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FSHN 360- Final

Willpower limited resource, but everyone has it
Microbiota controls appetite, energy, glucose/lipid metabolism, inflammation
SCFAs microbiota butyrate; anti-inflammatory anorexigenic
Leading cause of death for men/women & most ethnicities heart disease
___ Americans have at least one of 50%; high BP, high LDL, smoking
CAD risk factors (2) type two diabetes, post menopausal (others)
Inactive adults, what percentage have CHD risk factors? 53%
What affects cardiovascular health factors most? diet
LDL cholesterol transport
HDL reverse transport
Average %kcal from added sugars adolescents 16%
__ of all instances of CHD occur in individuals ___ overt dyslipidemia half, without
3 plasma biomarkers CHD C-reactive protein, homocysteine, lipoprotein A
C-reactive protein aka hs-CRP
C-reactive protein is a marker of inflammation (so atherosclerosis and thrombosis)
Homocysteine is a biomarker of (3) platelet aggregation, inflammation, oxidation of LDL
Lipoprotein a is a biomarker of myocardial infarction/angina
Fortified sources of plant sterols spreads, orange juice, butter
Precision reproducibility
Accuracy validity
Children usually have high___ BP if high BP diastolic
HTN adults normal, pre, stage 1, stage 2
HTN children CDC percentiles for sex, age, height
Nutrients associated with lowering sat/trans fat, cholesterol (5) protein, fiber, potassium, magnesium, calcium
High sodium considered an ___ cause of ____ indirect, obesity
High sodium intake associated with (3) in adolescents adiposity, leptin, tumor necrosis factor a
Adults with diabetes are ___x more likely to have ____ 2-4x, heart disease/stroke
Integrative medicine diabetes address the whole person
Diabetes microvascular disease (3) retinopathy, nephropathy, neuropathy
4 classes of diabetes gestational, 1, 2; due to causes like genetics, pancreas, diseases
3 symptoms of DM polyuria, polydipsia (thirst), polyphagia (hunger)
HbA1c 2-3 months; glycated hemoglobin
Cutoff for diabetes >126 mg/dL
3 targets for diabetes treatment improve insulin action, lower GI glucose absorption, improve insulin secretion
Bone strength density and quality
Bone strength density 70% of variation, amount of bone loss
Bone strength quality 30% variation, accumulation of damage to bone
Two types of bone cortical/compact and trabecular/cancellous
Turnover rate is faster in ___ bone trabecular
Osteoporosis classifications primary= age; secondary= lifestyle
Medications that cause osteoporosis (2) glucocorticoids, anticonvulsants
Vitamin A osteoporosis too much retinol bad, but has role in borrowing/depositing calcium in bone
Vitamin K osteoporosis calcium regulation, low levels associated w/ low bone density
Caffeine promotes ____ excretion in urine calcium
Two measures of bone density DEXA, QUS
QUS quantitative ultrasound (high frequency sound through bone), heel bone (does not measure mineral content, just bone mass)
Biochemical tests objective and quantitative assessment of nutritional status (detect deficits before clinical signs and symptoms)
Static test direct (biochemical)
Functional test indirect (biochemical)
Functional tests measure intended, nutrient dependent biological function
Functional test example dark adaptation for vitamin A
Limitation functional test nonspecific; not all nutrients have one
Sensitivity probability that the test is positive given that the patient is sick
Specificity probability that the test is negative given that the patient is not sick
No single test is___ sufficient for monitoring nutritional status by itself
Somatic protein skeletal muscle, 75% of body cell mass
Visceral protein organs/blood cells/serum protein, 25% of body cell mass
Body cell mass 30-50%
Malnutrition the pathophysiology over or undernutrition and inflammatory activity on body composition and biological function
Causes of protein insufficiency primary= insufficient intake, secondary= other diseases
Kwashiorkor protein deficiency w/ adequate kcal
Marasmus energy deficiency
CHI/creatinine affected by many factors, expressed as a % of the expected value
Protein is __% nitrogen 16%
Serum proteins reflect short term changes in nutritional status
Serum albumin and CRP high during acute stress
Serum albumin elevated during PCM
Prealbumin/retinol binding protein short half life
Calcium functions BP, muscle, nerve, hormones, enzymes
Ideal sources of calcium non-dairy with vitamin D
Calcium atherosclerosis calcium incorporated into fatty plaques
Excessive calcium interferes with iron absorption, constipation, prostate cancer, CVD, kidney stones
PTH calcium bone resorption of calcium and phosphorus
Calcitonin induce calcium accretion (addition) in bone
Serum calcium tightly controlled by the body
Urinary calcium more responsive to diet than serum
what causes decreased urinary calcium output? sodium, protein, low phosphate
What causes decreased urinary calcium output? increased phosphate, alkaline (f/v)
Phosphorus increases need for calcium, usually excess not deficiency
What converts 25OH-D to 1,25 OH D? kidney
Serum 25OH-D long half life
Serum 1,25OH-D short half life, levels don’t decrease until deficiency is severe
Vitamin D deficiency 1 billion worldwide (intake/sun exposure)
IOM vitamin D should probably be increased from 2000-4000 IU per day
VITAL see if omega 3 and vitamin D affect cancer/heart disease/stroke
Vitamin D and diabetes decreased insulin, hyperglycemia
Excess vitamin D can’t get it from the sun, can damage heart/blood vessels/kidneys
Total lymphocyte count high levels intake body is trying to fight viral infections
Delayed cutaneous hypersensitivity degree of reactivity is a function of T-cell mediated immunity (decreased w/ PEM, B6, iron, A, zinc deficiency)
Single most common nutrient deficiency iron
Absolute iron deficiency total body iron stores depleted (bleeding/intake)
Functional iron deficiency failure to release iron rapidly enough for erythropoiesis
4 factors that affect iron status stores, utilization, intake, loss
3 most common causes of anemia (RBCs) microcytic, macrocytic, hypochromatic (low hemoglobin)
children iron deficiency increased absorption of heavy metals (many others)
what elevates serum ferritin? inflammation, trauma, overload, hepatitis, cancers
soluble transferrin receptor # tfr proportional to requirement for iron
transferrin saturation low with iron deficiency
athletes iron deficiency significant portion have it, recuperation helps but not enough
erythrocyte phytoporphyrin precursor of heme, accumulates with iron deficiency
limitation of hemoglobin test not low until late deficiency
hematocrit % of RBCs making up entire volume of whole blood (depends on # and size)
body iron model ratio of sTfR to serum ferritin
ferritin model tends to over-estimate presence of deficiency
MCV iron model reflects altered RBC formation
Folic acid fully oxidized monoglutamate form (used in supplements)
Folate functions homocysteine metabolism, nucleic acid synthesis, amino acid synthesis, RBC formation
1 dietary folate equivalent= 1ug food folate, 0.6ug folic acid with food, 0.5ug empty stomach
primary sign of folate deficiency megaloblastic anemia
megaloblastic anemia sign of folate deficiency; large and abnormally nucleated erythrocytes
4 groups at risk of folate inadequacy alcohol dependence, women of reproductive age, pregnancy, malabsorptive disorders
excess folate generally non-toxic
serum folate sensitive to dietary and non-nutritional changes (3 weeks negative balance)
erythrocyte folate best clinical index of depleted tissue stores
intrinsic factor binds B12 in the ileum
pernicious anemia B12 malabsorption
excess B12 low potential for toxicity
B12 deficiency megaloblastic anemia, weakness, fatigue, neurological
Folic acid and B12 large amounts of folic acid can mask B12 deficiency
Does folate or B12 deficiency develop faster? folate
Functional indicators of B12 MMA, total homocysteine (no gold standard)
Groups at risk for vitamin A deficiency infants, pregnant, cystic fibrosis, premature infants
Excess vitamin A promotes fractures (retinol only)
Direct measurement of liver vitamin A gold standard of vitamin A (invasive)
Retinol isotope dilution ratio of labeled and unlabeled from blood
Created by: melaniebeale



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