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Medicine 3 > Nutrition > Flashcards

Nutrition Flashcards

1
Q

Which nutrients provide you energy

A
  • Macronutrients (lipids, protein, carbohydrates)

- micronutrients (minerals and vitamins) DO NOT provide energy

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2
Q

essential amino acids

A
  • Histidine
  • Isoleucine
  • Leucine
  • Methionine
  • Phenylalanine
  • Thronine
  • Tryptophan
  • Valine
  • Lysine
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3
Q

conditionally non-essential amino acids

A 
	Arginine
	Asparagine
	Glutamine
	Glycine
	Proline
	Serine
	Tyrosine
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4
Q

non-essential amino acids

A

 Alanine
 Aspartate
 Cysteine
 Glutamate

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5
Q

calculating energy requirements: estimation

A

 Weight maintenance: 25-35 kcal/kg
 Weight loss: 20-25kcal/kg
 Weight gain: 35-45 kcal/kg

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6
Q

simple carbohydrates

A
  • mono-/disaccharides
  • maltos (glucose-glucose)
  • sucrose (fructose-glucose)
  • lactose (galactose-glucose)
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7
Q

complex carbohydrates

A
  • starches (amylose, amylopectin)
  • cellulose
  • glycogen
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8
Q

essential fatty acids

A

-how derived: unsaturated –> polyunsaturated and monounsaturated –> omega 6, omega 3 from polyunsaturated, omega 9 from monounsaturated

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9
Q

energy scale for food

A
  • carbs = 4 calories per gram
  • protein = 4 calories per gram
  • fats = 9 calories per gram
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10
Q

structural differences between saturated, unsaturated, and trans fats

A
  • saturated is straight
  • unsaturated has a cis double bond
  • trans has a trans double bond
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11
Q

how are energy requirements calculated

A

-age, weight, hight

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12
Q

factors that require adjustment in energy requirements

A

-bed rest
-out of bed
-general surgery
-sepsis
-multiorgan failure
burns
-temperature

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13
Q

Nutrition: obesity

A
  • promote weight loss through calorie restriction
  • meds: contrave, qxymia, Belviq, Saxenda, Orlistat
  • diet = weight loss
  • exercise = weight maintenance
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14
Q

Nutrition: diabetes

A
  • Equal distribution of CHO throughout the day
  • 40% daily calories (Energy Requirements: 2000 kcal/day, 40% calories CHO: 800 kcal / 4 g/kcal = 200 g/day, 5 meals per day: 200 g / 5 meals = 40 g/meal)
  • 1 “serving” CHO = 15g (~2-3 servings per meal)
  • Glycemic Index
  • Carbohydrate Counting
  • Carbohydrate to Insulin ratio
  • Rule of 500 (500 divided by your TDD (Total Daily Dose of insulin) = grams of carb covered by one unit of Humalog or Novolog)
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15
Q

nutrition: dyslipidemias

A
  • CONTROL/RESTRICTION OF DIETARY FATS/LIPIDS
  • Avoid trans fats (Fast foods, Baked goods (shortening))
  • Limit saturated fats (=solid at room temperature) (Butter, Coconut oil)
  • Focus on mono- and polyunsaturated fats (=liquid at room temperature) (Olive oil, Grapeseed oil, Avocado, Nuts)
  • Limit simple carbohydrates (sweets, sodas, juices) for pure Hypertriglyceridemia
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16
Q

kidney disease (acute v chronic)

A

-PROTEIN, ELECTROLYTES, FLUID CONTROL/RESTRICTIONS

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17
Q

kidney disease restrictions

A
  • RESTRICTIONS
  • Low sodium (< 2000 mg/day) (Limit fast foods, canned foods, processed foods (e.g. lunch meats), etc., No added salt to cooking, Beware of salt substitutes (potassium chloride), Herbs)
  • Phosphorus restriction (Limit dairy (milk, yogurt), dark sodas, shrimp, organ meats, chocolate, broccoli, nuts, etc.)
  • Fluid Restriction (Water, coffee, teas, sodas, juices, soups, popsicles)
  • Protein (Reduced protein CKD 4&5, Increased PRO needs on dialysis (hemodialysis [HD], peritoneal dialysis [PD]), Meat, seafood, eggs, cheese, legumes (beans, lentils), nuts)
  • Low potassium (2g/day) Hyperkalemia (Dysrhythmia, sudden death, Treatment: Kayexalate, IV calcium, insulin + glucose, albuterol, bicarb, diuretics)
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18
Q

other considerations for kidney disease

A
  • Hypermagnesemia (Reduce Magnesium - Limit nuts, seeds, grains (rice, buckwheat), spinach, mackerel)
  • Vitamin D deficiency
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19
Q

CHF nutrition

A
  • SODIUM/FLUID CONTROL/RESTRICTION
  • Low sodium (<2g/day)
  • Fluid restriction (~1-1.5 L per day)
  • Increased potassium for patients on K-wasting diuretics (e.g. Lasix)
  • Promote high K foods: oranges, avocados, potatoes, bananas, green leafy vegetables
  • Limit alcohol
  • Low fat (CAD)
  • DASH diet
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20
Q

Atrial fibrillation nutrition

A
  • VITAMIN K CONTROL - NOT RESTRICTION
  • Coumadin/Warfarin
  • Consistent Vitamin K intake
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21
Q

cirrhosis

A
  • PROTEIN CONTROL
  • Questionable protein restriction d/t generalized malnutrition
  • Ammonia (Hepatic encephalopathy, Protein limitation, Lactulose, Branched Chain Amino Acid (BCAA) Supplementation)
  • Fluid restriction (Ascites)
  • Low sodium
  • High calorie (Small, frequent, calorically-dense foods)
  • Avoid alcohol
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22
Q

failure to thrive: post-surgery nutrition

A

-Malnutrition - Impairs wound healing and increases mortality, Increased needs for: Zinc sulfate: 220 mg qD x 10 days (Copper deficiency), Vitamin C: 500 mg BID x 10 days (Rebound scurvy), Vitamin A: 25,000 IU qD x 10 days (Toxicity)

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23
Q

failure to thrive: elderly

A

-Small, frequent meals, calorically-dense - Add healthy fats, Oral supplements (e.g. Ensure, Boost, Glucerna, etc.)

24
Q

failure to thrive: pediatrics

A
  • < 5th percentile on BMI for age

- “Picky eaters” - Portion size: 1 tbs per year of age, Introducing new foods (repeat, repeat, repeat), Creativity

25
Q

failure to thrive: eating disorders

A
  • Anorexia Nervosa

- Bulimia (Binge eating, Purging - Emesis, Laxatives, Exercise)

26
Q

celiac disease

A
  • GLUTEN AVOIDANCE

- Gluten = protein found in wheat, rye, barley

27
Q

Pancreatitis

A
  • NPO
  • Pancreatic rest
  • IVF vs IV nutrition (parenteral nutrition)
  • Pancreatic enzymes (Creon), AquADEKs
28
Q

seizures

A
  • CARBOHYDRATE RESTRICTION
  • Ketogenic diet
  • Very low carb, high fat, high protein
29
Q

biliary colic

A

-TEMPORARY FAT LIMITATION

30
Q

cystic fibrosis

A
  • NO RESTRICTIONS - EVER
  • High calorie
  • Additional sodium
  • PERT, AquADEKs
31
Q

bariatric surgery

A
  • PORTION CONTROL
  • Life-long vitamin/mineral supplementation
  • Vit B12: 500 mcg SL qD
  • Calcium/Vit D: 500 mg/400 IU QID
  • Iron-containing multivitamin qD
32
Q

diverticulosis

A
  • HIGH FIBER

- Fruits, veggies, grains, legumes

33
Q

diverticulitis

A

-low fiber

34
Q

GERD

A
  • PORTION CONTROL
  • Small meals
  • Limit coffee, tea, chocolate, spicy foods, citrus, fried foods, peppermint, alcohol
35
Q

Lactose intolerance

A

-AVOID DAIRY

36
Q

Cancer/transplant

A
  • FOOD SAFETY
  • Low microbial diet
  • Avoid unpasteurized foods, undercooked meats, raw grains/nuts,
  • Calorically-dense foods
  • Filtered water (1 micron or smaller filter)
37
Q

pregnancy

A
  • ENERGY AND MICRONUTRIENTS
  • Energy: 300 additional calories
  • Folate: 400-800 mcg qD
  • Iron: 27 mg qD
  • Calcium: 1000-1300 mg daily
38
Q

pediatrics nutrtion

A

 Children (based on age and weight):
 Infants 0-6 months of age: 108 calories/kg; 2.2 g PRO/kg
 Infants 6-12 months of age: 98 calories/kg; 1.6 g PRO/kg
 Children 1-3 years of age: 102 calories/kg; 1.2 g PRO/kg
 Children 4-6 years of age: 90 calories/kg; 1.1 g PRO/kg
 Children 7-10 years of age: 70 calories/kg; 1 g PRO/kg
 Children 11-14 years of age: 47-55 calories/kg; 1 g PRO/kg
 Adolescents 15-18 years of age: 40-45 calories/kg; 0.8 g PRO/kg

39
Q

breasmilk vs formula

A
  • for baby: reduced risk of infections, astham, dermatitis, allergies, obesity, diabetes, SIDS, childhood cancer, baby being stressed
  • for mom: reduced risk of ovarian and breast cancer, type 2 diabetes and heart disease, postpartum depression, osteoporosis (thin bones), helps lose weight by burning 500 calories/day, saves money and time
40
Q

vitamin D and iron supplementations

A
  • Vit. D supplementation: 400 IU daily

- Iron supplementation: 1 mg/kg until introduction of solids

41
Q

geriatrics

A
  • FLUID, TEXTURE, CALORIE/FLAVOR CONTROL
  • Taste changes
  • Zinc deficiency, loss of smell
  • Calorically-dense foods
  • Dentition
  • Swallow function
  • Thickened liquids
  • Modified food texture (Soft, Ground, Pureed)
  • Anemia of chronic disease
  • Fluid requirements (25 mL/kg/day, Dehydration)
42
Q

nutrient deficiencies and effects

A

o Vitamin A: elderly, developing nations
o Vitamin B9: pregnancy
o Vitamin B12: elderly, GI diseases, vegetarians, vegans
o Vitamin D: sun avoidance/block
o Calcium: Vitamin D; osteopenia/-porosis; elderly, medications (diuretics)
o Copper: zinc supplementation, decreased immune function
o Iodine: thyroid dysfunction, goiter, cretinism, developmental delay
o Magnesium: muscle cramps
o Phosphorus: brittle bones, fluid imbalance
o Potassium: muscle cramps, fluid imbalance
o Selenium: increased susceptibility to infection
o Zinc: growth and developmental delay

43
Q

iron deficiency

A
  • Microcytic hypochromic anemia (MCV<80) - Lead/cadmium poisoning
  • Pediatrics - Cows milk (High concentration, yet low bioavailability, Competitive absorption)
  • Absorption (mostly duodenum)
  • Iron losses (GI bleeds, Menstruation - RDA: 18 mg (female) vs 8 mg (male, non-menstruating))
44
Q

iron toxicity

A
  • Over-supplementation, poisoning (children)
  • Iron overload
  • Hemochromatosis
45
Q

protein-energy malnutrition

A
  • Protein Malnutrition = Kwashiorkor
  • Calorie/Protein Malnutrition = Marasmus
  • Marasmic Kwashiorkor
46
Q

MVI

A
  • Balanced diet = unnecessary
  • Consider if poor PO/dietary intake, food restrictions (e.g. vegans), children
  • Risk vs benefit (Beware of “mega” doses)
47
Q

prenatal vitamins

A
  • All pregnant/breastfeeding women and females of childbearing age
  • Increased folic acid provision - 800 mcg/daily
  • Additional iron
48
Q

calcium/vitamin D

A
  • Risk factors

- RDA Vit D: 600 IU daily (800 IU > 70 yo)

49
Q

Iron and B conplex

A
  • Anemia
  • Dietary restrictions
  • Pregnancy
50
Q

Lipids

A
  • made of glycerol backbone
  • Glycerol looks kind of like glucose
  • When we break this down, glycerol is made into glucose
51
Q

Medical nutrition therapy

A
  • Consider restricting protein intake once they reach about CKD stage 4 (Also consider reducing potassium)
  • Stage 5 CKD is severe
  • Use herbs to make things taste good
  • Failure to thrive – can happen after surgery
  • You want 10 days and no longer because zinc can cause a copper deficiency
  • With vitC, its water soluble and you just pee out the excess
  • With vitA, you can actually cause toxicity
52
Q

total daily energy needs

A 
-25 kcal/kg/d (for weight maintenance)
•	Example 1:  90 yo F @ 45 kg
o	45 kg x 25 kcal/kg/d = 1125 kcal/d
•	Example 2:  22 yo M @ 93 kg
o	93 kg x 25 kcal/kg/d = 2325 kcal/d
53
Q

tube feeding amount

A

-1.0 kcal/mL (Osmolite 1.0)
• Example 1: 1.0 kcal/mL x 1125 kcal/d = 1125 mL/d
• Example 2: 1.0 kcal/mL x 2325 kcal/d = 2325 mL/d

54
Q

tube feed rate

A

-Continuous feeds: infuse over 24 hours
o Example 1: 1125 mL/d ÷ 24 hours/d = 46.875 mL/hr  round it! = 45 vs 50 mL/hr
-Bolus: #meals/day
o Example 2: 2325 mL/d ÷ 3 meals/d = 775 mL/meal

55
Q

complications of enteral nutrition

A
  • Tube related (e.g. blockage, dislodgement)
  • Aspiration
  • Refeeding Syndrome
  • Intolerance
  • Diarrhea
56
Q

Contraindications of enteral nutrition

A
  • Anatomy (e.g. obesity, SBS)
  • Hemodynamic instability
  • Prolonged/Severe Ileus
  • Co-morbid conditions (e.g. ascites, coagulopathies)
57
Q

Parenteral nutrition

A
  • consists of peripheral parenteral nutrition (PPN) and total parenteral nutrition (TPN)
  • Calculating parenteral nutrition: 1. Its complicated  rely on your TPN pharmacist and dietitian, 2. When in doubt, use the “standard” formulation

Medicine 3 (11 decks)

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