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how many cals in pound?
3500
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what are micronutrients used for?
- required for use of major nutrients
- provide structural materials
- regulate metabolism, A/B balance, osmotic P
- maintain nerve and muscle irritability
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amt of carb body store in g
250 g
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where are carb body stores stored? as what?
in liver and mm as glycogen
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how long do carb body stores last before depleted?
15-20 hrs
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how much energy does PRO store in body in g?
6K
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what is PRO stored as in body?
- plasma protein
- hgb
- clotting components
- hormones
- Abs
- skeletal and smooth mm
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what is the amt of our bodies fat stores in g?
15K
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how is fat stored in body?
as triglycerides
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why is fat an excellent energy source?
b/c breakdown doesn't compromise essential body fx
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what happens in first 15-20 hrs of starvation?
all glycogen stores depleted (from mm and liver)
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in starvation, which energy is used after carbs?
fat
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what happens to metabolism in starvation?
why?
slows, to conserve PRO
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what happens once PRO breaks down in starvation process
- impaired wound healing
- decrease resistance to infection
- impaired work of breathing
- multi system organ failure
- death
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what conditions cause stress process?
- major trauma
- surgery
- sepsis
- burns
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what happens in first 15-20 hrs of stress process?
what next
CHO / carb stores depleted. then PRO loss.
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what differs b/w stress and starvation process (2)
- 1. in stress, PRO lost following CHO loss. in starvation, fat lost following CHO loss.
- 2. metabolism slows in starvation, speed up in stress
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where are catecholamines released?
adrenal medulla
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where are growth hormones released?
anterior pituitary
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where are glucocorticoids released?
adrenal cortex
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where is glucagon released?
alpha cells of pancreas
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at what age is brain at 100% of adult size
8 y/o
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what age should you switch to low fat diet?
2 y/o
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how should calorie intake change following puberty?
decrease by 200-300 cal
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avg wt gain / yr in women ages 20-40 y/o
1#/yr
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list 2 ways that med side FX can affect GI system
- nausea decreases intake
- diarrhea decreases absorption
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what happens to a person calorie needs in old age?
- decreased cal needs
- d/t decreased metabolic rate and decreased activity
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define overwt and underwt as a percentage of IBW
- underwt: <80% IBW
- overwt: >120% IBW
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mypyramid.gov recommends serving sizes bades on what? which important body statistic is ignored?
based on: age, gender, activity level
ignores wt
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what's recommended % of cals from fat?
25-35% from fat
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what's recommended % of cals from saturated fat?
<7%
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what's recommended % of cals from polyunsaturated fat?
<10%
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what's recommended % of cals from monounsaturated fats?
<20%
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what is daily rec for cholesterol in mg?
<200 mg/day
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ex of saturated fat?
anything solid at room temp
ex: meat fat, palm oil, coconut oil
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ex of polyunsaturated fat?
corn oil, safflower oil
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ex of monounsaturated fat?
avocado, olive oil
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where is cholesterol found?
any animal source
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which type of fat is most athrogenic?
trans
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approximate % of cal from fat in fast food?
40-45%
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recommended % of total cal from CHO, PRO, FAT?
- CHO: 50-60%
- PRO: 14-20%
- FAT: 25-35?
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amt of daily recommended fiber?
25-30g/day
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define binge drinking
>= drinks at once
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define ETOH moderation.
- men: 2 drinks / day
- women: 1 drink / day
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define "1 drink" in amt of wine, beer, hard liquor
- beer: 12 oz
- wine: 5 oz
- hard liquor: 1 oz
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list # cals, total fat, sat fat in whole milk (4%).
- cal: 150
- total fat: 8 g
- sat fat: 5 g
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list # cals, total fat, sat fat in 2% milk?
- cal: 120
- total fat: 5g
- sat fat: 3g
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list # cals, total fat, sat fat in 1% milk?
- cal: 100
- total fat: 3 g
- sat fat: 1.5
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list # cals, total fat, sat fat in skim milk?
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what is ACE in regards to nutritional health?
adverse childhood events
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why ask about meds in health history?
affect absorption, utilization, and metabolism of nutrients
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what is WDWN?
well developed, well nourished
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where do nutritional problems manifest themselves? (where to look in PE?)
where there is rapid turnover of epithelial cells:
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how can you observe decreased intravascular PRO in PE? why?
generalized edema
fluid moves out of blood vessels d/t decreased oncotic P
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what causes oncotic P?
"pulling force" of plasma proteins, pulling fluid to where the proteins are
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how do you measure ideal body weight in women?
100 lbs for the 1st 5 ft plus 5 lbs for each additional inch
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How do you measure the ideal body weight in men?
106 lbs for the 1st 5 ft plus 6 lbs for each additional inch
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What is the % variation allowed for ideal body weight in men AND women based on frame size?
+ or - 10% for a large or small frame
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how does BMI define underweight?
<18.5
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how does BMI define normal?
18.5-24.9
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how does BMI define overweight?
25-29.9
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how does BMI define obese?
> or = to 30
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What are the diseases that increase as the BMI increase?
ex. CV disease, HTN, OA, DM, etc.
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How is mild malnutrition defined as % of IBW
80-90% of IBW
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How is moderate malnutrition defined as % of IBW?
70-79%
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how is severe malnutrition defined as % of IBW?
<70% of IBW
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What are the ranges for significant unintentional weight loss?
- >5% in 1 month
- >7.5% in 3 months
- >10% in 10 months
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How do you calculate recent weight change as a percentage?
[(usual weight -current weight)/usual weight x 100]
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what does abd obesity predispose you to?
- type II DM
- dyslipidemia
- HTN
- CV disease
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what waist circumference is significant for ^ disease risk for men and women?
- men: > 40 in
- women: > 35 in
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what are anthropometric measurements?
what does it indicate?
for what pop is it not helpful?
triceps skin fold
indicates % body fat
not useful for elderly d/t changes in fat distribution and saggy skin
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2 methods for measuring frame size
- elbow breadth
- ht to wrist ratio
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when would you use arm span to estimate ht?
when pt is bent over and can't stand straight
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what do BMR and REE stand for?
- BMR: basal metabolic rate
- REE: resting energy expenditure
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what to BMR and REE measure? what units are they in?
measure minimal rate of energy expenditure needed to sustain life
in cals
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what regulates BMR/REE?
thyroxin, a thyroid hormone
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what factors cause ^ BMR?
- children, pregnant women
- lean body mass
- fever
- stress
- hot or cold environmental temps
- ^ thyroixin
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what factors cause decreased BMR?
- fasting or starvation
- obesity
- malnutrition
- decreased thyroxin
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what is the harris-benedict equation used for? what is its shortcoming?
estimates BMR.
overestimates BMR in overwt/obese ppl
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what is the mifflin equation used for? why is it preferred over harris-benedict?
used to measure BMR. factors in activity level
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what are approximate cal needs for kids?
1000 cal/day for 1 yr, then 100 additional cal/day for each yr up to age 12
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in pregnancy, what deviation from IBW indicates risk?
< / > 10% IBW
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what height decrease is expected for males and females in aging?
what causes this?
- females: 2 in
- males: 1.25 in
compression of vertebral space, kyphosis, bent knees
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what are normal hgb ranges for men and women?
- men: 14-18 g/dl
- female: 12-16 g/dl
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what hgb levels indicate anemia in men and women?
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pss causes of anemia?
- Fe, b12, folic acid deficiency
- blood loss
- chronic disease
- bone marrow disease
- overhydration --> hemodilution
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what would cause elevated hgb?
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what is polycythemia? what causes it?
polycythemia = too many RBC
chronic hypoxia
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how does dehydration contribute to elevated hgb?
^ hemoconcentration of blood
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what is formula for HCT?
hgb x 3 = hct
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what are normal hct levels for males and females?
- male: 37-49% (meaning 37-49% of total blood vol comes form RBCs)
- females: 36-46%
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goal lipid level for HDL
>50 mg/dl
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goal lipid levels for LDL for person with:
0-1 CAD risk factors
2 or more CAD risk factors
DM, CAD
- 0-1 CAD risk factors: < 160 mg/dl
- 2 or more CAD risk factors: <130
- DM, CAD: <100 or <70 in some cases
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what is goal lipid level for triglycerides in blood, fasting?
<150 mg/dl
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know CAD risk factors from notes
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how does high sat fat diet influence cholesterol and LDL?
low sat fat diet?
- high: raises cholesterol & LDL
- low: lowers chol. & LDL
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How does exercise influence cholesterol and HDL?
lowers cholesterol and increases HDL
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Know that genetics influence HDL levels
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What does Serum Albumin measure?
it measures visceral PRO stores
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What is the normal value of serum albumin levels?
3.5-5.5 gm/dl
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What protein store has the longest half life?
Serum Albumin- 17-20 days- indicates nutritional status almost 3-weeks prior
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How do we measure malnutrition with serum albumin?
- 2.8-3.5 = moderate visceral protein depletion
- < 2.8 g/dl = severe malnutrition
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What does serum transferrin do?
It is a protein that carries iron
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What is the half life of serum transferrin?
Shorter half life than albumin (8-10 days), therefore this is an earlier indicator of malnutrition than serum albumin.
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What protein has the shortest half life?
Prealbumin. Its half life is (2-3 days), therefore this is more reflective of current nutritional status.
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What is nitrogen measured by?
BUN= blood urea nitrogen.
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Nitrogen is the by-product of what?
protein breakdown
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What is a negative nitrogen balance?
Increase BUN may indicate protein catabolism and is referred to as "negative nitrogen balance"
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When is an increase BUN seen?
high protein intake, muscle trauma/destruction and decreased excretion as seen with renal failure.
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What is the normal nitrogen value?
8-25 mg/dl
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What is primary malnutrition?
- Due to dietary deficiencies
- Types- Marasmus and Kwashiorkor
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What is Marasmus?
PRO and calorie malnutrition (eg cancer cachexia)
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What is Kwashiorkor?
diets high in CHO/calories; low only in PRO
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What is secondary malnutrition?
- Malabsorption (e.g. gastrointestional disease, vomiting)
- Medication side effects (e.g. N & V, decreased absorption of nutrients)
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