Nutrition in Health and Illness Flashcards
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
_______ 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
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
Proteins are composed of carbon, hydrogen, oxygen,
nitrogen, _____, _______ and ______
phosphorus, sulphur and iron.
A complete protein is one that contains
all the nine indispensable amino acids, namely:
histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine , tryptophan and valine
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
Infants and children require_____ g protein/kg/day.
2–2.2
________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
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
Clinically, protein-energy malnutrition has three
forms:
1 dry (thin, desiccated)— \_\_\_\_\_\_ 2 wet (oedematous, swollen)—\_\_\_\_\_\_\_\_ 3 combined— \_\_\_\_\_\_\_\_
marasmus
kwashiorkor
marasmic kwashiorkor
What PEM
- grossly underweight
- gross muscle wasting
- no fat
- hungry
- _________’ face
- no oedema
- normal hair
Marasmus
‘old man’s
Caused by diet low in protein and calories.
Marasmus
Clinical features: • oedema • \_\_\_\_\_\_\_\_\_ face • anorexic • hair pale and thinned • apathetic • skin changes
Kwashiorkor
‘moon’
Caused by a diet low in protein with some
carbohydrate, leading to hypoalbuminaemia
Kwashiorkor
_________include simple sugars,
complex carbohydrates (starches) and indigestible
carbohydrate (dietary fibre).
Dietary carbohydrates
The two most
important crops feeding the world are ____ and ___
which are rich in starch.
rice and wheat,
Carbohydrates that are available in food are:
• ______—sucrose, lactose, maltose, glucose,
fructose
•______—sorbitol, xylitol, maltilol, lactilol
________—amylose, amylopectin
• dextrose
sugars
polyols
• starch
As long as adequate energy and protein are
provided in the diet, there is no specific requirement
for _______
dietary carbohydrate.
A small amount—____—is necessary to prevent ketosis. 3
100 g/
day
The two most
important crops feeding the world are ____ and ___
which are rich in starch.
rice and wheat,
Carbohydrates that are available in food are:
• ______—sucrose, lactose, maltose, glucose,
fructose
•______—sorbitol, xylitol, maltilol, lactilol
________—amylose, amylopectin
• dextrose
sugars
polyols
• starch
As long as adequate energy and protein are
provided in the diet, there is no specific requirement
for _______
dietary carbohydrate.
A small amount—____—is necessary to prevent ketosis. 3
100 g/
day
The_______ which applies to carbohydrate foods, is a
numerical index based on a reference point of 100.
GI,
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.
- five serves of vegetables and two serves of fruit
- three serves of ________
- 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
