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  1. Observational research design
    • study in which individuals are observed or certain outcomes are mesaured
    • no attempt (treatment) given to affect the outcome
  2. Cohort Research Design
    • study thtat compares a particular outcome in groups of individuals who are alike in many ways but differ by a certain characteristic
    • ex female nurses whos smoke compared those who dont
  3. Case control Research design
    • compares two groups of people
    • with disease or condition under sdudy(cases) and a very similar group of people who do not have the disease or condition (control)
    • study medical,lifestyles
    • learn factors
    • ex. one given a substance that other was not
  4. Epidemiological Research design
    • the branch of medical science that deals with the study
    • incidence
    • distribution
    • control of a disease in a population
  5. Randomized clinical Trial research
    • study in which the participants are assigned by chance to seperate groups that compare idfferent treatments
    • rsearchers nor the participants can choose group
    • patients choice to be randomized trial
  6. Cross Sectional research
    • analysis studies the relationship between different variables at a point in time
    • relationship between income,locality,and personal expenditure
    • related to how variables affect each other at same time and period
  7. Longitudinal research design
    • correlation research study involves repeated observations of the same items over ling periods of time
    • often many decades
    • type of observational study
    • used in psychology developmental trends
    • track same people
    • also used in medicine
  8. Prospectie Research
    • follows over time groups of individuals who are alike in many wasy but differ by certain characterisics
    • ex female nurses smoke and dont
    • compares them in a particluar outcome
    • may be combined as prospective cohort study
  9. Case Study research
    • detailed report of the diagnosis treatment and follow up of an individual patient
    • contain some demorpgraphic information
    • age,gender,ethnic origin
  10. Retrospective Research
    • compares two groups of people
    • those with the disease or condition under study (cases) and a very similar group of people who do not have the disease or condition (controls)
    • study medical,lifestyl histories, factors may be associated with disease
  11. Meta-Analysis
    • combines the reults of several studies that address a set of related research hypotheses.
    • Will include number of articles reviewed and otucome sof each to reach a summar conlusion
  12. Review
    summary of research on a particular subject
  13. Basic Research
    • Pure fundamental
    • increase a body of knowledge
    • explore unknown
    • not necessarily solve a problem
    • ex- studying the structure of a vitamin
  14. Applied Research
    • takes known information and attempts to solve
    • ex- effects of a low fat diet on hear disease
  15. Control Group
    • is given the traditional or standard care or medication
    • may be given placebos
  16. experimental group
    receives the treatmetn or medication that is being tested
  17. Dependent Variable
    • the variable that is of interest to researchers
    • ex HDL cholesterol
  18. Independent variable
    • the variable that is being manipulated by researchers
    • ex fiber intake
  19. Bias
    • is the distortion of results caused by some factor other than the study itself
    • can be caused by researchers
    • or by subjects
  20. Open Label A
    situation when both the researcher and the participant know the study
  21. Open Label
    opposite of double blind neither hte researcher nor the participant knows
  22. Single/blind Study
    • subjects are unawar if in control or experimentak
    • only researcher knows
  23. double Blind study
    both the subjects and researchers are unaware
  24. Placebo Effect
    this happens when subjects feel better just because they are involved in the study even if they are receiving the placebo
  25. Replication
    same study but different researchers and participants
  26. duplication
    same study same results
  27. positive correlation
    more calories you eat more you gain weight
  28. Sections of articles
    • Abstract
    • introduction
    • review of literature
    • methodology
    • results
    • conclusions
    • references
  29. ADA
    • position papers explain the associations stands on issues that affect the nurtitional status of the puplic.
    • positions staements and support paper based on sound scientific data
  30. validity
    • measure what you should be measuring
    • real accurate results
  31. Peer or refered articles
    • scientist rigoursly evaluates a research study to assure
    • original article
  32. reliable sources of nutrition
    • professional oganizations
    • american dietetic association
    • american society for nutrition sciences
    • american soceity for clinical nutrition
    • society for nutrition education
    • american college of sports medicine
    • nort american association for study obesity
  33. reliable sources of nutrition continued
    • journals
    • educational instituions
    • persons with credible credentials
    • hospitals and clinica
    • libraians books
  34. Common health Frauds
    nutritional schemes
  35. FAD diets nutritionally inadequate
    • become vary popular temp
    • special apeal or prestige
    • sound easy
    • little responsibilities
    • distort or ingore basci nutition
    • seldom include full variety of foods
  36. Checklist for nutrition misinformation
    • is something being sold
    • does if offer a quick fix
    • are catchy
    • are testimonalrs
    • does it sound to good to be true
    • is money back gurantee offered
  37. Using ADA evidenc based library
    • experts have crtically reviewed articles for you
    • summary and conlusions
    • strenghts and weakness of each article
  38. What is a healthful body Weight
    • appropriate for tour age and physical development
    • maintained withoud dieting
    • family hostory of body shape and weight
    • good eating habits and physical activity
    • acceptable to you
  39. underweight
    habing too little body fat to maintain health
  40. overweight
    habing a moderate amount of excess body fat
  41. Obese
    having an excess of body fat that adversely affects health
  42. Morbid obesity
    body weight exceeding 100% of normal, creating a very hogh risk for serious health complications
  43. Body mass index
    • expresses the ratio of a persons weight to their height
    • BMI values below 18.5 or above 30 have increased health risk
  44. BMI Calculation
    Weight (lbs)x703/height in inches2
  45. Limitations of BMI
    • it may overestimate body fat in athletes and others who have a muscular build
    • underestimat body fat in older persona ans others who have less muslce mass
  46. Underweight
    • BMI below 18.5kg/m2
    • increases the risk of infections and illness and can even be fatal
    • can be just as unhealthy as overweight
  47. overweight
    • BMI between 25 and 29.9 kg/m2
    • health risk
    • hogh blood pressure
    • heart disease
    • type 2 diabetes
    • sleep disordors
  48. Obesity and Morbid Obesity
    • Obesity BMI between 30 to 39.9kg/m2
    • Morbid obesity exeeds 100% of normal and or BMI>40
  49. Overweight and obesity
    • epidemic in US linked to many chronic disease
    • hypertension
    • dyslipidemia
    • type 2 diabetes
    • heart disease and stroke
    • gallbladder disease
    • sleep apnea
    • steoarthritis
    • gestational diabetes
    • depression
  50. Obestity and chornic disease
    • heart disease
    • all cancers: colon breast endometrial and gallbladder
    • stroke
  51. Body Composition
    measuement of body fat and lean muscle mass
  52. Densitometry
    underwater weighing
  53. Anthropometry
    measurment of skinfold thickness using skinfold calipers of body circumferences
  54. conductivity
    bioelectric impedance
  55. DEXA
    considered the most accurate
  56. Bod Pod
    air displacemetn (plethysmography) expensive
  57. The mosh inaccurate measuremt available
    • Skinfold measurement
    • dependent on person taking measurements and degree of training
  58. Bioelectric impedance
    • depends upon several factors
    • hydration
    • least invasibe and fairly accurate
  59. Fat distribution Pattern
    measured by waist to hip ratio and waist circumference
  60. Apple shaped fat patterning
    • upper body
    • increased risk for chonic deseases
    • android-men-visceral fat apple
  61. Pear shaped fat patterning
    • lower body
    • no significant increased risk for chornic desease
    • ganoid-woman
  62. Waist to hip ratio
    • WHR= waist circumference/hip cicumference
    • desirable values
    • <0.80 women
    • <0.90 men
    • high= central obesity
  63. Waist circumference
    • risk of death
    • chronic disease from all causes appears to be highest for individuals with central obesity which
    • > 40 in males
    • >35in females
  64. Gaining or lossing weight
    • depens on
    • energy intake vs energy expenditure
    • genetics
    • childhood weight
    • behavior/lifestyle
    • social factors
  65. Energy balance
    occurs when energy intake =energy expediture
  66. Energy intake
    • calcualting energy that is in a particular food
    • grams of prtoein or carbs or fat x kcal of coresponding energy
    • add together which = total kcal
  67. Weight gain results
    • when total daily energy intake exceeds the amount of energy they expend
    • an excessive intake of aprox 3,500 kcal will result in a gain of one pound
    • without exercise will be likely fat
  68. Basal Metabolic Rate(BMR)
    • energy expended to maintain basal ,or resting functions of the body
    • the highest protion of energy expenditure
  69. BMR increases with
    • more lean body mass,during stress, and period of growth
    • hogher lean body mass
    • greater height
    • younger age
    • elevated levels of thyroid hormone
    • stress fever ilness
    • male gender
    • pregn and lactation
    • drugs caffeine tobacco
  70. BMR Decreses with
    • older age and during energy restriction
    • fasting or starvation
    • lower lean body mass
    • lower height
    • depressed levels of thyroid hormone
    • female gender
  71. Basal Metabolism Rate (BMR)
    • energyt used to maintain life when the awake body is at complete rest
    • circulation
    • respiration
    • temperature maintenance
    • synthesis of new tissue
    • nerve activity
    • hormone secretion
  72. Energy Out Balance
    • BMR=60-75%
    • TEF(thermic EFfect of foods)= 5-10%
    • Physical Activ=15-35%
  73. Energy Expediture Measurment
    • 1. Direct calorimetry is the method that amount of heat the body releases
    • 2. Indirect Calorimetry estimates energy expenditure by measuring oxygen consumption and carbon dioxide production
    • used in hospitals
  74. Prevalence of obesity
    • nearly two thirds of US adults are overwieth
    • Nearly one third of US adults are obese
    • 1 in 5 children are obese
    • less than 1/2 have a healthy weight
  75. Causes of Obesity
    • Diet
    • Inactivity
    • physchological factors
    • genetics/environment
    • age
    • medication
    • medical problems
  76. Genetic Factors
    • about 25%
    • thrify gene theory
    • set-point theory
  77. Thrifty Gene Theory
    • proposes that a gene or genes cases people to be energetically thrifty
    • expend less energy than other people and therfore gain weight
  78. Set-Point Theory
    proposes that each persons weight stays within a small or narrow range set point
  79. Leptin Theory
    leptin is a hormone produced by fat cells that casues reduced food intake reduced weight ,decreased body fat
  80. Physiologic Factors
    • Hunger vs appetite
    • leptin - reduce food intake/less effect in obese
    • Ghrelin-stimulate appetite hour later hungry after eating
    • Peptide yy(pyy)- decreases appetite relasased in the GI
  81. ChildHood Factors
    • environmental factors in childgood can influence
    • childhood overweight inceases the risk of heart desease and premature death as an adult
  82. compositon of the diet
    theory states that overeating dietary fat promotes storage as adipose tissue / as well as carbs and protein
  83. Social Factors
    • influencing our diet
    • family
    • culture
    • holidays
    • easy acess
    • less physical act
    • societal expectations perfect body
  84. Co-Morbidites related to obesity
    • hypertension
    • diabetes
    • dyslipidemia abnormal blood fats- usually from diet hogh in saturated fat high ldl,low hdl, hogh triglycerides
  85. Co morbidities related to obesity continues
    • coronary artery disease
    • stoke
    • gall stones
    • gout
    • osteoarthritis
    • sleep apnea
    • cancer
  86. Fad Diets
    fads that do not results in long term healthful weight changes
  87. Sugar busters
    • basic conepts is all sugars, including sugar derived form colplex varbohydrates and starches ar toxic
    • potatoesmcornmcarrots
    • recommended for children prengant women diabetics
    • protein and fats should be limited
  88. Raw food diet
    • cooked food lose the natural vitamins nutrients and enxyme snecessary to build a strong immune system
    • only fruits and vegetable picked ripe
    • professional anaylysis of this diet
    • restrictions make difficult to get nurtients needed
    • example b12 and D
  89. Eat rigth 4 your type
    • type A vegetarians
    • type b omnivores
    • groups people based only on blood type and does not consider individual variences
  90. The Flavor Point diet
    • workd to sudue appetit on two levels
    • flavor
    • minimally processed foods
    • nutritionally sound but avoid taking the concept too far and becoming too restrictive
  91. Weight loss diets
    • high fat low carboydrates,high on protein diets
    • cause ketosis
    • nutritionally inadequate,require supplements
  92. Atkins diet and New Atkins Diet
    • mostly protein
    • high protein
    • low carbs
    • major restrictions on cabohydrates
    • ketones buildup
    • increased intake of sat fat and cholest
    • contradicts everhting we know about health promotion and disease prevention
  93. Moderate fat,high carbs, moderate protein diets
    • gradual weight loss
    • effective in weight loss
    • decrease in ldl
    • decrease in TG
    • decrease in Blood presur
    • nutritionaly adequate if follow general guidelines
  94. South Beach Diet
    • 3 phases
    • theory is that faster sugars and starches are digested the more weight is gained
    • 1400-1500 calorie intake
    • first phase unhealthy
    • compliant many fo the foods and recipes are not common to all areas
  95. The Zone
    • 40 cho 30 pro 30 fat 4:3
    • closer to what most dietetic profesionas recommend
  96. Behavior Modification
    • Most successful of all therapies
    • self monitoring
    • control
    • cognitive restructuring
    • aims change lifestyle
  97. Individual Approaches
    • helpful for figuring meal preration new recipes
    • nurtrient and k cal count s
    • may be expensive
  98. Low fat and very low fat diets
    • regular physical activity is a key component
    • effective at weight loss but difficult ot mantain over time because they are too restrictive
    • about 11-19% of total
  99. FAD Diets
    • Starvation
    • Very low calore diets <800 kcal
    • restricted diets 800-1600 kcals
  100. Adipose tissue
    • storage site of body fat
    • 1lb of fat = 3500 kcal
    • 5 lb = 17,500 kcal
    • to lose 5 lbs of fat in a week
    • 17,500kcal / 7 days = 2,500/day
  101. Appropiate weight loss
    • no more than 1-2 lbs per week
    • to lose 1lb 3500/7=500 kcals per day
    • to lose 2lbs 7000/7=1000 kcals per day
  102. Weight loss medications
    • should only be used if a person has
    • BMI of 30kg/m2
    • BMI of 27 kg/m2 and other health risk factors
  103. Effective weight gain
    • east 5500 to 1,00 extra kcal
    • eat frequently
    • limit fat 15-30%
    • exercise regularly with resistance training in order to gain lean muscle tissue
  104. Wight control diet
    • East less sugar and high sugar foods
    • 1 less 12 oz can of soda per day = a weight loss of about 15lbs in one year
  105. Effect of Exercise
    • increase metabolic rate or prevent decline due to calore restrictions
    • rduce fat mass
    • incrase in HDL-C
  106. Treatments for obesity
    • low calorie diet
    • regular exercise
    • prescription medication
    • surgery
  107. Medications
    for people with a BMI >30 or 27
  108. Meridia (sibtramine)
    • decreases appetite by altering brain neurtransmitters
    • side effects = increased blood pressure,dry mouth, anorexia, constipation,insomnia, dizziness,nausea
  109. Xenical (orlistat)
    • inhibits pancreatic lipase and decreases fat abosrption
    • side effects = abdominal pain, fatty and loos stool,leaky stools, flatulence, decreased absorption of fat solubl nutrients
  110. Alli-over the counter orlistat
    possible side effects the wall steet journal
  111. Surgery
    • only for morid obesity
    • new researth suggest that this surgery should be done before DM,CVD,etc are sever
  112. Surgery Qualification
    • BMI 35+ and
    • 2 co morbidities = diabetes,CVD or sleep apnea or
    • BMI 40+
  113. Gastric Banding
    • uses a premeasur prosthetic device to restrict oral intake
    • usually 0.5 com
    • can adjust
    • muche better with flexible band
    • less consistent than other banded
  114. Gastric Bypass
    • combines gastric resection with small amount of sub-clinical malabsorption
    • iron, B12
    • mean weight loss 35%
  115. Biliopancratic bypass BPB
    • modest amount of gasrtic restriction with intenstinal malabsorption
    • entire jejunum is excluded
    • metabolic complication in the first year
    • anemia
    • fat soluble vitamin deficiencies
    • treatment of protein calore malnutrition
  116. Gastric Bypass Sleeve
    • sleeve is new stomach pouch no chang to the anatomy
    • have less stomach stomach still attached to small intestine
    • still post surgery diet requirements
    • least amount of nutrient lost
  117. Complication of gastric surgery Possible
    • death
    • lung problems
    • infection
    • heart complicatin
    • leaks in GI
    • blood clots
    • post op ulcers
    • obstruction and strictures
  118. Early complications
    • wound infection
    • dificiency anemia
    • dumping sydrome
    • blood colt
    • walking blood thiners
    • bowel obstruction
  119. Early Potential
    • respiratory problems biggest risk
    • anastomotic leak
  120. Tachycardia
    • Possible causes leakage
    • uncontrolled pain
    • hypervolemia
    • hemorrahage
  121. Pulmonary embolism
    • primary cause of motrality after bariactric surgery
    • early ambulation necessary
    • stenosis
  122. Stricture
    • narrowing bleeding at anastomosis
    • rature or leakage from staple lines
  123. Long term complicatins
    • vitamin B12 deficiencies
    • iron anemia
    • hypoalbuminemia
    • ulcer at the gastrojen
    • bile reflux
  124. ulcers
    at the site of the stomach or intestinal anastomosis or acid peptic ulcer in non functional large stomach pouch
  125. gall stone
    related to rapid weight loss more than surgery
  126. Dumping syndrome
    • most common cuases of morbidity after gastric surgery
    • abnomality
    • fatality
    • gastriontestinal and vasomotor symptoms
    • postprandial fullness
    • crampy abdomonal pain
    • nausea
    • vomiting
    • explosive diarrhea
  127. Vastomotor symptoms(dumping Syndrome)
    • sweating
    • diaphoresis
    • weakness
    • dizziness
    • flushing
    • palpitations
    • intense desir to lie down
  128. Early Dumping syndrome
    • starts 10-30 minutes after ingestion of a meal
    • gastrointestinal and vasomoter compaints
  129. Late dumping syndrome
    • 2-3 hours postprandially
    • mainly vasomotor response
  130. dumping sydrome preventions
    • increase complex carbs
    • increase dietary protein
    • eat small frequent meals
    • eat dry meals , liquids on half hour after meal
    • avoid simple sugars
    • add fiber to diet
  131. Fat Malabsorption
    • in bypass operationthe fat obsorbing intestine is bypassed, this leads to malbsorption
    • high fat meal cause diarrhea
    • explosive and fouls smelling can last
    • best to aboid high fat or greasy foods
  132. Nutrients after surgery
    • eat healthy manner, snacking
    • adequat fluid intake
    • take the multiple vitamin/mineral
  133. Diet after surgery
    • several phases
    • phase 1 liquids only
    • phase 2 soft or puree foods
    • phase 2 and 4 normal foods
    • varies in physician
  134. Bariatric surgery nurtition guidlines
    • 6 meals daily eat every 2-3 hours
    • clear liquid 1-2 days after
    • blended diet 2 weeks 1 month
    • soft diet: 1 month 2 months
    • solid diet 2 months
    • meat size of pencil erasers
  135. Bariatric surgery guidlines continued
    • 30 minuts before and afgter meals
    • limit soups, yougart
    • limit caffein due to dehydtation
    • avoid carbonated beverages discomfort
    • stop eating and drinking when feelings of fullness occur
    • avoid food with more than 2 gm sugar alcohol
  136. Activity and exercise phychological effects
    • increased energy
    • less fatique
    • improvements inbody image and self esteem
    • emphasize walking and sweimming
    • more otion available as weigh decreases
  137. Outcomes of gastric surgery
    • 50% considered successful
    • is the best treatment for morbility obese
    • measured by weight loss and improvement of obesity related medical disorders
  138. Follow up surgeries
    • possible leaks from first
    • hernias are most common
    • plastic surgery for excessive skin
Card Set:
2012-02-24 07:13:52

exam 1
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