question

MNT Definition

answer

Therapeutic approach to treating medical conditions via use of diet devised by a medical doctor or registered dietitian

question

ADIME Acronym

answer

Assessment Diagnosis Intervention Monitoring Evaluation

question

5 Domains of Nutrition Assessment (ABCDN)

answer

Anthropometric measures Biochemical data / medical tests Client history Diet / food related history Nutrition focused physical findings

question

Nutrition Diagnosis definition and domains

answer

Finds nutrition PROBLEM that can be treated alone by dietitian from 3 domains - intake, behaviour, clinical

question

PES Statements

answer

Problem (P) related to etiology (E) as evidenced by signs and symptoms (S).

question

Behavioural-Environmental Domain

answer

Problems that relate to knowledge, attitudes/beliefs, environment, food access or food safety

question

Nutrition Intervention

answer

Actions to positively change a behaviour, environmental condition, or nutritional health status (work w/other health professionals) Direct interventions to etiology

question

4 Domains of Intervention

answer

Food & nutrient delivery Nutrition education Nutrition counselling Co-ordination of nutrition care

question

Four domains of monitoring and evaluation

answer

- Anthropometric measurements - Biochemical Data - Diet related history - Nutrition focused physical findings

question

Search Terms - PICO

answer

Participants (patient* or inpatient* or hospital*) AND adults Intervention/control: (feed* or meal* or assistan*) Outcome

question

Primary Deficiency Definition + two examples

answer

e.g Iron deficiency anemia, scurvy Caused by low level of nutrient in diet

question

Secondary Deficiency Definition

answer

e.g lack of intrinsic factor Factors that can interfere with ingestion, digestion, absorption or utilisation

question

Dietary Assessment Tools - Retrospective

answer

FFQ - measuring dietary patterns 24hr recall Diet history

question

Dietary assessment tools - Prospective

answer

Food records Food surveillance (covert vs. known) Food inventory (plate waste)

question

FFQ

answer

Semi-quantitative at best Most effective for assessing population intakes Recall bias

question

24hr Recall

answer

Recall bias Underestimates by 10% Depends on regular eating habits

question

Diet History

answer

Quantitative + qualitative, retrospective Reasonably accurate estimates Portion size difficult Recall bias

question

Australian Dietary guideline 1

answer

To achieve + maintain healthy wt, be active and choose of nutritious food to meet energy needs.

question

Australian Dietary guideline 2

answer

Enjoy wide variety of nutritious foods from five food groups every day + drink lots of water

question

Australian Dietary guideline 3

answer

Limit intake of foods containing saturated fat, added salt, added sugars and alcohol

question

Australian Dietary guideline 4

answer

Encourage, promote, support breastfeeding

question

Australian Dietary guideline 5

answer

Care for your food - prepare and store safely

question

EAR

answer

daily nutrient level estimated to meet requirements of 50% of healthy individuals

question

RDI

answer

EAR+2SD avg. daily intake to meet nutrient requirements of almost all healthy individuals Don't use to assess groups

question

AI

answer

Used when RDI can't be calculated. Avg. daily nutrient level based on observed/experimental estimates or estimates of a group of apparently healthy people that are assumed to be adequate

question

Anthropometry Limitations

answer

Insensitive, unable to distinguish btwn disturbances from nutrient deficiencies or from imbalances in protein and energy

question

Measurements for adults

answer

weight, height, BMI, WC, HC, WHR, MUAC, TSK

question

Measurements for children

answer

weight, height, head circumference, HC for age, ht for age, wt of rage, wt for ht

question

Measurements for sport

answer

sum of 7 skin folds, DXA, BIA

question

Measurements for research

answer

DXA, BIA, Air displacement plethysmography

question

How to interpret BMI

answer

Severely underweight <16kg/m² Moderately underweight 16 16.99kg/m² Mildly underweight 17‐18.49kg/m² Healthy weight 18.5‐25kg/m² Overweight 25‐30kg/m² Obese class I 30 - 35kg/m² Obese class II 35 - 40kg/m² Obese class III ≥40kg/m²

question

BMI Doesn't reflect

answer

Distribution of body fat, Muscle Mass, Age, Family History, Gender, Ethnicity, Lost Height due to aging

question

BMI unsuitable for

answer

Pregnant / lactating women, <18 years, ht 190cm, extreme obesity, eating disorders

question

Wait Circumference Interpretation

answer

Men: >94cm = At risk > 102cm = High risk Women: >80cm = At risk > 88cm = High risk

question

Waist Hip Circumference Ratio

answer

Distinguishes between fatness in the lower trunk and fatness in the upper trunk

question

Waist Hip Ratio Interpretation

answer

Increased risk at Men >1.0 Women >0.85

question

MUAC Average Values

answer

M - 29.3cm F - 28.5cm

question

Tricep Skin-fold Interpretation

answer

Correlates with % of body fat Varies between 6-12mm in lean individuals 40-50mm in obese individuals

question

Tricep Skin-fold Errors

answer

Parallax Error- if the assessor bends down to read caliper Intra-examiner- due to inexperience, skinfold site, difficulty in determining subcut fat from muscle in the subject

question

Interpreting Child Growth Measurements

answer

Use reference data, previous measurements of same child, CDC / WHO charts usually used < 32 weeks = low birthweight chart 32-37 week plotted in 'pre-term chart' until 2 weeks after estimated due date

question

Reason Child is >95th Percentile for Weight

answer

Tallness/Tall parents, Obesity, Oedema

question

Reason Child is >95th Percentile for Height

answer

Tallness/Tall parents, Accelerated maturation, Marfan syndrome

question

Reason Child is >95th Percentile for Weight vs Height

answer

Obesity, oedema, achondroplasia, hydrocephaly

question

Achondroplasia characteristics

answer

Genetic disorder Affects bone growth Arms / legs v. short but normal torso

question

Reason child <5th percentile in BMI

answer

dehydration, recent malnutrition, Marfan's

question

Energy intake definition

answer

Energy of food calculated by adding the protein, fat, CHO and fibre.

question

1g protein

answer

17kJ

question

1g fat

answer

37kJ

question

1g CHO

answer

16kJ

question

1g fibre

answer

8kJ

question

1g alcohol

answer

29kJ

question

Predictive Equations of Energy

answer

Harris Benedict - age / ht / wt Schofield - age wt

question

Adjusted Body Weight Calculation

answer

[0.25 x (actual wt - weight @ BMI 25)] + weight @ BMI 25

question

Energy Requirements for Sedentary + non-hypermetabolic

answer

100-125 kJ/kg

question

Energy Requirements for Wt. Gain / mildly hypermetabolic

answer

125-145kJ/kg

question

Energy Requirements for severely hypermetabolic

answer

145-165kJ/kg

question

Protein Requirements Depending on Stress Levels

answer

Normal: 0.8 - 1.0 g/kg Minor stress: 1.0 - 1.2 Moderate stress/ dialysis: 1.2- 1.5 Severe stress/ major trauma/ burns: 1.5 - 2.0

question

What does personal history include?

answer

General client info → age, gender, race, education, role in family

question

What does medical history include?

answer

History of client, family history Should focus on things that have nutritional impact

question

What does social history include?

answer

SES, living situation, community involvement

question

Nausea / vomiting due to

answer

Antivirals, antifungals, antibacterials, penicillin, sulphamethoxazole, analgesics, narcotic analgesics

question

Anti-emetics

answer

Granisetron, Tropisetron (for chemo / anaesthesia), Emetrol (for nausea / motion sickness), Maxalon / Dramamine ( gastroparesis), Domperidone (for gastroparesis), Metocloprimide (For chemo / radiation)

question

Causes of overweight / obesity

answer

genetic, sociodemographic, neurobiological / endocrinological, microbiota

question

Monogenic Obesity

answer

Extremely obese, absence of developmental delays, ↑ appetite, ↓satiety

question

Syndromic obesity

answer

Clinically obese w/ mental retardation, developmental abnormalities

question

Polygenic obesity

answer

General population, exposure to obesogenic environment required

question

Medications Causing Obesity

answer

Hormones: corticosteroids, thyroid stimulating hormones Psychiatric medications: clozapine, lithium, beta adrenergic blockers, sodium valproate, tricyclic antidepressants Diabetic medications: Insulin, amitriptyline

question

Risk Assessment for Obesity

answer

BP, thyroid function, HbA1c, BGL's, lipid profiles, nutrient deficiencies, BMI, WC, fatty liver test

question

Obesity guidelines (1-5)

answer

1. Measure WC 2. Discuss readiness to change 3. Let know that small wt. loss improves health 4. Use multicomponent approaches 5. Refer appropriately 6. Support self- management approach and monitor

question

Gastroplasty

answer

Gastric band reduces size of stomach, can be adjusted, filled with saline

question

Gastric Bypass

answer

Reduces size through stapling procedure, requires lifelong follow-up by MD team, possible deficiencies in K⁺, Mg²⁺, folate, B12, Fe²⁺

question

Orlistat / Xenical

answer

Inhibits GI lipase, ↓ 1/3 fat absorption, - GI side effects e.g feocal urgency, farting

question

Long term weight management

answer

If weight regain - reassess energy intake and PA → reintervene with wt. loss strategies

question

Diarrhoea side effects

answer

Loss of fluid / electrolytes / reduces nutrient absorption

question

Diarrhoea caused by which medications?

answer

Anti-emetics, laxatives, diuretics, phosphate binders (Gaviscon), anti-thrombotic, cholesterol lowering, Metformin

question

Anti-diarrhoea medications and side effects

answer

Immodium, codeine phosphate, lomotil Side effects: GI upset, constipation, dry mouth

question

Constipation caused by which medications?

answer

Codeine, panadeine, tramadol, di-gesic Morphine, oxycontin, oxycodone, endone

question

Laxative medications:

answer

benefibre, metamucil, senokot, sennetabs, senna plus, coloxyl with Senna, lactulose, movicol and agarol

question

Motility Agent Medications and Side-effects

answer

Buscopan / atrobel / setacol Side effects: GI spasms, enuresis, dry mouth, thirst Alvercol / Zelmac Side Effects: IBS, constipation

question

Diuretic Medication as well as treatment and side - effects

answer

Allopurinol for gout, reduces urea Side effects: sore throat / nausea Frusemide for oedema, ht Side effects: constipation, diarrhoea, high uric acid Spironolactone Side effects: cramps, hyperkalemia, hyponatremia

question

Dry Mouth caused by which medications?

answer

Narcotic analgesics, calcium channel blockers, anti-reflux meds, diuretics, antihistamines, decongestants

question

Inflamed gums caused by which medications?

answer

anti epileptics, erythromycin, Zoloft, anti-hypertensive, verapamil

question

Inflamed tongue caused by which medications?

answer

Valium, Zoloft, prozac, Nurofen, Voltaren, Penicillin, anti-epileptics

question

Oral thrush caused by which medications?

answer

inhaled steroids used for asthma, COPD, zyprexa, omeprazole (for GERD)

question

Burning mouth caused by which medications?

answer

ACE inhibitors (captopril), penicillin, prozac, Zoloft, HRT

question

Oral Ulcers caused by which medications?

answer

Bisphosphonates (for osteoporosis), NSAIDs, ACE inhibitors, cytotoxic meds, antipsychotics, tetracycline, erythromycin

question

Altered taste or smell caused by which medications?

answer

ACE inhibitors, Metformin, antibiotics, anti-epileptics, lithium, anti-psychotics, tricyclic antidepressants, antihistamines, decongestants, colchicine, calcium channel blockers, cholesterol ↓ meds, methotrexate

question

Absorption issues are caused by which medications?

answer

Metformin (B12) Proton pump inhibitors (B12, Ca²⁺) Anti-epileptics (Vit D, folic acid) Bile acids / resins (Fe²⁺, folate, Vit A) LT broad spectrum antibiotics (Vit K) Steroids (Ca²⁺) Diuretics (Na⁺, K⁺, Mg²⁺)

question

Anti-reflux agents / antacids and their side effects

answer

Aluminium hydroxide: constipation, diarrhoea, renal stones, Ca²⁺, P malabsorption Calcium carbonate: GI upset, Malabsorption B12, Fe²⁺ Sodium bicarbonate: Excess Na, oedema Losec HP7: dry mouth, confusion, tiredness

question

Blood Tests for Diabetes:

answer

Blood glucose levels Overnight glucose tolerance test (overnight fast) HbA1c (average)

question

For every gram of glucose how much water?

answer

4g

question

Hypoglycemia blood levels

answer

< 3.5mmol/L

question

Hyperglycemia blood levels

answer

>10mmol/L (glucose >12mmol/L will be excreted in urine)

question

Desirable Cholesterol levels

answer

<4.0 mmol/L

question

Desirable LDL levels

answer

< 2.0 mmol/L

question

Most prevalent micronutrient deficiency

answer

Iron deficiency anemia (infants, kids, pregnant women more at risk)

question

Absolute iron deficiency

answer

Stores inadequate to support bone marrow requirements

question

Functional iron deficiency

answer

Stores are adequate but iron can't be released or supplied to marrow fast enough to meet demand

question

Tests for anaemia

answer

Iron studies + full blood count

question

Changes in blood due to iron deficiency

answer

Serum Ferritin ↓ reflects iron stores Serum transferrin ↑ is total iron binding capacity Transferrin Saturation↓ = %iron binding capacity used

question

Iron deficiency stages

answer

Stage 1: Iron stars gone, measured by ↓ serum ferritin Stage 2: Serum transferrin ↑ total iron capacity, transferrin saturation ↓ Stage 3: Hb production ↓

question

Normal Hb levels

answer

M 13-18 g/L F 11-16 g/L

question

Full blood count includes

answer

Hb concentration, Haematocrit, Erythrocyte count, RBC Protoporphyrin, Mean corpuscular volume, Mean corpuscular Hb, Mean corpuscular Hb Conc, Platelet count, Red cell distribution width,

question

Main type of CVD's in Australia

answer

Coronary Heart Disease, Stroke, Heart Failure, Peripheral Vascular Disease

question

Deaths due to CVD in Aus

answer

43,603 in 2013 30% all deaths 1 every 12 mins (although fallen by 8%)

question

Most common form of CVD and outcomes?

answer

Failure of coronary arteries to supply blood to myocardium → angina, MI, stroke

question

Peripheral Vascular Disease and outcomes

answer

Reduced circulation to other body parts (not heart or brain) Stenosed vessels → functional impairment, limb ischemia, ulcers, amputation

question

Chronic / Congestive Heart Failure and outcomes. + mortality rate

answer

Underlying structural abnormality or cardiac dysfunction impairs ability of heart to fill or eject blood → shortness of breath, chronic fatigue, oedema, thickened mitral valve / chordae tendinae 5yr mortality rate 50%

question

Nutrition Therapy in CHF

answer

Maintain healthy weight low salt diet to reduce oedema

question

Stroke definition and outcomes

answer

artery supplying blood to brain suddenly becomes blocked or bleeds → impairment of speaking / thinking / movement

question

Thrombogenesis

answer

Thrombus formed at site of large atheromatous plaque Can totally occlude vessel Can lead to MI, stroke

question

Five Phases of Atherogenesis

answer

Phase 1: No symptoms Small fatty streaks Phase 2: Plaque with high LDL content that enters injured endothelial wall Phase 3: Lesion ruptures and forms non-occlusive thrombus Phase 4: Lesion ruptures and is occlusive Associated with angina, MI, stroke Phase 5: Fibrotic / occlusive lesions

question

Aneurysm Definition and Risk Factors

answer

Result of weakened vessel wall Risk of rupture → internal bleeding Risk factors - obesity, diabetes, HTN, smoking, alcohol, age

question

Metabolic Syndrome Caused by

answer

Any three of: Central obesity, hypertension, high BGL, high TG levels, low HDL

question

Stress

answer

Activates neurohormonal response → ↑HR, ↑BP

question

Cholesterol

answer

Waxy, transported by lipoproteins, produced in liver

question

Hyperlipoproteinaemia

answer

One or more classes of lipoproteins elevated

question

Desirable Triglyceride Values

answer

< 1.5 mmmol/L

question

Diagnosis of hypertension

answer

2 or more blood pressure readings on 2 or more separate occasions

question

CVD Diagnostics

answer

ECG, chest x-ray, ultrasound, coronary angioplasty, plasma enzymes

question

CABG procedure

answer

Blocked arteries bypassed by section of pt's saphenous vein

question

PTCA procedure

answer

Catheter with balloon directed to position of stenosis + gradually inflated

question

Coronary stent procedure

answer

Stent mounted on delivery balloon which is dilated; adapts to artery and remains in place

question

Lifestyle Modifications to Manage Hypertension

answer

Less salt, DASH diet (dietary approaches to stop hypertension), exercise, stop smoking, limit alcohol, have healthy weight

question

DASH diet

answer

fruits, veges, whole-grains, poultry, fish + low-fat dairy foods Replace sat + trans fats with poly / monounsaturated fats Decrease salt <1500mg ↑Fibre

question

How much can dietary intervention decrease LDL by?

answer

12%-16%

question

Every 1mmol/L decrease in total cholesterol reduces risk of coronary event by how much?

answer

20%

question

Top 3 sources of saturated fats

answer

Milk + dairy products (as well as ice cream) Biscuits, cakes, pastries Meat + poultry

question

Sources of trans fats

answer

Margarine, snack foods, packaged baked goods + fried fast food

question

Sources of monounsaturated fats

answer

Avocados, nuts, flaxseed, sunflower seed, olives, tahini, oils from plants or seeds, lean meats, eggs

question

Omega-6 includes which acids and how much to consume?

answer

Linoleic acid (essential) Arachidonic acid (non-essential, pro-inflammatory) 5%-10% total energy intake

question

Omega-3 includes which essential acids?

answer

ALA, EPA, DHA

question

Desirable ratio of N-3 and N-6

answer

< 5:1 is ideal

question

EPA Function

answer

Replaces arachidonic acid in platelets, ↓ thromboxane production → inhibits platelet aggregation → slows growth of atherosclerotic plaques

question

Sources of Omega-6

answer

Sunflower oils, margarines, tahini, flaxseed, nuts

question

Sources of Omega-3

answer

ALA - walnuts, pecans, seed oils EPA + DHA - oily fish Recommended 2-3 fish meals weekly

question

Recommendations to Lower Risk of CHD

answer

2-3 serves of fish (250-500mg n-3), 1g ALA / day

question

Daily serve of nuts

answer

30g

question

Fibre is classed as? Does it lower or increase cholesterol?

answer

pectins, gums, mucilages Lowers cholesterol

question

Salt recommendation

answer

<4g salt/d in hypertension <6g salt/d in general population

question

How much of our body weight is water?

answer

65%

question

Mediterranean diet includes which food groups?

answer

rich in legumes, red wine, fish and fruit Low in meat

question

Homocysteine / folate link with CHD?

answer

High levels = toxic effects on vascular endothelium By-product of folate pathway if deficiency exists

question

Sterols role in CHD?

answer

Found in plants, similar to cholesterol but poorly absorbed ↓ cholesterol by competition 2-3g or 2tsp / day

question

Antioxidant role in CHD?

answer

Prevents lipoprotein oxidation + restores normal endothelial function + protects myocardium from ischaemic damage

3101AHS Medical Nutrition Therapy – Flashcards

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