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In patients with a BMI greater than____ kg/m2, there is little additional risk from elevated waist circumference
35 kg/m2
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At the present time, the most commonly encountered nutritional problem seen in clinicalpractices in the United States and many developed countries is
obesity and its associated complications.
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Tests to perform for alcoholism
ALT, alanine amino transferase; AST, aspartate amino transferase; GGT, gamma-glutamyl transferase; thiamine, folate, vitamine b12
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Tests to perform for anemia
Complete blood count, CBC, serum iron and ferritin, total iron binding capacity (TIBC), transferrin saturation, mean corpuscular volume (MCV), reticulocyte count, red blood cell folate, and serum vitamin B12
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Test to perform for Diabetes
Fasting serum glucose, hemoglobin A1c, insulin levels, C-reactive protein (CRP), serum and urinary ketone bodies
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Tests to perform for Eating Disorders
Potassium, albumin, serum amylase, thyroid studies, beta carotene aspartate amino transferase (AST), alanine aminotransferase (ALT), and anemia.
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Tests for Fluid, Electrolyte, and Renal Function
Sodium, potassium, chloride, calcium, phosphorus, magnesium, blood urea nitrogen (BUN), creatinine, urine urea nitrogen, urinary and serum, oxalic acid, and uric acid
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Tests for Hyperlipidemia
: Cholesterol, triglyceride, low density lipoprotein – cholesterol (LDL-C) , high density lipoprotein – cholesterol (HCL-C), homocysteine, and thyroid stimulating hormone (TSH) (secondary cause).
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Test for Musculoskeletal pain, weakness
25(OH) vitamin D, phosphate, PTH
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Test for malabsorption
24-hour fecal fat, barium studies, electrolytes, albumin, serum triglyceride, and hydrogen breath test
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Test for metabolic syndrome
Fasting serum glucose, lipid panel, and uric acid
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Test for refeeding syndrome
Albumin, calcium, phosphorous, magnesium, and potassium
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The half life of serum albumin is approximately ____ days and is indicative of nutritional status over previous ___ months
18 to 20 days ; 1-2 months [not a good indicator of recent dietary status or acute changes in nutritional status (less than 3 weeks)]
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What levels of serum albumin are indicative of increased mortality/morbidity
<3.5 mg/dL
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The half life of serum transferrin is approximately ____ days and is indicative of ____, ____, and ___ intake over the previous ____
8-9 days; iron, protein, and calorie intake; 1-2 weeks
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Half life of serum prealbumin is ___ days and is indicative of ___ and ____ intake over previous _____.
2-3 days; protein and calorie intake; previous week. Note: Prealbumin levels may be falsely elevated with renal disease. However, as with albumin, the level is reduced with severe liver disease
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Main Dietary deficiency in Pregnancy
Folate
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Main Dietary deficiency in Alcoholism
Folate, Vitamin B12, Thiamine
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Main Dietary deficiency in Anemia
Iron, vitamin B12, folate
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Main Dietary deficiency in Ascites
Sodium, protein
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Main Dietary deficiency in Beri Beri
Thiamine
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Main Dietary deficiency in COPD/asthma
Vitamin D, Calcium
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Main Dietary issues in Kidney Stones
Uric Acid, oxalate, calcium
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Main Dietary deficiency in Pellagra
Niacin
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Main Dietary deficiency in Malabsorption
Vitamins A, D, E, K
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Dong Auai/warfarin interaction
Increased INR and bruising
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Siberian ginseng/digoxin interaction
Raised digoxin concentrations
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Gingko biloba/ASA/warfarin interaction
Spontaneous bleeding
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Ginseng/warfarin interaction
Decreased INR
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St. John’s wart /SSRIs /OCTs /Indinavir /cyclosporine interactions
Serotonin syndrome/Decreased serum drug levels
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Yohimbine/tricyclic antidepressants interactions
Hypertension
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The main target of herbal toxicity is
The liver
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Asian and American Ginseng is used as
An adaptive treatment for emotional changes and stress. Efficacy has not been established
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Black Cohosh is used for
Treatment of menopause and a replacement for hormone therapy. Studies contradict its ability to relieve menopausal symptoms. Side effects: minimal gastric distress
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Soy protein is used as
A hormone replacement therapy alternative and menopausal treatment. Physicians believe it is safe to use
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Chamomile is used as
A calming agent, anti-inflammatory, and anti-spasmodic agent. Often used to treat colic and used topically in cases of skin disorders. Side effects: can cause allergic reactions in those allergic to ragweed
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Echinacea is used to treat
Mild upper respiratory illness. Data suggests its use shortens duration of illness. Patients with Autoimmune disorders should not use due to its immune stimulating efffects.
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Ephedra (Ma Huang) is used for
Asthma, nasal congestion, and weight loss. Side effects: arrhythmia, tremor, hypertension. Death has been reported. Usually not recommended
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Ginger is used for
Motion sickness, and digestive aid for indigestion. No known clinical side effects. Shows significant capacity to prevent and treat motion sickness
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Garlic is used to
Treat infections, heart disease, and diabetes. Also used as an anti-thrombritic agent and anti-oxidant. Long term beneficial effects have not been established. Side effects: bad breath and body odor, risk factor for bleeding, flatulence, indigestion.
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Gingko is used for
Cognitive function, treat dementia and Alzheimer's in the elderly, premenopausal syndrome (PMS), vascular insufficiency. Side effects: mild gastrointestinal symptoms, such as constipation, stomach upset, and allergic skin reactions. More research needed to prove efficacy for dementia
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Milk thistle is used as
A hepatoprotectant in patients with viral hepatitis as well as cirrhosis of the liver from alcoholism
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Diets that lead to high body fat is a risk factor for which cancers?
Colon cancer, Breast cancer, Prostate Cancer. In the United States, a very high caloric diet is consumed with 37% of the calories coming from fat.
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Dietary Protein intake is associated with which forms of cancer.
Breast, colon, kidney, uterus, prostate
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Which vitamin plays an important role in cell growth and differentiation, particularly of epithelial (skin) tissue, and is linked to lowering cancer risk?
Vitamin A
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What are the best food sources for vitamin A?
Butter, milk, and liver
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Which vitamins prevent the formation of N-Nitroso compounds and act as anti-oxidants?
Vitamins C & E- also reduce the risk factor for cancers of the mouth and stomach
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Cervical Dysplasia was found in women whose diet was deficient in what vitamin?
Vitamin C
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More than ___ g of fiber should not be consumed in a day.
35g/day can cause intestinal discomfort and obstruction
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Food sources of flavanoids include....
soybeans and citrus fruits
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Polyphenols are found in high amounts in
Tea
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Indoles are found in high concentration in...
Cabbages
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Isothiocyanate is found in...
Broccoli and cruciferous vegetables
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Organo-sulfur compounds are found in.....
allium plants, garlic and onions
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