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99 Cards in this Set

  • Front
  • Back
Cycle of nutrient deficiency and poor health
Marginal nutritional status
Increased risk of infections and complications
Worsening malnutrition and surgical complications, prolonged recovery from disease
Inadequate nutrient intake
Resource rich environments and nutrition
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
Macronutrients
Provide energy
Measure in cals/gram

Carbohydrate, Fat, Protein
Alcohol cal/gram
7
Macronutrient consumption linked to diseases
Carbohydrate - diabetes, heart disease, some cancers
Protein - renal disease, liver disease, kwashiorkor (deficiency)
Fat - heart disease, diabetes, gall bladder disease, some cancer
Requirement of protein
12% of calories (50-60 grams)
Adequate amount of essential amino acids
Excess is converted to fat
Dietary fat requirements
Essential fatty acids, 2-3% of caloric intake
Fat soluble vitamins
<10-12% make diet unpalatable
Fat associated with cancer risk
Polyunsaturated
Vulnerability to free radical damage
Theoretical risk
Carbohydrate needs
None are essential
Source of b-vitamins and fiber
50-60% of calories
Glycemic index
Amount of insulin released in response to consumption of food
High fiber intake lowers risk of
Coronary heart disease
Cancer
Hypertension
Diabetes
Obesity
GI disease
Mechanism for fiber role in health
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
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
Problems IDed in US Pop data by NHANES
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
Food insecurity
Increases risk of chronic disease

Also increased in vulnerable pts (ig HIV)
5 Behaviors lower CVD risk in Nurses Health Study
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
DASH - dietary approaches to stop hypertension
Sodium, Potassium, Magnesium, Calcium, Fiber
Estimated Average Requirement
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
RDA -- recommended dietary allowance
EAR + 2 standard deviations (97.5% )
Prevent deficiencies in healthy adults of all ages
Only made w/ enough data available
AI - adequate intake
Level felt to meet needs of individuals
Not enough clinical data to establish an RNDA
Tolerable Upper Intake Level (UL)
Maximum level of daily nutrient intake that in unlikely to cause adverse health effects to
Seven nutrient groups
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)
New DRIs
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
Dietary guidelines
Science based
Promote health, prevent chronic ilnnes
Used by federal nutrition programs
Legislated ever 5 yrs

Healthy weight, adequate nutrients, enough physical activity
Dietary guidelines for
Fruit
Vegetables
Whole grain
Milk
fruit - 2 cups
veg 2.5
whole grain 3+ oz
milk 3cups low fat
Dietary guidelines limits for
Alcohol
Salt
1 drink/day women
2 drinks/day men

less than 2300 mg (1 tsp) sodium
Food frequency questionnaire
Usual intake during a period in the past is reported
Useful for relative intake (ranking of a gorup) rather than absolute quantification
Pallor is a clinical sign of deficiencies
Fe
folate
B12
Dermatitis is a clinical sign of deficiencies
essential fatty acid
zinc
niacin
Changes in hair distribution and texture are clinical sign of deficiences
protein
zinc
essential fatty acids
Riboflavin deficiency
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
Mucositis is a clinical sign of deficiencies in
Fe
B12
folate
Vit C
water
Wound or pressure ulcers are clinical signs of deficiency
Protein
Calories
Vit C
ZInc
Carbohydrate intake and B vitamins
Vit B requirements are in line with amount of CHO consumed

Unprocessed grains are also a source of the B vitamins
Niacin
NAD
Respiratory chain, beta oxidation, kreb cycle dehydrogenation

Sources: meat, fish, legumes, peanuts, cereal, coffee and tea
Can be synthesized from tryptophan
Riboflavin
FAD
Respiratory chain, b-oxidation, kreb cycle dehydrogenation

Food sources: liver, brewer's yeast, milk, eggs, oily fish, many vegetable, grains
Thiamin
TPP
Thiamin pyrophosphate
Transketolase
Vitamin B6
Pyridoxal phosphate
Phosphorylase (PLP)
Riboflavin (B2) Deficiency
Weakness
Sore
Red tongue (mangenta tongue)
Angular stomatitis and cheliosis
Scaly dermatitis
Normochromic, normocytic anemia

Usually as part of a B complex deficiency
Pellagra
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
Scurvy
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
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
Vitamin A
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
Vit A deficiency
Symptoms - night blindness, Bitot's spots on conjunctiva, xeropthalma (corneal scarring, follicular hyperkeratosis

Risk factors - diet, prematurity, fat malabsorption syndromes, alcoholism
Vitamin D
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
Vitamin D deficiency
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
Iodine
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
Iodine deficiency
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
Goitrogens
Impair iodine absorption

Cabbage, legumes, brussels sprouts, cassava
Thiamine (B1) deficiency
Beriberi
Wet - cardiac, CHF, edema
Dry- peripheral nerves, wasting

Wernick-Korsakoff - cerebral
vision changes, ataxia, impaired memory
Affect of famine on pregnancy
Increased miscarriage, prematurity, stillbirth, nenonatal death, malformation, low birth weight
Anemia in pregnancy increases risk of
Premature birth
?low birth weight
Poor neonatal health outcomes
Maternal mortality

Closely spaced children can increase anemia in mother
Spina bifidia
Decreasing incidence in the US 2/2 folic acid fortification

Hispanic women and children have increased risk
Breast feeding advantags
Nutritionally appropriate
Immunologic protection
decreased infections, allergy
Economics
Convenience
Psycholoigcally satisfying to mother and infant
Protein in breast milk
Whey: casein (70:30)
promotes rapid gastric emptying
high biological value protein
Fat in breast milk
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
Carbohydrate in breast milk
Lactose - enhance ca absorption
galactose + glucose -- brain energy
Immunologic protection of breast milk
Secretory IgA-- passive immunity to enteromammary system
Lactoferrin - iron-binding protein, reduces Fe-binding sites available for Fe-dependent pathogens
Lysozyme
Lactobacillus - comensal
Leukocytes
US breastfeeding prevalence
75% initiate
40% at 6 months
20% at 1 yr
Benefits for Mothers
Decreased postpartum bleeding, rapid uterine involution
Less menstrual blood loss
Delay in ovulation (reduced risk of EOC, premenopausal breast)
Improved reminearlizaiton
Weight loss
Indicators of poor nutritional status in kids
Head circumference for age <5th >95th
Length/height age <5th
Underweight weight for length <5th
BMI for age <5th
Overweight/obese kid definitions
Obese weight for length > 95th
or BMI for age

Overweight
BMI for age 85th to 85th percentile
AA Pediatric Guidelines for feeding
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
Iron deficiency prevalence
Most prevalent micronutrient deficiency
25% of infants in world
50% of kids in developing countries
10% of US toddlers
9% US adolescent girls
Iron deficiency consequences
Anemia
Lower test scores mental/motor
Variable neurologic improvement after treatment, hematologic improvement excellent
TV watching and BMI?
and hypercholesterolemia
Linear relationship for BMI
increase RR for > 2 hrs and >4 hrs TV
Elderly special concerns about nutrition
Decreased lean body mass and energy needs
Oral health
Social
Functionality (jars arthritis)
Chronic disease
Prevalence of malnutrition in elderly
3-11 % in community
17-65% in nursing home
15-40% in hospital
Metabolic changes of aging
Vit D
Need more D

Decreased bone density
Decreased calcium absorption
Decreased skin D3 synthesis
Increased winter PTH production
Metabolic changes of aging
Calcium
Need more Ca

Decreased bone density
Decreased calcium absortion
Metabolic changes of aging
B6
Need more B6

Decreased immune fnc
Decreased pyridoxal metabolic efficiency
Increased homocysteine
Metabolic changes of aging
Zinc
Need more zinc

Decreased immune fnc
Increased gastric pH
Metabolic changes of aging
E
Need more E

Decreased immune fnc
Increase oxidative stress
Metabolic changes of aging
B12, folic acid, iron, calcium
Need more

Increased gastric pH
Four component of Nutrition Assessment
Dietary assessment
Lab evaluation
Body composition
Clinical Symptoms and signs
Malnutrition
Primary
Secondary
Sustained period of inadequate nutrtion results in impairment of normal physiologic fncing
Primary - insufficient consumption
Secondary - metabolism altered
Secondary malnutrition mechanisms
Increased losses
Increased nutrient requirements
Decreased digestion or absorption
Decreased utilizaiton
Drug/nutrient interactions
Treatment nutrient interactions
How much unintentional loss is bad?
>10% of usual body weight means significant nutritional problems

=15-20% loss of body cells mass
Malnutrition % of ideal body weight definitions
<69% - severe malnutrition
70-79% moderate malnutrition
80-90% - mild malnutrition
BMI definitions
<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
BMI limitations
Underestimates body fat in those who have lost muscle (elderly)
Genders equated
Will overestimate body fat in the muscular

Investigators disagree about definitions
Waist circumference obesity numbers
>40 in in men, >35 in women
Mid-arm circumference measures?
Skeletal mass
Resting energy expenditure
Awake, fasting subject at rest in comfortable conditions

60-70% of total energy expenditure
Calorie deficient to lose one pound of body weight?
3500 kcal
Criteria for Metabolic syndrome
Waist >40 /30 inches
BP> 130/90
Fasting glucose > 110 mg/dl
Fasting Tgs >150
HDL cholesterol < 40/50

3 of 5 criterea
Marasmus
Energy deficiency
Generalized wasting (<60%)
Mortality 40-50% untreated, 5% treated
Kwashiorkor
Protein deficiency
Underweight, edema, fatty liver, dermatitis, hypoalbuminemia
Mortality 50-60% untreated, 5% treated
Special dietary needs of athletes
Supplemental B vitmaen, iron 2/2 high metabolic rate
Vit D reported to increase performance in winter
Protein needs of athletes
1-1.5g/kg weight
Glycemic index and foods for athletes
Low index food pre-excercise
High index post for rapid replacement
Muscle fuels
glucose
glycogen (gone by 90-120 minutes)
fatty acids (over 120 minutes)
Most detrimental nutrient deficiency to performance?
Dehydration

Urine should be pale yellow, can follow weights

Watch for excercise associated hyponatremia
Sport drinks?
Good for helping with volume

Water with food just as good
Ephedra
Stimulant, weight loss
Thermogenic, vasocontrictor
Probably related to deadly heatstroke in athletes
Creatine
Works by combining w/ phosphate to become donor for resynthesis of ATP

Works for short duration, high intensity
"Natural thyroid"
Sold to increase energy, burn fat
Usually contained porcine thyroid
Can cause hyperthyroidism
Pre game meals
Best to eat 4 hours before
Snack before and during
Androstendione/DHEA
Testosterone precursor, banned