Week 6- Nutrition, Nutraceuticals and Nutrition Disorders Flashcards
What is a healthy diet?
-Provides sufficient energy and nutrients to maintain
normal physiological functions, and permit growth and
replacement of body tissues
-Prevents deficiency symptoms
-Optimises body stores
-Optimises some biochemical/physiological function
-Minimises a risk factor for some chronic disease
-Minimises the incidence of a disease
what is the infant nutritional requirements?
Nutritional requirements are high – rapid growth and
development
what are the different types of infant formula?
- newborn= birth to 1yr
- follow-on= 6 months-1yr higher iron
- toddler milk 1-3yrs
what is infant formula?
cows milk modified to mimic breast milk
what are some of the prescribable formula?
-soya based= cows milk protein allergy, concerns of use before 6 months
-hydrolysed formula= modified cows milk hypoallergenic
-Others, including lactose free , anti-reflux,
higher energy, colic, prem infants
what is weaning?
introducing an infant to adult diet
what are the reasons for weaning?
• ↑ requirements for energy, vitamins/minerals
• Growth and development – nutrient requirements no longer met by milk alone
• Variety of foods
Six months recommended by DOH for introduction of solid food
what are some of the foods to avoid during weaning?
• Wheat/Gluten, Fish/Shellfish, Fruit Juices, Soya, Eggs
(before 6 months)
• Salt, Sugar, Honey (before 1 yr)
• Care with textures to avoid choking
what is important for development in school children?
-physical education
-Good supply of protein, calcium, iron, vits
A and D particularly important
-Varied diet with adequate energy and
nutrients for various growth periods which
are sometimes rapid during these years
during adolescents what happens and what are the nutritional requirements for them?
-Growth and development period, growth spurt during
adolescence
• Peak bone mass occurs during adolescence so calcium and vit D requirements increase. Physical activity aids bone strength
-energy and nutritional requirement are higher in boys than girls
-Iron requirements increase in girls after onset of
menstruation and continue to be higher through until
menopause
what are the nutritional requirements for an adult?
- requirements tend to stay the same between 19-50yrs unless pregnant/lactating
- males 2772kcal females 2175kcals
- protein 0.75g per kg of bw
- carbs 50% of total energy 30g fibre
- fat 35% total energy
what are the max units for alcohol a week?
- 14 units/week on regular basis
- spread evenly over 3 or more days
- Heavy drinking once or twice a week increases risk of death from longterm illness and accidents and injuries
- Risk of developing cancers increases the more you drink on a regular basis
what does the energy requirements increase by for a pregnant women?
- 200 kcal/day
- Avoid shark, swordfish and marlin and limit tuna
what are some of the micronutrients needed for a pregnant women?
– 400mg folic acid/day during first trimester
– Iron-rich foods and possibly supplements needed,
particularly last trimester
– Avoid vitamin A supplements and liver and liver products
-no alcohol, limit caffeine and stay active
what is a common problem for older adults?
malnutrition
– Inadequate intake of dietary energy = loss of
body weight, depletion of body fat stores and
muscle wasting
– Nutrient deficiencies
– Widespread metabolic physiological and
functional adaptations occur
what are some nutrients that are needed for bone micronutrients?
- Vitamin D
- Vitamin K
- Calcium
- Magnesium
- Phosphorous
what is vitamin D?
• Family of sterol derivatives • Calciferol (D2 ); cholecalciferol (D3 ); dihydrotachysterol, alfacalcifidol and calcitriol
where is vitamin D from?
fish liver oils, egg yolk (D3
animal, D2
plant) and
synthesised in the skin under UV light D3
What is the function of vitamin D?
-maintaining levels of vitamin D with parathyroid hormone
-immunopoiesis which is the synthesis of new blood cells
– Cell proliferation and differentiation
– Immunomodulatory
–10 μg/day
how is vitamin D made in the skin?
- we take cholestrol in the intestine or we make it in the liver
- its then taken up by the skin and converted to 7-dehydrocholesterol in the presence of sunlight its converted to vitamin D3
- its then travels in the plasma to the liver where its hydroxylated to 25-hyrdoxylation
- then transported to kidney and again hydroxylated again to 1-hydroxlation
what does vitamin D3 do by working with parathyroid hormone?
to increase Ca+ levels
what mechanisms vitamin D3 tdo by working with parathyroid hormone?
promotes intestinal absorption
increase Ca2+ mobilisation
decreases Ca2+ excretion
-has a negative feedback
what does vitamin D deficiency cause?
rickets
what is the aetiology of lactose intolerance?
-inablility to digest lactose , due to low levels of lactase
• Congenital lactase deficiency – extremely rare autosomal
recessive disorder with absence of lactase
• Childhood-onset and adult-onset lactase deficiency – common ,
inherited in autosomal recessive manner
• Late-onset primary hypolactasia – associated with C/C of the genetic variant C–>T(-13910) upstream of the
lactase phlorizin hydrolase gene (LCT) (reduced synthesis of precursor
protein) in Caucasians – Differences in rate of gene transcription account for inter-racial variation
• Persistent lactase activity into adulthood – autosomal dominant
• Acquired lactase deficiency – transient – damage of mucosa by infection or inflammation, resolves – often in children <2yrs
how is lactose intolerance diagnosed?
• Symptoms – check with GP
• Hydrogen breath test – Lactose metabolised by gut bacteria , producing
hydrogen that’s absorbed into blood and excreted
in lungs
• Dietary elimination – Does diarrhoea resolve when milk and products
removed? – Do symptoms recur upon reintroduction?
what is coeliac disease?
-gluten intolerance
-autoimmune disease
-caused by – Genetic predispositionand Consumption of gluten proteins
-– >95% patients express HLA-DQ2 or DQ8 – Receptors they encode bind gliadin peptides more tightly,
activating T lymphocytes and initiating autoimmune
response – 75% concordance among monozygotic twins – Up to approx 20% of first degree relatives affected – Increased risk in Type 1 Diabetes, Down Syndrome,
Turner’s syndrome, autoimmune thyroid disease and
dermatitis herpetiformis
what is the coeliac pathophysiology?
• Consumption of gluten: – Gluten proteins sometimes incompletely digested – Peptides are extremely immunogenic to affected
patients – Prolamines - alcohol-soluble fractions of gluten absorbed in small intestine and presented to APC in lamina propria, resulting in immune response in
mucosa
• Gliadins in wheat
• Hordeins in barley
• Secalins in rye
• Possibly avidins in oats
what are some signs and symptoms for coeliac?
• Common – Diarrhoea – Fatigue – Borborygmus – Abdominal pain – Weight loss – Failure to thrive – Abdominal distension – Flatulence
how is coeliac diagnosed?
• Symptoms – persistent diarrhoea, malabsorption, weight loss, gas, abdominal pain,
bloating or extra-gastrointestinal manifestations – Restricted to mucosa of small bowel so can differentially diagnose
from inflammatory bowel diseases
• Serological tests from blood sample – tissue transglutaminase (tTG) antibodies – endomysial antibodies – Total IgA antibodies if either of these negative but suspected disease
• Home kits eg Biocard – approx £20 in pharmacy and online
– but important to get medical diagnosis
• Endoscopy – Macroscopic changes possibly visible eg scalloping – Biopsy required to confirm diagnosis
what is the treatment for coeliac ?
- Removal of gluten from diet – No wheat, rye, barley – Check whether tolerant to oats and use pure source of oats
- Avoid manufactured products from flours – Flans, custards, ice creams – Malted foods – Beer, ale – Sauces, gravy and thickening agents – Sausages, pate, luncheon meats, – Cheese spreads – Soups, Chocolate and milk-flavoured drinks – Chocolate bars – Any canned food unless specifies gluten-free
what are the alternative routes for feeding for malnutrition?
• Avoid manufactured products from flours – Flans, custards, icecreams – Malted foods – Beer, ale – Sauces, gravy and thickening agents – Sausages, pate, luncheon meats, – Cheese spreads – Soups, Chocolate and milk-flavoured drinks – Chocolate bars – Any canned food unless specifies gluten-free
what are the advantages and disadvantages of nasal feeding route?
Advantages
Nasal Not invasive
Quick
Cheap Dysphagia
Disadvantages Irritation Risk of sinusitis, oesophagitis Dysphagia Risk of misplacement Risk of reflux Easy tube movement or removal Regular tube replacement X-ray confirmation Stigmatising
what are the +advantages and disadvantages of abdominal feeding route?
Type Advantages Disadvantages Abdominal \+ Less stigmatising Invasive \+Less tube migration Sedation and antibiotics \+Less tube removal Irritation at site \+Less reflux Leakage into abdomen \+No nasal irritation Translocation of bowel \+No dysphagia X-ray confirmation \+No tube replacement Tube clogging Hematomas causing bowel occlusion
what are some problems for feding?
• Diarrhoea – temp of feed / rate / check
date / fibre
• Constipation – fluid balance / fibre
• Vomiting – rate of feed / position of pt /
infection?
• Blocked tube – feed / meds / not flushed
what are causes of malnutrion under?
• Reduced food intake • Decreased absorption • Decreased activity of co-factors eg intrinsic factor and vitamin B12 • Increased metabolism • Underlying disease
what are the consequences of malnutrion under?
• Physical – Impaired immune function – Delayed wound healing – Decreased muscle strength and fatigue – Hypothermia – Reduced respiratory muscle function and cough
pressure, predisposing to chest infections – Immobility predisposing to venous thrombosis
and embolism and pressure sores – Reduced final height in women leading to reduced
pelvic size and small birth weight infants
• Psychological and behavioural – Depression – Anxiety – Reduced will to recover – Self-neglect – Poor bonding with mother and child – Loss of libido
what are some reasons for taking nutraceutics?
• Healthy lifestyle and increased awareness • Prevent or decrease disease • Explosion in range and availability • Media coverage • Increasing scientific evidence linking diet and health or disease prevention • Rising healthcare costs • Ageing population • Growing fixation with beauty
what are the main supplements in the UK?
• Vitamins and minerals - multi-complex and single • Selected vitamins and minerals with extra nutraceuticals aimed at targeting disease/health benefit • Pick-me-ups • Anti-oxidants • Amino acids • Fatty acids and oils • Bioflavonoids and phytoestrogens • Probiotics • Weight loss • Glucosamine, chondroitin sulphate • Stimulants
what are some foods that have benefits?
• Fruit, vegetables, nuts - contain antioxidants, folic acid, other
vitamins and minerals, and fibre
• Juices, tea, wine, beer, chocolate, herbs and spices – contain
vitamins, phenolic antioxidants and other active compounds
• Wholegrains – contain fibre and micronutrients
• Oily fish and low-fat products – contain PUFA, MUFA, plant sterols
and stanols
• Pre and probiotics
• Soy – contain phytoestrogens, fibre and protein
• Energy-boosting, stimulants, ‘ feel good’ drinks
• Foods with herbal extracts – novel
what are some factors influencing affect of nutraceuticals?
- genetic= will you react to it
- adverse affects
- drug ineraction with body and ohters
- processing
- active where in the body
- physiological state
what is Vitamin K?
Sources – green leafy vegetables, oils and liver K1
(+ synthesised by intestinal flora K2
)
Functions –
formation of prothrombin (II) and factors VII, IX and X
Warfarin is a competitive inhibitor
Interactions eg antibiotics
Evidence that increases bone mass
No RNI – Safe intake =1 μg/kg/d
Deficiencies – rare
newborn - ALL BABIES are given injection with consent 8
WHAT IS CALCIUM?
Most abundant mineral in body, 99% in skeleton • Active forms are calcium phosphate and ionic form, Ca2+ • Calcium balance regulated by Vit D, parathyroid hormone and calcitonin Functions • Structural - bone and teeth • Muscle contraction • Nerve impulse transmission • Blood clotting • Cell signalling and ion transport (second messenger) RNI = 700 mg/day adults Low intakes in teenage girls (11-18y)
what is magnesium?
Sources various Functions Enzymes eg decarboxylation, phosphorylation Skeletal development Protein synthesis Muscle contraction and Neurotransmission Closely linked with calcium metabolically RNI – 300 mg/d men, 270 mg/d women Low intakes in adolescents (NDNS)
what is phophorus?
Sources various -especially protein-rich foods Functions Energy formation (ATP) Bone mineralisation Component of cell membranes Cell signalling Component of nucleic acids Acid-base homeostasis Deficiency – rare (loss of appetitie, muscle weakness, bone fragility, numbness in extremities, rickets) RNI – 550 mg/d men
