Fruits and vegtables provide…
K
Whole grains provide…
Mg and fiber
Low fat fat free dairy provide…
Ca
Lean meats/ poultry/ fish provide…
Protein and Omega 3
Nuts/ seeds/ legumes…
Mg
Ca is protective from…
CVD
K efffects…
Blood pressure
If someone has high blood pressure they should…
Avoid salt
The DASH diet over sampled what groups
Blacks and women
Is the DASH diet clinically significant in lowering blood pressures?
yes
DASH diet changes what ratio?
Sodium/ potassium
reduces blood pressure due to generous amounts of K and other minerals
DASH diet is high in which food groups?
Grains, fruit/veg, dairy
Which diet has the best effects on cardiovascular risk factors?
Mediterranean
Therapeutic effects of physical activity
-lowers triglycerides, raises HDLs, lowers BP, promotes weight loss, improves insulin sensitivity, stregthens heart
Therapeutic effects of smoking cessation
Why to stop
- promotes vasoconstrition and blood coagualtion
- raises heart rate and BP
- descreases O2 carrying capacity
- damages blood vessels
Therapeutic effects of weight reduction
may improve CHD risk factors
initial goal should be no more than 10% of orginal body weight
High insulin levels are associated with
breast, colon, and prostate cancers
relative risk score related to no impact
1
What hormones or binding globulins are elevated with obesity?
Insulin, IGF1, and oestradiol (total & free)
Fat cells are the main source of…
estrogen
How does obesity increase risk for cancer?
excess weight –> decreased adiponectin; increasedresistin, FFA, TNFa –> insulin resistance (increase in insulin) –> target cells decreasing apoptosis; increase cell proliferation –> tumor development
Increased weight gain of 18-50 lbs after menopause causes…
increased risk of breast cancer
increased BMI in men
increased risk for colon cancer
Obesity is associated with which cancers?
breast, colon, endometrial, esophageal, renal, thryoid, gallbladder, and prostate
Who is at highier risk for gallstone?
Fat
Fertile
Female
How many kcal per gram in protein?
4
Protein contains…
nitrogen
How many common AA
20
Difference between essential and nonessential
nonessential- humans produce
essentail- must get from diet
Which AA are conditionally essential?
Glutamine and arginine
Glutamine
prevents bacterial translocation
Arginine
Enhances Tcell function
RDA protein amount
.8g/kg
Pregnancy protein amount
.8g/kg (pre-preg weight) + 25 gm
Lactation protein amount
.8g/kg (pre-preg weight) + 25 gm
Nephrotic syndrome protein amount
.8g/kg (dry weight)
CRF (cronic renal failure) protein amount
.6g/kg
CAPD (peritoneal dialysis) protein amount
1.5g/kg
Hemodialysis protein amount
1.2g/kg
CAVDH protein amount
1.5-2g/kg (feed for underlying injury)
Trauma/ stress protein amount
1.5-2g/kg
Who benefits from DASH diet?
HTN, black people, women
Can you limit intake of some AA by over supplementing?
yes
Food allergy most derive from foods with…
protien fragments
What is the most common food allergy?
peanuts
Celiac disease
immune response to gluten
most common genetically induced food intolerance
How do you confirm celiacs?
biopsy of proximal small intestine
Dirt theory
kids need to be exposed to dirt, dust, dogs in order to minimize allergies
How much gluten exposure is safe for someone with celiacs?
less than 1/2 tsp of bread
Breast milk v. cows milk
lower protein levels which causes less stress to the infants kidneys
Breast milk
- majority protein is alpha-lactalbumin
- IgA (IgM in colostrum)
- Bactericidial compounds (lactoferrin and lysoenzymes)
- less infections
low albumin levels
shifts fluid levels from blood to interstial space
Nitrogen status positive in…
Kids, injuried, pregnant
Nirtogen stauts negative in…
Starving, stressed
Excess protein gets…
converted to fat
High quality proteins (like eggs) provide…
all essential AA
Complementary proteins
two or more dietary proteins whose AA compliment each other with missing AA (ex. legumes and grains)
Protein deficiency malnutrition
PEM two forms:
Marasmus (chronic; seen in obese older and under 1.5 years)
Kwashiorkor (acute; 18m-2yr; 2nd baby)
death via infection
Refeeding syndrome
K & P abnormalities
Try to feed alot after body used to not having much
acute renal failure usually occurs with…
high blood loss
Prerenal factors of acute renal failure
low blood volume
renal artery disorder
heart disorders
Intrinsic factors of acute renal failure
vascular disorders
obstructions within kidney
renal injury
postrenal factors of acute renal failure
obstruction of ureter or bladder prostate disorders renal vein thrombosis bladder disorders pregnancy
How long does an av fistula take to mature?
2-4 months
only 50% mature
Why make fistulas?
engorges area (visulize easier) increases pressure
How long does it take for an av graft to mature?
about 2 weeks
Access locations for Continous Renal Replacement Therapy (CRRT)
Internal Jugular vein
Femoral vein
subclavin vein
Why is anemia associated with hemodialysis?
Blood going through non-self –> high creactive protein (not makeing epo) –> leads to anemia
What should be restricted with chronic renal failure?
K Mg Phos Na
Anabolism
small molecules to larger molecules
Catabolism
large molecules to small molecules
Metabolism
series of reactions that release energy
water and CO2 released
Function of kidney
Regulation of serum electrolytes and Production of erythropoietin
urea
produced from ammonia in the liver
what lab work indicates acute renal failure?
Elevated BUN, Creatinine, potassium, phosphorus and low urine output
Underlaying cause of acute renal failure
Blood loss and inadequte profusion
Continous ambulatory peritioneal Dialysis
dialysis through peritoneal membrane
Hemodialysis
blood goes through a machine filter from graft or fistula