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Medicine 3 > Nutrition > Flashcards

Nutrition Flashcards

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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

Study These Flashcards
A

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

24
Q

failure to thrive: pediatrics

Study These Flashcards
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
failure to thrive: eating disorders
- Anorexia Nervosa | - Bulimia (Binge eating, Purging - Emesis, Laxatives, Exercise)
26
celiac disease
- GLUTEN AVOIDANCE | - Gluten = protein found in wheat, rye, barley
27
Pancreatitis
- NPO - Pancreatic rest - IVF vs IV nutrition (parenteral nutrition) - Pancreatic enzymes (Creon), AquADEKs
28
seizures
- CARBOHYDRATE RESTRICTION - Ketogenic diet - Very low carb, high fat, high protein
29
biliary colic
-TEMPORARY FAT LIMITATION
30
cystic fibrosis
- NO RESTRICTIONS - EVER - High calorie - Additional sodium - PERT, AquADEKs
31
bariatric surgery
- 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
diverticulosis
- HIGH FIBER | - Fruits, veggies, grains, legumes
33
diverticulitis
-low fiber
34
GERD
- PORTION CONTROL - Small meals - Limit coffee, tea, chocolate, spicy foods, citrus, fried foods, peppermint, alcohol
35
Lactose intolerance
-AVOID DAIRY
36
Cancer/transplant
- FOOD SAFETY - Low microbial diet - Avoid unpasteurized foods, undercooked meats, raw grains/nuts, - Calorically-dense foods - Filtered water (1 micron or smaller filter)
37
pregnancy
- ENERGY AND MICRONUTRIENTS - Energy: 300 additional calories - Folate: 400-800 mcg qD - Iron: 27 mg qD - Calcium: 1000-1300 mg daily
38
pediatrics nutrtion
 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
breasmilk vs formula
- 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
vitamin D and iron supplementations
- Vit. D supplementation: 400 IU daily | - Iron supplementation: 1 mg/kg until introduction of solids
41
geriatrics
- 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
nutrient deficiencies and effects
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
iron deficiency
- 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
iron toxicity
- Over-supplementation, poisoning (children) - Iron overload - Hemochromatosis
45
protein-energy malnutrition
- Protein Malnutrition = Kwashiorkor - Calorie/Protein Malnutrition = Marasmus - Marasmic Kwashiorkor
46
MVI
- Balanced diet = unnecessary - Consider if poor PO/dietary intake, food restrictions (e.g. vegans), children - Risk vs benefit (Beware of “mega” doses)
47
prenatal vitamins
- All pregnant/breastfeeding women and females of childbearing age - Increased folic acid provision - 800 mcg/daily - Additional iron
48
calcium/vitamin D
- Risk factors | - RDA Vit D: 600 IU daily (800 IU > 70 yo)
49
Iron and B conplex
- Anemia - Dietary restrictions - Pregnancy
50
Lipids
- made of glycerol backbone - Glycerol looks kind of like glucose - When we break this down, glycerol is made into glucose
51
Medical nutrition therapy
- 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
total daily energy needs
``` -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
tube feeding amount
-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
tube feed rate
-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
complications of enteral nutrition
- Tube related (e.g. blockage, dislodgement) - Aspiration - Refeeding Syndrome - Intolerance - Diarrhea
56
Contraindications of enteral nutrition
- Anatomy (e.g. obesity, SBS) - Hemodynamic instability - Prolonged/Severe Ileus - Co-morbid conditions (e.g. ascites, coagulopathies)
57
Parenteral nutrition
- 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

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