P2. P 125-135 Flashcards
In terms of a 2009 study to assess the effectiveness of an exercise prescription, describe
Population
Intervention
Control
Outcomes
BR 126
Design: Cluster randomized study of 56 Spanish family doctors
P: 4317 physically inactive patients
I: a) Provided brief advice & educational materials to all pts & offered an additional 15 min appt to prescribe an individualized physical activity plan.
b) Prescription (for those who came): Negotiated a goal, addressed potential barriers, designed a 3 month plan, printed a specific prescription (with a self-monitoring log) & gave a brief printed guide
C: Usual care
At 6 mos:
a) Rx Gp did 18 min more mod/vigorous physical activity (28% more)(P<0.05). Effect limited to those > 50 yrs old.
b) Rx Gp had 3.9% more meeting physical activity recommendations at 6 mos (control had 15.0%)(P<0.05)
c) No change in V02 or QOL (SF-36)
At 2 years
a) Rx group did 7.3 min more mod/vigorous physical activity (28% more)(P<0.05)
b) Rx Gp had 2.4% more meeting physical activity recommendations at 6 mos (control had 15.0%)(P<0.05)
c) No change in V02 or QOL (SF-36)
d) Comment (by SCG): Note that in BOTH groups there was a HUGE increase in the proportion meeting minimal exercise requirements (30% !!) and time exercising (140 minutes/wk) which the authors don’t comment on. I think this is an example of the Hawthorne effect - ie the effect of being in a study and knowing that your activity is being tracked.
In terms of coconut oil
1) What is the #1 type of fat in it ?
2) What class of fats does this belong to
3) What are its effects on total & LDL cholesterol and HDL
4) What is the net effect on heart disease
BR 131
1&2) Lauric acid, a saturated fat, makes up 47% of coconut oil and is the #1 oil in it.
3) Lauric acid increases Chol-T, LDL, and HDL
4) Harvard recommends AGAINST coconut oil.
4) Net effect is to increase heart disease
In term of dietary fiber intake
1) What are the daily fiber recommendations ?
2) What is average US intake
3) What proportion of US population meets the above recommended intake ?
BR 132
1) Daily recommended fiber:
Women: 25 g/day, greater benefits if > 40 g/d
Men 38 g/day, greater benefits if > 45 g/d
2) Average US intake is 18 grams/d
3) Less than 3% of US popultation meets the recommended intake.
BR 132.
What are micronutrients ?
What are the two main classes of micronutrients ?
BR 132
Micronutrients are chemical elements or substances that are essential in small or minute amounts for growth and health.
Two main classes: vitamins + minerals
What are beneficial non-nutrients ?
Give 5 examples
BR 132
Beneficial non-nutrients are valuable to health, but not proven to be essential for life.
1) Anti-oxidants
2) Anti-inflammatory molecules
3) Phytochemicals
4) Polyphenols
5) Phytosterols
6) Glucosinolates
7) Carotenoids
Complete: “Anti-oxidant foods are also anti-__ foods”
BR 133
Anti-oxidant foods are anti-inflammatory foods
List 5 groups of anti-inflammatory foods
BR 133
1) Cruciferous vegetables
- contain sufloraphane & indole-3-carbinols
eg Broccoli, cauliflower, Brussels sroups, bok choy, kale
2) Dark berries & fruits
- contain polyphenols, such as ellagic acid, anthcyanidins, anthcyanins.
eg blueberries, raspberries, strawberries, cranberries, pomegranates
3) Allium vegetables
- rich in organosulfurs
eg garlic, onions, leeks
4) Orange, yellow & dark green vegetables/fruits
- contain carotenoids that stimulate natural killer celss which fight foreign inflammation
eg carrots, yams, mango
5) Dark green leafy vegetables
- high in potassium, calcium, and magnesium
eg spinach, collard, Swiss chard, dark lettuces, matard & turnip greens
Advanced glycation End Products-1
1) What effect do they have on our body ?
2) What disease(s) do they play a role in ?
3) Are formed by the reaction of a __ + __
4) Cause cell damage especially to __ cells
BR 134
- AGE are oxidative stress inducers & result in inflammation
- Disease: diabetes (1&2), atherosclerosis, kidney disease, slow wound healing
- Fomed by an amino acid (protein) + monosaccharide (simple sugar such as glucose)
- cause cell damage esp to cells with a long life (nerve & brain), collagen proteins in kidney, blood vessels & eye cells.
Advanced glycation End Products-2
1) What cooking methods increase AGEs
2) What types of food are high in AGEs ?
3) What are the implications for food preparation (2)
BR 134
Increased with dry heat (10-100x uncooked) - esp BBQing, grilling, roasting, baking, frying, sauteing, searing, toasting
High [AGE] in meat (esp red meat), certain cheeses, fried eggs, butter, cream cheese, margarine, mayo, oils & nuts
Food preparation
1) Increase consumption of unprocessed foods (vegetables, fruits, legumes, whole grains)
2) Decrease intake of fatty meats, solid fats, full dairy products, processed foods
3) Don’t prepare foods with dry heat, cooking, grilling, baking, frying
4) DO use moist heat: boiling, stewing, poaching, steaming. If cooking meat, add acidic ingredients (vinegar, tomato or lemon juice- see page 10).
Name the top two sources of saturated fat in the American diet
BR 135
1: Cheese
Sources of saturated fat in US diet:
What is one consequence of food manufacturers being told they must eliminate trans fats by 2018 ?
BR 136
As a result they are increasing the amount of saturated fats like coconut oil, palm oil, and lard.
List some common sources of trans fats
BR 135
1) Partially hydrogenated oils (shortenings, margarines)
2) Fried foods - french fries, doughnuts
3) Commercially baked goods - crackers, cookies, microwave popcorn
4) Coffee creamers
5) Refridgerated doughs
6) Naturally found in meat & dairy products
Rate the relative toxicity of the following:
Saturated fats
Trans fats
Omega-6 fatty acids
BR 136
Going from most to least toxic:
Trans fats > saturated fats > omega 6 fatty acids.
In terms of dietary fats:
1) Name 4 basic types
2) Which are bad/good ?
3) Name 4 types of saturated fat & where they are found
BR 130-131
Review here
1 & 2) Bad:
- Saturated fats in general raise cholesterol (see here)
- Trans fat - increases MI & strokes
Good (should replace above):
- polyunsaturated - Omega 3s, omega 6 (bad = arachadonic acid, good = linolenic)
- Monounsaturated - help lower LDL - Canola, Olive, Peanut (C.O.P.)
3) Saturated fats - Lauric - coconuts, palm oil, meat - ^ Chol-T, ^ LDL, ^ HDL
- Stearic - cheese, dairy, meat, poultry - may lower LDL
- Palmitic - palm oil, dairy, meats - ^ Chol-T, ^LDL, ^ HDL
In terms of trans fats
1) What is a trans fat ?
2) Do they occur naturally ?
3) Is there a difference in the health effects of man-made vs natural trans fats
4) What specific effects do they have on lipids
5) What specific health effects do they have
BR 131 & here.
In trans fats, there are two carbons joined by a double bond. If the hydrogens are on OPPOSITE sides, it is called ‘trans’; if they are on the same side, it is called ‘CIS’.
- Cis are more flexible and thus liquid at room temp; trans are less flexible, leading to oils which are solida at room temp and have longer shelf life.
- natural trans fats occur in the body fat & milk of ruminant animals, mainly cows & sheep - not harmful
- commercial trans fats raise LDL-C & lower HDL
- a 2% increase in energy intake from bad trans fat (vs carbohydrates) is assoc with riks of CAD of 1.93 (P<0.001)
