G&D Final Part 3

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G&D Final Part 3
2013-12-17 12:59:14
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  1. 1. what does malnutrition contribute to in older life?

    2. What are 6 charac of diagnosis for adult malnutrition in which 2 or more classifies malnutrition?
    1. Increased morbidity, mortality, frequency/length of hospital stay, costs and decreased function/quality of life. 

    2. Insufficient energy intake, weight loss, loss of muscle mass, loss of subcutaneous fat, localized fluid accumulation, diminished functional status measured by hand-grip strength
  2. 1. What causes malnutrition in older adults?

    2. Define frailty

    3. What are the 3/5 symptosm of frailty?

    4. What causes frailty? (4)
    1. (1) inadequate intake, (2) malabsorption, (3) loss of nutrients from diarrhea, sweating, hemorrhage, renal failure (4) drug addiction (5) infection

    2. Biological syndrome of decreased resistance to stressors, resulting for cumulative declines across multiple physiological systems, causing adverse outcomes. 

    3. Weakness, slow walking speed, low level of physical activity, unintentional weight loss, exhaustion

    4. Malnutrition, atherosclerosis, cognitive impairment, and sarcopenia
  3. 1. How to improve malnutrition? (5)

    2. Who tends to have malnutrition?

    3. What are six indicators within a systematic approach to nutrition assessment?

    4. What is anthropometry
    1. Alleviate dry mouth, encourage eating at mealtimes, provide specialized nutrition support (parental nutrition IV), use volunteers to help assist with feeding, provide high calorie, nutrient-rich oral supplements for those unwilling to eat. 

    2. older, white, male, poor, on Medicare in the midwest/south

    3. (1) history and clinical diagnosis (2) clinical signs and physical examination (3) anthropometric data (4) laboratory indicators (5) dietary data (6) functional outcomes

    4. Measurements of weight, size, and proportions of the human body
  4. 1. What are the physical signs of anorexia of aging? (3)

    2. What contributes to sarcopenia? 7

    3. How does nutritional treatment affect sarcopenia?

    4. What is xerostomia?

    5. Risk factors for malnutrition in older adults?
    1. Gradual decrease in natural drive to eat and drink that occurs with age - decreases in sensation of taste and smell, orexigenic signals, increased satiety signals. 

    2. Loss of a-motor neurons, decrease in physical activity,  increase in inflammatory cytokines, bed rest, humoral factors, inadequate food intake (specifically protein-poor diet), geriatric anorexia

    3. Nutritional supplementation is effective esp when coupled with physical exercise ---> improvement in muscle mass and potentially muscle function.

    4. Dry mouth

    5. Physiological - olfactory/taste losses --> increases in risk of GI illnesses bc you can't tell if food has gone bad. Decreased BMR, poor oral health (3)

    Medication-related - loss/distorted tastes, xerostomia, early satiety, anorexia, nausea, malabsorption  (6)
  5. 1. How does chronic illness contribute to malnutrition? (3)

    2. Psychosocial factors common in aging that affect nutrition? (2)

    3. What is sarcopenia?

    4. What are some of the effects?

    5. What is sarcopenic obesity?
    1. Impaired activities of daily living, cognitive impairment, can affect ability to prepare or ingest food. 

    2. Isolation (less desire to cook bc of loneliness, disabilities, transportation), depression (decreased dietary intake, appetite, weight loss), higher depressive symptoms correlate with poor nutrition. 

    3. Loss of muscle protein mass, muscle function, and muscle quality that accompanies advancing age (generally associated with weight loss) INFLAMMATORY STATE

    4. Less muscle function, difficulty getting around and doing things

    5. High BMI may obscure the body weight loss, but there is loss of protein muscle mass.
  6. 1. What is marasmus? - energy def

    2. What is kwashiorkor? - protein def

    3. Can you have both?

    4. How is inflammation characterized? 

    5. What is not a good indicator of inflammation?
    1. Marasmus - depletion of muscle mass and fat stores, with normal visceral protein and organ function. Individuals look malnourished and cachectic - they function well unless exposed to additional metabolic stress. 

    2. Kwashiorkor - hypoalbuminemic malnutrition - loss of visceral protein,edema, does not appear malnourished. The state in which the first child stops getting breast milk because the mother has the second child. 

    3. yes - mixed marasmus and kwashiorkor

    4. By lab values, CRP (main), cytokines, procalcitonin) and CLINICAL signs (fever, leukocytosis, hyperglycemia)

    5. Albumin bc it increases with infection
  7. 1. What is evidence of severe suboptimal intake for acute? chronic? environmental/social circumstnaces?

    2. The same but for nonsevere suboptimal intake?

    3. What are negative health outcomes associated with malnutrition and how does hospital admission exacerbate this?
    • 1. Acute: >5 days with intake of <50% of total estimated requirement.
    • Chronic: > 1 month with intake <75% of estimated energy intake req
    • Envr/Social: >1 month with intake <50% of requirement


    • >7 days with intake <75% total estimated energy 
    • >1 month with intake of <75% of total estimated energy
    • Environmental/social: >3 months with intake <75% of requirement

    3. Increased length of hospital stay, impaired wound healing, increased morbidity/mortality, increased muscle loss/functional loss, higher infection/complication rates, increased admission/readmission rates, increased cost per patient

    Decreased food intake, nPO status (nonthing by mouth), lack of assistance, frequent interruptions, modified diets, plate waste, bed rest can increase rate of muscle loss further contributing to sarcopenia.
  8. 1. What can 150-250 min/week of moderate exercise do?

    2. What about >250 min/week?

    3. What happens when you combine exercise with diet? What is effective to prevent weight gain?

    4. Does resistance training enhance weight loss? (3)
    1. Allows modest weight loss and prevents weight gain.

    2. Clinically significant weight loss. 

    3. Moderate intensity of 150-250 min/week with moderate diet restriction prevents weight gain and causes weight losses >3% in most adults. 

    4. No but it increases fat-free mass and increases loss of fat mass and is associated with reductions in health risk
  9. 1. What would be considered a program of exercise?

    2. How many days/week should adults perform resistance exercises? Flexibility exercises? 

    3. What factors are important in modifying an exercise program? (5)

    4. What are neuromotor exercises?

    5. What is resistance training made up of?

    6. What is recommended intensity frequency of resistance training?
    1. A program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor exercise training beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults.

    2. 2-3 (balance, agility, and coordination). 2

    3.Should be modified for an individual’s habitual physical activity, physical function, health status, exercise responses, and stated goals.

    4. "functional fitness training" - incorporates motor skills such as balance, coordination, gait, agility and proprioceptive training (i.e., tai ji, qigong, yoga) really good for older people to improve balance, agility, muscle strength, and reduce risk of falls. 

    5. concentric, eccentric, and isometric muscle actions and the performance of bilateral and unilatera single- and multiple-joint exercises

    6. 2-3 days for novices, 3-4, 4-5
  10. 1. Connection between childhood and adult obesity?

    2. Is weight-training safe for kids? What injury are people afraid of?

    3. Weight-training guidelines for kids? (5)

    4. How do resistance training and high intensity aerobic exercise affect bone density?

    5. How does exercise affect hormones? (6)
    1. Yes, excess weight gained from 2-11 is a strong predictor of fat and fat-free mass 5-6 decades later. Can be managed via aerboic exercise, weight lifting and parental involvement

    2. Yes; growth-plate injuries

    3. (1) close adult supervision (2) realistic expectation based on pre-during post pubsecence (3) 1-3 sets, 1-15 reps to start progressing to 6-15 reps, 2 or 3x/week

    (4) Single and multi-joint exercises should be incorporated at a lower weight (5) gradual progression of training loads 5-10% -relative vs. absolute. 

    4. Both positively affect bone density into adult (increasing cortical thickness and decreases endocortical diameter)

    5. Increases epinephrine, norepinephrine, cortisol, glucagon, insulin, growth hormone

    All have lipolytic effects, except insulin.
  11. 1. How does exercise affect mitochondria? (3)

    2. Why can't you spot reduce? Where is adipose tissue most available?

    3. During weight loss, how much is from fat-free mass? How can you avoid this?

    4. WHy does exercise not result in as much as weight loss as diet? Why should you exercise when losing wieght?
    1. Increases total mitochondrial protein synthesis, surface area, and biosynthesis.

    2. Because there are lipolytic regional differences. Adipose tissue in the torso is catecholamine sensitive, while lower extremeities are insulin sensitivities. 

    3. 40%, resistance training/aerobic exercise

    4. Because people tend to overcompensate caloric intake with exercise --> people tend to be less active. Exercising is still sueful to preserve fat-free mass and to maintain weight loss.
  12. 1. Why do people feel stronger very rapidly after starting an exercise regimen?

    2. What is interval training and what is the benefit? Physiological benefits? (4)
    1. Motor unit discharge rates increase quickly --> increase in strength (~35% for older adults

    2. Brief, intense exercise training with 1:3 training ratio work: active recovery. Sees same effects over same period of tiem with signficantly shorter workout time. 

    Greater cytochrome oxidase (higher fat metabolism), muscle buffering capacity (less acidity), increased muscle glycogen (increased storage of energy in muscle), increased performance.
  13. 1. Do you burn more fat at vigorous or moderate intensity exercise?

    2. can you be fit and fat?

    3. Do most teens meet PA guidelines?

    4. Do Adults?

    5. Do young children eat too much and move too little? Is there a relationship between TEE and fat mass in infants?

    6. How does weight lifting affect BMD in boys?
    1. You burn more absolute fat during high intensity exercises even though you burn a smaller relative percentage of fat. 

    2. Yes, metabolically lean, which is better than being lean and unfit. 

    3. No only 25%/10% do.

    4. No half don't

    5. Yes, no. BUT infant fatness does predict fatness and physical activity patterns later on. 

    6. Increases
  14. 1. How does BMI in teens and PA in teens affect adult patterns?

    2. When does visceral fat increase until?

    3. How does an exercise program affect visceral fat, HbA1C, insulin sensitivity, and body weight?

    4. How does exercise improve vascular function?

    5. What is lower extremity body fat correlated with?
    1. Heavy and sedentary teens tend to be heavy and sedentary adults.

    2. Until 70

    3. Improves everything but not that much weight loss

    4. Shear stress releases NO from endothelial cells dilating vessels. 

    5. Negatively correlated with risk factors (protective effect)
  15. 1. Intramuscular triglycerides are found in greater concentrations in athletes. Is this good or bad?

    2. How does mitochondrial protein synthesis change with aging?

    3. Can you lose weight without exercise? Inches? Keep off weight?

    4. How does weight lifting burn fat?
    1. Seemingly good. 

    2. decreases by 40%


    4. weigh tlifting improves respiratory quotient --> lower RQ --> more fat oxidation
  16. 1. How much  muscle is lost every decade?

    2. What is the order of fuel recruitment during exercise?

    3. What does prolonged exercise change in terms of substrate use?
    1. 5 lbs

    2. (1) phosphocreatine (2) muscle glycogenolysis (3) liver glycogenolysis (4) gluconeogenesis (5) blood glucose (6) fat

    3. CHO --> Fat metabolism.