4900 Exam II Flashcards
(279 cards)
0
Q
HITECH
A
Health Information Technology for Economic and Clinical Health Act. Enacted by Pres Obama. Electronic health records for every American by 2014.
1
Q
PHR
A
Personal Health Record
2
Q
HIT
A
Health Information Technology. Tools used to collect, store, and exchange health information in an electronic environment.
4
Q
What are the 5 goals of the HITECH Act?
A
Ensure privacy & security of PHR. Improve public & population health. Improve care coordination. Engage patients & families. Improve quality, safety, & efficiency & reduce health disparities.
5
Q
Nationwide Health Information Network
A
A byproduct of the HITECH Act. Will allow data to be shared within and across facilities via the Internet to improve health care.
6
Q
Interoperability
A
The ability to exchange pt data between facilities efficiently. The data being present for the right pt , at the right place, at the right time. The interconnection of different health technologies across distributed health care systems.
7
Q
What are the interrelated areas of the HITECH Act?
A
EHR incentive program. HIT infrastructure. Workforce development.
8
Q
EHR Incentive Program
A
Provides financial incentives for Medicaid/Medicare eligible providers who adopt meaningful use certified EHR technology in the efficient delivery of health care.
9
Q
HIT Infrastructure
A
Infrastructure of for nationwide adoption efforts, best practices in implementation, use of EHRs, and focus on health care improvement through consistent quality measures reporting.
10
Q
Beacon Community Center Program
A
Are demonstration projects awarded to expert facilities who have been using HIT to improve health care.
11
Q
Regional Extension Center (REC) Programs
A
Are organized centers for technical assistance, guidance, and information on best practices to support EP’s efforts to become meaningful users of EHRs.
12
Q
Health Information Exchanges (HIE)
A
Provide the ability to electronically transfer clinical info between health care information systems while maintaining the meaning of that information. Goal is to facilitate access to & retrieval of clinical data to provide safe, efficient, effective pt-centered care.
13
Q
Workforce Development
A
People will need to be trained in EHRs. Are 2 programs: University Based Training, Community College Consortia.
14
Q
A standard is?
A
A well-defined approach that supports a business process, & which has been developed by a group of experts; has been publicly vetted; provides rules, guidelines, or characteristics; helps to ensure that materials, products, processes, & services are fit for their intended purpose; is available in an accessible format; & is subject to ongoing review & revision.
15
Q
IDNT
A
International Dietetics & Nutrition Terminology. Will help support consistent documentation of nutrition care in EHR. Standardized language.
16
Q
AND Evidence Analysis Library
A
The AND Evidence Analysis Library is a synthesis of the best, most relevant nutritional research on important dietetic practice questions in an accessible, online, user-frendly library.
17
Q
Nutrition Care Manual (NCM)
A
Internet-based professional resources.
18
Q
informatics
A
How humans find, store, analyze, and manage information.
19
Q
nutrition informatics
A
The effective retrieval, organization, storage, & optimum use of information, data, & knowledge for food & nutrition related problem solving & decision-making. It is supported by use of information standards, processes, and technology,
20
Q
Electronic medical record
A
A clinical application utilized by a health care organization to store, organize, manage, and share information about a person’s care delivered by that organization.
21
Q
e-health
A
Health services & health info delivered or enhanced through the Internet & related technology
22
Q
Consumer health informatics tools include?
A
PHRs, apps, condition specific websites, social networking
23
Q
The primary goal of the HITECH Act is?
A
Improving health and health care through best possible use of HIT.
24
Q
Nutrition care indicators
A
Allow the practitioner to determine whether a nutrition problem exists & to make informed decisions about the nature, cause, & significance of nutrition-related problems that do exist.
25
The 5 Categories of Nutrition Assessment Data & Monitoring and Evaluation Data
1. Food/Nutrition related history 2. Anthropometric measures 3. Biochemical data 4. Nutrition-focued physical findings 5. Client hx
26
The purpose of the nutrition intervention is?
to resolve or improve the pt/clnt's nutrition problem by planing & implementing appropriate strategies that will change nutritional intake, nutrition-related knowledge & behavior, environmental conditions impacting diet, or access to supportive care & services.
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What are the 2 components of the nutrition intervention?
Planning and implementation
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nutrition prescription
A concise summary of intake recommendations, along with a brief description of the pt's health condition & the nutrition diagnosis
29
nutrition monitoring
Those activities necessary to provide timely information about the contribution of food & nutrient consumption & nutrition status to the health of the US population.
30
RDA
Recommended Dietary Allowances. The levels of intake of essential nutrients that are judged to be adequate to meet the known nutrient needs of practically all healthy persons
31
Dietary Reference Intakes (DRI)
Reference values that are quantitative estimates of nutrient intakes to be used for planning and assessing diets for apparently healthy people. Include EAR, RDA, AI, UL, EER
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Acceptable Macronutrient Distribution Ranges
Provide guidance to individuals on the consumption of total fat, Omega-3, Omega-6, CHO, and PRO to ensure adequate intake and to decrease risk of chronic disease. Expressed as a percent of energy.
33
Percent of energy: Fat
1-3 y: 30-40. 4-18 y: 25-35%. Adults: 20-35% of total kcal
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Percent of energy: CHO
1y throughout adulthood: 45-65% of total kcal
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Percent of energy: PRO
1-3 y: 5-20%. 4-18 y: 10-30%. Adults: 10-35%
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nutrient density
A food's vitamin & mineral content relative to its energy content.
37
Diet Quality Index (DQI)
Is an instrument used to assess the overall diet quality of groups & to evaluate risk for chronic disease related to dietary pattern. 10 indicators of diet quality.
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Healthy Eating Index
Instrument for assessing how well the diets of Americans adhere to U.S. federal dietary guidance. Used to monitor changes in food consumption patterns, evaluate menus, nutrition education, and as an evaluative tool.
39
Dietary Guidelines
Statements form authoritative scientific bodies translating nutritional recommendations into practical advice to consumers about eating habits. Intended to address more common and pressing nutrition-related health problems: CVD, HTN, cancer, TIA
40
reference amounts
Express in metric units. The amounts of various foods that people customarily consume per eating occasion.
41
Food Guides
A nutrition education tool, translates the science, and dietary standards & recommendations into a understandable & practical form for use by those who have little or no training in nutrition.
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shortfall nutrients
Nutrients whose intakes are below recommended levels among a significant part of the population.
43
food exchange system
A method of planning meals that simplifies controlling energy consumption (particularly from CHO), helps ensure adequate nutrient intake, and allows considerable variety in food selection.
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How to calculate Percent of Standard
= Intake of nutrient ÷ Recommended intake of nutrient
45
Four reasons for measuring diet?
1. Assessing & monitoring food & nutrient intake 2. Formulating & evaluating government health & agricultural policy 3. conducting epidemiological research. 4. Commercial purposes
46
The 3 reasons measurement dietary intake is conducted?
Compare average nutrient intakes of different groups, to rank individuals within a group, & to estimate an individual's usual intake.
47
Advantages of the 24-Hour Recall
Inexpensive & quick to administer. Its administration does not alter the usual diet. Requires very little of the respondent. Useful in clinical setting. Can provide detailed info on types of food consumed.
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Disadvantages of the 24-Hour Recall
Respondents may over or under report consumptions of some foods. May not be an accurate descriptor of an individual's usual intake. Relies on memory. Data entry can be labor intensive.
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multiple-pass 24-hour recall (MPA)
Interviewer & respondent review the previous day's eating episodes several times to obtain detailed & accurate information about food intake.
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phantom foods
Foods not eaten, but reported on a recall.
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USDA Automated Multiple-Pass Method (AMPM)
A computer assisted, 5-step, multi-pass 24-hr recall system used in NHANES.
52
ASA24
A web-based tool to researchers, educators, & the public for collecting multiple automated self-administered 24-hr recalls. Developed by the National Cancer Int.
53
Advantages of a 3, 5, 7 day Food Record
Does not depend on memory. Can provide detailed intake data & data about eating habits. Multiple-day data more representative of usual intake, especially if it contains a weekend day. Reasonably valid up to 5 days.
54
Limitation of 3, 5, 7 day Food Records
Requires high degree of cooperation. Response burden = low response rates. Literate. More time to obtain data. Alter diet. Analysis is labor intensive & expensive.
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MEDFICTS Dietary Assessment Questionnaire
Meat, Eggs, Dairy, Fried foods, In baked goods, Convenience foods, Table fats, Snacks. Recommended by the TLC diet. Assess a person's intake of total fat, saturated fat, & dietary cholesterol.
56
Strengths of Food Frequency Questionnaires
Self-administered. Machine readable. Modest demand on respondents (30-60 min). Relatively inexpensive. More representative of usual intake. Can be used in large population. Considered by some to be method of choice for research on diet-disease relationships.
57
Limitations of Food Frequency Questionnaires
May not represent usual foods or portion sizes chosen by respondents. Intake data can be compromised when multiple foods are grouped within single listings. Depend on ability of subject to describe diet: portion size. Inaccurate for energy intake.
58
Diet History
Used to assess an individual's usual dietary intake over an extended period of time, such as the past month or year.
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Strengths of the Diet History Method
Assesses usual nutrient intake. Can detect seasonal changes. Data on all nutrients can be obtained. Can correlate will with biochemical measures.
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Limitation of the Diet History Method
Lengthy interview process. Highly trained interviewer needed. Difficult and expensive to code. May overestimate nutrient intake. Respondent must be cooperative and have ability to recall usual diet.
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Duplicate Food Collection
Participants place in collection containers identical portions of all foods and beverages consumed during a specified period. Is then chemically analyzed for nutrient content.
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Strengths of the Food Collection Method
Can provide more accurate measurements of actual nutrient intake than calculation based on food composition tables.
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Limitation of the Food Collection Method
Expense and effort of preparing more food. Much effort & time consuming to collect duplicate samples. May underestimate usual intake.
64
Food Accounts
Are used to measure dietary intake within households & institutions where congregate feeding is practiced. Accounts for all food on hand at the beginning, plus what comes in throughout the survey period, and all that remains at the end.
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Strengths of the Food Account Method
Suitable four use with large sample sizes. Can be used over relatively long periods. Gives data on dietary patterns & habits of families & other groups. Less likely to lead to alterations in diet. Relatively economical.
66
Limitations of Food Account Method
Does not account for food losses. Literacy and cooperation necessary. Not appropriate for measuring individual food consumption.
67
Strengths of Telephone Interviews
Cheaper than personal interview. Fewer time, logistical, & personnel constraints. Lower respondent burden. Gives respondent more personal security.
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Limitation of Telephone Interview
Estimation of portion size. Lack of telephone
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Diabetes Mellitus
A group of diseases characterized by a deficit in insulin secretion &/or increased cellular resistance to insulin, resulting in elevated plasma (or serum) glucose levels, abnormalities of CHO & lipid metabolism, characteristic pathologic changes in the nerves and small blood vessels, & aggravation of atherosclerosis.
70
What are the 5 categories of pt with diabetes?
Type 1, Type 2, gestational diabetes mellitus, impaired fasting glucose, & impaired glucose tolerance, also known as pre-diabetes.
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Type 1 diabetes
Generally the result of autoimmune disease. Insulin secreting beta cells of the pancreas are destroyed. Generally diagnoses in children and young adults. 5-10% of cases.
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Type 2 diabetes
Resulting from insulin resistance & relative insulin deficiency.
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Insulin resistance
Abnormalities in the binding of insulin to the insulin receptor located within the cell's plasma membrane, to defects in glucose transport into the cell, & abnormalities in other intracellular processes involved in glucose metabolism, including insulin-stimulated glycogen syntheses.
74
Impaired fasting glucose (IFG)
Occurs when fasting plasma glucose levels are greater than the upper limit of normal but are not sufficiently elevated to be diagnostic for diabetes
75
Impaired fasting glucose (IFG) numbers
plasma glucose ≥100 mg/dL, but ≤ 126mg/dL
76
Impaired glucose tolerance (IGT)
Have normal blood glucose levels in their daily lives, & may exhibit hyperglycemia when tested for diabetes using an oral glucose tolerance test
77
Impaired glucose tolerance (IGT) numbers
Plasma glucose level is ≥ 140 mg/dL, but ≤200 mg/dL when tested two hours after consuming a drink containing 75g of glucose.
78
Oral Glucose Tolerance Test (OGTT)
pt drinks a beverage containing a known amount of glucose, usually 75g. Blood draws occur immediately prior to drinking the beverage and then at set time intervals after.
79
Diagnostic plasma glucose level for diabetes
≥ 200 mg/dL at two hours, for 75g glucose.
80
What is the major form of hemoglobin in RBCs
Hemoglobin A (HbA)
81
Glycated hemoglobin
Glucose in the blood binds to the major form of hemoglobin (Hb) in the RBC. When this occurs the hemoglobin is said to be glycated.
82
HbA1C
Reflects average blood glucose levels during the past 8 to 12 weeks or 2-3 months.
83
Nutritions monitoring
The assessment of dietary or nutritional status at intermittent times with the aim of detecting changes in the dietary or nutritional status of a population.
84
What is the ideal assessment method?
There is no ideal assessment method. They all have some degree of error.
85
What is the best method for teaching portion size?
It is best to use quizzes, but use other methods as well.
86
What is the first step in diet assessment?
Screen for potential nutrition problems using a set of questions to assess the client's status to determine risks & mobilize to create a plan to address the problems.
87
What is the second step in diet assessment?
After screening you assess pt dietary intake & information.
88
Strengths of using photos to collect intake data?
Good validity & reproducible. Takes less time than a recall/record. Less subject burden. Less change in daily habits. Works well in institutions &/or among disabled.
89
Limitations of using photos to collect intake data?
Large initial expense, and updates required. Technical issue can destroy data. Cannot distinguish same foods when cooked differently.
90
Food Propensity Questionnaire
Is 24-hour recall + FFQ. Is probability that client will consume specific food or beverage.
91
Strengths of a Propensity Questionnaire?
Provides reasonable accuracy. Similar to FFQ.
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Limitations of Propensity Questionnaire?
May not provide amounts as accurately as other methods. same a FFQ and 24-hour recall.
93
U.S. National Cancer Institute's Risk Factor Monitoring & Methods Branch's FFQ
A FFQ used to estimate an individual's usual intake of % energy from fat. Also have them for assess fruit and vegetable intake.
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Willett Questionnaire
Series of self-administered semiquantitative FFQ used in epidemiological research on relationship between nutrient & food intake & risk of chronic disease.
95
Diet Analysis
Is what happens AFTER you ask or assess what they ate. Is what we learn from the data of the assessment. Is a report of the nutrients &/or foods they consumed.
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What do you get when you analyze a diet?
Quantitative info: Per nutrient or food component, overall for some soft wear (comparison to DRI, RDA, etc). Qualitative info: overall view of adequacy, food group view of adequacy
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The USDA's Nutrient database, SR24, is built on:
NDBS-7400 foods, other foods info from Food Industry, published sources from sci literature, other gov agencies w/ data (NCI), research studies contracted by the government. Some nutrients/ food components could be missing
98
USDA Food & Nutrient Database of Dietary Studies (FNDDS)
Has >6900 foods w/ nutrient values & typical portions. Used to provide info for NHANES analysis. Many of the foods in FNDDS are mixtures of foods. NOT missing data; imputing not needed. Greater variety of portion sizes.
99
Nutrient Data Laboratory's National Nutrient Databank
Publishes USDA Nutrient Database SR (standard reference). SR-24 has >7400 foods, 140 nutrients & components.
100
What do NDSR, ESHA, & FFQs or other nutrient analysis programs provide in a printout or spreadsheet?
Food components.
101
Limitations with Software Databases
Not all as extensive as NDSR. Some systems are incomplete for all nutrients - micronutrients & newer components, food additives, herbals, supplements. Adding more every year - NDSR makes > 200,000 changes/y.
102
Is nutrient analysis the only way to analyze a diet?
Hardly!: Healthy Eating Index (HEI), Alternative Health Eating Index (AHEI), Diet Quality Index-Revised (DQI-R), Dietary Variety Score (DVS), Food Group Score (FGS), Serving Score (SS), Dietary Diversity Score (DDS), Nutrient Adequacy Score / Mean Adequacy Ration
103
What do you get when you enter data into a program like ESHA or NDSR?
A list of nutrients & food components eaten that day, and maybe a comparison to the DRI, but maybe not a food group comparison.
104
Diet Variety Score (DVS)
15 days of records. Gives food grouping analysis.
105
Alternative Healthy Eating Index (AHEI)
Quantitative measure of diet. Designed to target food choices & macronutrients sources associated with reduced chronic disease risk. Often used in CVD risk associations.
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Nine categories of AHEI
Fruit intake. Veg intake, Nuts & soy, cereal fiber, whit meat: red meat ratio, trans-fat % total kcal, P:S fat ratio, alcohol consumption, multivitamin use.
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Mediterranean or Prudent Diet Pattern?
Abundant in plant foods ( veg. legumes). Low in red meat, wine, eggs. Moderate in chicken, fish, cheese, low fat dairy. Fruit as desert.
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ERS Food Availability (Per Capita) Data System
The USDA's Economic Research Service (ERS) collects food availability data. Three types of data: food availability data, loss-adjusted food availability data, and nutrient availability data.
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National Health & Nutrition Examination Survey (NHANES)
Purpose is to monitor the overall nutritional status of the US population through detailed interviews & comprehensive examination.
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NHANES interviews include:
Dietary, demographic, socioeconomic, & health-related questions.
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Examinations as part of NHANES consist of?
Medical & dental examination, physiologic measurements, & laboratory tests.
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National Nutrient Databank
A computerized info system for storing & summarizing data on the composition of foods. Is operated by the USDA Nutrient Data Laboratory
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USDA Nutrient Database for Standard Reference (SR)
SR nutrient data serve as the core for most commercial databases & are the numerical foundation of essentially all public & private work in the field of human nutrition.
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The Nutrient Databank System (NDSB)
A repository for information on up to 146 nutrients & food components found in more than 7900 foods.
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glycated hemoglobin
Hemoglobin that has glucose bound to it. Also referred to as hemoglobin A1C or simply A1C test, it reflects average blood glucose levels during the past 8-12 weeks.
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Classic symptoms of diabetes
Polyuria, polydipsia (thirst), polyphagia, unexplained wt loss, blurred vision, recurrent infections.
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Diagnostic criteria for diabetes: random fasting BG
≥ 200mg/dL, and classic symptoms
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Diagnostic criteria for diabetes: hemoglobin A1c
HbA1c value ≥ 6.5%.
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Diagnostic criteria for diabetes: fasting plasma BG (FPG)
≥ 126mg/dL after minimum of 8 hour fast
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Diagnostic criteria for diabetes: OGTT
2-hour plasma glucose ≥ 200 mg/dL. 75g anhydrous glucose in water.
121
How is muscle involved in gluconeogenesis?
The protein (AA) from the breakdown of muscle is used in the liver to make glucose. The muscle does not directly provide glucose to the body.
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How do BG monitors measure BG?
oxidation of glucose by enzyme, which is linked to color test, or electrical signal.
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Blood serum
Clear liquid that can be separated from clotted blood.
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Blood plasma
liquid portion of normal unclotted blood. Clotting factor is the difference between serum.
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DCA-2000
point of care instrument for HgbA1c. Latex immune-agglutination inhibition.
126
monoclonal antibody
DCA-2000. Is specific for glucose, once attached, color reactions and light passed through sample. Change in absorbance equated to glucose concentration.
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Normal fasting blood glucose
60-100mg/dL
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OGTT BG normal numbers
BG < 200 mg/dL @ 1hr, < 140 mg/dL @ 2hr.
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HgbA1c goal for diabetics
< 7% (ADA). <6.5% (A Assoc Clin Endocrinology)
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Pre-diabetes numbers
IFG >100 mg/dL, but less than < 126mg/dL. IGT - 2hr OGTT >140mg/dL, but <200mg/dL
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Gestational Diabetes Mellitus
Usually develops in late pregnancy. Precursor to Type 2 DM. All women tested at 24-28wks.
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Numbers for GDM
50-100g dose, non-fasting, BG measured at 1 hour. If BG is >140 mg/dL, full 3 hour OGTT is indicated.
133
The three major metabolic defects in diabetes?
1. decreased insulin secretion 2. resistance to insulin by major tissues (muscle & fat) 3. production of more glucose by liver in attempt to fix the problem.
134
IGT is defined as blood glucose:
>140mg/dL at 2 hours after test starts
135
OGTT testing guidelines in research
1. in good health 2. not taking meds that affect blood glucose 3. Eat 150-200g CHO in 3 days prior to exam. 4. No smoking or drinking on morning of test.
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OGTT Results at 2-hour: normal
2-hour PG <140mg/dL = normal glucose tolerance
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OGTT Results at 2-hour: IGT
2-hour PG >140mg/dL and <200mg/dL = IGT, impaired glucose tolerance
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OGTT Results at 2-hur: diabetes
2-hour PG >200mg/dL = provisional diagnosis of diabetes, but must confirm on alternative day.
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Abnormal 3-hour 100g OGTT values: 2-hour mark
2-hour > 155mg/dL = IGT
140
Impaired Glucose Tolerance 75g at 2-hour mark
2-hour >153mg/dL = IGT
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Gestational Diabetes Endpoints
A woman has gestational diabetes when she is pregnant & has any 2 of the following: fasting BS >105mg/dL. 1-hr BS >190. 2-hr BS >165. 3-hr BS >140
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C-peptide
The connecting peptide. A short 31-AA protein. Connects insulin's A-chain to its B-chain in the proinsulin molecule.
143
preproinsulin
Is first secreted in the insulin synthesis pathway from the beta cells of pancreas with A & B-chain and C-peptide, and a signal sequence.
144
What happens to the signal sequence on pre-proinsulin?
It is cleaved from the N-termunus of the peptide by a signal peptidase, leaving proinsulin.
145
How is proinsulin converted to insulin
The C-peptide is removed, leaving the A & B-chains that constitute the insulin molecule
146
Normal value for C-peptide
0.5-3ng/mL A lower number often indicated T1DM.
147
HOMA-IR
Homeostatic model assessment-insulin resistance. Is a method used to quantify insulin resistance and beta-cell function
148
QUICKI
Quantitative insulin sensitivity check index. Is derived using the inverse of the sum of the logarithms of the fasting insulin & fasting glucose. A test for diabetes.
149
Metabolic Syndrome
A collection and description of risk factors that increase chances of heart disease and diabetes.
150
Markers of metabolic syndrome
Waist circumference: ≥40in men, ≥35in women. TG >150mg/dL. Reduced HDL: 130/85. Elevated fasting glucose: >100mg/dL
151
What does HEI tell us?
Healthy Eating Index. Quality of diet by groups of foods consumed.
152
Healthy Eating Index (HEI)
2-3 day diet analysis of FFQ. Uses MyPlate portions and Daily Food Guide. Sat fat<2400mg.
153
Diet Quality Index-revised (DQI-R)
2-3 day. Uses pyramid portions; fat, sat fat, chol, and includes Ca & Fe.
154
Diet Variety Score (DVS)
15 days of records. Not nutrient analysis; food grouping analysis.
155
Alternative Healthy Eating Index (AHEI)
Quantitative measure of diet designed to target food choices and macronutrient sources associated with reduced chronic disease risk. Most often used in cardiovascular disease risk association. Out put of diet analysis or FFQ; must be programed.
156
How many categories does the AHEI have?
Nine:
157
Mediterranean diet, or Prudent diet
Includes abundant plant foods, PA, Low in red meat, wine, eggs. Moderate in chicken, fish, cheese, low-fat dairy. Fruit is dessert
158
The Western of American Diet
Higher in fat, meats, and refined grains.
159
The prudent diet is show to lower risk of:
Lowers risk of death from all causes, cardiac death, and non-fatal MI.
160
The Western Diet is associated with?
Higher BMI. Increased insulin, c-peptide, homocysteine, leptin. Cholesterol and BP.
161
What BP and above is considered a risk factor for Type 2DM?
BP ≥140/90 mmHg in adults.
162
TG above ? is considered a risk factor for diabetes?
TG ≥ 250 mg/dL
163
HDL below ? is considered a risk factor for ?
HDL ≤35mg/dL is considered a risk factor for Type 2 DM.
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Risk Factors for Coronary Heart Disease
Smoking. HTN. Low HDL. Family hx of premature CHD. Presence of CHD risk equivalents. Age.
165
BP above ? is considered a risk factor for Heart Disease?
BP ≥ 140/90 mmHg
166
HDL level associated with increased risk of Heart Disease?
HDL < 40 mg/dL
167
Premature CHD in a male/female relative?
First degree male relative < 65 yo is considered increases risk for CHD
168
Friedewald equation
LDL = TC - HDL - (TG ÷ 5)
169
Optimal LDL Cholesterol?
< 100 mg/dL
170
High LDL cholesterol?
160-189 mg/dL
171
Desirable Total Cholesterol
< 200 mg/dL
172
High Total Cholesterol
≥ 240 mg/dL
173
High HDL cholesterol
≥ 60 mg/dL
174
Acceptable Total cholesterol in children
< 170 mg/dL
175
High Total cholesterol in children
> 200 mg/dL
176
Acceptable LDL cholesterol in children
< 110 mg/dL
177
High LDL cholesterol in children
≥ 130 mg/dL
178
TG level of Metabolic syndrome
≥ 150 mg/dL
179
HDL associated with Metabolic Syndrome
Males < 40 mg/dL. Females < 50 mg/dL
180
BP associated with Metabolic Syndrome
S ≥ 130 mmHg. D ≥ 85 mmHg
181
Fasting BG associated with Metabolic Syndrome
≥ 110 mg/dL
182
Somatic protein
Is found within skeletal muscle
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Visceral protein
Protein within the organs or viscera of the body, RBCs, WBCs, and serum proteins.
184
Creatinine
Is a by-product of muscle breakdown that is excreted in relatively constant proportion to the mass of muscle in the body.
185
Where is creatinine excreted?
In the urine. It can be collected (24-hours) and used to estimate lean body mass.
186
Creatinine-Height Index (CHI)
A ratio of a patient's measured 24-hour urinary creatinine excretion & the expected excretion of a reference adult of the same sex and stature. Is expressed as a percent of expected value.
187
A CHI of 60-80% indicates?
mild protein depletion
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A CHI of 40-60% indicates?
moderate protein depletion
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A CHI of < 40% indicates?
Severe protein depletion.
190
A 1% decrease in cholesterol = ? decrease in CHD
1% ↓ in cholesterol = a 2% ↓ in risk of CHD.
191
What is the name of the machine used as point of care to test cholesterol?
Cholestech
192
Cholestech Technology how does it work?
A solid-phase + enzyme. Reflective photometry (amount of light reflected). This signifies a color change due to a reagent induced reaction which correlates with a concentration of the analyze. (i.e. the compound you are measuring).
193
Cholestech will give you what value?
Cholesterol. Triglycerides. HDL. LDL must be derived with a formula. Some give glucose as well.
194
ATP III
Adult Treatment Panel.
195
When should pt begin having cholesterol checked?
Every five years after the age of 20.
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Risk factors for CHD
Elevated total cholesterol. elevated LDL. Decreased HDL. Obesity: high fat/low fiber diet, high kcal intake. HTN. Diabetes. Smoking. Family hx. Age >45M, >55W. Risk equivalents.
197
Warning signs of heart attack
Pressure, fullness, squeezing or pain in center of chest, can be continuous or come and go. Pain spreading - shoulders, neck, arms, and possible abdomen. Chest discomfort with lightheadedness, fainting, sweating, nausea, SOB.
198
What is the best indicator of protein status?
There is no single best test for protein status.
199
What is the normal level for albumin & pre-albumin?
Albumin: 3.5 - 5 mg/dL. Prealbumin: 0.3 g/L, or
200
Insulin is a protein. What is its structure?
Insulin in composed of two AA chains in their primary structure. The two chains are linked by disulfide bonds.
201
What are the two compartment of metabolically available body protein?
Visceral pool, and somatic pool.
202
Metabolically available proteins are called?
Body Cell Mass (BCM) and are comprised of both visceral and somatic proteins. Make up 30-50% of total body protein.
203
Visceral pool
Serves many structural and functional roles. Comprises 25% of BCM. Is the protein located in the organs, blood cells, and serum proteins.
204
Somatic pool
Proteins of the skeletal muscle. Comprises 75% of the BCM.
205
Metabolically unavailable proteins
Are non-BCM proteins located in the skin, bone, and connective tissues that is not readily exchangeable with the somatic and visceral pools. Cannot be used for ATP synthesis.
206
Where are body proteins made?
within each cell for its own needs, and in the liver for the whole body.
207
What happens to excess protein?
It is converted to fat - the N2 is removed and excreted. Cs can be used for energy. Priority system for protein synthesis, but other nutrients/coenzymes are needed.
208
What happens if the body does not get enough protein?
Body will access protein in BCM. Some proteins may not get made.
209
How many g of protein per ounce of meat
7g/oz.
210
In what forms do we absorb proteins
Proteins are absorbed as di- try- and single AA
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Whole body measurements of proteins status:
Densitometry (or other body comp tests). Total body potassium. N balance. Ceatinine-ht index. 3-methyl histidine. Mid-Arm muscle area.
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Things to consider for serum protein tests.
Half-life of protein. Body pool. Response to protein & energy depletion & replenishment. Non-nutritional factors that can affect serum protein levels. Is the liver healthy
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What does a short half-life indicate?
That the protein gets remade more often.
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Functions of Albumin in the body?
Maintains oncotic pressure. Carrier of small molecules (including some drugs).
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What is the most abundant blood protein?
Albumin 3.5-5.0 mg/dL
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What is the most readily available protein?
Albumin is the proteinmost readily available clinically.
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Low albumin is an indicator of?
Of depleted protein status & poor diet.
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Albumin is a poor indicator of?
Early change in protein status because it responds slowly to change in nutritional status. It has a long half-life (approximately 3 weeks), and a large body pool (5g/kg).
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Factors that can decrease albumin in blood:
Acute phase response. Severe liver disease (i.e. liver not synthesizing proteins). Intravascular overload. Increased losses - nephrotic syndrome, burns, protein-losing enteropathies; severe zinc deficiency.
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A sever zinc deficiency will cause increased losses of?
Albumin
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Factors that increase albumin in the blood?
Intravascular V depletion. Intravenous albumin or blood transfusions. Anabolic steroids.
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Dominant proteins in blood before injury (normal state)
Albumin. Transferrin. Pre-Albumin. Transcortin. Retinol-binding protein.
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Proteins in blood during injury:
CRP. D-dimer protein. mannose-binding PRO. a-1-antitrypsin. a-1-antichymotrypsin. a-2-macroglobulin. Fibrinogen & all clotting PROs. Complement. Ferritin. Serum amyloid P & A. Orosomucoid glycoprotein. Ceruloplasmin. Heptoglobin.
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Pre-albumin
aka Transthyretin. Transport protein for thyroxine (T4) and for retinol-binding protein.
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The half-life of pre-albumin is?
2-3 day - very short.
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Decreased levels or pre-albumin are seen in?
Both protein & energy malnutrition. It can predict early stages of malnutrition.
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What other factors (non-nutritionally related) can decrease pre-albumin?
Decreased levels seen in liver disorders, sepsis, hyperthyroidism, acute catabolic states.
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What other factors (non-nutritionally related) can increase pre-albumin?
Chronic renal failure and in pt on dialysis.
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How did transthyretin (pre-albumin) get its name?
It transports thyroxine & retinol binding protein
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Transferrin
Binds and transports Fe in blood to bone marrow.
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What is the half-life of transferrin?
8 to 9 days.
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How is transferrin measured?
It can be measured directly, but is generally estimated through TIBC (total iron binding capacity).
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Transferrin predicts changes in nutrition status ? than albumin.
earlier due to its shorter half-life.
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What non-nutritional factors decrease transferrin levels?
Chronic infection. Acute catabolic state (surgery/trauma). Kidney disease.
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What non-nutritional factors increase transferrin levels?
Pregnancy, Estrogen therapy. Acute hepatitis.
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Normal range of transferrin
204-360 mg/dL
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Retinol-binding protein (RBP)
Transports Vit A in plasma. Exists in blood as 1:1:1 of RBP: pre-albumin: retinol
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The half-life of RBP?
10-12 hours.
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Normal range of RBP
2.1-6.4 mg/dL. It has a small body pool, which makes it difficult to measure.
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What does RBP indicate about protein status?
It responds quickly to protein/energy deprivation & repletion. Is an indicator of recent dietary intake vs. overall nutritional status.
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High levels of RBP are seen in what disease state?
Renal disease. RBP is filtered and reabsorbed by the kidney
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Low levels of RBP are seen in?
Liver disease. Hyperthyroidism. Cystic fibrosis. Vit A deficiency. Acute catabolic states.
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Insulin-like Growth Factor-1 (IGF-1)
aka somatomedin C. Growth promotin peptide
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Half-life of IGF-1
2-6 hours
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Effect of PEM on IGF-1
levels are decreased in PEM.
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Normal concentration of IGF-1
0.55-1.4 g/dL
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Is IGF-1 a routine test?
No
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How does IGF-1 compare as a protein status indicator?
May be more sensitive to recent protein intake than pre-albumin. More sensitive indicator of protein status than albumin, transferrin & pre-albumin.
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Fibronectin
A glycoprotein made by many cell types - liver, endothelial & fibroblasts. It functions in cell adhesion, wound healing, hemostasis (blood clotting) and macrophage function.
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What does fibronectin indicate about nutrition?
Reflects poor nutrition intake quickly, but returns to normal after refeeding (malnourished children).
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Is fibrnectin a routine test?
No, but it could be an early functional indicator; more research is needed.
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What affects fibronectin levels:
Trauma. Burns. Shock. Sepsis.
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Assessment of protein status with N2 balance:
The oldest biochemical tool used to assess protein status. Only measurement that truly reflects both visceral & somatic protein pools. Is considered accurate.
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Positive N2 balance is seen in?
Pregnancy. Growth in children. Athletes in training (accretion of protein). Anabolic state
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Negative N2 balance is seen in?
Fever, severe sepsis. Surgery, inactivity (bed rest). Skeletal trauma, starvation (PEM). Major burns, prolonged stress/anxiety
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Formulas for N2 balance
N2 balance = [PRO intake (g/d) / 6.25] - (UUN (g/d) - 4). or = [PRO intake (g/d) / 6.25] - [UUN + (0.2 x UUN) +2]
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How does CHO intake influence N2 balance?
CHOs are protein sparing. If insufficient energy intake protein will be used for energy.
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Creatinine Height Index (CHI) =
24-hr CR (mg) x 100 / reference 24-hr creatinine (mg).
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Limitations of the CHI
High ascorbic acid & meat intakes ↑ creatine excretion. Can be larger intra-individual variations in urine output. If person is too this, tall, muscular. Personal collection error
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3-methylhistidine
Methylation of histidine - a 'derived amino acid' from actin-myosin-histidine during muscle contraction. Occurs in skeletal muscle during muscle catabolism. Is release and excreted in urine. Levels in urine are proportional to muscle and FFM.
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Levels of 3-methylhistidine are influenced by:
Diet. Age. Sex. Maturity. Hormonal status. Degree of physical fitness. Recent intense exercise. Injury & disease.
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Limitations of 3-methyhistidine
Improper collection of 24-hour urine. Effects of diet on urine concentration. Don't eat meat during test. Daily changes in urine excretion volume.
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Which protein test should you not eat meat during?
3-methyhistidine 24-hour urine collection.
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Is 3-methyhistidine a routine test?
No.
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Mid-Are Muscle Area (MAMA)
MAMA = [MAC - (TSF x 3.14)] / 4 x 3.1416
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The 50th%ile for MAMA
18-24 yo M: 49.4 cm^2. F: 28.3 cm^2
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What does CBC and Differential tell us about protein status?
If the person is immune-competent they are likely in good protein status. They are able to produce acute phase proteins - cytokines.
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Delayed cutaneous hypersensitivity (DCH)
No response to DCH = anergy.
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What non-nutritional factors influence DCH?
Age. Drugs. Infection. Inflammation. Immune alterations and some cancers.
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Total lymphocyte count (TLC)
= (%lymphocytes x WBC) / 100. Levels will be decreased with poor nutritional stays, or increased with infection.
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Normal TLC
Normal > 1800 lymphocytes/mm^3.
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In mild depletion TLC =
1200-1800 lymph/mm^3
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In moderate depletion TLC =
800-1199 lymph /mm^3
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In severe depletion TLC =
<800 lymph / mm^3
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Other factors that influence TLC
Cancer. Inflammation. Infection. Stress. Steroids. Chemotherapeutic agents. Immunosuppressive agents.
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Transferrin normal serum level
200-400mg/dL. Binds iron in plasma & transports to bone marrow
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Prealbumin normal serum level
16-40mg/dL. Binds T3 & to a lessor extent T4; carrier for RBP.
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Retinol-binding protein (RBP) normal serum level
2.1-6.4mg/dL. Transports Vit A in plasma; binds non-covalently to pre-albumin.
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Insulin-like Growth Factor (IGF-1) normal serum level.
0.55-1.4g/dL
