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Obesity & Nutrition
| Question | Answer |
|---|---|
| ATP | Adenosine triphosphate is in cytoplasm of all cells and provides energy for cellular needs |
| kcal | measurement of ATP 1 kcal = amt of energy required to raise 1 kg of water 1 degree 40% converted to ATP 60% used for heat |
| Basal Metabolic Rate (BMR) | Rate of energy used in resting tissue after 12-hour fast BMR in children > adults Declines with age ~2% per decade Body composition: lean vs. fat mass Other: Nutritional status, sleep, fever, temp, stress |
| Carbohydrates | 4 kcal per gram 2 Sources: Milk & Plants 100% converted to glucose (used for energy) Protein-sparing 50-60% of diet Glycemic Index (GI): the rate at which blood glucose levels rise |
| Monosaccharides (type/examples) | Glucose, fructose: fruits, roots, corn, honey |
| Disaccharides (type/examples) | Sucrose, Lactose, Maltose: sugar cane, sugar beets, molasses, maple sure |
| Polysaccharides (type/exmaples) | Complex CHO, Starch, Dietary Fiber: grains seeds legumes vegetables Eat these! |
| Benefits of Dietary Fiber | Aids regular bowel elimination Aids in weight control-increases satiety Reduces glycemic index-possibly slows the rate in which blood glucose levels rise Aids in reducing serum cholesterol levels Reduces risk of cancer |
| Hormonal Actions on Carbohydrates (4 types) | Insulin, Glucagon, Catecholamines, Cortisol |
| Hormonal action by insulin on CHO | glucose uptake by insulin-sensitive cells stimulates glycolysis. gluconeogenesis |
| Hormonal action by glucagon on CHO | Stimulates glycogen breakdown in liver gluconeogenesis. |
| Hormonal action by catecholamines on CHO | Maintain glucose levels. glucose uptake at liver and muscle cells glycogenolysis |
| Hormonal action by cortisol on CHO | gluconeogenesis. cellular glucose uptake |
| Info about Proteints | 1 gram PRO = 4kcal 20% of diet Found in all foods: highest in meats, nuts, legumes Contains nitrogen Tissue growth and repair Synthesis/maintenance Hormones, collagen, antibodies, DNA & RNA, hemoglobin Prevents edema: maintains vascular osmotic pre |
| Hormones and Protein Metabolism | Insulin Amino acid transport into cells. Protein synthesis. Glucagon Increases amino acid movement into hepatic cells. Cortisol Protein breakdown |
| Fats | Most calorie-dense 9 Calories per gram Digested slowly: only @10% converted to glucose Limit to 30% of total calories: Promotes absorption of fat-soluble vitamins Insulate organs in body Steroid, cell membrane synthesis Adds flavor |
| Dietary fats (types and examples) | Saturated solid at room temperature meat/dairy and coconut/palm oils Hydrogenated or trans fats Polyunsaturated safflower,sunflower oils, fish, walnuts Monounsaturated Lowers LDL/maintains HDL canola/olive oil, nuts, avocados |
| Hormonal Actions on Fats | Insulin fatty acid uptake into cells. glucose uptake into fat cells. Glucagon Promotes fat cell lipolysis. Catecholamines fat mobilization. serum FFAs Cortisol fat cell membrane permeability. |
| Nutrient Deficiencies (types) | Vitamin B12 & Folate deficiency Iron Calcium Vitamin D |
| Vitamin B12 & Folate deficiency | RBC formation, cell growth, tissue repair, DNA synthesis Macrocytic, megaloblastic anemias Vitamin B12 deficiency: neuropathy Folate deficiency in pregnant women: Low birth weight, prematurity, neural tube defects |
| Iron deficiency | Most common nutrient deficiency in U.S. Most common anemia |
| Calcium (dfn and sources) | Most abundant mineral 99% stored in bones/teeth Muscle contraction Vascular regulation Sources Dairy: 8 oz. low-fat milk/yogurt, 1.5 oz unprocessed cheese Kale, broccoli Fortified products |
| Calcium deficiency: reasons and results | Adequate vit. D necessary 4 ca absorb Most Americans do not meet recommended intake Calcium deficiency: Loss of bone mass-osteopenia/osteoporosis Possible risk for HTN, CA Adequate calcium intake: High Ca++ may decrease risk for stones Weight man |
| Vitamin D | Fat-soluble vit Necessary 4 Ca absorb in gut Bone growth/remodeling Neuromuscular & immune fcn Inflam Sources: food: fatty fish, beef liver Sunlight, added to foods, dietary supplement in inactive form |
| Vitamin D deficiency | Deficiency Ricketts in children-rare, seen in AA Osteomalacia in adults Obesity-sequestered in fat and less entering blood |
| Nutriton-related Chronic Disease | Cardiovascular disease Type 2 diabetes Hypertension Overweight & Obesity |
| Obesity background and dfn | >100 mil american adults 1.6 bil adults worldwide 20 mil children worldwide Having a very high amount of body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher. |
| disease obesity can contribute to | Hypertension Type 2 diabetes Coronary heart disease Gallbladder disease Certain cancers Dyslipidemia Stroke Osteoarthritis Sleep apnea |
| Obesity as a disease state | Chronic, relapsing neurochemical disease Deranged neural circuitry responding inappropriately to a toxic environment |
| Abdominal Obesity and Insulin Resistance | Fat compartments: Intra-ab (visceral fat) Ab subQ (peripheral fat) Products of abdominal adipose tissue causing insulin resistance Excess free fatty acid release Adiponectin Inflammatory cytokines |
| Adipose tissue | Connective tissue made up of adipocytes expands by Hypertrophy: the normal, 1st response 2 incr caloric intake & growth Hyperplasia: when hypertrophied adipocytes reach a critical vol hyperplasia occurs & the number & size of adipocytes increases signi |
| FFA: dfn | Lipolysis is the breakdown of stored fat into FFA Insulin blocks this In states of insulin resistance (caused by gen & environ factors) FFA secretion is up. FFA are taken up by the liver. |
| FFAs: results | The liver packages FFA into TG rich lipoproteins (VLDL) ->hypertriglyceridemia. Met of high levels of VLDL lead to drops in HDL & sm dense more atherogenic LDL particles. |
| Products of Adipose tissue: cytokines and plasminogen activator inhib 1 | Inflam cytokines (TNF alpha & IL-6) – Enhance endothelial inflam – Incr C-reactive prot (CRP) Plasminogen activator inhibitor 1 (PAI-1): prothrombotic substance |
| Products of Adipose tissue: Adiponectin & Leptin | Adiponectin – adipose tissue product that fights insulin resistance. Decreased in obesity. • Leptin – protein that affects satiety. Obesity possibly r/t “leptin resistance” |
| Weight Assessment: BMI | BMI: weight Lbs./height (in)2 x 705 weight in Kg/height in meters2 18.5-24.9 kg/m2 Healthy weight 25 - 29.9 kg/m2 Overweight > 30 kg/m2 Obese |
| Weight Assessment: Waist circumference and waist-hip ratio | Waist circumference: men < 102 cm or 40 in, women < 88 cm or 35 inches Waist-to-hip ratio 0.95 men 0.8 women waistline measurement (in) Hip measurement (in) |
| Hypertension | Despite insulin resistance in adipose & muscles kidneys remain insulin sensitive. High insulin increases renal na retention 50% of pts w/ essential htn have insulin resistance. Insulin resis pts with HTN are at more risk of CVD than non-insulin resis p |
| Polycystic Ovarian Syndrome | Sex specific metabolic Syndrome XX 5-10% prevalence. Multigenetic characterized by hyperandrogenemia & insulin resis. Muscle & adipose cells are resistant to insulin -> hyperinsulinemia, ovary is normal responsive to insulin. -> more ov testosterone pr |
| Polycystic Ovary Disease High risk of other insulin resistant problems | • Glucose metabolism – By 4th decade patients have • 35% risk of IGT • 10% risk of DM2 • Sleep Apnea • Lipid abnormalities • Coronary artery disease |
| Nonalcoholic Fatty Liver Disease | • Resis of insulin action on adipose -> increased FFA release. • If the liver takes up these FFA, converts them to TG but lags behind in packaging the TG in VLDL particles, fatty liver results. • Correlates better with insulin resistance than obesity. |
| Obesity Etiological Factors | Energy Density & Food Intake – Energy density of diets is increasing. – Avail of processed foods/super-sizing Reduced phys activity, sedentary Behavioral / Social factors Poverty |
| Increased Energy Density of food | Standard food portions have increased over the last 20 years |
| Metabolic syndrome dfn | Cluster of mult metabolic risk factors Atherogenic dyslipidemia Elevated blood pressure Elevated plasma glucose Prothrombotic state Proinflammatory state |
| Underlying Risk Factors of the Metabolic Syndrome | Overweight/obesity (esp. abdominal obesity) Insulin resistance Additional underlying factors Physical inactivity Aging Endocrine dysfunction Genetic factors |
| ATP III Definition of Cardiometabolic syndrome (CMS) | Must have three of the following: Fasting glucose > 110 Waist circumference > 40" in men & > 35" in women Triglycerides > 150 mg/dl HDL Cholesterol levels <40mg/dL in men and < 50mg/dL in women ● Blood pressure > 130/85 |
| Metabolic Concomitants of Insulin Resistance | Atherogenic dyslipidemia -High TG/HDL-C ratio Higher bp Hyperinsulinemia and hyperglycemia/impaired glucose tolerance Prothrombotic and proinflammatory states Endothelial dysfunction and microalbuminuria Fatty liver |
| Obesity therapy | Lifestyle changes Behavioral Therapy Pharmacological interventions |
| Sibutramine (Meridia) | Seratonin-norepinephrine reuptake inhibitor Contraindicated: uncontrolled HTN CAD, HF, arrhythmias, stroke Patients on SSRIs or MAOs |
| Orlistat (Xenical, Alli) | Pancreatic lipase inhbitor Decreased intestinal absorption of fat May interfere with absorption of fat-soluble vitamins Severe GI side effects-require adherence to low-fat diet |
| Nutrition and the Nursing Process Assessment | Anthropometrics; weight, BMI Skin integrity Lab values; glucose, cholesterol, albumin, hemoglobin Physical/cognitive abilities I & O’s Diet history-cultural/religious preferences Food preferences |
| The Five A’s of Nutrition Intervention | Ask about current eating habits and knowledge Advise about desirable changes and why Assist in identifying/making changes that the patient is willing to make Arrange for support Adopt a follow up plan |
Created by:
Marissagostanian
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