Nutrition in Healthcare Flashcards
What is the Hamilton Family Health team?
- services approx 300, 000 pt in hamilton area
- 166 physicians
- nurses, NPs, dietitians, pharmacists, physician assistants etc.
- “our mission is better care, together”
what can RD’s support management for?
diabetes, HTN, dyslipidemia, GI issues, IBS, celiac, anemia, eating disorders, bariatric surgery
what factors are included in preventative care with RD’s?
- food security
- prenatal nutrition
- infant feeding
- diabetes prevention, heart health, depression
- seniors fragility, malnutrition and healthy aging
what do RD’s tackle on a daily basis?
nutrition misinformation
- some are evidence based an some are not
- goal is to “do no harm”
what percentage of woman in Canada want to reduce their body wt?
70
teens who self report dieting, end up developing what 2 things?
- become overweight
- develop an eating disorder
self dieting and restriction can lead to:
- metabolic changes
- mental health impacts (binge, eating, feelings of guilt, shame)
- weight cycling (wt loss, wt gain, repeat)
what is optimized nutrition?
- meeting nutrient needs
- flexibility in food choices
- enjoyment in food
what is disordered eating?
- restricting/limiting
- food rules
- lack of enjoyment
- feelings of shame/guilt
what is eating disorder?
- ++ time spent in eating disorder behaviours
- impact on function wellness, health
- self eval based on weight, shape
what is the most common eating disorder?
binge eating disorder
what does the HFHT eating disorder toolkit for early detection an intervention include?
screening, assessment, lab Rqn, resources, referrals. registry
what physical changes can put someone at risk for eating disorder?
- early puberty
- abnormal growth
- activities that emphasize body, wt, shape
- low BMI, wt suppression
- T1D
- amenorrhea
- fam hx of eating disorders
what populations are at risk for eating disorders?
- racilized persons
- gay men/trans
- ppl with ADHD, autism an women with disbilities
- ppl in larger bodies
- wt stigma
what are the impacts of weight bias on mental and emotional health?
- stress, depression, anxiety, psychiatric diagnosis, suicidal thoughts
- poor body image
what are the impacts of weight bias on physical health?
- avoid physical activity
- unhealthy eating practices
- delay/avoid seeking healthcare
- increased BP, pain substance use and stress
what are the impacts of weight bias on social health?
- bullying and harassment
- social isolation
- difficulties with relationships
what are the impacts of weight bias on monetary?
- discrimination in education and workplace settings
- lower performance
can you tell how healthy someone is by looking at them?
no
what is “health”?
state of complete physical, mental and social well being endnote merely the absence of disease or infirmity (WHO)
what are the 4 M’s in an assessment?
mechanical, metabolic, mental, monetary health
what are the 5 A’s in an assessment?
ask, assess, advise, agree and assist
what are the tx options to becoming healthier?
- lifestyle
- meds
- bariatric surgery
intuitive eaters tend too;
- enjoy food
- less likely to binge eat or show eating disorder symptomology
what factors can influence wt gain or inadequate nutrition?
mental health, dieting, meds, chromic stress, behaviours, physical activity, sleep, metabolism, culture, gut microbiome, environment
what are the main hormones in our appetite control system?
- ghrenlin
- leptin
- pancreatic peptides
- cortisol
the body is designed to defend against what?
weight loss
high stress levels increasing cortisol can override what?
our appetite (hypothalamus)
what is the HFHT bariatric toolkit?
ongoing follow up and pre surgical support to help pt achieve their health goals and reduce complications
what are some long term complications of bariatric surgery?
- weight regain
- nutritional deficiencies
- high suicide rates an depression
- relapse of diabetes an HTN
- coping after surgery
what is a main common post op complication of bariatric surgery?
hair loss, 1 year post op
what should be assessed and completed for a pt recovery bariatric surgery?
- assess for deficiencies in protein, fatty acids, iron, zinc
- annual bloodwork
- treat deficiencoes
- ensure taking adequate supplementation
what meds can be poorly absorbed after bariatric surgery?
- SSRI
- levothyroxine
- antibiotics
- BC pills
when should you watch for signs of rapid wt gain or loss?
- pregnancy
- infancy/children
- teens
- menopause
- older adults
at 1 year of age, what do infants eating patterns usually look like?
infants diet often mimics the unhealthy eating patterns seen in older children and adults
9-18 months is critical time for nutrition and adequate diets. t or f
t
how many extra cals should be consumed in first trimester?
none
how many extra cals should be consumed in second trimester?
350
how many extra cals should be consumed in third trimester?
450
how much wt gain should there be in first trimester?
1-2 kg
when a womens pre pregnancy BMI is over 30, it is highly linked with increased risk for what?
- gestational diabetes
- pre eclampsia
- c sec
- pre term birth
meeting with an RD to improve OB outcomes can improve what factors in pregnancy?
- optimize dietary intake
- ensure appropriate supplementation
- slow down rate of wt gain
what infants are at high risk of anemia?
- pre term, low birth wt
- breast fed babies
- low socioeconomic status
- born to new immigrants
- insufficient iron rich foods at 6 months of age
- excessive milk consumption
in children an youth, wt loss of what percentage indicates malnutrition and is a medical emergency?
10-20%
<80-88% usual wt for children is an indication of what?
malnutrition and requires urgent assessment
vasomotor symptoms in menopause are associated with a higher incidence of CVD and depression. t or f
t
if menopausal hormone therapy started within first 10 years of menopause, risk of HD and dying of any cause is reduced by what percentage?
40%
what is a key factor in reducing menopausal symptoms and CVD risk?
optimized diet
what dietary pattern has been shown to reduce menopausal symptoms?
Mediterranean diet
what is the A, B, C, D, E, F, G lifestyle?
A- avoid caffeine, alcohol, excess Na an sugars, smoking
B-balanced healthy diet
C- calcium from foods to maintain bones an BP
D- D3 for bone health an immune function
E- exercise - 30 mins x 5 days = 150 min/week
F- chose foods rich in heart healthy fats
Fan- stay cool, dress in layers, stay hydrated
what are common foods challenges amongst seniors?
- food an drug interactions
- constipation
- dehydration
- cooking for one
- eating well on fixed income
what things may you notice about seniors eating habits?
- low appetite
- easily full
- fatigue (skip more meals, rely on processed food, settle for tea)
- trouble chewing, dry mouth, dentures, constipation
what amount of seniors are at risk for malnutrition?
1/3
what population is the most vulnerable and most at risk for malnutrition?
- older women
- socially isolated
- living with depression
- polypharmacy
- poor oral health
malnourished seniors are more likely to:
- more visits to doc
- more likely to have a fall
- admitted to hospital
- increased med use
- reduced quality of life
during hospital admission in malnourished seniors, what is the result?
- worsen during their stay
- stay 2-7 days longer
- high 30 day re admission rate
symptoms of hypoglycaemia:
headache, sweating, dizziness, hunger, blurred vision, fast HR, shaking, anxiety, tired, weakness, irritability
losing wt without trying increases risk of:
- muscle loss
- risk of malnutrition
- falling
- hospitalization an further decline
what is the EMR Tool - Screen?
looks at wt loss, changes in appetite, dysphagia, etc
- consists of 8 questions
what does DASH diet stand for?
dietary approaches to stop HTN
what does combination of Mediterranean and DASH diet reduce?
cognitive decline
Med diet reduces ____ by 28-30%.
CVD
1/3 of participants with depression in the SMILES study reported no symptoms of depression after following which diet?
Mediterranean diet
protein an carbs work tg to boost ____________ in the brain which helps with mood, sleep and feelings of joy.
Serotonin levels
lack of tryptophan an glucose can cause:
low mood, difficulty sleeping, lacking joy, pain inhibition
lack of tyrosine can cause:
lacking drive, motivation an or enthusiasm for life
lack of glutamine can cause:
anxiety, irritable, inability to relax
lack of glucose, methionine and folate can cause:
memory, learning, recall
how much protein should be consumed at each meal?
25g protein/meal
how can you prevent feeling hangry?
eat at reg times, q4-5 hours
is olive oil or coco nut oil better?
olive oil
benefits to olive oil:
- boost in HDL, lowers LDL
- anti inflammatory
-reduce impact of Alzheimers - prevents stroke CVD
- antioxidant
benefits of coconut oil:
- boosts HDL but also LDL
- improve body composition
- handles heat well
DASH diet can lower sbp by how many points of mercury?
11
- this is = to 1 BP med
what is gas an bloating cause by?
swallowed air, certain foods, drinks, meds, supplements
what can gas an bloating indicate?
lack of fibre, an intolerance, or IBS
soluble fibre can lower LDL cholesterol by what percentage?
10
soluble fibre sources:
psyllium, barely, legumes, oats, ground flax an chia seeds and several fruits/veggies
what yogurt should you buy to reduce constipation?
a) danactive
b) yoptimal or logo
c) activia
activia
low levels of vitamin D3 are associated with what?
falls, depression an poor immune function
is vitamin D3 in a lot of our foods?
no it is limited (fish an milk)
who is at risk for vitamin B12?
1/3 of adults over age of 50
risk factors for low B12 status including:
- vegan diet
- med use
- older age
- heart burn
- other GI conditions
- gastric surgery
what is the #1 deficiency in the world?
iron
what populations are mostly deficient in iron?
infants, women and children
when should iron start to be given in life?
5-6 months of age
why should more fruits an veggies be added to meals when you are deficient in iron?
fruits an veggies as vit C can enhance iron absorption
what drink should be avoided when eating a meal (associated with low iron)?
avoid tea/coffee
in child bearing years, what should be tested for? (due to low levels of iron)
test CBC and ferritin
