Nutrition Final, Ch 7, energy balance – Flashcards

45% in 1960 to 69% in 2011 35% are obese 6.3% are extremely obese Women are more likely to be overweight or obese Hispanic/ African American/ Indians are mire likely to be overweight over whites 1 in 3 kids are either overweight or obese 17% of kids are obese Obesity is the #2 killer after smoking

Intake and expenditure are the same Positive Intake is greater than the expenditure Negative Expenditure is higher than intake Certain situations for positive energy balance Traumatic disease to gain weight Kids need positive energy balance to grow Pregnancy

Assessed using Bomb Calorimeter Chamber that measures energy content Heat released = amount of energy Heat is captured by layer of water which is measured by thermometers Insulation is used to keep the heat in 1kcal = amount of heat required to raise the 1kg of water by 1 degree Celsius

Basal Metabolism Physical Activity Thermic affect of food Non exercise activity thermogenesis or adaptive thermogenesis

Energy expenditure in a fasting state (>12 hours) to keep a resting, awake body alive in a warm quiet environment 60-70% of total expenditure is due to metabolic rate Does not include physical activity or thermic affect of food Resting metabolic state is similar but not the same Not as pure as basal metabolic rate

Body temperature Respiration Organ Function Heart Rate

1. Body surface and higher surface area = higher BMR Gender 2.Men have higher BMR (more muscle mass) 3. Body Temperature 4. Fever = increased BMR 5. Thyroid hormone is involved in all BMR activity Epinephrine and norepinephrine (stress hormone) 6. Can raise BMR rate, enhance synaptic nervous system 7.Caffeine and Tobacco Coffee raises BMR by 10% Cigarettes raise BMR by 10% Both activate synaptic nervous system 8. Lean body mass-Muscles, bones, organs, connective tissue Fat mass has less activity

Makes up 25-40% of total energy expenditure

10%

Meal can have an impact Protein rich = 20-30% increase in thermic effect. CHO rich = 5-10% Fat rich = 0-3% Meal size also has impact Larger the meal the higher the thermic effect

Active Thermogenesis or Non-exercise active thermogenesis (NEAT) NEAT may be expressed in response to Cold ,Overfeeding NEAT expression in response to overfeeding By fidgeting The fidgeting is involuntary Can increase EE by 100-800 kcal/d NEAT expression in response to cold NEAT is induced in response to cold by activation of brown adipose tissue (BAT) Brown adipose tissue has lot of blood vessels and mitochondria [Symbol] when activated it generates a lot more energy to stay warm BAT is found in certain areas like the spine, clavicle and kidneys BAT is found in hibernating animals, newborns It is detected by a PET scan that measures the uptake of F-fluorodeoxyglucose into the adipose tissue

Direct:Determines energy use by measuring heat released from the body Whole body calorimetry A layer of water around the room captures heat and measures heat expenditure limitations: Very expensive Indirect: Determines energy use by measuring the amount of oxygen used or carbon dioxide produced

1. Metabolic cart 1 liter of oxygen is used to burn 4.85 kcal 2. Room Respirometer Size of bedroom where patient stays for 24 hours Door to room has hatch to open so nothing leaves the room strengths: Very accurate limitations: expensive, you need trained personal 3.3. Doubly Labeled Water Free living conditions Subject consumes stable isotope of water 2H2O - can only be eliminated in water H2^(18)O- can be eliminated in water and CO2 Collect urine samples after 2 weeks The H isotope will be eliminated in water only The O isotope will be eliminated as both water and CO2 Mass Spectrometer used for measuring

-Height/weight standards A. Weight ranges by gender, height, and frame size associated with greatest longevity. 1. Listening to the body's hunger cures, regularly eating a healthy diet, and remaining physically active helps one maintain an appropriate height/weight value. B. Limitations 1. After weight is lost when dieting, people often regain their original weight plus more. 2. Weight has to be considered in terms of health, not a mathematical calculation. -Body mass index A. Preferred weight-for-height standard because it is the clinical measurement most closely related to body fat content. B. Body mass index is calculated => Body weight (in kg) / height '2 (inches). C. Body mass index alternative calculation => weight (pounds) X 703 / height '2 (inches). D. The concept of body mass index is convenient to use because the values apply to both men and women. 1. Healthy BMI is 18.5-24.9. 2. Health risks from excess weight may begin when the BMI is 35 or more E. Limitations 1. The BMI standards are markers for overweight not over-fat a. Many men have a BMI greater than 25 because of excess muscle. b. The BMI does not take into account the weight measured from fat vs muscle. 2. Short adults may have high BMIs that may not reflect overweight from fatness. -Pounds per inch shortcuts A. Women 1. Start with 100 lb., and then add 5 lb. for each inch of height above 5 ft. 2. 5 ft. 6 in. woman: 100 + 30 = 130 lb. B. Men 1. Start with 106 lb., and then add 6 lb. for each inch in height above 5 ft.

BMI - body weight/ height^2 (kg/m^2) Underweight or equal to 30 Severe or morbid or extreme obesity > or equal to 40

1. A muscular person can be miss classified 2. Asians have a lower BMI scale because many health risks begin at a lower BMI compared to Americans

1. Men Obese - greater than or equal to 25% Desirable - 8-24% 2. Women Obese - greater than or equal to 35% Desirable - 21-34&

1. Underwater weight Pretty accurate Principle Fat is less dense than lean body mass Volume = (wt in air - wt in water/ density of water) - residual lung volume Body density = wt in air/ volume % Body fat = (495/body density)-450 2. Air Displacement Measure volume of air the patient displaces in a pod Measuring changes in atmospheric pressure 3. Skinfold Thickness Calipers are used to measure the layer of fat directly under the skin Can be done at various sites of the body % body fat is calculated from body density using age, sex and race specific equations Limitations - often inaccurate 4. Bioelectrical Impedance Procedure: Patient lying down Attach electrodes Measure resistance of electric current in body More fat - more resistant to electric current Water in body mass would transfer current Limitations: Too much coffee or alcohol causes dehydration, and affects water levels Exercise will also affect water levels

1.abdominal obesity 2. it is linked to heart disease, HTN, type 2 diabetes and metabolic syndrome 3. causes-Excess energy intake, inactivity, high testosterone, The increase in free fatty acids from intraabdominal fat adipocytes sent via the portal can enter the liver and skeletal muscles which then cause an increase in insulin resistance causing hyperinsulinemia leading to T2D and HTN 4.Central obesity, is the most dangerous because of insulin resistance-muscles don't do the signal, cells are not sensitive to insulin, glucose does not get taken up, so the pancreas tries to compensate, death of beta cells, leads to type 2 diabetes 5.o Bllod is more likely to clot because obese people make more fibrogen

Men > 40 Women > 35 Asians > 32.5 in men and women

1. gynoid obesity 2. causes-Excess energy intake, inactivity, progesterone and estrogen After menopause, blood estrogen falls, increasing upper body fat

1.Visceral -Fat around the organs, 10-15% total fat is visceral fat, Associated with health risks 2. Subcutaneous fat- Under the skin, Not harmful Liposuction can remove Subcutaneous fat not visceral, but blood pressure and blood glucose remain the same

1. type 2 diabetes 2. can lead to increased blood volume and hyperinsulinemia (excess insulin) 3. CVD-Higher LDL cholesterol, higher BP, high TG, type 2 diabetes, inflammation in the arteries, lower HDL 4. sleep apnea 5. increased cholesterol-Bile becomes saturated and will crystalize to form gallstones 6. cancers - specifically Estrogen for breast cancer because obesity can lead to increased estrogen production 7. Fatty Liver Disease (90% prevalence in obese people) ceentral obesity leads to Too much fat in the liver Serious insulin resistance You can tell by feeling the liver 8. Short Stature (early onset of puberty) Obese girls might start menstruation at an earlier age Once menstruation starts, girls will only grow for another year 9. problems with gait 10. gestational diabetes

1. Nature- Study 1-Genetic predisposition Parent- children studies No obese parent - 10% risk One obese parent - 40% risk Two obese parents - 80% risk Identical twins raised apart studies In Sweden a pair of identical twins were separated and raised in separate house holds but had the same growth patterns Non biological siblings raised together had results of different growth Metabolic study Study 2-Metabolic study Formally obese women and naturally lean women were matched in groups based on height and weight Study found that energy expenditure was significantly lower in formally obese women Naturally lean women had higher energy expenditure in everything 2. Nurture-Gene predisposition cannot explain steep rise in obesity Environment has caused the change Husband and wife, pets, low SES all influence each other Increase in portion size, and energy dense foods

-We have preset weight and our body fights to maintain that weight -Weight gain causes the body to work harder -Weight loss causes the body to fight less to loose weight -To loose weight- increase hunger hormones because when we and reduce fidgeting activity Study was done in the 1960's to prisoners Overfed the prisoners to gain weight Some had a predisposition to gain more weight

1.When you lose weight, decrease in thyroid hormone levels-this decreases your metabolic rate 2.When you lose weight, your fatty acids store them as triglycerides, are not releasing a lot of fatty acids into the blood 3.decrease leptin levels- level of satiety decreases-made by adipocytes Leptin shots do not help lose weight, when they lose weight, give them leptin shots-maintain weight loss 4. you have increased ghlerin levels so your level of hunger increases

you are leptin resistance, when you lose weight you become more leptin resistance

three components 1. Control of energy intake-No less than 1200kcal for women No less than 1500kcal for men Control portion size (people are unable to guess correct portion sized when shown to them) Low energy density but high volume foods High fiber and high volume will distend stomach to being full on less calories Read food labels 2. Regular physical activity-it is difficult to just lose weight through exercise, o Lifestyle related activity • What things can you do at home? Take your dog for a wal Do resistance training at least twice a week • Because you lean mass burns more calories • Helps with bone health 3. Behavioral strategies a. chain breaking-breaking link between eating and behavior that encourages eating b. stimulus control c. cognititve restructuring-change frame of mind regarding eating, deal with difficult day with not eating d. altering the environment e. contigency management-prepare for high risk situations f. self monitoring g. relapse prevention h. social support

1.As weight is lost, the calorie cost of weight- bearing activity decreases, so that an activity that burned 100kcal before weight loss may only burn 80kcal after weight loss 2.When calorie intake is reduced, the blood concentration of thyroid falls, which slows basal metabolism 3.With weight loss, the body becomes more efficient at storing fat by increasing the activity of enzyme - lipoprotein lipase, which takes fat into cells More fat will be stored in cells

1. energy intake A. Limit calorie intake => No more than 1200 kcal for women B. Limit calorie intake => No more than 1500 kcal for men C. Control portion size D. Want to consume low energy density but high volume of food. E. The lower fat, high-fiber approaches have been most successful in long-term studies. F. When shopping, you should read food labels for nutrient content. 1. Important because some foods are more energy dense than they appear (sweeteners and sugars added). G. Limit liquid calories H. Should consume 3 or more meals a day.

A. Important for those who want to lose and maintain a lower body weight. 1. Complements reduction in calorie intake for weight loss. 2. Expending only 100 to 300 extra kcal a day above and beyond normal activity, while controlling calorie intake, can lead to a steady weight loss. a. Expend 250 kcal extra/d => .5 lb. loss per week. B. Hard to lose weight with just exercise. C. PA is crucial for weight loss maintenance 1. Recommended: 150 min of moderate workouts 2. Recommended: 75 min of vigorous exercise D. Resistant training while losing weight 1. Best way to improve body composition 2. Minimizes loss of muscle mass 3. Body composition and metabolic rate benefit. a. Train => lose weight => metabolic rate stays up.

1. Weight maintenance 2. strategies 3. Regular exercise 4. Self monitoring 5. Problem solving 6. Social support 7. Self efficacy

1. VLDC-very low calorie diet low CHO--> ketosis-->suppressed appetite 2. it is usually 400-800 kcal.day 3. expect 3-4 lbs lost per week 4. cannot be on for more than 6 months

1. pharmocontherapy-anti suppressants, suppress epinephrine or norepinepherine -you can only do for 6 months because it will raise blood pressure because it suppresses your sympathic nervous system 2. orlistat -inhibits action of fat being absoprted -causes oily discharge etc. because undigested fat goes to large intestine -it prevents absorption of fat soluble molecules, if fat is not being digested, there will be a decrease in chylomicron production because of less fat so the fat soluble vitamins are not carried by chlyomicrons -should take orlistat along with meals

1. have a BMI of 30 or above 2. BMI of 27 or higher and two or more risk factors 3. must be a part of comprehensive weight loss program

1.BMI of 30 or higher 2. BMI of 27-29.9 with weight related health conditions like type 2 diabetes, cardiovascular disease, etc.

1. malabsorptive 2. restrictive 3. hormonal changes -decreases gherkin (feel less hungry) -increase PYY (feel less hungry) -increase GLP -increase oxytomadmlin

1. dumping syndrome-because when you eat sugar, it draws water and leads to diarrhea, it causes patients to stop eating things with sugar 2. nutriitional deficiencies 3. little acid is made which is needed to absorb calcium and micronutrients

have the patients take supplements

1. put a band around your stomach and use saline to tighten it, restrictive in nature

• 1. Stomachs can stretch, so you will eat more food • 2. Liquid calories-can go through stomach faster • 3. Increased ghrelin levels for banding people • when they lose weight, health is improved a ton, if they gain some weight back will lose some of the benefits

o Remove 80% of the stomach o Restrictive in nature, in addition to malabsorption o Ghrelin levels-since ghlerin levels will go down since ghrelin is made in the stomach

-Promotes quick weight loss -Limits food selections and dictates specific rituals -Uses testimonials from famous people -Bills themselves as "cure-all" -Often recommends expensive supplements -No attempts are made at long-term behavior change -Critical of the scientific community

because of low CHO-->ketosis-->suppresses appetite

1. it is hard to sustain 2. high in saturated fat 3. diet lacks fiber 4. not a good diet for diabetics-especially those with kidney disease already-the more protein you consume, the more your kidneys have to work 5.o can lead to gout because red meat→purines→uric acid→gout o mortality 6. fatigue because you have low glycogen stores