Ntr 550 Final

Front 1

NTR Care Process - 4 interrelated steps

Back 1

1. Assessment
2. Diagnosis
3. Intervention
4. Monitoring/Evaluation

Front 2

Evolution of RDAs to DRI

Back 2

Replaced by DRIs due to limitations - no recs for older adults, no recs for macronutrients, no guidance for nutrient supplements

Front 3

Purpose of DRIs

Back 3

guidance for average need of a nutrient over a period of time
to maintain health in already healthy people

Front 4

EAR

Back 4

Estimated Average Reqiurement
Meet needs of half of healthy individuals in a group
RDA set requires EAR
2 STD

Front 5

RDA

Back 5

2 STD above EAR
Estimation of avg physiological requirement for an absorbed nutrient + safety factor
Meet known nutrient need of practically all healthy individuals (98%)

Front 6

AI

Back 6

Adequate Intake
Used if no EAR, RDA
Based on intake of healthy population

Front 7

UL

Back 7

Tolerable Upper Intake Level
highest intake level that is likely to pose no risk
>UL--> Risk

Front 8

AMDRs

Back 8

Acceptable Macronutrient Distribution Ranges
Fat: 20-35%
CHO: 45-65%
Pr-:10-35%

Front 9

Exchange Lists: Starch

Back 9

g CHO 15g
g PRO 0-3 g
g Fat 0-1 g
kcals 80

Front 10

Exchange Lists: Fruit

Back 10

g CHO 15 g
g PRO 0
g Fat 0
kcals 60

Front 11

Exchange Lists: Veggie

Back 11

g CHO: 5g
g PRO: 2g
g Fat: 0
kcals: 25

Front 12

Exchange Lists: Dairy

Back 12

g CHO 12
g PRO 8
g Fat 0-3
kcals 100

Front 13

Exchange Lists: Meat

Back 13

g CHO 0
g PRO 7
g Fat 0-3
kcals 45

Front 14

Antrhopometrics

Back 14

Measurement of body size, weight, proportions
Ht, wt, head circumference, body fat, body water, lean body mass
Used to evaluate, monitor, and assess

Front 15

Skinfold Measurements

Back 15

Measures thickness of a double fold of skin + subcutaneous fat
Advantages: non-invasive, closely correlated with underwater weighing

Front 16

Bioelectrical impedance analysis (BIA)

Back 16

Electric current through extremities
measures impedence of electrical current
Cell mass, FF mass, Fat mass, total body H2O -> fat & bone are poor conductors of electricity

Front 17

Hydrodensitometry

Back 17

UWW
validation for body density
% body fat calculated from body density
fat less dense than water
Weaknesses:
Ref equations based on caucasions
All components of FFM are not constant
Must correct for lung volume --> difficult

Front 18

Near Infrared Interactance (NIR)

Back 18

Light absorption + reflection to measure body fat
water, pr-, fat comp
for livestock

Front 19

Dual Energy X-Ray Absorptiometry

Back 19

Measure absorption of photons at 2 energy levels
Water, fat, bone, absorb photons at different rates
Most accurate assessment of body comp.

Front 20

Air displacement

Back 20

Chamber with known volume
Subject body volume = reduction in chamber V

Front 21

EER equation

Back 21

EER= REE x AF x IF

Front 22

What is AF?

Back 22

Thermic Effect of Activity
Energy expended during activity
second largest contributor of energy needs

Front 23

What is IF?

Back 23

Thermic Effect of Disease or Injury
Additional energy expended due to disease or injury

Front 24

IBW

Back 24

Females: 100 lbs first 5 feet + 5 pounds every inch after
Males: 106 lbs first 5 feet + 6 pounds every inch after

Front 25

% IBW

Back 25

current weight / IBW x 100

Front 26

% Usual weight

Back 26

current weight / UBW x 100
*best indicator of NTR status

Front 27

% weight change

Back 27

usual - current / usual x 100

Front 28

Waist to hip ratio

Back 28

index of regional body fat distribution
>0.9 males
>0.8 females

Front 29

Gynoid obesity

Back 29

pear (females)

Front 30

Android obesity

Back 30

Apple (males)
higher risks

Front 31

Two-compartment model

Back 31

Fat mass
all solvent-extractable lipids in adipose tissue and other tissues
FF mass
denser than adipose
include:
skinfold, UWW, bioelectrical impedence

Front 32

Four-compartment model

Back 32

Water, protein, mineral, fat
isotope dilution techniques, air displacement plethysmography

Front 33

Uses of Biochem Measures

Back 33

Detect abnormal NTR status BEFORE clinical signs/symptoms or change in anthropometrics
Objective data

Front 34

Limitations of Biochem Measures

Back 34

Method limitations
Sampling errors
Subject-related
Biological factors
Health related

Front 35

Direct tests (Static)

Back 35

Nutrient or it metabolite

-in blood, urine, tissue, saliva, breast milk, amniotic fluid, hair, nails, mucus, RBC, WBC
Limitations:
homeostatic regulation

Front 36

Indirect tests (Functional)

Back 36

End-product of a process that requires the nutrient for optimal performance
-greater biologic signifigance
-enzyme fxn or its metabolite
blood, urine, tissues, cells
-changes in blood components, abnormal metabollic products, reduction in enzyme activity

Front 37

Stages of Iron Depletion

Back 37

1. Depleted iron stores
-no symptoms
-low serum fettitin
-children&menstruating women
2. Iron Deficiency w/o anemia
-early/mild
-mild symptoms
-Decreased fettitin, transferrin saturation
-Increased erythrocyte protoporphyin, TIBC
3. Iron deficiency anemia
-Decreased: Hgb, serum ferritin, transferrin saturation, serum iron, Hct, MCV, MCH
-Increased TIBC, erythrocyte protoporphyin

Front 38

Biochem markers for dehydration

Back 38

BUN, Na, K, Comprehensive metabolic panel (CMP)

Front 39

Somatic Protein, ways of assessing

Back 39

Skeletal muscle protein
AMA, BIA, CT, MRI, DEXA
Biochem assessment:
Urinary Creatinine excretion
3 methyl histidine

Front 40

Visceral Protein, ways of assessing

Back 40

Organs, viscera of body (liver, kidney, pancreas, heart, etc), RBC, WBC, serum proteins
Serum proteins are synthesized in the liver

Front 41

Which serum proteins are most accurate
Factors affecting serum protein levels other than inadequate intake

Back 41

Albumin - most abundant, good indicator
Prealbumin - sensitive indicator of recent repletion + early stages of malnutrition
IGF-1 responds to repletion/depletion of protein, not calories alone
Factors: liver function

Front 42

Positive nitrogen balance occurs when... and is seen in...

Back 42

intake > loss
anabolism

Front 43

Negative nitrogen balance occurs when... and is seen in...

Back 43

losses>intake
low protein intake
catabolism
excessive protein loss (burns, GI, renal)

Front 44

Acute phase reponse

Back 44

^REE
^muscle catabolism
Inhibit Pr- synthesis & muscle repair
Expansion of extracellular fluid compartment
^ production of positive acute-phase reactants
Anorexia

Front 45

What is anemia?

Back 45

Blood has lower than normal # RBC's or RBC's don't contain enough Hb

Front 46

What is the most common for of anemia?

Back 46

Iron deficiency anemia

Front 47

What are the symptoms of anemia?

Back 47

fatigue, weakness, shortness of breath, difficulty concentrating

Front 48

What are the three main causes of anemia?

Back 48

Blood loss, decreased of faulty RBC production, high rates of RBC destruction

Front 49

Basic Metabolic Panel vs Comprehensive Metabolic Panel

Back 49

BMP --> Ca, Na, K, CO2, Cl, BUN, Creatinine, Glucose
CMP--> Ca, Na, K, CO2, Cl, BUN, creatinine, glucose, ALT, ASP, AST, Bilirubin, Alb, Total Protein

Front 50

What does the comprehensive metabolic panel check for?

Back 50

Check of
1. electrolyte fluid balance
Na, K, Cl, Ca
2. kidney function
BUN, Creatinine
3. liver function
AST, ALT, Alk Phos, Bilirubin, Albumin
4. protein status
Total protein, albumin
5. Acid-base balance
CO2
6. Blood glucose

Front 51

Mechanisms of Deficiency

Back 51

1. Impaired dietary intake
2. Malabsorption
-pernicious anemia, surgery, parasites, drugs
3. Maldigestion
4. Impaired Metabolism
-inborn errors, drugs
5. Nutrient excretion
-wounds, blood loss, diarrhea, alcohol abuse, dialysis
6. Increased requirements
-fever, hyperthyroidism, pregnancy/lactation, trauma/illness, smoking

Front 52

Effects of Drugs on Nutrients

Back 52

-Alter absorption of nutrient

-^ metabolism of nutrient
-^ excretion/loss of nutrient
-metabolic effects - ^ blood lipids or glucose levels

Front 53

Poor Wound Healing

Back 53

Essential Fatty Acid deficiency
Vitamin C
Zinc
Protein

Front 54

Angular Stomatitis

Back 54

B6
Riboflavin
Pyridoxine
Niacin

Front 55

Glossitis

Back 55

Riboflavin
Niacin

Protein

B12

Iron

Pyridoxine

Folate

Front 56

Atrophic Lingual Papillae

Back 56

~slick tongue

riboflavin

niacin

pyridoxine

folate

B12

Front 57

Angular Stomatitis

Back 57

Riboflavin

Pyridoxine

Niacin

Front 58

Edema

Back 58

Thiamin

Protein

Front 59

Petechiae

Back 59

Small bleeds @ hair follicle
Vitamin C

Front 60

Dementia

Back 60

Niacin
Phosphate