final revision Flashcards

Question

When would creatine excretion increase? Decrease?

Answer 1

* Increase with exercise, meat intake, menstruation, infection, fever, trauma * Decrease with renal failure and age

Answer 2

* Rely on complete 24h urine collections: errors * Meat-free diet prior to testing * not sensitive * not possible to detect small changes

Answer 3

* **Hemoglobin** (g/L, deficit \<120 women; \<140 men) * Total amount in RBC * Decresed during PEM, hemorrhage and other anemias * **Hematocrit** (%, deficit \<37 women; \<40 men) * % of RBC in total blood volume * Increased during dehydration * Decreased during hemorrhage and water overload * **RBC count** * **Mean Corpuscular Volume** (MCV) * Size measure to differentiate between micro and macrocytic * **Mean Corpuscular Hemoglobin** (MCH) * Indicator of colour * **Hematocrit** * MCHC = Hb/Hct

Answer 4

1) Storage iron (ferritin) 2) Iron transport (Transferrin) 3) Essential iron (RBC, myoglobin, enzymes)

Answer 5

* **Serum Ferritin** * Low in early deficiency state * Depleted iron stores * **Serum Iron** * ****Low in early deficiency state * Reflects iron bound to transferrin * **Total Iron Binding Capacity, TIBC** * Measures the saturation ability for **transferrin**, high in deficiency * **Transferrin Saturation** * Progressively decreases with diminished transport iron * **Erythrocyte Protoporphyrin** * Increases in later deficiency state with limited Hb production

Answer 6

TEF (\<10%) Physical Activity (20-30%) REE or BMR (65-70%)

Answer 7

Healthy adults: 1.0 g/kg/day Elderly adults: 1.0-1.2 g/kg/day

Answer 8

* Energy- Reduced due to reduced LBM and activity = low appetite * Protein- 1-1.2 g/kg/day, may be higher if other conditions present * Fat- Careful evaluation of balancing: too high vs too low * Calcium- Decreased Ca absorption with age (DRI=1200 mg \>50 y) * Vitamin D- Less efficient synthesis by skin, kidney conversion, and exposure * Fluids- Decreased sense of thirst, presence of other diseases

Answer 9

10-40 is mild inflammation 40-100 is moderate inflammation 100-200 is marked inflammation

Answer 10

Progressive chronic disease characterized by excess or abnormal body fat that can impair health

Answer 11

• Asian populations BMI: overweight ≥23, obesity ≥27 kg/m2 Waist (↑ risk): ≥90 cm in men, ≥ 80 cm in women • African-american, hispanic, native Americans: same as for Caucasians

Answer 12

Cancer Breathing problems: sleep apnea and asthma Arthritis Hepatobiliary disorders Reproductive and obstetrical complications Surgical risk and complications Psychosocial and emotional consequences

Answer 13

Obesity increases cancer risk Women: Endometrium, Ovary, Cervix, Breast (postmenopausal) Men: Prostate, Pancreas, Oesophagus Women & Men: colon, gallbladder, kidney, liver

Answer 14

Obesity ↑ risk of gallstones (cholelithiasis) – More related to abdominal obesity, more in women than men – Risk is also increased with rapid weight loss

Answer 15

Abdominal obesity ↑ risk of non-alcoholic fatty liver disease (NAFLD) – Steatosis-\> steatohepatitis-\> cirrhosis-\> liver failure

Answer 16

• Men: – Reduced testoterone, increased estrogens levels – Gynecomastia • Women: – Polycystic ovary syndrome (PCOS) in 5-10% of women: -\> irregular cycles, acne, excess body hair, infertility – During pregnancy: ↑ risk gestational diabetes, preeclampsia (high blood pressure), labor and deliveries complications, fetal and maternal death.

Answer 17

central regulation of food intake takes place in hypothalamus, in arcuate nucleus where there are 2 main pathways of opposing functions: has 2 pathways of opposing functions 1) NPY- with AgRP stimulates appetite 2) POMC neurones decrease appetite the balance between the 2 dictates the regulation of appetite

Answer 18

peripheral system will also regulate appetite 1) vagus nerve- lines our GI tract distention of the stomach will signal to our brain that we ate drinking water can thus decrease appetite -. causes distention 2) peripheral hormones and peptides will also signal the brain - stimulate or inhibit appetite

Answer 19

Low- 1.3 Moderate- 1.5 High- ``1.8

Answer 20

• Metabolic equivalent task: energy cost of physical activities * 1 MET = 3.5 mL O2 uptake/kg BW/minute * 1 MET= 1 kcal/kgBW/hour (sitting or lying quietly)

Answer 21

Liver-21% Brain- 20% Skeletal muslce- 22%

Answer 22

they woudl increase as these are glycolysis intermediates and glycolysis increases after a meal

Answer 23

Brain at a diminished rate RBCs, renal medulla

Answer 24

via lungs (acetone) and kidneys

Answer 25

§ When ketones are excreted via kidneys they must be “salted” out which involves the loss of either Na, K, H, or NH4 § Ideally NH4 is excreted because it is a waste product § BUT K is the preferred ion to be excreted hypokalemia

Answer 26

Less is excreted Ammonia makes up a much bigger poriton, urea makes up a much smaller portion

Answer 27

Cardiovascular and Renal • Decreased cardiac output, heart rate, BP • Increased tachycardia (compensatory mechanism) • Decreased stress on kidney (acid/base balance) Immune Function • Decreased T-cell function/lymphocytes • Decreased cytokines

Answer 28

Gastrointestinal Function • Decreased Lipid absorption – steatorrhea • Decreased Gastric, pancreatic and bile secretion/production • Decreased Villous surface area Electrolytes • Potassium losses (LBM and intracellular losses)

Answer 29

* shift back to glucose as the main fuel * Rapid fluxes of insulin due to CHO load * Rapid shift of electrolytes and intracellular anions and cations to intracellular space (PO4, K, Mg) * Sodium and water retention

Answer 30

ECF expansion * Edema from increased Na intake and electrolyte imbalance Glycogen synthesis * May lower serum PO4 and K concentration Increased REE * Due to reversal of starvation and LBM rebuilding Increased insulin secretion from CHO intake * Fed signal is now present and uptake into cells resumes * Stimulates N retention * Stimulates cell synthesis, growth, and rehydration

Answer 31

Energy storage: * Decreased energy expenditure * Decreased fat oxidation * Decreased thyroid hormones * Increased cortisol Food intake: * Decreased leptin * Decreased PYY * Decreased amylin * Decreased insulin * Increased ghrelin, appetite * altered neural activation

Answer 32

Increased Glucose tolerance Increased Insulin sensitivity Decreased Need for glucose lowering medications

Answer 33

Normalizes triglyceridelevels Raises HDL cholesterol Lowers LDL cholesterol Improves CHD risk profile Reduces need for antihyperlipidemic medication

Answer 34

Decreased Systolic blood pressure Decreased Blood volume Decreased Cardiac output Decreased Sympathetic activity Decreased Need for antihypertensive medication

Answer 35

0.5 kg of fat =3500 kcal

Answer 36

High protein, low GI

Answer 37

* Antiplatelet agents – to prevent blood clots and keep a stent open. * Example: aspirin. * Statins – to lower cholesterol levels. * Beta blockers, ACE inhibitors – to treat high blood pressure * Nitrates – to expand the arteries and relieve chest pain. • nitroglycerin * Anticoagulants – to reduce the blood’s ability to clot. • Warfarin (Coumadin) * Medications to protect the stomach (stress + aspirin) * Examples: cimetidine (Tagamet), famotidine (Pepcid) and ranitidine (Zantac), or proton pump inhibitors such as pantoprazole (Pantoloc).

Answer 38

• Limit or avoid sugar, sweets, sweetened beverages * Avoid alcohol * Achieve healthy weight * Follow other heart healthy guidelines

Answer 39

Left ventricular ejection fraction (LVEF or EF) = measurement of how much blood is being pumped out of the left ventricle of the heart

Answer 40

Less effective pump, has to pump more Less blood flow Kidney tries to compensate: renin + aldosterone cause vasoconstriction and try to increase blood volume Heart has to work harder, vicious circle With time, gets worse

Answer 41

• Sodium:2,000mg/day • Fluid:1–2L/day * Fluid restrictions * 1to2LperdayformildCHF * 1 to 1.5 L per day for more severe CHF or more severe hyponatremia (\< 130 mmol/l Na+ in blood test) • Texture and timing of foods should be adjusted to allow adequate energy intake without discomfort * Limit alcohol intake to one drink per day * In patients in whom alcohol is believed to be a causative factor in the heart failure, abstinence from alcohol is mandatory EstimatedEnergyrequirement:Calculationistypicallyforcomparison purposes (to compare to intake). If edema present and low activity, then 25 kcal/kg actual weight could give a rough initial estimate. Use judgement. Protein: 1.1 – 1.4 g/kg actual body weight as a target for comparison purposes. If edema is increasing weight, then use lower end of range. Use judgement. Severityofdisease:Inmoreadvancedheartfailure,typicallywewantto prevent further weight loss and optimize protein and kcalorie intake since there is high risk of malnutrition and poorer prognosis with malnutrition.

Answer 42

weigth loss physical activty – Volume/intensity of exercise has greatest benefits (kcal spent) – Resistance exercise has little effect

Answer 43

saturated fat

Answer 44

LDL receptor is mainly affected Changes: - Increased conversion of VLDL remnant to LDL – Decreased synthesis and activity of hepatic LDL receptors – Increased cholesterol in chylo and chylo remnantsàmore atherogenic and increased chol delivery to liver – Increased cholesterol in VLDL and VLDL remnantsàmore atherogenic – Interferes with ability of HDL to clear cholesterol

Answer 45

may decrease HDL-c

Answer 46

• Reduce activity of LDL receptors by: – Decreasing transcription of LDL receptor gene including gene transription of LDL receptor – Altering PL composition of cell membranes to decrease binding -\> decreased LDL clearign from concentration – Altering LDL itself and delays binding to receptors

Answer 47

eat less than 10% of total calories Replacing SFA with MUFAs and PUFAs -\> improved lipid profile and reduced CVD risk Replacing SFA with carbohydratesàno benefit on CVD risk Recommendations: no limit on saturated fats, instead focus on healthy balanced diet

Answer 48

Increase LDL-C, similar to saturated fats, but reduce LDL size (more atherogenic) Reduce HDL-C May ↑inflammatory markers and endothelial damage

Answer 49

Omega-6 (linoleic) increases LDL clearance: LDL lowering effect is partly passive – removes the suppressing effect of SFA (similar to oleic acid and carbohydrates) May decrease HDL formation and/or Apo-AI especially if \>10% of total kcal. However, this level of intake is rarely found in any population.

Answer 50

5-10% of calories

Answer 51

* Goal is no more than 20% of total calories – assuming a lower saturated fat intake * Result in derepression of LDL-receptor synthesis that was caused by SFA * Compared to PUFA, oleic acid does not lower HDL-C * Compared to saturated fats (C:12 – C:16) oleic acid lowers LDL-C * But, MUFAs are often consumed with saturated fats

Answer 52

– Do not decrease HDL as does PUFA and carbohydrates – Less susceptible to oxidation than PUFA – Do not increase triglycerides as carbohydrates often do – Do not increase cancer risk as high PUFA intakes could

Answer 53

* Decrease TG in hyperlipidemic and hyperTG patients * May reduce risk of mortality in those with CVD * Do not reduce the number of VLDL particles being secreted by the liver but rather decrease the TG content of these particles * Omega-3 PUFAs do not lower LDL-C concentrations except as their PUFA replace SFA in the diet * Omega-3 PUFAs interfere with platelet aggregation and thereby prevent coronary thrombosis; delay proliferation of fibroblasts * Reduce plaque formation and growth as they reduce adhesion molecules

Answer 54

Soluble fibers decrease total-C and LDL-C – may be dependent on initial level of hypercholesterolemia

Answer 55

High intake (30-60 g/d) reduces risk of CHD, moderate intake reduces LDL-C and improves endothelial function

Answer 56

decreases intestinal absorption of cholesterol

Answer 57

Lower triglyceride levels are associated with decreased CVD risk

Answer 58

no, only lifestyle modifications

Answer 59

For use in highly elevated TG (familial hyperTG)

Answer 60

More prevalent over the age of 65 and in men

Answer 61

low HDL-C: \<1.0 mmol/L men \<1.3 mmol/L women

Answer 62

Primary: single or poly-genetic abnormalities affecting lipoprotein function resulting in hyperlipidemia or hypolipidemia Secondary: environmental causes +/- predisposition; more prevalent

Answer 63

Increased substrate flux to liver: • Postprandial – Due to excess calories (lipids and carbohydrates) • Postabsorptive – Due to high adipose tissue and hormone-sensitive lipase (HSL) activity (because of insulin resistance) resulting in increased FFA flux to liver Hypertriglyceridemia of Obesity: overproduction of TG-rich VLDL whihc inhibit lipolytic effect-\> accumulation of VLDL remnants in the circulation

Answer 64

this has to do with higher production of VLDL and increased transfer of CH form HDL to VLDL; and increase TG transport from VLDL to HDL this will result in an increased catabolism of HDL by excess adipose tissue and increased uptake by the liver-\> decreased HDL levels

Answer 65

Stronger association of BMI with HDL than LDL

Answer 66

MAP = cardiac output X peripheral resistance Cardiac Output (CO): CO = stroke volume x heart rate Resistance:(length of vessel x viscosity of the blood) /radius^4

Answer 67

* Sympathetic nervous system * Renin-angiotensin-aldosterone system * Renal function * Hormones involved: epinephrine, vasopressin, angiotensin II

Answer 68

* *Primary/essential/ idiopathic (95% of cases)** - Unknown etiology - Interaction from environmental and genetics factors - Influenced by dietary and behavioral factors * *Secondary (5% of cases)** - Occurs secondary to another condition such as renal, endocrine, or neurological disorders

Answer 69

Non-modifiable § Age \>60 y § Men, postmenopausal women, ethnicity (African-American, Russians, Finns) § Family history of CVD : women \<65 y or men \<55 y Modifiable § Smoking § Sedentary lifestyle § Abdominal obesity, insulin resistance § Excess sodium intake § Poor diet quality § Stress

Answer 70

Goals: * Reduce risk of CD and renal disease * Lower BP to clinically appropriate level Comprehensive plan includes : * Physical activity * Weight reduction * Nutrition therapy * Moderation in alcohol, relaxation therapy, smoking cessation * Pharmacological interventions: loop diuretics; thiazides; carbonic anhydrase inhibitors; potassium sparing diuretics

Answer 71

§ Insulin resistance/hyperinsulinemia § Overactivity of the sympathetic nervous system § Alterations in the RAAS § Leptin increases sympathetic activity; this function is preserved with leptin resistance

Answer 72

§Weight loss is indicated both in treatment and prevention of HTN

Answer 73

To decrease blood pressure, consider reducing sodium intake towards 2,000 mg (5 g of salt or 87 mmol of sodium) per day

Answer 74

◦ Natriuresis ◦ Suppressed renin ◦ Attenuates vascular contractionàvasodilation ◦ May reduce sympathetic activity and angiotensin II

Answer 75

§For normotensive people obtaining 60 mmol of dietary K daily, K supplementation is not recommended as a means of preventing high blood pressure §K supplementation above daily dietary intake of 60 mmol/d is not recommended as a treatment for hypertension

Answer 76

increasing potassium, magnesium, calcium and fibers, while reducing saturated fatty acids and sodium.

Answer 77

The DASH diet improves blood pressure, LDL, VLDL and triglycerides.

Answer 78

Spirometry: Lung function test * Forced Expiry Volume (FEV) * FEV1 is the volume of air that can forcibly be blown out in one second, after full inspiration.

Answer 79

Subjective Global assessment form ## Footnote Acute illness and Chronic Illness form

Answer 80

* Small, frequent, nutrient dense, high kcal meals and snacks * 6 meals per day * Soft foods with sauces may be easier to chew and swallow * Nutrient dense beverages * Add kcalories with cream, margarine, etc * Limit low kcalorie or less nutrient dense foods/fluids * Use convenient or easy-to-prepare meals * Encourage healthy choices * May need to limit salt and fluid if fluid retention is a problem, but try not to restrict too much if malnutrition is a major concern (use clinical judgement)

Answer 81

* Low salt/sodium * Long term use: High calcium/vit D (consider supplements) * High protein * May need diabetic diet (monitor glucose, TG) * May need heart healthy diet (monitor chol, TG)