US Diets and MNT - Abali 3/15/16 Flashcards
metabolic syndrome
aka
- dysmetabolic syndrome
- hypertriglyceridemic waist
- insulin resistance syndrome
- obesity syndrome
- syndrome X
BMI ranges
healthy: 18.5-24.9
overweight: 25-29.9
obese: 30-39.9
extreme obesity: 40 or above
- eligible for bariatric surgery
clinical ID of metabolic syndrome
waist circumference: M > 40; F > 35
TG: > 150
HDL chol: M < 40; F < 50
bp: > 135/85
fasting glucose: > 100
NEED 3 OR MORE OF THE ABOVE
causes and risks of metabolic syndrome
causes:
abd obesity + insulin resistance, compounded by physical inactivity
risks: 2x CVD; 5x DM2 → 3x CVD
development of unhealthy fat stores
healthy vs dysfunctional adipose tissue
how your body processes positive energy balance is affected by:
- smoking
- unfavorable genotype
- maladaptive response to stress
influences fat deposition!
healthy adipose tissue : subcutaneous obesity : no ectopic fat
dysfx adipose tissue : visceral obesity : ectopic fat
- muscle fat (assoc with intracellular lipids)
- epicardial fat
- liver fat, fx
3 pieces of long-term weight loss puzzle
- healthy diet
- physical activity
- behavioral modification
*diets/interventions that fail to target all three will prob yield only short term/temp effects
risks and benefits of Atkin’s diet (low carb diet)
benefits
- less hunger : higher protein content, more satiety
- lower chol : decrease in LDL
- rapid wt loss : ketosis (soluble molecule, lose some water wt) , utilization of stored fat
risks
- lack of energy/weakness : ketosis, low stores of glycogen
- high sat fat : 25% calories from sat fat
- low fiber
- ketogenesis
- low vitamins
metabolic effects of low carb diets
reduction in circulating insulin, increase in circulating glucagon
- favors gluconeogenesis
low carbohydrate intake → increased rate of FA mobilization → buildup of acetyl CoA → conversion to ketone bodies
- favors ketogenesis, ketosis
brain will be counting on the a.a.s from your diet, not from muscle tissue you’re breaking down
high carbohydrate diet (Ornish diet)
benefits
- high fiber, low fat → lower chol, lower bp
risks/challenges
- so little fat that you might run risk of lacking essential FAs
- limits fish/nuts/olive oil which can protect against heart disease
- difficult to maintain long term adherence!
fad diets
- associated with short term effectiveness
- after initial pd, results may fall off
- nutrition plan isnt always safe/effective
- may exclude/restrict healthy foods → deficiencies
- could have long term effects on health, cause tissue wasting
Mediterranean diet
focus on whole foods, food patterns (versus macronutrients)
- lifestyle : cooking (awareness of what you eat), eating together (slow consumption)
- high fluid (incl alcohol)
- small portions of meat/fish, high content of nuts/beans
maintaining weight loss
fad diets often result in weight cycling
key: maintain habits used to achieve loss after loss
new lower weight requires less calories to maintain
- hard to change eating habits, cut down further
- instead, 60-90 min moderate exercise can maintain
medical nutrition for diabetes
restrict carbs (< 130 g/day)
- low glycemic index
increase fiber
- improves glycemic reg
increase proteins (?)
- protein ingestion lowers absorption of glucose → improves glycemic reg
- high protein could have renal effects → bad
- alcohol in moderation (interferes with gluconeogenesis)
medical nutrition therapy for dyslipidema
avoid sat fat foods
reduce saturated FA
- sat FAs → decreased production of LDL receptors
- 1% increase in sat fat → 2% increase in LDL
increase PUFA (polyunsaturated FA) → lower LDL, lower CVD risk
- omega 3 FAs (linolenic acid) > omega 6
- fatty fish (SMASH - salmon, mackerel, albacore, sardines, herring) > supplement
increase MUFA (monounsaturated FA) → lowers LDL, TAGs without lowering HDL
- olives, olive oil, nuts, bananas, dark choc
*degree of weight loss directly related to magnitude of decrease in TAGs
increase soluble fiber
- bind/remove bile acids from body → force body to compensate by raiding its chol stores → increased LDL receptor synth → decrased circ LDL!
- increase satiety
increase fruits/veggies/whole grains
- each fruit, 4% decrease in CHD
- rich in antioxidants (recommended; vitamins rich on antiox not recommended)
alcohol
- increased HDL, decreased oxidation of LDL
hypertension
when to treat
contributions
over 60? > 160/90
under 60? >140/90
risk factors
- obesity
- high Na
- low K, low Ca
- excessive alcohol
nutrition therapy
- weight loss, physical activity
- lower Na
- increase K, increase Ca
- decrease alcohol
DASH plan for HTN
& other lifestyle changes to drop bp
Dietary Approaches to Stop HTN
- lower sodium intake (tons of added salt in preservatives and processing)
- lots of fruits and vegetables
lifestyle changes
- weight reduction, physical activity
- DASH diet, Na restriction
- moderate alc consumption
chronic kidney disease
gradual, irreversible deterioration of kidney fx
causes
- DM, 45%
- HTN, 27%
- inflamm/immuno/heretidaty disease that affect kidneys
end stage renal disease (ESRD) : requires either dialysis or kidney transplant to survive
consequences of kidney dysfx
- Na retention → volume overload
- hyperkalemia
- metabolic acidosis
- increase in PO4, decrease in Ca
- anemia
medical nutrition therapy for chronic kidney diease (CKD)
lower protein intake → avoid uremic toxicity
need alt sources of energy
- complex and simple carbs + MUFA and PUFA
- monitor for dyslipidemia!
adjust Na, K, Ca, P, vit D (bc you cant make active form without kidney fx)
supplement with folic acid and Fe (bc you cant get them through protein sources anymore)
CKD and…
sodium
potassium
in extremely low GFR, Na excretion drops
- water retention
- hypertension
- edema
in diabetic nephropathy, K excretion drops
- need to restrict K in diet in later stages of renal disease
recommendations for protein-uremic toxicity
CKD stages 1-3
drop protein intake to .75g/kg body weight
- should pick “high bio value” proteins (complete, all essential a.a.s)
- supplement deficiencies that pop up due to reduced protein intake [vitamin D!!!]
bariatric surgery
- requirements
- conseqs of malabs
need to be able to demonstrate ability to lose wt and maintain it
need to be morbidly obese
need to pass psych evals
more malabsorption → more weight loss, but also higher risk
- less weight loss/risk : gastric banding, sleeve gastrectomy
- medium weight loss/risk : roux en y gastric bypass
- high weight loss/risk : biliopancreatic diversion with duodenal switch
post bariatric surgery diet, deficiencies
- small portions, eat slow
- no beverages during, up to 30min after eating
- min 60g protein/day
- no grazing, yes physical activity
- many will experience dumping syndrome!
need nutrient/vitamin supplementation!
- protein malabs : jejunum and mid ileum bypassed
- iron deficiency → need low pH to reduce iron for absorption, have less stomach space to make this happen
- Ca and vit D def → leading to secondary hyperparathyroidism
- deficiency in folic acid - low dietary intake
- deficieny in soluble vitamins (bc we don’t have good store besides folic acid and B12)
- esp thiamine (measure thiamine or measure RBC transketolase activity)
- vit B12 deficiency → R protein and IF swap happens in stomach → might not get good B12 abs
