US Diets and MNT - Abali 3/15/16

Question 1

metabolic syndrome

aka

Answer 1

• dysmetabolic syndrome
• hypertriglyceridemic waist
• insulin resistance syndrome
• obesity syndrome
• syndrome X

Question 2

BMI ranges

Answer 2

healthy: 18.5-24.9

overweight: 25-29.9

obese: 30-39.9

extreme obesity: 40 or above

• eligible for bariatric surgery

Question 3

clinical ID of metabolic syndrome

Answer 3

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

Question 4

causes and risks of metabolic syndrome

Answer 4

causes:

abd obesity + insulin resistance, compounded by physical inactivity

risks: 2x CVD; 5x DM2 → 3x CVD

Question 5

development of unhealthy fat stores

healthy vs dysfunctional adipose tissue

Answer 5

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

Question 6

3 pieces of long-term weight loss puzzle

Answer 6

1. healthy diet
2. physical activity
3. behavioral modification

*diets/interventions that fail to target all three will prob yield only short term/temp effects

Question 7

risks and benefits of Atkin’s diet (low carb diet)

Answer 7

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

Question 8

metabolic effects of low carb diets

Answer 8

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

Question 9

high carbohydrate diet (Ornish diet)

Answer 9

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!

Question 10

fad diets

Answer 10

• 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

Question 11

Mediterranean diet

Answer 11

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

Question 12

maintaining weight loss

Answer 12

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

Question 13

medical nutrition for diabetes

Answer 13

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)

Question 14

medical nutrition therapy for dyslipidema

Answer 14

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

Question 15

hypertension

when to treat

contributions

Answer 15

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

Question 16

DASH plan for HTN

& other lifestyle changes to drop bp

Answer 16

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

Question 17

chronic kidney disease

Answer 17

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

Question 18

medical nutrition therapy for chronic kidney diease (CKD)

Answer 18

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)

Question 19

CKD and…

sodium

potassium

Answer 19

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

Question 20

recommendations for protein-uremic toxicity

Answer 20

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!!!]

Question 21

bariatric surgery

• requirements
• conseqs of malabs

Answer 21

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

Question 22

post bariatric surgery diet, deficiencies

Answer 22

• 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