Nutrition Science, Assessment and Prescription Guidelines Flashcards

1
Q

What was the key clinical takeaway of the BROAD study?

A

BMI was reduced more with a WFPB dietary pattern as compared to normal care (no dietary intervention)

This was a prospective, 2 arm, parallel superiority RCT.

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2
Q

What is the key clinical takeaway of the New DIETs (new dietary interventions to enhance the treatments?

A

vegan diets demonstrated greater weight loss compared to omnivorous, semi-vegetarian and pesco-vegetarian diets.

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3
Q

According to a mini review of RCTs that compared plant based diets to control how are health outcomes effected ( Weight, CV health, BP, glucose metabolism)?

A

Health outcomes such as weight, cardiovascular health, bp and glucose metabolism are improved on a plant-based diet, particularly in obese individuals

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4
Q

What does the WHO recommend both adults and children limit their daily consumption of added sugar to?

A

<10% of total calories. <200 kcal in a 2000kcal diet. up to 12 teaspoons or 48g with a goal amount of <5% calories, up to 6 teaspoons/24 g.

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5
Q

What are the recommendations from the AHA regarding sugar consumption?

A

AHA recommends a maximum of 100kcal, 6 teaspoons or 24 g of added sugar/ day for women, children, and teens and no more than 150kcal, 9 teaspoons/36 g of sugar/day for men.

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6
Q

Which foods have high concentrations of saturated fat?

A

higher fat cuts of beef, pork and lamb, salami, sausages, and other processed meats, lard, butter, cheese, coconut and coconut oil, palm oil and palm kernel oil.

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7
Q

What are the top 5 sources of percent saturated fat in the diets of US adults?

A

cheese 16.5%
beef 9.1%
other fats and oils 8.9%
milk 6.7%
Frankfurters, sausages and luncheon meats 6.7%

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8
Q

Which foods are NOT considered high in saturated fats but have more substantial levels of saturated fats?

A

nuts/seeds, brazil nuts are the highest
avocados
plant oils
Eggs
Fish

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9
Q

What was the INTERHEART study and what are the key takeaways?

A

It was a standardized case-control study about acute myocardial infarction risk factors.

There are 9 significant risk factors for AMI –> smoking, lipids, HTN,DM, obesity, physical inactivity, alcohol use, dietary pattern and psychosocial.

Psychosocial risk factors were comparable to the effect of high blood pressure, and abdominal obesity

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10
Q

According to the INTERHEART study what 5 risk factors account for 80% of the population attributable risk for AMI?

A

Smoking,
Lipids,
HTN,
DM
Obesity

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11
Q

What was the INTERSTROKE study?

A

prospective case-control study used to determine the stroke risk factors.

10 RF were identified, HTN, current smoking, abdominal obesity, unhealthy dietary pattern, physical inactivity, diabetes, alcohol intake, psychological stress, depression, cardiac causes and abnormal lipids.

These were associated with 90% of the risk of stroke in men and women of all ages.

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12
Q

What was the Chicago Heart Association Detection Project Industry?

A

Demonstrated that the risk of heart disease is determined by the number of cardiac risk factors a person has. It also showed an association btwn ppl who were lower in risk in middle age with a better quality of life at older ages and lower Medicare costs.

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13
Q

Making changes to modify which 6 factors can reduce the risk of heart disease as much as 90-95%?

A

50% decrease in total cholesterol
6 mmHG decrease in diastolic pressure
smoking cessation
maintain ideal body weight and waist size
>150 minutes per week of moderate exercise
>5 servings of fruits and vegetables per day

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14
Q

What was the Framingham Heart Study?

A

the study looked at the lifetime risk for atherosclerotic cardiovascular disease in ppl who were free of cardiovascular at age 50.

men with optimal risk had a 5% lifetime risk of atherosclerotic cardiovascular disease vs men who had 2 or more risk factors, who had a 69% lifetime risk.

women with optimal risk had 8% lifetime risk of atherosclerotic cardiovascular disease vs women with 2 or more risk factors, who had 50% lifetime risk

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15
Q

Explain the study Actual causes of death in the U.S by McGinnis

A

Objective: To identify and quantify the major external factors that contribute to death in the US.
Study design: article review utilizing data from 1977-1993
Key conclusions: approximately 1/2 of all deaths in the US could be contributed to following actual causes of death: tobacco, diet and physical activity patterns, alcohol, microbial agents, toxic agents, firearms, sexual behavior, motor vehicles, and illicit drug use.

Top 3–> tobacco, diet and physical activity and alcohol are all rooted in behavior choices.

Take home point: lifestyle behaviors are critically important to health in the US and represent modifiable risk factors that could significantly reduce premature mortality.

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16
Q

Describe the “Healthy livings is the best revenge: findings from european prospective investigation into cancer and nutrition-postdam” study, written by Ford ES and Bergmann.

A

Objective: To describes the reduction of the relative risk of developing chronic disease associated with 4 healthy lifestyle factors: never smoking, BMI <30, >3.5 hours/wk of physical activity and adhering to health diet principles.

Study design: prospective cohort

Sample population:German adults

Key findings: participants with four healthy lifestyle factors had a 78% reduction in risk compared with those with none.

Each lifestyle factor was associated with a reduction in risk of developing any chronic disease after adjusting for age, sex, educational status and occupational status.

The biggest impact of having all 4 healthy lifestyle factors as compared to none was seen on incident diabetes risk (93% reduction). The reduction in MI was 81%, stroke was 50%, and cancer was 36%.

BMI <30 exerted the largest reduction risk of any chronic disease, diabetes, or stroke followed by never smoking.

Never smoking exerted the largest risk reduction for MI and cancer.

Conclusions: adopting health behaviors can have a major impact on the risk of morbidity. Having all 4 healthy lifestyle factors reduced the risk of major chronic disease by 80% compared with those with no healthy lifestyle factors in this population in Germany.

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17
Q

Healthy Lifestyle Heart Trial by Dean Ornish

A

Objective: to determine the feasibility of patients sustaining intensive lifestyle changes for a total of 5 years, and the effects of these changes on CHD without lipid lowering drugs.

Study design: RCT
Sample population: N=48

Intervention: Intensive lifestyle changes included a low-fat (10% of calories) vegetarian diet, aerobic exercise, smoking cessation, stress management, and group psychosocial support. No lipid lowering medications were used.

Key results: Mean relative reduction in stenoses of 7.9% for experimental group and increase in stenosis of 27.7% for control. There was a 46.7% relative increase in stenosis in the controls who were not taking lipid lowering medications.

There were 45 cardiac events in the control group vs 25 cardiac events in the experiment group.

More regression of CHD occurred after 5 years than after 1 year in the experimental group, meaning intervention continued to reverse CHD, whereas the control group had continued progression and more than double the rate of cardiac events.
Key conclusions: comprehensive lifestlye changes in ambulatory patients with moderate to severe CHD resulted in significant reductions in both LDL and anginal episodes after 1 year and showed more regression of coronary atherosclerosis after 5 years. In contrast patients following usual care showed even more progression of coronary atherosclerosis after 5 years then after 1 year, with more than twice as many cardiac events.

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18
Q

Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin by Knowler

A

objective: compare the effectiveness of a lifestyle intervention or treatment with metformin in preventing or delaying the onset of diabetes.
Study design: parallel- group randomized control trial with placebo group (placebo BID + standard lifestyle recommendations) metformin (850 mg of metformin BID + standard lifestyle recommendations) and life-style modification program.

Sample population: N 3234 adults without diabetes who had elevated fasting and post-load plasma glucose concentration.
Intervention: randomly assigned to 1 of 3 interventions. standard lifestyle recommendations plus metformin, standard lifestyle recommendations plus placebo twice daily, or an intensive program of lifestyle modification.
The goals of the participants in the intensive lifestyle modification intervention were to achieve and maintain a weight reduction of at least 7% of initial body weight through adopting a healthy low calorie, low fat diet and engage in moderate intensity physical activity for at least 150 minutes/wk.

Key results: Baseline characteristics were similar for all groups. Participants were follows for 2.8 years. 50% of participants in the lifestyle medicine intervention group had achieved the goal of weight loss of 7% or more by the end of the curriculum (24 wks) and 38% had weight loss of at least 7% by the time of their most recent visit.

74% of participants met the goal of 150 minutes of physical activity per week at 24 weeks. The cumulative incidence of of diabetes was lower in the metformin and life-style intervention groups than in the placebo group during the follow-up period.

The incidence of diabetes was 58% lower in the lifestyle intervention group and 31% lower in the metformin group as compared to placebo.

The incidence was 39% lower in the lifestyle-intervention group as compared to the metformin group. Based on these results 6.9 persons would need to be treated via lifestyle intervention for 3 years to prevent once case of diabetes, vs 13.9 persons who would need to be treated with metformin.
Significance for lifestyle medicine: demonstrated how a comprehensive and sufficiently intensive lifestyle intervention can be more effective than medication at treating pre-diabetes/preventing the development of diabetes. It highlights the importance of addressing multiple lifestyle medicine pillars and ensuring sufficient intensity to reach pre-specified goals.

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19
Q

Describe the Lyon heart study

A

1988-1993, N=605
Tested if the mediterranean diet is associated with reduced risk of recurrent MI vs the AHA step 1 diet. The study was stopped early bc of signifiant beneficial effects noted in the original cohort.
50-70% lower risk of recurrent heart disease. recommends step 1 diet–> fruit, root vegetables, leafy green vegetables, breads, cereals, fish, foods high in alpha linolenic acid.

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20
Q

Clinical trial of the effects of dietary patterns on BP (DASH diet)

A

Objective: study the different dietary patterns on BP.
Study design: parallel, RCT with 3 groups. control diet, fruits/vegetables and combination diet (fruits/vegetables and low fat dairy).

Sample population: N=459 adults, 22yo and older who were not taking anti-hypertensive medication.

key conclusions: a diet rich in fruits, vegetables and low-fat dairy products and with reduced saturated and total fat lowered SBP by 5.5mmHg and DBP by 3.0mmHG more than control diet.

These effects were more pronounced in subjects with HTN, lowering SBP by 11.4mmHg and DBP by 5.5mmHg.

A diet rich in fruits and vegetables also reduced bp but to a lesser extent. These changes occurred after 2 weeks and persisted for 6 weeks. These effects seem to be independent of weight loss and physical activity and they were not related to sodium or alcohol intake.

significance for lifestyle medicine: compared to control diet a combination diet was able to significantly decrease BP in subjects with mild to moderately elevated BP. This is comparable to results in trials of drug monotherapy for mild hypertension. Dietary pattern adjustment appears to be an effective strategy to help prevent, treat, and reverse elevated BP with effects that can be seen in a matter of weeks.

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21
Q

2- year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring vs. control to prevent cognitive decline in at risk elderly people (FINGER) RCT

A

Objective: to assess a 2 year multidomain approach to prevent cognitive declined in at risk elderly ppl from the general population.
Study design: double blind, parallel, rct
Sample population: N =1260 adults aged 60-77 years

Control group attended visits with nurse/physician at 6,12, and 24 months and relieved regular healthcare advice on health diet, physical, cognitive and social activites beneficial for managements of vascular risk factors and disability prevention

The intervention group attended the same visits as the control group and received 4 intervention components- nutritional guidance, physical exercise, cognitive training and social activity and management of metabolic and vascular risk factors

Key conclusions: suggest that a multi-domain intervention could improve or maintain cognitive functioning in at risk elderly people from the general population.
Significance for lifestyle medicine: one of the first trials of this scope and scale that demonstrate the impact that a comprehensive lifestyle medicine intervention can have on reducing global cognitive decline, executive functioning and processing speed scores in elderly adults with early signs of cognitive decline.

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22
Q

Reversal of type 2 diabetes: normalization of beta cell function in association with decrease pancreas and liver triacyglycerol by Lim EL.

A

Objective: to test the hypothesis that both beta cell failure and insulin resistance can be reversed by dietary restriction of energy intake. to test the hypothesis that acute negative energy balance alone reverses type 2 diabetes by normalizing both beta cell function and insulin sensitivity.

Study design: intervention study with matched control group.

Sample population: n= 11 ppl with diabetes

Key conclusions: normalization of both beta cell function and hepatic insulin sensitivity in type 2 diabetes was achieved by dietary energy restriction alone. This was associated with decreased pancreatic and liver triacylglycerol stores. The abnormalities underlying type 2 diabetes are reversible by reducing dietary energy intake.

The first phase insulin response increased during the study period and approached control values.

Significance for lifestyle medicine: dietary energy restriction alone can lead to the reversal of abnormalities underlying type 2 diabetes within weeks. Specifically dietary caloric restriction can lead to normalization of both beta cell function and hepatic insulin sensitivity in patients with type 2 diabetes with a wk

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23
Q

Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease by Hambrecht R.

A

Objective: to determine if patients with stable CAD can improve myocardial perfusion and reduce disease progression and to compare the effects of exercise training to standard percutaneous coronary intervention with stenting on: clinical symptoms, angina-free exercise, myocardial perfusion, cost-effectiveness, frequency of a combined clinical endpoint

Study design: randomized control trail over 12 month period.

Intervention: 20 minutes of bicycle ergometry per day.

Key results: exercise training was associated with higher event free survival, increased maximal oxygen uptake, increased exercise tolerance, elevated ischemic threshold by 30%, significantly increased HDL serum levels after 12 months, whereas HDL dropped in the control group. LDL levels remained unchanged during the study period.

clinical symptoms significantly improved in both groups during the study period.

Key conclusions: after 12 months of exercise training, maximal exercise tolerance was increased significantly along with the ischemic threshold. Exercise training was associated with a 16% increase in maximal oxygen uptake. expenses for 1 year of exercise training averaged $3708, compared with $6086 per PCI patient, both groups clinical symptoms improved during the study period.

Significance for lifestyle medicine: compared with PCI 12 month program of regular physical exercise in selected patients with stable CAD resulted in superior event free-survival and improved exercise capacity at lower cots, as well as reduced hospitalizations and fewer repeated revascularizations.

More than double was spent to lessen angina in the PCI group. clearly demonstrates that lifestyle medicine in this case exercise can be more effective and affordable than a conventional medical procedure.

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24
Q

Comparison of the atkins, ornish, weight watchers and zone diets for weight loss and heart disease risk reduction.

A

Objective: Sought to provide a valuable comparison of popular diets for both patients and clinicians.

Study design: RCT for 1 year
S
ample popuation: N=160 overweight or obese patients btwn the ages of 22-72 who had diagnosed HTN, dyslipidemia or fasting hyperglycemia.

Key results: each of the various dietary approaches can be used to reduce weight and improve markers of CV risk. All 4 diets resulted in modest weight loss at 1 year. no statistically significant difference btwn diets. as adherence scores increase, weight loss increased, regardless of the dietary program. each diet significantly reduced the LDL to HDL cholesterol ratio by approximately 10% with no significant effects on BP or glucose at 1 year. for each diet weight loss was significantly associated with decreasing levels of total to HDL cholesterol ratios, crp, and insulin.

Key conclusions: all 4 diets resulted in modest weight loss at 1 year. Adherence to diet not diet type largely determined treatment effects and weight- loss.
Significance for lifestyle medicine: demonstrates that one of the most important predictors of successful weight loss, with any diet is the ability of the patient to adhere to that dietary program. losing weight is more related to consistent caloric restriction and can be achieved in a variety of ways. long term success will require persistent adherence to that dietary plan to lose the weight and keep it off.

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25
Q

dietary recommendations for diabetes

A

decrease dietary fat, processed sugar and processed grains. increase fiber.

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26
Q

dietary recommendations for cancer

A

decrease pro-inflammatory food (saturated fat, processed sugar, processed meat, red meat, highly processed foods)
increase protein from plant food, fiber, anti-oxidant rich food

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27
Q

Trans fat

A

they increase CHD. FDA mandated the removal in 2018. Can still find it in shortenings, fried foods, commercial baked goods, coffee creamers, refrigerated doughs, meat and dairy products.

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28
Q

What are micronutrients?

A

vitamins
minerals

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29
Q

examples of anti-oxidant foods

A

cruciferous vegetables ( broccoli, cauliflower, brussel sprouts, cabbage, kale, bok choy)
dark berries and fruit
allium veg (onion)
orange/yellow vegetables
dark green leafy vegetables

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30
Q

food sources of over consumed nutrients

A

added sugar
saturated fat
sodium

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31
Q

What were the results of clinical events in prostate cancer lifestyle trial: results from 2 years of follow-up

A

93 patients with early stage prostate cancer under going active surveillance
low fat plant based diet, exercise, stress management, group session vs standard of care.
no significant difference

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32
Q

Expanded model for mindful eating for health promotion and sustainability: issues and challenges for dietetics practice

A

promising results have been observed in the management of depression, stress, physical fxn, quality of life and chronic pain.

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33
Q

Environmental impact of dietary change: a systemic review- How does diet effect greenhouse gas emissions?

A

dietary changes in areas with affluent diet can reduce diet greenhouse gas emissions and land use demand by up to 50%

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34
Q

Effects of a dietary portfolio of cholesterol lowering foods vs lovastatin on serum lipids and CRP

A

RCT, 46 patients
Diet low in saturated fat vs same diet plus lovastatin vs diet high in plant sterols, soy protein, viscous fibers and almonds.
LDL was decreased by 8%, 30%, 28.6%
there were significant changes btwn control and portfolio/statin groups.

no difference btwn statin and portfolio group.

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35
Q

vegetarian diets improves insulin resistance and oxidative stress markers more than conventional diet in subjects with T2DM

A

24 wk
RCT of 74 patients
43% of vegetarian diet decreased meds
5% of control decreased meds
body weight decreased more in the vegetarian group. Vegetarian group had great capacity to improve insulin sensitivity possibly due to decreased visceral fat, decreased adipokines and oxidative stress markers

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36
Q

a low fat vegan diet and conventional diabetes diet in the treatment of type 2 diabetes: RCT 74 wk

A

99ppl
both groups lost a significant amounf of weight and had significant improvements in total cholesterol, ldl and non significant improvements in a1c. after adjusting for medication changes a low fat vegan diet appeared to improve glycemia and lipids more.

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37
Q

effects of intensive diet and exercise intervention in patients taking cholesterol lower drugs

A

patients on cholesterol lowering medications were placed on a very low fat, high complex carb diet with daily aerobic exercise and achieved 19,20 and 29% decrease in total cholesterol, ldl and triglycerides.

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38
Q

effects of a low fat, high fiber diet and exercise program on breast ca risk factors in vivo and tumor cell growth and apoptosis in vitro

A

significant reductions in serum estradiol, serum insulin, insulin like growth factor-1 with significant increase in IGF binding protein-1 were seen.

in vivo serum changes that slowed the growth and induced apoptosis in serum and stimulate breast cancer cell lines in vitro were also see with these interventions.

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39
Q

what is the mediterranean diet associated with?

A

adherence to a mediterranean type diet was associated with improvement in health status, decreased mortality, decrease in CV mortality and decrease in mortality from cancer, parkinson’s and alzheimer’s

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40
Q

What were the key findings from the Harvard nurses study?

What did it show were the effects on CHD?

Breast Cancer?

Vitamin D?

A

3 cohorts.
Decades long prospective cohort study.

CHD:
moderate alcohol reduces the risk of CHD.
mediterranean dietary pattern decreases the risk of CHD, stroke.
fish also decreases the risk of stroke. nuts and whole grains are associated with decrease risk of CHD.

Breast cancer:
1 or more alcoholic drink/day increases risk of breast cancer. higher intake of red meat increased risk of premenopausal breast ca.

Risk of colon cancer is increased with 2 alcoholic drinks/day, red and processed meat
folate, vitamin B6, calcium and vitamin D associated with lower risk of colon cancer.

Higher levels of vitamin D are associated with lower risk of colon polyps and colon cancer

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41
Q

Framingham heart study

A

original cohort 1948-2014 75k men/women.
on their 3 generation cohort
aim to identify common factors/characteristics that contribute to CVD by following its development over time.
increase risk of CHD morbidity with increase BP at baseline. high SBP is predictor of CVA and HF.

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42
Q

multi-ethnic study of atherosclerosis (MESA)

A

2000 first exam, last update in 2019.
objectives: study the characteristics of subclinical CVD and the RF that predict progression to clinical overt CVD or progression of subclinical disease. characterized dietary patterns in relation to incidence of T2DM.

Diabetes:
higher intake of whole grains, fruits, nuts/seeds, green leafy vegetables and low fat dairy was associated with 15% lower risk of diabetes.

high intake of tomatoes, beans, refined grains, high fat dairy and red meat was associated with 18% greater risk of T2DM

Additional research topics:There is a benefit of ASA in high risk patients.

association of obesity and higher BMI with disease risk.

CVD:
strong association btwn coronary artery calcium score and cardiovascular health.

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43
Q

National health and nutrition examination survey (NHANES)

A

surveys began in 1960 and 1999. AIM- assess the health and nutrition status of adults and children in the US.

Examine the association btwn usual % of calories from UPF and CVH.
undiagnosed diabetes is a significant problem in the us.

CVD- every 5% calories from UPF was associated with 0.14 points lower CVH (cardiovascular health) score

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44
Q

OmniaHeart- opitmal macronurtient intake for heart health trial

A

conducted btwn 2003-2005 N=164 with pre-HTN, Stage HTN, randomized, 3 periods, cross over feeding studying. Compared the effects of BP/lipids of 3 different diets.
Carb rich, protein rich or diet rich in unsaturated fats.

-Recommendations to eat 1-2 servings of fruit and every meal, extra breakfast 2-3 servings of vegetable at lunch/dinner. fruit and nut trail mix for snacks. each day have a serving of fat-free or low-fat milk and milk product at 2 meals and occasionally a 3rd meal.
select lean versions of meats and remove skin from poultry

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45
Q

What is the DASH diet? Dietary approach to stop hypertension trial

A

1997 n=459
to investigate the effects of dietary patterns of BP on ppl with DBP btwn 80-95.

Mean decrease SBP by 3.2 mmHG. Mean decrease of DBP by 2.5mmHG

2 dietary patterns compared to a control diet.
1. diet enriched in fruits and vegetables
2. diet enriched in fruits, vegetables, and low fat dairy products and low in total saturated fat. (combination diet)

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46
Q

Prevencion con dieta mediterranea

PREDIMED trial

A
  1. N=7447 at high CV risk.

evaluated 3 dietary patterns and their impact on major CV events.
med with EVOO
med with mixed nuts
control diet reduced fat

lower MI ,stroke, death from CV causes with Mediterranean diet with EVOO or nuts.

largest RCT to compare the mediterranean dietary pattern to lower fat dietary pattern

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47
Q

What are the NOVA food classifications

A

Group 1- unprocessed/ minimally processed foods.
Group 2- minimally processed foods and culinary ingredients. (butter, salt, oils from plants, seeds, nuts)
Group 3- processed foods obtained by combining foods from NOVA 1 +2. ex: animal food/cheese/canned legumes/ freshly baked bread
group 4- UPF

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48
Q

What are the key findings of Harvard health professionals follow-up study in regards to sugar sweetened beverages (SSB)?

A

compared with drinking SSB <1/ month drinking 2 or more/day was associated with 21% higher risk of overall mortality and 31% higher risk of death from CVD.
Intake of T2D and other cardiometabolic conditions (CAD, HTN, wt gain)
intake of SSB is associated with long-term CHD,HTN,CVD RF and other cardiometabolic conditions

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49
Q

What are the key findings of Harvard health professional follow-up study and cancer?

A

men and women with higher levels of vitamin D binding protein.
had significant decrease in overall morbidity and mortality relating to colon cancer.

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50
Q

What are the key findings of Harvard health professional follow-up study and red meat and CHD?

A

men with higher intake of red meat had 11-15% higher risk of developing CHD.
Substituting plant protein for red meat was associated with 14-17% lower risk of CHD.

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51
Q

key findings of the women’s health initiative and hormone therapy

A

hormone therapy did not prevent heart disease in post-menopausal women.
resulted in 4.3 million fewer post-menopausal women using combined HT, helped saved $35.2 billion in direct medical costs due to fewer cases of CVD, breast ca and more quality adjusted life years

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52
Q

EPIC oxford Study key findings

A

vegans were able to keep saturated fatty acids to 5% energy < 1/2 of the mean intake for meat ears. Vegans had the highest intake of most vitamins and nutrients. BMI increased with increasing meat. Compared to meat eaters other groups had lower risk of DM and pre DM. Vegetarians had 22% lower rate if ischemic heart disease. 12% lower risk of cancer over in vegetarains/vegans

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53
Q

What did the 7th day adventist health study find?

A

AHS-1Designed to find out which components of Adventist lifestyle to give protection against disease.
AHS-2 continued to follow-up on diet and lifestyle as related to chronic disease incidence.
Found that eating nuts 1-4 times a week lowered the risk of nonfatal heart attack by 74% and lowered the risk of fatal CHD by 73%

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54
Q

What was the interheart study?

A

This was a standardized case-control study about acute MI risk factors. The study identified 9 significant risk factors for AMI. They were smoking, lipids, hypertension, obesity, physical inactivity, diabetes, dietary pattern, alcohol consumption and psychosocial factors. 5 of the factors identified (smoking, lipids, hypertension, obesity and diabetes) accounted for 80% of the population attributable risk for MI.
the 9 RF accounted for more than 90% of the attributable risk of MI in men and 94% of the attributable risk of MI in women.
this study found that psychological risk factors were comparable to the effect of high blood pressure and abdominal obesity.

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55
Q

Interstroke study

A

prospective case control study used to determine stroke risk factors based on data from 32 countries. 10 significant RF world wide were identified they were HTN, current smoking, abdominal obesity, unhealthy dietary pattern, physical inactivity, diabetes, alcohol intake, psychological stress, depression, cardiac causes and abnormal lipids. these were associated with 90% of the risk of stroke in men and women

56
Q

RDA

A

Recommended dietary allowances. the recommended intakes of nutrients that vary by age/sex. consuming the RDA of a particular nutrient will meet the needs of 97-98% of health individuals.

57
Q

daily valve

A

standardized reference amounts in % grams/mg to consume or not exceed each day. developed by the FDA for the labels of foods/dietary supplements.

58
Q

nutrient dense

A

foods high nutrients and low in calories in relation to their weight.

59
Q

carbohydrates

A

primary energy source for the brain and body wt maintenance. RDA 130g. quality is important. highly processed carbs are associated with negative health outcomes.
4 calories/gram

60
Q

protein

A

serves as the major structural component of all cells in the body and fxns as enzymes in membranes as transport carriers and some as hormones.
0.8g/kg
56g/day for men
46 g/day for women
soy bean= complete protein
RDA is based on weight
4 calories/gram

61
Q

fat

A

most fat is made by our body
omega 3 and 6 are essential, we do not makes these. Can only get these from food.
want monounsaturated and polyunsaturated fat.
9cal/gram

62
Q

vitamin A

A

Apricots, broccoli, cantaloupe, carrots, collards, mango, romaines, lettuce, spinach. squash, sweet potatoes, sweet red peppers.

protects eye health, improves skin and hair, lowers cholesterol, helps bones and teeth, boost immunity, promotes tissue repair, supports muscle growth, slows aging.

63
Q

plant based dietary patterns and incidence of T2DM in US men and women: results from a 3 prospective cohort studies

A

plant based diets rich in high quality plant foods are associated with substaninal lower risk of developing DM

64
Q

analysis and valuation of the health and climate changes cobenefits of dietary change

A

transitioning toward a more plant based diet could reduce global mortality by 6-10% and food related greenhouse gas emission by 29% to 70% by 2050

65
Q

climate benefits of changing diet

A

a global transition to less meat or a complete switch to plant based protein food would have a dramatic effect on reducing land use, methane and no emissions

66
Q

Global diets link environmental sustainability and human health

A

alternative diets that offer substantial health benefits cld if widely adopted reduce global agricultural greenhouse gas emissions, decrease land clearing and species extinctions and decrease diet related non communicable disease

67
Q

Nutritional update for physicians: plant based diets

A

research shows that a plant based diets are cost effective, low risk interventions that may lower BMI, hgba1c and cholesterol.
may reduce the # of medications needed
should recommend plant based diet to ppl with HTN,DM,CVD and obesity

68
Q

usefulness of vegetarian and vegan diets for T2DM

A

research to date has demonstrated that a low fat, plant-based nutritional approach improves control of wt, glycemia and CV risk
carefully planned vegans diets can be more nutritious than conventional diets

69
Q

advanced glycation end products in foods and a practical guide to their reduction in the diet

A

dry heat promotes the development of dietary AGEs >10-100 fold above uncooked.
animal dervied foods that are higher in fat and protein are generally rich in AGS
frying, broiling, grilling, roasting, bakings, searing and roasting can accelerate the formation of new AGEs and increase AGE levels

70
Q

milk and health

A

milk consumption does not reduce fractures, not related to weight control, dm or CVD. may increase risk of prostate cancer and possibly endometrial cancer.

71
Q

function of omega-6

A

essential component of structural membrane lipids, involved with cell signaling, precursor of eicosanoids required fro normal skin function.
17g/day for men
12g/day for women
nuts, seeds, corn oil
pro-inflammatory
ratio of omega 3:6 1:1 or 4:1

72
Q

BROAD study

A

prospective two arm parallel superiority study
low fat version of WFPB
BMI was reduced more with WFPB than standard care. BMI <4.4
6 months
WFPB diet to unaltered diet with stand medical care.
cholesterol was not significantly different

73
Q

current evidence of healthly eating

A

good date now supports the benefits of diets rich in plant sources of fats, protein, fish, nuts, whole grains, fruits/vegetables, and avoidance of partially hydrogenated fats, limit red meant and refined carbs .

74
Q

Omega-3

A

involved with neuro development and growth, precursor of eicosanoids
1.6g/day men
1.1g/day women
fish, flax seed
anti-inflammatory

75
Q

Fiber

A

improves laxation, increases satiety, lowers risk of CAD, helps maintain normal blood glucose levels, only found in plants. cannot be broken down into sugar
38g/day men
25g/day women
more fiber is associated with decrease of CAD, insulin resistance, colonic diseases, legumes, whole grain, veg, fruit, nuts and seeds

76
Q

What are the components of a carb?

A

fiber
sugar
starch

77
Q

Saturated fats

A

usually solids are room temp.
lauric acid, stearic acid, palmitic acid and myristic acid

78
Q

lauric acid

A

found in coconut oil.
increases HDL and LDL in healthy ppl with cholesterolemia
health benefits are unknown.
coconut oil does not improve weight loss or satiety

79
Q

polyunsaturated fat

A

omega-3
omega-6

80
Q

monounsaturated fat

A

generally liquid at room temp.
if used in the replacement of transfat or saturated fat they can help lower LDL and decrease risk of CV events and all cause mortality
olive oil, canola oil, peanut, salflower and seseame oil

81
Q

diet specific recommendations for HLD

A

Decrease transfat, saturated fats, processed foods, animal products and total meat consumption

increase polyunsaturated fats, complex carbs, plant sterols, stanols and viscous fiber

82
Q

diet specific recommendations for HTN

A

Decrease sodium intake, alcohol and caffeine.
increase potassium, calcium, magnesium, garlic, and water only fasting

83
Q

myristic acid

A

found in dairy products and tropical oils
increases cholesterol
associated with CVD and all cause mortality and T2DM

84
Q

palmitic acid

A

found in palm oil, butter, cheese, milk and meat.
most COMMON saturated fat
associated with insulin resistance
may lead to CVD risk

85
Q

stearic acid

A

found in cheese, meat, poultry and dairy
harmful health effects
increases endothelial damage and cell death. decreases progenitor cells essential to repair
associated with increased risk of colon cancer
doesnt raise cholesterol as much as other long SFA

86
Q

Vegetarian diets: what do we know of their effects on common chronic diseases?

A

there is convincing evidence that vegetarians have lower rates of CHD, largely due to low LDL, decrease HTN, DM and obesity

lower rates of cancer
longer life expectancy
specific cancers need more research.
need better definition of vegetarian diet

87
Q

effect of life style changes on ED in obese men: RCT

A

110 obese men
35-55yo
intervention vs control.
intervention group got detailed info about how to achieve weight loss of 10% or more.
control group received general info about healthy food and exercise
lifestyle changes were associated with improvement in sexual fxn for about 1/3 of the obese men

88
Q

increased telomerase activity and comprehensive lifestlye changes: a pilot study

A

3 month study
24 men- low risk prostate cancer
comprehensive lifestyle changes significantly increase telomerase activity and telomere maintenance capacity in human immune system cells

89
Q

association btwn consumption of UPF and all cause mortality: SUN prospective cohort study

A

prospective cohort 19899 graduates
high consumption of UPF was independently associated with 62% hazard for all cause mortality with each additional serving of UPF increase all cause mortality by 18%

90
Q

rapid reduction of serum cholesterol and bp by 12 day very low fat and strictly vegetarian

A

500 adults
12 day live in program
avg decrease in total serum cholesterol of 11%, bp 6% and wt loss 2.5kg for men and 1 kg for women.
effective way to lower serum cholesterol and BP

91
Q

Providing nutritional care in the office practice: team, tools and techniques

A

motivational interviewing, shared decision making and collaboration btwn patients and providers

92
Q

effects of nutritional supplements and dietary interventions on CV outcomes: an umbrella review and evidence map

A

decrease salt intake and decreased risk for all cause mortality, low certainty evidence that omega-3 decreases risk for CHD, low certainty that folate decreases risk of stroke, moderate certainty that calcium and vitamin d increased risk for stroke.

93
Q

association of skipping breakfast with CVD and all cause mortality

A

prospective cohort
6550 adults 40-75yo
hazard ratio of 1.87 for CV mortality and 1.19 all cause mortality in participants who never consumed breakfast compared to those who did daily
survival is higher in those who consume breakfast

94
Q

healthful and unhealthy plant-based diets and the risk of CHD in the us

A

eating more plant foods is associated with lower CHD but eating more healthy pland foods is assocaited with substantially lower CHD risk, whereas a plant based diet index < healthy plant foods is associated with high CHD risk

95
Q

According to the US Dietary Guidelines, which of the following types of foods accounts for the most sodium intake?

A

mixed dishes, such as sandwiches, burgers, and tacos; rice, pasta, and grain dishes; pizza; meat, poultry, and seafood dishes; and soups

96
Q

what is the primary saturated fat in coconut oil?

A

lauric acid.

97
Q

what is palm oil and how oil is palm oil is from saturated fat?

A

palm oil is a type of vegetable oil.
50% of it is saturated fat.

98
Q

where do you find pre-vitamin A?

A

animals sources

99
Q

where do you find pro vitamin A?

A

plants- sweet potatoes, mango, carrots, spinach, pumpkin, cantaloupe and peppers.

100
Q

How much of the RDV of calcium can you get from kale?

A

15%

101
Q

How much of the RDV of calcium can you get from chia seeds?

A

14

102
Q

What are the risk factors from the Framingham Heart Score?

A

systolic blood pressure, total and HDL cholesterol ratio along with age, sex, and smoking status.

It does not include VLDL or LDL cholesterol or diastolic blood pressure.

103
Q

According to the AHA/ACC/TOS Guidelines for Management of Overweight and Obesity in Adults, abdominal obesity associated with increased cardiometabolic risk is defined as ?

A

waist cumference of 35 inches (88 cm) or greater for women and 40 inches (102 cm) or greater for men. The measurement should be made on the horizontal plane level with the iliac crests.

104
Q

What is an alternative to fish as sources of EPA?

A

The ultimate sources of these fatty acids for the fish, however, are seaweed, spirulina, nori and chlorella, all forms of algae. Algal supplements are an alternative

105
Q

What cooking methods increase AGEs the most ?

A

Cooking methods with higher temperatures tend to increase AGEs the most. Broiling (225o C/437o F) seems to create the highest level of AGEs, followed by frying (177o C/350o F), then roasting (177o C/350o F) and boiling (100o C/212o F). Other factors to consider include length of time and presence of moisture.

106
Q

The proportion of the US population projected to have diabetes in 2050 is closest to which of the following

A

1/3

107
Q

Lifestyle interventions have been shown to reduce the progression of prediabetes to diabetes by approximately what percent

A

In the Diabetes Prevention Program, lifestyle interventions were shown to reduce the progression of prediabetes to diabetes by 58%

108
Q

what are adipokines?

A

Adipokines include leptin, adiponectin, resistin, TNF, IL-6, CCL19, IL-10, and TGF-beta

109
Q

What are some food packaging terms that regulated by the FDA?

A

Good source- 10-19% of daily value
excellent source- +20% of daily value
gluten-free
certified organic

110
Q

Was the broad study a RCT?

A

yes

111
Q

Was the new DIETs study a RCT?

A

Yes

112
Q

What did a mini review of 12 did RCT find when they compared plant based diet to control diets?

A

plant based diet improved weight, cardiovascular health, bp, glucose metabolism especially in ppl who are over weight.

113
Q

What was the study design for the reduction in the incidence of type 2 diabetes with lifestyle or metformin study?

A

Parallel group randomized control trial with a placebo group, metformin group and lifestyle modification group. Goal of at least 7% weight loss and 150 minutes of physical activity per week

114
Q

According to the article “Healthy living is the best revenge: Findings from the European Prospective Investigation into Cancer and Nutrition-Postdam Study” which disease did having all 4 healthy lifestyle factors compared to none have the biggest impact on?

A

the biggest impact was on diabetes 93% risk reduction
81% risk reduction for myocardial infarction
50% risk reduction in stroke
36% risk reduction in cancer

115
Q

According to the article “Healthy living is the best revenge: Findings from the European Prospective Investigation into Cancer and Nutrition-Postdam Study” which lifestyle factor exerted the largest reduction risk in any of the chronic diseases?

A

BMI >30
followed by smoking

116
Q

According to the article “Healthy living is the best revenge: Findings from the European Prospective Investigation into Cancer and Nutrition-Postdam Study” which lifestyle factor exerted the largest reduction risk of MI and cancer?

A

smoking

117
Q

According to the “Healthy Lifestyle Heart trial” what was the mean relative reduction in stenoses?

A

7.9% relative reduction in stenosis for the experimental group and increase of 27.7% stenoses for control group

118
Q

According to the “Healthy Lifestyle Heart trial” how many cardiac events occurred in the control group vs experimental?

A

45 cardiac events occurred in the control group compared to 25 cardiac evens in the experimental group

119
Q

According to the “Healthy Lifestyle Heart trial” what results did you see at 1 year for the experimental and control group?

A
120
Q

How long were participants followed in the Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin followed?

A

2.8 years

121
Q

What percentage of weight loss did patients in the lifestyle intervention group for “reduction in the incidence of type 2 diabetes with lifestyle” study have at 24 weeks and their most recent visit?

A

50% of participants had achieved goal weight loss of 7% at the end of the 24 weeks and 38% had at least 7% of weight loss at most recent visit

122
Q

What percentage of patients achieve the goal of 150 minutes of moderate physical activity in the lifestyle intervention group for “reduction in the incidence of type 2 diabetes with lifestyle” study have at 24 weeks and their most recent visit?

A

74% reached their goal at 24 weeks and 58% had achieved their goal at the most recent visit

123
Q

How much lower was the incidence of diabetes in the lifestyle medicine group compared to the metformin and placebo group?

A

The incidence of diabetes was 58% lower in the lifestyle medicine intervention group and 31% lower in the metformin group compared to the placebo group.
The incidence of diabetes was 39% lower in the lifestyle medicine intervention group compared to the metformin group.
These were all statistically significant.

124
Q

What was the objective of the Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with EVOO or nuts study?

A

To asses the long-term effects of the Mediterranean diet on incident cardiovascular disease in high risk men and women.

125
Q

What were the key conclusions from the Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with EVOO or nuts study?

A

high risk persons with CVD assigned to an energy-unrestricted Mediterranean diet supplemented with EVOO or nuts was associated with a lower risk of major CV events over a period of 5 years compared to control.

126
Q

What were the key conclusions from the “ A clinical trial of the effects of Dietary Patterns on BP (DASH diet)?

A

At baseline the combination diet reduced SBP by 5.5 and DBP by 3.0mmHg more than the control diet.

The combination diet reduced SBP by 11.4mmHg and DBP by 5.5mmHg more than the control diet in patients with HTN.

In patients without HTN SBP was reduced by 3.5mmHg and DBP was reduced by 2.1mmHg more than the control group.

The combination diet reduced SBP and DBP significantly more than the Fruits and vegetables diet

saw results in as little as 2 weeks.

Effects seem to be independent of weight-loss, physical activity and not related to sodium or alcohol intake.

127
Q

What were the key results of the “Percutaneous Coronary Angioplasty Compared with Exercise Training in Patients with Stable Coronary Artery Disease?

A

Exercise training was associated with higher event-free survival, increase maximal oxygen uptake, increase exercise tolerance by 20%, elevated ischemic threshold by 30% and significantly increased HDL after 12 months, LDL was not effected.

Clinical symptoms significantly improved in both groups during the study period.

In the PCI group only the ischemia threshold showed a significant increase after 12 months and maximal exercise tolerance was increased along with ischemia threshold.

128
Q

What nutrients under-consumed by the entire population?

A

Calcium
Choline
Fiber
magnesium
potassium
Vitamin a
Vitamin C
Vitamin D
Vitamin E
Vitamin K

129
Q

Under consumed nutrients that are a public health concern.

A

Calcium
Potassium
Vitamin D

130
Q

What are some unregulated front-of-package claims?

A

Natural and Low sugar. No regulation on these terms

131
Q

Common regulated front of package claims

A

Good source- contains 10-19% of DV
Excellent source- contains >20% DV
Gluten free- contains <20 parts per million of gluten
Certified organic- produced without pesticide, herbicides, synthetic fertilizers, sewage sludge, bioengineering or ionizing radiation and not genetically modified.

132
Q

2020-2025 Dietary Guidelines for Americans
Who are the guidelines intended for?
How often are they updated?

A

Intended for health professional audience to guide nutrition advice given to patients and consumers.

Updated every 5 years

Jointly issued by the USDA and Department of Health and Human Services

133
Q

Dr. T. Colin Campbell wrote an article called, “Diet, Lifestyle, and Etiology of CAD.” What did he say in this article?

A

In this article he described the differences btwn those living in rural China and those in the US and the incidence of CVD.

Subjects in China ate about 1/2 the fat, 1/10th the meat and 3x the fiber.

There was 16.7 fold greater CAD mortality in US men and 5.6 fold greater CAD in mortality in US women compared to their China counterparts.

No recorded CHD events in a 3 year period among 246,000 males <64 from 5 countries and 130 villages in rural mainland China

134
Q

What is the portfolio diet?

A

it is an intervention diet from a RCT that used a dietary portfolio for treatment of hypercholesterolemia.

Very low saturated fat dietary pattern, high in plant sterols, soy protein, viscous fibers, and almonds.

Patients treated with this dietary pattern had decrease in LDL by 28.6%, which was not statistically different from treatment with 20 mg of lovastatin which lowered LDL by 30.9%

135
Q

Was the New DIETs study a RCT?

A

Yes, It was a 5 arm RCT

136
Q
A