Lecture 12 (Nutrition) Flashcards
(199 cards)
1
Q
Nutrition is essential for(4):
A
1) normal growth and development
2) tissue repair and maintenance
3) cellular metabolism
4) organ function
2
Q
what is food security?
A
access to sufficient, safe, and nutritious food to maintain a healthy lifestyle
3
Q
what is MNT?
A
medical nutrition therapy - uses nutrition therapy and counseling to manage diseases
4
Q
what is BMR?
A
basal metabolic rate - energy needed at rest to maintain life-sustaining activities for a specific amount of time
5
Q
what is resting energy expenditure (REE)?
A
resting energy expenditure - amount of energy needed to consume over 24-hour period for the body to maintain internal working activities while at rest
6
Q
what affects energy requirements(9)?
A
1) age
2) body mass
3) gender
4) starvation
5) menstruation
6) illness or injury
7) infection
8) activity level
9) thyroid function
7
Q
what factors influences metabolism(3)?
A
1) illness
2) pregnancy and lactation
3) activity level
8
Q
describe kcal effects on weight
A
kcal intake = energy requirements => no change in weight
kcal intake > energy requirements => weight gain
kcal intake < energy requirements => weight loss
9
Q
what is nutrient density of food?
A
the proportion of essential nutrients to the number of kcals
- high-nutrient-dense foods provide large amounts of nutrients in relation to the number of kcals (fruits and vegies)
- low-nutrient-dense foods are high in kcals and low in nutes (sugar and alcohol)
10
Q
describe carbohydrates
A
- saccharides (simple or complex)
- main source of energy
11
Q
how much energy does carbohydrates provide?
A
4kcal/gram
12
Q
what are monosaccharides?
A
simple carbs - cannot be broken down further
(e.g. glucose (dextrose) and fructose)
13
Q
what are disaccharides?
A
simple carbs - composed of 2 monosaccharides and water
(e.g. sucrose, lactose, maltose)
14
Q
what are polysaccharides?
A
complex carbs - chains of carbs
(e.g. glycogen, starches)
- some poly saccharides cannot be broken down in the body because we dont have the enzymes necessary; those do not contribute to kcals
(e.g. fiber)
15
Q
what is the difference between soluble and insoluble fiber?
A
soluble - is soluble in water and can be broken down in our body
(e.g. barley, cereal grains, cornmeal, oats)
insoluble - cannot be broken down and does not contribute to calories in our diet
(e.g. cellulose, hemicellulose, lignin)
16
Q
describe proteins
A
provide a source of energy and are essential for growth, maintenance, and body repair
17
Q
how much energy is in proteins?
A
4 kcal/gram
18
Q
what are some things in the body made of protein?
A
1) collagen
2) hormones
3) DNA
4) RNA
19
Q
what processes in the body rely on proteins(4)?
A
1) blood clotting
2) fluid regulation
3) acid-base balance
4) transportation of nutrients and drugs
20
Q
what are indispensable amino acids?
A
amino acids that the body does not synthesize (we need to ingest them in our diet)
21
Q
what are dispensable amino acids?
A
amino acids that our bodies synthesize
22
Q
what is an amino acid?
A
the simplest form of protein made up of oxygen, hydrogen, nitrogen, and carbon
23
Q
what is a complete protein?
A
aka high quality protein - contains all essential amino acids to support growth and maintain nitrogen balance
24
Q
what is nitrogen balance?
A
intake and output of nitrogen are equal
25
what is positive nitrogen balance?
when intake of nitrogen is greater than output
26
what is positive nitrogen balance necessary for?
1) growth
2) normal pregnancy
3) maintenance of lean muscle mass and vital organs
4) wound healing
27
what is negative nitrogen balance?
when the body loses more nitrogen than it gains
occurs due to body tissue destruction or loss of nitrogen-containing body fluids
28
when does negative nitrogen balance occur(6)?
1) infections
2) burns
3) fever
4) starvation
5) head injury
6) trauma
29
what are lipids?
fats - the most calorie-dense nutrient
30
how much energy does lipids provide?
9 kcals/gram
31
what are fats composed of?
triglycerides and fatty acids
32
what are triglycerides?
molecules that circulate the blood - composed of three fatty acids attached to a glycerol
33
what are fatty acids?
chains of hydrogen and carbon atoms with an acid group on one end of the chain and a methyl group at the other
34
what are the four types of fatty acids?
**saturated** - each carbon in the chain has two attached hydrogen atoms
**unsaturated** - unequal number of hydrogen atoms are attached and the carbon atoms attach to each other with a double bond
**monounsaturated** - have one double bond
**polyunsaturated** - have two or more double carbon bonds
35
when does deficiency occur with fat intake?
when it falls below 10% of daily nutrition
36
why is water critical?
all cellular function depends on a watery environment
37
what percentage of total body weight is made up of water?
60-70%
38
who has the greatest percentage of total body water and who has the least?
**infants** = greatest percentage of total body water
**older people** = least percentage of total body water
39
describe fluid intake and output in healthy individuals
fluid intake = fluid output
40
what are some situations that lead to intake/output that is not ideal?
people with fever or diarrhea need more water intake
people with cardiopulmonary or renal disease have a reduced ability to excrete water
41
what are vitamins?
organic substances present in small amounts in foods that are essential to normal metabolism
act as catalysts in biochemical reactions
42
what are antioxidants?
vitamins that neutralize free radicals which produce oxidative damage and increase risk of cancers
43
what are some antioxidative vitamins(4)?
1) beta-carotene
2) vitamin A
3) vitamin C
4) vitamin E
44
in what foods are vitamin content highest?
fresh foods with minimal exposure to heat, air, or water prior to their consumption
45
what are fat soluble vitamins?
vitamins that are stored in fatty compartments of the body
46
what are some examples of fat soluble vitamins?
1) vitamin A
2) vitamin D
3) vitamin E
4) vitamin K
47
what is hypervitaminosis?
excessive fat soluble vitamins
48
how can hypervitaminosis occur(3)?
1) mega-doses supplemental vitamins
2) excessive amounts of fortified food
3) excessive intake of fish oils
49
what are minerals?
inorganic elements essential to the body as catalysts in biomechanical reactions
50
how are minerals classified?
macro minerals or trace minerals
51
what are some examples of macro minerals(6)?
1) calcium
2) phosphorous
3) magnesium
4) sodium
5) potassium
6) chloride
52
what are examples of trace minerals(5)?
1) iron
2) copper
3) iodine
4) zinc
5) flouride
**less than 100mg is needed daily**
53
what do macro minerals do(2)?
1) balance pH
2) promote electrolyte balance
54
enzymes...(3)
* act as catalysts to speed up chemical reactions
* most have one specific function
* function optimally in specific pH
55
what is digestion?
mechanical breakdown (chewing, churning, mixing with fluid) and chemical reactions that reduce food to its simplest form
56
why does enzyme activity rely on mechanical breakdown of food?
it increases the surface area for chemical action
57
what do hormones have to do with digestion?
regulate flow of digestive secretions
58
what factors regulate the secretion of digestive juices and motility of the GI tract?
1) physical factors
2) chemicals
3) hormones
59
what does nerve stimulation via parasympathetic nervous system do to digestion?
increases GI action
60
what is salivary amylase?
an enzyme that acts on cooked starch
61
what do chief cells in the stomach secrete?
pepsinogen
62
what do pyloric glands secrete?
gastrin - a hormone that triggers parietal cells to secrete hydrochloric acid
63
what do parietal cells secrete(2)?
* **hydrochloric acid** - stomach acid
* **intrinsic factor** - necessary for the absorption of vitamin b12
64
what does HCl do to pepsinogen?
converts it into pepsin which splits proteins
65
what is gastric lipase and amylase?
enzymes that help digest fat and starch
66
where are alcohol and asprin absorbed?
directly through the lining of the stomach
67
how long does food remain in the stomach?
approx. 3 hours (1-7hours)
68
what is chyme?
a mixture of liquified food and acid in the small intestine
69
where is bile made and stored?
made in the liver, stored in the gallbladder
70
what does bile do?
emulsifies fats
71
what is amylase?
an enzymes secreted by the pancreas that breaks down starch
72
what is lipase?
an enzyme secreted by the pancreas that breaks down fats
73
what are trypsin, elastase, chymotrypsin, and carboxypeptidase?
enzymes secreted by the pancreas that break down proteins
74
what happens to the pH of chyme as it progresses through the small intestine?
it becomes increasingly alkaline inhibiting the action of gastric enzymes and promoting action of duodenal secretions
75
what are enzymes secreted in the small intestine(5)?
1) sucrase
2) lactase
3) maltase
4) lipase
5) peptidase
76
how long does it take peristalsis to move chyme through the small intestine?
about 5 hours
77
what are villi?
finger-like cells in the small intestine that are the primary absorption site for nutrients (their structure increases surface area for absorption)
78
how are carbs, proteins, minerals, and water-soluble vitamins absorbed?
1) absorbed in the small intestine
2) processed in the liver
3) released into circulation through the portal vein
79
how are fatty acids absorbed?
through the lacteal ducts at the center of each microvilli in the small intestine
80
what percentage of water is absorbed in the small intestine?
85-90%
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the body absorbs nutrients via(4):
1) passive diffusion
2) osmosis
3) active transport
4) pinocytosis
82
digestion of what occurs in the small intestine(4)?
1) carbs
2) proteins
3) minerals
4) water soluble vitamins
83
what are the two processes of metabolism?
anabolism - building
catabolism - breaking down
84
anabolism
building of more complex biochemical structures by synthesis of nutrients
(physiologically possible when body is in positive nitrogen balance)
85
catabolism
breakdown of biochemical substances into simpler substances
(occurs during a state of negative nitrogen balance)
86
when does chyme become feces?
once it passes through the ileocecal vale between the small intestine and colon
87
what happens to water as feces moves toward the rectum?
water absorbs in the mucosa causing feces to become more firm
88
what does exercise and fiber do to peristalsis?
stimulates peristalsis
89
what maintains consistency of feces?
water
90
what does feces contain(5)?
1) cellulose and other indigestible substances
2) sloughed epithelial cells from the GI tract
3) digestive secretions
4) water
5) microbes
91
What are DRIs and what are the four components?
dietary reference intakes
1) EAR (estimated average requirement
2) RDA (recommended dietary allowance)
3) AI (adequate intake
4) UL (tolerable upper intake level)
92
what is EAR?
**estimated average requirement** - amount of nutrients that appears sufficient to maintain a specific body function for 50% of the population based on age and gender
93
what is RDA?
**recommended dietary allowance** - the average needs of 98% of the population (not the exact needs of an individual)
94
what is AI?
**adequate intake** - suggested intake for individuals based on observed or experimentally determined estimates of nutrient intakes used when not enough evidence to set RDA
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what is UL?
**tolerable upper intake level** - highest level that poses no risk of adverse health events
96
what are the five food groups?
1) grains
2) vegetables
3) fruits
4) dairy products
5) meats
97
what age are the dietary guidelines meant for?
older than 2 years
98
choosemyplate provides basic guidelines for:
1) balancing calories
2) decreasing portion size
3) increasing healthy foods
4) increasing water consumption
5) decreasing fats, sodium, and sugar
99
what are the two sets of reference values the FDA established for daily values on food labels?
1) RDIs (referenced daily intakes) - for proteins, vitamins, and minerals based on RDA
2) DRVs (daily reference values) - consist of nutrients (total fat, saturated fat, cholesterol, carbs, fiber, sodium, and potassium)
100
what are daily values based on?
percentages of a diet based on a 2,000 kcal/day for adults and children 4 years +
101
. A 22-year-old new mother is breastfeeding. You ask her if she is taking the correct quantities of nutrients. Which statement reflects that she understands the dietary guidelines?
A. “I am not concerned with what I am eating.”
B. “I am taking vitamin doses based on TV.”
C. “I am taking a daily MVI.”
D. “I am making eating choices according to the recommended dietary allowances.”
D
102
what factors are associated with eating and drinking in all societies(4)?
1) sociological
2) cultural
3) psychological
4) emotional
103
what are the factors that nutrition requirements depend on(5)?
1) developmental stage
2) body composition
3) activity levels
4) pregnancy and lactation
5) presence of disease
104
why do environmental factors beyond the control of individuals contribute to the development of obesity?
environmental factors can limit a persons likelihood of healthy eating and participation in exercise or other activities of healthy living
105
what are environmental factors that contribute to obesity?
1) lack of access to good grocery stores
2) high cost of healthy food
3) more access to unhealthy foods (fastfood or restaurants)
4) lots of advertisement for less healthy food
5) poor access to safe places to play or exercise
106
what developmental stage is characterized by rapid growth and a high need of protein?
infants
107
how long is breastfeeding recommended and what are the benefits(3)?
recommended for the first 6 months of life
Benefits:
1) reduced food allergies and intolerances
2) easier digestion
3) fewer infant infections
108
what sources does formula get its protein from(5)?
1) whey
2) soy
3) cow's milk
4) casein hydrolysate
5) elemental amino acids
109
why should infants not consume cow's milk during the first year of life?
* too concentrated for the kidneys
* poor source of iron, vitamin C and vitamin E
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how should solid foods be introduced to toddlers?
one at a time 4-7 days apart to identify food allergies; they begin exhibiting food preferences
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how much milk do toddlers consume per day?
24 ounces/day
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why do toddlers sometimes develop milk anemia?
because milk is a poor source of iron
113
what occurs with growth and energy requirements of school aged children 6-12 YO?
they grow at a slower rate with a gradual decline in energy requirements per unit of body weight
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in children 6-12 years of age its important to assess diets for...
adequate protein and vitamins A and C
115
what age is more important than chronological age to use for estimating nutritional needs?
physiological age
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describe growth and energy needs for adolescents
increased energy needs due to higher metabolic growth demands
* Protein increase needed
* calcium and continuous iron important for females
* vitamin B-complex assists metabolic activity
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pregnancy within 4 years of menarche...
places mother and fetus at risk because of anatomical and physiological immaturity
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the onset of eating disorders such as anorexia nervosa and bulimia nervosa often occurs when?
adolescence
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factors other than nutritional needs that influence diet in adolescence(5):
1) body image and appearance
2) desire for independence
3) eating fast-food
4) peer-pressure
5) fad diets
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describe the growth and energy requirements for young and middle aged adults
growth slows and energy required only for maintenance and repair
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how many additional calories are needed during lactation?
an additional 500 above usual allowance with a higher need for protein
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what does poor nutrition during pregnancy cause?
low birth weight in infants and decreases chances of survival
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why is folic acid particularly important?
needed for DNA synthesis and the growth of RBCs
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what can insufficient folic acid in pregnancy cause(3)?
1) fetal neural tube defects
2) anencephaly
3) maternal megaloblastic anemia
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what are the energy requirements for adults 65 and older?
decreased need for energy due to slowed metabolic rate
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what are age related changes that affect nutrition?
1) appetite
2) taste
3) smell
4) digestive system changes
5) fixed incomes
6) oral issues
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what do zen microbiotic diets consist of?
brown rice and other grains and herbal teas
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vegans lack complete proteins in single foods. how can they get sufficient protein?
by using complementary proteins from two or more foods
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why are vegans at risk for vitamin b12 deficiency?
because vitamin b12 is only available from animal sources
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whats wrong with zen microbiotic and fruitarian diets?
they lack sufficient nutes and carry a risk of malnutrition
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what is a ovolactovegitarian diet?
avoids:
* meat
* fish
* poultry
eats:
* eggs
* milk
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what is a lactovegetarian diet?
drinks milk but avoids eggs
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what is a vegan diet?
eats only plant foods
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when dealing with nutrition, sources of professional standards are:
1) DRIs
2) USDA myplate dietary guidelines
3) healthy people 2020
4) american heart association
5) american diabetes association
6) american cancer society
7) american society for parenteral and enteral nutrition
135
what is SGA?
subjective global assessment - uses **patient history + weight + physical assessment** data to evaluate nutritional status
* this technique is inexpensive
* can predict nutrition related complication
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what is **anthropometry**?
a measurement system of the size and makeup of the body
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what is **IBW**?
ideal body weight - an estimate of what a person should weigh
138
what is **BMI**?
Body mass index - measures weight corrected for height and serves as an alternative to traditional height-weight relationships
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how many mL is one pint?
500 mL
140
how many pounds/kg is i pint (500mL) of fluid?
1 lb/ 0.45 kg
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how do you calculate BMI?
weight(kgs)/height(meters) squared
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what are factors that alter the diagnostic test results for malnutrition(4)?
1) fluid balance
2) liver function
3) kidney function
4) presence of disease
143
what can be calculated to determine **serum protein status**?
nitrogen balance
144
how do you calculate **nitrogen balance**?
6.25/total grams of protein ingested in 24 hour period
145
what are **factors that influence serum albumin levels**(5)?
1) hydration
2) renal or hepatic disease
3) large amounts of drainage from wounds, drains, burns, or the GI tract
4) steroid administration
5) exogenous albumin
146
what is involved in an assessment of a patient's **dietary health history**(10)?
1) health status
2) age
3) cultural background
4) personal and religious food preferences/patterns
5) socioeconomic status
6) psychological factors
7) use of alcohol or other substances
8) use of supplements
9) prescription or OTC drug use
10) general nutrition knowledge
147
what is dysphagia?
difficulty swallowing
148
what are the **signs of dysphagia**(8)?
1) coughing during eating
2) change in tone of voice after swallowing
3) abnormal movements of the mouth, tongue, or lips
4) slow, weak, or uncoordinated speech
5) abnormal gagging
6) delayed swallowing
7) pocketing, regurgitation, pharyngeal pooling
8) inability to speak
149
what does dysphagia often lead to?
inadequate food intake which leads to malnutrition
150
how does HF influence food intake(6)?
patients with heart failure experience:
1) decreased hunger
2) dietary restrictions
3) fatigue
4) shortness of breath
5) anxiety
6) sadness
151
who should you consult when dealing with a patient with dysphagia(4)?
1) SLP
2) RD
3) pharmacist
4) speech therapist
152
what is involved with **health promotion** associated with nutrition(5)?
1) education
2) early detection of potential or actual problems
3) meal planning
4) weight loss plans
5) food safety
153
what is the preferred method of nutrition delivery for those who cant swallow but have a functioning GI tract?
EN - enteral nutrition
154
what type of formula is **polymeric**?
milk-based and blenderized
**pt GI tract needs to be able to absorb whole nutrient**
155
what type of formula is **modular**?
single-macronutrient (proteins, glucose, lipids, polymers, or lipids) formula that are added to other foods to meet pt needs
156
what type of formula is **elemental formula**?
predigested nutrients, easier for partially dysfunctional GI tracts to absorb
157
what type of formula are **specialty formulas**?
formulas designed to meet specific nutritional needs in certain illnesses
158
what are some examples of EN formulas?
osmolite and jevity
159
how do you make sure a patient can tolerate an EN formula?
start at slow rates and increase every 8-12 hours
160
if EN will be provided for less than 4 weeks, what is the preferred method?
NG tube
161
what form of EN is preferred for long term use?
surgical or endoscopically placed tubes
162
what can happen if EN formula is aspirated?
infection
163
what is **MNT**?
medical nutrition therapy - specific nutritional therapy used to treat illness or injury
164
what is **MNT** necessary for(3)?
1) metabolizing certain nutrient
2) correcting nutritional deficiencies
3) eliminating foods that worsen disease states
165
MNT is most effective with a team approach that promotes collaboration between..
the healthcare team and RD
166
how are peptic ulcers controlled?
1) regular meals
2) medications such as h2 receptor antagonists or PPIs
167
what is helicobacter pylori?
a bacterium that causes up to 85% of peptic ulcers
168
how are helicobacter pylori infections detected?
confirmed using lab tests or a biopsy during endoscopy
169
what types of foods should people with peptic ulcers **avoid**(5)?
foods that increase stomach acidity and pain such as:
1) caffeine
2) decaffeinated coffee
3) frequent milk intake
4) citric acid juices
5) certain seasonings (hot chili peppers, chili powder, black pepper)
170
beside food, what else should people with peptic ulcers **avoid**(5)?
1) smoking
2) alcohol
3) asprin
4) NSAIDs
5) large meals (eat 3 small meals or regular small meals
171
what disease classification are Crohn's disease and idiopathic ulcerative colitis?
inflammatory bowel disease
172
what does treatment of **acute inflammatory bowel disease** include(2)?
1) elemental diets (formula with nutrients in their simplest form ready for absorption)
2) PN when symptoms like diarrhea or weight loss are prevalent
173
what kind of diet is needed for people with **chronic inflammatory bowel disease**(2)?
1) a regular high-nourishing diet
2) vitamins and iron supplements often needed to correct or prevent anemia
174
how do people manage **irritable bowel syndrome**(4)?
1) increase fiber
2) reduce fat
3) avoid large meals
4) avoid lactose or sorbitol-containing foods (if intolerant)
175
treatments of malabsorption syndromes such as celiac disease includes:
gluten-free diet
176
what foods is gluten present in(4)?
1) wheat
2) rye
3) barley
4) oats
177
what is short-bowel syndrome?
extensive resection of bowel that causes patients to suffer malabsorption due to lack of intestinal surface area
* patients require lifetime feeding with either elemental enteral formulas or PN
178
what is diverticulitis?
inflammation of the diverticula
179
what are diverticula?
abnormal but common pouch-like herniations that occur in the bowel lining
180
what is the treatment for diverticulitis(2)?
1) moderate or low-residue diet until infection subsides
2) high-fiber diet for chronic diverticula problems
181
what is the difference between treatments for type one and type two diabetes?
**type 1** - requires both insulin and dietary restrictions for optimal control
**type 2** - patients control type 2 with diet and exercise initially. if ineffective, oral medication is added. if these measures are still insufficient, insulin injections are necessary
182
for type 2 diabetes, the ADA recommends a diet that includes carbohydrates from:
1) fruits
2) vegetables
3) whole grains
4) legumes
5) low-fat milk
183
what is the recommended cholesterol/saturated fat/protein intake for type 2 diabetics?
**saturated fat** - less than 7%
**cholesterol** - less than 200mg/dL
**protein** - 15 - 20% of diet
184
what are the goals of MNT treatment in diabetics(3)?
1) maintain blood glucose levels that are normal or as close as possible
2) lipid and lipoprotein profiles that decrease the risk of microvascular, cardiovascular, neurological, and peripheral vascular complications
3) BP in normal range
185
what is the goal of the american heart association dietary guidelines?
reduce risk factors for the development of hypertension and CAD
186
diet therapy for reducing the risk of cardiovascular disease include:
1) balancing calorie intake with exercise to maintain a healthy body weight
2) eating diet high in fruits, vegetables, and whole-grain high-fiber foods
3) eating fish 2 times per week
4) limiting food and beverages high in added sugar and salt
187
AHA saturated fat/trans fat/cholesterol recommendations:
**saturated fat** - less than 7%
**trans fat** - less than 1%
**cholesterol** - less than 300mg/day
188
how does the AHA recommend accomplishing the saturated fat/trans fat/cholesterol intake goal(3)?
1) lean meats and vegies
2) fat-free dairy products
3) limit intake of fats and sodium
189
why does most cancer patients experience nutrition problems?
1) malignant cells compete with normal cells increasing patients metabolic needs
2) treatment often causes anorexia, nausea, vomiting, and taste issues
190
what is the goal of MNT in cancer patients?
meet the increased metabolic needs of the patient
191
radiation therapy destroys rapidly dividing malignant cells, what cells are also affected in the GI tract and why?
epithelial cells in the GI tract because they also rapidly divide
192
what GI issues does radiation therapy cause(5)?
1) anorexia
2) stomatitis
3) severe diarrhea
4) strictures of the intestine
5) pain
193
what does radiation therapy to the head and neck cause(3)?
1) smell disturbances
2) decreased salivation
3) dysphagia
194
what kind of diet does a patient with cancer require?
1) intake that maximizes intake of nutrients and fluids
2) individualized diets that fit patients needs, symptoms, situation
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what do patients experience with HIV/AIDs when it comes to nutrition?
body wasting, severe weight loss, malnutrition
196
why do patients with HIV/AIDs experience body wasting, severe weight loss(8)?
1) anorexia
2) stomatitis
3) oral thrush infections
4) nausea
5) recurrent vomiting
6) GI malabsorption
7) altered metabolism of nutrients
8) meds
197
why do HIV/AIDs patients acquire hypermetabolism?
systemic infection results in hypermetabolism from cytokine elevation
198
what is the focus of restorative care with HIV/AIDs?
1) maximizing kcal intake and nutrients
2) hand hygiene and food safety to prevent infections
3) minimize exposure to cryptospordium in drinking water, lakes, swimming pools
199
