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92 Cards in this Set
- Front
- Back
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What is the clinical standard for weight for height estimation?
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Body Mass Index
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How is BMI calculated?
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kg/m^2
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BMI: What is underweight?
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<18.5
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BMI: What is normal weight?
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19 - 24.9
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BMI: What is overweight?
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25 - 29.9
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What is a BMI of 30 - 34.9?
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Class I Obesity (Mild)
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What is BMI of 35 - 39.9?
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Class II Obesity (Moderate)
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BMI: What is extreme obesity?
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>40
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What are the limitations of BMI?
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Small changes in weight
High weights due to excess fat, large muscle mass, or edema |
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How many are incorrectly classified by BMI?
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27%
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Between 1976 and 1994, how much weight did adults aged 20 to 40 gain?
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2 lb/year
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Walking at 3 MPH, how many calories are burned in one mile?
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100 Calories
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As BMI increases what happens to:
LDL, HDL, BP, Cardiovascular events, Cancer? |
HDL decreases
Everything else increases |
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What is high blood pressure?
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Systolic over 140
or Diastolic over 90 |
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What factors contribute to dysmetabolic syndrome?
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Hyperglycemia
High BP Central obesity Low HDL High Triglycerides |
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What can the physician do with the patient it not ready to lose weight?
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Prevent weight gain and explore barriers to weight reduction
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What are the medical causes of obesity?
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Hypothyroidism
Cushing's syndrome Depression |
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What is the threshold waist circumference to determine high risk patients?
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Men >40 inches
Women >35 inches |
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How many steps in a mile?
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2000-2500
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What ailments are caused by vitamin D deficiency?
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Hypocalcemia
Hypophophatemia Rickets |
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What is the threshold level for high risk triglycerides?
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>150 mg/dl
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What are the threshold levels of HDL?
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<40 mg/dl
<50 mg/dl |
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What is the threshold level of fasting glucose?
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>100-110 mg/dl
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What is the number one cause of death for individuals with diabetes?
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Ischemic heart disease
Cardiovascular disease |
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What is dyslipidemia?
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Low HDL
High small LDL |
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What is the LDL goal for a risk level of 0-1?
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<160
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What is the LDL goal for a risk level of 2 or more?
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<130
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What is the LDL goal for a CHD or CHD risk equivalent?
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<100 (<70 if possible)
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Describe the activation of plasminogen and the role of PAI-1.
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Plasminogen is the inactive proteinase that is activated by tPA. Plasmin is then able to convert Fibrin to soluble products which result in clot dissolution. PAI-1 is a tPA inhibitor.
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Is an increase or decrease of PAI-1 desirable?
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Decrease
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What is the action of PAI-1?
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Makes clots dissolve. Promotes bleeds.
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What is the effect of DM2 on PAI-1 concentrations?
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Increases PAI-1 concentrations
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What is the most important intervention affecting PAI-1 concentration?
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Weight reduction
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What is the role and action of CRP?
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C-reactive protein
Marker and mediator of atherothrombtic disease. Binds ligands in damaged tissue and activates compliment-mediated inflammation. |
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What are the independent indicators of CV disease? What is strongest?
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LDL and CRP
CRP stronger indicator |
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How does increased abdominal fat affect CRP?
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High abdominal fat increases NF-kB proinflammation activity (via angiotensin II), which in turn increases CRP.
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What is the effect of metabolic syndrome on CRP levels?
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positive correlation, increased characteristics of metabolic syndrome will yield higher CRP levels
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Describe the setup and findings of the Jupiter trial.
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Use of rosuvastatin on individuals with normal LDL and high hsCRP.
Showed benefit of statin-reduced CRP in prevention of cardiovascular events. |
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What is adiponectin?
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A fat hormone with anti-inflammatory properties. It is a structural homologue to TNF-alpha
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What happens to adiponectin levels with increasing BMI?
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Decreases
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What happens to adiponectin levels with increasing characteristics of metabolic syndrome?
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decreases
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Will high adiponectin levels promote or prevent a cardiovascular event?
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prevent
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HDL is acutely decreased with weight loss. What can be done to prevent this?
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Increased physical activity
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When will HDL levels stabilize following weight loss?
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When weight stabilizes after loss
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What type of foods are rich in saturated fats and can acutely increase cholesterol levels?
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Animal fats
Tropical oils (16:0 and 14:0) |
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What type of foods are rich in monounsaturated fats, but also have saturated and polyunsaturated fats?
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olive oil
canola oil nuts |
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What is the effect of polyunsaturated fats on cholesterol levels?
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Lowers cholesterol levels
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What essential fatty acids lower cholesterol?
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Omega 3
Omega 6 |
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Which essential fatty acid is more thrombic and inflammatory?
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Omega 6
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What food sources are rich in omega 6?
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corn oil
safflower oil sunflower oil |
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What foods are rich in omega 3?
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Oily fish
flaxseed canola oil soybean oil |
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What is the goal of a dyslipidemia diet?
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Low LDL
Low TG High HDL |
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What lifestyle/diet factors increase serum LDL?
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>7-8% of energy from sat. fats
>1% of energy from trans. fats >35% of energy from fat <30 minutes of exercise/day |
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What diet/lifestyle factors can decrease serum LDL by 20-40%?
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5-7% weight loss
High polyunsat fats High fiber High flavonoids stanols/sterols antioxidants |
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How much soluble fiber is needed to reduce LDL?
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10g/day
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How much pectin and B-glucan is needed to decrease LDL? What foods have these nutrients?
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5 servings/day
Vegetables, nuts, seeds, legumes, fruits, grains, and meds such as psyllium. |
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How many servings of fruit and vegetables are needed to reduce LDL?
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5 servings/day
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How much soy protein is needed per day to reduce serum LDL?
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25g/day
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In a healthy diet, how much will serum LDL concentration be reduced with soy protein?
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5%
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Why do sterols and stanols reduce serum LDL?
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Structurally very similar to cholesterols, so they block normal cholesterol uptake.
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How much reduction of serum LDL can be expected with an increased diet of phytosterols?
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8-15%
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How much phytosterol is needed per day for maximum effect?
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2g/day
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What vitamins/antioxidants have shown to be beneficial for CHD?
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A, C, E, Beta carotene
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What are the proposed effects of chromium and Co-Q 10?
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Co-Q: no effect
Chromium: improve insulin sensitivity, decrease visceral fat |
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Moderate fat intake is necessary for what vital nutrient?
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to maintain HDL
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What age demographic has little to gain from increased alcohol intake?
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Men <35 years old
Women < 50 years old |
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How much weight reduction is necessary for 1 mg/dl increase in HDL?
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7 pounds
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How will caloric restrictions effect HDL levels?
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acutely lowers HDL
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How does Omega 3 FA effect TG levels?
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reduces elevated levels
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What nutrient can moderate tachycardia?
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Omega 3 FA
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At what threshold do you see adverse effects of Omega 3 FA?
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4g/day
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How much omega 3 should normal people eat?
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Food rich in omega 3 twice a week
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How much omega 3 should pt with documented CHD eat?
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1 g/day
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How much omega 3 should pt with elevated TG eat?
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2-4g/day
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What is the effect of a diet rich in fish oils? What does this ultimately mean?
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Lowers TG 30-40%
LDL is unchanged or increased Must be given with LDL reducing therapy (statins). |
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What are ways to get 1g/d omega-3?
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Fish
Dietary Drugs Cod liver oils |
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What foods should be given an individual who is at risk for a thrombic CV event?
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Omega 3
Fish B vitamins |
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What foods/nutrients should not be five to an individual that is a risk for a thrombic CV event?
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Homocysteine
High fat diet Vitamin K |
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What did the Lyon Diet Heart Study find?
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Mediterranean diet with increased ALA (omega-3).
50-70% reduction in risk of recurrent CVD--similar to statin therapy. |
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What did the GISSI Prevenzione trial find?
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Omega-3 supplements work
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What does homocyteine do? What patients should avoid it?
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Damages the lining of the arteries and increases the risk of thrombus.
Thrombic patients should avoid |
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How can you test for low B12?
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Build up of methylmalonic acid or homocysteine
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How can you test for low folate?
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Build up of homocysteine
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What are clinical consequences of folate and B12 deficiency?
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Fatigue
Weight loss Diarrhea Loss of appetite Fever Sore Tongue Jaundice Fundal Hemorrhage macrocytic pancytopenia hyperhomocysteinemia |
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What are some clinical features of B12 deficiency?
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Neuropathy
Dementia Paraesthesia Itchy tongue White spots on forearms Demyelinating lesions of spinal cord and peripheral nerves |
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What diet is prone to B12 deficiency?
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Vegan diet
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Supplementation of what nutrient will decrease homocysteine?
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folate (and B12)
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A reduction in Na and increase K will do what to the BP?
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Lower it
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In pts with hypertension, Carbohydrates can be replaced with what?
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Protein from plants
monounsaturated fats |
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What is the connection between HTN and obesity?
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Increased salt sensitivity
Hyperinsulinemia causes sodium retention and catecholamine release |
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What nutrient needs to be controlled for pts with HTN?
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Sodium
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How much will BP lower for every 10kgs of weight loss?
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5-20 mmHg
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