Nutrition and Weight Management in Preventive Medicine Flashcards
Name the three classes of obesity and the BMI ranges for each
- Underweight= <18.5
- Normal weight= 18.5-24.9
- Overweight= 25-29.9
- Obesity= BMI of 30 or greater
List the different obesity-related comorbid conditions.
Heart disease Diabetes Hypertension Gallbladder disease Osteoarthritis Sleep apnea and other breathing problems Some cancers (uterine, breast, colorectal, kidney, and gallbladder) Obesity is associated with pregnancy complications High blood cholesterol Menstrual irregularities Hirsutism (excessive hair growth) Stress incontinence Psychological disorders Increased surgical risk Social discrimination against obese persons has strong negative effect on their quality of life
Describe different nutritional assessments a healthcare provider may employ to identify individuals who are at risk and need further intervention.
Tanita Analysis: bioelectrical impedance machines, body fat analyzer
- Body fat mass actual weight of fat in your body
- Body fat % proportional of fat to total body weight
- Body water %: 45-60% in W, 50-65% in M
- BMR: daily minimum level of calories body needs at rest
- DCI: calories needed to maintain current weight
- Metabolic metabolic: compare BMR to your age group (higher than actual age then need to increase activity)
- Bone Mass: predicted weight of bone mineral in the body
Waist circumference: most common way to measure visceral fat in clinical practice; vary with examiner and are frequently inaccurate.
- 35 in in women
- 40 in in men
Define the mnemonic D-E-T-E-R-M-I-N-E, which helps to identify warning signs for malnutrition in older adults.
Disease Eating poorly Tooth loss/mouth pain Economic hardship Reduced social contact Multiple medicines Involuntary weight loss/gain Needs assistance with self-care Elderly, age >80
Discuss popular diets among Americans to include the following:
Vegetarian
Abstain from consumption of meat, but can replace with other protein sources like legumes, nuts, and tofu. Do consume eggs and dairy.
Vegan
Abstain from any animal products; variety of nuts, seeds, legumes, fruits and vegetables, bread, rice, pasta, and dairy alternative. (No eggs or dairy)
DASH diet
Dietary Approaches to Stop Hypertension; focuses on foods rich in potassium, calcium, and magnesium. Vegetables, fruits, whole grains, low fat dairy and meats. Limit sodium, saturated fat, and sugar.
Watch out for hyperkalemia (sodium substitutes are high in potassium)
Mediterranean diet
Heart disease not as prevalent in Med. than rest of the world; plant-based, olive oil is the primary added fat. Seafood, dairy, and poultry in moderation. Sweets and red meat only occasionally.
MIND diet
Mediterranean-DASH intervention for neurodegenerative delay. Brain healthy, limits saturated fat and added sugar, doesn’t focus on weight loss, plant-based.
Paleo diet
Modeled on prehistoric diet; foods that can be obtained by hunting/gathering. Meat, fish, fruits, vegetables, nuts, and seeds. No grain or dairy (advent of farming).
Watch out for deficiencies in calcium and vitamin D, effects of too much saturated fat
TLC diet
Therapeutic lifestyle change; goal is to reduce cholesterol, thereby reducing risk of cardiovascular disease.
Very perscriptive: 6 servings whole grains, 3-5 servings veggies/beans, 2-4 servings of fruit, 2-3 servings of low fat dairy, 5 or fewer oz meat or fish
Limits sodium, alcohol, and saturated fat intake.
Weight Watchers
Paint-based system for weight loss, group meeting culture. Points are based on your individual needs, more points awarded for increased activity.
Indicate some potential complications of a vegetarian or vegan diet.
- Vitamin deficiencies- B12, calcium iron, zinc
- Underweight
- GI distress (from veggies)
Discuss the importance of waist-to-hip ratio and abdominal obesity as risk factors for coronary artery disease (CAD).
- Abdominal adiposity increases risk of cardiovascular disease
- Abdominal obesity is defined as waist-hip ratio above 0.90=M and above 0.85=F, or a BMI above 30.
(Calculated as waist measurement divided by hip measurement)
List some physiologic changes that occur in the elderly that might affect their nutritional status.
- Decreased mobility
- Chronic medical conditions
- Nutrition-related disorders to watch for in the elderly: osteoporosis, anemias, heart disease, diabetes.
List some complications of chronic illness which might compromise nutrition
- Cardiovascular= atherosclerosis, decreased CV capacity
- Digestive= dental changes, slowed gastric motility, constipation, decreased absorption of some nutrients.
- Skin= decreased vitamin D synthesis
- Nervous= reduced senses, cognitive change
- Musculoskeletal= decreased bone density, cartilage wear, muscle loss
Summarize the different components of a person’s life and how this may impact their health, which must be considered when proposing healthy behavior changes.
Prepregnancy/Pregnancy
Nutritional status can affect the mother, the fetus, and risk of birth defects
Adolescent mothers and 3+ pregnancies/2 years have higher nutritional requirements
overwight/obese mothers are at higher risk of gestational diabetes
Folic acid supplementation is essential to prevent neural tube defects
Breast-feeding
Nursing mothers have to increase calorie intake
Breat-fed infants to receive 400 I.U. vitamin D supplement
Infant-toddler
Do not restrict dietary fat <2 years of age- brain development
As a toddler is weaned from breatmilk, recommendation is 24 oz/day of cow’s milk–need a calcium supplement if intolerant
Limit sugar containing beverages including juice for dental health
Adolescence
90% of lifetime bone mass is accrued by 18 years of age – meeting the RDA of 1300mg calcium daily is essential
Adolescent pregnancy, substance use, disordered eating all pose challenges for nutritional adequacy
Older Adults
Goals for the elderly are to maintain adequate weight and appetite
Largest demographic at disproportionate risk for nutritional deficiencies
DETERMINE
Caloric needs diminish but nutrient requirements do not
Monitor for changes in body weight, adequate hydration
Understand the importance of nutritional counseling.
- Adopting a healthy diet is not always easy
- No single educational technique works for everyone
- Practitioner needs to be aware of the patient’s knowledge, culture and normal practices, literacy, motivation, interest in meal planning, and readiness
Consider how medications (and/or their side effects) may influence an individual’s nutritional status
- nausea/vomiting- antibiotics, oral contraceptives, antidepressants, NSAIDs, opioids, chemotherapy
- Diarrhea- metformin, antidepressants, antibiotics, magnesium supplements
- Constipation- opioids, NSAIDs, antihistamines, tricyclic antidepressants, meds for urinary incontinence, iron supplements
- Heartburn- osteoporosis meds, anxiolytics, antibiotics
Describe the role of prevention in cardiovascular health.
- Overweight puts more stress on the heart and blood vessels
- Limiting salt and alcohol can lower your blood pressure
- Limiting sugar can lower your blood sugar
- Physical activity can help you maintain a healthy weight and lwoer your blood pressure, cholesterol, and blood sugar
- Cigarette smoking increases your risk for heart disease
