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99 Cards in this Set
- Front
- Back
Cycle of nutrient deficiency and poor health
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Marginal nutritional status
Increased risk of infections and complications Worsening malnutrition and surgical complications, prolonged recovery from disease Inadequate nutrient intake |
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Resource rich environments and nutrition
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Adequate nutrition
Decreased vulnerability to disease (infectious, etc) Improved recovery from disease Increased Incidence of chronic disease Obesity, diabetes, HTN, heart disease, stroke, some cancers |
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Macronutrients
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Provide energy
Measure in cals/gram Carbohydrate, Fat, Protein |
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Alcohol cal/gram
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7
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Macronutrient consumption linked to diseases
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Carbohydrate - diabetes, heart disease, some cancers
Protein - renal disease, liver disease, kwashiorkor (deficiency) Fat - heart disease, diabetes, gall bladder disease, some cancer |
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Requirement of protein
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12% of calories (50-60 grams)
Adequate amount of essential amino acids Excess is converted to fat |
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Dietary fat requirements
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Essential fatty acids, 2-3% of caloric intake
Fat soluble vitamins <10-12% make diet unpalatable |
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Fat associated with cancer risk
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Polyunsaturated
Vulnerability to free radical damage Theoretical risk |
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Carbohydrate needs
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None are essential
Source of b-vitamins and fiber 50-60% of calories |
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Glycemic index
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Amount of insulin released in response to consumption of food
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High fiber intake lowers risk of
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Coronary heart disease
Cancer Hypertension Diabetes Obesity GI disease |
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Mechanism for fiber role in health
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Normalization of intestinal transit time
binds cholesterol decreases peak serum glucose binds toxin Associations -- inversly related to energy density, high fiber low fat, plant food rich in micronutrients |
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NHANES?
Purpose |
National Health and Nutrition Examination Survey
Representative study of US pop ID at risk populations for interventions Track over time Associations between dietary intake/nutrition status and disease mnm |
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Problems IDed in US Pop data by NHANES
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22-26% of adults consume less than 30% fat
<33% of adults have 5aday in 72 hours, 24% of adults had no fruit and 6% no vegetable 35-40% of adults take a dietary supplement |
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Food insecurity
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Increases risk of chronic disease
Also increased in vulnerable pts (ig HIV) |
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5 Behaviors lower CVD risk in Nurses Health Study
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Non-smoking
BMI <25 1/2 drink alchol/day moderate/vigorus excercise 30 min/day top 40% of cohort for healthy eating (high fiber, high n3 fatty acids, high folate, high polyusaturat/saturated, low trans fatty acids, low glycemic load) 82% reduction in CVF events |
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DASH - dietary approaches to stop hypertension
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Sodium, Potassium, Magnesium, Calcium, Fiber
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Estimated Average Requirement
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Nutrient intake that is estimated to mee the requirement of half of the healy individuals in a group
Used to asses intake adequacy of population groups |
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RDA -- recommended dietary allowance
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EAR + 2 standard deviations (97.5% )
Prevent deficiencies in healthy adults of all ages Only made w/ enough data available |
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AI - adequate intake
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Level felt to meet needs of individuals
Not enough clinical data to establish an RNDA |
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Tolerable Upper Intake Level (UL)
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Maximum level of daily nutrient intake that in unlikely to cause adverse health effects to
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Seven nutrient groups
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1. Calcium, D, phos, magnesium, fluoride
2. B complex, folate 3. Antioxidants (C, E, seleium, carotenoids) 4. Macronutrients 5. Trace elements (iron, zinc) 6. Electrolytes and water 7. Other (eg fiber) |
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New DRIs
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More age groups
0-6mo, 7-12 months, 1-3 yrs, 4-8, 9-13, 14-18, 19-20, 31-50, 51-70, >71 pregnancy lacation |
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Dietary guidelines
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Science based
Promote health, prevent chronic ilnnes Used by federal nutrition programs Legislated ever 5 yrs Healthy weight, adequate nutrients, enough physical activity |
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Dietary guidelines for
Fruit Vegetables Whole grain Milk |
fruit - 2 cups
veg 2.5 whole grain 3+ oz milk 3cups low fat |
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Dietary guidelines limits for
Alcohol Salt |
1 drink/day women
2 drinks/day men less than 2300 mg (1 tsp) sodium |
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Food frequency questionnaire
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Usual intake during a period in the past is reported
Useful for relative intake (ranking of a gorup) rather than absolute quantification |
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Pallor is a clinical sign of deficiencies
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Fe
folate B12 |
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Dermatitis is a clinical sign of deficiencies
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essential fatty acid
zinc niacin |
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Changes in hair distribution and texture are clinical sign of deficiences
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protein
zinc essential fatty acids |
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Riboflavin deficiency
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weakness, soreness, "magenta tongue", angular stomatitis and cheilosis, scaly dermatitis
Norochromic, normocytic anemia Risk factors: jaundiced neonate undergoing phototherapy, alcoholism Usually part of mixed B deficiency |
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Mucositis is a clinical sign of deficiencies in
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Fe
B12 folate Vit C water |
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Wound or pressure ulcers are clinical signs of deficiency
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Protein
Calories Vit C ZInc |
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Carbohydrate intake and B vitamins
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Vit B requirements are in line with amount of CHO consumed
Unprocessed grains are also a source of the B vitamins |
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Niacin
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NAD
Respiratory chain, beta oxidation, kreb cycle dehydrogenation Sources: meat, fish, legumes, peanuts, cereal, coffee and tea Can be synthesized from tryptophan |
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Riboflavin
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FAD
Respiratory chain, b-oxidation, kreb cycle dehydrogenation Food sources: liver, brewer's yeast, milk, eggs, oily fish, many vegetable, grains |
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Thiamin
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TPP
Thiamin pyrophosphate Transketolase |
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Vitamin B6
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Pyridoxal phosphate
Phosphorylase (PLP) |
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Riboflavin (B2) Deficiency
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Weakness
Sore Red tongue (mangenta tongue) Angular stomatitis and cheliosis Scaly dermatitis Normochromic, normocytic anemia Usually as part of a B complex deficiency |
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Pellagra
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Niacin deficiency
Dermatitis - pruritic, on sun-exposed Diarrhea - from mucositis Demetia - demyelinization and degeneration Death - untreated mortality 40-70% Risk factors: diet, malabsorptive disease, alcoholism, Hartnup syndrome, isoniazid or 5fu |
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Scurvy
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Vit C deficiency
Problem w/ hydroxylation of proline and lysine in collagen synthesis, synthesis of nerotransmitters/steriod hormones Symptoms: bleeding in joints/muscles, poor wound healing, corkscrew hairs, gingivitis, perifollicular and splinter hemmorhage Untreated high mortality Risk factors: alcoholism, diet |
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Vitamin A deficiency
Prevalence |
Leading cause of preventable blindness
100 to 140 million kids are deficient 250K-500K become blind/year Almost 50% of those who become blind die w/in year |
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Vitamin A
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Present in retinal cells, impt in cellular differentaition, gene expression, reproductive fnc, embryogenesis, T-cell immune response
Food sources Vit A -- liver, eggs, dairy Precursors (carotenoids) - vegetables and fruits |
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Vit A deficiency
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Symptoms - night blindness, Bitot's spots on conjunctiva, xeropthalma (corneal scarring, follicular hyperkeratosis
Risk factors - diet, prematurity, fat malabsorption syndromes, alcoholism |
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Vitamin D
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Fncs: regulation of calcium and phosphorus metabolism in bone, intestine and kidney, gene transcription, proliferation
Food sources-- fatty fish, cod liver oil, fortified goods, egg yolk Photosynthesis of precurosor D3 in skin |
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Vitamin D deficiency
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Symptoms - bony abnormalities (rickets in children, osteomalacia in adult), muscle weakness, pain
Risk factors - aging, dark skin, limited sun exposure, breast-fed infants, diet, malabsorption syndromes |
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Iodine
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Fnc- component of thyroid hormones
(metabolic rate, HR, temp, mental fnc) Food sources: based on level of iodine in soil, high is seaweed, iodized salt, dairy and processed food in US |
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Iodine deficiency
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Symptoms:
Postnatal- hypothyroidism and goiter Congenital -- mental retardation (formerly called cretinism), blunting of IQ, neonatal infections Risk factors - iodine poor soil excessive consumption of goitrogens |
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Goitrogens
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Impair iodine absorption
Cabbage, legumes, brussels sprouts, cassava |
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Thiamine (B1) deficiency
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Beriberi
Wet - cardiac, CHF, edema Dry- peripheral nerves, wasting Wernick-Korsakoff - cerebral vision changes, ataxia, impaired memory |
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Affect of famine on pregnancy
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Increased miscarriage, prematurity, stillbirth, nenonatal death, malformation, low birth weight
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Anemia in pregnancy increases risk of
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Premature birth
?low birth weight Poor neonatal health outcomes Maternal mortality Closely spaced children can increase anemia in mother |
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Spina bifidia
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Decreasing incidence in the US 2/2 folic acid fortification
Hispanic women and children have increased risk |
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Breast feeding advantags
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Nutritionally appropriate
Immunologic protection decreased infections, allergy Economics Convenience Psycholoigcally satisfying to mother and infant |
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Protein in breast milk
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Whey: casein (70:30)
promotes rapid gastric emptying high biological value protein |
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Fat in breast milk
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Provides 40-50% of cals
Bile salt-stimulated lipase and lipoprotein lipase to breakdown TGs Essential FAs LCFAs -- DHA and arachadonic Cholesterol -- essential for CNS devo |
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Carbohydrate in breast milk
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Lactose - enhance ca absorption
galactose + glucose -- brain energy |
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Immunologic protection of breast milk
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Secretory IgA-- passive immunity to enteromammary system
Lactoferrin - iron-binding protein, reduces Fe-binding sites available for Fe-dependent pathogens Lysozyme Lactobacillus - comensal Leukocytes |
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US breastfeeding prevalence
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75% initiate
40% at 6 months 20% at 1 yr |
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Benefits for Mothers
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Decreased postpartum bleeding, rapid uterine involution
Less menstrual blood loss Delay in ovulation (reduced risk of EOC, premenopausal breast) Improved reminearlizaiton Weight loss |
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Indicators of poor nutritional status in kids
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Head circumference for age <5th >95th
Length/height age <5th Underweight weight for length <5th BMI for age <5th |
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Overweight/obese kid definitions
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Obese weight for length > 95th
or BMI for age Overweight BMI for age 85th to 85th percentile |
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AA Pediatric Guidelines for feeding
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Exclusive breast to 6, continue to 12
Iron fortified infant formula Complementary food 4-6 Whole cows milk 1-2 yrs Low fat dairy after 2 Limit juices |
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Iron deficiency prevalence
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Most prevalent micronutrient deficiency
25% of infants in world 50% of kids in developing countries 10% of US toddlers 9% US adolescent girls |
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Iron deficiency consequences
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Anemia
Lower test scores mental/motor Variable neurologic improvement after treatment, hematologic improvement excellent |
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TV watching and BMI?
and hypercholesterolemia |
Linear relationship for BMI
increase RR for > 2 hrs and >4 hrs TV |
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Elderly special concerns about nutrition
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Decreased lean body mass and energy needs
Oral health Social Functionality (jars arthritis) Chronic disease |
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Prevalence of malnutrition in elderly
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3-11 % in community
17-65% in nursing home 15-40% in hospital |
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Metabolic changes of aging
Vit D |
Need more D
Decreased bone density Decreased calcium absorption Decreased skin D3 synthesis Increased winter PTH production |
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Metabolic changes of aging
Calcium |
Need more Ca
Decreased bone density Decreased calcium absortion |
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Metabolic changes of aging
B6 |
Need more B6
Decreased immune fnc Decreased pyridoxal metabolic efficiency Increased homocysteine |
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Metabolic changes of aging
Zinc |
Need more zinc
Decreased immune fnc Increased gastric pH |
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Metabolic changes of aging
E |
Need more E
Decreased immune fnc Increase oxidative stress |
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Metabolic changes of aging
B12, folic acid, iron, calcium |
Need more
Increased gastric pH |
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Four component of Nutrition Assessment
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Dietary assessment
Lab evaluation Body composition Clinical Symptoms and signs |
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Malnutrition
Primary Secondary |
Sustained period of inadequate nutrtion results in impairment of normal physiologic fncing
Primary - insufficient consumption Secondary - metabolism altered |
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Secondary malnutrition mechanisms
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Increased losses
Increased nutrient requirements Decreased digestion or absorption Decreased utilizaiton Drug/nutrient interactions Treatment nutrient interactions |
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How much unintentional loss is bad?
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>10% of usual body weight means significant nutritional problems
=15-20% loss of body cells mass |
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Malnutrition % of ideal body weight definitions
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<69% - severe malnutrition
70-79% moderate malnutrition 80-90% - mild malnutrition |
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BMI definitions
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<18.5/19 - underweight
20-24.9 - normal 25-29.9 - overweight 30-39.9 obese 40+ extreme obesity J shaped curve BMI vs mortality |
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BMI limitations
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Underestimates body fat in those who have lost muscle (elderly)
Genders equated Will overestimate body fat in the muscular Investigators disagree about definitions |
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Waist circumference obesity numbers
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>40 in in men, >35 in women
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Mid-arm circumference measures?
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Skeletal mass
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Resting energy expenditure
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Awake, fasting subject at rest in comfortable conditions
60-70% of total energy expenditure |
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Calorie deficient to lose one pound of body weight?
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3500 kcal
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Criteria for Metabolic syndrome
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Waist >40 /30 inches
BP> 130/90 Fasting glucose > 110 mg/dl Fasting Tgs >150 HDL cholesterol < 40/50 3 of 5 criterea |
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Marasmus
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Energy deficiency
Generalized wasting (<60%) Mortality 40-50% untreated, 5% treated |
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Kwashiorkor
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Protein deficiency
Underweight, edema, fatty liver, dermatitis, hypoalbuminemia Mortality 50-60% untreated, 5% treated |
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Special dietary needs of athletes
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Supplemental B vitmaen, iron 2/2 high metabolic rate
Vit D reported to increase performance in winter |
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Protein needs of athletes
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1-1.5g/kg weight
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Glycemic index and foods for athletes
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Low index food pre-excercise
High index post for rapid replacement |
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Muscle fuels
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glucose
glycogen (gone by 90-120 minutes) fatty acids (over 120 minutes) |
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Most detrimental nutrient deficiency to performance?
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Dehydration
Urine should be pale yellow, can follow weights Watch for excercise associated hyponatremia |
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Sport drinks?
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Good for helping with volume
Water with food just as good |
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Ephedra
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Stimulant, weight loss
Thermogenic, vasocontrictor Probably related to deadly heatstroke in athletes |
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Creatine
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Works by combining w/ phosphate to become donor for resynthesis of ATP
Works for short duration, high intensity |
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"Natural thyroid"
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Sold to increase energy, burn fat
Usually contained porcine thyroid Can cause hyperthyroidism |
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Pre game meals
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Best to eat 4 hours before
Snack before and during |
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Androstendione/DHEA
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Testosterone precursor, banned
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