Natural Health Products and Clinical Nutrition

Question 1

What are Nutrceuticals?

Answer 1

Food, Drug or Natural Health product

A nutrient compound that has health benefits in addition to the basic nutritional value contained in food.

Question 2

What are the “health benefits” of a nutracetical?

Answer 2

Major physiological endpoint like skeletal muscle mass or cholesterol levels

Question 3

Examples of NHP?

Answer 3

-Probiotics
-Herb remedies
-Vit and Minerals
-Homeopathic Medicines
-Traditional medicines such a traditional chinese med
-AA and Essential Fatty Acids

Question 4

Do NHPs need a perscription?

Answer 4

No, NHPs must be safe to use as over-the-counter products

Question 5

Who decides of a NHP is allowed on the shelves?

Answer 5

Health Canada

Question 6

What does it take for NHP to get on the shelves?

Answer 6

NHP license applications
-Evidence supporting the safety and efficacy of the NHP according to its recommended conditions of use must be submitted to health Canada

Question 7

What are health claims?

Answer 7

Statements that indicate the intended beneficial effect of a product when used in accordance with its RECOMMENDED conditions of use

Question 8

What is NHP licensing based on?

Answer 8

Based on at least one health claim to support at least one of the medicinal ingredients in the product

Question 9

Health claims can be related to what 3 outcomes?

Answer 9

Functional
Therapeutic
Preventative

Question 10

Health Canada uses a risk-based assessment approach. What does that mean?

Answer 10

Standard evidence required to support the safety and efficacy of the product is proportionate to health risk

Question 11

Requirement for the legal sale of NHPs in Canada x3

Answer 11

1)Natural Product Number (NHP): Shows Health Canada has reviewed and approved the product for sale

2)NHP complaint label: Shows NPN, ingredients, directions for use and warnings

3)Licensed importer of record: NHP manufactured outside of Canada must be a licensed importer of record with health canada. NHPs manufactured in Canada need to be manufactured, packaged and labelled in a licensed facility.

Question 12

What is included on a NHP compliant label? x4

Answer 12

Shows NPN
ingredients
directions for use
warnings

Question 13

What is on a NHP product monograph x7

Answer 13

1)Branding name consisting of trade name and product name in English and French

2)Health claim authorized by Health Canada

3)Potency

4)Quantity per dosage unit

5)MPN

6)Net amount, dosage form

Question 14

What is included on a product label x7

Answer 14

1)Medicinal Ingredients

2)Uses

3)Warnings
-Allergens
-Ask health care prof before use f
-When using this product consult a health care prof. if
-Keep out of research of children

4)Directions

5)Other info

6)Non-medical ingredients

7)Questions

Question 15

What is B-Hydroxy-B-Methylbutyrate (HMB)

Answer 15

HMB is a product of leucine breakdown but only 5% of leucine is converted to HMB

Question 16

True or False: HMB + Vit D supplementation may improve muscle function in older adults deficient in vit D

Answer 16

True, sig difference in handgrip strength, with or without exercise

Exercise showed same benefit

Question 16

Exercise perscription for HMB and Vit D supplementation to improve muscle function in older adults Vit D deficnet

Answer 16

60 minutes full body resistance exercise 4x/week

Question 17

Benefits of HMB?

Answer 17

1)Proposed mechanism of action is enhancement of muscle protein synthesis

2)HMB may also help reduce muscle damage and promote muscle recovery following exercise while also attenuating muscle disuse atrophy

Question 17

Supplementation for HMB and Vit D supplementation to improve muscle function in older adults Vit D deficient

Answer 17

HMB 3g/day
Vit D 2000IU/Day

Question 18

Main takeaway of Supplementation for HMB and Vit D supplementation to improve muscle function in older adults Vit D deficient

Answer 18

If you are not exercising taking HMB+D supplementation is beneficial in improving muscle function over time

BUT if you are exercising it makes no difference

Question 19

What are some key considerations when studying the effects of a NHP?

Answer 19

-Minimial effective dose
-Formulation + Active Ingridents
-Pop: quality of the tsudy/who was tested
-Interactions with meds
-Immediate versus chronic effects (potency over time)

Question 20

True or False HMB +D inreases weight gain?

Answer 20

True in a positive way

Question 21

T or F: Hypercaloric HMB and Vit D ONS may improve clinical outcomes in older adults.

Answer 21

True, however it was difficult to tell because the supplement and placebo had very different amounts of calories, protein, Fat, and CHO

Question 22

T or F: Reactive oxygen species are always bad

Answer 22

False too much results in cell damage, but a little is good for cell signaling

Question 23

What are antioxidants

Answer 23

Substances that inhibit or reduce oxidative damaged caused by ROS

Question 24

When may ROS damage proteins and cellular membranes?

Answer 24

Only when they get too high enough levels

Question 25

What are polyohenols

Answer 25

ANTIOXIDANT -Naturally occur compounds found in plants, fruits (grapes, perars, berries, apples)

Question 26

Why are polyphenols important

Answer 26

Antioxidant that may protect cells from oxidative damage and limit risk of various diseases

Question 27

What are the 4 classes of polyphenols

Answer 27

Flavonoids (most abundant in human diet) Phenolic Acids Stilbenes Lignans

Question 28

True or False Flavonoid intake decreased risk of all cause mortality in older women

Answer 28

True reduced risk of CVD, Cancer mortalityb

Question 29

What is malnutrition

Answer 29

Deficiencies, excess or imbalance in a persons intake of energy or nutrients

Question 30

True or False the definition of manutrition has evolved over time

Answer 30

True, grows and includes more research and resources

Question 31

Why should we care about malnutriment in clinical populations and settings as a public health concern

Answer 31

1)Malnourished surgical patients experience poor postoperative outcomes including increased hospital length of stay and readmission 2)Malnutrition is often a precursor to sarcopenia

Question 32

What defines preoperative nutritional supplementation

Answer 32

Carbs, Fats, Protein

Question 33

True or False: Preoperative nutritional supplementation and other nutritional considerations can decrease infection risk, hospital length of stay, and other negative postoperative outcomes

Answer 33

True

Question 34

What is prehabilitation

Answer 34

Supplementation of nutrient containing or immune-enhancing nutrition in preop period

Question 35

Trauma and Critical Care Considerations

Answer 35

-Patients may require serial procedures or surgeries that interrupt or alter nutrient delivery and requirements -After a traumatic injury tissue damage triggers an acute response characterized by protein catabolism, insulin resistance, and increased energy expenditure (20-50% higher in trauma patients compared to those undergoing elective surgery) -State of hyper-metabolism where your body is trying to make sure it gets enough nutrients. This leads to increased energy expentiture and is more severe in traumatic surgey than scheduked

Question 36

What are Oral Nutritional Supplements (ONS)

Answer 36

Sterile liquids, semi-solids or powders that contain additional protein, engery, and micronutrients and potentially other specialized nutrients to improve nutritional status

Question 37

Situations where ONS are used?

Answer 37

Acute or Chronic Preparation of undernourished patients Dysphagia Disease related metabolism

Question 38

Enteral Nutrition

Answer 38

Delivery of a nutritionally complete feed via a tube into the stomach, duodenum, or jejunum

Question 39

Enteral Nutrition is used for

Answer 39

People who have inadequate oral intake but functional GI tract

Question 40

Parenteral Nutrition

Answer 40

Delivery of a nutritionally complete feed via a central or peripheral venous catheter Bypass the GI tract and portal venous systems

Question 41

EFFORT Study: Early nutritional support on fraility functional outcomes and recovery

Answer 41

Length of stay greater than 4 days with nutritional support initiated no later than 48 hours after admission Early use of individualized nutritional support in medical inpatients at nutritional risk lowers risk of mortality and functional decline within 30 days High score = worse outcome

Question 42

What is the ERAS Enhanced Recovery After surgery knowledge translation

Answer 42

Aims to develop peri-op care and to improve patient recovery Gudelines used in many surgical procdures and incuded guidance on nutritoon, wound healing, etc.