Nutrition Flashcards
(133 cards)
1
Q
Energy intake recommendation for men
A
2500kcal
2
Q
Energy recommendation for women
A
2000kcal
3
Q
Macronutrient example
A
Protein, carbs, total fat, alcohol
4
Q
Protein average intake
A
88g men
64g women
5
Q
What is fibre?
A
Carbs
Non starch polysaccharides, soluble and non soluble
6
Q
Unhealthy fats
A
Saturated
Trans-fats
Increase LDL cholesterol in blood
7
Q
Healthy fats
A
Mono and polyunsaturated (omega 3)
8
Q
High fat
A
> 5g saturates per 100g
9
Q
Low fat
A
<1.5g saturates per 100g
10
Q
Micronutrients
A
Vitamins and minerals essential for survival
11
Q
Vitamin
A
Water soluble = vitamin C
Fat soluble = vitamin D
12
Q
Minerals
A
Minerals and electrolytes = sodium
Trace elements = iron
13
Q
Salt limit
A
6g salt a day
- currently = 8.1g
14
Q
Which macronutrient provides the most energy?
A
Fats = 9kcal
15
Q
Kwashiorkor vs. Marasmus
A
Look at year 2 PBL
16
Q
Main oral diseases
A
Dental caries
Periodontal disease
Oral cancer
Dento-facial trauma
17
Q
Most common oral disease affecting children and young people
A
Tooth decay
18
Q
Dental caries
A
Tooth decay
Due to acids made by bacteria
Fermentable carbs
Low saliva flow and function
19
Q
Protective factors against caries
A
Saliva
Fluoride
Antimicrobials
20
Q
Preventing caries
A
- brushing twice dialy with fluoride toothpaste
- control diet sugars esp at bedtime
- provide procedures = fissure sealants and fluoride varnish
- frequency of dental attendance according to risk
21
Q
Caries in developing countries
A
Decline as fluoride toothpaste
22
Q
Caries in developing
A
Increasing as free sugar consumption and low access to fluoride
23
Q
Caries fundamental shift
A
1970s
fluoride toothpaste after this
24
Q
Sugar tax
A
2018 on soft drinks
Public Health Intervention
24p charge if contain 8g of sugar per 100ml
18p a L if 5-8g of sugar per 100ml
Not pure fruit juices as no added sugar
By manufacturers to HM Revenue and Customs
25
Impacts of Sugar Tax
- manufacturers re-formulating drinks
| - tax contributing to support for sports in schools
26
What does oral health depend on?
Controlling consumption of free sugars, tobacco & alcohol via healthy diet, brushing x2 daily with fluoridated toothpaste
Not smoking
27
WHO recommendation on sugars
2015
| No more than 5% of total energy
28
Opportunistic Pathogens
```
Found in healthy hosts
Reservoir
Take advantage of an opportunity
Commensals = staph, strep
Cannot infect healthy
Do not make people infectious
Do not cause epidemics
```
29
Obligate Pathogens
```
No environmental reservoir
Must cause disease
Transmitted
Infect healthy
Make people infectious
Cause epidemic
```
30
Ebola
fruit bats
31
Syphilis
Bejel
32
Leprosy
TB
33
Skin to skin transmission
MRSA
Chicken pox
Influenza
34
Faecal-oral transmission
Polio
H. pylori
Rotavirus
Cholera
35
Organisms which find a safe haven
TB
H pylori
Varicella
Typhoid fever
36
Cholera outbreak management
- clean water
- food wash in water beware
- dispose faeces safely
37
Mumps Risk Complications
Orchitis >>> Encephalitis
| Unless < age of 10
38
Determinants of case severity
New organism
Age
Nutritional Status
Infecting Dose
39
Examples of removing the means for suicide
- removing CO from domestic gas
- gun laws
- pits under track, doors barring access to track on tubes
- barriers to jumping from tall buildings
- limit size of drug pack
- blister pack format
- substitute safer alternatives
40
Weight change when smoke
Gain 5kg when quit
41
How much does smoking cost the NHS?
£2.7 billion
42
Varenicline
Selective nicotinic receptor partial agonist
| smoking cessation medication
43
Bupropion
Developed as anti-depressant
Antagonist of various neuronal receptors
Mechanism in smoking cessation poorly understood
(smoking cessation medication)
44
Why do most cancers develop in epithelial tissues?
- higher rate of mitosis so higher change of copying error
| - epithelial cells more exposed to environmental factors
45
Male Common Cancers
1) Prostate
2) Lung
3) Bowel
4) Head and Neck
5) Melanoma Skin Cancer
46
Female Common Cancers
1) Breast
2) Lung
3) Bowel
4) Uterus
5) Melanoma Skin Cancer
47
Cancer absolute reduction
- no. of cancer deaths reduced
| - proportion of deaths from cancer gone up as deaths from infections/non malignant gone down
48
What cancers does UV light cause?
Basal carcinoma
Squamous cell carcinoma
Melanoma
49
What cancers does ionising radiation cause?
Myelogenous leukaemia
Breast
Thyroid
Lung
50
ER Positive Cancers
- oestrogen receptors
- examine excised tumour tissue
- 70% breast cancers
- older, postmenopausal women
- better survival
51
Aromatase Inhibitors
Prevent oestrogen formation from fat
Only in post menopausal women
Greater survival than tamoxifen in post menopausal women
52
Tamoxifen
Binds to oestrogen receptors in all tissues
| Reduction in density = reduced breast cancer
53
NHS Began when
1948
54
Obamacare official name
Patient Protection and Affordable Care Act
| PPACA
55
What is government money being spent on?
Mostly pensions
Then health
Then education
Then defence
56
NHS Money Flow
HM Treasury -> Dpt. of Health 107 billion -> NHS England £96 billion -> CCG £64 billion
Dpt of health also to PH spending and centrally managed services
57
What does NHS England pay for?
- GP services
- specialised services
- offender healthcare
- military healthcare
58
What does PH England pay for?
- immunisation
| - screening
59
Specialised services?
- provided in few hospitals
- accessed by small numbers of patients
- catchment population > 1 million
60
CCGs
- membership bodies made up of GP practices in the area they cover
- respond to health needs of local population
- Clinical Commissioning Groups
61
Greatest expenditure according to illness
Mental illness
Then Gastro and GUS
Then circulatory
62
Changes in medical care
- length of stay remained t 5days
- number of beds fallen
- number of admissions rising
63
Screening for which cancers?
Cervical
Breast
Colorectal
64
Lead time bias
Time diagnosis is advanced through early detection without changing date of death
65
Length bias
Apparent increase in survival due to tendency to selectively detect slowly growing cancers at screening examination instead of typical cancers
66
Survival define
Average time from diagnosis to death
| NOT NUMBER OF DEATHS
67
Mortality defne
Measures number of deaths in a given population
| NOT TIME
68
Extreme form of lead time bias or length bias
Overdiagnosis
69
How to avoid selection bias?
Randomise - allocating women to screen and no screen at random
Therefore more health aware aren't the only ones going to get screened
70
When is p value due to chance?
p<0.05
| p>0.06 = maybe
71
Absolute benefit
Number of women needed to screen to prevent one breast cancer death
72
How long is needed to see the full benefit of screening?
20 yrs
73
What should primary analysis of screening be on?
An intention to treat basis
74
Breast Cancer Screening
>50 yrs - 69
2 view mammography every 3 years
1 in 6 have cancer
75
Cervical Cancer Screening
```
25-64 women
detects and removes preinvasive lesions to prevent cancer occurring
cervical smear every 3-5yrs
1 in 5 have lesion
sample for HPV
cytology only for HPV positive
```
76
Colorectal Cancer Screening
```
60-74 yrs
single flexible sigmoidoscopy at age 55
faecal occult blood exam every 2 yrs
1 in 10 have cancer
changing to faecal immunochemical testing so only need 1 stool not 3 separate
increased participation
aim to change for 50-74
```
77
Prostate Cancer Screening
PSA
Reduces deaths but heavy cost and overdiagnosis
Would not matter if treatment was well tolerated
78
Lung Cancer
```
Low dose CT of lungs
Reduces mortality
Majority have low risk as non-smokers
Poor cost-effectiveness
More harm than good?
Need to specify target population = smoking history and occupational exposures
```
79
How many people are affected by dementia?
50 million worldwide
| triple by 2060
80
Features of alzheimers
Amensia
Failure of episodic memory
Posterior cortical atrophy
81
Lewy body dementia
Hallucinations
Fluctuation
Parkinson's
82
Vascular dementia
Step wise deterioration
83
Frontotemporal dementia
Behavioural variant
| Language variant
84
Biomarkers of dementia
Imaging (MRI, PET, amyloid and tau)
| Fluid (spina fluid, raised tau, low Abeta412)
85
Parkinsons
```
Females >
60-70
FH
TBI
Environ
```
86
Parkinsons protective factors
Smoking
Coffee
Alcohol
87
Features of Parkinson's
```
Bradykinesia
Rigidity
Tremor
Hyposomia/Anosmia
Autonomic
Sleep insomnia
Psychiatric
Cognitive
Hypersalivation and speech
```
88
Smallpox eradication
1980 by WHO
89
Live vaccines
Rotavirus
MMR
HPV
Influenza
90
Age of MMR vaccine and why
12-15months
| Passively acquired maternal AB would destroy live vaccine if given earlier
91
Sole purpose of rubella vaccine
Prevent in pregnancy
92
Which HPV causes cervical cancer
16 and 18
93
Which HPV causes genital warts
6 and 11
94
Least effective vaccine
Pneumococcus
| Rotavirus
95
Efficacy of most vaccines
96-100%
96
Length of immunity of influenza vaccine
1yr
97
Length of immunity of pneumococcal vaccine
5years
98
Meningococcus B vaccine adverse reaction
Fever common
| Liquid paracetamol advised for parents prophylactically
99
Adverse reactions to vaccines
MMR - rash
rare = limpness, cyanosis
very rare = anaphylaxis
100
CI to vaccines
Febrile illness not mild
Live = if immunosuppressed child
within 3w of another live vaccine
101
Routine child vaccines stored what temp.
2-8 degrees
102
Pertussis vaccine when
Mother in pregnancy
28 w +
As cases occurring in first few weeks of life before childhood vaccine
103
Which vaccines do you give in pregnancy
Pertussis after 28w
Influenza any stage
NOTHING ELSE
104
Elderly vaccines
Shingles age 70
Influenza annually after 65
Pneumococcal once at 65
105
England Mumps Epidemic
2005
| College students and army recruits
106
When are vaccines bad?
If low uptake
107
Why do vaccines work?
Herd immunity
108
Why do vaccines work?
Herd immunity
109
Largest cause of fetal and infant deaths
Preterm birth complications
110
Most common birth malformations
Ventricular Septal Defect
111
Conditions for teratogenesis
- teratogen contact with developing fetus
| - contact during phase where organ systems forming
112
When does teratogenesis most likely affect normal dev?
Organogenesis (14 days -14 weeks)
113
Examples of teratogens
Rubella
Radiation
Using a sauna = CNS defects
Cocaine = microcephaly, SIDS, prematurity
114
Who detects congenital malformations?
UK FASP = Fetal Anomaly Screening Programme
| Since 2010
115
Dietary folic acid and serum folate relationship
0.1mg folic acid adds extra 1ng/ml to persons serum folate
116
Serum folate and neural tube defect risk relationship
Proportional
| Double serum halves neural tube defect risk
117
Which foods have the highest folate?
Brussel sprouts
Cornflakes
Then spinach
118
Hazards of folic acid
Masking B12 neuropathy
Impaired control of epilepsy
Twins
miscarrigae
119
Cause of Downs
usually 22 pairs of alleles and 1 pair of sex chromosomes = 46 chromosomes
Trisomy 21 so total of 47, extra chromosome 21
During formation of parental germ cell (non-disjunction)
120
Where are Downs cases reported
National Down's Syndrome Cytogenetic Register
121
Causes of Downs
Regular trisomy
Then Robertsonian translocation
Then mosaic
Then multiple chromosome
122
Define intellectual disability
IQ<70
| Caused by Downs most commonly
123
Most common heart defect in Downs
VSD
AVSD
Then patent DA
124
Downs complications
```
Leukaemia
Hypothyroidism > Hyper
Epilepsy
Alzeheimers
GI defects
Heart defects
```
125
Antenatal Screening Examples
- Physical exam of eyes, heart, hips, testes
- Heel prick = sickle cell, hypothyroidism, metabolic diseases, cystic fibrosis
- Audio/hearing loss
- HIV, Hep B, syphilis, rubella
- Downs
- Major Fetal Congenital Malformations
126
Detection Rate
Proportion of affected individuals with screen positive results
127
FPR
False Positive Rate
| Proportion of unaffected individuals with screen positive results
128
Markers for screening in the first trimester
- nuchal translucency high
- free beta hcg high
- PAPPA low (pregnancy associated plasma protein A)
129
Markers for screening in the second trimester
```
AFP low
uE3 low (unconjugated oestriol)
Free beta HCG high
Total HCG high
Inhibin A high
```
130
Risk
No of people who acquired event/no of people at risk at outset
131
Odds
No. of people with event/no. of people without event
132
Why are RCTs not susceptible to reverse causality?
Exposure is allocated as part of study design
| Allocation is random
133
Hierarchy of causality
```
RCT
Mendelian randomisation
Cohort
Case Control
Cross Sectional
```
