Domain II

3.5-5.0g/dl

• Edema
• DOES NOT REFLECT CURRENT PROTEIN INTAKE --> LONG HALF-LIFE

>200mg/dl

• Rising levels indicate iron deficiency
• -can also be determined by TIBC total iron binding capacity

Dehydration

16-40mg/dl

• Better indicator of protein malnutrition.
• -short half-life helps pick up changes in protein status quickly

3-6mg/dl

Best indicator of current protein malnutrition. Travels with prealbumin/transthyretin with a 12 hour half-life.

Men 44%, Women 38%, Pregnant 33%

Measure of cell number in whole blood

Men 14-17 Women 12-15 Prego < or equal to 11

Hb is the iron containing pigment of RBC (which are produced in the bone marrow) -->anemia

Male 12-300ng/ml, Female 10-150ng/ml

Size of Iron Storage Pool

0.6-1.4mg/dl

• Measures somatic protein as related to muscle mass.
• >Renal Disease OR
• >Muscle Wasting

80%

• Creatinine Excreted / 24 hours OVER Height
• >Estimates LEAN body mass - somatic protein
• >@ 60-79% there is mild muscle depletion

10-20mg/dl

• Related to protein intake
• >Indicates renal disease

10-15:1

115+/-20ml/min

A measure of GFR and Renal Funx

• Normal >2700 cells/cu mm
• Moderate depletion 900-1800
• Severe depletion <900

• Immunocompetency
• Levels decrease with protein-energy malnutrition

• Marker of Acute Inflammatory Stress
• Low levels indicate need for nutrition therapy

• Direct measure of toxic effects of lead on heme synthesis.
• Levels increase with lead poisoning
• Lead depletes iron --> ANEMIA
• Displaces CALCIUM in the bone --> ZINC DEFICIENCY

• 11-12.5 sec
• 85-100% if normal

• Prolonged PT with Anticoagulants 
• Evaluates Clotting Adequacy
• Vitamin K intake will alter PT

• Not for nutritional analysis
• Useful in measuring intake of toxic metals

• Sedentary BEE X 1.2
• Active BEE X 1.3
• Stress BEE X 1.5

• Appetite Stimulant 
• M.A. > Mega Appetite or megestic appetite or appetite fit for a king

Binds to LIPASE to decrease FAT absorption

• Appetite Stimulant 
• Same as megestrol acetate (M&Ms stimulate the appetite)

Decrease LDL & TG AND Increase HDL

Malabsorption (not only are they not hungry and in need of Marinol and Megestrol they also don't absorb well)

Decrease the absorption of fat and fat soluble vitamins 

• Protein deficits 
• GCs treat diseases caused by an overactive immune system, such as allergies, asthma, autoimmune diseases, andsepsis.

Decreases Folate, B6, and C

Deplete K, Na, Mg, Ca, Chloride

Decrease K, Mg BUT absorb Ca

• Decrease Vitamin K
• Depletes protein

• Decrease Bone Growth
• CHO intolerance
• Raise Blood Sugars

• Decrease FOLATE
• Anti-cancer agent

• Weight Gain
• Increased appetite
• Sodium and caffeine cause lithium excretion and prevent toxicity

• Diminishes Vit K (supplementation required)
• Avoid Ginko Biloba, garlic, ginger and high doses of Vitamin A & E

• Administered in oil 
• Consider Fat calories

Decreased folic acid, Vit B12, D, K, B6

Hyperlipidemia, hyperglycemia, hyperkalemia, hypertension (cyclosporin is psycho)

• Depletes pyrodoxine (B6)
• Peripheral neuropathy
• Interferes with vitamin D
• Don't take with food

• Sedative effect
• Weight gain
• Increased appetite

Levadopa

Tetracycline

• MAOI (monamine oxidase inhibitor) for parkinson's and depression
• Tyramine is a part of tyrosine and is a stress hormone releaser.
• Tyramine and MAOI together will release NE and elevate BP

• Eliminate dopamine and tyramine
• Restrict aged, fermented, dried, pickled, smoked, and spoiled foods (bacteria release causes the formation of amines)
• Avoid hard, aged cheese, sauerkraut, sausage, lunch meats, tofu, miso, chianti wine
• Limit sour cream, yogurt, and buttermilk
• BUY COOK EAT FRESH FOODS

• Population by age
• Ethnic groups
• Sex
• Birth rates
• Deaths

• Census data
• Housing statistics

# of new cases of a dz over a period of time/total # of people at risk ALL X 100K

Total # of people with a dz during a period of time/Average # of people ALL X 100K

• 1. Demographic Information
• 2. Socioeconomic status
• 3. Morbidity and Mortality ratios
• 4. Incidence
• 5. Prevalence
• 6. Identify accessible services (dental, medical, etc.)
• 7. Cultural factors, geographical, unemployment, environment
• 8. School nutrition programs, educational achievement, language spoken
• 9. Welfare programs, % on aid
• 10. Transportation availability 
• 11. Anthropometric, biochemical, clinical dietary intake data

• The access by all people at all times to sufficient food for an active and healthy life.
• Ready availability of nutritionally adequate and safe foods
• Assured ability to acquire them in a socially acceptable manner

Ensures that all have access to culturally acceptable, nutritionally adequate food at all times

• 1. Farmer's Markets
• 2. Food recovery and gleaning programs - collect whole foods trash food and deliver to poor
• 3. Prepared and Perishable Food Programs (PPFP) - unused cooked and fresh foods to the hungry

• Examination of population at particular time
• Cross-sectional
• Prevalence of condition at specific time

• Continuous collection of data
• Associated with WIC, CDC, EPSDT (early periodic screening diagnosis and treatment)
• Identifies needs and type of intervention needed

• Identify nutritional problems for elderly (above 80) early and improve care
• DETERMINE checklist - determines nutritional risk
• LEVEL I screen to see who needs more assessment
• LEVEL II used with those at higher risk of medical and nutritional problems

• Means of nutritional surveying
• 5-12 people talk about concerns, beliefs, problems
• Advice, insights, info
• Attitudinal data

• All data collection and analysis activities of the federal government 
• DHHS and USDA

• Native American and Alaskan Natives
• Tried to determine causative factors for obesity
• Genetics or physical activity?
• Consumed 12% less than the average american yet experienced increased heart dz and diabetes
• Lack B vits and antioxidants 

• DHHS
• Birth-17 yrs w/ emphasis on 0-5
• Ht, wt, birth-wt, Hct, Hb, cholesterol, BF
• Growth & Nut status
• Infant Feeding

• DHHS
• Pregnant women
• Maternal wt gain, anemia 
• Identify and reduce risk factors (smoking, drinking) birth wt, # of women who BF)

• Ongoing to retrieve info on health of Americans in general
• Clinical, chemical, anthropometric, nutritional data
• NHANES III - Large sample over 65
• NFNS + CSFII
• Six one day food and nutrient intakes by individuals over one year

• Info on intake of individuals and households all over US
• Protein, calcium, iron, thiamin, riboflavin, C, A
• Diet good if = or > RDA
• Poor if < 2/3 RDA

• DHHS
• > 18 years in households with telephones
• Ht, wt, smoking, alcohol, fat, fruits, veggies, preventable health problems, diabetes

• DHHS
• Grades 9-12
• Smoking, alcohol, wt control, exercise, eating habits

• DHHS
• > 18 trying to lose weight
• BMI, diet hx, self-perception

• USDA
• Assesses the main meal preparer of the house
• Beliefs about food safety, labels, knowledge of nutrients

The state determines eligibility of needy families and their potential benefits and services

• Provides food to meet the needs of children and adults
• Supports American farmers
• Food to School Lunch, Elderly feeding, supplemental food programs

• State
• Monthly commodity canned, packed foods
• Women (pregnant, BF, postpartum), infants, children up to 6 years, elderly, @ nutritional risk

• Local, private nonprofit agencies
• Quarterly distribution
• Supplements diets

• USDA Food and Nutrition Service (FNS)
• Utilize surplus production of food to feed children
• grants and donations, schools reimbursed based on # meals served
• DGs
• Lunch must be 1/3 of recommended intake for calories, protein, A, C, iron and calcium
• Amended 1977 NET Nutrition Education Training Program

• USDA
• Meals must meet DG
• 1/4 of daily protein, calories, A, C, Iron, Ca

• USDA
• Healthy Snacks

• USDA
• Encourage milk consumption
• Subsidy for milk to children in school, and after school programs
• Free milk to needy kids

• USDA School Lunch; FNS, state ed programs, summer camps
• Encourage foodservice programs to children who are NOT in school

• USDA
• Supports public and nonprofit food service programs for day care and neighborhood house 
• Reimburse for meal cost, commodity food, nutrition education

• USDA
• Pregnant & Infants and children up to 5
• Low income mothers at nutritional risk
• REQUIRED health exam
• Iron-fortified formula, cereal, milk, cheese, fruit
• NOT entitlement program: fed $ caps out
• Priority: preg, BF, infant <1yr

• USDA
• Grants to university that encourage community development
• Nutrition aides to educate the public
• Works with small groups, teaching skills needed to maintain a healthy diet

• DHHS
• Title V of SSA
• Public Health nutrition programs @ state and local
• Training consulting funding
• Women of child bearing age, infants, children, state eligibility requirements

• DHHS
• Reduce infant mortality
• Health of women, infants, children, fams

• USDA Older Americans Act Title III
• Foster independent live
• $ and commodity to state

• DHHS
• Offshoot of NSIP Nutrition Services Incentive Program
• 1. One hot meal every day 5 days/week (1/3 of recommended intake)
• 2. 60 and older + spouse
• 3. Congregate meals - ambulatory for rural elderly
• 4. Home delivered meals - Meals on wheels
• 5. Counseling, nutrition education, social interaction

• USDA
• Low income with monthly benefits 
• Not for non-food items
• Thrifty food plan for June of preceding year
• Least costly of 4 USDA food plans

• DHHS
• Health insurance for >65
• ESRD any age
• Part A - Hospital insurance
• Part B - Optional insurance for supplementary benefits

• DHHS
• Federal law administered by state
• Payment for medical care for all eligible needy: all ages, blind, disabled, dependent children

• DHHS
• Ages 3-5
• New foods and good habits to kids (activities)

• USDA 1977
• Amendment to School Lunch Act
• Nutritional education to teachers and foodservice staff

Burns, accidents, obstructions, severe dehydration

• Oliguria (urine output <500ml)
• Azotemia (N in the blood)

IV glucose, lipids, protein

• Oliguric phase -> Edema (low salt, low fluid)
• Diuretic phase (adequate salt to replace loss)
• -Replace fluid output from the previous day + 500mL

• Defect in the capillary membrane of the glomerulus 
• Protein is allowed into the filtrate and tubules

• Albuminuria
• Edema
• Malnutrition
• Hyperlipidemia: Inc synthesis and Dec clearance of VLDL

• Anemia: decreased EPO
• Blood pressure: upset
• Vitamin D: Not activated & decreased Ca absorption

• Solutes excreted in 1L urine
• Measures NITROGEN (60%) and SODIUM/ELECTROLYTES
• Daily Fixed: 600mOsm

• Syndrome of inappropriate antidiuretic hormone
• Hyponatremia: hemodilation
• Fluid restriction

• Anorexia
• Weakness
• Wt loss
• Nausea
• Vomiting 
• Anemia: deficient EPO

• BUN: >100mg/dl (normal 10-20mg/dl)
• (related to protein intake and assoc with renal dz)
• Cr: 10-12mg/dl (normal 0.6-1.4mg/dl)
• (related to muscle mass/somatic protein and can indicate renal dz and muscle wastage)

Giovanetti diet (20g HBV protein)

Retention of Nitrogen Metabolites

• Giovanetti Diet (20g HBV protein)
• Increase calories
• Control Edema
• Prevent deficiency

Continuous ambulatory peritoneal dialysis 4-5x/day

• Aspart (Novolog)
• Lispro (Humalog)
• Notes: When the LISPing Beaver's ASs PARTs a LOG leaves RAPIDLY 

5-15min

• 4 Hours 
• Note: 4 hours in between meals. Get you from one meal to the next.

Regular Insulin

30-45 min before meal

3-6 Hours

• NPH
• Note: Neutral PH is INTERMEDIATE

• Glargine (Lantus)
• Determir (Levemir)
• Note: Levemir and Lantus are the LONG bearded wizards. They are GLARGely DETremental.

2-4 hours

18-24 hours

Increased need for insulin at Dawn due to increased glucagon action breaking down glycogen to battle fasting hypoglycemia

• Pre-breakfast - Reg:NPH 1:2
• Pre-supper - Reg:NPH 1:1

• Pre-breakfast: Regular + NPH
• Pre-supper: Regular
• Pre-bedtime: NPH (a little longer than short acting to battle the Dawn surge)

• Multiple Daily Injections
• Before meals (3x): Regular
• 1-2X/day: NPH

• Basal, Rapid-Acting, or Short Acting pumped continuously
• BOLUSES of insulin given before meals

• Bedtime: Glargine (Lantus) offers basal insulin
• Meals: Rapid Acting BOLUS

• Sulfonylureas, meglitinides (Gluctorol)
• Note: Mega Glucosaurs Troll Secretly in the Sulfur pools of Yellowstone

• metformin (Glucophage)
• Note: The BIG one. Macrophage is the BIG bacteria eater. Glucophage is a BIG sugar eater.

Promote Insulin Secretion

• Enhance insulin action
• Suppress Hepatic Glucose production

• Actos
• Note: Thia...blah blah blah is a long word that is represented by Big Fish arms. It ACTS on peripheral insulin sensitivity

• Acarbose, Precose
• Note: verbOSE and PREtentious honors society members

• Inhibit enzymes that digest carbohydrates
• Delay absorption

• Byetta
• Note: Princess Byetta EXists in a far away land

• Enhances insulin secretion 
• Suppresses postprandial glucagon

pramlintide (Smylin)

Decreases glucagon production

Insulin and rehydration (polyuria/polydypsia)

• The pancreas releases too much insulin OR Insulin excessively sensitive
• Blood glucose falls <50mg/dl 2-5 hours after eating

To prevent rapid rise in blood glucose that might stimulate excessive insulin

• Atrophy of the Adrenal Cortex
• Decreased Cortisol: glycogen depletion, hypoglycemia
• Decreased Aldosterone: NA loss, K retention, dehydration
• Decreased Androgenic: tissue wasting, wt loss

• Excess secretion of thyroid hormone
• Elevated T3 and T4
• Increased BMR = Wt loss

• Thyroid hormone deficiency
• Low T4 with Low or Normal T3
• Decreased BMR = Wt Gain

Inadequate iodine intake leading to insufficient thyroid hormone

• Iodized salt
• Foods without GOITROGENS (inhibit synthesis thyroid hormone)

• Dysfunctional purine metabolism
• Increased serum URIC ACID (deposits in joints)

• broth
• anchovies
• sardines
• organ meats
• sweetbreads
• herring
• mackerel

• Urate Eliminate
• Colchicine
• May cause nutrient loss

• Missing enzyme that metabolizes galactose
• TREATED SOLELY BY DIET

• Organ meats
• MSG extenders
• Milk
• Lactose
• Galactose
• Whey 
• Casein
• Dry milk
• Solids
• Curds
• Calcium
• Sodium caseinate
• Dates
• Bell peppers

• Soy
• Hydrolyzed casein
• Lactate
• Lactic acid
• Lactalbumin
• Pure MSG

Ammonia accumulation

• Vomiting
• Lethargy
• Seizures
• Coma 
• Anorexia
• Irritability

OTC Ornithine transcarbamylase deficiency

• Missing phenylalanine hydroxylase
• Unable to convert phenylalanine into tyrosine
• Poor intellectual function

Guthrie blood test

• Formulas low in phenylalanine:
• Phenex 1,2
• Phenyl-free 1,2
• No aspartame

• Deficiency of glucose-6-phosphatase in liver
• Impaired gluconeogenesis and glycogenolysis

Hypoglycemia: liver can convert glycogen to glucose

• Inherited disorder of amino acid metabolism
• Elevation of methionine and homocysteine (w/ high homocysteine in the urine)

• Cannot metabolize BCAA (LIV)
• Poor sucking reflex, anorexia, FTT, irritability, sweet burnt maple syrup odor of seat and urine

Formula with BCAA for maple syrup urine

• High CHO and fat to save Amino Acid
• Restrict BCAA
• Small amounts of milk for growth
• Gelatin (No BCAA)
• Avoid eggs, meat, nuts, dairy