Nutrition Diet & Assessment (1/2)

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Nutrition Diet & Assessment (1/2)
2013-11-20 21:23:08

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  1. Nutrition 1
  2. Macronutrients
    • nutrients utilized for energy; usually ingested in larger amounts (grams)
    • there are 4 types:
    • 1. Fat (9 calories per gram)
    • 2. Ethanol (7 calories per gram)
    • 3. Carbohydrate (4 calories per gram)
    • 4. Protein (4 calories per gram)
  3. Micronutrients
    • nutrients required or ingested in smaller amounts (usually mg or mcg)
    • eg. Vitamins (biotin, thiamin, Vit Bs) & Minerals (Ca, I, K, Fe)
    • nutrient density = the amount of micronutrients in food
  4. trace elements
    a subset of minerals consumed in very small amounts
  5. essential nutrients
    cannot be synthesized and must be ingested
  6. conditionally essential nutrients
    • nutrients that are unessential in health but become essential in situations imposed by illness, physiologic stress, or deficiency of other nutrients for which the conditionally essential nutrient is a precursor
    • eg. end stage renal disease requiring dialysis takes a lot of nutrients out of the blood stream; often need more carnitine in diet
    • increased use of glutamine in critical illness
    • need more methionine & folate to make choline
  7. bioavailability
    • the extent to which a nutrient can be digested and absorbed
    • it can be affected by many factors
  8. Food Record (FR)
    • used to record food intake at the time of consumption, over a number of days (not necessarily sequential)
    • respondents weigh on a small scale all food & beverages consumed or estimate all food consumed using household measures or portion size estimating aides
  9. Diet History (DH)
    • questionnaires that are a retrospective assessment method asking about a respondent’s “usual” food intake by collecting descriptive detail & amount information about each food
    • DHs may include questions on meal patterns, lists of common foods, & groups of generic food
    • can be administered by a trained interviewer in-person, by phone, or self-reported
  10. 24-Hour Recall (24HR)
    • a retrospective assessment method where interviewer prompts a respondent to recall + describe all foods & beverages consumed in the preceding 24 hours
    • interview can be conducted in-person or by telephone
  11. Food Frequency Questionnaire (FFQ)
    • "How many servings of X do you have in a week? month? year?"
    • retrospective method asking respondents to report how often they have eaten a type of food over a specific period of time (frequency of consumption categories include per day, week, or month over months or year)
    • portion size information is collected in semi-quantitative FFQs
    • portion size information NOT collected in NON-quantitative FFQs
  12. Biomarkers
    • a way of assesing the types of food we eat
    • eg. urinary Na excretion, or membrane FA composition
  13. What two diet surveys are conducted regularly in the U.S.,
    • 1. National Health and Nutrition Examination Surveys (NHANES)
    • 2. Behavioral Risk Factor Surveillance System (BRFSS)
    • they also collect data about health conditions & mortality
  14. NHANES
    • National Health and Nutrition Examination Surveys
    • conducted in U.S. non-institutionalized persons of all ages
    • data are collected IN PERSON (visits are made to peoples’ homes or done elsewhere, eg. mobile health examination van)
    • includes an interview, physical examination, clinical
    • assessments, blood sample, & diet assessed w/ 24HR & questionnaires
  15. BRFSS
    • Behavioral Risk Factor Surveillance System
    • conducted in U.S. non-institutionalized persons of all ages
    • data are collected over the PHONE & reported by state
    • phone survey asks about weight, height, intake of selected foods, chronic disease, injury, health prevention, risk behaviors, & health care access
    • are attempts to ensure self-reported data are accurate by comparing it to directly collected data
  16. Dietary Reference Intakes (DRI)
    • gives recommendations for specific macronutrients, micronutrients, & water --> to promote growth, maintain health or prevent disease
    • are developed for different sex & age groups
    • a set of values that serve as standards for nutrient intakes for healthy persons in the United States & Canada
    • categories: EAR, RDA, AI, UL, AMDR
  17. Estimated Average Requirement (EAR)
    • the average daily nutrient intake estimated to meet the requirement of HALF of healthy individuals in a particular life stage and gender group
  18. Recommended Dietary Allowance (RDA)
    • the average daily dietary nutrient intake level sufficient to meet the nutrient requirement of nearly ALL (97-98%) healthy individuals
    • in a particular life stage and gender group
    • is calculated from the EAR (2 standard deviations above the mean)
  19. Adequate Intake (AI)
    • the recommended average daily intake level based on observed or experimentally determined approximations of nutrient intake by a group of healthy people
    • used when an RDA cannot be determined
    • occurs if there isn't enough scientific evidence to support an RDA (a recommendation can NEVER be both an AI & an RDA)
  20. In what category are AIs (adequate intake) most prevalent?
    for infants
  21. Tolerable Upper Intake Level (UL)
    • the highest average daily nutrient intake level that is likely to pose NO risk of adverse health effects to almost all individuals in the general population
    • if intake increases above the UL the risk of adverse effects increases
  22. Average Macronutrient Distribution Range (AMDR)
    the range of intake for a particular energy source (Pro, Fat, CHO) expressed as a percentage of total energy (kcal) that's associated w/ reduced risk of disease in addition to adequate intake of essential nutrients
  23. Dietary Guidelines for Americans (DGA)
    • provides advice for people 2 y/o + about how good dietary habits can promote health & reduce risk of chronic disease
    • gives recommendations for food types & patterns; serves as a basis for federal food and nutrition education programs
    • issued by the Departments of Health and Human Services (HHS) & Agriculture (USDA); federally mandated that it's revised every 5 years
  24. Goals of the 2010 DGA
    • 1. reduce obesity
    • 2. shift food intake patterns to a more plant-based diet
    • 3. reduce the intake of food that has added sugars + solid fats
    • 4. reduce sodium intake
    • 5. eat fewer refined grains
    • 6. meet the 2008 physical activity guidelines for Americans
  25. Supplemental Nutrition Assistance Program (SNAP)
    • provides financial assistance for purchasing food to low-income & no-income families
    • formerly food stamps
    • can be used to purchase breads, cereals, fruits, vegetables, meats, fish, poultry, diary products, seeds/plants to grow food
    • doesn't cover hot food, vitamins, or medicine
  26. Women, Infants & Children (WIC)
    • federal grant program to provide nutritious foods, nutrition education, & referrals to other health & social services for women & children who meet 4 categories:
    • 1. categorical: women [pregnant, postpartum, breastfeeding], infant [up to 1st birthday], or children [up to 5th birthday]
    • 2. residential: must reside in the state giving the services
    • 3. income: must fall at or below 185% of the federal poverty income guidelines
    • 4. nutrition risk: anemia, underweight, history of failed pregnancy, poor food intake, poor diet
  27. National School Lunch Program
    • provides nutritionally balanced lunches at low or no cost to eligible children of families at or below 130% of the poverty level
    • reduced cost lunches are provided to children of families between 130-185% of the poverty level
  28. Why are micronutrients such as Vitamin A, C, Ca 2+, or Fe on food nutrition facts labels?
    from a public health perspective because they have been characteristically low
  29. Reference Daily Intakes (RDI) or Percent Daily Values (DV)
    • RDIs are nutrient intake standards set by the FDA based on 1968 RDAs (recommended dietary allowances)
    • RDIs tend to be the highest RDA value
    • [THESE ARE DIFFERENT FROM Dietary Reference Intakes (DRI)]
  30. Daily Reference Values (DRV)
    nutrient intake standards established for Pro, CHO, Fat & other nutrients that LACK an RDA (recommended dietary allowances)
  31. dietary supplement
    • a product taken by mouth that contains a dietary ingredient intended to supplement the diet
    • "dietary ingredient" includes vitamins, mineral, herbs, botanicals, AAs, enzymes, organ tissues, glandulars, & metabolites
    • they're regulated by FDA (food & drug administration) similarly to foods
    • the manufacturer, not the FDA, is responsible for ensuring all claims are truthful & not misleading about supplements
  32. Federal Food, Drug, & Cosmetic Act (FD&C)
    • 1938
    • gave FDA the authority to oversee safety of food, drugs, & cosmetics
    • (also identified standards for vitamins & minerals)
  33. The Dietary Supplement Health and Education Act (DSHEA)
    • 1994
    • amended the FD&C Act (1938)
    • New Dietary Ingredients (NDIs - not sold in the U.S. before DSHEA) must undergo pre-market review [a process not a rigorous as drug regulation] before sold
    • defined "dietary supplement" & "dietary ingredient"
    • established a regulatory framework regarding labeling & safety
    • created the office of dietary supplements w/in the NIH
  34. Nutrition Labeling & Education Act (NLEA)
    • 1990
    • gave the FDA the authority to require nutrition labeling
    • required that nutrient content & health claims be consistent w/ agency regulations
  35. Labeling
    describes the nutritive value of a food
  36. What are the 3 categories claims about food fall into?
    • 1. Nutrient content claims: if product is source of a nutrient
    • 2. Health claims
    • 3. Structure function claims
  37. Health claims
    • an expressed or implied food label statement about the relationship between a food substance and a disease or health-related condition
    • requires pre-approval by FDA
    • applies to foods and dietary supplements
    • eg. Ca2+ & osteoporosis; saturated fat & cholesterol/heart disease
  38. Structure function claims
    • describes nutrient function in the body or how a nutrient maintains a required structure or function in the body
    • eg. Ca2+ & bone health; fiber & bowel regularity
  39. Nutrition 2
  40. nutrition screening
    • a means of identifying people with or at risk for malnutrition
    • prompts a more detailed nutrition assessment of those who are most likely to benefit from nutrition education or intervention
    • occurs usually w/in 24 hours of hospital or facility admission
    • can occur at ambulatory appointment
  41. Screening Tools
    • MNA (Mini Nutritional Assessment): malnutrition screen for the elderly
    • MUST (Malnutrition Universal Screening Tool): adults, hospital, community
  42. nutrition assessment
    • detects nutrition problems and etiologies using
    • A: anthropometry
    • B: biochemical tests [lab values]
    • C: clinical signs & symptoms
    • D: dietary factors [what, how, why people are eating]
    • E: exercise/energy balance
    • F: functional status
  43. Fat Free Mass (FFM, or lean body mass)
    • any part of the body that isn't mass (eg. lean muscle, body water, bone structure)
    • provides structure & function (respiration, perfusion, immunity, ambulation)
  44. Fat Mass (FM)
    • adipose tissue - used for energy & produces adipokines
    • lipids precursors for hormones & cytokines
    • makes up cell membranes & myelin
  45. dieting v. rapid weight loss v. illness
    • dieting to reduce weight: 2/3-3/4 of lost weight is FM; the remainder is FFM
    • very rapid loss: majority of lost weight = FM but more is lost as FFM than with dieting
    • involuntary weight loss due to illness: a greater proportion of weight is lost as FFM than observed w/ voluntary dieting (sometimes only FFM is lost while FM stays stable)
  46. "Ideal body" Weight
    • a number associated w/ the lowest mortality & morbidity
    • can be confounded by things like bone density
  47. "Dry" Weight
    • a number important for diseases that promote fluid retention (eg. heart failure, liver failure, kidney disease, edema)
    • dry weight refers to metabolically active weight for drug dosing & energy expenditure
  48. BMI (Body Mass Index)
    • weight (kg) / height (m^2)
    • generally correlated with FFM (fat free mass), FM (fat mass), morbidity, & mortality
    • underweight: <18.5
    • normal: 18.6-24.9
    • overweight: 25-29.9
    • obesity: 30-39.9
    • Xtreme obesity: >40
  49. Confounders of BMI
    • 1. edema (interstitial fluid)
    • 2. increased muscle mass
    • 3. ascites (intra-abdominal fluid)
  50. What happens to your fat free mass when you gain weight?
    • it increases - there is a structural need to increase FFM in order to hold extra weight
    • when you lose weight you also lose both (*except in terms of critical illness*)
  51. Dual Energy X-Ray Absorptiometry (DEXA)
    • two x-ray sources of different energy results in differential absorption by tissues
    • can quantify bone, fat, & fat-free mass
  52. What information can the biochemical tests [lab values] of a nutrition assessment provide?
    • by examining blood concentration, urine concentration, & functional measures (how well organs are working) we can detect
    • 1. declining or deficient nutrient stores
    • or 2. physiologic abnormalities
    • limitations of lab values include the fact that they're expensive & need to be interpreted by a professional
  53. Blood Tests
    • isolated from serum or plasma which contain recently absorbed nutrients and those that are being transported
    • they most often serve as an acute biomarker, & are not necessarily reflective of long term nutrition status
  54. Anticonvulsants
    • impair calcium absorption
    • decrease folate levels
    • eg. phenytoin, phenobarbital
  55. Bile Acid Sequestrants
    impair fat and fat soluble vitamin absorption
  56. Corticosteroids
    increase appetite and weight, cause hyperglycemia, decreases vitamin D, & decrease calcium --> precipitating bone loss
  57. Diuretics
    increase urinary potassium, magnesium, sodium, & thiamine excretion
  58. Insulin
    increases appetite and weight
  59. Isoniazid
    interferes with vitamin B6 absorption
  60. Methotrexate
    folate antagonist (interferes w/ pyrimidine synthesis)
  61. Proton pump inhibitors
    negatively affect Vitamin B12 absorption
  62. Internal Dietary Factors that Affect Intake
    • 1. chewing/swallowing difficulty (eg. dentures)
    • 2. gastrointestinal symptoms
    • 3. sensory abilities to taste, smell, & see
    • 4. food allergies & intolerances
    • 5. mental health
  63. Internal AND External Dietary Factors that Affect Intake
    • 1. appetite
    • 2. alcohol use
    • 3. dietary restrictions/picky eater-ness
    • 4. muscle mass/functional capacity
    • 5. medications/dietary supplements
  64. External Dietary Factors that Affect Intake
    • 1. meal/snack patterns
    • 2. social setting/location
    • 3. culture/religion
    • 4. food availability/food security
    • 5. food presentation/labeling
    • 6. nutrition knowledge or misinformation