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Nutrient specifics Flashcards

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1
Q

Vitamin A

A

Large amounts in: Beef liver, spinach, carrots (raw), squash/sweet potato

Lesser amounts in: Boiled egg, dairy, herring, fortified cereal

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2
Q

Vitamin K

A

Large amounts in: Oils (e.g. sunflower/safflower oils) and their seeds, dark green leafy veg + broccoli and sprouts, dried prunes

Lesser amounts in: Herbs and spices

Spicy PODS
Prunes, Oils, Dark, Sprouts
H&S

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3
Q

Hyperlipidaemia prescription…

What studies underpin the evidence?

A

Increase:
Portfolio diet - almonds, sterols/stanols, viscous fibre
Fibre (40-45g)
Beneficial MUFA (canola, peanut, avocado, olive, nuts) and PUFAs (omega 3s - found in oily fish, flax/chia/hemp) in place of SF/TF

Decrease:
Saturated fat - AHA/ACA guidelines 5-6% total calories
Trans fats - eliminate
Free fats

Studies:
Portfolio diet - Jenkins 2003
Orlich - Lifestyle heart trial, sorta
Adventist 2 - stepwise decrease in lipids in different diets

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4
Q

Iron sources (plant based)

What aids apsorption?

A

High sources - lentils/chickpeas/beans/quinoa, tofu, cashew/chia/pumpkin, dried apricots/figs/raisins, dark green leafy veg - kale/spinach

Vit C aids absorption

Easy way to remember - all the dried whole foods in my cupboard (fruit and legumes)

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5
Q

Vitamin C

A

High sources (all the Cs) - citrus, cantaloupe (and tropical fruit), cabbage and associated (sprouts, broccoli, boy chow), cauliflower

Less high sources - other fruit and veg

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6
Q

Calcium

Special considerations

A

High sources - dairy, calcium fortified juices and plant based milks, TOFU, CHIA

Less high sources -almonds, low oxalate dark green veg

High oxalate veg such as spinach, chard and beet greens limits calcium absorption

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7
Q

Vitamin D

A

High sources - fortified milks etc, oily fish

Less high sources - dairy, fortified marg, egg, fortified cereal, beef liver

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8
Q

Magnesium

A

High sources - dark chocolate, brazil nuts, cashews, almonds

Less high sources - Tofu, beans, wholegrain, meat and dairy

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9
Q

Vitamin E

A

High sources - Sunflower/safflower, almonds and hazelnuts (seed oils and nut milks)

Less high sources - peanuts, avocado, and spinach/brocolli (dark leafy greens) (spreads and sides - guacamole)

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10
Q

Potassium

A

High sources - potato, sweet potato, squash, banana, plantains, beans/peas

Less high sources - diary, fish, poultry, veg in general

(Carribean stew - with a healthy protein and veg)

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11
Q

4 types of saturated fat:
What are the two most common?
What are their sources?
What are their effects?

A

Lauric acid

  • mainly coconuts, also palm kernel (not palm) oil, a little in dairy
  • raises HDL and LDL
  • may cause heart disease

Steric acid (second most common)

  • animal fats, dark chocolate
  • Lowers LDL
  • Increases colorectal cancer and endothelial damage

Palmitic acid (most common)

  • palm oils, as well as meats and dairy
  • harmful, increases LDL
  • heart disease

Mystiric acid

  • palm oil, coconut oil, dairy
  • biggest raiser of cholesterol, also raises trigs, possibly HDL
  • increased heart disease
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12
Q

Where does sugar come from?

A

Fizzy drinks 47%
Snacks and sweets 31%
Desserts

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13
Q

Where does saturated fat come from?

A

One source : Cheese and pizza

Other source : 
Burgers 19%
Snacks 18%
Protein foods 15%
Dairy 13%
Condiments 7%
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14
Q

Where does sodium come from?

A 
Mixed meals 44%
Protein foods 11%
Grains 11%
Tomatoes/potatoes 11%
Sweets 8%
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15
Q

Where do transfats come from?

A

Grain based processed foods 40%
Animal products 21%
Margerine 17%

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16
Q

Where does cholesterol come from?

A 
Eggs 24.6%
Chicken 12.5%
Beef 11%
Cheese 4.2%
Pork 3.9%

All the major proteins

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17
Q

Fibre - guideline amounts?

Soluble:

Insoluble sources:

A

25/38g, better 40/45g

Fruit Legumes Oats Soluble (FLOwS)

Veg Seeds Wheat Insoluble Bran (Very SWIB)

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18
Q

What did the EPIC study show about diabetes?

A

EPIC study: each 5% calories from animal protein gives 30% increased diabetes risk

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19
Q

What did the combined NHS1/2 and HPFUS show about diets and diabetes?

What other outcome did they look at?

(regarding healthy and unhelath PB diets)

A

A health plant based diet reduces diabetes risk by 34%, whilst unhealthy PB increases by 16%
(are these the same numbers as the Pan et al substitution studies?)

CAD: 0.92 overall, 0.75 healthy, 1.32 unhealthy
DM2: 0.67 healthy, 1.16 unhealthy

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20
Q

What did the NIH study into nutrition in diabetes show?

What did it compare?

Broad outcomes?

A

It compared a plant based diet with the ADA advised diet

Plant based diets gave 3 x reduction in HbA1c, 2 x reduction in LDL, decreased weight and meds

4 findings, 3/2/1/1
aka 4/3/2/1/1

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21
Q

Mechanisms of endothelial injury? (3)

What is TMAO?

What outcomes does TMAO associate with?

A

Diminished nitric oxide
Diminished progenitor cells
Increased TMAO

TMAO produced by bacterial metabolism of choline (internet) and lectin/pectin (book).
These bacteria are more present in regular meat eaters.

TMAO levels associated with all-cause mortality and cardiovascular disease/atherosclerosis

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22
Q

The mixed evidence on dairy…

What benefits are there to dairy?
What about yoghurt?
What about plant based milks?

In who does milk help bone health? by how much?

A

Dairy weakly helps CVA and heart disease…
Yoghurt helps DM
Plant based alternatives probably much better

Milk improves bone health in children and women.
Bone mineral density increases of 0.7-1.3%

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23
Q

Breast cancer - obesity and lifestyle…

A

You can be obese or non-obese - same mortality if physically active and getting your fruit and veg!

180 minutes and 5 F&V

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24
Q

Weight and diet:

What difference do calories make?

Whole food plant based diets, do they cause weight loss?

Do adults or children having sugary drinks result in weight change?

A

If the calories are the same, no evidence that weight will change.

Yes they do!

Adults yes, children no

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25
The EPIC study: Population number Follow up length BP findings (3) Bone health (2) Cancer (3) All-cause (1) Heart disease (1) 4 behaviours and how much years of life?
500000 European adults >10 years Blood pressure: Low sodium and high potassium, fruit and veg Bone health and bone fractures Physical activity with high impact activity Cancer: Obesity - increases a number of cancers Fibre - reduces colorectal Sex hormone and fat intake - increases breast cancer All cause death Increases in eating fruit and vegetables Heart disease High blood sugar levels ``` 14 years of life gained from 4 behaviours: not smoking being physically active moderate alcohol intake five fruit and vegetable servings a day ```
26
The exercise tolerance tests... If <30% If >70% In between?
<30% - symptom limited ECG >70% - angiography in between either MRI or 12 minute tolerance test
27
Epidemiology of diabetes: How many diagnosed in US, how many undiagnosed? How many pre-diabetes? Whats the costs - direct and indirect? WW prevalence and US prevalence?
23 million diagnosed, 7 million undiagnosed 80 million pre-diabetes Costs: total 300bn 230bn + 90bn 8.5 and 9.3% Ways to remember: Costs overall the same as smoking (300bn with 150/130 split) 30ml and 300mil 23 diagnosed and 230 direct 7mil undiagnosed, 80pre-d, 90 indirect costs
28
Positive psychology - the 5 pillars
``` Positive emotions Engagement Relationships Meaning Accomplishments ```
29
Sleep restriction study and food seeking behaviours: What did they do? What did they seek - calories and type?
4 hours for 5 nights 300 calories, saturated fats
30
Obesity counselling: 4 important CBT techniques:
4 techniques: - self monitor - goal set - normalise healthy diet - problem solve ``` MNOP Monitor Normalise gOal set Problem solve ```
31
What do physicians with increased empathy produce? (number please) How long do they need training for? What else does the patient provider relationship affect? (3 things) What are the two key asepcts of behaviour change?
Much better HbA1c (56% vs 40%) 10 hours sufficient HTN, BM and function (trust in provider is one of the key aspects of behaviour change, as well as having a good support system)
32
FLEXIBILITY guidelines
Adults - 10 mins, 2-3 times a week (but daily is best) 10-30seconds per stretch, 60 total, 2-4 reps For older adults it is the same but 30-60s per stretch
33
BALANCE guidelines
Adults 20-30min 2-3 days a week | Older 1 hour, 3+ days a week
34
Patient provider interaction systematic reviews: Which 3 interactions were looked at?
1) Patient activated 2) Provider enhanced 3) combination 22/30 - intervention altered the interaction 11/25 improved health outcomes 5/25 worsened Health outcomes overall poorly assessed
35
Esselstyn Diet and aim of diet
Low fat 10%, no oils, WFPB Aim of cholesterol <150mg/dL Statins individualised 24 patients 5-year experience 6 non-adherent released to standard care in 12-18 months 18 adherent - by 5 years 1) 11 had angiography - 100% disease arrest, 73% (8) reversal 2) 9 had angina - 2 stopped, 7 improved 3) 1 died after angio, having had disease reversal, post mortem showed no MI 4) Cholesterol went from 237 to 137 at 12 years: - 1 further became non-adherent - Mean cholesterol 147 - no extension of clinical disease, no coronary events, and no interventions. - original compliant 18 participants experienced 49 coronary events in the 8 years before the study - Non-adherent had 13 events
36
DASH for hypertension Patient group and numbers? Interventions and control? What wasn't changed? Results: Baseline mean BP Changes by group (compared to control)? How many had hypertension? What did combo do?
n=459, SBP<160, DBP 80-95 3 weeks of US diet THEN: 1) continue US diet 2) High F&V diet 3) Combination diet - high F&V, low fat dairy, low sat fat and total fat Sodium and body weight maintained Baseline 131/85 F&V decreased 2.8/1.1 Combo 5.5/3 326 had hypertension Combon decreased 11.4/5.5 (Note 1.1 and 5.5 vs 11/5.5 for HTN group)
37
DIETFITS trial What diets were compared? What follow up? What findings? - weight loss - other (2) significant associations
- Low fat versus low carb 12 months FINDINGS: Low fat wt loss 5.3kg Low car 6.0kg Adherence key, neither INS30 nor the 3 genotypes
38
Epigenetic studies: Dutch winter hunger - what conditions were affected (4)
obesity schizophrenia fertility finger print
39
Epigenetic studies: How does hyperglycaemia affect it (a specific promotor region)
The NFkB p65 promotor (3 genes...) Remember NfKB is 'key' in diabetes - hyperglycaemia affects it PGC-1 is a key epigenetic aspect of DM2 susceptibility RXRA methylation affected in pregnancy
40
Epigenetic studies: Agouti mice
Genes can be changed by lifestyle
41
Epigenetic studies: What promotor region is affected by maternal diet? What does this affect? What aspects of a plant based diet are important in this?
RXRA promotor methylation Genes associated with adiposity and metabolic syndrome Methyl and B vitamins in a plant based diet
42
What epigenetic changes does exercise induce?
GLUT4 expression in skeletal muscle However, no change in microvascular risk in 5 years
43
What epigenetic gene is important in diabetes type 2 susceptibility?
PGC-1
44
Epigenetic 4 affectors 4 positives 4 negatives
``` Affectors: Sleep Diet Physical activity Obesity ``` ``` Positives: Polyphenols and B vits Exercise Low stress Maternal and paternal diet ``` ``` Negatives Sugar Alcohol Sat fat Processed food ```
45
The microbiome and fibre - what's the importance? What does the important thing do? (5)
Butyrate, a SCFA, is produced by bacterial metabolism of viscous fibre. 5 benefits 1) Insulin sensivity 2) Mineral absorption 3) Lower cholesterol and trigs 4) Lower hepatoglycolysis 5) Increased satiety 2 blood sugar 3 others
46
Adiponectin - 3 benefits! 2 things that inhbiit/reduce it
1) clears trigs 2) reduces TNFa 3) protects endothelium FFAs and inflammation
47
Insulin resistance What happens as a result of adipocyte hyperplasia/trophy? Whats happens from the NFkB pathway?
- release 3 mediators 1) leptin - pro-angiogenic, cytokine release, apoptosis, 2) RBP - prevents activation of glucose binding proteins, 3) EDF - causes IR) - cause exogenous adipose tissue (liver/muscle) - cause inflammation (TNFa, JNK, NFkB, CRP, IL6, MCP1, PAI1) - greater lipolysis - therefore TAG, DAG, free fatty acids (inflammatory) NFkB activates telomerase, cytokines, adhesion molecules, VEGF and TNF. Also results in macrophage recruitment. NOW That Cat Attached My Violet Turtle
48
Beta cell death
``` Dyslipidaemia - VLDL/LDL --> apoptosis Glucotoxicity --> apoptosis Cytokines - NFkB/JNK --> macrophages Oxidative stress - FFA, BM, NFkb/JNK Leptin - cytokines, apoptosis, proangiogenic ```
49
How much have the following increased? Sugar intake Oil intake Chees intake TV
Sugar - 63.5kg/year Oil - 41.7kg/year Cheese - 11.3kg/year TV from 0 to 4 hours a day
50
Hypertension nutrition advice: Increase Decrease
Increase: K+, Ca2+, Mg2+ Fibre/fruit and veg ``` Decrease: Sodium Saturated fat Caffeine Alcohol - J shaped curve ```
51
Breast cancer and diet - 2 studies: Women who were their own crossover: Women who were overweight, normal or obese:
1) 12 women, 2 weeks control and 2 weeks exercise and diet intervention decreased cancer growth, IGF1 and increased IGF1BP 2) 1490 women - if you ate 5FV and 180PA you have 50% RR mortality independent of weight category
52
Anderson showed what about plant based diets and insulin use?
in 16 days - 11 stopped insulin and 9 decreased without weight change
53
Dietary prescription for cancer: What are the aims? Avoid what foods? Increase what foods?
1) Support the immune system 2) Provide low inflammatory/antioxidant state Avoid inflammatory foods: Processed grains, sugar Red and processed meats Saturated and transfats Increase: Fibre and antioxidants
54
Antioxidant list from the 'cancer' section:
``` Beta carotene - in carrots and yellow/orange veg Lycopene - in tomatoes Resveratrol - in grapes and blueberries Selenium - in mushrooms and brazil nuts Vitamin C and vitamin E ``` Resveratrol - sounds like petrol - the smell of a good wine
55
Tobacco costs?
130bn direct, 150bn in lost productivity
56
Human cost of tobacco? What is tobacco number 1 for?
CDC states it is the number one cause of preventable disease and death - Cleveland clinic in 2017 say that obesity may have overtaken
57
``` From smoking: How many die prematurely every year? How many suffer from disease caused by smoking? Smokers lose how much LE? Smokers are more likely to what? ```
50 million 16 million lose 10 years suffer health problems and disability
58
Smoking and cancers how many carcinogens in smoke? how many linked cancers? if nobody smoked, how many cancer deaths would not happen?
70 carcinogens 40+ cancers 1/3rd
59
Smokers and US deaths: What number? What proportion of deaths? What proportion of users?
480000 1/5th 1/2 will die from use
60
What may nicotine be as addictive as?
heroin, cocaine, alcohol
61
How many smokers want to quick %? How many will manage without assistance?
68% 5%?
62
Is there a dose-dependent effect in smoking cessation? What does the most effective counselling involve?
yes - more intense, is better, with more than 4 person-to-person sessions being best practical counselling involving problem solving an skills training, and social support
63
USHHS recommendations on medications in smoke cessation? What are the special populations with poor evidence (4)?
Recommends everyone uses except if CI or special populations with poor evidence Pregnant, teenage, smokeless tobacco and light msokers
64
How many FDA approved treatments are there for smoking?
5 NRT and 2 non-NRT Off label is nortrip and clonidine
65
Bupropion and varencyline MODA?
bupropion is a NA and DA rey-take inhibitor | Varencycline is a nicotinic receptor partial agonist
66
What are the most effective smoking cessation treatments? What 2 things are recent studies suggesting?
Varencyline and bupropion gives 71% at 12 weeks, and 58% at 6 months Bupropion patch and lozenge are 54% at 8 weeks, whilst B and L is 50% Recent studies suggest that NRT and varenicline may be effective without SE worsening, whilst V+B+NRT may be even better
67
Smoking cessation in chronic disease or mental illness: -what is recommended and what's it's success rate?
Triple threrapy - Bupropion, patch and another NRT 62% vs 37% with patch alone at 8 weeks 35% vs 19% at 6 months
68
Weight gain and smoking cessation: How much? Who is most affected? What delays it?
<10lbs More common in women Bupropion and NRT may delay but not prevent weight gain
69
Specific mental illness and smoking cessation: 2 conditions and their recommendations
Bipolar - no bupropion - patch recommended Schizoids - patch recommended
70
How long can you use bupropion and vareniclin
B for 6 months | V for 12 weeks, twice in a year
71
Smoking cessation: 2 treatments not effective 4 with limited evidence
Acupuncture and hypnosis Physiologic feedback, restricted environmental stimulation therapy, use of incentives, cigarette fading Also eCigs are not well evidenced
72
Effective counselling in helping people quit: 2 principles 5 specifics
Should include problem solving skills/skills training and social support 1) Help recognise situations where they may be vulnerable to smoke 2) Develop coping skills 3) provide info about smoking and quitting 4) Provide support and encouragement, communicate care and concern 5) Engage in discussions about quitting
73
5 As of tobacco cessation?
``` Ask Advice Assess (willingness to quit) Assist (quit date within 2 weeks) Arrange (FU within 3 days of quit date, then within 1month) ```
74
Short model of tobacco cessation? 3As
Ask Advise Refer
75
Coverage of smoking cessation counselling?
Medicaid - Individual>group>telephone covered Medicare - 4 sessions per quit, 2 quits per year. Intermediate 3-10 minutes of intensive >10 minutes. Prescription drugs

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