Nutrition week 1 Flashcards
1
Q
A healthy diet results in
A
Appropriate growth and development, absence of illness or discomfort.
Fitness, longevity, and optimum health
2
Q
Factors which influence nutritional demands
A
Stage of development
Level of inflammatory stress
Previous nutritional exposure in utero
Genotype
3
Q
Nutritional disease problems of 21st century not involving immune system
A
Hypertension
4
Q
“Hormones” of the immune system
A
Pro-Inflammatory cytokines
- IL1
- IL6
- TNF-a
5
Q
Feedback systems that activate pro-inflame cytokines
A
IL10
Heat shock proteins
6
Q
TWEAK/Fn14
A
Tissue remodeling system
Activated by pro-inflame cytokines (IL1, IL6, TNFa)
7
Q
How are antioxidant defenses strengthened?
A
Via glutathione synthesis
- glutamine–> glutathione
- sulphur AAs–> glutathione
8
Q
Nutrients released from host tissues in response to pro-inflam cytokines
A
Sulphur AAs
Glucose
Glutamine
9
Q
Nutrients that activate T and B cells
A
Glucose
Glutamine
10
Q
Inflammatory effects on Albumin
A
Serum Albumin= negative acute phase protein.
Becomes reduced when levels of inflammatory stress are raised
11
Q
NFkB
A
activated by oxidants–> activates gene transcription during inflammation
12
Q
Level of significant weight loss
A
10% of normal within one month
13
Q
Lethal weight loss
A
40% of normal
14
Q
Examples of Disadvantageous Inflammation
A
Diabetes Insulin insensitivity Hyperlipidemia Atherosclerosis MI
15
Q
Tissues that need insulin for glucose uptake
A
Skeletal mm.
Adipose tissue
16
Q
Tissues that don’t require insulin for glucose uptake
A
Brain and nervous tissue
Immune cells
17
Q
Insulin insensitivity
A
During inflammation, glucose is taken up by inflammatory/immune cells bc they don’t require insulin–> causes insulin insensitivity after inflammation ceases.
18
Q
Factors influencing level of inflammation in the body
A
Antioxidant intake Type of fat in diet Obesity Gender Aging Genetics
19
Q
Essential nutrients
A
Cannot be synth'd in humans -minerals -most vitamins -some AAs -some FAs Must get from diet
20
Q
Non-essential nutrients
A
Can be synth'd in humans -few vitamins -some AAs -many FAs -Carbs May also come from diet
21
Q
Macronutrients
A
Carbs
Fat
Protein
Alcohol
22
Q
Micronutrients
A
Vitamins
Minerals
23
Q
Malnutrition
A
Demand is not met by food supply, or is grossly exceeded
- Poor growth
- Impaired development
- Impaired Function (cognitive, physical, immune)
- Poor repair of damage and injury
24
Q
Excess energy
A
Stored as fat in adipose tissue. No matter how it enters the body
25
Overweight/Obesity categories
25-29.9 BMI --> Grade 1 Overweight
30-39.9 BMI --> Grade 2/Obese
>40 BMI --> Grade 3/Morbidly Obese
26
Energy balance equation
E intake - E expenditure = Change in body E stores
27
Components of Energy expenditure
aka Metabolism
1. Activity
2. Thermogenesis
- Dietary
- Thermoregulatory
- Adaptive
3. Maintenance (BMR)
28
Types of Malnutrition
1. Undernutrition - low food intake
2. Specific deficiencies - imbalanced nutrient intake
3. Excess energy - overweight/obesity
29
Impacts of rate of whole body protein synthesis
Speed of wound healing
| Recovery from infection
30
Energy expenditure in obesity
Raises greatly
31
Lifestyle Diseases
aka Chronic diseases of Aging
- Cardiovascular disease
- Metabolic disease
- Sarcopenia
- Osteoporosis
- Respiratory disease
- Cancer
- Cognitive decline/Dementia
32
#1 CoD worldwide
CVDs
33
Breastfeeding recommendations
Exclusive breastfeeding up to 6months, and then continue w other foods up to 2 years.
34
Mothers more likely to breastfeed
First time mothers
>30 yrs
Higher social class
Longest in education
35
Protein intake requirements for breastfeeding mothers
No need to increase protein intake with breastfeeding. Already get enough with balanced diet.
-Meet Protein and E requirements for infants up to 6 months
36
When lactation performance is compromised
In famine/near-famine conditions.
| Unaffected by fasting (Ramadan) and with low BMIs (18-26)
37
Human breast milk composition
- Protein: 9g/l (compared to 34 in cow)
- Fat: 38g
- Lactose: 70g
- Casein: 40% total protein
- Whey: 60% total protein
- B-lactoglobulin: ABSENT
- Sodium: 15mg (Compared to 65 in cow)
Abs, immune cells, and stem cells are also present
38
Breast milk Micronutrients
Vit A and B6 normally sufficient
Vit D is insufficient in breast milk for infant needs
Poor source of Fe and Zn, but stores in infant should be sufficient up to 6 months
39
Breast milk Carbs
Lactose is main carb
- disaccharide of glucose and galactose (only in mammals)
- requires hydrolysis by lactase on gut brush border
40
Breast milk Fat
provides ~50% of F
Allows for absorption of fat soluble vitamins (A,D,E and K)
Provides FAs for brain, eye, skin and hair development as well as immunity
41
Brain growth
Rapid growth from birth to 2 years, then slows and plateaus by about 6 years
42
DHA
needed for brain and visual development in infants/children
In adults: lowers TGs, increases HDL, lowers heart rate.
Low levels assoc w cognitive decline, risk of dementia, and macular degeneration
43
Other human milk components and their roles
Lactoferrin- Fe uptake and immune defense
Abs- immune defense (sIgA)
Cytokines- immune defense
Immune cells- Immune defense
Oligosaccharides- gut and immune maturation, and immune defense
44
Benefits of breast feeding
Decreases risk of neonatal infections and risk of infant allergy
Promotes development of immature gut.
45
HIV and breastfeeding recommendations
In countries with endemic HIV with no antiretroviral drugs- formula if available, breastfeeding if not for first few months.
In US HIV women should never breastfeed their babies
46
Contraindications for breast feeding
Infants: inborn errors of metabolism (galactosemia, congenital lactase def, PKU)
Mother:
- maternal infection where transmission is possible (HIV, HTLV, CMV, TB)
- on therapeutic drugs that can be transferred
- mother consuming other drugs
47
What reduces acidity in formula (1857)
Cooking with potassium carbonate
48
Short term advantages of breastmilk v. formula
Decreases:
- necrotising enterocolitis
- diarrhea
- GI infections
- Resp infections
- Otitis media
- Risk of DM Type I
49
Long term advantages of breastmilk v. formula
Decreased:
- IBD
- Diastolic BP
- Systolic BP
- Risk of DM type II
- Risk of obesity
- Risk of CVD
- Severity/delayed onset of Celiac disease
50
Number of centiles raising concern on growth charts
>2 up or down
51
Diseases smaller babies are at risk for
Greater risk for
Type 2 DM
CHD
Metabolic syndrome
52
Epigenetics
Stable DNA changes-- modify gene expression and are carried between generations
- DNA methylation (CpG dinucleotides) - gene promoter region
- Histone modifications
53
DNA methylation
Cytosine methylated--> 5-methyl cytosine (majority found as dinucleotide CpG)
- CpGs clustered at 5'ends of genes--> inhibit transcription
54
Life expectancy at birth
White female >
Black female >
White male >
Black male
55
Detoxification systems
Efficiency declines with age
| Enzymes involved in xenobiotic detoxification systems declines with aging.
56
Fasting proteins and age
Fasting TGs and CRP both increase with increasing age
57
Theories of aging
Programmed aging- loss of telomeres. Limited # of cell divisions
Inefficient DNA repair- proportion of cells carrying DNA abnormalities increases w age.
Free radical damage
Summation of damage to life systems sustained throughout lifetime- accumulation of damaged cell lipids and proteins and raised levels of oxidant and inflammatory stress
58
Telomere length and exercise
Exercise is assoc w longer telomeres later in life.
59
Biological Growth v. Aging
Growth= accumulating capacity. Increasing form and fxn
Aging= losing capacity. Decreasing form and fxn.
60
Impact of vitamin D on muscle function
1,25(OH)2D3 binds a VDRE in muscle tissue--> protein synthesis and muscle cell growth with improved muscle cell function
61
Inflammatory stress & mortality
High blood IL-6 and CRP double mortality risk in healthy non disabled elderly.
62
Vit B6, B12 and selenium effects on age related disorders
Improve immune fxn if deficient
63
Bit B6, B12 and folate effects on age related disorders
protect against lung cancer in non-smokers
64
Carotenoids, vit C & E effects on age related disorders
Prevent decline in cognitive function
65
Omega-3 FAs effects on age related disorders
Prevent or reverse atherosclerosis, reduce inflammation, and improve immune fxn.
66
Memory decline factors
Memory declines quicker in both smokers as well as overweight individuals
67
Decreased food intake in elderly
- Tooth and gum problems
- Swallowing difficulties
- Less snacking between meals
- Smaller meals eaten at slower pace
- Decline in olfaction and taste sensation
- Higher level of satiation and reduced gastric emptying
68
Frailty
Syndrome characterized by 3+ of the following:
- Weight loss (>5kg/year)
- Self reported exhaustion
- Weakness (fall in hand grip strength)
- Slow walking speed
- Low physical activity
69
Aging and body mass
Lean body mass (particularly skeletal m.) is greatly reduced with aging
70
Sarcopenia
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Excessive loss of skeletal muscle. Causes:
- Impairment in daily living activities
- Loss of strength
- Increased incidence of falls
- Increased hip fractures
Creates 18.5 B in health care costs
```
71
Factors of increased morbidity/mortality in elderly
Sarcopenia
Undernutrition
Frailty
72
Criteria for undernutrition in elderly
Weight loss >5% in 3m or 10% in 6
BMI <20
Serum albumin <3.5
Calf circumference <31 cm (sarcopenia)
73
Causes of undernutrition in hospital
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Hospital catering:
- Unappetizing
- 50% left on the plate
Patient mil-by-mouth or missing meals for investigations
Staff shortages/lack of help w/feeding
```
74
Non-hospital associated causes of undernutrition in elderly
Poverty
Chronic disease/disability
Unfit housing
75
Consequences of undernutrition in elderly
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Increased mortality
Falls and bone fragility
Stroke, CHD, heart failure
Increased susceptibility to infection
Anemia
Poor response to vaccination
Edema, Ulcers
Constipation
Cognition and self care
Social functioning
Poor recovery from illness or hospitalization
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76
12 recommendations for nutrition in the elderly
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1- Dietary reference values
2- Nutrient dense, varied diets
3- Moderate fat intake
4- Reasonable fibre intake
5- Vegs, fruit and cereals
6- good milk/Ca2+ intake
7- Reduced Na+ intake
8- More sunlight or VitD supplements
9- Increase health professional awareness
10- active lifestyle
11- Improve institutional catering
12- Nutritional assessment as routine part of hospital admission
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