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Therapeutics II > Block 2: Nutrition Intro > Flashcards

Block 2: Nutrition Intro Flashcards

1
Q

What the dietary guideline for obesity?

A

Limit calories from added sugars and saturated fats and reduce sodium intake

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2
Q

What is the one source of carbs for americans?

A

Sugar-sweetened beverages

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3
Q

What are the 5 recommendatiosn according to the dietary guidelines?

A

Follow healthy eating pattern over lifespan
Focus on variety, nutrient dense, and amount
Limit calories from sugar and saturated fats, and reduce sodium
Shift to healthier food and beverges
Support healthy eating patterns

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4
Q

What should a healthy eating pattern look like?

A
  1. Variety of veggies
  2. Whole fruit
  3. Whole grains
  4. Fat-free or low-fat dairy
  5. Variety of proteins
  6. Oils
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5
Q

What do healthy eating patterns limit?

A
  1. Saturated fats and trans fats, added sugars, and sodium
  2. < 10% of calories/day from added sugars
  3. < 10% of calories/day from saturated fats
  4. < 2,300 mg/day of sodium
  5. 1 drink/day for women and up to 2 drinks/day for men of alcohol
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6
Q

What is the cause of obesity?

A
  1. Inbalances between energy intake and energy output
  2. Cushing, leptin def, psychiatric
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7
Q

What are the hormones that regulate appetite? MOA?

A
  1. Leptin: Decrease appetite when energy reserves are high
  2. Ghrelin: Increase appetite and secreted in gut
  3. Incretin: Secreted w/ insulin to decrease blood sugar and suppress appetite (GLP-1 mimics)
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8
Q

How is leptin regulated?

A

Leptin signals through proopiomelanocortin neurons to produce a-MSH -> agonizes MC4 to inhibit appetite

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9
Q

What are the atypical AD that cause weight gain?

A

Atypical antipsychotics: Olanzapine, Quetiapine, Risperidone

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10
Q

Anticonvulsant and mood stabilizer that cause weight gain?

A

Anticonvulsants and mood stabilizers: Gabapentin, Divalproex, Carbamazepine

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11
Q

Hypoglycemic drugs that cause weight gain

A

Hypoglycemic: Tolbutamide, pioglitazone, sulfonylureas, sitagliptin, insulin
GCC

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12
Q

Antidepressants that cause weight gain?

A

Antidepressants: Mirtazepine, Paroxetine, Trazadone

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13
Q

What are the risk factors of obesity?

A
  1. Hx of
  2. Medical conditions
  3. Poor dietary habits
  4. Inadequate exercise
  5. Drug tx
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14
Q

What would anthropometric eval look at?

A

BMI and waist circumference

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15
Q

State the BMI classifications and why its used?

A

Overweight:≥25 to <30 kg/m^2
23 for some Asian ethnicities
Obesity:≥30 kg/m^2

Clinically consisten with excess adiposity

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16
Q

State the waist circumference classifications and why its used?

A

Marker of high risk:
Men≥ 102 cm (~40 in)
Women≥ 88 cm (~35 in)

Excess abdominal fat is an independent predictor of risk factors and morbidity

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17
Q

How do you calculate BMI?

A
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18
Q

What are the classifications of BMI?

A
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19
Q

What measurements are you looking for in screening?

A

Annually:
1. BMI
2. Waist circumference

Metabolic syndrome:
1. A1C
2. BP
3. Lipid panel

20
Q

What are your goals of obesity tx?

A

Weight loss goal: 5-10% baseline within 6 mths

Create an energy deficiet:
1. A deficit of ≥ 500 kcal/day may be achieved with dietary intake of1200-1500 kcal/d for women and 1500-1800 kcal/d for men
2. Moderate physical activity for at least 30 minutes/day on mostdays of the week

21
Q

What are your nonpharm for obesity?

A
  1. Healthy meals
  2. PA (≥150 min/wk)
  3. Resistnace training 2-3/wk
22
Q

What does a healthy plate look like?

A
  1. Non-Starchy Fruits and Vegetables (1/2 plate)
  2. Grains [(including rice) (1/4 plate)]
  3. Protein (1/4 plate)
  4. Milk/Dairy (unspecified, sparingly)
23
Q

What are behavioral interventions for obesity?

A
  1. Self-monitoring
  2. Clear and reasonable goal-setting
  3. Education from multiple disciplines
  4. Cognitive behavioral therapy
  5. Social support structures
24
Q

How do you monitor obesity?

A
  1. Self-monitoring
  2. Social group
  3. Follow up every 6 m
25
Q

What are the types of bariatric surgeries?

A
  1. Restrictive – limits the amount of food the stomach can hold
  2. Restrictive malabsorptive – combines stomach restrictive and small intestine bypass
  3. Malabsorptive
26
Q

Who is eligible for bariatric surgery?

A
  1. BMI ≥40
  2. BMI ≥35 and ≥1 obesity related complication
  3. BMI 30-34.9 with diabetes or metabolic syndrome
27
Q

What are the complications of bariatric surgery?

A
  1. N/V
  2. Difficulty advancing diet
  3. Micronutrient defs
28
Q

Identify the types of bariatric surgery?

A

A. Laparoscopic adjustable gastric banding
B. Laparoscopic sleeve gastrectomy
C. Roux-en-Y gastric bypass
D. Biliopancreatic diversion with duodenal switch
E. Biliopancreatic diversion

29
Q

What is malnutrition?

A

Acute, subacute, or chronic state of nutrition a combination of varying degrees of overnutrition or undernutrition that have led to change in body composition and diminished function

30
Q

How does malnutrition affect clinical outcomes?

A
  1. Longer LOS
  2. Increased risk of infection and other complications
  3. Higher resource utilization and cost of care
  4. Higher rate of readmin
  5. Higher rate of mortality
31
Q

What are the types of malnutrition?

A

Starvation, Chronic disease, acute illness/injury related

32
Q

What are the characteristics of starvation malnutrition?

A
  1. Chronic starvation, anorexia
  2. Minimal inflammation
33
Q

What are the characteristics of chronic disease malnutrition?

A
  1. Organ failure, pancreatic cancer, RA, obesity
  2. Inflammation is usually chronic and of mild-to-moderated degree
34
Q

What are the characteristics of acute/injury malnutrition?

A
  1. Major burns, infections, trauma, internal bleed
  2. Inflammation is acute and severe
35
Q

What are the types of screening nutrition tools? Indications?

A
  1. Mini-Nutritional Assessment–Short Form (MNA-SF) Ambulatory
  2. Malnutrition Screening Tool (MST)
  3. The Nutrition Risk Screening 2002 (NRS 2002)
  4. The Nutrition Risk in the Critically Ill (NUTRIC) Hospital
36
Q

What is a nutrition focusees physical?

A

Systematic head-to-toe examination of a patient’s

37
Q

According to a nutrition focused physical exam what are the classifications of malnutrition?

A

Presence ≥2 of the following:
1. Insufficient energy intake
2. Weight loss
3. Loss of muscle mass
4. Loss of sub q fat
5. Localized or generalized fluid accumulation
6. Decreased functional status

38
Q

What is the presentation of mucsle and fat loss?

A

Muscle loss:
* Depression or pit at the temples
* Prominent clavicle bones or sharply squared-off, bony shoulders

Fat loss:
* Hollows, depressions, or loss skin around the eyes
* Fat loss at the triceps

39
Q

What are the visceral proteins?

A
  1. Serum visceral proteins
  2. Albumin, prealbumin (negative proteins)
  3. CRP: contest of clinical status and acute and chronic inflammations
40
Q

Describe the albumin concentration of biochem assessment?

A

t1/2 = 21 days and large body pool

Good prognostic indicator and good for assessment of long-term nutritional status

41
Q

Describe the prealbumin concentration of biochem assessment?

A

t1/2: 2 days and small body pool

Good short-term assessment of nutrition support

42
Q

How do you calculate nitrogen balance?

A

Nitrogen Balance = Nitrogen intake - Nitrogen loss

43
Q

How do you calculate N output?

A

TUN + 1.05g

44
Q

How do you diagnose malnutrition based on phenotype and etiology?

A

Phenotype: Weight loss, Low BMI, reduced muscle mass
Etiology: Inflammation, reduced food intake/assimilation

Requires at least 1 phenotypic and 1 etiologic criteria for dx

45
Q

Severity grading of malnutrition?

A

Therapeutics II (30 decks)

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