Terms Flashcards
EAR
Estimated average requirement - amount of a nutrient that is estimated to meet the requirement of HALF of all healthy individuals in the population
100 gm/d (carbs)
AI
Adequate intake - observed intakes of the nutrient by a group of healthy persons
9 Essential Amino Acids
HILL MPTTV
Principal contributor to resting energy expenditure
Lean body mass
Metabolic adaptation
Maintenance of > or = 10% reduction in body weight results in decreased EE and increased muscle efficiency
How does glycemic index vary?
Preparation - fat, fiber, and acid lower the glycemic index; cooking starches (pasta) longer - higher glycemic index
Ripeness - fruits like bananas have an increased glycemic index as they ripen
Combining high-glycemic index foods with lower will reduce the GI of a meal
Glycemic Index (GI)
How much and how quickly an ingested food affects blood glucose
Low GI >55, Med 56-79, High > 70
American Diet Association (ADA) Exchanges
Non-Starchy Veggies - 2 gm prot, 5 gm carb, 25 kcal
Protein - 7 gm prot, 0-8 gm fat, 35-100 kcal
Fat - 5 gm fat, 45 kcal
Dairy - 8 gm prot, 12 gm carb, 0-8 gm fat, 90-150 kcal
Fruit - 15 gm carb, 60 kcal
Starch - 3 gm prot, 15 gm carb, 0-1 gm fat, 80 kcal
RDA
Recommended daily allowance - average daily dietary intake of a nutrient that is sufficient to meet the requirement of NEARLY ALL healthy persons 130 gm/d (carbs) 56 gm/d (prot - M) 46 gm/d (prot-W) 25-38 gm/d (fiber)
Calorie?
Measure of energy 1 Calorie (Cal) = kilocalorie (kcal) = 1000 calories
Kcal/gram of macro-nutrients
Carbs - 4 kcal/gram Fat - 9 kcal/gram Protein - 4 kcal/gram water - 0 alcohol - 7 kcal/gram (not a maconutrient)
TEF
Thermogenic effect of food (increased energy expenditure); it is highest for protein and high protein diets; fat has the lowest TEF
FITTE
Exercise Rx: Frequency, Intensity, Time, Type, Enjoyment
MET
Metabolic Equivalent of Task
1 = RMR; <3 = Light; 3-6 = Moderate; >6 = Vigorous
Diets and Health Benefits Summary
Low Carb: dec TAG and DM2, inc HDL
Low Fat: dec LDL and total cholesterol
Mediterranean: dec CV mortality and DM2 (as well as LDL)
Veg/Vegan: dec LDL, CV mortality, and DM2
DASH: dec BP
Meal replace: best weight loss
VLCD: dec DM2, most aggressive dietary strategy
High protein, low GI: maintaining weight loss
GI sites of Nutrient Absorption
Duodenum - iron and calcium
Jejunum - Carbs, AAs, Potassium, many vitamins
Ileum - Water, K, Minerals, Salts, Fats (ADEK)
Colon - Vit K, Biotin, B12, B2, B1, water, sodium, Cl
Protein Maintenance and Weight loss
Maintenance - .7-1 mg/kg/d
Weight loss - 1.2 - 1.5 mg/kg/d (90-120 gm/d)
Benefits of 5-10% of weight loss
Reduction T2DM Improved BP Reduction CVD risk factors Improved lipid profiles Improvement in sleep apnea up to 50%
Mortality Data For Obesity
Least among BMI 22.5 to 25; mortality increases for each 5 kg/m2 increase in BMI; overweight BMI (25-29) at age 40 lived 3 years less, 30-30 lived 2-4 years less, BMI 40-45 lived 8-10 years (comparable with the effects of smoking)
BRFSS
Behavioral RIsk Factor Surveillance System -State level; telephone survey and underestimates obesity
NHANES
National Health and Nutrition Examination Survey - Nationwide, interviews and physical exams - random selection via census data
Edmonton Obesity Staging System
Stage 0 - No signs of risk factors
Stage 1 - subclinical risk factors
Stage 2 - Comorbidity requiring intervention
Stage 3 - Significant end organ damage
Stage 4 - End-stage disease or disability
International Diabetes Federation (IDF)
Asian Countries (overweight >23-24; Obesity > 27-29)
OMA Diagnosis of Obesity
Obesity is defined as a chronic, relapsing, multifactorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, bio mechanical, and psycho social health consequences.
Obesity definition - American Council on Exercise Classification (waist circumference)
Cau M - 40”; F - 35”
AA M - 37”; F - 31.5”
Latino M - 35.5”; F - 31.5”
Asian M - 33.5”; F - 31.5”
American Association of Clinical Endocrinologists
Overweight - BMI 25-29.9 without complications
Obesity - BMI > 30 - no complications
Obesity Stage 1: BMI > 25 with mild-moderate complications
Obesity Stage 2: BMI> 25 with severe obesity related complications
Treatment of choice for Binge Eating disorder and Bulima
CBT
Stages of Change
Pre-contemplation (use motivational interviewing here)
Contemplation - use MI here
Preparation - Use CBT here and forward in stages
Action
Maintenance
Upper leg length and obesity
Short upper leg length can indicate risk for metabolic syndrome (more than BMI or waist circumference); it is more reliable
Laboratory Eval of Childhood Obesity
85-94%tile WITHOUT risk factors - Fasting Lipids
85-94%tile WITH risk factors (10 and up) - Fasting Lipids, glucose, LFTs
95%tile (10 and up) - Fasting lipids, glucose, LFTs, TFTs (consider others based on family hx or PEx
ADMR
Acceptable Macro Distribution Range
ADMR for Carbs
45-60%
AMDR for proteins
10-35%
ADMR for fats
25-35%
Definition of Childhood Obesity
<5% - underweight 5%-84% - Healthy Weight 85% - 94% - Overweight 95% - 99% - Obesity 120% of the 95 or BMI or >35 - Severe obesity
Obesity EKG abnormalities
LAD, T wave, PACs (OSA), Hypertrophy (HTN), QT abnormalities
TEE = REE + TEM + EEPA
Total Energy Expenditure = Resting energy expenditure (60-75%) + Thermic effect of meals (10%) + Energy expenditure from physical activity (15-30%)*
*Non-exertional (NEAT)and exertional/exercise
Resting metabolic rate calculations
10xW (kg) + 6.25xHt (cm) - (5xAge) (+5 in males; - 161 in females) = Miffin-St Jeor Equation
Also is the Harris Benedict (more complicated formula…)
BMR
Basic Metabolic Rate - comprises roughly 70% of TDEE; muscle and brain are most metabolically active tissues
Increased neck circumference for OSA
Men - > 17 inches; Women - > 16 inches
American Council on Exercise Classification of % body fat
Obesity: > or = 32% in women and > or = 25% in Men Acceptable: 25-31% and 18-24% Fitness: 21-24% and 14-17% Athletes: 14-20% and 6-13% Essential Fat: 10-13% and 2-5%
Waist Circumference - Obesity
MEN > 40 inches or 102 cm; WOMEN > 35 inches or 88 cm
Mediterranean Diet and effects
Diet plan that emphasizes healthy fats, fruits, veggies, whole grain, beans, nuts, and seeds. It decreases risk of atherosclerosis, coronary artery disease and cerebrovascular disease. Improves LDL (decreases) and TAGs (decreases); no affect on HDL
Treatment of choice for Binge Eating disorder and Bulima
CBT
OMA Diagnosis of Obesity
Obesity is defined as a chronic, relapsing, multifactorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, bio mechanical, and psycho social health consequences.
Principal contributor to resting energy expenditure
Lean body mass
