What is the classification for a 1. ) Low carbohydrate diet 2. ) Very low carbohydrate diet

1. ) 60-130 g/day 2. ) 0-60 g/day

Medical Nutrition I Flashcards by Joel Glotfelty

One of the most pressing and concerning public health problems in the US and other resource rich countries

Obesity

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Adult obesity prevalence increased from 22.9% in 1988 to

35% in men and 40.4% in women

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Equally as troublesome as these statistics is the trajectory of these findings. The projected prevalence of obesity is

50% by 2030

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What is a good initial goal for weight loss?

Losing 5-7% of body weight

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The rate of weight loss has the potential to reduce after

3-6 Months of weight loss

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With weight loss, we see an increase in hunger stimulation by

Ghrelin

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With weight loss, energy storage is increased by

GIP

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Work to decrease appetite during weight loss

CCK and Leptin

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If patients lose 10% of their weight, their energy expenditure goes

-makes it harder to continue to lose weight

Down

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Diets that promise quick weight loss through what is usually an unhealthy, unbalance diet

Fad diets

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Short-term, typically unsupported by data, and promise results without commitment or lifestyle changes

Fad diets

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A common theme with many of these fad diets is

Weight cycing

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An important determinant of short term (less than 2 weeks) weight loss

Carbohyrate content of diet

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What is the classification for a

) Low carbohydrate diet
) Very low carbohydrate diet

) 60-130 g/day

2. ) 0-60 g/day

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When no carbohydrates are ingested, body energy stores are mobilized, particularly

Glycogen

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Glycogen is broken down and fluid loss is

Plentiful

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Further reduction in carbohydrate ingestion results in break down of

TAGs

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Begins at ingestion of less than 50 g of carbs per day

Ketosis

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In the short-term, however, high-fat, low-CHO ketogenic diets cause a greater loss of body water than

Body Fat

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What are two examples of popular low carb diets?

Paleo diet and Atkins diet

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The body is taking in no nutrition. As a result, the body reaches to its own stores and tissues in order to provide substrate for energy production

Starvation

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Muscle is broken down to feed amino acids into gluconeogenesis during

Starvation

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This diet focuses on high fat and protein but minimal carbohydrate intake

Ketosis diet and low carb diet

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In the ketosis and lo carb diets, the triglycerides consulted are shunted to production of acetyl coA as a substrate for the

TCA cycle

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Also, the protein is broken down into amino acids, which shunted into

Gluconeogenesis and the TCA cycle

What are some of the benefits of a low carbohydrate diet?

Rapid weight loss, decread TAG, increased HDL

Low carbohydrate diets can cause deficiency in

B6, Folate, Ca, Mg, K, and fiber

Constipation and headaches are common with

Low carbohydrate diets

Focus on reducing fat intake and eating healthy carbohydrates like beans, vegetables, and fruits

High carb and low fat diets

In the high carb/low fat diet, what percentage of calories come from fat?

Less than 10%

What can not be eaten in the high carbohydrate/low fat diet?

Meat, avocado, nuts, seeds

What are the benefits of a high carbohydrate, low fat fad diet?

High fiber, plenty of vitamins and minerals

What are some of the potential risks of a high carbohydrate, low fat fad diet?

Increased TAGs, decreased HDL, difficult to sustain

Studies have shown that some people that adopt gluten-free diet actually might

Gain weight

Improvement of symptoms and growth issues, if patient has celiac disease of gluten-sensitivity

Benefit of GF diet

The GF diet could cause deficiency in

Iron, folate, niacin, and other vitamins

A gluten free diet can also reduce beneficial

Gut bacteria

Has been associated with improvement in dyslipidemia in individuals without celiac or gluten-sensitivity

Gluten

Have been reported to inhibit angiotensin converting enzyme (ACE)

Gliadin hydrosylates

Gluten may boost the

Immune system

Refers to a period of 3-10 days of mainly fruit and vegetable juices

Juice cleanse

Is there any scientific evidence to support juice cleanses?

For example, there is a case report of oxalate nephropathy requiring hemodialysis and reduction in GFR due to increased consumption of

Oxalate-containing fruits and veggies

The nutritional properties of whole foods and food patterns — rather than macronutrients and micronutrients — are an important focus of the

Mediterranean diet

Rather than restricting foods and calories or eating like a Mediterranean for several days, this is viewed as a

Lifestyle change

The diet focuses on vegetables and fruits, whole grains, lean proteins, nuts, with olive oil or fats with oils high in PUFA like olive oil

Mediterranean diet

An important part of the Mediterranean diet is the bottom row, which is the

Social component of the diet

In an older population, a Mediterranean diet supplemented with olive oil and nuts is associated with improved

Cognitive function

A Mediterranean diet was associated with reduced incidence of major

CVD

Was associated with reduced insulin resistance, endothelial dysfunction, inflammatory markers, and metabolic syndrome

Mediterranean Diet

Immediately starting the diet, there is a significant weight loss in patients with the

Low carb diet

However, this eventually turns into

Returned weight gain

A patient on this diet loses weight and then levels off at a new set point without regaining to initial weight or fluctuating significantly

Mediterranean Diet

Preferable and easier to maintain and adhere to leading to better long term outcomes for weight loss and other lipid and cholesterol levels

Meiterranean diet

What is stage one of hypertension?

Systolic 130-139 mm Hg OR diastolic 80-89 mm Hg

What is stage 2 of hypertension?

Systolic greater than 140 OR diastolic greater than 90

Causes are other general medical conditions that can lead to hypertension. For example, if your body has a tumor of the adrenal gland zona glomerulosa that is independently and inappropriately secreting aldosterone into the blood stream

Secondary hypertension

One of the diets recommended for people with high BP is the

DASH diet

Showed in an NEJM article to have a significantly lower systolic BP at every sodium level

DASH diet

The diet itself emphasizes fruits, vegetables, and low-fat dairy foods; includes whole grains, poultry, fish, and nuts; and contains smaller amounts of red meat, sweets, and sugar-containing beverages than the typical diet in the United States

DASH diet

Very similar to the Mediterranean diet

DASH diet

Also contains smaller amounts of total and saturated fat and cholesterol and larger amounts of potassium, calcium, magnesium, dietary fiber, and protein than the typical diet

DASH diet

What are the normal levels for total cholesterol?

Less than 200

High cholesterol is classified as total cholesterol greater than

240

Has been proven to improve reductions of LDL beyond changes in diet alone. These changes can be evident in 6-12 months

Exercise

In patients with poor baseline diets, it has been shown that changes in diet alone can lower LDL by as much as

30%

Have also been shown to reduce LDL levels

PUFAs

Lower LDL and TAGs without lowering HDL

MUFAs

Once diagnosed, the goal of diabetes management is

Glycemic control

In treating diabetes, we want HbA1c levels to be

Less than or equal to 7

A measure that indicates blood sugar control over the last 3 months

HbA1c

Tells you the percent of red blood cells that have had sugars attached to their membrane due to the high amounts of circulating sugars in a patient with diabetes

HbA1c

The following are the indications for? BMI ≥ 40 without comorbid illness BMI 35 – 39.9 with at least one serious comorbid illness BMI 30 – 34.9 and uncontrollable Type 2 DM or metabolic syndrome

Bariatric surgery

What are the 4 types of bariatric surgery?

Roux-en-Y, Sleeve, Lap Band, and Biliopancreatic diversion

Take a small pouch of the proximal stomach and connect it to the small bowel

Roux-en-Y

Results in restrictive weight loss but also a malabsorptive component

Roux-en-Y

With a Roux-en-Y, the connection between the small stomach pouch and the jejunum causes dumping syndrome if the patient eats too much

Sugar

Inhibited by a Roux-en-Y as it is released by the foregut and much of the foregut is bypassed

Ghrelin

Increased after a Roux-en-Y procedure

CCK and GLP-1

Most of the greater curvature of the stomach is removed and a tubular stomach is created

Sleeve

With the sleeve, there is restricted food intake as well as a 1. ) Decrease in 2. ) Increase in

1. ) Ghrelin | 2. ) GLP-1 and PYY

Insulin resistance improves with the

Sleeve

A soft silicone ring is connected to an infusion port in the subcutaneous tissue. The port allows for adjustment of the ring by infusing saline resulting in restrictive weight loss

Lap Band

This procedure divides the duodenum from the pylorus, removes the pylorus, and then divides the ileum

Bilopancreatic Diversion

Then, the surgeon anastomoses the distal ileum to the stomach and proximal ileum to the

Distal ileum

This procedure is not as well studied from a diabetes perspective and few centers actually do it

Bilopancreatic diversion

The result of a bilopancreatic diversion is essentially having two parallel circuits running and connecting to a

Common limb

Medical literature has shown that bariatric surgery can be the best option for severely obese patients with diabetes. Even without weight loss, patients who have bariatric surgery have improved

HbA1c

What is the minimum protein requirement per day for patients who have undergone bariatric surgery?

Minimum 60g protein per day

Medical Nutrition I Flashcards

(89 cards)