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Diet Therapy Exam 4

Terms in this set (81)

What is a food desert?
Neighborhoods and communities characterized by limited access to nutritious and affordable foods
What is food insecurity? Why is obesity often associated with food insecurity?
Limited or uncertain access to foods or sufficient quality or quantity to sustain a healthy and active life; inadequate diets lead to poor health
What are strategies for alleviating food insecurity in the US?
WIC, Meals on Wheels, SNAP, food recovery programs (Feeding America), food banks
Define atherosclerosis.
An arterial disease characterized by a buildup of lipids and fibrous scar tissue on the inner walls of arteries
Define angina pectoris.
A condition caused by ischemia in the heart muscle that results in discomfort or dull pain in the chest region
Define myocardial infarction.
Death of heart muscle caused by a sudden obstruction in blood flow to heart muscle, a heart attack
Define transient ischemic attack.
Brief ischemic strokes that cause short-term neurological symptoms
Define ischemic stroke.
Strokes cause by the obstruction of blood flow to brain tissue
Define hemorrhagic stroke.
Strokes caused by bleeding within the brain, which destroys or compresses brain tissue
Define thrombosis.
The formation or presence of a blood clot in blood vessels
Define embolism.
An abnormal particle, such as a blood clot or air bubble, that travels in the blood
In general terms, how does atherosclerosis develop? What are the consequences?
1. Monocytes circulate bloodstream and respond to injury in arterial wall
2. Monocytes slip under blood vessel cells and engulf LDL cholesterol, creating a thin layer of foam cells, "fatty streaks"
3. Fatty streak thickens and forms plaque
List the risk factors for CHD. Which are modifiable? Which are impacted by diet?
Modifiable: high LDL, high VLDL, low HDL, high BP, diabetes, obesity, physical activity, smoking, alcohol consumption, atherogenic diet
Nonmodifiable: age, gender, family history
Know the desirable laboratory levels for CHD: total cholesterol, LDL cholesterol, HDL cholesterol.
What other lab measures are important for CHD risk?
Total: <200
LDL: <100
HDL: >60
VLDL (triglycerides): <150
BP: <120/<80
BMI: 18.5-24.9
What are the dietary recommendations, rationale, food sources to limit/consume for total fat?
Dietary Recommendations: 25-35%
What are the dietary recommendations, rationale, food sources to limit/consume for saturated fat?
Dietary Recommendations: <7% of total kcals, switching to poly/monounsaturated fats
Food Sources: vegetable oil, fat-free products, lean meat
What are the dietary recommendations, rationale, food sources to limit/consume for polyunsaturated or monounsaturated fat?
Dietary Recommendations: use instead of saturated fats
Food Sources: omega-6 fatty acids, omega-3 fatty acids
What are the dietary recommendations, rationale, food sources to limit/consume for trans fats?
Dietary Recommendations: levels as low as possible, reduce hydrogenated oils
Food Sources: baked goods, snack foods, fried foods
What are the dietary recommendations, rationale, food sources to limit/consume for dietary cholesterol?
Dietary Recommendations: <200 mg/d
Food Sources: eggs
What are the dietary recommendations, rationale, food sources to limit/consume for soluble fiber?
Dietary Recommendations: consume to reduce LDL
Food Sources: oats, barley, legumes, fruit
What are the dietary recommendations, rationale, food sources to limit/consume for plant sterols and stanols?
Dietary Recommendations: consume to reduce LDL, added to foods
Food Sources: in margarine, orange juice, dietary supplements
What are the dietary recommendations, rationale, food sources to limit/consume for alcohol?
Dietary Recommendations: light to moderate consumption, one drink a day
Food Sources: beer, wine, liquor
What are lifestyle recommendations to reduce CHD?
Healthy eating habits, regular physical activity, not smoking, maintaining a healthy weight
What is a lipoprotein? What is the role of a chylomicron, VLDL, LDL, and HDL?
Lipoprotein: cluster of lipids associated with proteins that serve as transport vehicles for lipids in the lymph and blood
Chylomicron: transport lipids from the intestinal cells to the rest of the body
VLDL: transport tg from the liver to other tissues
LDL: transport cholesterol in the body
HDL: remove cholesterol from the body by transporting it to the liver for reuse or disposal
What factors affect LDL levels? What factors affect HDL levels?
LDL: dietary factors
HDL: aerobic exercise
What factors contribute to increased triglyceride levels?
Dietary, stagnant lifestyle
Define systolic blood pressure.
Heart muscle contraction
Define diastolic blood pressure.
Heart relaxation
Define hypertension.
High blood pressure
State the 2017 blood pressure classifications.
Normal: <120/<80
Prehypertension: 120-139/80-89
Hypertension: >140/>90
What are the consequences of hypertension?
Heart attack, heart failure, stroke, aneurysm, kidney disease, peripheral artery disease, retinopathy, dementia
What are the risk factors for hypertension? Which are modifiable?
Unmodifiable: race, age, family history, gender
Modifiable: obesity, physical activity, metabolic syndrome, tobacco use, sodium intake, low potassium, alcohol intake, stress, diabetes, sleep apnea
What is the DASH diet? What are key components of DASH?
Diet meant to help lower blood pressure; focuses on whole grain, fruit, vegetables, low fat milk, poultry, fish, nuts, limits processed foods, limits red meat, limits sugars
What is the recommendation for Na? What are some practical tips to decrease Na?
<1500 mg daily; avoid fast food, eat fresh and unprocessed foods, don't salt at the table, check food labels
What are factors contributing to childhood/adolescent obesity?
Growth, physical health, psychological development, diet, physical activity
What is the effect of childhood obesity on growth, physical health, and psychological development?
Growth: begin puberty earlier but stop growing at a shorter height, develop greater bone and muscle mass
Physical Health: early onset atherosclerosis, high levels of all cholesterols, high BP, high risk of Type II diabetes
Psychological Development: may have poor self-images, sense of failure, passive approach to life
What is the goal for weight management for obese children? What are strategies to combat obesity in children?
Improve long-term physical health through permanent changes in lifestyle habits; integrating diet, physical activity, psychological support, and behavioral changes
Why is it so important that adolescents meet their vitamin D and Ca requirements?
Both are essential for bone growth and development
Be able to discuss food consumption habits that are common to adolescents.
Skipping breakfast, snack more often, more soft drinks, not eating at home, influences from peers
How does body composition change with age (older adults)? How can you prevent these age-related changes?
Tend to lose bone and muscle and gain body fat; optimal nutrition with maintaining muscle mass and strength
Be able to discuss age-related changes that affect nutrition: GI, dental, psychological, social,
economic, immune.
GI: slow intestinal motility, diminished appetite, impaired digestion, difficulty swallowing
Dental: tooth loss, gum disease, dry mouth, lesions
Psychological: late-life depression
Social: more likely to suffer from malnutrition from being lonely
Economic: income becomes higher
How does energy need change in the older adult? Why does energy density become more
important?
Declines about 5% per decade; although energy expenditure declines, nutrient needs remain the same, so it's important to consume nutrient-dense foods
Describe how the following nutrients affected by age: water, vitamin B12, vitamin D, iron.
Water: water intake decreases, total body water decreases
Vitamin B12: bacterial overgrowth uses up vit B12
Vitamin D: limited exposure to sunlight, intake increases
Iron: iron intake for women decreases
What are programs or policies discussed in class that are designed to help to improve the nutritional health of older Americans?
Food Bank for Central and NE Missouri, Center for Urban Agriculture, local church food banks
Define diabetes mellitus.
Metabolic disorder characterized by elevated blood glucose concentrations and disordered insulin metabolism
Define prediabetes.
The state of having plasma glucose levels that are higher than normal but not high enough to be diagnosed as diabetes
Define diabetic coma.
A coma that occurs in uncontrolled diabetes
Define retinopathy.
Damage to the retina of the eye caused by abnormal blood flow
Define neuropathy.
Damage to nerves, causing numbness
Define nephropathy.
Kidneys start to incur damage, leading to kidney failure
Define gastroparesis.
Delayed stomach emptying
Compare type I and II diabetes.
Type I: 5-10% of cases, age onset <30 years, little or no insulin produced from pancreas, related to autoimmune disease, insulin injections required
Type II: 90-95% of cases, age onset >40 years, insulin resistance, related to obesity, insulin injections optional
What are the risk factors for type II diabetes?
Age >45 years, obesity, family history, physical inactivity, race, hypertension, low HDL or high TG, gestational diabetes
Describe the 4 lab tests used to diagnose diabetes. What results are indicative of diabetes?
1. Fasting blood glucose (8 hour fast, >126 mg)
2. Random blood glucose (>200 mg)
3. Oral glucose tolerance test (75 g glucose load, >200 mg)
4. Glycated hemoglobin (>6.5%)
What makes HbA1c (glycated hemoglobin) "unique"?
Assists health care providers to evaluate long-term glycemic control, reflects hemoglobin's exposure to glucose over preceding 2-3 months
What are the signs and symptoms of hyperglycemia?
Glucosuria, polydipsia, polyuria, polyphagia, weight loss, fatigue, blurred vision, ketoacidosis, hyperosmolar hyperglycemic syndrome
What are the signs and symptoms of hypoglycemia?
Shakes, sweats, confusion, heart palpitations, weakness, dizziness
Describe the effects of insulin insufficiency. Be able to describe how this affects CHO, protein and lipid metabolism.
Increase in glycogen breakdown, triglyceride breakdown in adipose tissue, protein breakdown, decrease in glucose uptake by cells, triglyceride synthesis in adipose tissue, protein synthesis
What is diabetic ketoacidosis? Who is at risk? What are the causes?
Unrestrained breakdown of the triglycerides in adipose tissue and protein in muscles results in an increased supply of fatty acids and amino acids arriving in the liver, fueling production of ketone bodies and glucose; mostly in those with Type I diabetes
What is hyperosmolar hyperglycemic syndrome? Who is at risk for this?
Severe hyperglycemia and dehydration that develops in the absence of significant ketosis; mostly in those with Type II diabetes
Describe the complications of diabetes.
Damage to heart, brain, periphery, eyes, kidneys, and diabetic neuropathy
Describe key dietary considerations discussed in class. What is the premise of CHO counting?
Increase in carbs, decrease sugars from foods, alcoholic effects (depends on amount of alcohol and food consumed), time of consumption most important
Describe the functions of the kidney.
Filters blood, regulates blood pressure, stimulates RBC production, maintains bone structure
What is acute kidney injury? When can it occur? What is treatment?
Rapid decline of kidney function over a period of hours or days, potentially a cause of acute renal failure; treatment involves drug therapies, dialysis, and nutrition therapy
What is chronic kidney disease (CKD)?
Kidney disease characterized by gradual, irreversible deterioration of the kidneys
What blood tests are used to monitor for those with CKD? In predialysis, are these blood tests usually low, normal, or elevated?
Blood urea nitrogen (BUN) and creatinine, elevated levels
What are the consequences of CKD?
Decreased glomerular filtration rate, cardiovascular complications, anemia, bone disease, growth failure and wasting syndrome, GI disturbances, uremia
Define hemodialysis.
Blood is circulated through a dialyzer where it is bathed by dialysate
Compare diet therapy for predialysis and hemodialysis. Why do they differ?
Water increase during dialysis, protein, phosphorus, sodium, and potassium restrictions predialysis
What is a phosphate binder and why is it used?
Medication used to reduce the absorption of dietary phosphate
What is cancer? In general terms, how does a tumor develop?
Group of diseases characterized by the uncontrolled growth and spread of abnormal cells; genetic mutations in cells begin abnormal division, proliferation of the altered cells result in formation of a tumor, eventually leading to cancer cells being released into the blood stream or lymphatic system
What is metastasis?
The spreading of cancer from one organ or tissue to another through the bloodstream or lymphatic system
Define carcinogen. What nutrition factor has the largest impact on cancer incidence?
A cancer causing substance; alcohol
Identify the three primary medical treatments for cancer.
Surgery, radiation, chemotherapy
Identify factors that can result in anorexia and reduced food intake in cancer patients.
Stress, chronic nausea and vomiting, fatigue, pain, GI obstructions, treatment side effects
What is cancer cachexia? Why does this occur? What is the consequence?
Characterized by anorexia, muscle wasting, weight loss, and fatigue; caused by cytokines and results in poor appetite, altered metabolism, and a tumor itself
What are the goals of nutrition therapy for cancer patients?
Maintain a healthy weight, preserve muscle tissue, prevent or correct nutrient deficiencies, and provide diet that the patient can tolerate
For Missouri, what four cancers are estimated to be the highest new cases?
Lung and bronchus, female breast, prostate, colon and rectum
List the American Institute for Cancer Research (AICR) 10 recommendations for cancer
prevention (Third Expert Report, Diet, Nutrition, Physical Activity and Cancer: A Global Perspective, May 2018).
1. Healthy weight
2. Be physically active
3. Eat a diet rich in whole grains, fruits, vegetables, and beans
4. Limit consumption of fast foods
5. Limit consumption of sugar sweetened drinks
6. Limit consumption of red and processed meats
7. Do not rely on supplements
8. Limit alcohol
9. For mothers, breastfeed if possible
10. After cancer treatment, follow the recommendations
What is the importance of WCRF/AICR's continuous update project?
It is an ongoing program to analyze cancer prevention and survival research related to diet, nutrition, and physical activity from all over the world
Differentiate the role of nutrition in cancer intervention versus cancer prevention.
Intervention: maintaining a healthy weight, preserving muscle tissue
Prevention: eating certain foods to help lower risk of cancer
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