Nutrition

Question 1

what is the UK life expectancy?

Answer 1

• males: 79yo
• females: 83yo

Question 2

what are the 4 main factors which influence life expectancy?

Answer 2

• nutrition
• exercise
• smoking
• drinking
• (weight, sleep, drugs, social life)

Question 3

what are the main factors of diet that affect life expectanacy and health?

Answer 3

• high intake of sodium
• low intake of whole grains
• low intake of fruit

Question 4

how does social status relate to life expectancy?

Answer 4

• lower socioeconomic status relates to lower life expectancy (poorer diet)

Question 5

what are the 3 main classes of macronutrients?

Answer 5

• carbohydrates
• proteins
• fats and oils (lipids)

Question 6

what are the 2 main classes of micronutrients?

Answer 6

• minerals
• vitamins

Question 7

what amount of vitamin C per day would likely lead to scurvy?

Answer 7

• less than 10mg of vitamin C a day (very rare in UK)

Question 8

what are good sources of vitamin C?

Answer 8

• fruit and veg (citrus fruits in particular)

Question 9

what are the recommended daily intakes of vitamin C?

Answer 9

• children: 30mg
• men and women: 40mg
• pregnant: +10mg (for last trimester)
• smokers: +35mg

(optimal is 100mg+)

Question 10

what can too much vitamin C intake lead to?

Answer 10

• kidney stones and diarrhoea
• (particularly avoid in people with renal problems)

Question 11

what are some good sources of selenium?

Answer 11

• brazil nuts
• bread
• shrimp, kidney, liver

Question 12

what are some selenium deficiency conditions?

Answer 12

• Most common: Selenium is needed for the conversion of thyroid hormone thyroxine (T4) into the more active counterpart (T3), therefore if patient has low selenium then check thyroid function
• also dementia links
• more rare: Selenium deficiency in combination with Coxsackie infection can lead to Keshan disease (cardiomyopathy)

Question 13

what is the danger of too much selenium intake?

Answer 13

• Selenosis: nausea, diarrhoea, fatigue, motor weakness

Question 14

what are some consequences of dehydration?

Answer 14

• affects mental performance
• low blood pressure
• acute kidney injury

Question 15

how much protein is the recommended daily intake (per kg)?

Answer 15

• 0.8g per kg

Question 16

what is a good source of EPA+DHA (omega-3 fats)?

Answer 16

• oily fish (sardine, salmon, mackarel)
• > 450mg per day reccomended

Question 17

what can carbohydrates be broken down into?

Answer 17

• Simple (monosaccharides and disaccharides): glucose, fructose, galactose, maltose, lactose, sucrose)
• Complex (polysaccharides): starches, fibres, glycogen

Question 18

what are the 3 components of a wholegrain?

Answer 18

• endosperm (starchy inner part of grain)
• bran (outer part)
• germ

Question 19

what are the 3 main treatments for obesity?

Answer 19

• Diet: low fat, low carbs, portion control, support groups, higher protein diet is good
• Pharmacotherapy (eg. orlistat - lipase inhibitor)
• Bariatric surgery

Question 20

what is the Atkins diet and when is it often used?

Answer 20

• high protein and high-fat diet (low carb)
• induces ketosis (body burns fat for energy instead of glucose) and rapid weight loss

Question 21

what is the DASH diet?

Answer 21

• Diet Approaches to Stop Hypertension
• diet used to treat high blood pressure
• high intake of fruit and veg, high intake of low fat dairy (reduce salts and saturated fats)

Question 22

what is the mediterranean diet?

Answer 22

• rich in fruit, veg, whole grains, olive oil
• low in meat and confectionery (processed foods)

Question 23

For osteoporosis, describe two dietary interventions that can be made and the specific advice that the GP would give for each of them

Answer 23

• Calcium: dairy products
• Vitamin D: oily fish, fortified cereals
• Moderate protein intake: red meat, chicken
• Reduce alcohol intake

Question 24

If patient is lactose intolerant, why can they not digest lactose?

Answer 24

• The patient cannot produce the enzyme lactase

Question 25

List two treatment options for a patient who is lactose intolerant

Answer 25

- avoid eating lactose-containing foods - enzyme-replacement therapy (taking lactase before meals)

Question 26

How can individual clinicians, government and other organisations help patients to eat a healthy diet?

Answer 26

- **Health Promotion:** vitamin D for breastfed babies and breastfeeding Mums, healthy start vitamins (all children under 5 to have mutivitamin supplement), reduce saturated fats - **Education:** part of curriculum - **Government Policies:** eg. recent requirement to state calories on menus - Labeling foods - **Taxes on less healthy foods** - **Screening**: eg. diabetes and heart disease (with dietary advice for those at increased risk)

Question 27

Does a Mediterranean diet lead to increased or reduced risk of cardiovascular disease?

Answer 27

- reduced risk of cardiovascular disease - (more fruit/veg and less meat)

Question 28

Key micronutrients, sources and effect of deficiency

Answer 28

- **Iron:** if deficient then anaemia - **Vitamin C:** antioxidant, enhances absorption of iron and aids wound healing, deficiency leads to scurvy - **Folate:** megaloblastic anaemia, really important in pregnancy to prevent neural tube defects (Spina Bifida) in babies - **Selenium (very high levels in brazil nuts):** antioxidant, reduces cancer risk, anti-aging, involved in activation of thyroid hormones, improves cognition and may reduce dementia, improves immune function and fertility - **Vitamin D:** good for bones, deficiency can cause rickets/osteomalacia

Question 29

How to assess nutritional status

Answer 29

- History, Physical examination, Antropometric measurements, Laboratory results, Immune Function

Question 30

Calculate and interpret BMI

Answer 30

- BMI: weight (kg) / height ² (m) - underweight: <18.5 - normal range: 18.5 to 24.9 - overweight: >25 - obese: >30 (but note muscle mass may affect BMI so therefore not always accurate representation)

Question 31

Use of waist measurement

Answer 31

Waist measurement measure of truncal fat

Question 32

Which vitamin is teratogenic in high doses?

Answer 32

- Vitamin A

Question 33

What vitamins are alcoholics commonly deficient in?

Answer 33

- folate - vitamin B6 - thiamine - vitamin A