| 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 |
