Term
| Name some conditions associated with increased risk of malnutrition |
|
Definition
| cancer, diarrhea, vomiting, dysphagia, bowel resection, COPD, organ transplant, decubitus ulcers. |
|
|
Term
| Name 3 reason that we do nutrition assessment |
|
Definition
1) data used to plan nutritional care - appropriate referrals
2) used to justify nutritional care - helps reimbursement
3) used to monitor effects of nutritional care - chronic vs acute intake status, may need to adjust labs to tailor. |
|
|
Term
| Name the ABCs of nutritional assessment |
|
Definition
A - anthropometric data (body measurements)
B - biochemical data (lab tests)
C - clinical data (signs and symptoms)
D - dietary data (typically chronic, but can be acute if assessing effects of intervention |
|
|
Term
| How do you get signs and symptoms in Clinical Data? |
|
Definition
Interview
Physical exam
Clues from table posted |
|
|
Term
| Name some interview tips for dietary assessment |
|
Definition
open-ended questions
non-leading questions
objective response
ask about supplements
ask about Rx or OTC medications |
|
|
Term
Define
1) Drug-nutrient interaction =
2) Food-drug interaction=
What are the effects of the above? |
|
Definition
1) specific changes to pharmacokinetics of a drug caused by nutrients or changes to the kinetics of nutrients caused by a drug
2) broader term that also includes effects of medication of nutritional status
Effects are
-alter response to medication
-drug toxicity
-alter nutritional status |
|
|
Term
| What are risk factors for food-drug interactions? |
|
Definition
polypharmacy, especially in older patients
chronic disease
malnutrition
cancer and AIDS
GI tract alterations
body composition
fetus, infant, pregnant woman |
|
|
Term
| Name some effects of FOOD on DRUG therapy |
|
Definition
Drug absorption: bioavailability, effects of fat and other food components, chelation, adsorption, pH
Drug distribution: albumin and binding sites
Drug metabolism: inhibition/enhancement, competition for metabolizing enzymes
Drug excretion: renal resorption, pH |
|
|
Term
| Name some effects of DRUGS on FOOD therapy |
|
Definition
Nutrient absoption: chelation, adsorption, transit time, GI environment, damage to intestinal mucosa, intestinal transport
Nutrient metabolism: increase speed, vitamin antagonism
Nutrient excretion: interfere with resorption, increase/decrease excretion |
|
|
Term
| name some examples of drug action altered by foods |
|
Definition
MAOIs and pressor agents
Caffeine and stimulants
warfarin and Vit K
St. John's Wort and anti-depressants |
|
|
Term
| Name some effects of drugs on nutritional status |
|
Definition
Side effects
Oral taste and smell: dysgeusia, hypogeusia, mucositis, xerostomia
GI effects; irritation, nausea, vomiting, constipation, diarrhea, kill flora, fat malabsoprtion
Appetite changes: lose/gain weight, imbalance, appetite suppressants/stimulats, CNS
Organ system toxicity: hepato or nephro toxicity
Glucose levels: too much or too little |
|
|
Term
| Name and define some ways to estimate typical intake in the Nutritional assessment, include the up and down sides of each. |
|
Definition
1) 24-hour recall: ask what they ate in 24 hour time
-Good=quick, short term memory, not alter intake
-Bad=not representative (need 3 days), seasonal variation not addressed, requires some memory
2) Food record=keep record for 1-7 days
-Good=not require memory, representative, self-administered
-Bad=high respondent burden, needs literacy, no seasonal variation addressed, alter intake via desire to please or laziness.
3) Food fequency Q: checklist of consumption
-Good=low respondent burden, self-administered, addresses seasonal variation
-Bad=need complete food list, integrate memory
4) Diet history: continues beyond the 24 hr recall
-Good=good idea of intake habits, ID potential barriers to change, address seasonal
-Bad= lots of time, long term memory, may over estimate intake. |
|
|
Term
Name Harris Benedict equation, how accurate, and when it was developed?
Name Mifflin St. Jeor Equation, how accurate, and when it was developed?
What are they both used for ? |
|
Definition
HB: accurate (within 10%) 69% of the time, 1919
MSJ: accurate (within 10%) 82% of the time, 1990
Calculating Resting Metabolic Rate |
|
|
Term
| How do you estimate energy needs? |
|
Definition
| Get RMR and multiply by Activity Factor and an additional stress factor if it exists |
|
|
Term
| How do you estimate energy needs for obese people? |
|
Definition
Use adjusted body weight
desirable weight+(actual-desired) x 0.25
The adjustment is for their adipose tissue because you assume only 25% of weight is metabolically active. |
|
|
Term
| How do you estimate protein needs for stressed adults? |
|
Definition
0.8 g/ kg healthy
0.8-1.2 g/kg mild stress
1.2-1.8 g/kg moderate stress
1.6-2.2 g/kg severe stress |
|
|
Term
How do you antropometrically assess infants/toddlers?
Whats the deviation allowed to be? |
|
Definition
Head circumference for birth-36 months.
Length for birth-36 mo, height for 2-20 yo.
Weight
Plot these on the CDC growth charts. Deviation not more than 2 percentile above or below the 5-85 percentile marks. Growth needs to have a consistent pattern. |
|
|
Term
| How do you measure antropometrically in adults? |
|
Definition
Percent desirable weight
BMI
Weight change
Waist circumference
Body composition (%fat, muscle mass, bone density) |
|
|
Term
| How do you get "desirable" weight for adults? |
|
Definition
Hamwii formula
-female 100lb for 5 feet + 5lb per in >5feet
-male 100lb for 5 feet + 6lb per in >5feet
Metropolitan life insurance (miller method)
-female 119lb for 5ft + 3lb per in >5ft
-male 135lb for 5ft + 3lb per in >ft
Always get a range (+or - 10%) on either method based on frame size!) |
|
|
Term
| What are the difficulties in using height/weight tables from life insurance data? |
|
Definition
Potential bias
Data collection methods not always standard
Methods to estimate frame size vary
Confounding variables not always addressed or controlled (ex: they made people who were fat look healthier because smokers are thin) |
|
|
Term
What is the percentage weight for the following:
Underweight
Normal weight
Overweight
Obese |
|
Definition
Underweight= <90% desirable
Normal = 90-120%
Overweight = >120%
Obese= >130% |
|
|
Term
| How do you classify and define Unintentional weight loss in adults? |
|
Definition
Significant
5% in 1 month
7.5% in 3 months
10% in 6months
Severe
>5% in 1month
>7.5% in 3 months
>10% in 6months |
|
|
Term
Why is it ok to use BMI for adults?
Who is it not useful for?
Define the BMI classes |
|
Definition
<18.5 and >24.9 correlated with risk of chronic disease
correlated with percent body fat (not count muscle mass)
BUT not as useful for athletes due to their increased lean mass.
Underweight<18.5
Normal 18.5-24.9
Over 25.0-29.9
Obese class I 30-34.9
Obese class II 35-39.9
Obese class III >40 |
|
|
Term
| How to measure BMI for adults? |
|
Definition
-Hydrostatic weighing: gold standard, displacement of either water or air (Bod Pod)
-Skinfold measure: with caliper, need 3 sites that are different between men and women, only accurate if you have a skilled tech.
-Electrical impedance: measure speed of electrical signal through body, include height, weight, gender, and age.
-DXA: (dual x-ray absorptometry) info on fat, lean, and bone mass. Uses x-rays. |
|
|
Term
Adult changes in body fat composition
Women?
Age? |
|
Definition
Women can have higher % fat without risks: need for reproductive health and successful pregnancy
Some increase in body fat is normal with aging but can delay/reduce that with exercise. |
|
|
Term
| How is body fat estimated? |
|
Definition
Waist to hip ratio used.
Today you really only need the waist circumference
Women >35 in
Men >40 in |
|
|
Term
| What are 2 types of malnutrition and what are their signs? |
|
Definition
Kwashiorkor: primary deficiency is protein
-some weight loss or decreased growth, muscle wasting, edema, fatty liver, skin lesions, dry brittle hair easily plucked
Marasmus: protein and energy deficiency
-severe weight loss, growth, muscle wasting
-no edema, or fatty liver
skin dry and thin, hair sparse and easily plucked |
|
|
Term
| What are 2 measures of biochemical assessment? |
|
Definition
Static- nutrient or metabolites in the blood, but not always helpful due to homeostatic regulation.
Functional - test body processes that depend on specific nutrients. |
|
|
Term
| Name ways of doing protein status from most common to least, their half lives, and their specificity. |
|
Definition
Serum albumin - chronic protein status
-18-20 days, low specificity
Serum transferrin - iron protein
-8-9 days, low specificity
increases with depleted iron stores
Serum prealbumin (transthyretin)-monitor Tx effect
-2-3 days, used a lot, may be decreased by renal or zinc insufficiency.
Serum retinol-binding prot
-12 hours, affected by Vit A status |
|
|
Term
| What are some factors to consider in using serum proteins to assess protein status? |
|
Definition
Levels may be maintained even in protein malnutrition
Levels may be decreased by inflammation even with adequate protein status
Can use markers of inflammation to assess likelihood of inflammation effect on serum proteins. |
|
|
Term
| What serum protein is LEAST affected by inflammation? |
|
Definition
|
|
Term
What is C-reactive protein?
What can it help to determine? |
|
Definition
CRP is inflammatory biomarker
Can help determine when hypermetabolic phase of acute inflammation goes down |
|
|
Term
Name ways to determine iron status in order of markers of early to later deficiency.
What is NOT useful and why? |
|
Definition
Ferritin level (1st stage)
Transferrin saturation (2nd stage)
Total iron-binding capacity (2nd stage)
Erythrocyte protoporphoyrin (2nd stage)
Hemoglobin (3rd/4th stage)
Hematocrit (% RBC in total blood vol)-3rd/4th stage
Serum iron not useful because of daily variation. |
|
|
Term
| How do you assess micronutrients? |
|
Definition
Not a good way.
Serum, tissue, functional tests are sometimes helpful. Hair content is debatable. |
|
|
Term
| Give examples of micronutrient status eval for Vit B12, Vit B6, Vit D, Vit A, Vit C, Calcium, Magnesium, and zinc |
|
Definition
Vit B12/folate- RBC or serum, homocystein levels, Schilling test, serum B12
Vit B6- serum pyridoxal phosphate (PLP)
Vit D- serum 25OHD3
VitA- plasma retinol, liver stores, dark adaptation, histological assessment.
Vit C-plasma and serum for recent, WBC store for long term.
Calcium - not routine available, need bone scan
Magnesium - serum done routinely but not good measure. 1% of total in blood. RBC and peripheral lymphocyte Mg is better.
Zinc - problematic, serum levels used most often but not specific and decreases ONLY in severe deficiency. |
|
|
Term
| Why should doctors counsel in nutrition? |
|
Definition
If you don't acknowledge there is a problem pt not perceive there's a problem.
Counseling increases pt motivation and confidence.
Improves behaviors.
Recommended by task force for obesity. |
|
|
Term
| What are some barriers to lifestyle counseling by physicians? |
|
Definition
| Time, training, expertise, reimbursement, personal health behaviors, personal health status |
|
|
Term
| What are the steps to nutritional counseling? |
|
Definition
Discuss rationale for behavior change
Assess current behavior (readiness to change, past efforts, knowledge of risks related to current behavior)
Provide clear strong message about what needs to be changed and why.
Refer to dietitian or nutritionalist when needed.
Follow up so they think you care. |
|
|
Term
| What are some resources for nutrition counseling? |
|
Definition
MyPyramid online tracking stuff
Dietary Guidelines Consumer Brochure
CDC consumer info
State and local health department
American heart assoc, american diabetes assoc,
Drug companies (check for bias first) |
|
|
Term
| What are some resources for nutrition counseling? |
|
Definition
MyPyramid online tracking stuff
Dietary Guidelines Consumer Brochure
CDC consumer info
State and local health department
American heart assoc, american diabetes assoc,
Drug companies (check for bias first) |
|
|
Term
| What are some things that influence physicians addressing pt nutritional counseling? |
|
Definition
Doc's own health status
Doc's own physical activity status
Also above two affect the Doctor's attitude regarding importance of health and activity in maintaining good health. |
|
|
Term
Fill in the percentages for physician-pt perspectives
__pts reported preference for no or minimal weight discussion.
__pts reported being comfortable discussing weight with physician
__physicians comfortable discussing weight, diet, physical activity with obese pts.
__physicians report routine discussions.
__physicians reported never having discussions with obese pts |
|
Definition
|
|
Term
| What are some key points in physician nutritional counseling? |
|
Definition
Anything is better than nothing
Acknowledge problem is key
More specific is beter
More tailored is better
Follow up is important. |
|
|
Term
| Name the energy systems used during exercise in order of use. |
|
Definition
ATP stores (3oz)
ATP-CP system (8sec)
Lactic acid path (60-120 sec)
Aerobic path (after 2 min and on) |
|
|
Term
| What are the determinants of athletic perfrmance |
|
Definition
genetics
training
nutrition |
|
|
Term
| What is the oxygen usage for the 3 levels of intensity? |
|
Definition
Low <30% V oxygen max
-use muscle fat stores
Moderate 40-60% VO2max
-mix of FA oxidation and glucose use
High >60% VO2max
-glycogen stores used due to limited ability to access fat stores (not enough time to oxidize) |
|
|
Term
| What predominates with duration of training? |
|
Definition
Oxidation of FA increases
Aerobic metabolism
But still need glucose to prime the pathways |
|
|
Term
| How can training help performance? |
|
Definition
Increase O2 delivery to tissues
Increase mitchondrial mass for oxdiation
Enhance muscle ability to oxidize all fuels. |
|
|
Term
Name the calories required for the following levels of fitness
Normal fitness program
Intense training
Elite athletes |
|
Definition
Normal fitness= 25-35kcal/kg (1800-2400 per day)
Intense (2-3hrs daily, 5-6xweekly)= 50-80kcal/kg or 2500-4000kcal/day
Elite= 150-200kcal/kg (7000-10,000kcal/day) |
|
|
Term
| What are the carb requirements to enhance performance? |
|
Definition
45-65% of kcal but close to 65% for endurance training.
5-10g/kg or closer to 10 for endurance |
|
|
Term
| What are the fat requirements for performance? |
|
Definition
20-35% of kcals for day.
Not good to be above 35% because still need glucose to prime.
Not good to be below 20% because you can increase capacity to oxidize fat by increasing intake. |
|
|
Term
What are the protein requirements for performance?
What are the dangers to excess? |
|
Definition
10-25% of kcals
14g/day over RDA= 2 ounces of meat extra
28g/day over RDA for 2lb lean tissue gain per week. More than 2lb per week gain is not feasible.
Dangers= renal load, increased urinary calcium loss, risk of dehydration, extra kcal if using supplements. |
|
|
Term
| What do the ADA/ASCM and NAS recommend for protein intake for performance? |
|
Definition
ADA/ACSM-> recommend increase for neutral to positive balance
NAS does not recommend increase due to adaptations during training. |
|
|
Term
What do strength atheletes need in terms of proteins, why?
What do endurance athletes need in terms of proteins, why? |
|
Definition
Strength
>1.6-1.7g/kg to gain
>1.2-1.4g/kg to maintain
Right after workout to stimulate anabolism
Endurance
>1.2-1.4g/kg
Need more a.a. for oxidation due to high energy needs and support of damaged tissue. |
|
|
Term
What are the vitamin/mineral requirements for athletes?
What is the limit? |
|
Definition
Current DRI seems adequate
Can increase B vitamins for energy
Antioxidants may enhance recovery.
Limit to 100% DRI, or else could be toxic. |
|
|
Term
What is the iron requirement for athletes?
What is sports anemia? |
|
Definition
Supplementing only helpful with anemia.
Endurance athletes may be at risk for iron-deficiency anemia so may need supplements.
Transient decrease in volume of blood with low ferritin and hemoglobin. usually goes away after training for a while and there is not effect on performance. |
|
|
Term
| What are the calcium requirements for athletes? |
|
Definition
Female athlete triad
1) Estrogen deficiency
2) Disordered eating
3) Low body fat
Reduce treatment and supplement with D3 and estrogen replacement therapy. |
|
|
Term
What is the minimum hydration level for athletes?
Sources?
What to do for water weight loss? |
|
Definition
12 cups/day females
16 cups/day males
20% foods
80% beverages
1lb of H2O loss needs 2 cups + 1 cup replaced. |
|
|
Term
What does carbohydrate loading do?
How do you do Modified Depletion Taper Precompetition Program? |
|
Definition
Helpful for events lasting at least 90 minutes.
D1=90 min workout at 70-75% VO2max
-eat mixed 50% CHO
D2-3= gradual taper time/intensity
-eat mixed 50% CHO
D4-5=cont gradual taper
-eat mixed 70% CHO
D6=complete rest
-eat mixed 70% CHO
D7=competition
-eat pre-event meal |
|
|
Term
| What does the pre-event meal consist of? |
|
Definition
Should be CHO high and fat limited <25%
3.5-4 hours prior=200-350 g CHO or 4g CHO/kg
1g CHO/kg body weight per hour prior to event. |
|
|
Term
Does eating during event help?
How to do it? |
|
Definition
only helpful if event lasts longer than 1hour.
stabilizes blood glucose and may spare glycogen stores.
30-60g/hr CHO in frequent small portion
sports drinks or other food. |
|
|
Term
What do you eat post event?
How do you increase anabolic hormone profile? |
|
Definition
1-1.85g CHO/kg/hr for first 5 hours
-right away then hourly
5-9g protein/100gCHO promotes anabolic hormone profile |
|
|
Term
How to hydrate endurance athletes?
Electrolytes? |
|
Definition
Before= 14-22oz H2O 2-3 hrs
During=6-12oz every 15-20 min
After= 16-24oz per pound lost (25-50% more than weight loss)
Electrolyte replacement= 0.5-0.7g/L sodium (sports drink or water)
Only if event >1hr |
|
|
Term
Whats the problem with protein supplements in strength athletes?
Whats one good aspect? |
|
Definition
Be careful of extra protein calories.
Most people already eat more than RDA
Could cause imbalance
BUT Arginine, Lysine, and Ornithine can increase anabolic hormones |
|
|
Term
| What is the creatine dose in strength athletes? |
|
Definition
Loading 20-30g/day for 1 week
Maintain 10-15g/ day while training |
|
|
Term
| What are the risks for obese adults? |
|
Definition
| coronary heart disease, hypertension, dyslipidemia, stroke, type II diabetes, cancer, gyno problems, sleep apnea, asthma, osteoarthritis, liver dz, gall bladder dz, surgical risk, depression, quality of life, depression, discrimination, psychological effects, premature death. |
|
|
Term
| Risks of obesity in children? |
|
Definition
abnormal glucose intolerance (early type II diabetes)
hypertension, increase blood cholesterol, fatty liver, sleep apnea, greater risk for adult obesity, SOCIAL DISCRIMINATION |
|
|
Term
| What are indicators of risk for obesity? |
|
Definition
> Rapid weight gain after age 40 (1-2lb per year on average)
> rapid increase BMI before age of 5 in kids
? increase in BMI percentile > 2 curves for kids. |
|
|
Term
| What is etiology of obesity |
|
Definition
> genetics (50-70% disposition)
> behavioral factors (energy intake, physical activity, sedentary behavior)
> environmental factors (toxic or obesogenic environment)
--> portion sizes, easy access to food, sedentary lifestyle |
|
|
Term
| What is a Dx for metabolic syndrome? |
|
Definition
3 or more of the following
-waist circumference >40in men, >35 women
-serum TG>150mg/dL
-HDL <40mg/dl men, <50mg/dl women
-BP >135/85 mmHg
-fasting glucose >110mg/dl |
|
|
Term
| What are some ways of preventing obesity in adults? |
|
Definition
Approrpriate total calories
-eating breakfast regularly
-frequent healthy small meals or snacks
-increase fruits, veg, whole grain, lowfat dairy
-focus on lower fat food
-INFREQUENT EATING OUT
-CONTROL PORTION SIZES
Planned physical activity
NEAT
Stess management
Policy
-environmental characteristics (promote healthiness in neighborhood)
-Work environment
-Health insurance
|
|
|
Term
| What are some ways of preventing childhood obesity? |
|
Definition
-diet
limit sugar sweetened beverages
increase fruits, grains, veg
no clean plate club
intro variety of healthy food
-planned physical activity(60min/day)
-limit TV and games to 2hrs
-policy
environmental- facilities in area
school environment |
|
|
Term
|
Definition
Non-Exercise Activity Thermogenesis
anything not used for sleeping, eating, or planned working out
need >2.5 hrs per day standing/walking |
|
|
Term
| How to establish appropriate adult weight goal? |
|
Definition
-even 5-10% may give health benefits so start slowly
-do not starve
-0.5 to 1.0lb per week for BMI 27-35
-1.0 to 2.0lb per week for BMI>35 |
|
|
Term
| What approach is most effective for adult weight loss? |
|
Definition
Combination of approaches!
Healthy food choice+exercise+lifestyle modification
Phamaceutical or surgical intervention may not be warranted |
|
|
Term
| Describe the adult restricted calorie diet |
|
Definition
500-1000 calorie reduction (0.5-1.0lb per week)
25-30% from fat
15-25% protein
Vit/min supplement needed if ...
>1200kcal/day women
>1800kcal/day men |
|
|
Term
Describe the Very Low Calorie Diet
Who can do it?
What are the risks? |
|
Definition
200-800 calories per day
0.8-1.5g/kg protein
ONLY for BMI>30, failed other programs, not recommended unless has medical justification.
Risks: gout, gallstones, loss of lean mass |
|
|
Term
| What are the good and bad sides of formula/meal replacement diets for adults? |
|
Definition
Good= appropriate composition, portion controlled
Bad = removes need for decision making, doesn't alter lifestyle after program completed. |
|
|
Term
| What is the best form of exercise for management for obesity? |
|
Definition
Combo of aerobic and resistance exercise
Aerobic- burns calories and increases CV/resp fitness
Resistance- maintain/increase lean body mass, maintain RMR, maintain/increase bone density |
|
|
Term
| Who is most successful at maintaining lost weight? |
|
Definition
-low fat diet (25%)
-breakfast almost everyday
-weight once weekly
-high levels of physical activity (60-90 min daily) |
|
|
Term
| When would you start to manage obese children 2-7? |
|
Definition
BMI=85th-95th percentile
-maintain, let height catch up
BMI= >95th%, no medical complications
-maintain, let height catch up
BMI= >95th% with complications
-gradual weight loss (<1.0lb/mo) |
|
|
Term
| When would you start to manage obese children >7 years? |
|
Definition
BMI=85th-95th percentile
-maintain, let height catch up
BMI=85th-95th% w/ medical complications
-maintain, let height catch up
BMI= >95th% w/ or w/o complications
-gradual weight loss (<1.0lb/mo) |
|
|
Term
| When would you start to manage obese children who are older than 7 years? |
|
Definition
| If already exceeds optimal adult weight then slow weight loss of 10-12lb per year. |
|
|
