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86 Cards in this Set

  • Front
  • Back

The factor that has the greatest effect on basal energy expenditure is?

Fat free mass

A valuable technique for measuring total energy expenditure is...

The double labeled water technique

The thermic effect of food is the

Increase in energy expenditure associated with digestion, absorption, and metabolism of food

The effect of caffeine, nicotine, and metabolic rate is as


What are the three components of total energy expenditure?

Basal Energy Expenditure

Thermic Effect of Food

Activity thermogenesis

What is BMR

minimum amount of energy expenditure that is compatible with life

What percentage does BMR have on total energy expenditure?


What is the difference between resting metabolic rate and BMR

More commonly used that BMR, basically the same thing, usually 10-20% higher than BMR

What are some factors that affect RMR?


Body Composition (Fat free mass vs body mass index and high metabolic organs)

Hormonal status


Caffeine, nictotine, and alcohol

How does chronic fever effect RMR? specifically how much

increases energy needs 7% each degree above 98.6

What percentage of Total Energy Expenditure is the thermic effect of food?


What are factors that effect the thermic effect of food?

Increased after consumption of CHO and protein as opposed to fat

Spicy foods increase and prolong effect (33% for 3 hours)

What does NEAT stand for?

Non-exercise activity thermogenesis

(workday, shopping, fidgeting)

What is direct calorimetry?

Monitors the amount of heat produced by a person inside of a structure big enough for physical activity.

Provides no info on kind of fuel being oxidized

Seldom used

What is indirect calorimetry?

Estimates energy expenditure by measuring oxygen consumed and co2 produced.

The gold standard

What is the best formula for estimating RMR?

Mifflin St. Jeor

What is a downfall of Mifflin St. Jeor's formula?

underestimates obese

What are the steps in the determining nutrition status?

Nutrition screening--> nutrition assessment --> Nutrition status

What is nutrition screening?

the process used to identify nutritional problems or risk factors

What is the goal of nutrition screening?

Quickly identify individuals who warrant a more detailed assessment (5-10 minutes)

Who performs nutrition screening?

diet tech, nurse, physician or other qualified health professionals. Once completed those at nutritional risk are referred to the RD.

This is cost effective.

Screening usually includes

degree of weight loss, current need for nutrition support, skin breakdown, poor intake, chronic us of diets

What is the first step in the Nutrition Care Process?

Nutrition Assessment

What is nutrition assessment?

Comprehensiveevaluation carried out by a registereddietitian for defining nutrition statususing medical, social, nutrition, and medication histories; physicalexamination; anthropometric measurements; and laboratory data.

(RD interpretation of screening)

What are three goals of nutrition assessment

1. identify individuals who require aggressive nutrition support

2. Restore or maintain an individual's nutrition wellness

3. Identify appropriate MNT (Intervention)

(Provides the Basis for the Nutrition Diagnosis)

Nutrient intake analysis; definition, advantages, and disadvantages

72 calorie count hospital setting

Advantages: Actual observation

Disadvantages: doesn't reflect possible variation in portion sizes, or reflect intake of free living ind.

Daily food record/diary; advantages, and disadvantages

Advantages: Provides daily records or food intake. Can provide info on quantity of food, prep, and timing.

Disadvantages: Literacy of patient, ability to measure or judge portion sizes. Influenced by the recording process.

Food frequency: advantages, and disadvantages

Advantages: Easily standardized. Beneficial when considered in conjunction with usual intake.

Disadvantages: Literacy skill. Doesn't show meal patterns. Ability to measure portions.

24 hour recall

Advantages: quick and easy

Disadvantages: Relies on memory, ability to measure portions, doesn't reflect usual intake, interviewing skills necessary

The purpose of nutrition screening is?

quickly identify individuals who are malnourished or at a nutritional risk

Retrospective methods for collecting dietary intake data include?

food frequency questionaires

What are laboratory test's used for in the nutrition care process?

Diagnose disease

Support nutrition diagnoses

Monitor nutrition intervention

What is the only objective data used in the nutrition care process?

Lab data

What are static testing procedures?

Measuring actual level of nutrient in the specimen

Specimen nutrient concentrations do not reflect the amount of the substance stored in body pools that are not sampled

Influenced by recent dietary intake (requires fasting)

What are functional testing procedures?

Measures activity that depends on the nutrient of interest

What is hypOvolemia

Loss of water and electrolytes leading to ECF volume contraction

What is hypERvolemia

ECF volume expansion

Fluid overload in the intravascular compartment occurs to an increase in total body SODIUM content

NOT overhydration your body is retaining water not over consumption

What happens to lab results during hypOvolemia?

They all increase

Fluid is in a contracted state, everything is concentrated

What happens to lab results during hypERvolemia?

They all decrease

Retaining fluid, lab values are being diluted by excess fluid

C-reactive protein is a ______ biomarker

inflammatory; identifies when inflammatory response

When C-reactive protein is high the body is ______


What are some positive acute phase responders?

C- Reactive Protein


What are some negative acute phase responders?




Retinol Binding Protein

All negative acute phase responders _______ with inflammation

Decline with inflammation and thus do not reflect current dietary intake or protein status

Creatine is used along with _____ to assess kidney function, drawn from _______



What does low albumin imply?

During inflammation?

albumin low? Sometimes consideredmalnutrition.. Not a good assumption. If you have a liver disease its nevergoing to make albumin like it used to, because the liver makes albumin. If youare inflammatory, it will still be low.

Water in plasma moves to the interstitial compartment and promotes edema

what is the major purpose of albumin?

Maintains colloidal osmotic pressure of the plasma

Retinol Binding Protein compared to albumin and prealbumin

Not as effected by inflammatory stress

Transferrin's role

Transportsiron to the bone marrow for production of Hgb

Plasma transferrin level controlled by

size of iron storage pool


Measure of the % of RBC's in total blood volume

Total Iron Binding Capacity

Measure of all protein available to bind mobile iron and depends on the number of free binding sites transferrin

Sinceiron moves through the blood attachedto transferrin,tells how well that protein can carry ironin the blood

Transferrin saturation low/high and TIBC low/high with iron deficiency

Transferrin low

TIBC high


¡Quantifiestotal Hgbin RBCs rather than a % of total blood volumeàmore direct measure of Fe than Hct


Storageprotein that contains theiron normally gathered in the liver, spleen and marrow.

Indicator of the size of body's iron storage pool

As iron goes up/down ferritin goes up/down

Iron stores increase ferritin increases

Ferritin is an acute phase protein --> value increase/decrease in presence of inflammation


Thus not a reliable indicator of irons stores in acute inflammation

Is the lab value of iron reliable?

no large day to to day changes

What are the three types of anemia?



Normoytic/Anemia of Chronic Disease

Microytic Anemia

Associated with iron deficiency

Small pale cells

Macroytic Anemia

Associated with folate and B12 deficiency

Few large cells, filled with Hgb

Normocytic/Anemia of Chronic Disease

Associated with rheumatic disease, CHF, chronic infection, and cancer

Assessing folate and vitamin b12 metabolic function

serum homocystein.. if either are low it will build up

RBC folate reflects....

tissue stores and most reliable indicator of folate status

Serumproteins that decrease during the acute-phase response (negative acute-phaserespondents) include

albumin,transferrin, and retinol-binding protein.

Acutelyill patients experiencing inflammatory stress would be expected to have highserum levels of

c reactive protein

Anemiacaused by deficiencies of folate or vitamin B12 isusually


The Schilling test is used to

detect defects in vitamin B12 absorption.


Tetracycline will chelate with calcium from dairy foods and supplements, making both the drug and the calcium unavailable for absorption.


increases/decreases intestinal metabolism of drugs

Fruit and juice inhibit the cytochrome enzyme which is responsible for the oxidative metabolism of many drugs can last for 72 hours


Can increase the metabolism of a nutrient causing it to pass through the body faster

is an anticonvulsantonly free fraction drug is able to leave the serum and exert the drugs effect on the target organs, people with albumin levels <3 g/dL will need a lower dose of phenytoin

Loop diuretics

Increase the excretion of potassium, magnesium, sodium, chloride, and calcium

long term use need supp. Mg and Ca

MAOI inhibitors

Alter the intended pharmacologic action of a medication by enhancing the medication effects

Signifigant ingestion of high Tyramine foods while on MAOI can cause hypertension crisis


Inhibits action of drugs

Vitamin K opposes the action of warfarin and allows the production of more clotting factors


urine= muscle protein

blood= kidney function (filtration)

if kidney is not functioning right build up of creatine


Transports thyroid hormone

has a half life of 2 days

Retional Binding protein

Best way to test..


controlled by iron stores

transports iron for Hmg production

Hemotocrit vs Hemoglobin

Hemo is % of Hmg in total blood volume Hmg is the total amount in body

TIBC(Total Iron Binding Capacity)

depends on transferrin

trans down TIBC up


indicator of the body's iron storage pool

values increase during inflammation

Serum homocysteine is a biomarker of.... but _____ is better for folate and ____ better for ....

B12 or folate low it will build up

but RBC folate better

Shillings test better for b12

Who credentials? DPD and RD's

Acend during DPD

CDR once you are a RD

what are the six criteria of malnutrition

1. insufficient energy intake

2. weight loss

3. loss of muscle mass

4. Loss of subcutaneous fat

5. Localized or general fluid accumulation

6. Diminished functional state (hand grip)

low levels of albumin effect on drugs (malnutrition)

fewer binding sites for protein bound drugs , increased action of the drug

Iron absorption goes up or down with food

down 50 percent