Nutrition in Health and Illness Flashcards by MA CARMELA CONCEPCION SALES

The essential components of nutrition 1 can be
classified as:

•_________—proteins, fats and
carbohydrates, which are interchangeable sources
of energy and also water
•________—sodium, chloride, potassium,
calcium, phosphate and magnesium
•________—water-soluble vitamins (e.g. C,
B); fat-soluble vitamins (e.g. A, E, K); essential
trace elements (e.g. copper, iodine, iron, zinc)

macronutrients

macrominerals

micronutrients

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_______ factors may play a vital role in the
causation of several of the major diseases, such as
coronary artery disease, hypertension, diabetes and
cancer

Nutritional

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Special diets are important in the management
of many hereditary metabolic disorders, such as
____ and ______ and several
other disorders such as ______

phenylketonuria and galactosaemia,

coeliac disease

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Proteins are composed of carbon, hydrogen, oxygen,

nitrogen, _____, _______ and ______

phosphorus, sulphur and iron.

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A complete protein is one that contains

all the nine indispensable amino acids, namely:

histidine, 
isoleucine,
 leucine, 
lysine, 
methionine,
phenylalanine, 
threonine
, tryptophan 
and valine

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Protein in animal products (fish, meat and milk) is
of high quality and that in vegetable products is lower
because of a limited supply of ______(in cereals) and
methionine and ______ (in legumes)

lysine

cysteine

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Infants and children require_____ g protein/kg/day.

2–2.2

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________content foods—lean beef and lamb,
chicken, fish, eggs, milk, cheese, soy beans

______ content foods—bread,
spaghetti, corn, potatoes (cooked), rice (cooked),
cabbage, cauliflower

High protein

• Medium protein

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This is a deficiency syndrome with a reduction in
all macronutrients, energy (kilojoules) and many
micronutrients due to an inadequate intake of protein
and energy foodstuffs

PEM

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Clinically, protein-energy malnutrition has three
forms:

1 dry (thin, desiccated)— \_\_\_\_\_\_
2 wet (oedematous, swollen)—\_\_\_\_\_\_\_\_
3 combined— \_\_\_\_\_\_\_\_

marasmus

kwashiorkor

marasmic kwashiorkor

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What PEM

grossly underweight
gross muscle wasting
no fat
hungry
_________’ face
no oedema
normal hair

Marasmus

‘old man’s

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Caused by diet low in protein and calories.

Marasmus

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Clinical features:
• oedema
• \_\_\_\_\_\_\_\_\_ face
• anorexic
• hair pale and thinned
• apathetic
• skin changes

Kwashiorkor

‘moon’

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Caused by a diet low in protein with some

carbohydrate, leading to hypoalbuminaemia

Kwashiorkor

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_________include simple sugars,
complex carbohydrates (starches) and indigestible
carbohydrate (dietary fibre).

Dietary carbohydrates

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The two most
important crops feeding the world are ____ and ___
which are rich in starch.

rice and wheat,

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Carbohydrates that are available in food are:

• ______—sucrose, lactose, maltose, glucose,
fructose
•______—sorbitol, xylitol, maltilol, lactilol
________—amylose, amylopectin
• dextrose

sugars

polyols

• starch

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As long as adequate energy and protein are
provided in the diet, there is no specific requirement
for _______

dietary carbohydrate.

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A small amount—____—is necessary to prevent ketosis. 3

100 g/

day

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The two most
important crops feeding the world are ____ and ___
which are rich in starch.

rice and wheat,

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Carbohydrates that are available in food are:

• ______—sucrose, lactose, maltose, glucose,
fructose
•______—sorbitol, xylitol, maltilol, lactilol
________—amylose, amylopectin
• dextrose

sugars

polyols

• starch

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As long as adequate energy and protein are
provided in the diet, there is no specific requirement
for _______

dietary carbohydrate.

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A small amount—____—is necessary to prevent ketosis. 3

100 g/

day

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The_______ which applies to carbohydrate foods, is a

numerical index based on a reference point of 100.

GI,

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It is a measure of the capacity to increase postprandial glucose levels compared to a glucose load. The standard food is glucose, which is given an arbitrary level of 100.

The glycaemic index (GI)

The higher the GI, then the higher the rise in | blood glucose level and thus the greater the ___

insulin | response

_______, which is composed mainly of fatty acids and dietary cholesterol, is the most concentrated source of food energy

Dietary fat

Fatty acids are classified according to the number | of _____

unsaturated double bonds

Classification of FA according to # of bonds nil—________(e.g. butyric and stearic acids) • one—_______ (e.g. oleic acid) • more than one—__________ (e.g. linoleic acid, eicosapentanoic acid [EPA], docosahexanoic acid [DHA])

saturated monounsaturated polyunsaturated

The n-3 and n-6 polyunsaturated fatty acids with chain lengths of 18 or more are called _________because they are required for vital body functions and animals, including humans, are unable to synthesise them

essential | fatty acids

The current strategy is to reduce total fat intake and reduce saturated fats and increase unsaturated fats, especially _______

n-3 polyunsaturated fats.

_________- contains omega-3 fatty acids, which are considered more potent than the omega-3 fatty acids found in plants

Fish oil

The value of____________in preventing cardiovascular mortality has been well proven. They have no effect on cholesterol levels but have a well-documented potent hypotriglyceridaemic effect.

omega-3 fatty acids

The plasma cholesterol level, and hence the amount of cholesterol in the diet, has been related to the development of ________________

atherosclerosis

Nutritional assessment The first step in nutritional assessment is to identify the ______________

high-risk patient

When taking the history it is appropriate to include a _____________ eaten and ideally get the patient to complete a symptom questionnaire that can then be linked to a computerised nutritional evaluation program, such as Nutricheck

24-hour recall of foods

A nutritionally focused physical examination should be performed on each patient at risk, with the emphasis on _____________, ____________ and signs of micronutrient deficiencies

body weight, waist size, muscle wasting, fat stores

Deficiencies of vitamins B6 and B12 cause neurological disorders, such as

peripheral neuropathy.

The oral cavity, especially the gums, teeth and buccal mucosa, are affected by __________ and ________deficiencies

vitamin B complex and vitamin C

The important anthropometric measurements include height and weight, skin-fold thickness and ______

waist:hip circumference ratio

The RACGP in its red book 6 outlines dietary recommendations based on national guidelines. For adults this is summarised as follows. 1. five serves of vegetables and two serves of fruit 2. three serves of ________ 3. one or two serves of ________

cereals (including breads, rice, pasta and noodles) lean meat, fish, poultry and/ or alternative

The RACGP in its red book: at least 2 g per day of ________________by including foods such as canola-based or soybean- based oils and margarine spreads, seeds (especially linseeds), nuts (particularly walnuts), legumes (including soy beans), eggs and green leafy vegetables

alpha-linolenic acid

The RACGP in its red book: Take care to: limit saturated fat and moderate total fat intake, but consume about 500 mg per day of combined ______ and _______

docosahexaenoic acid and eicosapentaenoic | acid

The RACGP in its red book: Take care to: limit salt intake to less than______________ day (approximately 2300 mg of sodium a day), which is approximately 1½ teaspoons of salt

6 g of salt a

This very impressive prospective, randomised, singleblinded, secondary prevention trial investigated the effects of a ‘Mediterranean’-type diet containing a plant oil rich in omega-3 fatty acids on 605 subjects who had survived their first heart attack

The Lyon Heart Study 7

The Lyon Heart Study: The control group were given a ________. The intervention group had a diet higher in _______ and _________, fibre and vitamin C (olive and canola oils were used in food preparation).

low-cholesterol diet with a mix of unsaturated fats oleic acid, omega-3 fatty acid

The Lyon Heart Study results: Intervention group: ______

the cardiovascular mortality was reduced by 73%. the benefit was independent of any reduction in cholesterol or triglycerides.

Explanation of results of Lyon Heart Study:

One explanation is that the antioxidants and phytochemicals in the plant-based diet stabilise the endothelium of arteries.

The program involves drinking a lot of water, cutting down consumption of dairy produce and eating plenty of complex carbohydrates

Ornish nutritional program

Food antioxidants appear to protect against _______which can suppress immunity

free radicals,

Example of anti-oxidants: ``` Vitamin A, especially ______ Vitamin C Vitamin E ______ (co-enzyme Q10) Selenium, zinc, manganese and copper (nutrient cofactors ```

beta-carotene Ubidecarenone

studies have proved | that antioxidants have a preventive role in ____

macular | degeneration

It causes dryness with keratinisation of the conjunctivae and cornea. It causes growth retardation in children.

Vitamin A (beta-carotene/retinol).

causes beriberi and also Wernicke–Korsakoff syndrome (typically in alcoholics).

Vitamin B1 (thiamine) deficiency

deficiency causes growth retardation, dry scaly skin and angular cheilitis

Vitamin B2 (riboflavin)

causes pellagra.

Vitamin B3 (niacin, nicotinic acid)

deficiency may cause | oral soreness, anaemia and CNS dysfunction

Vitamin B6 (pyridoxine

deficiency causes | pernicious anaemia and memory dysfunction

Vitamin B12 (cobalamin

deficiency is responsible | for scurv

Vitamin C (ascorbic acid)

Features of Vitamin C deficiency

``` deficiency is responsible for scurvy. Clinical features: weakness, malaise, fatigue, bleeding swollen inflamed gums, atraumatic haemarthrosis, impaired wound healing, impaired bone growth. ```

Vit C deficiency: One sign is the __________with surrounding hyperaemia. Diagnosis by decreased plasma ascorbic acid and X-rays of bones and joints.

hyperkeratotic hair follicle

______causes rickets | in children and osteomalacia in adults

Vitamin D (calciferols) deficiency

Features of rickets: Clinical features (rickets): impaired growth, skeletal deformities (bow legs, pelvis, _______), inability to walk, bone pain (arms, legs, spine, pelvis),______ and _____

‘rachitic rosary’ dental deformities, muscle weakness.

diagnosis of rickets

low plasma 25(OH) D3 and phosphate; elevated PTH and alkaline phosphatase; X-rays of joints and long bones of leg.

______causes no specific disease but may result in vague, undifferentiated symptoms and anaemia

Vitamin E (tocopherol ) deficiency

______deficiency is rare and | can lead to an increased bleeding tendency.

Vitamin K (phylloquinone )

_____ deficiency is responsible for pernicious | anaemia and neural tube defects in the fetus.

Folic acid

``` Certain foods can aggravate gout. These include: 1 2 3 4 ```

* tinned fish (e.g. sardines, anchovies) * organ meats (e.g. liver, pancreas, brain, kidney) * alcohol (the major one) * fizzy, sugary soft drinks

Since gout and hyperuricaemia | have a proven association with ______, a healthy heart prevention diet is advisable.

coronary artery | disease

As many as _____ of people who suffer from diabetes are now taking insulin and oral hypoglycaemic medications.

30%

In summary, the diet for both type 1 and type 2 diabetes is based on achieving ideal weight and following a diet of_____ and ____-

high-fibre carbohydrates with a | low GI and low fat

__________is a common problem in our society, particularly in children from 6 months to 2 years who have been given a lot of cow’s milk

Iron-deficiency anaemia

``` Guidelines for safe consumption of alcohol (current NH & MRC recommendations ```

Healthy males and females • No more than two standard drinks per day • No more than four standard drinks on any single occasion

People aged _____years should delay drinking | for as long as possible.

15–17

_______occurs as a result of sensitivity to gluten. It is quite common and often undiagnosed. In some cases, it can occur after a bout of gastroenteritis.

Coeliac disease

Food associated with migraine

* wine, particularly red wine * cheese * oranges * tomatoes * caffeine in some people

Recurrent urinary calculi: 1 Drink at least______of water every day, or more if there is increased fluid loss: this is the most important step.

2 L

Recurrent urinary calculi: Minimise consumption of foods that contain _____ or ____

oxalate or uric acid.

Recurrent urinary calculi: Avoid _____—calcium precipitates oxalate.

milk in tea

Recurrent urinary calculi: Reduce animal protein consumption: restriction to one major ____

meat meal a day (includes chicken | and fish).

Add ______containing fruit juices to the diet, | including grapefruit, apple and orange juice

citrate-

The body needs small amounts of _____ to maintain normal function of the thyroid gland—crucial for normal growth and development.

iodine

In iodinedeficient areas (in soil and water) there is a high rate of__________, ___________, ________

stillbirths, congenital hypothyroidism and | cretinism.

The usual intake of iodine in healthy persons is_______, mostly from iodised salt.

100–200 mcg day

An adequate intake is 150 mcg/day | with higher requirements for ______ and _____

``` pregnancy (220 mcg) and breastfeeding (290 mcg). ```

Measurement is by urinary iodine levels (WHO replete level standard __________ and _______ in pregnancy

≥ 100 mcg/L and ≥ 150 mg/L

Dietary guidelines for children and adolescents in Australia (NHMRC) Reduced-fat milks are not suitable for young children under _____, because of their high energy needs, but reduced-fat varieties should be encouraged for older children and adolescents.

2 years

Dietary guidelines for children and adolescents in Australia (NHMRC) limit _______ and ______intake — low-fat diets are not suitable for infants

saturated fat and moderate total fat