Clinical Nutrition Exam 5 (Week 12)

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reduced HDLless removal of cholesterol from circulation and less inhibition of inflammationHow does smoking cigarettes increase the likelihood of atherosclerosis?- smoke causes endothelial injury - increases inflammation - increases vasoconstriction - increases blood clotting - increases LDL - decreases HDLHow does diabetes increase the risk for atherosclerosis?- increased protein glycation promotes inflammation and ROS - increases vasoconstriction - increases endothelial permeability - increases plaque rupture - increases blood clottingHow does age and sex increases odds of atherosclerosis?Men: - more likely at the age of 45+ - homocysteine elevated in older men Women: - more likely at 55+ - due to decline in estrogen - alter lipoproteins and arterial functionmost common cardiovascular diseasecoronary heart diseasecoronary heart disease (What is it? What are the common symptoms?)- impaired coronary blood flow that leads to ischemic regions in the heart (angina/ heart attack) - symptoms: pain or discomfort in the chest; feeling of heaviness; constriction or squeezing of the chest FOR WOMEN: only shortness of breath, weakness/ fatigue, nausea, vomiting abdominal discomfortangina- symptoms triggered by exertion and subside when restheart attack- more severe pain that lasts longer (than angina) not resolved by rest - occur without exertionRisk factors for coronary heart disease1. total cholesterol over 200 mg/dl 2. LDL <100 mg/dl 3. HDL >60mg/dl 4. triglycerides <150 mg/dl 5. blood pressure <120/80 6. BMI <25what is suggested to decrease the risk of coronary heart disease?- eat healthy - reduce saturated fats - reduce total fat ingestion - eliminated trans fats - ingestion of <200 mg of cholesterol per day ( no real link so why did dave include it??? who knows) - fish and omega 3 FA - soluble fiber and plant sterols - limit alcohol (1/2 drinks) - reduce BP - exercise regularly - don't smoke! - lose weightwhat is hypertriglyceridemia?blood triglycerides above 200 mg/dlWhat people are more likely to have hypertriglyceridemia?- people with diabetes - obese people - metabolic syndrome patients - people who ingest high levels of alcohol and refined carbs (sucrose and fructose)Statins (Lipitor)reduce cholesterol synthesis in the liverEzetimidereduce cholesterol absorptionBile Acid Sequestrants (Cholestrid)reduce lipid absorptionPCSK9 inhibitors (Praluent)increase removal of circulating LDLsfibrates (Lopid)decrease VLDL productionNicotinic aciddecrease VLDL and LDL-c productionaspirinanticoagulantstrokereduced blood flow to the brain____________________ is a warning of a more severe stroketransient ischemic attacks ; brief strokessymptoms of strokeconfusion, slurred speech, paralysis, numbness, difficulty speakingischemic strokeobstruct blood flow due to narrowed vessel or embolismhemorrhagic strokebleeding in the brain; ruptured blood vessel weakened by atherosclerosis or hypertensionhow to prevent strokeavoid hypertension, decrease LDL, no diabetes, exercise, don't be old, don't smokeHow to manage stroke- take medications that prevent clotting (aspirin/antiplatelet or coumadin/anticoag) - consider how deficits will affect the patient's eating/swallowing and plan accordinglyhypertension: ________ arteries, _______ arterial wall and _______ plaque growth.Hypertension: damages arteries, thickens arterial walls, and increases plaque growthWhen patient has high BP for an extended period of time- this __________s the heartweakensequation for blood pressureBP= CO * TPR CO= cardiac output TPR= total peripheral resistancehypertension is influenced by _____________ nervous activity. This increases ___________ volume , _____________ rate , and resistance .sympathetic. 1. blood volume 2. heart rateincreased angiotensin II- increases TPR - increases blood volume (due to increased salt retention>>aldosterone>>and water absorption>>>ADH>>>> **** increases venous return which increases stroke volume which increases cardiac outputvalues to determine if patient is hypertensive> 120/80: prehypertensive > 130/80: stage 1 > 140/90: stage 2suggested diet for hypertensive patients- lose weight - DASH: limit sat fats, sugars, red meats, and cholesterol * decrease sodium * increase K to 3500-5000 mg/day * exercise *moderate alcoholheart failure (what is it? what are the immediate results?)- inability of the heart to pump blood - increase venous volume and edemaleft sided heart failure- pulmonary edema leads to shortness of breath, decreased blood oxygen, respiratory failure - increased fluid in the pulmonary circulation damages the right side tooright sided heart failure (symptoms)- abdominal edema (ascites) - impaired GI function - edema of the legs/feet - often see patients reducing the amount they eat due to bloating/enlarged liver - reduced activity due to fatigue - end stages lead to cachexiacardiac cachexia- severe malnutrition, weight loss, and wasting - due to proinflammatory cytokines, elevated metabolic rate, reduced food and malabsorptionNutrition therapy for those afflicted with heart failure- sodium restriction (1500-3000 mg/day) if on diuretic to reduce edema - Restrict fluid intake to 2 Liters/day - Prone to constipation - adequate fiber - No alcohol as that worsens heart function - Cachexia - liquid supplementation or enteral or parenteral feeding required7th leading cause of death in the USdiabetes________ contributes to the development of cardiovascular disease and kidney failurediabetes_____________ affects more than 12% of adults in the US. And nearly ______ are unaware of the conditiondiabetes; 1/4How does reduced action of insulin affect glucose production?- patient becomes hyperglycemic - decreased glucose uptake by muscle - decreased glycogenolysis and glycogenosis in liver and muscle - increased gluconeogenesis in liverHow does reduced insulin action affect use of lipids?- blood fatty acids, triglycerides, and ketones increase - triglyceride uptake in adipose tissue is decreased - increased lipolysis in adipose tissue - increase ketogenesis and VLDL in the liverHow does reduced insulin affect protein action in body?- increase amino acids in the blood - decrease amino acid uptake in the muscle cells - decrease protein synthesis - increase protein breakdownSymptoms of hyperglycemia- blood glucose above 200 mg/dl results: - glucosuria - polyuria - polydipsiaDiagnosis of hyperglycemia- plasma glucose above 126 mg/dl (8 hours post ingestion) - glycated proteins - hemoglobin > 7% - circulating proteins: preceding 2/3 weeks - oral glucose tolerance testoral glucose tolerance test75 g glucose ingested and follow blood glucose; if hyperglycemic patient will have BGL over 200 mg/dl after 2 hourspatient is considered prediabetic if their BGL is _________ mg/dl100-125 mg/dlType I Diabetes Mellitus- insulin dependent - pancreatic atrophy *** loss of beta-cells 5-10% - often diagnosed before age 20 - hyperglycemia begins once 80-90% of beta cells affected - caused by auto immune response - diagnosis often follows illness (viral infections and inherited factors - rapid onset of classic symptoms and ketoacidosisType II Diabetes Mellitus- non insulin-dependent - tissue loses sensitivity to insulin (insulin resistance) - risk factors: obesity, low activity level, genetics - more common for kids to have Type II as time goes on - hyperglycemia and hyperinsulinemia ** release declines as disease goes on, why patients need insulin injectionsketoacidosis (what tf is it? what are the symptoms? How would ya treat it?)- risk in DM I - inadequate insulin and elevated glucagon - increased fatty acid metabolism generates ketones - symptoms: ketonuria, acetone breath, rapid breathing, polyuria - treatment: insulin to correct blood glucose issue, along with fluid and electrolyte replacementhyperosmolar hyperglycemic nonketotic state- happens in type II diabetes - develops slowly - characterized by: inadequate fluid replacement, infection, medications, non-adherence - polyuria will lead to profound dehydration - treated similarly to ketoacidosishypoglycemia- frequent complication in Type I - happens in poorly managed diabetes, too much insulin relative to glucose ingested - symptoms: sweating, heart palpitations, weakness, dizziness - treatment: glucose ingestion, 15-20g, glucose faster than disaccharideschronic complications of DM- damage to vasculature - macrovascular and microvascular: retinopathy, neuropathy, nephropathymacrovascular damage (DM)- develop atherosclerotic plaques - cause heart attacks, strokes, peripheral vascular disease all of which reduce blood flow - people with Type II have more risk factors: obesity- higher blood lipids, hypertension and increased clottingmicrovascular complications (DM)- capillary damage affects retina, kidney, and nervesretinopathy60-80% lose vision within 15-20 years due to leaky capillaries and new blood vesselsnephropathymicroalbuminuria from leaky capillaries, decrease filtration and urine output consequently - 20-40% develop - more likely to cause failure in those with Type INeuropathy- peripheral or autonomic nerves - if peripheral: lead to foot injuries that are not addressed until they develop into ulcers, can progress to gangrene - if autonomic: bladder, sweating, stomach and rectum, arrythmiaTreatment Goals for those with diabetes- maintain normal glucose levels - healthy lipid profile - control blood pressure - manage weightfasting hyperglycemia (3 types)- early morning overnight fast, inadequate insulin the night before - morning increase in growth hormone, release of glucose from the liver (Dawn phenomenon) - rebound hyperglycemia after undetected hypoglycemia (DM unstable due to excessive insulin- Type II)Type II Diabetes diet (macronutrient suggestions)- low carb diet can help - consistent carb ingestion and smaller meals - carbs affect the glucose level the most after eating - low glycemic index foods - high fiber and less processed - unsaturated fats - if drinking alcohol EATType II Diabetes diet (micronutrient suggestions)- same as healthy people_____________% weight loss improved insulin sensitivity, glycemic control, blood lipid levels, and blood pressure5-10Meal planning suggestions for people with diabetes and problems associated- carb counting - food lists: what IS allowed? - substitution of similar options - problems: not focused on nutrient, less flexible than counting, no advantage in glucose controlInsulin therapy ( type I/II) What are the time frames associated?- can be immediate, long acting or ultralong acting (8-24hrs) - rapid/short acting: prevent post meal glucose spike (2-4 hrs) - Type I: require intensive insulin therapy - Type II: switch to insulin therapy- concern about drug toxicityDrug therapies (Type II)- slow stomach emptying, slow carbohydrate absorption - suppress glucagon, reduce release of glucose from liver - inhibit liver glucose production, release less glucose - improve insulin secretion, release more insulin for a given glucose load - decrease tissue insulin resistance, increase insulin action at tissue - reduce glucose reabsorption by kidneys, lower blood glucose by releasing in urine - insulin: 1-2 doses per day (usually in conjunction with drugs)Pregnancy increases insulin __________.resistanceWhy it is important for the mother to have good glycemic control in her first trimester?- decrease risk of birth defects and fetal deathWhy is it important for the mother to maintain good glycemic control in her 2nd/3rd trimester?reduce the risk for macrosomia and morbidity **macrosomia: large baby due to fetal pancreas releasing considerable insulin ** morbidity: due to respiratory distress and metabolic problems