You are what you eat Flashcards

1
Q

What is nutrition?

what is process broken down into? (6)

what is a better definition of nutrition?

A

Nutrition: “The sum of the processes concerned with growth, maintenance and repair of the living body as a whole, or its constituent parts”

This process is broken down into different stages:

  1. Ingestion
  2. Digestion
  3. Absorption
  4. Transport
  5. Assimilation
  6. Excretion

This definition overlooks the fact that there are foods that have non-nutritional value.

Therefore, a better definition would be nutrition is concerned with understanding the effects of food on the human body in health and disease

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2
Q

Diet, Food and Nutrients

define

A
  • Diet: The sum of food consumed by a person
  • Foods: Substances that we take into the body
  • Nutrients: The components of food
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3
Q

Factors that influence our diet:

A
  • Personal beliefs
  • Physiological (e.g. age)
  • Economic
  • Education
  • Food characteristics
  • Advertised

Foods are classified into different groups based on the nutrients they contain, we have the eat-well plate which tells us the foods that make up our diet and what proportions they should be in.

1/3 starchy carb, 1/3 fruit and veg, Non-dairy sources of protein, food high in fat/sugar and dairy.

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4
Q

Nutrients
macro and micro nutrients

what are macro nutrients? what are they used for?
what are micro nutrients? use?

A

Nutrients, the components of food, are divided into macronutrients and micronutrients

Macronutrients include:
Fat, carbs, protein and alcohol
• These can be used for energy, structural materials e.g. membranes, teeth, bones and can be used for hormone/enzyme synthesis
• Most energy dense is fat (9kcal/g), then alcohol (7kcal/g), then protein and carbs/CHO (4kcal/g)

Micronutrients include:
Vitamins and trace minerals
• These are used as cofactors in metabolism (e.g. thiamin/B1 in CHO and AA catabolism)

Food groups complement each other to give a balance of nutrients e.g. rice and peas

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5
Q

Proteins and amino acids

how many aminos acids?
what is an essential amino acid?

what is a complete protein?
what is an incomplete protein?

how can vegeterians get their amino acids?

A

There are 20 amino acids and of these we have some essential amino acids (Leucine, Valine, Threonine, Methionine, Phenylalanine, Lysine).

Essential AAs cannot be made by the body and hence we must obtain them through our diet.

A complete protein is a food that contains adequate amounts of all the essential amino acids e.g. fish, chicken, eggs, cheese
-> An incomplete protein is deficient in one or more essential acids.

But vegetarians can still get all their amino acids by protein combining, this is where they eat complementary proteins, these are two or more incomplete protein sources that when combined provide adequate amounts of all the essential amino acids.

E.g. Rice is limited by its lysine content, beans are limited by methionine content, but mixed together they are complete

Food composition and how we process them affects the way foods are handled in the body. Food processing effects the palatability, digestibility and metabolic response

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6
Q

Blood Glucose Regulation

3 fates of glucose?

what does insulin tell liver and muscles to do? adipocytes and liver to do?

A

When we intake carbs, glucose will enter our blood. This glucose has three possible fates:

  1. Used as an energy source through glycolysis
  2. Can be stored as glycogen
  3. Converted and stored as fat.

When we eat the meal our blood level rises, and insulin is released from the pancreas. Insulin tells liver and muscle cells to convert glucose to glycogen, it also tells them to convert amino acids -> protein and tells adipocytes/liver to convert glycerol -> FA to TAGs.

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7
Q

Blood Glucose Regulation
Insulin resistance

what does this mean?
what can this damage?
what is part due to insulin resistance?

A

Obese people can develop insulin resistance, so they must release more insulin to control their blood levels.
-> Type 2 DM is in part due to insulin resistance (so linked to obesity).

Insulin resistance means that cells do not absorb glucose from the blood stream, so blood sugar levels rise. This damages small and large blood levels leading to complications of diabetes -> retinopathy, heart disease, nephropathy, neuropathy,

Reducing the rate of glucose absorption into the blood therefore is useful for managing type 2-DM.

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8
Q

Glycaemic Index and how is it worked out?

what does this refer to?
how do you measure it?

A

Glycaemic index refers to the how much and how quickly a food will push your blood sugar levels up (rate and extent of rise in glucose after food).

You give person in fasting state 50g of glucose to eat and then measure their blood glucose levels (every 15min) over the next two hours.

You then send them away, put them back into fasting state, the next day you give them baked beans (for example, of testing GI of baked beans) to eat which contain 50g of available carbohydrate. You measure blood sugar over next 2 hours again and plot it.

The ratio of the area under that curve compared to the glucose one is the GI

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9
Q

What affects GI? Does a new potato or white bread have a lower GI?

what 2 things does the new potato have that lower GI?

what could increease or drecrease the GI? (4)

A

The new potato has a lower GI because the potato has more fibre which slows gastric emptying meaning everything enters the small bowel more slowly.

The new potato also has intact cell walls, cell walls inhibit access by digestive enzymes and slow digestion.

o If we added fat/protein this would further slow gastric emptying and digestion.
o If we peel the potato we increase the GI because we reduce the fibre content
o If we mash it we increase as broken cell wall
o If we add butter, we decrease as adding fat to delay stomach emptying

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10
Q

So, should we suggest type-2 diabetics to add butter to their meals?

A

NO! Because fat is our most energy dense macronutrient and type-2DM is (in part) caused by insulin resistance the main cause of which is being overweight/obese.

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11
Q

Why do we develop deficiency?

A

We need a balance of nutrients to stay healthy, if we do not get enough of one nutrient we will develop a deficiency disease.
Examples include: Kwashiorkor, rickets,

  • Inadequate intake e.g. Reduced appetite, poor availability of food, vegetarian
  • Reduced absorption e.g. Coeliac disease
  • Increased losses e.g. diarrhoea, vomiting
  • Increased demand e.g. growth, pregnancy

-> If demand outweighs supply of nutrients you will go through several stages of deficiency: health, subclinical deficiency, deficiency, death

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12
Q

Example: Vitamin A Deficiency

A

Vitamin A is stored and can last a long time, if you eat too much it can cause toxicity.

If you have a deficiency, first your liver stores become depleted, then your blood levels start to fall. At this point you become at increased risk of infection.

If the deficiency persists you can then develop Xeropthalmia, starting with night blindness which can progress onto complete blindness.

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13
Q

Estimating Nutritional Requirements

Vitamin c example

A

We can estimate nutritional requirements by looking at it in order to prevent/cure deficiency and toxicity (called minimal requirement) and/or we can estimate the level to optimise biochemical processes that rely on that nutrient.

E.g. Vitamin C
o 10mg/day avoids scurvy
o 20mg/day normal wound healing
o 30mg/day reduces risk of gingivitis

So 10mg/day is suboptimal! Therefore, this method is slightly flawed, as original minimal requirement isn’t good.

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14
Q

So rather than looking at the minimum to prevent deficiency/disease we could look at how much you need to maintain a balance between how much you take in and how much you use? Why is this flawed?

A

But this method is also flawed as our body adapts to our intake.

In experiments we found as our body pool of vitamin C for example decreased, the turnover of that nutrient decreased.

If a nutrient is in short supply, we can reduce the rate of turnover and/or increase absorption.

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15
Q

Why is excess iron bad?

A

50% of iron is carried in RBC as haemoglobin, its job being to carry oxygen. Excess iron generates free radicals -> this is damaging to cells however there are no excretory pathways for iron.

There are some losses via shedding cells (e.g. urinary tract, GI tract, skin, hair, bleeding). Therefore, we must be able to regulate iron absorption then store it and release according to demand.

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16
Q

How is iron transported and absorbed?

A

When iron is in our gut enterocytes, it enters the circulation by binding to transferrin. The iron-transferrin complex moves from the circulation to a new cell via the transferrin receptor. Most cells express these.

Once iron-transferrin complex binds to its receptor it enters via receptor-mediated endocytosis.

There is a drop of pH and this stimulates release of iron from transferrin. So, in order to alter iron absorption, we alter how many receptors we have on the cell surface, production of the iron-transferrin receptors is controlled by an iron regulatory protein.

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17
Q

How is iron absorption altered when iron is low or high?

A

When iron is low -> The iron regulatory protein binds to an iron responsive element on transferrin receptor mRNA, this prevents the mRNA being degraded, meaning there can be more translation can occur, -> more iron-transferrin receptors can be produced and put to cell surface = more iron absorbed

When iron is high -> The iron regulatory protein releases from the iron responsive element, exposing it. There is then rapid degradation of the receptor mRNA. So, the transferrin receptors are not being produced = less absorption.

18
Q

Ferritin

A

Ferritin is an iron storage molecule. The mRNA of ferritin also contains an iron responsive element (IRE).

So, when iron is low iron regulatory protein binds to IRE in ferritin mRNA.

But this time, it REDUCES translation rates, so ferritin is not synthesised and hence iron is not going into storage.

19
Q

Malnutrition consequences

A

Malnutrition affects over 3 million people in the UK, with older people being more at risk. Most are in the community, but around a ¼ admitted to hospital are at risk of malnutrition. This may be due to greater losses (e.g. diarrhoea), increased demand (e.g. wound healing), decreasing intake (e.g. dementia).

Consequences of malnutrition affects every system:
o Immune system – Less able to fight infection
o Muscle – Falls, pressure ulcers, chest infection, heart failure
o Impaired wound healing
o Kidneys – Over hydration or dehydation
o Reproduction – Reduces fertility
o Brain – Apathy, depression
o Impaired temperature regulation - Hypothermia
o Micronutrient deficiencies – Anaemia, rickets, scurvy, night blindness

Malnutrition increases mortality and length of hospital stay. More at risk of complications. Leading to more hospital admissions, prescriptions etc.

So, if we give nutritional support and supplements we can reduce these risks.

20
Q

Nutritional Assessment

A

Nutritional assessment is how we determine someone’s nutritional status, so we know who will benefit from nutrition support. There is no one-way of doing the assessment (determining their nutritional status) but it usually involves 4 parts:

  1. Anthropometry
  2. Biochemical and haematological markers
  3. Clinical state and physical condition
  4. Diet
21
Q

Anthropometry

what is it? and limitations?

A

Is an external measure of body composition, so is broken down into things like weight, BMI etc.

A single weight isn’t very helpful other than to calculate someone’s BMI (Kg/m2)
o A BMI of less than 18.5 suggests a significant risk of malnutrition

Serial weight is better because it allows to calculate percentage weight loss. Weight loss of 10% in 3-6 months is associated with a 7x increase in mortality.

Limitations:
Difficult to obtain weight in bedbound patients (can get relatives to estimate) and affected by the presence of oedema/ascites

22
Q

Hand Grip Strength

what is it? and limitations?

A

Is an index/measure of muscle function, these markers respond more quickly to nutritional support than other anthropometric measures. Also, good indicator of mortality. Serial measure assess change over time

This is a useful tool because it is quick, inexpensive, non-invasive

Limitations: Affected by motivational status, ability improves with repeated use, arthritis or confusion

23
Q

Biochemical Markers

what is it? and limitations?

A

Albumin (35-55g/L) job is for oncotic pressure, as well as transporting certain molecules e.g. bilirubin, FA -> Levels fall if the body is not absorbing enough protein

Urea (6-20mg/dL) -> Formed when protein breaks down

So low levels of these indicate poor protein intake

24
Q

Example: David Blaine

Went 44 days without food, going in 96kg, BMI = 25.8, coming out 70.5kg BMI = 18.9. 27% weight loss

His albumin was = 52.9, upper end of normal
Why was his albumin normal?

A

albumin has a long half-life so not sensitive to short term changes. (21days)

It is also affected by things other than nutritional status e.g. dehydration will increase albumin.

Also falls due to stress.

Albumin also falls when ill, as liver will prioritise produce immune proteins instead – CRP.

Albumin is therefore a poor marker of nutritional status.
His urea = 0.7 (better indicator)

25
Q

Dietary Assessment

A

A detailed diet history is a necessary and time-consuming part of a dietetic consultation.

The patients reported intakes of energy, protein and other nutrients are compared with recommended intake levels, so that any imbalances/deficits can be identified and corrected

Less intensive assessments can be undertaken with the use of food record charts and shorter diaries completed by the patient, nurse or other professional.

-> However there is recall bias and someone may under/over report what they eat

26
Q

We screen for malnutrition by using the Malnutrition Universal Screening Tool (‘MUST’).

A

This takes into account BMI, unintentional weight loss % and an acute disease effect score.

The latter asking nurses if the patient’s condition means they are unlikely to eat for 5 days or more.

This gives the patient a score identified as low, medium or high risk of malnutrition

27
Q

Summary of malnutrition diagnostics

A

o No single marker to measure nutritional status
o Anthropometry is time consuming
o Interpret biochemistry with caution
o Make your conclusion from all information available

Screening tools such as MUST need to be used in conjunction with other methods, until more reliable patient group specific tools are available

28
Q

Dietary Reference Values (DRVs)

and the 4 different types

A

DRVs are an estimate of the amount of energy and nutrients needed by different groups of healthy people in the UK population, with allowances for physiological state (e.g growth, pregnant, breast feeding)

• Note DRVs cannot be used for individuals, ill or injured people or people outside of the UK

There are four types of DRV
•	Estimated Average Requirement (EAR)
•	Reference Nutrient Intake (RNI)
•	Lower Reference Nutrient Intake (LRNI)
•	Safe Intake (SI)
29
Q

How are they calculated?

EAR

A

EAR – Is an estimate of the average requirement for energy. Approximately 50% of the population will need less and 50% will need more. EAR is used for energy

30
Q

How are they calculated?

RNI

A

RNI – The amount of nutrient that is enough to ensure that the needs of nearly all the population (97.5%) are being met. Many within the group will need less, only 2.5% will need more. Often used as a reference amount for population groups.

• Used for protein, vitamins and minerals

31
Q

How are they calculated?

LNRI

A

LRNI – The amount of a nutrient that is enough for only the small number of people who have low requirements (2.5%). The majority of population will need more.

Intakes below LRNI are almost certainly not enough for most people. Useful measure of nutritional inadequacy .

32
Q

Why do we need DRVs?

Clinical Application

A

As a benchmark to evaluate dietary adequacy in healthy groups

Use it to plan what to provide e.g. in hospital menus, school meals, war rations

Clinical Application of DRVs:
If we had an anaemic child, what is the change the child’s iron deficiency anaemia (IDA) is due to
o Low intake
o Illness e.g. blood loss, malabsorption

So, estimating the child’s intake can be helpful. If the child’s habitual intake is near the RNI, it is unlikely their IDA is due to inadequate intake.

If it is closer to the LRNI it is likely they are not meeting their requirements

33
Q

The metabolic response to starvation

A

adaptive process

In prolonged starvation basal metabolic rate (BMR) falls by 30%

↓in mass of metabolically active tissues (liver & GIT)
minimise protein losses

maintain supply of glucose to tissues

34
Q

The metabolic response to injury, trauma or sepsis

A

Different to starvation

Need to mobilise energy for defence and repair
3 stages
–Ebb phase
–Flow phase
–Anabolic phase (recovery 
phase)
35
Q

The metabolic response to injury, trauma or sepsis

Ebb = shock (hours)

A

Energy reserves mobilised, but body struggles to use it
↓ BMR
↓ body temperature

36
Q

The metabolic response to injury, trauma or sepsis

Flow phase = catabolism (days)

A
Breakdown of energy stores
↑ BMR
↑ body temp
Acute insulin resistance
Visceral & SK muscle breakdown
37
Q

The metabolic response to injury, trauma or sepsis

Recovery= anabolism (weeks)

A

Building up energy stores

Nutritional therapy aims to increase protein synthesis & restore lean body mass

38
Q

summary of starvation vs injury

A

Starvation
Metabolic rate = decreased
Weight = slow loss, almost all from fat stores
Nitrogen = losses reduced
Hormones = early small increases in catecholamines, cortisol, GH. slow fall in glucagon and cortisol. Insulin decreased.
Water and Na = initial loss

Injury
Metabolic rate = increased
Weight = rapid loss, 80% from fat stores, remainder from body protein
Nitrogen = Losses increased
Hormones = increases in catecholamines, glucagon cortisol, GH. Insulin increased but insulin resistance
Water and Na = retention

39
Q

Screening: clinical

malnutrition

A

Sunken eyes / skin pinch

Loose clothing, rings

Pressure sores

Diarrhoea / vomiting / pain

40
Q

DRVs are not infallible

A

Bioavailability.

Assume that requirements for other nutrients are met.

Differences in DRVs between countries.

Based on best available evidence.

Reflect the needs of health people and are not usually appropriate in clinical circumstances.