Second Half Flashcards
minerals
- inorganic
- non-energy yielding micronutrients
- major and trace minerals (major=more of them in body)
calcium
- most abundant mineral in body
- 99% is stored in bones and teeth
- 1% is in body fluids and it helps with muscle contraction and relaxation and blood clotting
- bone density
- muscle contraction
roles of calcium
integral part of bone structure and bones serve as a calcium reserve
what do calcium phosphate salts do
crystallize hydroxyapatite crystals that add rigidity to the bone
how is calcium regulated
by hormones
what can a calcium-poor diet do
during growing years can prevent a person from reaching peak bone mass, which is achieved at age 20
- increases risk of osteoporosis; reduction of bone mass in older adults and children will have stunted growth and weak bones
what are sources of calcium
milk/milk product, fortified soy beverage and juice, fish with bones, broccoli
what can inhibit calcium absorption
spinach, swiss chard
calcium toxcity
constipation, kidney stones, absorption interference of other minerals
osteoporsis
a reduction of bone mass in older ppl in which bones become fragile due to a calcium deficiency
“silent thief”
causes most hip fractures
risk factors: advanced age, females, being underweight, rheumatoid arthritis
osteomalcia
vitamin d deficiency w an overabundance of unmineralized bone protein
phosphorus
2nd most abundant mineral in the body
found in bones and teeth
needs are easily met by diet
- DNA/RNA, phospholipids, metabolism
phosphorus roles
help maintain acid-base balance, part of DNA/RNA, metabolize energy yielding nutrients
phosphorus toxicity
calcification of soft tissues
phosphorus sources
widespread of food and animal proteins
kidney disease may require a phosphorus controlled diet
magnesium
50% in bones
1% is in body fluids
- enzymes, bones, crystallization, muscle
how to maintain magnesium
to maintain concentration in blood, it can be taken from bones to conserve it
magnesium sources
easily washed and peeled away from food sources; nuts, legumes, whole grains, chocolate, dark green veg
magnesium deficiency
muscle weakness, heart attack, high blood pressure
magnesium toxicity
occurs w high intakes of supplements and causes diarrhea, acid base imbalance
sodium roles
fluid electrolyte balance, acid base balance, muscle contraction
- biocompounds, antioxidants
sodium deficiency
rare but can occur from vomiting or extreme sweating
- endurance athletes can become hyponatremic
amount of sodium excretion and intake is
AI: 1500mg
CDRR: 2300 mg
Daily value: 2300mg (1 tsp)
do males or females consume less sodium
females
what does more salt result in
higher blood pressure
DASH diet
dietary approach that may help salt-sensitive ppl lower blood pressure
- high in fruit in veggies
- reduce salt
controlling salt intake
- 15% unprocessed foods
- 75% processed foods
- 10% added salt
chloride role
acid-base balance
found in salt, deficiency does not occur
- negative ion, HCl, electrolyte
Potassium
Intake is generally below AI
Ppl w kidney disease may require a potassium restricted diet
potassium sources
fresh whole food; banana, potato, tomato
potassium toxicity
injected into the vein can stop the heart
sulphate role
helps protein strands assume their function shape
where is sulphate found
in protein containing food
sulphate toxicity
diarrhea
Iodine
Hormone synthesis and regulates metabolic rate
Iodine deficiency and toxicity
enlarged thyroid (goiter), weight gain
Iodine sources
seafood, iodized salt
where is iron found
most iron in body is a component of hemoglobin or myoglobin
iron role
help carry O2, make new cells and hormones
vitamin c enhances absorption
iron deficiency
result of absorption not compensating for loss of low dietary intakes
stage 1: low iron stores
stage 2: depleted iron stores
preg ppl need a iron supplement
can a person be iron deficient w/o being anemic
depletion of iron stores causing low blood hemoglobin
- microcytic anemia = iron
- macrocytic anemia = B12
Pica
craving for non-foods that occur w iron deficiency
iron toxicity
toxic in large amounts as it is difficult to excrete once absorbed
body defends against iron overload by controlling its entry
Iron can occur in 2 forms
heme iron: iron part of hemoglobin and myoglobin found in meat, fish, poultry and is better absorbed than non-heme iron; MFP factor promotes iron absorption
non heme: found in animal and plant foods
to reduce iron absorption
- tanins found in tea and coffee
- Ca and P found in milk
- Phytates found in fibre
- Sources: red meat, eggs, fish, legumes, green leafy veggies
Zinc role
antioxidant pathway
Zinc deficiency
keshan disease; causes heart enlargement and insufficiency
Zinc toxicity
nausea and hair loss from supplements
Zinc sources
meat and veg grown in selenium rich soil
fluoride
not essential but beneficial
fluoride role
crystalline deposits in bone and teeth
fluoride deficiency
dental decay
fluoride toxicity
fluorosis; pitting of tooth enamel
chromium
works w insulin to regulate glucose
widespread of sources
deficiency: impaired insulin action - high blood glucose
copper
- forms hemoglobin and collagen and helps in bodys handling of iron
- deficiency: menkes disease; intestinal cells absorb copper but can’t release it into circulation
- toxicity: wilson’s disease; copper accumulates in brain and liver
body composition
proportion of muscle, bone, fat, and other tissue that makes up a person’s total body weight
59.8% of canadian adults are overweight or obese
risks of being underweight
- risk of during famine and when they are hospitalized
- undernutrition, osteoporosis, impaired immune function, infertility are problems associated with being underweight
- some underweight ppl may benefit from gaining weight for energy reserve
risks of being overweight
- type 2 diabetes, dyslipidemia, coronary artery disease, hypertension (genetics and lifestyle also contribute)
- central obesity may increase the risk of death compared to fat accumulation elsewhere in the body
- apple shape: more common in males and females after menopause (beer belly)
- pear shape: females in reproductive years are prone to carry fat around hips and thighs for protection
edmonton obesity staging sys
stage 0: no apparent risk factors
stage 1: presence of obesity related subclinical factors; borderline hypertension
stage 2: presence of established obesity related chronic disease
stage 3: end organ damage and myocardial infarction
stage 4: severe disability or death
how is body weight assessed
- BMI: kg/m2; generally correlates with degree of body fatness and disease risk
- no indication about how much weight is at and where its located and not appropriate for athletes, pregnant women, ppl 65+
<18.5 = underweight
18.5-24.9 = normal
25-29.9 = overweight
20-34.9 = obese class 1
35-39.9 = obese class 2
>40 = obese class 3
waist circumference: reflects the amount of visceral fatness
> than 102 cm for men and 88 cm for women increased risk of heart problems
disease risk profile states that the more risk factors and the greater the obesity = greater risk
weight bias
-‘ve attitudes and views about obesity and ppl with obesity
weight stigma
social stereotypes about obesity
weight discrimination
when bias and stigma is acted on and you treat ppl with obesity unfairly
3500 kcal =
1 pound of fat
weight maintenance
energy in = energy output
basal metabolism
sum total of energy expanded on all involuntary activities needed to live
basal metabolic rate
the rate at which the body uses energy to support its basal metabolism
- its higher in younger, taller, growing, men ppl and ppl with more lean muscle mass
- its lower in older ppl, fasting ppl, ppl with undernutrition and hypothyroidism
hunger
unpleasant sensation that signals we need food
appetite
psychological desire to eat and can occur without hunger
satiation
perception of fullness that builds throughout a meal and tells us to stop eating
saiety
the feeling of fullness that lingers between meals
- leptin is the saiety hormone produced by adipose tissue
- sensory specific satiety is the concept that we tend to get bored of food as we eat
estimating energy requirements
- males: kg body weight x24 = kcal/day
- females: kg body weight x22 = kcal/day
- these equations often include, sex, age, physical activity, body size, and weight
how the body loses and gains weight
- slight or rapid change in body weight may not indicate a change in body fat, it can reflect a change in body fluid content
- too lose weight, energy in must be < than energy out
balanced diet will use its fat stores =
gradual weight loss
3 pillars to support medical nutrition therapy and physical activity
- psychological intervention
- pharmacotherapy; tends to be underused (sibutramine no longer allowed, xenical/orlistat, saxenda/liraglutide, contrave, wegory)
- surgery (gastric bonding, gastric bypass, duodenal switch, gastric sleeve)
gastric bonding
places a band around the lower esophageal sphincter and provides a restrictive method
gastric bypass
reconfigures the stomach and small intestine and provides and malabsorptive method
- creates small stomach and cuts out intestine
- 4 tbsps eaten/meal
duodenal switch
more of the small intestine is bypassed, more restrictive and malabsorptive
gastric sleeve
restrictive approach by removing part of the stomach
eating disorders
85% start during adolescents
- athletes and dancers are at a higher risk
- female athlete triad; an ultra slim appearance has been desired in some sports
- a person can be affected regardless of gender and size
muscle dysmorphia
a psychiatric disorder concerning obsession with building body mass
anorexia
a distorted body image that overestimates body fatness
bulimia
binge eating and purging
binge eating disorder
recurrent episodes of eating large quantities of food and experiencing guilt after
orthorexia
eating only foods regarded as healthy
preparing for pregnancy
- placenta is a metabolic active organ - if mothers nutrient stores are inadequate it increases risk of a low birth weight baby
- infant birth weight is most potent single indicator of an infant’s future health
- low birth weight is associated with high risk of chronic illness and brain impairments
- gestational weight gain is important for fetal outcomes
- a slower weight gain as a sudden large weight gain can cause preeclampsia (a dangerous condition causing edema and hypertension)
BMI and recommended weight gain during pregnancy
- underweight = 12.5-18 kg
- normal = 11.5-16 kg
- overweight = 7-11.5 kg
- obese = 5-9 kg
What can malnutrition during pregnancy cause
- malnutrition during critical periods can cause heart, lung, and brain defects
- teen moms are required to gain 15kg
development of fetus and amount preg mom has to eat
1st trimester = no extra calories/day
2nd trimester = 340 extra calories/day
3rd trimester = 450 extra calories/day
nutrients needed during pregnancy
- carbs: to fuel brain and spare ketosis, protein RDA is 25 grams higher/day
- fat: important for growth and development of the fetus
- folate: involved in cell reproduction, RDA is 600mg DFE/day
- vitamin B12
- magnesium
- zinc: severe deficiency causes low birthweight
- iron: during preg iron absorption increases
- calcium: RDA is same during pregnancy
high mercury foods
canned albacore tuna, swordfish, tuna steak
low mercury foods
salmon, trout, sole, pollock, canned light tuna
women who are pregnant should obtain how much folate from supplements in addition to eating ______ rich foods
400 mcg of folate
when preg take a multivitamin with _________ and _________
multivitamin with iron and 0.4 mg folic acid
smoking and pregnancy
toxic to fetus, is linked to SIDs
how much caffeine/day during preg
300 mg
alc and preg
should not be consumed as its toxic and affects CNS development
morning sickness
can occur during anytime in the day and it’s a sign of a healthy preg
preg and heartburn
caused by the pressure of growing baby and hormones (to help, eat slowly, avoid spice)
listeria and preg
causes miscarriages, stillbirth, or severe infection
preg and single massive dose of vit a
has caused birth defects
gestational diabetes
abnormal glucose tolerance appearing during preg
- risk if 35+, have obesity or pre-diabetes, use corticosteroids
- leads to surgical birth and high infant birth weight
- usually resolves after infant is born
how long should u breast feed a baby
birth-6 months
galactosemia
only rare case when an infant can’t tolerate breat milk
what vitamin do newborns need
vitamin k
breastfeeding provides:
appropriate nutritional composition, improves cognitive development, and protects against infections
breast-fed healthy infants receive a vitamin d supplement of
10 mcg
breast milk contains
alpha lactalbumin and lactoferrin protein
during lactation what do breast produce and what does it do
columstrum, which contains white blood cells that help newborns prevent infections
irons fortified cow’s milk infant formula is-
the standard for all infants not exclusively breast-fed
infants first food
- prioritize iron rich foods
- excessive cow’s milk consumption can displace iron-rich food and lead to iron-deficiency/anemia = milk anemia
- juice and milk should be served in a cup
- 3.25 milk can be introduced between 9-12 months as it helps with growth
- do not feed directly from jar to avoid contamination of bacteria
- do not include foods and added sugar or salt
- no honey because botulism
- healthy habits support normal weight as child grows
Healthy young child feeding
- 12-24 months diet changes from milk and infant food to adult foods modified
- calorie needs increase but calories per kg decreases
- energy can increase and decrease (fluctuating hungar)
- 1 year olds need 130g of glucose
- fibre AI for 1-3 is 19g/day
- fibre AI for 4-8 is 25g/day
- fibre should be down for picky eaters as it is filling
- fat AMDR age 1-3 is 30-40%
- fat AMDR age 4-18 is 25-35%
- 3.25% milk, avocado, salmon, cheese, nut butters = high nutritious fat foods
- demand for vitamin and minerals grow w the child (iron needs special attention)
- limit 3.25% milk to 750ml for 9 months to 2 year old
- treats should be nutritious
- government of canada recommends:
- limit juice, eat together as a family and be a role model
- the parents eating habits are the single biggest influence on a childs food habits
Mealtimes and snacking
- Last years in childhood for the parents to influence the kids food choices
- many kids like veggies that are mild flavours (carrots corn peas, slightly undercooked, bright colored crunchy
- small portion of new foods at beginnign of meal
- do not force, bribe or forbid foods
- toddlers often go on food jogs
- parent is responsible for what a child is offered to eat, child decides how much to eat
Childhood and teenage years
- tough meat, popcorn,, chips and whole grapes pose a choking risk
- children can snack so much that they are not hungry at meal time but this is ok if the snacks are nutritious
nutrient deficiencies
- children that have physical and behavioural symptoms
- protein, zinc, vitamin a and iron deiciencies can cause death and stunt growth
- iron deficiencey causes an energy crisis and changes learning ability
food allergies
10 most common
- eggs, mustard, wheat, peanuts, tree nuts, seafood, sesame, sulphites, milk, soy
allergy: an immune reaction to a foreign substance
- food allergies can be introduced at 6 months
for diagnosis eliminate suspect foods and introduce one at a time
-anaphylactic shock: a life threatening reaction to an offending substance
-food intolerance: an adverse reaction to a food with unpleasant symptoms but no immune reaction
-food aversion: an intense dislike of a food
Teen years
-easily fall into irregular eating habits, fast food and quick snacks
- females need more iron to gain lean body mass
- iron deficiency is the most common in adolescent females
- sodium intake of adolescent is associated with a risk of health effects
- calcium needs are high to support bone mass
- adult becomes the gatekeeper by controlling the type of foods in the teens environment but the rest is up to the teens as they make choices
breakfast
- nutritious breakfast is a central feature to support health growth and development
- children that miss it are more likely to be overweight and perform bad in school
- missing it = missing nutrients
Older adults life expectancy
the average of years lived by ppl in a given society
- 84 for feamles and 80 for males in canda
-determined by genes and health related behaviours
older adult life span
max # of years of life attainable by a member of a species
- humans is 130 years
- no diet or supplement has been found to increase longevity
- nutrient needs must be more indevidual with age
Energy and Activity
- energy needs decrease with advancing age
- # of active ceus in each organ decrease
- decrease in lean body mass
- reduction in physical activity
- 5% less energy expended per decade
- magnitude of declining energy needs is changeable
- physical activity and a diet rich in phytochemicals helps maintain energy balance
- involuntary weight loss need to be examined and treated
- BMI’s for best health and lowest risk o deaht is 25-30 for ppl 70+
-18.5-24.9 for younger people
Physical activity
physically active older adults have more flexibility and greater endurance, more lean body mass, a stronger immune system better overall health and ability to live longer
- ppl b5+ should accumulate at least 150 min of moderate to vigorous intensity activity per week
Macronutrient needs
protein RDA = 0.8g.kg of bodyweight
- too much can damage stressed kidneys
- ppl w chronic constipation may benefit from a fibre rich low fat legumes rather than meat
Older adults
- fibre helps prevent constipation
- soluble fibres can help with blood cholesterol and glucose control
- most elderly don’t obtain the daily AI of 21+g/day of fibre
- adequate essential fatty acids support good health
- limiting trans and saturated fat can help reduce heart disease risks
- a balanced diet high in vegetables, fruits, whole grains, oil from fish, and low in saturated fat is beneficial for heart health and arthritis pain
Vitamin needs
Vit a absorption increase with age but RDA is not lowered with age, increased amounts are toxic
- vit d RDA inreases after age 70 because the skin synthesis declines
– everyone over 50 should take a daily 400 ICU supplement
- suffieicne tvit B12, B6 and folate may prevent loss of mental ability
- Diets high in vit C and E may protect against cateracts
Mineral needs
- iron deficiency may occur from diminished appetite, poor absorption, chronic blood loss
- zinc deficiencies are common as many medications interfere with absorption
- Ca absorption decreases with age
Risks
- dehydration risk
- thirst mechanisms become less sensitive
- kidneys recapture water loos less efficient
- worsens constipation
- thickens mucus in lungs
- food borne illness risk, weakened immune system, decrease in eyesight and sense of smell
- hard to read expiry dates
Older adults nutrient and drug interaction
- do not occur everytime a person takes a drug
- foods can enhance delay or prevent a drugs absorption
- drugs can enhance delay or prevent a nutrients absorption
- dairy and calcium fortified juices can interfere with antibiotic absorption
- weak links b/w nutrition and alzheimer’s, abnormal deterioration of brain areas that coordinate memory
– mediterranean diet and fish oils are benficial
– important to prevent weight loss
Malnutrition in hospitals
- malnourished patients have longer hospital stays, increased morbidity and morality with decreased quality of life
- CNST is used to asses nutrution risks upon admission
– “have you lost weight in the past 6 months without trying to and have you been eating less than usual for more than 1 week”
– 2 yes = nutrition risk
IOSS I
–minced and moist can be eaten w fork or spoon and small lumps easy to squish - pureed texture or extremely thick is eaten with a spoon and no chewing
- mildly thick is sippable but slow
- Enteral nutrition/tube feeding delivers enternal products into functinoing GI tract and is used when a person cant eat enough due to illness or appetite
– short term = NG, NJ tube
– Longer term = G, J, GJ tube - paraenteral nutrition is given through the vein and used when enteral tubes are not an option
– used for impaired absorption or loss of nutrients
