NURS 231B Final – Flashcards
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What fraction of Americans are overweight?
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2/3
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The United States has the highest calories available per capita. What is it?
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2673
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What has become the focus of nutrition research and policy?
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Diseases of overconsumption
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What diseases does diet relate to?
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Development of vitamin and mineral deficiencies, compromised growth and impaired mental capability in children, and body's inability to fight off infectious diseases.
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What is the DGA and what does it do?
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Dietary Guideline for Americans: science based guidelines; comes out every five years; promotes good health and reduces the risk for major chronic disease; stresses the consumption on nutrient dense foods, balancing caloric intake and output, and increasing physical activity.
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What is a problematic factor regarding nutrition information?
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It does not necessarily have to be true to be reported to the public.
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What are some facts regarding sources of nutrition information?
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1. Reliable sources meet the standards of proof required by science. 2. Based on multiple studies and arrived at by scientific consensus. 3. Decisions represent the majority opinion of knowledgeable scientists. 4. Nutrition recommendations based on this consensus of scientific opinion.
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What are types of research design?
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Epidemiological, clinical trials, randomized controlled trial (RCT; employs strong methodology), placebo effect
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What is statistical significance?
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Research findings that likely represent true or actual results and not results due to chance.
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What is the only source of nutrition information one can count on?
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Scientific studies
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What is evidence based medicine?
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The conscientious, explicit, and judicious use of the current best evidence in making decisions about health care of individuals.
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Are food preferences pre-determined or learned?
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Learned.
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Which has a greater effect on dietary behaviors: knowledge about how to eat right or value one assigns to eating right?
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Value one assigns to eating right.
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Value GREATER THAN knowledge
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...
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Food habits can and do change
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...
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The smaller and more acceptable the dietary change....
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The longer it lasts.
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What can be affected by diet?
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Behavior and mental performance.
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What kind of foods have been identified in the US?
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Comfort, health, junk, fun, soul, fattening, mood, pig-out.
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Food choices are not driven by need for nutrients or food selection genes.
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...
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Humans are born with mechanisms to help decide when and how much to eat.
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...
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What dictates food preferences?
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Strong symbolic, emotional, and cultural meanings; we choose foods that give us pleasure;
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Food relieves our hunger pains, delights our taste buds, or provides comfort and a sense of security.
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...
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What helps promote change relating to our diet?
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Knowledge, attitude, and values.
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When is change most likely to succeed?
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When the benefits outweigh the disadvantages.
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The value individuals place on diet and health is reflected in the food choices we make.
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...
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What are three characteristics to a successful diet change?
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Make a specific plan, start with small, easy changes, and be prepared for relapses.
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Is alcohol a food, drug, or both?
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Both-- food because it contains carbohydrates (energy) and drug because it modifies body functions and is harmful in high doses.
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What is considered moderate alcohol consumption for men and women?
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Men: 2 drinks/day Women: 1 drink/day
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What are the benefits of moderate alcohol consumption?
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Reduces risk of heart disease, type 2 diabetes, hypertension, stroke, and dementia; increases HDL cholesterol; improves glucose utilization; decreases chronic inflammation; improves cognitive function.
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What is alcoholism?
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Illness characterized by dependence on alcohol and a level of alcohol intake that interferes with health, family, social relationships, and job performance.
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What is alcohol poisoning?
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Life-threatening condition due to excess alcohol consumption; a medical emergency
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What is alcohol poisoning characterized by?
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Mental confusion, vomiting, seizures, slow or irregular breathing, and low body temperature.
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Alcohol depresses nerves that control which involuntary actions?
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Breathing, the heartbeat and the gag reflex that prevents choking.
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What does fetal alcohol syndrome cause in children?
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Long-term mental and growth retardation.
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What is the safe level of alcohol intake during pregnancy?
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None.
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As calories from alcohol increase....
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Quality of the diet decreases.
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Heavy drinkers receive too little of what vitamins?
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Thiamin, vitamin A, vitamin C, calcium, and iron.
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Alcohol is easily and rapidly absorbed where?
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In the stomach and small intestine.
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Due to lag time between intake and utilization of alcohol, what builds up in the body?
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Blood levels of alcohol.
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Do blood alcohol levels increase faster in men or women?
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Women.
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Women experience intoxicating effects of alcohol on lower amounts of alcohol than men require.
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...
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Underage drinking accounts for what percentage of all alcohol consumed in the US?
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20%.
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What is defined as binge drinking?
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Consuming 5 or more drinks in a row for men, 4 or more drinks in a row for women.
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What does not receive the same scrutiny as prescription drugs?
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Dietary supplements.
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What is a dietary supplement?
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Intended to supplement the diet not substitute for healthy foods; contains one or more dietary ingredients or their constituents (vitamins, minerals, herbs/botanicals, amino acids, enzymes); intended to be taken by mouth as pill, capsule, tablet, liquid or powder; is labeled on the front panel as being a dietary supplement.
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What is a new dietary supplement?
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A dietary ingredient that was not sold in the US in a dietary supplement before October 15, 1994.
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What does GRAS stand for?
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Generally recognized as safe.
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What supplement ingredients and food additives are grandfathered into GRAS?
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Ones that have been present in the food supply prior to October 14, 1995.
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Are dietary supplements regulated as a food or drug?
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Food, by FDA.
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What does FDA not currently require regarding dietary supplements?
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Testing for safety, effectiveness, or interaction or approval before supplement is produced and sold.
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FDA can take action if the supplement is either unsafe or mislabeled.
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...
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Manufacturers of dietary supplements are expected to ensure....
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Safety of ingredients, label information is accurate, declared contents matches container contents.
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The FDA banned what weight-loss/stimulant herb? When?
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Ephedra in December 2003.
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No government body monitors contents of herbal supplements.
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...
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New regulations for dietary supplements are being considered by FDA.
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...
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Before purchasing supplements, what should one consider?
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1. Your own dietary intake and personal health status (including any medications you may be taking) 2. Supplement claims and are they valid? 3. How the active ingredient work in the body 4. The amount of ingredient in the supplement 5. Scientific evidence supporting claims 6. How much, how often and for how long it is safe to take this supplement 7. Potential risks/side effects 8. Cost worth benefit
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What is bioavailability?
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The amount of a nutrient consumed that is available for absorption and use by the body.
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Who should take multi-vitamin-mineral supplements?
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Pregnant and lactating women (increased need for some nutrients, of note iron & folate); women with heavy menstrual bleeding (iron, vitamin C); women of childbearing age/premenopausal women (folate, iron, calcium); smokers (B vitamins, vitamin C) Individuals who abuse alcohol (multivitamin-mineral supplement, specifically vitamin B1, folate, B6, C); individuals with restricted or limited diets (multivitamin-mineral supplement); vegetarians (calcium, iron, zinc, vitamin B2 and B12, vitamin D); individuals with limited milk intake and/or sun exposure (calcium, vitamin D); older adults > 70 years of age (calcium, vitamin D, vitamin B6 and B12, zinc); individuals with a health condition that affects nutrient utilization or absorption; individuals with compromised immune function; some infants (vitamin D--breastfed infants, fluoride, iron).
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For vitamin-mineral supplements...
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Don't view as replacements for healthful foods; choose a combination that contains < 100% DV for your age and gender; avoid "mega"-doses or high potency formulas; for economy, consider the generic brand and skip the extra ingredients that add to the cost, but offer no proven nutritional benefits; check the expiration date; take only in recommended doses.
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What is the difference between natural and synthetic supplements?
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Nothing, besides cost-- generally have the same chemical makeup and have no differences in absorption, utilization, or effectiveness.
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What are "high-potentcy" supplements?
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Significantly in excess of the Daily Values for one or more nutrients/ingredients; sometimes in excess of the "UL" (Tolerable Upper Intake Level); no current law prohibits supplement potency, except for potassium; Taking high levels for a prolonged time can be toxic (fat-soluble vitamins-- A and D); can result in nutrient-nutrient imbalances/interactions-- high doses of some nutrients may reduce absorption and utilization of other nutrients.
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Herbs in the field of medicine can be defined as what?
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Crude drugs of vegetable origin utilized for the treatment of disease states or to attain or maintain a condition of improved health.
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In the medicinal sense, herbs are what kind of drugs?
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"diluted"
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Herbal supplements are regulated by FDA as foods and do not undergo the same stringent approval process as drugs. As a result.....
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Many herbs contain toxins in addition to active "useful" components.
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Herbals have active ingredients.
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...
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Knowledge of risks and benefits incomplete.
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...
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Herbs' risk to health depends on:
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Amount and duration of use, age and health status of user, and other factors.
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FDA warns against use of botanicals with which active ingredients?
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Aristolochic acid, chaparral, comfrey, ephedra, lobelia, gerrymander, magnolia-stephania, willow bark, wormwood, yohimbe.
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What are functional foods?
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Foods modified to enhance contribution to health; formulated to improve health, or with high amounts of compounds to prevent disease; no statutory definition of "functional foods"; no specific regulations that apply.
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Examples of functional foods
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Whole foods, enriched foods, fortified foods, enhanced foods
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What are prebiotics?
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Non-digestible carbohydrates broken down by colon bacteria; breakdown products foster good bacteria
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What are probiotics?
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Live, beneficial bacteria found in fermented foods.
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Vegan
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A food plan consisting only of plant foods.
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Lacto-vegetarian
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A food plan consisting of plant foods plus dairy products.
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Lacto-ovo vegetarian
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A food plant consisting of plant foods plus dairy products and eggs.
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Quasi-vegetarian
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Exclude beef, pork, and poultry, include fish, eggs, dairy products, and plant foods.
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"Far"-vegetarian
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Excludes red meat
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Flexitarian (or semi-vegetarian)
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Those who eat a mostly vegetarian diet, but occasionally eat meat.
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Benefits of vegetarianism
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1. Lower intake saturated fat and cholesterol 2. Higher intake dietary fiber 3. Lower Body Mass Index (BMI) 4. Lower blood cholesterol and LDL levels 5. Lower blood pressure 6. Lower risk of obesity, heart disease, stroke, hypertension, type 2 diabetes
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Nutrition considerations for vegetarians
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Protein Iron Zinc Calcium Vitamin D Riboflavin (B2) Vitamin B12 Vitamin A/beta carotene Omega-3 fatty acids Iodine
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Vegetarians who eat fish, dairy, or eggs get important nutrients and complete proteins.
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...
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What are complete proteins?
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Proteins that contain all nine essential amino acids in the amounts needed to support protein tissue construction.
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What are complementary proteins?
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Plant sources of protein that together provide sufficient quantities of the nine essential amino acids.
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What is an example of complementary proteins?
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Beans/legumes combined with a grain source
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Key factors to vegetarians planning healthful diets
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1. Choose a variety of foods including whole grains, vegetables, fruits, legumes, nuts, seeds, and if desired, dairy products and eggs. 2. Choose whole, unrefined foods often and minimize the intake of highly sweetened, fatty and heavily refined foods. 3. Choose a variety of fruits and vegetables. 4. If animals foods such as dairy foods and eggs are used, choose lower-fat varieties and use both eggs and dairy products in moderation 5. Use a regular source of vitamin B12 and, if sunlight exposure is limited, of vitamin D.
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Key components of the Mediterranean diet
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-Eating a generous amount of fruits and vegetables -Consuming healthy fats such as olive oil and canola oil -Eating small portions of nuts -Drinking red wine, in moderation, for some -Consuming very little red meat -Eating fish on a regular basis
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A 50% drop in deaths from heart disease related to:
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-Declines in blood cholesterol levels -Reduced rates of smoking -Improved blood pressure control -Advance in medicine
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What is slowing improvements with cardiovascular disease?
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Rising obesity.
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Risk of heart disease in women increases substantially when?
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After menopause.
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Why does menopause increase risk of heart disease?
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Menopause brings declines of estrogen and HDL and increases in LDL.
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What are some of the gender differences regarding cholesterol?
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Women have higher HDL and total blood cholesterol than men.
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Atherosclerosis or Coronary Heart Disease (CHD)
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-A slow, complex disease that begins in childhood and progresses with age -Theorized to begin with an injury to the endothelium (inner most layer of the artery) -The most common form of cardiovascular disease -Characterized by the accumulation of plaques along the inner walls of the coronary arteries -Plaques may grow large enough to significantly reduce the blood flow through an artery
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How are cholesterol and plaque buildup related?
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Generally, the higher the blood cholesterol level, the more plaque builds up.
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What type of diets raise blood cholesterol?
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Diets high in saturated fat and cholesterol.
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Trans fat raises cholesterol levels more or less than saturated fat?
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More.
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Unmodifiable risk factors for heart disease
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Increasing age (80% mortality in persons 65 years or older); gender (men are at greater risk and at earlier ages); heredity (family history of premature CHD in first degree relatives-- male < 55 years, female <65 years; race)
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Modifiable risk factors for heart disease
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Tobacco smoke (risk of heart attack is more than twice that of nonsmokers), high blood cholesterol, high blood pressure, diabetes mellitus, obesity, physical inactivity.
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Cholesterol
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A fat-like, waxy substance that is present in all animal cell membranes; produced by liver and taken in through animal foods; affected by age, gender, heredity, and diet; carried by lipoprotein carriers in the blood (LDL: Low Density Lipoprotein, HDL: High Density Lipoprotein); risk rises as cholesterol levels increases; clinically defined as > 240 mg/dl; all individuals should be screened; requires diet and/or drug therapy for elevated levels.
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Desirable total blood cholesterol
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< 200 mg/dl
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Borderline high total blood cholesterol
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200-239 mg/dl
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High total blood cholesterol
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> 240 mg/dl
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LDL or "Bad" cholesterol
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Primary carrier for cholesterol in the blood; associated with increased risk for heart disease; elevated levels injure arteries and promote plaque formation/progression of CHD.
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Optimum LDL levels
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< 100 mg/dl
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HDL of "Good" cholesterol
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Transports 25-35% blood cholesterol; associated with reduced risk for heart disease; plays a role in transporting cholesterol away from arterial walls; HDL above 60 considered a "negative" risk factor, actually statistically removing one risk factor total risk factor profile
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Higher HDL cholesterol levels
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Lean individuals, active individuals, moderate alcohol use, nonsmokers, nondiabetics
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Higher HDL levels in women. However, when do these levels fall?
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After menopause.
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High blood pressure
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Defined as blood pressure exceeding 140/90 mm Hg for an extended time; increases the heart's workload.
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Lifestyle modifications for those with high blood pressure
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Weight control, physical activity, moderation in alcohol intake, moderate sodium restriction (< 2300 milligrams per day).
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Even with controlled blood glucose levels, diabetes greatly increases risk.
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...
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Diabetes is often associated with what other risk factors that compound the risk of heart disease?
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Obesity, high blood pressure, and elevated cholesterol.
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Obesity is an independent risk factor for heart disease.
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...
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Risk is significantly associated with
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Weight gain during young adult life or intra-abdominal fat or waist circumference.
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Obesity also increases one's risk for
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Hypertension or high blood pressure, elevated cholesterol or LDL levels, elevated triglyceride levels, diabetes, or stroke.
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Body Mass Index (B.M.I)
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A formula used to assess weight relative to height.
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How much does a sedentary lifestyle affect the risk of heart disease?
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Doubles it.
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Regular physical activity can
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Lower blood pressure, lower heart rate, increase HDL-cholesterol, promote healthier body weight, and improve insulin sensitivity.
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Elevated triglyceride levels are associated with
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Low HDL cholesterol levels and diabetes (elevated blood glucose levels).
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Heart healthy diet and food choices
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Fruit and vegetable consumption, dietary fiber, fish consumption, and soy protein.
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Prevention of heart disease
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Heart healthy diet and food choices, moderate alcohol intake (?), stress management and positive coping skills
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DHA and EPA
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Fatty fish from cold waters are sources of DHA and EPA; omega-3 fatty acids protect against heart disease.
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Wine and Heat Disease Prevention
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Moderate intake is associated with reduced risk; wine and alcohol are nonessential dietary components with significant health hazards; wine drinkers tend to be leaner, exercise more, and drink with meals as compared to beer and spirits drinkers; no clear evidence that wine is more beneficial than other forms of alcohol; wine's risk reduction through its antioxidant properties is an unproved strategy; AHA maintains that alcohol use is an item for consideration between patient and physician.
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Key concepts and facts about cancer
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Cancer has many causes primarily linked to environment and heredity; diet is a factor that influences the development of most types of cancer; diets based on plant foods that include lean meats, fish, and low-fat dairy products, regular physical activity, and normal levels of body fat reduce cancer risk; cancer is largely preventable, but there are no absolute guarantees that an individual will not develop cancer.
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What is cancer?
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A group of conditions that result from the uncontrolled growth of abnormal cells that is the second leading cause of death in the U.S.
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Cancer Phases
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Initiation, promotion, progression.
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Initiation
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Something alters DNA in certain cells.
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Promotion
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Cancer cells with altered DNA divide, producing large numbers of abnormal cells. This phase takes place over 10 to 30 years
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Progression
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Unless corrected by some means, abnormal cells continue to divide, leading to this phase.
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Progression phase
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Body loses control over abnormal cells, numbers increase rapidly; eventually cells become so numerous they erode normal functions of the body in the sites of growth; abnormal cells can migrate to other tissues and cause DNA damage and abnormal cell development.
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What causes cancer?
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80-90% of cancers are initiated by environmental factors that alter DNA; diet is a major environmental factor and may account for 40% of cancer risk; most factors are modifiable.
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What process regarding dietary intake and lifestyle increases the risk of many types of cancer?
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Westernization.
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Genetic factors of cancer
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Some people have tendency toward cancer; they develop cancer if regularly exposed to certain substances in the diet or environment.
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Lifestyle risks of cancer
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Cancer-promoting diets are low in vegetables and fruits; high saturated fat, regular intake of charred and nitrate-cured meats, and excessive alcohol are associated with cancer; low intakes of whole grains, dried beans, nuts, and seeds increase cancer risk; other risk factors include smoking, physical inactivity, and excess body fat.
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Cancer prevention
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Cancer is a largely preventable disease; increasing rates of new cases of cancer took a turn for the better after 1992 and correspond to declines in rates of tobacco use; other improvements in lifestyles and diets will lead to further declines in cancer rates.
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Consumption of tomato products is related to decreased risk of what kind of cancer?
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Prostate
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Green tea reduces the risk of what kind of cancer?
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Breast
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Diets and lifestyles that prevent cancer are represented by characteristics, not hard rules about specific foods, dietary restrictions, or types of physical activities.
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...
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Fruits and vegetables
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People who consume plenty of vegetables and fruits (5 or more servings daily) have a lower risk of developing a number of types of cancer than people who eat few; Cancer continues to decline as intake of fruits and vegetables increases; Some experts advise people to consume 5 to 9 servings daily; It is not clear why fruits and vegetables have this effect.
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What are the antioxidants in fruits and vegetables?
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Vitamin C, beta-carotene, vitamin E, and selenium.
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What biological molecule in vegetables and fruits may participate in cancer prevention by protecting cells from damage due to oxidation and by inhibiting the multiplication of abnormal cells?
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Phytochemicals
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Three servings of what a week reduced the risk of lung, bladder, and prostate cancer?
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3 cruciferous vegetables (broccoli, cabbage, cauliflower, and brussel sprouts).
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Phytochemicals act as antioxidants.
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...
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Phytochemicals participating in cancer prevention are brightly colored. Thus, one should.....
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Select and consume colorful vegetables and fruits.
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Whole grains and cancer
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Whole grains have vitamins, minerals, fiber, unsaturated fatty acids, and phytochemicals that work in cancer prevention; effect on cancer risk is related to the combined action of these substances; isolation of a single substance destroys its ability to function in cancer prevention; Americans are advised to include three or more whole grain products in their daily diet.
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Saturated fat and cancer
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High saturated fats from meats and dairy products increase risk of cancer.
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Dietary patterns and lifestyles to reduce risk of cancer are compatible with dietary recommendations to reduce the risk of what?
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Heart disease.
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Considered together, recommendations for cancer prevention can be transferred to dietary intake by proper selection of foods
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...
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Body fat and cancer
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Central obesity increases the risk of cancer at several sites.
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Improve your odds of not getting cancer by...
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Not smoking or drinking, consuming five or more fruits and vegetables daily, sticking to a low-saturated-fat diet, being physically active, and maintaining a normal level of body fat.
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Simple steps to prevent cancer
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Choose a diet rich in a variety of plant-based foods, eat plenty of vegetables and fruits, maintain a healthy weight and be physically active, drink alcohol only in moderation, if at all, select foods low in fat and salt, prepare and store food safely, and do not use tobacco in any form.
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Overweight and obesity
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Result from an energy imbalance-- this involves eating too many calories and not getting enough physical activity.
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Body weight is the result of...
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Genes, metabolism, behavior, environment, culture, and socioeconomic status.
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Which two areas play the greatest role in causing people to be overweight and obese?
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Behavior and environment; these are the greatest areas for prevention and treatment actions.
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Genetic traits influence a person's susceptibility to becoming obese.
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Inborn errors in metabolism (rare) or predisposing traits triggered by environmental factors.
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Environmental triggers
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Environmental factors such as inactivity, high-fat diet, or high-sodium intake that causes a genetic tendency to be expressed.
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When does weight gain result?
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When more energy is consumed than expended.
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Caloric utilization
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Resting metabolic rate, physical activity (occupational work, household chores, leisure time activity), thermic effect of food.
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Body Mass Index (B.M.I.)
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An indicator of body weight status based on a person's height; calculated as kilograms per meter squared; estimate of body fat content.
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Being overweight or obese gives an increased risk of...
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Hypertension, type 2 diabetes, coronary heart disease, gallbladder disease, certain cancers, elevated cholesterol, low HDL-cholesterol, stroke, osteoarthritis, sleep apnea, and shorter life expectancy.
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What percentage of weight loss reduces the risk of obese people having metabolic abnormalities?
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10-15% weight loss.
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Loss of 5-10% of body weight benefits the overweight and obese
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Lowers blood insulin, triglycerides, glucose, and C-reactive protein, increases insulin sensitivity and HDL cholesterol, reduces risk of heart disease and diabetes, decreased severity of sleep apnea, reduced symptoms of degenerative joint disease, and improved gynecological conditions.
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Waist circumference high risk
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Men >102 cm (40 in.) Women >88 cm (35 in.)
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Strategies for weight loss and management
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Dietary therapy, physical activity, behavior therapy, "combined" therapy, pharmacotherapy, or weight loss surgery.
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What is the most important factor in preventing weight loss regain?
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Increased physical activity.
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Increased physical activity also has...
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Health benefits independent of weight loss.
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Pharmacotherapy
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Drugs approved for long-term use by the FDA may be used as part of a comprehensive weight loss program including diet and physical activity; for patients with a BMI of 30 or above with no concomitant risk factors or diseases or for patients with a BMI of 27 or above for those with concomitant risk factors or diseases (hypertension, dyslipidemia, CHD, type 2 diabetes, sleep apnea).
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Pharmacotherapy drugs should...
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Never be used alone and should be used in combination with diet, exercise, and behavior modification.
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Weigh loss (Bariatric) surgery
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Option for limited number of patients with clinically severe obesity.
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What is the most effective method for weight loss and maintenance?
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Gastric bypass surgery.
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Gastric bypass surgery results in a loss of what percentage of excess fat?
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50-60%. This often leads to a resolution of weight-related health problems.
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Common behavioral strategies for successful weight loss
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Eat a diet low in total fat; frequent self-monitoring of body weight and food intake; high levels of regular physical activity.
