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158 Cards in this Set
- Front
- Back
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In the body composition in the elderly, what 3 things is there a net decrease in?
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Bone mass
Lean mass Water content |
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There is a decrease in total energy expenditure in the elderly. What is this dependent on?
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BMR
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What is BMR dependent on?
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Lean muscle mass
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What is the most common fluid/electrolyte disturbance in the elderly?
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Dehydration
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What percentage of weight loss (especially unintential weight loss) is an indicator for nutritional risk in the elderly?
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5%/month or 10%/6 month period
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What is the mainstay of nutritional assessment?
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Anthropometrics
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What BMI is the cut off for concern in the elderly?
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< 18.5
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What is the most common cause of blindness in the elderly?
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age related macular degeneration
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How does the indirect calorimetry determine energy expenditure?
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Through measurement of oxygen consumption and carbon dioxide production.
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What is the respiratory quotient?
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Ratio of carbon dioxide produced to oxygen consumed
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What does the respiratory quotient reflect?
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Net substrate utilization
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Oxidation of each major nutrient class occurs at a known RQ. What are they?
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RQ > 1.0...glucose oxidation
RQ 0.7...fat oxidation RQ = 0.85 a mixture of substrate utilization |
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What is the best form of intake for nutritional intake?
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ORAL
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What is the second choice for nutritional intake?
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Enteral (feeding tube) if GI tract is intact.
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What is the last resort for nutritional intake?
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Total parental nutrition (through the veins)
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Use GFR to estimate protein requirements for dialysis patients. What is the limit?
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>40 ml/min no modification
< 40, then limit protein to 0.6 to 0.8 gm/kg |
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Is more protein lost with peritoneal dialysis or hemodialysis?
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Peritoneal dialysis
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What happens when phosphorus is elevated in kidney dialysis patients?
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Depression of Ca2+ which stimulates parathyroid hormone and eventually can lead to hyperparathyroid/hyperphosphatemia (Linked to progressive renal failure).
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What are the 2 major causes of hypermetabolism in patients with COPD?
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Increased work of breathing (COPD patients may have a 10 fold increase in caloric need for breathing--700 cal per day)
Frequent, recurrent respiratory infections |
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What happens if COPD patients have excessive feeding?
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Excessive CO2 production
Leads to increased work of breathing |
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What is the stress factor for burn patients?
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Around 1.8 or 2
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What is the theory that low carbohydrate diets are based on?
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That carbohydrates stimulate secretion of insulin, which promotes storage of fat, and therefore leads to weight gain, obesity, etc.
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What is the theory that glycemic index diets are based on?
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The theory that high glycemic index foods induce an over-secretion of insulin leading to obesity, insulin resistance and type 2 diabetes.
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Which diet was more effective at weight loss at 6 months, but not at one year?
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Low-carbohydrate diets
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What did the low-fat diet induce more favorable changes in with regards to cholesterol?
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Total cholesterol
LDL cholesterol |
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What did low-carbohydrate diets indue more favorable changes in with regards to cholesterol?
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HDL cholesterol
Triglycerides |
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What is currently marketed as a stimulator of the immune system and as a prophylactic treatment at the first sign of cold or flu?
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Echinacea
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How does Echinacea enhance the immune system?
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-Stimulating phagocytosis
-Increasing the motility of leukocytes -Release of tumor necrosis factor, IL-1, interferon beta-2 |
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What happens if Echinacea is taken longer than 8 weeks?
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Immunosuppression and/or tachyphylaxis can occur.
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What patients is Echinacea contraindicated?
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HIV, tuberculosis, multiple sclerosis, collagenosis, lupus and other autoimmune diseases because of the non-specific immunostimulant properties
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What is currently marketed for its hypotensive, hypocholesterolemic activities?
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Garlic
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What herb has been noted to be effective in reducing serum cholesterol, serum triglycerides, and LDL concentrations and increase HDL concentrations but is dose related?
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Garlic
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How does garlic reduce triacylglycerol biosynthesis?
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Via a reduction in tissue NADPH and an increase in lipase activity.
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What herb has antimicrobial activity?
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Garlic
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What herb may increase postoperative bleeding and should be used with caution in conjuction with aspirin, warfarin or other anticoagulants?
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Garlic
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What herb has recently been shown to significantly decrease the bioavailability of Saquinavir (protease inhibitor used to treat HIV/AIDS)?
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Garlic
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What has antioxidant and free-radical scavenging activity, counteraction of platelet and RBC hyperaggregability, increased neurotransmitter turnover, increased oxygen utilization and cellular uptake of glucose under ischemic conditions, and may vasodilate via stimulation of EDRF and prostacyclin?
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Ginkgo biloba
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What herb showed no effect on memory enhancement even though it is marketed as this?
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Ginkgo biloba
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What patients should not take ginkgo biloba?
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patients on thrombolytic therapy, patients anticipating surgery, and epileptic patients and those treated with anti-convulsants
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What is marketed today as a performance enhancer, "adaptogen", anticancer treatment and aphrodisiac?
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Ginseng
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What is the most promising application of ginseng?
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Prophylaxis of nonspecific conditions such as stress-related disorders, age-related conditions and physical or mental fatigue
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Which herb has the most common side effects of tachycardia and hypertension?
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Ginseng...Do not take with caffeine.
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What herb may cause breast tenderness or other estrogen associated side effects?
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Ginseng
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What herb has shown monoamine oxidase inhibition?
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St. John's Wort
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What herb has a high affinity for GABA receptors?
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St. John's Wort
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What herb may intensify or prolong effects of narcotics and anesthetic agents?
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St. John's Wort
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What herb induces the cytochrome p450 pathway and may substantially decrease blood concentrations of protease inhibitors?
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St. John's wort
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What herb has recently been shown to decrease the effectiveness of irinotecan used to treat colon cancer by 40%?
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St. John's wort
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What is the most common side effect of taking St. John's wort?
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photosensitivity
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What herb is marketed for weight control and performance enhancement?
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Ephedra
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What is considered a doping substance because of the danger of development of tachyphylaxis and dependence?
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Ephedra
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What herb is used to treat urinary tract problems particularly BPH?
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Saw palmetto
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What is the most common side effect of taking saw palmetto?
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GI upset
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Which herb contains tannins which may interfere with iron absorption?
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Saw palmetto
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What is a normal plasma level of homocysteine?
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Less than 16 micromol/L
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What converts homocysteine to cysteine and how?
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Vitamin B6 by a transamination-like reaction with serine
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What is needed for the conversion of homocysteine to methionine and why is it needed?
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Folic acid and vit B12...It is needed for the conversion by one-carbon (methyl) addition
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What is positively correlated with heart diseases and particularly cerebrovascular disease?
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High plasma homocysteine levels
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How does homocysteine promote vascular disease?
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By damaging the endothelium secondary to decreasing nitric oxide.
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What appears to decrease the risk of CHD (particularly when combined with modest alcohol consumption)?
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Increased intake of folic acid (up to 400 micrograms/day. This raises plasma folic acid levels.
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What vitamin when supplemented in the diet appears to reduce the risk of stroke?
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Folic acid
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What is the daily recommended intake for vitamin B12?
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1 mg
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How does vit E and ascorbic acid antagonize oxidation?
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By functioning as reducing agents
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What underlies atherosclerosis and could contribute to cancer?
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Lipid peroxidation
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What is the RDA for vit E and what is recommended to antagonize CHD and cancer?
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15 IU/d
200-400 IU/d |
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What is not a practical source for vitamin E intake above 50 IU/d?
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Diet...because of the need to ingest great amounts of fats (oils).
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Recent clinical trial results of what vitamin appear not to reduce the risk of CHD?
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vit E
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A high intake of what vitamin appears inversely related to the incidence of prostatic cancer?
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vit E
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How much do some experts suggest that adults should consume of vitamin E per day?
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200-800 IU of vitamin E/day
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Which vitamin did a recent meta-analysis indicate that high-doses of it is associated with increased death?
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vit E
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What is proposed to decrease formation of reactive oxygen species (particularly the superoxide radical in mitochondria)?
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Ubiquinone (coenzyme Q)
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What disease is proprosed to result from oxidative damage to mitochondria in the substantia nigra that results in a decrease in dopaminergic neurons?
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Parkinson's disease
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What may prevent or slow progression of Parkinson's disease in humans?
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Ubiquinone (Coenzyme Q)
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Secondary to gene activation, what vitamin has anticancer activity, may protect against multiple sclerosis and other autoimmune disorders, and may potentiate natural antibiotics?
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Vitamin D
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What organ is the only organ that makes totally active 1,25-hydroxyvitamin D3 starting with 7-dehydrocholesterol?
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Skin (specifically the keratinocytes).
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How does activated vit D promote intestinal calcium absorption and renal reabsorption of calcium and phosphate?
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By stimulating the transcription of calcium binding proteins.
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What are the 2 disease (1 in children and 1 in adults) that results as failure to calcify bones?
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Rickets in children
Osteomalacia in adults |
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1,25 D binds to a cytoplasmic receptor (VDR) which when bound to what supporting protein becomes a powerful transcription factor that binds to vit D responsive elements in DNA and activates or silences genes?
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Retinoid-x receptor
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What are the natural peptide antibiotics that human cells, particularly keratinocytes and immune cells produce?
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Cathelicidin and defensin
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What is the best source for vit D3?
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SUNLIGHT
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What are the 2 main omega 3 fatty acids from fish oil?
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EPA (20:5)
DHA (22:6) |
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What type of diet is positively associated with elevated coronary heart disease?
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A diet rich in palmitic acid and shorter chained fatty acids
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How does EPA decrease platelet aggregation?
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Diverting cyclooxygenase to form PGI3 (antithrombic) and TXA3 (no effect on platelets).
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What are the therapeutic uses of fish oil?
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-Lowers plasma triglycerols (approved by FDA)
-Antagonizes several inflammatory conditions -Used to treat psychiatric disorders |
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What is the basis of the anti-inflammatory activity of fish oil likely due to?
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Diverting lipoxygenase to form the anti-inflammatory 5-series leukotrienes rather than the inflammatory 4-series (from arachidonic acid).
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What are the potential consequences of T-3 fatty acid deficiency in children at least until they are 2 yr old?
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Impaired vision
Impaired cognitive development |
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What is an example of saturated fat (contains no double bonds)?
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Palmitic acid and other animal fat and tropical plant oils.
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True or False: Dietary cholesterol appears less important than dietary fat intake in controlling blood cholesterol.
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True
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Why does T-3 fatty acids from fish oils protect against Clinical Heart Disease?
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Most acute coronary thrombosis is probably initiated by hemorrhage through fissures in atherosclerotic plaques. A decrease in platelet aggregability will decrease thrombosis. EPA (from fish oil) decreases platelet aggregation.
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What are the precursors of compounds which control platelet aggregation?
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Arachidonic acid 20:4, PUFA from plants
EPA, 20:5, PUFA from sea plants and fish |
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What is decreased in production when EPA competes with arachidonic acid for substrate utilization by cyclooxygenase?
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Decreases thromboxane A2 production in platelets
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Do people such as Inuits who consume a lot of omega 3 and omega 6 fish oils have an increased bleeding rate?
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Yes
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True or False: A little fish (at least one meal per week) or soy (or canola) salad oil reduces the risk of sudden cardiac death from MI.
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True
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What does fish oil do in treating hypertriglyceridemia?
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The omega-3 fatty acids inhibit the assembly of hepatic VLDL and increase degradation of apo B100 in the liver.
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Consumption of a diet rich in EPA results in the formation of what which are less active than the 4 series and compete with the 4 series for cell receptors?
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Leukotrienes of the 5 series
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How can omega-3 fatty acids protect against depression, hostility and aggressive behavior?
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By modulating seratonergic neurotransmission.
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What accounts for about one-half of the fatty acid in retinal phospholipids?
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Docosahexaenoic acid (22:6, T-3)
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What is omental fat?
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Adipose tissue in the peritoneal cavity that is in close association with the mesenteric arteries.
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Why does omental fat have direct communication with the liver?
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Because the omental fat is drained into the portal vein.
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What symptoms do you need to have in order to be considered as having metabolic disorder?
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Abd obesity
Hypertriglyceridemia low HDL hypertension and insulin resistance |
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How much does the risk of death from coronary heart disease and cardiovascular disease increase with metabolic disorder?
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As much as 6 fold
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In response to what, forces omental fat to release large amounts of free fatty acids?
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Catecholamines...These free fatty acids travel directly to the liver.
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What causes hypertriglyceridemia in patients with metabolic syndrome?
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The over production of VLDL and their decreased removal from the circulation because of insulin resistance. Because LDL comes from VLDL, the increased VLDL can elevate LDL.
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What is lipolysis in human adipose tissue controlled by?
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Norepinephrine
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Why is FFA release in response to catecholamine much greater in omental than in subcutaneous fat?
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Because omental fat contains more catecholamine receptors.
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In diabetes, the kidney and ovary remain insulin responsive. What does hyperinsulinemia do to the kidney?
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It increases sodium reabsorption by the kidney which can contribute to hypertension.
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Besides affecting the sodium absorption in the kidney, what is another way that hyperinsulinemia do to increase BP?
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It can increase sympathetic activity (vasoconstriction).
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What is the most frequent tool to assess obesity?
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Body mass index (BMI: kg/m2)
BMI > 25 = overweight >30 = obese |
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What is the gold standard for determining body fat?
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Dual X-ray aborptiometry
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What are the statistics of obesity in this country?
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15% of adolescents
30% of US adults |
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What is the greatest health risk for obesity?
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Type II diabetes
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What risk accompanies obesity?
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Increased risk of CHD...omental fat causes special risk.
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What is the biggest factor explaining U.S. obesity?
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Sedentary lifestyle
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What is a peptide mainly from adipose which inhibits feeding?
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Leptin
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How does leptin inhibit feeding?
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By stimulating the MCR4 receptor in the hypothalamus. Receptor activation decreases feeding behavior.
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Why not give leptin to obese people?
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Leptin given to obese people had little effect on weight loss.
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What may the physiological purpose of leptin be better explained by?
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Promotion of feeding when leptin levels fall.
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What promotes feeding?
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Agouti protein and neuropeptide Y promote feeding (orexigenic) by inhibiting the MCR4 receptor.
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What is a stomach hormone that promotes feeding?
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Ghrelin
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What s an anorexic stomach hormone?
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Obestatin
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What are both ghrelin and obestatin derived from?
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The same prepropeptide by posttranslational processing.
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What likely explains the prevalent obesity among Pima Indians?
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"Thrifty genes" coupled with social factors.
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What are the current major pharmaceuticals to treat obesity?
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Orlistat...inhibits dietary fat absorption.
Sibutramine...an amphetamine-like appetite suppressant. |
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What is the most effective treatment for morbid obesity? BMI >40.
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Bariatric (bypass) surgery. It may work more due to decreasing feeding behavior (ghrelin production) than restricting eating capacity.
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What is obesity?
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Body fat in excess of 20% of body weight in men and 30% in women.
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What does Agouti do?
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It inhibits the anorexic center in the hypothalamus: a center which suppresses feedings and increases metabolic rate.
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What does agouti block?
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Melanocyte-stimulating hormone binding to its receptor.
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What is the protein that is produced mainly in adipose tissue and is a potent stimulator of the anorexic control center in the hypothalamus?
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Leptin...It promotes formation of MSH from the POMC precursor.
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What is an agonist for the MC4R receptor in the effector nuclei of the hypothalamus?
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alpha-MSH
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What does stimulation of the MC4R receptor do?
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It inhibits appetite and feeding behavior.
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What stimulates beta-adrenergic sympathetic activity (promotes lipolysis in adipose tissue)?
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Leptin
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What acts on hypothalamic neurons to promote feeding through stimulating neuropeptide Y and the agouti-related protein, orexigenic functions, and inhibiting anorexic functions?
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Ghrelin
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What is the main function of leptin?
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To defend against starvation.
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A mutation in what receptor is more frequent in obese patients?
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beta3-adrenergic receptor (missense mutation)
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Who has the highest reported incidence worldwide of Type II diabetes and an extreme rate of severe obesity?
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Arizona Pima's Indians
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What drug is a norepinephrine-reuptake inhibitor that is used for weight loss?
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Sibutramine
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What protein levels are decreased following a gastric bypass surgery?
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Ghrelin
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What does muscle use mainly in the aerobic state? in the anaerobic state?
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Aerobic: Fat
Anaerobic: Glucose |
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Muscle contains enough ATP + phophocreatine for how long?
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About 5 sec of intense activity
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As the intensity of exercise increases the dependance on what increases?
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Muscle glycogen; <50% VO2 mainly fat is used; >50% VO2 glucose is mainly used.
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What can be rapidly depleted by intense exercise?
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Muscle glycogen
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What can result in athletic exhaustion?
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Depletion of muscle glycogen. As glycogen decreases, use of blood glucose increases.
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What are the most common causes of athletic fatigue?
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Dehydration and hyperthermia. Loss of 1-3% of body weight as water can decrease performance.
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What is the main special nutrient requirement of athletes?
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Extra calories (1000-2000/day)
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What can decrease athletic performance?
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Fasting for 24 hrs. Liver glycogen will be depleted.
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Why does dehydration occur?
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Water loss exceeds rate of G.I. absorption
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How long does it take to restore hydration after exercise induced dehydration?
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Up to 24 hours
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What type of beverages are recommended for long endurance events?
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Beverages containing some sodium (0.5 to 0.7 g/l to 1.7 to 2.9 g/l for ultra-endurance events).
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What electrolytes do athletes need more of and where should they get them?
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Na+ and K+...These should be replaced by diet and not tablets.
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Athletes need more protein, but a how many calorie diet should supply this?
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4000 Cal
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True or False: Athletes need more vitamins (particularly water soluble) to metabolize the extra calories. These should come from the diet.
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True
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What do female athletes need to be tested for? and what blood tests would you use?
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Test female athletes for iron status before supplementing diet. Use serum ferritin and hemoglobin as markers for anemia.
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The capacity for endurance exercise increases as what increases?
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As muscle glycogen increases...A high carbohydrate diet coupled with exercise can increase muscle glycogen.
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What does classic glycogen loading involve?
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Intense exercise for 2 or 3 days with a low carbohydrate diet followed by 3 days of rest with a high carbohydrate diet. A one day loading protocol has been described.
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What can be increased 3 fold with loading?
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Muscle glycogen...Also, the water content of muscle increases (3 ml/g glycogen).
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What can improve performance, especially in endurance competition exceeding 3 hours?
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Carbohydrate from beverages with carbohydrates (30 to 60 g/hr).
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What can increase short duration - intense forms of exercise?
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Creatine supplementation...Consequences are water retention, cramping and ethical questions.
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What cannot occur when oxygen supply to a muscle plateaus?
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Increased fat oxidation
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