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Nutrition > Special Nutritional Considerations in Disease > Flashcards

Special Nutritional Considerations in Disease Flashcards

1
Q

What is the major killer of Americans?

A

Heart disease – can be effected by diet, proper sleep, and exercise

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2
Q

What are recommendations for hypertension?

A
  • Weight loss - if overweight, for every 10 pounds of weight loss, blood pressure decreases by 4/4mmHg
  • DASH
  • eat fewer calories
  • eat more fruit, veggies, and low-fat dairy food s
  • cut back on high sat and trans fats
  • eat more whole-grain foods, fish, poultry, and nuts
  • less sodium, sweets, sugary drinks, and red meats
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3
Q

What are ideal habits for those with cardiovascular risk?

A
  • Five serving of veggies and fruits
  • two fatty fish meals/week
  • replace trans and sat fats with monosaturated fats
  • 1-2 drinks max per day if a chronic drinker
  • 30 min of exercise a day
  • use an exposure to tobacco should be avoided
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4
Q

What are the perferred foods for those at risk of atherosclerotic cardiovascular disesase (ASCVD)?

A
  • whole grains
  • raw and cooked veggies
  • lentils, beans, fava beans, peas, chickpeas, soybean
  • fresh or frozen fruit
  • lean and oily fish, poultry without skin
  • skim milk and yogurt
  • vinegar, mustard, fat free dressing
  • grilling, boiling, steaming
  • coconut oil is not as bad as sat fat
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5
Q

How does sleep effect heart disease?

A
  • inadequate amounts of sleep increases hunger, body weight, and risk of heart attack and stroke
  • sleep apnea is a big killer (heavy snoring, breath pauses, and gasping for breath while sleeping) increases nighttime blood pressure and risk of cardiac disease
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6
Q

What are some tips that can be given to help with sleep?

A
  • Sleep when tired, don’t fight it off
  • no screen time 30 min before sleep
  • low blue light exposure 2hrs before bed
  • use bed for sleeping
  • keep room dark and quiet
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7
Q

What is type 1diabetes?

A
  • inability to make insulin
  • needed injected insulin
  • injected insulin requires consistent carbohydrate intake
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8
Q

What is type 2 diabetes?

A
  • excess of insulin resistant tissue
  • patient can make insulin, but not enough
  • weight loss can enhance glucose control and improve cardiac and joint health
  • diet is incredibly important, drugs or insulin added to attain control
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9
Q

How do we manage a diabetes diet?

A
  • determine a meal plan
  • estimate energy needs
  • distribute carbohydrate (CHO) exchanged evenly throughout the day
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10
Q

What are zero calorie sweeteners?

A
  • artificial sweeteners = aspartame, saccharine, and sucralose
  • natural extract sweetner = RebA
  • zero calorie sweetners alter bacteria- kill mouth bacteria that promotes tooth decay (stevia extract containting RebA was found to kill Borrelia (Lyme Disease) and 3 antibiotics)
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11
Q

What are the draw back to zero calorie sweeteners?

A
  • zero calorie sweetners alter bacteria- kill mouth bacteria that promotes tooth decay (stevia extract containting RebA was found to kill Borrelia (Lyme Disease) and 3 antibiotics)
  • can change the mix of bacteria in the microbiome
  • can impatie the ability of people to use glucose and raises the animals blood sugar concentrations
  • those whole consume a lot of artifical sweetener have higher blood sugar concentrations
  • RebA doesn’t impact blood glucose concentrations but kills lactobacillus, a goof bacteria in the gut
  • consumption of thse foes not promote weight loss
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12
Q

What is celiac disease?

A

gluten causes local allergic reaction with visible intestinal inflammation or damage
can cause diarrhea, bloating, gut pain, headache, fatigue
can take 3-6 months off gluten to resolve

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13
Q

Where can gluten be found?

A

Wheat, barley, and rye

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14
Q

What are some non-gluten startches?

A

corn, oats, rice, quinoa, potato, buckwheat, amaranth, chickpea, millet, sorghum

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15
Q

What is Infalammatory Bowel Disease (IBD)?

A
  • includes ulcerative colitis (just in the rectum) and chron’s disease (large intestine)- cause diarrhea, bloating, gut pain
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16
Q

What are recommeded foods and supplements for IBD?

A
  • Limit red meat, processed meat, and dairy – more plant protien, chicken, and fish
  • vitamin B supplementation during bouts
  • supplement with probiotics
  • eat prebiotic foods (onions, asparagus, fresh fruits, soluble fiber, garlic)
  • pre + probiotics = increased small fatty acids like butyrate – help protect the gut
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17
Q

What nutritional factors must be considered for cancer?

A
  • Preventing excessive weight loss
  • management of treatment related side effects like N/V/D and mucositis
  • N/V - smaller more frequent meals, antiemetics, promobility agenta
  • D- water and electrolyte repletion, soluble fiber, antidiarheal drugs
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18
Q

What are the outcomes of chronic kidney disease?

A
  • manage altered electrolytes
  • minimize levels of nitrogenous waste
  • manage underlying cause of CKD (DM and HTN)
19
Q

What is the recommended nutrition for CKD?

A
  • Na+ and fluid restriction as needed to control BP and fluid balance
  • K is limited to prevent cardiac events
  • phosphorus restricted
20
Q

What are the recommended medications for CKD?

A
  • phosphate binders taken with food
  • calcium supplements best binders
  • propofol contains ~400mg of phosphorus
  • kayexalate: cation exchange resin is a potassium reducer
  • dialysate losses of water soluble vitamins
21
Q

What are the effects of critical illness on nutrition?

A
  • nutrition risk from hypermetabolism and catabolic state
  • inflammatory state rapidly depletes protein stores
  • bad nutrition means longer hospitlat stay, poor wound healing, compromised immune function, organ dysfunction
22
Q

What are the nutrition requirements for critically ill patients?

A
  • protein: 1.2-2.5g/kg (disease dependent)
  • fluid requirements: depends on need for volume resuscitation (ins and outs of GI tract, and insensible losses)
23
Q

When wouldbe the best time to provide nutrition?

A
  • 24-48hrs of ICU admission
  • hemodynamic stability prior to starting enteral feeds
  • arginine enriched products should not be used if pts have HTN (elevated nitric oxide levels reduce BP
24
Q

What are the different types of nutritional support and monitoring?

A
  • diarrhea: related to Rx, malabsoprtion
  • needs soluble fiber to bulk stool (not to be used in pts with ischemic bowel or bowel dysmotility); or probiotics
  • Aspiration: reduce this risk by keeping head elevated, high residuals with promotility agents, advancing tube post pyloric
  • Hyperglycemia: history of diabetes, insulin resistance, steroid rx
  • Refeeding syndrome: reintroducing CHO into diet of starved patients- rapid shift in chemicals– slower advacement of feeding
25
Q

What is cirrhosis?

A
  • liver is damaged causing issues in nutrient circulation
  • all nutrients go through portal circulation reach liver and then the blood stream
26
Q

What is portal hypertension?

A
  • slowing or block of blood flow through the liver
  • decreases the processing of nutrients, hormones, drugs, and toxins and the production of protein (albumin)
27
Q

What are some complication with nutritional implications?

A
  • ascites - excess abdominal fluid
  • encephalopathy- brain disease
  • poor gluconeogenesis
  • edema
  • insulin resistance
  • esophageal varices- enlarged vein in the esophagous
28
Q

What is the recommended nutrition for cirrhosis?

A
  • Na+ to alleviate ascites, edema, portal HTN
  • reduce the risk of encephalopathy- small requent meals; lactulose (decreases ammonia absorption by protonating it)
  • if caused by alcoholism, thiamine deficienct may be present
29
Q

What nutrition is needed for wound care?

A
  • if vitamin/mineral deficiencies suspected, recommended a multivitamin & multimineral that contains RDI levels
  • when there is no deficiency, supplementation will not decrease risk or aid in healing
  • inadequate protein intake impairs would healing (arginine and glutamine are the most relevant)
  • arginine is not appropriate in patients with hypotension
30
Q

How much are OTC supplements worth worldwide?

A

$60 billion

31
Q

What companies were included in the cease-and-desist letters?

A

GNC, Target, Walgreens, and Walmart

32
Q

Why were cease-and-desist letters sent out?

A

study failed to detect generic material for plants depicted on the label in most herbal supplement products and detected things that were not on the label.

33
Q

What are the three important messages to recieve from OTC supplements?

A
  1. GMP means it exhibits good manufactoring practices
  2. Indepenent lab verifcation or USP seal guarantees the contents in the product
  3. cheap supplements are cheap for a reason
34
Q

What is vinegar?

A
  • sugar from any plant source that is fermented by yeast to produce alcohol and then converted by acetobacter to acetic acid
35
Q

What are the benefits to vinegar?

A
  • feeling of fullness after a meal
  • blood glucose control in normal
  • blood glucose control in pre-diabetes and diabetes
36
Q

What are the main take home messages from vinegar use?

A
  • If diluted, there is little risk of harm for occasional use
  • Small daily use diluted in water or other liquid is safe but chronic use can cause hypokalemia
  • there are few instances where vinegar on or in the body may be beneficial but it may not be effecitve or safe for daily use
37
Q

What are omega-3 fatty acids?

A
  • PUFAs
  • three types: EPA (20 carbons), DHA (22 carbons), ALA (18 carbons)
  • Sources: EPA/DHA- made by plankton (algae) then eaten and concentrated in fatty fish; land plant sources
38
Q

Would omega-3 be effective for hypertriglyceridemia patients (very high triglycerides)?

A

Yes, EPA/DHA 2-4g per day in an effective adjunctive therapy to lower triglycerides

39
Q

What does the American Heart Association say Omega-3 Supplements are effective for ?

A
  • coronary heart disease
  • chonic heart failure
40
Q

What are the main messages regarding omega 3 fatty acids?

A
  • everyone should eat two servings of fish per week for general health
  • hypertriglyceridemics get benefits from high dose EPA/DHA
  • EPA/DHA has some benefist in pts with myocardial infarction, angina, or heart failure
  • cannnot replace other mortatlity reducing drugs
  • no proof of benefit in other groups
41
Q

What are soy beans?

A
  • made of both good and bad consituents
  • high nutrients and fiber
  • lectins can block nutirent absoription – cooking can eliminate this
  • some components act like estrogen– but does not effect breast cancer
42
Q

How does soy actually effect health?

A
  • slightly reduce LDL cholesterol and triglycerides
  • mildly reduce some menopausal symptoms
43
Q

Are lectins really harmful?

A
  • anti-nutrients
  • pro-inflammatory substances
  • aren’t healthy but they are nutritious
  • avoiding them is not advisable
44
Q

Are there benefits from lauric acid, palmitic acid, and sunflower oil?

A
  • modest benefit in total and LDL cholesterol from using monounsaturated or mon/poly oils vs MCT oils
  • unknown difference in health outcomes

Nutrition (6 decks)

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