Qs from study guide Flashcards
1
Q
What type of eating pattern may benefit glycemic control and CVD risk factors?
A
MUFA-rich eating pattern
2
Q
What is the possible etiology of NAFLD?
A
insulin resistance fails to suppress the lipolysis of adipose tissue which increases FFA
3
Q
What is the adverse effect of omega-6 fatty acids?
A
- gets converted to arachidonic acid which increases immunity and clotting
4
Q
What are the 4 effects of PD procedure?
A
- abdominal discomfort
- glucose absorption
- peritonitis
- protein losses of 8-10 g per day
5
Q
How is alcoholic steatosis characterized?
A
by fatty deposits in the liver
6
Q
Fill in the blanks about Leptin:
- it is secreted from the ___________
- it works in the ___________
- it ___________ appetite
- it promotes negative energy balance by ___________ energy expenditure
A
- it is secreted from the fat cells
- it works in the hypothalamus
- it decreases appetite
- it promotes negative energy balance by increasing energy expenditure
7
Q
What are the 3 ways PTH increases calcium level?
A
- efflux of calcium from bone
- decrease loss of calcium in urine
- enhanced absorption of calcium from intestine
8
Q
What are the 3 goals when treating hypertriglyceridemia?
A
- achieve a healthy weight
- increase physical activity
- reduce serum glucose < 100 mg/dL
9
Q
What is the best feeding tube for short term duration? (<4-8 weeks)
A
- nasoenteric/oroenteric
10
Q
Cancer patients are at high risk of what?
A
malnutrition
11
Q
What is the best eating pattern for T2DM?
A
a pattern individualized based on assessment
12
Q
Which 2 food factors NEGATIVELY effect energy intake?
- increased protein
- increased glycemic index
- increased energy density
- increased fiber
- increased portion size
- increased availability
- increased eating out
- increased variety
- increased palatability
- increased liquid form
A
- increased protein
- increased fiber
*everything else has a POSITIVE effect on energy intake
13
Q
Fill in the blanks about Ghrelin:
- it is secreted from the ___________
- it works in the ___________
- it ___________ appetite
- it ___________ when body is in a negative energy balance
A
- it is secreted from the stomach
- it works in the hypothalamus
- it increases appetite
- it increases when body is in a negative energy balance
14
Q
Treatment for NAFLD/NASH include these 5 things.
A
- weight loss and exercise
- avoid juice/soda
- physical activity
- manage diabetes
- adequate protein
15
Q
What are the clinical and lab findings consistent with alcoholic hepatitis?
A
- clinical = fever, tender hepatomegaly
- lab = AST:ALT > 2:1
16
Q
What is the obesity treatment for the following BMI.
a. 25-26.9
b. 27-29.9
c. 30-34.9
d. 35-39.9
e. >40.0
A
a. 25-26.9 = diet, exercise, behavioral therapy
b. 27-29.9 = diet, exercise, behavioral therapy + pharmacotherapy*
c. 30-34.9 = diet, exercise, behavioral therapy + pharmacotherapy
d. 35-39.9 = diet, exercise, behavioral therapy + pharmacotherapy + surgery*
e. >40.0 = all the treatment options
- = in patient’s with obesity related disease
17
Q
What common drink has been shown to decrease hepatic fibrosis seen in NAFLD/NASH?
A
black coffee
18
Q
What are 3 therapies used for sodium and fluid maintenance?
A
- diuretics
- ultrafiltration
- diet modifications
19
Q
what are the 3 causes of malnutrition?
A
- decreased intake
- increased nutrient losses d/t malabsorption
- other metabolic abnormalities
20
Q
What are the 5 advantages of EN?
A
- prevention/treatment of malnutrition
- safer
- more physiologic
- has immune benefits
- cheaper cost
21
Q
What macronutrient has the greatest satiety of them all?
A
protein
22
Q
How should you manage malnutrition d/t nausea in a patient with cancer?
A
- avoid noxious odors by using microwaves or opening windows when cooking
23
Q
What is the most common cause of diarrhea with EN?
A
medication administration through feeding tubes
24
Q
In patients with CKD 5D HD it is recommended to avoid supplementation of what 4 things?
A
- vitamin A
- vitamin E
- zinc
- selenium
25
In patients with high cholesterol and CHD what medications should you consider?
nicotinic acid or fibrates
26
What are the adaptations to undernutrition with decreased protein intake?
- increased AA recycling
| - reprioritization towards visceral protein synthesis
27
__________________ may provide clinical benefit in GI and head and neck cancer patients when used 5-7 days prior to GI surgery
immune modulating formulas
28
What is the long-term effect on body weight of high protein diets?
no consistent long-term effect
29
In patients with heart disease what is the ELA recommendation for omega-3 fatty acids?
recommendation increases to two or more 4-ounce servings of fatty fish per week
30
What is the best way to lose weight?
a. diet
b. exercise
c. diet and exercise
c. diet and exercise
31
This alcoholic liver disease may develop after years of alcohol abuse.
alcoholic hepatitis
32
What is the cause of T2DM?
combination of insulin resistance and insulin deficiency
33
Patients with liver disease may have metabolic abnormalities that mimic these conditions
sepsis or trauma
34
What are the 3 proposed mechanisms why whole grains is associated with a decreased risk of CVD?
- decreased total and LDL cholesterol
- reduced glycemic and insulinemic response
- increase intake of micronutrients, antioxidants, and phytochemicals
35
What is the treatment of ascites? (3 part)
- paracentesis
- diuretic treatment
- dietary sodium restriction (2 g Na/day)
36
What is best feeding tube for long term? (>4-8 weeks)
- ostomies
37
In patients with diabetes you can increase protein intake to _______ g/kg for CKD stages 3-5 in order to maintain glycemic control.
0.6-0.8 g/kg
38
Weight at which all or most excess body fluid will have been removed is called what?
dry weight
39
______ is often accepted as the standard of nutrition support during the acute post transplant period
PN
40
How should you manage malnutrition d/t dysphagia in a patient with cancer?
change textures of foods based on level of pain
41
Omega-3 fatty acids (linolenic acid) can be found in what type of foods?
walnuts, flaxseeds, canola oil, fatty fish (salmon)
42
What is the benefit of small intestinal feeds compared to gastric feeds?
may reduce aspiration risk
43
Feeding tubes can be placed through what 3 places?
- nose
- mouth
- abdominal wall
44
What are the 4 environmental causes of dyslipidemia?
- excess intake of saturated fat and trans fatty acids
- lack of fiber in eating plan
- excess BW
- sedentary lifestyle
45
What is the protein recommendation with acute encephalopathy?
gradually increase protein to 1-1.5 g/kg/day
*once encephalopathy resolves gradually increase protein to normal levels
46
This alcoholic liver disease may develop with transient alcohol use over days or chronic alcohol use.
alcoholic steatosis
*asymptomatic*
47
What milk has the highest amount of phosphorus?
What about the lowest amount?
- skim milk (125 mg)
| - rice milk (17 mg)
48
What are the 3 short-term benefits of low glycemic index foods?
- increases satiety
- reduces intake at subsequent meal
- reduces blood glucose response
49
In hospitalized patients the nutrition goals involves maintaining these 2 things and minimizing these 4 things.
- maintain:
1. lean body mass/bw
2. physiologic function
- minimize:
1. complications
2. length of stay
3. recovery time
4. readmission rate
50
Polymeric concentrated has a concentration of _____ cal/ml.
1.5-2
51
What is the biggest adverse affect with EN?
diarrhea
52
The DASH diet recommends limiting these 2 things to control blood pressure
- salt
| - sodium intake
53
How should you manage malnutrition d/t radiation enteritis in a patient with cancer?
- follow a lactose-free and low-fat diet
54
Polymeric with or without fiber has a concentration of _____ cal/ml.
1-1.2
55
What is the first thing you do in treatment of cachexia?
treat reversible causes
56
When administering dextrose PN, what is the maximum oxidative capacity of glucose for adults?
5 mg CHO/kg/min
57
In US what is the most commonly consumed high fiber foods?
cereal fibers
58
NAFLD is considered the hepatic manifestation of what syndrome?
metabolic syndrome
59
How does diet change in patients with CKD 5D who are receiving PD instead of HD?
likely will need less restrictive diet due to increased frequency of dialysis
60
What is the benefit of gastric feeds compared to small intestinal feeds?
more physiologic to feed into the stomach
61
What are the 2 health benefits of omega-3 fatty acids?
- reduce risk of heart attack by making blood less "sticky"
| - can reduce blood triglyceride levels
62
The dose of _____ g/day EPA + DHA has been shown to decrease risk of death from cardiac events in patients with heart disease.
1 g/day
63
Weight loss of _______ % in patients with obesity is significant.
3-10%
64
What are the 4 things that can result in hypertriglyceridemia?
- being overweight
- sedentary
- drinking too much alcohol
- uncontrolled DM
65
What type of anemia is commonly seen in renal disease?
normocytic normochromic anemia
66
What are 5 common high PO4 foods?
- high protein foods
- nuts/legumes
- dairy products
- whole grains
- cola drinks
67
What is the most common liver disease in the world?
NAFLD
68
The DASH diet has been shown to lower both systolic and diastolic BP as soon as _____ days.
14 days
69
How should you manage malnutrition d/t esophagitis/gastritis in a patient with cancer?
- eat bland, pureed, or soft foods
| - avoid alcohol, coffee, or spicy/acidic foods
70
Emulsified lipids are contraindicated for patients with this type of allergy.
egg allergy
71
What are the 3 main risks with PN lipid administration?
- hypertriglyceridemia
- arachidonic acid production
- possible chance of bacteremia/fungemia
72
How should you manage malnutrition d/t mucositis/stomatitis in a patient with cancer?
consume soft, nonfibrous, nonacidic foods
73
What are the long-term benefits of low glycemic index foods on weight?
glycemic index does not influence weight change over 12 months
74
The DASH diet recognizes the roles of these 3 minerals in controlling BP
- calcium
- magnesium
- potassium
75
The liver stores what 4 things?
- glycogen
- vitamin B 12
- fat soluble vitamins ADEK
- iron/ferritin
76
What are the indications for a low bacteria diet?
- ANC <500
- post- stem cell transplant (SCT)*
* 50 days post autologous
* 100 days post allogeneic
77
What are the 4 adverse effects of HD procedure?
- CVD instability
- nausea, vomiting
- post HD fatigue
- protein loss of 6-8 g per treatment
78
What is the cause of T1DM?
autoimmune B cell destruction resulting in absolute insulin deficiency
79
How much weight loss should you expect with exercise alone and no energy restriction?
1-2 kg
80
What is the difference between gastric feeds and small intestinal feeds as it relates to bolus administration?
- you can't give bolus doses in small intestinal feeds because there is no reservoir
81
What 2 nutritional factors increase LDL?
- consumption of saturated and trans fatty acids
| - excess body weight
82
What type of fat has the lowest risk of coronary heart disease?
polyunstaturated fats
83
# Fill in the blanks about the nutritional needs for a mature adult
1. there is ___________ energy needs
2. protein needs are ___________ per kg of body weight as younger adults
3. adults are more likely to be intolerant to ___________
4. it is recommended for adults to maintain a ___________ diet.
1. there is reduced energy needs
2. protein needs are the same per kg of body weight as younger adults
3. adults are more likely to be intolerant to lactose
4. it is recommended for adults to maintain a moderate-low fat diet.
84
What is the cause of secondary hyperparathyroidism in CKD?
- decrease in active vitamin D leads to increase in PTH which leads to increase calcium intake via resorption from bone
85
What is the cause of anemia in renal disease?
decreased production of the hormone EPO
86
What is the most malabsorptive gastric surgery?
a. adjustable lap band
b. vertical gastric sleeve
c. Roux-en-Y gastric bypass
d. biliopancreatic diversion with duodenal switch
d. biliopancreatic diversion with duodenal switch
87
What is the most restrictive gastric surgery?
a. adjustable lap band
b. vertical gastric sleeve
c. Roux-en-Y gastric bypass
d. biliopancreatic diversion with duodenal switch
a. adjustable lap band
88
What 4 nutritional factors decrease LDL?
- polyunsaturated fatty acids
- viscous fiber
- plant stanols/sterols
- weight loss
89
How should you manage malnutrition d/t xerostomia in a patient with cancer?
chew sugar-free gum or suck on tart candies
90
How should you manage malnutrition d/t dumping syndrome in a patient with cancer?
- avoid drinking beverages with meals
- consume soluble fiber
- follow a lactose-free diet
91
What foods should be avoided in a low bacteria diet?
avoid fresh fruits and vegetables and foods at high risk for food borne pathogens
92
How should you manage malnutrition d/t dysguesia in a patient with cancer?
- if metallic taste: use plastic utensils, eat nuts, cheese, and poultry for protein
- if sweet sensitivity: drink flavorless supplements or diluted juice
93
What is the change in energy expenditure with increasing severity of illness?
EE increases with severity of illness
94
What is the ELA recommendation for omega-3 fatty acids for the general population?
two 4-ounce servings of fatty fish per week
95
How is NAFLD diagnosed?
- steatosis by histology (biopsy)
- no significant alcohol consumption
- exclusion of other causes of chronic liver disease
96
What is the difference between acute vs. chronic graft versus host disease (GVHD)?
- acute = <100 days
| - chronic = >100 days
97
Omega-6 fatty acids (linoleic acid) can be found in what type of foods?
vegetable oils (e.g. corn or soybean oil)
98
What is the primary target of therapy when managing high cholesterol?
LDL cholesterol
99
The metabolic response to illness is characterized by these 3 things
- increased metabolic rate
- altered protein synthesis and catabolism (e.g. increased protein breakdown)
- altered substrate utilization (insulin resistance)
100
What are the adaptations to undernutrition with decreased energy intake?
- reduced EE
- reliance on FFA and ketones
- decrease use of protein for gluconeogenesis
101
What form of amino acids do you administer PN?
crystalline form
4 kcal/gram
102
What type of fat has the greatest increased risk of coronary heart disease?
trans fat
103
How may calories/gm are there in fat compared to CHO and protein?
- fat 9 calories/gm
| - CHO/protein 4 calories/gm
104
What is the second target of therapy when managing high cholesterol?
non-HDL cholesterol (if triglycerides > 200 mg/dL)
