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71 Cards in this Set
- Front
- Back
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What are the different factors that influence what fuel source is used when exercising- intensity, duration, etc.
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High intensity- relies on anaerobic production of ATP, glucose and glycogen from muscle
Moderate Intensity- like jogging, cycling, aerobics, uses glycogen, blood glucose, fatty aicds Moderate to low intensity-walking entirely aerobic fatty acids supply ATP Fat will be used as a primary fuel source in exercise that is long duration, moderate intensity Longer duration, greater fat contribution |
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Components of Total Energy Expenditure
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TER
Resting energy-energy needed to sustain normal functions (homeostasis) 60-75% Thermic Effect of Food-10% Physical Activity-20% |
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Know what factors affect RMR and how
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Resting Metabolic Rate
Factors That Affect: -Age: RMR highest during rapid growth -Gender:women have lower RMR than men -Body size: larger people have higher RMR than smaller people -Body composition: athletic people have higher RMR -Hormonal Status: endocrine disorders, menstrual cycle -Other factors: fevers increase metabolic rate |
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direct calorimetry
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used to measure RMR, person is placed in a chamber, the body heat given off changes the temperature of the chamber reflecting the energy used by their bodies for basic functions
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indirect calorimetry
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measures RMR
Its to measure O2 consumed and CO2 expired |
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Other methods to measure RMR
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heart monitors, pedometers, accelerators, predictive equations
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Activity factors
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1.3=sedentary, little or no exercise
1.4-1.6=moderate exercise/sports 3-5 days/week 1.6-1.9= active, hard exercise/sports 6-7 days/week 1.9-2.5= very active, very hard exercise/very physical job |
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benefits of exercise
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-lowers risk of heart disease
-reduces risk of certain cancers -lowers blood pressure -improves lipid profiles -prevents obesity -prevent diabetes -enhances immune function -relieves stress, improves mood, promotes self-esteem -improves cognitive health -increase function health |
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2008 physical activity guidelines for adults and older adults
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Avoid inactivity
Do at least 150 minutes of at least moderate-intensity PA OR at least 75 minutes vigorous-intensity PA per week OR a combination At least 3 days per week At least 10 minute bouts Muscle strengthening 2 times per week At least one set of 8-12 muscle groups |
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Hydration status for an athlete
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Minimal weight loss (i.e. < 1 lb) during exercise is the best indicator you stayed well hydrated
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how to calculate BMI
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kg/m2
underweight- below 18.5 normal-18.5-24.9 overweight- 25-29.9 obese I-30-34.9 |
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Gynoid v android
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waist to hip ratio
Gynoid- "pear" larger hips compared to waist, less chronic disease risk Android- "apple" larger waist compared to hips indicator of morbidity |
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Waist Circumference
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women waist to hip less than 0.8
men less than 0.95 assessing abdominal obesity risk determining disease risk monitoring progress measure at the iliac crest men >102 cm (40 in) Women>88 cm (35 in) |
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Medical Conditions with Obesity
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Coronary Artery Disease
Myocardial Infarction Hypertension Stroke Dyslipidemia Type 2 DM Osteoarthritis Gallbladder Disease Cancers of the breast, colon, prostate and edometrium Polycystic Ovary Syndrome Sleep Apnea and respiratory problems Non-alcoholic fatty liver |
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Metabolic Syndrome
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abdominal obesity, high fasting plasma glucose, high triglycerides, low HDl cholesterol, hypertension
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% weight loss proven to have positive effects, what are these effects?
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10% weight loss
HbA1c Blood Pressure Total Cholesterol HDL cholesterol Triglycerides-decrease |
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Practice the Mifflin St Jeor Equation
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!
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Weight regainers
National weight control registry |
Wt regainers
-are not committed to gradual wt loss -take diet pills -exercise little -stress eat -do not seek out social support -cope with problems by escape and avoidance NWCR 78% eat breakfast everyday 75% weight themselves at least once per week 62% watch less than 10 hours of tv per week 90% exercise on average, about 1 hour per day |
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Identify modifiable factors to reduce the likelihood of a LBW or preterm infant
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Underweight prior to pregnancy
Low pregnancy weight gain Smoking during pregnancy Certain maternal infections Iron deficiency anemia early in pregnancy |
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Management of Nausea/Vomiting in Pregnant Women
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Separate liquid and solid food intake
Small frequent meals Avoid odors and foods that trigger nausea Vitamin B6 |
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Management of Heartburn in Pregnant Women
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Ingestion of small, frequent meals
Avoid lying down after a meal Limit high fat and spicy foods |
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Management of Constipation in Pregnant Women
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Consume 30 grams fiber/day
Laxatives are NOT recommended Bulk forming fiber supplements with water Metamucil |
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Amt of weight gain recommended for pregnant women
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based on BMI
Normal BMI (18.5-24.9): 25 to 35 lbs Underweight BMI (less than 18.5): 28 to 40 lbs Overweight BMI (25-29.9): 15 to 25 lbs Obese BMI (greater than 30): 11-20 lbs |
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How calories needs change during both pregnancy
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Increase need averages 300 kcal/day
Necessary during 2nd and 3rd trimesters Increased work of the heart (~ one third) Increased energy necessary for respiration and development of breast tissue, uterine muscles and placenta (~ one third) Fetus (~ one third) |
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Food safety and pregnant women
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Avoid raw fish, oysters, soft cheeses, raw or undercooked meat, unpasteurized milk
Mercury – avoid shark, swordfish, king mackerel, tile fish 12 ounces or less of other types appears to be safe Potential teratogens: drugs, alcohol, tobacco, caffeine (if >300 mg/day) |
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Calories needed for lactation and why
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750 kcal/day for breast milk production
assumes 500 kcal contributed by extra food and 250 kcal mobilized from maternal fat stores |
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What fat is of particular importance when pregnant and why
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Fat
essential fatty acid, omega-3 DHA Fetal vision development Neurological development |
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Benefits of breast feeding
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Immunologic protection to infant
Unique formula with best profile and bioavailability of nutrients Reduces risk of food allergies Convenience Cost Less chance of bacterial contamination Oral development of infant Chronic disease protection Bonding Decrease breast cancer risk in mom decrease incidence and severity of serious diseases (meningitis, gastritis, sepsis,etc) decrease incidence of SIDs, DM, asthma, etc |
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Growth patterns that occur in baby's first year of life and how this impacts nutritional
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Birth Weight:
Doubles by 6 mos Triples by 1 yr Length/Height: Increases by 50% in 1 yr |
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Common food allergies
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Eggs
Wheat Peanuts Tree nuts Soy Seafood |
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what not to feed infants and why
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Honey
Excessive formula or breast milk High risk foods for choking hot dogs, grapes, popcorn, raw carrots, nuts Cow’s milk Too much juice Apple, white grape, pear, etc. |
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Recommendations for starting babies on solid food, how we know
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Introducing solid foods: 4-6 months
physiologically ready developmentally ready sit with support, move jaws, lips and tongue independently for bolus formation show interest in other family’s members food caregivers “read” baby’s cues: satiety, etc At 6 months One individual food at a time every 4-5 days Identifies intolerances and allergies Start with iron fortified infant cereals, then add individual plain, strained veggies and fruits NO SUGAR, SALT, SAUCES, FLAVORINGS |
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what should the first foods be? why
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one individual food at a time, helps with identifying allergies and intolerances
iron fortified infant cereals, then add individual plain, strained veggies and fruits at 6-8 mos Add to the previous diet: Mashed or chopped fruits and veggies Water (and juice) from a cup at 9-12 mos Mashed, ground or chopped meats, grain products Crackers, toast, soft/dry cereals (Cherrios) Cottage cheese, yogurt Egg yolk Cut up pieces of soft fruit (banana) |
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Vitamins and minerals that are of specific importance to babies that are breast fed versus formula fed
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Vitamin D
Vitamin K Vitamin B12 Iron Fluoride dkbif |
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Normal growth patterns for infant, toddler, preschooler
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Infants (birth – 12 months)
BW triples in first years Toddlers (age 1-3) gain on average 8 ounces/month, 1 cm height/mo Preschoolers (age 3-5) gain on average 2 kg and 7 cm per year |
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Eating for toddlers/preschoolers
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Nutrient Dense Meals and Snacks
Child-sized Portions Role Models New Foods: 10 times before accepted Different ways Example: broccoli |
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Division of responsibility
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“What” to eat and “When” to eat
Parents’ responsibility “How much” to eat Child’s responsibility |
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Common issues with toddlers/preschoolers with nutrition
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Iron Deficiency Anemia
“milk anemia”: 6-24 mos Consequences: delayed cognitive development including speech, increased infections Good Sources: Fortified cereals Animal protein Plant Protein with vit C |
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Techniques to deal with picky eaters
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Eat well during pregnancy and lactating
Get in lots of variety Make unfamiliar foods familiar Be a good role model Make time for family meals Engage them in the process Avoid feeding on demand Refrain from labeling them as “picky eaters” Avoid overpraising healthy eating |
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kids growth chart
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figure this out
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health consequences of overweight/obesity
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Premature Death
Cardiovascular Disease MI, angina, congestive heart failure (CHF) Stroke (cerebrovascular accident/CVA) Hypertension Osteoarthritis Certain cancers Diabetes----and it’s terrible consequences |
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Factors involved in adolescent food intake
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social practices
fitness goals desire to be healthy peers discretionary income |
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common dietary patterns in adolescents
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snacking
skip meals eat away from home consume fast food diet (females) |
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Food allergy v Food intolerance
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allergies have an actual immune response even though food intolerance may have allergy symptoms
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Physiological changes in early adulthood
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By age 20, growth has for the most part ended
Bone density continues to develop until age 30 Muscle mass continues to grow For women: attention to maintaining calcium and iron intakes continues After age 18, calcium and phosphorous decrease |
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Physiological changes in middle adulthood and important nutritional factors
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On average, after age 40 adults start to gain weight
Body composition begins to change in response to hormonal shifts and decreased activity Time to reassess earlier nutritional habits Men:Decline in testosterone begins about age 40 to 50 Women/Menopause: need calcium |
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Older adulthood physiological changes and nutrition concerns
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Decrease in RMR
Reduced strength Reduced LBM (bone mass, muscle, water) Increased fat mass Sense of taste and smell decline Hunger and satiety cues diminished Vitamin B12, vitamin D |
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AHA guidelines for alcohol consumption for men and women
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less than 1 drink for women
less than 2 drinks for men a drink is 12 oz beer 1.5 oz 80 proof distilled spirits 5 oz wine |
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Iatrogenic nutrition and examples
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Iatrogenic-physician induced
Monitor for diet orders, nothing by mouth (NPO) order, or on clear and full liquid diets |
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Physiological effects of malnutrition in a pt care setting
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increased infections: pneumonia, UTIs
metabolic stress further depresses infection, fever, meds depress appetite When malnourished, microvilli is flattened with contributes to further malnourishment affects wound healing |
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ABCD's of a nutrition assessment
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Anthropometric-wt/ht/bmi/skin fold
Biochemical-albumin/glucose/liquids/electrolytes/nitrogen Clinical-health history/wasting/edema/cheilosis Dietary Assessment |
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What would cause a pt to be at nutritional risk
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Liquid diet > 3 days (w/o nu support)
NPO> 3-5 days TF or TPN Abnormal growth in children, pg women Hypermetabolic conditions (????) GI problems (Why?) Over or underweight Albumin (what levels?) Unintentional weight loss |
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BMI formula
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m/kg2
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Indicators to ID visceral protein status
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visceral: circulation in the blood and organ tissues
Albumin (3.5-5) insensitive to acute changes Prealbumin more sensitive to short term changes |
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Enteral v Parenteral
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Enteral-uses the gut, preferred method
indicated when oral intake is not adequate or not possible 7-10 days after po determined not effective Contraindications: bowel rest, pancreatitis, high output fistula, intestinal obstruction, multisystem organ failure Parenteral indications: no po intake and severe gi problems Parenteral |
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%UBW
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current wt/usual wt
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% wt change
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change in wt/usual wt
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significant weight changes
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one week 2% significant, less than 2 % severe
one month 5%, less than...severe six months 10%, ditto unlimited 20%, ditto |
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Risks of enteral nutrition and ways to prevent problems
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Risks:
Complications with tube placement NG/OG tubes Malposition/perforate esophagus/stomach Long term access Tube displacement Leakage/peritonitis Aspiration/Diarrhea Underfeeding Prevention Placement Verify placement radiographically Occlusion Flush tubes routinely (medications, free water) Aspiration (most serious EN complication) Head of bed elevated to 30-45 degrees Verify tube placement Small bowel feeding Continuous infusion Promotility agents |
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Elemental
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GI Disorder Formulas
Indicated for short bowel, Crohn’s, pancreatitis etc Partially predigested - di- or tri- peptides Elemental – low or minimal fat, elemental aa |
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Advantages/Disadvantages of tube feeding routes
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NG tube- short term
NJ tube- short term G tube-long term J tube-long term |
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When is it appropriate to give continuous v intermittent v bolus feeds
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Continuous-small volume, for those that can't tolerate large volumes
Intermittent-gravity drip, allows for more free time and autonomy Bolus-more convenient, mimics breakfast, lunch, dinner |
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Body response to stress v starvation
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Stress-hypermetabolic, decreased O2 consumption, hyperglycemia
Starvation-hypometabolic, downshifting of BMR, fat metabolism-gluconeogenesis |
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refeeding syndrome
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Severe electrolyte and fluid shifts associated with metabolic abnormalities in malnourished patients undergoing refeeding orally, enterally, or parenterally
Fat based metabolism to carbohydrate metabolism Low insulin to high insulin patients electrolytes actually go down even though more are being added, yikes! Patients at Risk Classic kwashiorkor and marasmus Chronic malnutrition Chronic alcoholism Gastric by-pass operation for obesity Oncology patients Postoperative patients Prolonged fasting of ≥ 10 days |
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clinical complications of DM
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7th leading cause of death
Greater risk of CVD and stroke Leading cause of blindness Leading cause of nontraumatic limb amputations |
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individuals at greater risk for DM
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Type 2 risk in children:
Acanthosis nigricans Reflects chronic hyperinsulinemia Polycystic ovarian syndrome (PCOS) Associated with insulin resistance and obesity Hypertension Occurs in 20% to 30% of patients with T2DM Women with gestational diabetes |
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pre-prandial, peak post-prandial
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AIC< 7%
Pre-prandial plasma glucose 90-130 mg/dl Peak post-prandial plasma glucose < 180 mg/dl |
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HbA1c
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Glycosylated hemoglobin
Reflects average BG levels over past 3 months HbA1c: 6% about BS=120 mg/dl 7% about BG=150 mg/dl 8% about BS=180 mg/dl to measure BG over time! |
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carb counting for DM individuals
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Appropriate for use in Type 2 and gestational diabetes
space carbohydrates evenly throughout the day One carbohydrate choice = 15 g carbohydrate |
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how working out affects BSL in a diabetic,
recommendations |
Type 1
monitor BG determine if extra food is required food for activity is in addition to the meal plan Type 2 monitor BG determine best time to exercise additional food usually not necessary |
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Diabetic exchange system
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Foods vary—exchanges don’t
In theory |
