: contrave, qxymia, Belviq, Saxenda, Orlistat
- diet = weight loss
- exercise = weight maintenance
Nutrition: diabetes
- Equal distribution of CHO throughout the day
- 40% daily calories (Energy Requirements: 2000 kcal/day, 40% calories CHO: 800 kcal / 4 g/kcal = 200 g/day, 5 meals per day: 200 g / 5 meals = 40 g/meal)
- 1 “serving” CHO = 15g (~2-3 servings per meal)
- Glycemic Index
- Carbohydrate Counting
- Carbohydrate to Insulin ratio
- Rule of 500 (500 divided by your TDD (Total Daily Dose of insulin) = grams of carb covered by one unit of Humalog or Novolog)
nutrition: dyslipidemias
- CONTROL/RESTRICTION OF DIETARY FATS/LIPIDS
- Avoid trans fats (Fast foods, Baked goods (shortening))
- Limit saturated fats (=solid at room temperature) (Butter, Coconut oil)
- Focus on mono- and polyunsaturated fats (=liquid at room temperature) (Olive oil, Grapeseed oil, Avocado, Nuts)
- Limit simple carbohydrates (sweets, sodas, juices) for pure Hypertriglyceridemia
kidney disease (acute v chronic)
-PROTEIN, ELECTROLYTES, FLUID CONTROL/RESTRICTIONS
kidney disease restrictions
- RESTRICTIONS
- Low sodium (< 2000 mg/day) (Limit fast foods, canned foods, processed foods (e.g. lunch meats), etc., No added salt to cooking, Beware of salt substitutes (potassium chloride), Herbs)
- Phosphorus restriction (Limit dairy (milk, yogurt), dark sodas, shrimp, organ meats, chocolate, broccoli, nuts, etc.)
- Fluid Restriction (Water, coffee, teas, sodas, juices, soups, popsicles)
- Protein (Reduced protein CKD 4&5, Increased PRO needs on dialysis (hemodialysis [HD], peritoneal dialysis [PD]), Meat, seafood, eggs, cheese, legumes (beans, lentils), nuts)
- Low potassium (2g/day) Hyperkalemia (Dysrhythmia, sudden death, Treatment: Kayexalate, IV calcium, insulin + glucose, albuterol, bicarb, diuretics)
other considerations for kidney disease
- Hypermagnesemia (Reduce Magnesium - Limit nuts, seeds, grains (rice, buckwheat), spinach, mackerel)
- Vitamin D deficiency
CHF nutrition
- SODIUM/FLUID CONTROL/RESTRICTION
- Low sodium (<2g/day)
- Fluid restriction (~1-1.5 L per day)
- Increased potassium for patients on K-wasting diuretics (e.g. Lasix)
- Promote high K foods: oranges, avocados, potatoes, bananas, green leafy vegetables
- Limit alcohol
- Low fat (CAD)
- DASH diet
Atrial fibrillation nutrition
- VITAMIN K CONTROL - NOT RESTRICTION
- Coumadin/Warfarin
- Consistent Vitamin K intake
cirrhosis
- PROTEIN CONTROL
- Questionable protein restriction d/t generalized malnutrition
- Ammonia (Hepatic encephalopathy, Protein limitation, Lactulose, Branched Chain Amino Acid (BCAA) Supplementation)
- Fluid restriction (Ascites)
- Low sodium
- High calorie (Small, frequent, calorically-dense foods)
- Avoid alcohol
failure to thrive: post-surgery nutrition
-Malnutrition - Impairs wound healing and increases mortality, Increased needs for: Zinc sulfate: 220 mg qD x 10 days (Copper deficiency), Vitamin C: 500 mg BID x 10 days (Rebound scurvy), Vitamin A: 25,000 IU qD x 10 days (Toxicity)
failure to thrive: elderly
-Small, frequent meals, calorically-dense - Add healthy fats, Oral supplements (e.g. Ensure, Boost, Glucerna, etc.)
failure to thrive: pediatrics
- < 5th percentile on BMI for age
- “Picky eaters” - Portion size: 1 tbs per year of age, Introducing new foods (repeat, repeat, repeat), Creativity
failure to thrive: eating disorders
- Anorexia Nervosa
- Bulimia (Binge eating, Purging - Emesis, Laxatives, Exercise)
celiac disease
- GLUTEN AVOIDANCE
- Gluten = protein found in wheat, rye, barley
Pancreatitis
- NPO
- Pancreatic rest
- IVF vs IV nutrition (parenteral nutrition)
- Pancreatic enzymes (Creon), AquADEKs
seizures
- CARBOHYDRATE RESTRICTION
- Ketogenic diet
- Very low carb, high fat, high protein
biliary colic
-TEMPORARY FAT LIMITATION
cystic fibrosis
- NO RESTRICTIONS - EVER
- High calorie
- Additional sodium
- PERT, AquADEKs
bariatric surgery
- PORTION CONTROL
- Life-long vitamin/mineral supplementation
- Vit B12: 500 mcg SL qD
- Calcium/Vit D: 500 mg/400 IU QID
- Iron-containing multivitamin qD
diverticulosis
- HIGH FIBER
- Fruits, veggies, grains, legumes
diverticulitis
-low fiber
GERD
- PORTION CONTROL
- Small meals
- Limit coffee, tea, chocolate, spicy foods, citrus, fried foods, peppermint, alcohol
Lactose intolerance
-AVOID DAIRY
Cancer/transplant
- FOOD SAFETY
- Low microbial diet
- Avoid unpasteurized foods, undercooked meats, raw grains/nuts,
- Calorically-dense foods
- Filtered water (1 micron or smaller filter)
pregnancy
- ENERGY AND MICRONUTRIENTS
- Energy: 300 additional calories
- Folate: 400-800 mcg qD
- Iron: 27 mg qD
- Calcium: 1000-1300 mg daily
pediatrics nutrtion
Children (based on age and weight):
Infants 0-6 months of age: 108 calories/kg; 2.2 g PRO/kg
Infants 6-12 months of age: 98 calories/kg; 1.6 g PRO/kg
Children 1-3 years of age: 102 calories/kg; 1.2 g PRO/kg
Children 4-6 years of age: 90 calories/kg; 1.1 g PRO/kg
Children 7-10 years of age: 70 calories/kg; 1 g PRO/kg
Children 11-14 years of age: 47-55 calories/kg; 1 g PRO/kg
Adolescents 15-18 years of age: 40-45 calories/kg; 0.8 g PRO/kg
breasmilk vs formula
- for baby: reduced risk of infections, astham, dermatitis, allergies, obesity, diabetes, SIDS, childhood cancer, baby being stressed
- for mom: reduced risk of ovarian and breast cancer, type 2 diabetes and heart disease, postpartum depression, osteoporosis (thin bones), helps lose weight by burning 500 calories/day, saves money and time
vitamin D and iron supplementations
- Vit. D supplementation: 400 IU daily
- Iron supplementation: 1 mg/kg until introduction of solids
geriatrics
- FLUID, TEXTURE, CALORIE/FLAVOR CONTROL
- Taste changes
- Zinc deficiency, loss of smell
- Calorically-dense foods
- Dentition
- Swallow function
- Thickened liquids
- Modified food texture (Soft, Ground, Pureed)
- Anemia of chronic disease
- Fluid requirements (25 mL/kg/day, Dehydration)
nutrient deficiencies and effects
o Vitamin A: elderly, developing nations
o Vitamin B9: pregnancy
o Vitamin B12: elderly, GI diseases, vegetarians, vegans
o Vitamin D: sun avoidance/block
o Calcium: Vitamin D; osteopenia/-porosis; elderly, medications (diuretics)
o Copper: zinc supplementation, decreased immune function
o Iodine: thyroid dysfunction, goiter, cretinism, developmental delay
o Magnesium: muscle cramps
o Phosphorus: brittle bones, fluid imbalance
o Potassium: muscle cramps, fluid imbalance
o Selenium: increased susceptibility to infection
o Zinc: growth and developmental delay
iron deficiency
- Microcytic hypochromic anemia (MCV<80) - Lead/cadmium poisoning
- Pediatrics - Cows milk (High concentration, yet low bioavailability, Competitive absorption)
- Absorption (mostly duodenum)
- Iron losses (GI bleeds, Menstruation - RDA: 18 mg (female) vs 8 mg (male, non-menstruating))
iron toxicity
- Over-supplementation, poisoning (children)
- Iron overload
- Hemochromatosis
protein-energy malnutrition
- Protein Malnutrition = Kwashiorkor
- Calorie/Protein Malnutrition = Marasmus
- Marasmic Kwashiorkor
MVI
- Balanced diet = unnecessary
- Consider if poor PO/dietary intake, food restrictions (e.g. vegans), children
- Risk vs benefit (Beware of “mega” doses)
prenatal vitamins
- All pregnant/breastfeeding women and females of childbearing age
- Increased folic acid provision - 800 mcg/daily
- Additional iron
calcium/vitamin D
- Risk factors
- RDA Vit D: 600 IU daily (800 IU > 70 yo)
Iron and B conplex
- Anemia
- Dietary restrictions
- Pregnancy
Lipids
- made of glycerol backbone
- Glycerol looks kind of like glucose
- When we break this down, glycerol is made into glucose
Medical nutrition therapy
- Consider restricting protein intake once they reach about CKD stage 4 (Also consider reducing potassium)
- Stage 5 CKD is severe
- Use herbs to make things taste good
- Failure to thrive – can happen after surgery
- You want 10 days and no longer because zinc can cause a copper deficiency
- With vitC, its water soluble and you just pee out the excess
- With vitA, you can actually cause toxicity
total daily energy needs
-25 kcal/kg/d (for weight maintenance) • Example 1: 90 yo F @ 45 kg o 45 kg x 25 kcal/kg/d = 1125 kcal/d • Example 2: 22 yo M @ 93 kg o 93 kg x 25 kcal/kg/d = 2325 kcal/d
tube feeding amount
-1.0 kcal/mL (Osmolite 1.0)
• Example 1: 1.0 kcal/mL x 1125 kcal/d = 1125 mL/d
• Example 2: 1.0 kcal/mL x 2325 kcal/d = 2325 mL/d
tube feed rate
-Continuous feeds: infuse over 24 hours
o Example 1: 1125 mL/d ÷ 24 hours/d = 46.875 mL/hr round it! = 45 vs 50 mL/hr
-Bolus: #meals/day
o Example 2: 2325 mL/d ÷ 3 meals/d = 775 mL/meal
complications of enteral nutrition
- Tube related (e.g. blockage, dislodgement)
- Aspiration
- Refeeding Syndrome
- Intolerance
- Diarrhea
Contraindications of enteral nutrition
- Anatomy (e.g. obesity, SBS)
- Hemodynamic instability
- Prolonged/Severe Ileus
- Co-morbid conditions (e.g. ascites, coagulopathies)
Parenteral nutrition
- consists of peripheral parenteral nutrition (PPN) and total parenteral nutrition (TPN)
- Calculating parenteral nutrition: 1. Its complicated rely on your TPN pharmacist and dietitian, 2. When in doubt, use the “standard” formulation
