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NUTR*3090 > Midterm 1 (Lab) > Flashcards

Midterm 1 (Lab) Flashcards

1
Q

What are the 2 types of error and their definitions? What do they affect?

A
  1. Random
    - Happens by chance
    - Affects precision
  2. Systematic
    - Happens regularly due to design
    - Affects internal validity; cannot be fixed, only prevented
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2
Q

How does random error occur?

A
  • Respondent memory lapse (client is unintentionally hiding things)
  • Incorrect estimation of portion sizes
  • Coding errors (can happen when converting portion sizes or inputting food items into nutrient analysis programs)
  • Mistakes in handling of mixed dishes
  • Inaccurate food composition values
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3
Q

How does systematic error occur?

A
  • Non-response bias: sample is not representative of the population of interest
  • Respondent bias: systematic underreporting or overreporting
    • Client is intentionally changing their reports due to social desirability
  • Interviewer bias: probing for information, omitting certain questions, recording responses incorrectly
  • Omitting supplement use
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4
Q

What are methods to reduce error?

A
  • For random error, increase # of days in dietary recall
  • Good equipment
  • Calibration checks
  • Training
  • Protocols
  • Correct equations and assumptions
  • Use multiple indices together to provide more accurate measure
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5
Q

What is the sensitivity of a measure?

A
  • Tool is able to capture anyone who is ill or malnourished or at risk
  • 100% sensitive ⟶ no malnourished person classified as “well”
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6
Q

What is the specificity of a measure?

A
  • Tool identifies those who are well-nourished

- 100% specific ⟶ no well-nourished people classified as “ill”

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7
Q

What is anthropometry?

A

Measurements of variations of the physical dimensions (growth) and the composition of the human body

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8
Q

What are the benefits of anthropometry?

A
  • Simple
  • Safe and non-invasive
  • Provide information on long-term nutritional status and challenges
  • Can identify malnutrition
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9
Q

What are the cons of anthropometry?

A
  • Insensitive (not able to detect short-term changes)

- Cannot distinguish nutrient deficiencies

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10
Q

What are the indices for anthropometry?

A
  • Single raw measurement (eg. weight)
  • Combination of raw measurements (eg. BMI)
  • Combinations used in prediction equations (eg. % body fat from skinfold thicknesses)
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11
Q

What types of anthropometric measurements might you take for a child?

A

Head circumference, weight, length (<24 months as they cannot stand), height (>24 months), knee height, lower leg length

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12
Q

What do growth charts indicate?

A
  • Compare weight for height for age with population to assess growth
  • Can indicate stunting (long-term malnutrition) and wasting (short-term malnutrition)
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13
Q

What types of anthropometric measurements might you take for an adult?

A
  • Weight, height, knee height, arm span, elbow breadth, waist circumference, hip circumference
  • Elbow breadth estimates frame size (related to body fat and FFM)
  • Lower leg span, mid-arm span, and knee height estimates height
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14
Q

What is the relevance of measuring waist circumference?

A
  • Better correlation to abdominal fat (related to metabolic disturbances) than waist-to-hip ratio (WHR)
  • Cut-off value for WC varies by gender and race
  • Done for BMIs between 18.5-34.9 to identify risk
  • For BMI of 35+, WC doesn’t provide additional information (high risk of disease)
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15
Q

What are the 3 methods of measuring waist circumference

A
  1. WHO Waist Circumference Measurement Technique
    - Middle of lower page of rib cage and highest part of hip bone
  2. NIH Waist Circumference Measurement Technique
    - Highest part of hip bone
  3. Umbilicus Waist Circumference Measurement
    - Belly-button
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16
Q

Why would you take weight measurements?

A
  • Identify changes over time (to see if patient is responding to intervention)
  • Use weight-height ratios to plug into equations (Ponderal Index, BMI or Quetelet’s Index)
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17
Q

How do you take height measurements?

A
  • If the individual can stand, use a stadiometer
  • Take a full breath in to reduce slouching
  • Head should be in the Frankfurt Plane (having head straight and parallel to the earth)
  • Heels should be touching the wall
  • Arms relaxed at the sides
  • Height should be read to the nearest inch or 0.5 cm
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18
Q

What are the 3 body composition models?

A

2 COMPARTMENTS:
- Fat mass (essential + storage lipids)
• More sensitive than muscle to acute malnutrition
- Fat free mass ⟶ body mass - fat mass (muscle, bone, connective tissue)
• Lean body mass is FFM + essential fat in body

3 COMPARTMENTS:

  • Fat mass
  • FFM
  • Mineral mass (separates bone from FFM)

4 COMPARTMENTS:

  • Fat mass
  • Water
  • Protein
  • Mineral mass
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19
Q

What measurement do you take to assess muscle? What are the limitations of this method?

A
  • Mid-arm muscle circumference (MAMC) measures total body muscle mass (index of protein stores)
  • Most common and easy
  • May not correlate with muscle in entire body, assume that bone and fat mass are negligible, not sensitive to small changes
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20
Q

Where are skinfold measurements taken and what do they tell you? What are the limitations?

A
  • Done at triceps, bicepts, subscapular, suprailliac
  • Measurements are plugged into equations for body fat
  • May be inaccurate depending on how fat is distributed throughout the body, poor calibration, measurements may vary depending on training of person
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21
Q

What is BIA and what does it assess?

A

BIOELECTRICAL IMPEDANCE ANALYSIS:

  • Safe and cheap machine found in all clinical settings
  • Sends electrical current through body, which passes through water (high conductivity)
  • Fat has low conductivity
  • Machine converts water content to FFM
  • Based on assumption that 73% of FFM is water
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22
Q

What are the benefits of biochemical assessment?

A
  • Very sensitive (small changes, short-term)

- Highly specific (measures only substance of interest)

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23
Q

What are the components of blood?

A
  1. Whole blood (eg. hemoglobin, hematocrit, glucose)
  2. Serum (supernatant from coagulated blood)
    - Will not contain coagulation proteins
  3. Plasma (supernatant from anti-coagulated blood)
    - Does contain coagulation factors
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24
Q

What is the most common deficiency in the world and its stages?

A

Iron deficiency

  • Fe depletion ⟶ low ferritin
  • Fe deficient erythropoiesis ⟶ less production of RBC in bone marrow
  • Fe deficiency anemia ⟶ less Hb
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25
Q

Discuss hemoglobin to assess Fe status.

A
  • Low sensitivity (only detects 3rd stage anemia)
  • Poor specificity (iron, folate, vitamin B12, copper, and protein can decrease hemoglobin)
    • Malaria
    • Pregnancy (blood volume increases to dilute Hb) ⟶ cut-offs should be lower
    • Smoking decreases O2 in RBC which will increase production of Hb to compensate
    • Other factors can affect such as race and altitute
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26
Q

What does clinical assessment consist of?

A
  • Review of medical history
  • Family history
  • Signs (objective) and symptoms (subjective; patient’s feeling)
  • Use of medications (past and current)
  • Previous surgeries, medical procedures
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27
Q

What are the types of dietary assessment and where are they used?

A
  1. Diet History (clinical practice)
  2. 24-Hr Recall (research, sometimes in clinical practice)
  3. Food Record (research, sometimes in clinical practice)
  4. Food Frequency Questionnaire (FFQs) (research, sometimes in clinical practice)
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28
Q

Discuss the method and pros/cons of diet history.

A
  • Asks about a typical day to get a general idea of intake
  • Doesn’t require literacy (interview process), doesn’t require patient to be eating regular diet, quick, easy
  • Based on client perception/memory, only gives rough estimate, not standardized method that can be used for research
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29
Q

Discuss the method and pros/cons of 24-hour recalls.

A
  • Asking patient to remember what they ate over the past day
  • Quick, easy, literacy not required, doesn’t affect dietary intake of client
  • Relies on memory, estimated serving sizes, one day may not be representative of usual intake, does not account for seasonal variation
  • Better to do multiple 24-hour recalls
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30
Q

Discuss the method and pros/cons of food records.

A
  • Asking patients to write down everything they eat for a few days
  • Best method of dietary assessment
  • Does not rely on memory, accurate data, weighed or estimated food for accurate portion sizes
  • May affect dietary intake of client, burdensome, literacy required, does not account for seasonal variation
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31
Q

Discuss the method and pros/cons of food frequency questionnaires.

A
  • Ask patients to indicate how frequent they consume list of food items
  • Better at assessing general patterns than nutrient and kcal intakes
  • May assess the full diet or only nutrients of interest (eg. calcium-rich products)
  • May be quick, does not affect the dietary intake, may account for seasonal variation
  • May be time-consuming, literacy required, relies on perception/memory, cognitively difficult, FFQ must be suitable for client’s culture
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32
Q

What is the role of probes in 24-hour recalls?

A

Interviewer probes respondent to describe intake in detail:

  • Specific food description (eg. brand names, packaging)
  • How food was prepared
  • Portion size
33
Q

What are the aids that an RD may use in 24-hour recalls?

A
  1. Food Description Prompt Sheet helps RD remember to prompt for commonly missed details (eg. smoked or unsmoked bacon)
  2. Techniques to enhance food portion size estimation:
    • Household measures (eg. teaspoon, ruler)
    • Hands to estimate (eg. 1 cup cereal = fist)
    • 3D food models
    • Food photographs (range of portion sizes for the same food item)
34
Q

What are some Dos and Don’ts for 24-hour recalls?

A
  • Do not pass judgements on food (“did you eat anything healthy?”
  • Do not refer to a meal structure (“what did you have for breakfast?”)
  • Establish good eye-contact and build rapport
  • Ask client if they have any questions before you start
  • Explain what you are doing
    Ask “how much did you eat of - this meal”
35
Q

What are the steps for the most common type of 24-hour recall?

A

AUTOMATED MULTIPLE-PASS METHOD:
1. Quick List
• List all the foods and beverages consumed the day before the survey (midnight to midnight)

  1. Forgotten Foods
    • Prompt recall of commonly forgotten foods (eg. snacks, beverages)
  2. Time and Occasion
    • Time and what the respondent would call the eating occasion (eg. breakfast, lunch, supper, snack)
  3. Detail Cycle
    • Specific description of food type, preparation method, portion size, location, and emotions
    • Use list of foods and go through for details
  4. Final Review
    • Probe for any foods or details missed (eg. vitamin and mineral supplements)
36
Q

How do you analyze diet information collected?

A
  1. Compare approximate food intake from the different food groups to new CFG
    • CFG is useful for average person, but not with healthcare professionals
    • May be used with quantitative method to give suggestions
  2. Analyze macro-and micronutrient intakes by entering into software (eg. ESHA) that will give you detailed analysis
    • Program is only as good as the nutrient database (list of foods with their nutrient compositions)
    • Generate multi-column reports or pie charts
37
Q

What is the role of RD in assessing PA?

A
  • Recommend general guidelines for age and gender

- Specific exercise plans, demonstrations, and helping patients do exercises fall outside scope of practice

38
Q

What are the types of assessments for PA?

A
  1. Direct Measures
    - VO2 Max
    - Pedometer
    - Accelerometer
  2. Self-reported Measures
    - PA logs or diaries
    - Questionnaires
39
Q

How is VO2 max assessed? What are the pros?

A
  • Indirect calorimetry
  • Using metabolic cart to measure concentration of O2 and CO2 in inspired and expired air
  • Figure out energy expenditure
  • Used in clinical practice for patients with extreme metabolic stress (eg. obese)
  • More accurate than prediction equations
40
Q

What are PA diaries?

A
  • Keep a careful record of activity levels throughout the day
  • Can use published values for energy expenditure associated with each activity level
41
Q

What is 1 MET?

A

1 MET = 1 kcal/kg/hour = 3.5 ml/kg/min

For calculations, just cancel out the units!

42
Q

What is the IPAQ? How do you use it to categorize PA levels?

A
  • Developed as a tool to produce internationally comparable data
  • Includes questions about sitting time

To calculate MET-min/week:

  • Walking = 3.3 * walking minutes * walking days
  • Moderate = 4.0 * mod-intensity activity minutes * moderate days
  • Vigorous = 8.0 * vigorous-intensity activity minutes * vigorous days
  • Total PA = walking + moderate + vigorous MET min/week scores

Scores can be used to categorize PA levels

  • Low = no activity is reported or some is reported but not enough
  • Moderate = at least 600 MET-mins/week
  • High = at least 3000 MET-mins/week
43
Q

What is BTB?

A
  • Provides a general meal pattern to start people off with
  • Follow preferences of client
  • Design pattern to spread out CHO choices (15g/serving) throughout the day
44
Q

What are the CHO-containing food groups for BTB?

A
  1. Grains and Starches (15g CHO/serving)
    - Available CHO = total CHO - dietary fibre - ½ (sugar alcohols)
  2. Fruits (“)
  3. Milk & Alternatives (“)
  4. Other Choices (“)
    - “Junk food” group that promotes variety and choice
45
Q

What are the low CHO food groups for BTB?

A
  1. Extra Foods (0-5)
    - Foods/drinks that are low in nutrients when consumed in small portion sizes
    - Includes spices, herbs, tea, lemon, sugar-free soft drinks and jello, coffee, sauces, etc.
  2. Meat & Alternatives (0; except for some beans)
    - Includes cultural choices
    - Use heart-healthy plant choices instead of meat
  3. Vegetables (0; except squash, parsnips, peas)
  4. Fats (0)
    - Promote heart healthy choices (MUFA, PUFA)
46
Q

How do you plan a BTB meal plan?

A
  1. Determine energy requirements
  2. Determine % and grams CHO, protein and fat
    - Focus on CHO first
  3. Distribute CHO exchanges through day according to insulin regime
  4. Determine protein and fat grams in CHO exchanges; compare with goal; add as required
  5. Consider vegetable intake
  6. Ensure food groups make sense for client
  7. RECHECK CALCULATIONS or use Excel tool
47
Q

What are the BTB messages for grains and starches?

A
  • Good source of carbohydrate, fiber, vitamins, minerals and energy
  • Need a minimum of 4 servings a day – changes with age, gender, weight & activity
  • Try to enjoy the natural taste of grain products by limiting spreads and sauces
  • Choose green-boxed foods more often with fiber
48
Q

What are the BTB messages for fruits?

A
  • Good source of carbohydrate, fiber, vitamins, minerals and energy
  • Experiment with colorful fruit
  • Should be consumed 2-3 times a day
  • Don’t forget to look at portion sizes
  • Reduce dried fruit and juice in yellow boxes
49
Q

What are the BTB messages for milk & alternatives?

A
  • Good source of calcium, vitamins A & D
  • Choices include fortified soy beverages, flavored yogurts and chocolate milk
  • Children need 2 servings a day to reach their Vitamin D requirements, and men and women over the age of 50 should consume a supplement containing 400 IU of Vitamin D (due to higher needs)
  • Try consuming milk after exercising to encourage muscle recovery
50
Q

What are the BTB messages for other choices?

A
  • Makes your meals interesting
  • Usually lower in nutrients, and higher in [trans] fat, sugar, salt and calories, therefore these items should be eaten only occasionally
  • Don’t necessarily have to be given up; can be worked into meal plan
51
Q

What are the BTB messages for meats & alternatives?

A
  • Lean cuts of meat with low salt are encouraged as well as cutting/trimming the visible fat
  • Having protein at a meal may help satisfy your hunger
  • Canada’s Food Guide recommends consuming 2 servings of fish a week. To see the heart benefits of the Omega-3 Fatty Acids (EPA and DHA), choose from the following: char, herring, mackerel, rainbow trout, salmon, and sardines
52
Q

What are the BTB messages for fats?

A
  • Heart-healthy fats (eg. nuts) are OK in small amounts

- Yellow boxes for “choose less often”

53
Q

How do you interpret anthropometric data? What do you compare to?

A
  1. Compare with population
    - CHMS for Canada
    - NHANES for US
    - WHO for globally
  2. OR Compare to reference standard associated with good health
54
Q

Do we use BMI on children?

A

No, to assess growth, we use percentiles and CDC growth charts.

55
Q

What are the risks of being underweight?

A
  • Undernutrition
  • Osteoporosis
  • Infertility
  • Impaired immunity
56
Q

What are the risks of being overweight?

A
  • T2DM
  • Dyslipidemia
  • Hypertension
  • Coronary heart disease
  • Gallbladder disease
  • Obstructive sleep apnea
  • Certain cancers
57
Q

What are the BMI classes and their risk?

A
  • Underweight (<18.5) = increased risk
  • Normal weight (18.5-24.9) = least risk
  • Overweight (25-29.9) = increased risk

Obese:

  • Class I (30-34.9) ⟶ high risk
  • Class II (35-39.9) ⟶ very high risk
  • Class III (≥ 40) ⟶ extremely high risk
58
Q

Why might someone be underweight?

A
  • Eating disorders (inadequate intake)
  • Chronic disease or cancer
  • Homelessness or food insecurity
  • Alcoholism
59
Q

What are the considerations when using BMI?

A
  • For people 65+, normal range may begin above 18.5 and extend into overweight range
  • Not used for children or athletes
60
Q

When is waist circumference used and which protocol does Canada use?

A
  • Used for individuals in BMI 18.5-34.9
  • Men ≥ 102 cm
  • Women ≥ 88 cm
  • NIH protocol
61
Q

Why is hip circumference measured?

A
  • Used to calculate waist-to-hip ratio
    • Simple way to distinguish between fat in the lower and upper body
    • May be better predictor of CVD risk than WC
    • ≥1.0 for men
    • ≥0.85 for women
  • Currently not considered to be as useful as waist circumference
62
Q

Why are skinfold measurements used?

A
  1. Monitor body fat changes in one patient over time
  2. Compare to reference standards
  3. Calculate % body fat
63
Q

How do you take a skinfold measurement?

A
  1. Calculate body density using equations based on gender and number of skinfold sites (at least 2) assessed
  2. Use BD to calculate % body fat using population specific formulas
  3. Calculate total body fat/and or the fat-free mass
    - Total body fat (kg) = (weight (kg) x % BF)/100
    - Fat-free mass (kg) = weight (kg) – BF (kg)
64
Q

How might you use mid-upper arm circumference?

A
  1. Measure the skin fold
  2. Measure the arm circumference
  3. Calculate:
    a) Total arm area (TAA)
    - TAA = Arm Circumference (cm)²/(4π)

b) Arm muscle area (AMA)
- AMA = [MAC (mm) - (π x TSF)]2/4π
- TSF = triceps skinfold
- MAC - mid-upper arm circumference
- This formula overestimates muscle as it includes bone and tissue
- To correct, subtract 10 cm2 for males and 6.5 cm2 for females

c) Arm fat area (AFA)
- AFA = total arm area – arm muscle area (uncorrected)

65
Q

What does heart rate and blood pressure tell you?

A
  • HR is not relevant as there are many reasons for variation
  • Take 3 blood pressure readings (you may be nervous or just standing up for first reading)
    • Different cutoffs for different populations
66
Q

What is the requirement distribution?

A

DRI recommendations are based on a requirement distribution

67
Q

What is the intake distribution?

A

Obtained from observed or reported intakes

68
Q

What are EARs? What might they be used for?

A
  • Estimated Average Requirement
  • Intakes that meet the estimated nutrient needs of 50% of individuals in a gender and life-stage group
  • Mean of requirement distribution
  • Can be used to estimate needs of a population
69
Q

What are RDAs? What might they be used for?

A
  • Recommended Dietary Allowance
  • Intakes that meet the nutrient requirements of ~98% of individuals in a population
  • Calculated using EAR + 2 SD
  • Goal intake for an individual
70
Q

What are AIs?

A
  • Adequate Intake

- Goal intake for an individual when there is insufficient data to set an EAR

71
Q

What are ULs?

A
  • Tolerable Upper Intake Level
  • Represents the highest amount of the nutrient that will not cause toxicity symptoms in the majority of the population
  • NOT the recommended intake
  • Especially dangerous for fat-soluble vitamins which are stored in adipose
  • Applies to chronic consumption (not just on one day)
72
Q

What is the probability of adequacy?

A
  • Certain nutrients have a bell-shaped requirement distribution
  • We can determine if someone is getting enough of a nutrient
73
Q

What do z-scores tell you? When are they used to determine probability of adequacy?

A
  • How many SDs we are from the mean
  • Used to determine if someone is getting enough of a nutrient if the nutrient has a bell-shaped requirement distribution
74
Q

What do z-scores tell you in relation to EAR?

A

“There is a __% probability that the nutrient intake is adequate”

75
Q

What do z-scores tell you in relation to AI?

A

Probability of Correct Conclusion that Usual Intake is Adequate

  • Usual intake at or above the AI has a low probability of inadequacy
76
Q

What do z-scores tell you in relation to UL?

A

If mean intake (for 1 day, based on food record) is less than and close to the UL, you can determine probability that usual intake is less than the UL

77
Q

What are some things to consider with z-scores?

A
  • DO NOT DO Z-SCORE CALCULATIONS if CVintake ≥ 60-70%
  • If mean intake is less than the AI, probability of adequacy cannot be determined (don’t calculate)
  • Do not use a statistical approach if mean intake is greater than the UL = they are already at risk
78
Q

What is CV?

A
  • Coefficient of variation
  • CVear = variability of data for EAR (requirement) for a nutrient
  • CVintake = the variability of nutrient intake for individuals from one day to another

NUTR*3090 (4 decks)

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