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Nutrition > TA review 2 > Flashcards

TA review 2 Flashcards

1
Q

total energy used =

A

BEE + TEF + EEPA

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2
Q

BEE or REE

  • ratio of TEE
  • definition
  • tissue det
  • hormonal det
  • measured how
A
  • energy to maintain physiological homeostasis at rest
  • 2/3 of TEE
  • main tissue determinant is fat free mass
  • main hormonal determinant is thyroid hormone (catecholamines, uncoupling proteins, drugs, disease, fat mass)
  • measured by indirect calorimetry
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3
Q

TEF

  • def
  • percent of TEE
  • proportional to what
A
  • increase in EE above BEE after eating
  • usually 10-15% of intake
  • proportional to dietary intake and macronutrient comp (protein>carbs>fat)
  • may have an effect on weight if you ate only protein
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4
Q

EEPA

  • what
  • sub section
A
  • exercise and post exercise oxygen consumption

- non-exercise activity thermogenesis (NEAT)

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5
Q

high protein dietq

A
  • seems to have a satiation effect (stops you from eating)

- may be fuller longer (satiety)

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6
Q

glycemic index

A
  • may make you feel fuller sooner

- makes BS increase quickly then decrease

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7
Q

hormones that regulate intake in the short term

A

-GLP1 and CCK

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8
Q

short term regulators of intake function to

A

-insure adequacy of substrate for the brain

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9
Q

function of long term regulation of intake

A

-indicators of body fate stores

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10
Q

hormones of long term intake regulation

A
  • leptin and insulin

- act on the hypothalamus and modulate the short term signals

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11
Q

GLP1

  • stimulus
  • action
A
  • stimulated by undigested macros in the ileum
  • released from L cells
  • results in increased insulin secretion (incretin effect), increased satiety, and reduces subsequent food intake (ileal brake or second meal effect)
  • triggered mainly by fiber
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12
Q

CCK

  • secreted wehre and why
  • results in
A
  • secreted in the SI due to protein and fat

- results in satiation and delayed gastric emptying

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13
Q

ghrelin

  • produced where
  • function
  • acts where
  • decreased in
  • increased in
A

produced in stomach

  • stimulates hunger
  • acts in hypothalamus via the vagal afferents
  • circulating levels increase with fasting and decrease with feeding
  • decreased in obese persons and decreases with weight gain
  • increased in underweight, annorexia, and with weight loss
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14
Q

leptin

  • produced where
  • protportional to
  • acts on
  • action
A
  • protein produced in fat cells
  • proportional to fat
  • acts on hypothalamus
  • decreases food intake
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15
Q

endocrine causes of obesity

A
  • these are rare
  • hypothyroidism
  • excess cortisol (cushings, exogenous)
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16
Q

conditions associated with decreased physical activity

A
  • cardiac
  • pulmonary
  • muscoloskeletal problems
  • exercise has some affect but modulatingfood intake is a much better way to lose weight
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17
Q

genetic causes of obesity

A
  • single gene (leptin def, MC4R)
  • syndromic
  • polygenic
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18
Q

obesity and disease

A
  • inflammation
  • adipokines
  • lipid overflow (ectopic fat deposition).
  • tissue hypoxia
  • neural
  • coagulation
  • mechanical (joints)
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19
Q

weight loss percentage that can imrove weight related comorbidities

A
  • 5 to 10%
  • improves glycemic control, reuces BP, improves lipid profile, reduces inflammatory molecules, decreases procoagulant profile
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20
Q

benefits of exercise

A
  • expends enegery
  • increases/maintains FFM
  • promotes maintenance of lost weight
  • reduces risk of cVD and diabetes
  • reduces mortality risk
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21
Q

nutritional prep for pregnancy

A
  • achieve and maintain helathy weight
  • chose and adequate and balanced diet
  • be physically active
  • recieve regular medical care
  • manage chronic conditions
  • avoid harmful influences
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22
Q

what is the most reliable indicator of the infants health

A

-birthweight

23
Q

when is weight gain most critical

A

in the second and third trimester

-brain development occurs in last trimester

24
Q

folate in pregnancy

A
  • anencephaly and spina bifida (neural tube closes 18-26 days post conception, defect arise from failure to close)
  • folate reduces NTD’s
  • consumed in periconceptual period
25
Q

iron during pregnancy

A
  • RDA increases during pregnancy (18 to 27mg)
  • increased needs due to increased blood volume, fetal needs, and loss of blood during delivery
  • body absorbs iron more efficiently during pregnancy
  • during the last trimester the mother iron stores are transferred to the fetus (important because breast milk is low in iron)
26
Q

nutritional risks during pregnancy

A

vitamin or mineral megadoses (vitamin A)

  • excessive caffeine (miscarriage and fetal death)
  • alcohol
  • sugar substitutes
27
Q

vegetarians in pregnancy

A

-meet most of the needs except iron

28
Q

vegans in pregnancy

A
  • may require B12, Fe, Ca, VitC

- B12 def leads to spinal cord damage, psychomotor retardation

29
Q

infant supplementation recommendations

A
  • multivitamin not recommended
  • Vit K IM given at birth for prevention of early vit K def bleeding
  • Vitamin D
  • Iron
30
Q

cause of wasting versus stunting

A
  • wasting is acute and refers to low weight, correlated with mortality
  • stunting is chronic and refers to low height
31
Q

organic FTT

A

-refers to child with an underlying medical condition

32
Q

non-organic FTT

A

-under 5 with no known medical condition

33
Q

general nutrition of childhood

A
  • energy and protein need per kg of body mass decrease
  • variety of vitamins and minerals
  • influenced as to habits and intake
34
Q

adolescent growth spurt

A
  • boys begin at 12-13
  • girls begin at 10-11
  • change in body composition
  • changes in emotional maturity
35
Q

visceral proteins

A
  • albumin or prealbumin
  • made in liver-
  • reflect nutrition in health, not illness
36
Q

acute phase proteins

A

-synthesis and catabolism are influenced by illness

37
Q

caloric restriction

A
  • volitional reduction for longevity

- adequate protein and micronutrient

38
Q

starvation

A
  • absence or near absence of food intake

- unintentional

39
Q

protein energy malnutrition

A
  • prolonged def of energy

- clinical manifestations

40
Q

cachexia

A
  • inflammation induced loss of FFM
  • can be associated with decreased intake
  • secondary PEM (chronic disease)
41
Q

sarcopenia

A
  • loss of muscle mass associated with aging
  • also in part realted to inflammatory process
  • secondary PEM
42
Q

primary vs secondary PEM

A
  • primary is deficit of energy or protein (marasmus or kwarshiorkor)
  • secondary is due to acute or chronic illness
43
Q

examples of secondary PEM

A
  • increased metabolic demans
  • increased nutrient loss (diarrhea)
  • impaired intake
  • impaired absorption
  • impaired utilization (cachexia_
44
Q

decreased energy intake leads to

A
  • reduced energy expenditure
  • increased reliance on fatty acids and ketones
  • decrease use of protein for gluconeogenesis
45
Q

decreased protein intake leads to

A
  • increased amino acid recycling

- reprioritization towards visceral protein sythesis

46
Q

characteristics of kwashiorkor

A
  • edema
  • low albumin
  • flaky pale skin
  • fatty liver
  • frizzled hair with reddish tone
  • insulin promotes this process
47
Q

marasmus characteristics

A
  • muscle wasting
  • fat loss
  • stunting and wasting in children
48
Q

lab assessment of protein energy status

A
  • test for albumin and prealbumin

- no test can assess chronic status if patient is acutely ill due to acute phase response

49
Q

how to evaluate for pre existing malnutrtion

A
  • weight history
  • anthropometrics
  • physical appearance
  • physiology/funcional manifestations
  • immune function
  • Albumin should not be considered in formulation nutritional plans
50
Q

right/acute phase stress

A
  • doing gluconeogenesis constantly
  • NOT adapting
  • breaking down muscle due to increase in hormones
51
Q

benefits of parenteral nutrtion in patients

A

-more calories quicker

52
Q

who benefits from nutrition support?

A
  • pre op patients with moderate to severe PEM
  • in patients with severe alcoholic liver disease
  • patients undergoing bone marrow transplant
  • acute ill patients unable to meet 80% of their needs ad libitum in the next 48 hrs
  • well nourished patients that may not meet 80% of their needs in the next 7-10 days
53
Q

refeeding syndrome (RFS)

A
  • if have not eaten in a while will be low in K and Mg

- if refeed quickly, phosphate will go into cells and cause signalling problems and edema

Nutrition (18 decks)

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