Medical Nutrition Therapy Exam 3 – Flashcards
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Resting Energy Expenditure
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(REE) 60-75% of energy expenditure; sustains life
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Factors of REE
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lean body mass, age, gender, genetics, body temperature, energy restriction, endocrine system
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Thermic Effect of Food
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(TEF) 10% of EE
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24 hour energy expenditure
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REE + TEF + Physical Activity
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Physical Activity
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23% of EE
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Estimating Equations
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Harris Benedict, WHO, Mifflin-St. jeor, IOM
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Indirect Calorimetry
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used for metabolic research or critically ill; measures inspired & expired air by minute; EE is proportional to to Oxygen consumption
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Hypothalamus
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controls appetite hormones
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Prader-Willis Syndrome
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extreme appetite & massive obesity; 3x normal ghrelin levels
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Adiponectin
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secreted by adipose tissue; signals that body has capacity to store fat
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Leptin
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secreted by adipose tissue; signals that the body has stored enough fat.
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Ghrelin
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produced by stomach; stimulates appetite
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adipocyte
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fat cell (mostly triglyceride). 90% of fat reserves; insulation, fills crevices, cushioning.
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White fat
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WAT; predominant type of fat; stores triglycerides
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Brown Fat
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BAT; a lot of mitochondria; maintains body temperature
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Lipoprotein lipase
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LPL; found on adipose and muscle cell membranes; promotes fat storage; more fat cells=more activity
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LPL Increase
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after weight loss; causes adiposity rebound
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Hormone Sensitive Lipase
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hydrolyzes stored triglycerides within adipocytes for release into circulation for utilization
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Body Composition
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skin fold, hydrodensitometry (underwater), bioelectrical impedance analysis (BIA), Air-displacement plethysmography, dual energy x-ray absorptiometry (DEXA)
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Body Mass Index
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regarded as best & most convenient clinical approach
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Body Fat Distribution
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important predictor of health status; abdominal body fat causes higher risk; lower-body fat= no increase in risk
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Waist cicumference
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>40 in men and >35 in women= increased risk of type 2 DM, hypertension, dyslipidemia, CHD, metabolic syndrome
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Waist-to-hip ratio
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waist (in.)/hip (in.); superiore to BMI in identifying cardiometabolic risk
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Psychosocial consequences of Obesity
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"the age of caloric anxiety"
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Physiological consequences of Obesity
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type 2 diabetes, high blood pressure, lipid abnormalities, hepatobiliary disorders, cancers, reproductive disorders
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Etiology of Obesity
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medical disorders, pharmacological treatments, and smoking cessation. Genetic effects on body weight
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Obesigenic Factors
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physical, social, cultural, & economical evironments; food choices & eating behaviors; disordered eating; sleep patterns; changes in physical activity
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Treatment of Obesity
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two step process= assessment & management. Diet, physical activity, behavioral therapy. Bariatric surgery for some.
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Pharmacologic Treatment of Obesity
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Lipid inhibitors, appetite suppressants.
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Considerations of medication for obesity
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BMI >30 or >27 with risk factors; cost; side effects; rebound weight gain.
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Appetite Suppressents
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promote weight loss by acting on the CNS to decrease appetite and increase satiety.
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Lipase Inhibitor
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blocks action of pancreatic and gastric lipases
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Bariatric Sugery
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BMI >40 or >35 with risk factors; open or laproscopic
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Benefits of Bariatric Surgery
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significant weight loss w/ improvements in obesity-related co-morbidities.
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Risks of Bariatric Surgery
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postoperative complications
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Laparoscopic Adjustable Gastric Band
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LAGB; band at the top of the stomach restricts amount of food that can be consumed
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Laparoscopic Vertical Sleeve Gastrectomy
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LVSG; 85% of stomach surgically removed.
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Roux-en-Y Gastric Bypass
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RYGB; creates a small pouch at the top of the stomach; golden standard of gastric surgery.
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Duodenal Switch with Biliopancreatic Diversion
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DS-BPD; more complicated and more dangerous.
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Complications of Gastric Surgeries
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deficiency of fat soluble vitamins ( A, K, D, E), Vitamin B12, folate, iron, and calcium; calorie and protein malnutrition.
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Nutrition Diagnoses: Obesity
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excessive fat intake; food & nutrition related to knowledge deficit; disordered eating pattern; undesirable food choices; overweight/obesity; involuntary weight gain; physical activity
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Gastric Bypass Diet
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dry meals, no concentrated sweets, start with clear liquid and progress from there.
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Epicardium
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outer layer of heart
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endocardium
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inner layer of heart
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myocardium
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middle layer; muscle
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Electrical Activity of Heart
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Originates at SA node; measured by electrocardiogram (ECG)
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Mean Arterial Pressure
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MPA; determined by cardiac output and total peripheral resistance
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Sympathetic Nervous System
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regulates blood pressure
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Epinephrine
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causes vasoconstriction
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vasopressin
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antidiuretic hormone; causes reabsorption of water by kidneys=increase blood pressure
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Angiotensin II
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stimulates secretion of aldosterone; increases sodium and chloride reabsorption=higher blood pressure.
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Hypertension
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>= 140/90 mmHg; risk factor for many CVDs, kidney disease, causes visual disturbances
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Prevalence of Hypertension
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1 in 3 adult Americans; varies by gender, age, & race/ethnicity.
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Primary Hypertension
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idiopathic hypertension but influenced by lifestyle factors & inflammatory response
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Secondary Hypertension
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hypertension as a result of another chronic condition
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Factors of Hypertension
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smoking, exercise, diet; sodium chloride intake.
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Healthy People 2020 Goal
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achieve blood pressure control
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Treatment of Hypertension
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reduce risk of CD & renal disease; lower BP
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Lower Blood Pressure
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weight reduction, physical activity, nutrition therapy, medications
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Hypertension Medications
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loop diuretics, thiazides, carbonic anhydrase inhibitors, potassium sparing diuretics
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Diuretics
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decrease blood volume by increasing urinary output; inhibits renal sodium & water reabsorption
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ACE inhibitors
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vasodilators that reduce BP by decreasing peripheral vascular resistance; interferes with production of angiotensin II.
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Beta-1-Blockers
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block beta-receptors in heart to decrease heart rate and cardiac output.
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Beta blockers, alpha activity
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block alpha-1 receptor in addition to increase vasodilation
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intrinsic sympathomimetic beta blockers
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possess intrinsic sympathomimetic activity
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alpha adrenergic blockers
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block vascular muscle response to sympathetic stimulation; reduce stroke volume
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calcium channel blockers
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affect movement of calcium; blood volume relaxes
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aldosterone antagonists
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interrupt aldosterone; increases sodium & water excretion
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Angiotensin II receptor blockers
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ARB; interfere with renin-angiotensin system without inhibiting degradation of bradykinin
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Hypertension Diagnosis
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excessive energy intake; excessive or inappropriate intake of fats; excessive sodium intake; inadequate calcium, fiber, potassium, or magnesium intake; overweight/obesity; food and nutrition knowledge deficit; physical inactivity.
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Hypertension Intervention
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DASH: Dietary Approaches to Stop Hypertension
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Hypertension Lifestyle Changes
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weight loss; lower sodium, low alcohol, increased potassium, calcium, and magnesium; physical activity; smoking cessation
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Atherosclerosis
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thickening of blood vessel walls caused by presence of plaque; results in restricted blood flow; associated with: MI, CVA (stroke), PVD, CHD, CHF when CHD or MI occurs.
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AS Pathophysiology
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incompletely understood; endothelial cells, smooth muscle, platelets, & leukocytes;
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Inflammatory Markers of CAD
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Nitric Oxide (NO), C-reactive protein
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Total Cholesterol
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less than 200 mg/dl
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HDL Cholesterol
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40-59 mg/dl
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LDL Cholesterol
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less than 100 mg/dl
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Triglyceride Levels
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less than 150 mg/dl
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AS Treatment
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modification of lipids and major risk factors; medications; percutaneous coronary intervention (PCI); Laser angioplasty; Coronary artery bypass graft (CABG).
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AS Assessment
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TLC standard, MEDIFICTS assessment tool, dietary CAGE questions, REAP
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TLC
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therapeutic lifestyle changes; DASH diet w/ weight loss program
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CAGE questions
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cheese, animal fats, got it away from home, eat high fat commercial products.
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REAP
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rapid eating assessment for patients
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AS Diagnosis
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prioritize nutrition problems; nutrition diagnoses will focus on fat, fiber, weight, food choices, and physical inactivity
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AS Intervention
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Weight loss, physical activity, total dietary fat, saturated fat, trans fatty acids, monounsaturated fat, omega-3 fatty acids linolenic acid.
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Standard of Care AS
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Drug therapy
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AS Nutrition Therapy
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RD; strong evidence; time spent w/ RD; low total cholesterol, low LDL, low dependence on prescription treating CVD.
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Ischemic Heart Disease
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coronary arteries are occluded to the point that blood flow to distal portions is compromised
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Heart Attack
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every 34 seconds; 34% of individuals die in a year.
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IHD Treatment
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restore blood flow through obstructed coronary artery; reduce pain, stabilize cardiac function, reduce the work of the heart, & prevent or limit complications
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IHD Nutrition Therapy
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post Myocardial Infarction; limit oral intake, progress oral diets liquids to soft, eat small frequent meals, TLC dietary recommendations
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Heart Failure
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impairment of the ventricles' capacity to eject blood from the heart or to fill with blood. Underlying cause structural or functional; often end stage of CVD.
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Clinical Manifestations of Heart Failure
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vary depending on the predominance of either left- or right-sided failure; dyspnea, fatigue, weakness, exercise intolerance, poor adaptation to cold; may progress to cardiac cachexia
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Heart Failure Treatment
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Treat underlying cause; control symptoms; prevent further damage; estimated 1/2 are malnourished.
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Heart Failure Assessment
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sodium & fluid intake; problems with early satiety & possible drug-nutrient interactions.
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Heart Failure Intervention
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control symptoms, promotion of nutritional rehabilitation, sodium (2 g), energy & protein, fluid, drug-nutrient interactions
