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C787 nutrition study guide notes
Nutrition Notes » DRI: Dietary refence intakes/ Family name of other recommendations
- Food Labeling must include about them
- The differ depending on age group » Nutrition labeling
- Serving size will always be found (In US) » Recommended Daily Allowance (RDA) Most important RDI
- People who are sick don’t count as a healthy population for RDA.
- Use when planning meals » Acceptable Macronutrient Dietary Range (AMDR)
- a range of percentage of calories that you should get each day. Not just one food.
- Carb AMDR for a typical adult: is between 45-65 %. Which means 45-65% of the calories throughout the day should come from carbs.
- 20-30% should come from fat
- CARBS-45-65%
- FATS -20-35%
- PROTEINS- 10-35% » Macronutrient : Big nutrients that supply calories.
- Carb, Fat, protein » Tolerable upper intake level
- The highest level of daily consumption that current data has shown to cause no side effects in humans
- Ensures people do not take harmful amounts
- Used for people taking supplement » Estimated Average Requirements (EAR):
- Used to guide recommendations and meal planning for communities (NOT FAMILY) in combination with upper intake » Myplate.gov
- Half the plate should be veggies (over the course of the day) » What is the nutritional benefit of fruits and veggies?
- They provide nutrients and reduce the risk of some types of cancers. » Fruit and veggie Facts
- People should get 9 servings daily
- Increasing the amount of colorful veggies
- Reduces the risk of stroke
- Fruits and veggies don’t have B » Skim milk has roughly the same amount of calcium and protein as whole milk » The current dietary guidelines suggest/emphasize reduced fat dairy products » Half of all grain products consumed should be wholegrain products
» There is no DRI for trans-fat & added sugar » Recommended daily amount of protein intake
- Multiply whole thing by 703 » Risk factors for heart disease that are modifiable
- Sedentary lifestyle
- Diet high in trans fat
- BMI > » Obese kids and teens are at an increased risk for coronary heart disease » Obesity is a significant risk factor for osteoarthritis » As BMI increases, these also increase:
- Heart disease
- Type 2 diabetes
- Premature death
- Osteoarthritis
- Sleep apnea » Genetic influence on body weight
- Body weights of parents are often predictive of that of their children » Maintain body weight loss long term patients should:
- Eat just enough calories for activity level “Balance energy expenditure w/ intake” » Weight loss diet advice: The Draft
- Reduce processed foods
- Increase activity
- Ask yourself “am I hungry?”
- Eat 5 small meals to maintain energy
- Limit sugary drinks » A person that sticks to their diet long term are more likely to keep it off » Managing body weight how much to lose to make health changes
- Move decimal place over » Social reason to lose weight -> not sustainable
- Need positivity goals » Societal factors in obesity epidemic:
- More desk based low activity jobs
- Increased size of food portions at restaurants and home
- Increased consumption of processed foods » Don’t serve different/ separate meals to different family members » Along with diet to support weight loss : patients should strive for 90 min of moderate physical activity for at least 3x a week » Ergogenic aids: Anything that purports athletic ability
- Protein powder: Legal supplement body builder use to increase muscle mass and increase retention » Anthropometrics
- Weight management assessment tools including weight, height, and waist size » How do you calculate Physical Activity Level (PAL)?
- Total energy expenditure (cal you burn working out) / Basal metabolic rate (cal you burn being alive)
» Infants and nutrition
- Human milk contains immune factors that infant formula does not » Juice isn’t recommended for infants because:
- It contributes to dental decay
- Lacks fibers and may contribute to diarrhea
- Highly caloric source of fluid » Infants need more water per body weight than adults » Sharing utensils may lead to risk cavities in infancy » Pacifier use PAST infancy can cause dental problems » What behavior do parents have that may put a child at risk of having a poor relationship with food?
- Not involving children in meal planning
- Avoiding of food choices » How does the CDC define overweight in childhood?
- BMI for age is over the 85th percentile » Educating 5-6-year old students: Teach them rhyme with concepts » Advice for a 9-year-old obese child & their parents:
- High family stress can contribute to poor eating
- Limit portion sizes and avoid restaurants
- Encourage child to help choose & prepare meals
- Encourage physical activity play
- Provide and model choices of healthy plant-based snacks and colorful fruit and veggies at meals » Strategies to AVOID when teach high school students
- Do not Focus on how good nutrition will make them pretty
- Do not Explain ways to skip or replace meals » Adolescent girls= 130% calcium for daily values » Malnutrition
- Can cause stunted growth
- Slow development
- Cognitive development » Young adults need more thiamine than adults » Advice for a newly pregnant mom
- Alcohol should be avoided during all trimesters
- Possible effect of alcohol consumption during pregnancy: permanent development disability
- Folate/ Folic Acid Deficit -> neural tube defects » Dietary sources of folate
- Lentils, spinach, oats
- How can a pregnant mother minimize the risk of preterm delivery?
- Abstain from tobacco and drugs prior to conception and through pregnancy
- Stop all alcohol use
- Maintain healthy weight » Healthy diet => prevent gestational diabetes
- Assists in providing research and analysis on food security issues in developing countries » Food deserts
- characterized by their lack of: availability and accessibility of healthy food
- Food deserts are filled with people who are “food insecure
- Fast food is more affordable in that area
- Markets in that area don’t have fresh produce or are limited » Where some public strategies to reduce food deserts?
- Implement urban farmers market
- Supporting public policy to reduce costs of fresh foods » Main focus of the food security survey model: Financial limitations to adequate nutrition » Undernutrition
- A person who consumes many calories but without adequate nutrition
- Also included chronically hungry » Child food security module
- Use anywhere from 4 years to adolescence
- Determines if a child is experiencing hunger at home
- Be able to use this over on the phone » Household food security status
- An outcome measure to examine the public’s ability to secure adequate food
- Outcome measures: what result did you get out of the security survey » Food Security: Means all people have access, at all times, to sufficient food for an active and healthy life » Food Security Survey Module:
- It measures sufficiency of food and very low food security requires intervention
- If the outcome you get at the end of the Survey is very low that’s a diagnosis which requires an intervention » Low Food Security is characterized by: Reduced quality, variety, or desirability of diet » What was one effect of the national nutrition monitoring and related research act of 1990?
- Development of standardized questionnaires for measuring household food security status » Hunger: the uneasy or painful sensation caused by lack of food » A factor for a patients frequent ED visits for CHF: the patient often goes without medication because they cannot afford them until they are paid » What problems or factors can be associated with food insecurity?
- Poor nutrition
- Trouble obtaining food
- Obesity
- Lower cognitive and academic performance
- Poorer health status
» What does the supplemental nutrition assistance program (SNAP) do?
» What foods have been common sources of food containment in recent years?
- Bean Sprouts – fresh grown close to the ground; low sugar, low sodium; wet
- Spinach-----------^
- Milk
- Frozen Berries » High sugar and high sodium can be antimicrobial if high enough » Food Safety Matching
- Campylobacter undercooked poultry
- E. Coli Foods contaminated with fecal matter
- Mycotoxins Molds
- Glycoalkaloids Potatoes exposed to light
- Ciguatoxin Fish such as grouper
- Monosodium Glutamate Flavor enhancer which can cause chest pain, edema, facial numbness, headache » Enteritis and diarrhea are commonly caused by : E. Coli and Salmonella » Pregnant women should only eat pasteurized cheese because: Listeria in unpasteurized cheese increases the risk of spontaneous abortion and congenital infection of the newborn » Ultra-pasteurized can be stored at room temperature » Obesogen- Bisphenol A
- Chemical that causes obesity » USDA organic seal indicates:
- That food is 100% organic according to current standards
- Food is not genetically engineered and no synthetic fungicides or insecticides were used » a snack with 240 calories, 120 calories from fat is too high in fat » A hard-boiled egg is appropriate for a patient on a low-sodium diet » Which statement is an appropriate nutritional recommendation when planning a balanced meal? spices or herbs are added to season food without adding salt » Which Dietary Reference Intake (DRI) value provides information to assist in developing recommendations for populations? Estimated average requirement (EAR) » Which foods create a nutrient-dense breakfast? Oatmeal and blueberries » A school nurse selects an activity to reinforce nutrition education given to fourth-grade students, aged 9 and 10.Which activity is appropriate for this age group? Have the students identify the food groups in a particular meal. » Which two instructional methods are effective for creating a nutritional teaching plan for a group of recent immigrants who have limited English proficiency (LEP)? Include familiar dietary habits; Show pictures of foods.
» A middle school nurse is developing a program to help students control or prevent obesity Avoid using food as a reward for students’ accomplishments; Encourage students to critique media messages about food. » Which nutrient needs to be supplied in a bioavailable form for an individual on a vegetarian diet? Calcium » daily reference intakes (DRIs) for infants? The recommended dietary allowance for protein has not been established for infants younger than 7 months. C787 Study Guide:
1. Identify the differences between macronutrients and micronutrients o Macro Nutrients: Nutrients that the body needs in large amounts: Carbs, Proteins, Fat o Micro Nutrients: vitamins and minerals that organisms require in very small amounts for good health and development. 2. Differentiate the S/S for the following diseases: obesity, marasmus, kwashiorkor, anorexia nervosa, bulimia nervosa, pellagra. o Obesity: o Marasmus: means to “waste away”, an acute form of malnutrition. It is caused by a deficiency of both calories and protein in the diet and is the most severe form of childhood malnutrition. Body fat stores are used up to provide energy, and eventually muscle tissue is broken down for body fuel. Victims appear as skin and bones, gazing with large eyes from a bald head with an aged, gaunt appearance. Once severe muscle wasting occurs, death is imminent o Kwashiorkor: A form of malnutrition caused by inadequate protein intake and occurs most commonly in areas of famine, limited food supply, and low levels of education. As protein deprivation continues, symptoms include failure to gain weight and linear growth. Signs of kwashiorkor are a potbelly, dry unpigmented skin, coarse reddish hair, low muscle mass, lethargy, failure to grow, and edema in the legs o Anorexia Nervosa: Self-induced malnutrition resulting in a body weight that is 15 percent or more below normal for age and height combined with a pathological fear of becoming fat. o Bulimia Nervosa: recurrent episodes of binge eating followed by purging or other inappropriate efforts to avoid weight gain. o Pellagra: the deficiency disease of niacin (vitamin B3). It is
3. Identify diseases/illness related to specific vitamin deficiencies (vitamin A, vitamin C, vitamin D, iron, iodine, etc.). o Scurvy: Vitamin C deficiency characterized by hemorrhages in body tissue, muscular pain, tender gums, physical exhaustion, and vision disorders, especially night blindness. In advanced cases, teeth fall out, and complications with kidney or intestinal functions may lead to death o Rickets: Vitamin D deficiency, causing softening & weakening of the bone o Vitamin A deficiency: can cause blindness o Iodine Deficiency: physical and mental delays o Iron deficiency: Anemia o Beriberi: is the deficiency disease of thiamine (vitamin B1) in which the heart and nervous systems are damaged and muscle wasting occurs. 4. Identify the differences between kwashiorkor and marasmus o Kwashiorkor: Children who develop kwashiorkor are often older than children who develop marasmus. o Marasmus: occurs more often in young children and babies. 5. Identify effects and treatments for malnutrition o Treatment for PEM involves refeeding with a diet adequate in protein, calories, and other essential nutrients. Response to treatment is influenced by many factors, such as the person’s age, the stage of development in which the deprivation began, the severity of the deficiency, the duration of the deficiency, and the presence of other illnesses, particularly infections. o Prevention of PEM is the preferred therapy. In areas with unsafe water supplies and high rates of poverty, women should be encouraged to breastfeed. o Education about proper weaning foods provides further defense against PEM. o Other preventive efforts involve combining plant proteins into a mixture of high-quality protein, adding nutrients to cereal products, and using genetic engineering to produce grains with a better protein mix. The prevention of underlying causes such as famine and drought may not be feasible. 6. Briefly define HEI, NHANES, DGA, and the foods/products regulated by the FDA/USDA. o HEI: The Healthy Eating Index (HEI) is a measure of diet quality, independent of quantity, that can be used to assess compliance with the U.S. Dietary Guidelines for Americans (DGAs) and monitor changes in dietary patterns o NHANES: The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. Began in 1960s, continuous survey. o DEGA: 7. What changes were made when DRIs were established in the late 1990s? o It expanded from the RDA. It contains several different groups
to provide more adequate information needed
8. What are the Physical Activity Guidelines for Americans for different age groups and what benefits are seen with these levels of physical activity? o
o All pregnant women should take at least 400 micrograms (mcg) of folic acid daily.
19. Provide examples of whole grains versus refined grains and how could a patient better meet the recommendation for consumption of whole grains? o whole grains contain the entire grain kernel ― the bran, germ, and endosperm. Examples of whole grains include whole-wheat flour, bulgur (cracked wheat), oatmeal, whole cornmeal, and brown rice. o Refined grains have been milled, a process that removes the bran and germ. This is done to give grains a finer texture and improve their shelf life, but it also removes dietary fiber, iron, and many B vitamins. Some examples of refined grain products are white flour, de-germed cornmeal, white bread, and white rice. 20. Identify at least 4 ways to modify a diet creating a healthier eating style/pattern. o Emphasizes vegetables, fruits, whole grains, and fat-free or low-fat dairy products o Includes lean meats, poultry, fish, beans, eggs, and nuts o Limits saturated and trans fats, sodium, and added sugars o Controls portion sizes 21. Compare and contrast the calcium and sodium RDA across the lifespan. What is the recommended UL for sodium? **o
- Define nutrient-dense and give examples of nutrient-dense foods.** **o
- Identify foods that are typically high in sodium and strategies to** reduce sodium in the diet. **o
- What are AMDRs for carbohydrates, fats and proteins?** https://health.gov/dietaryguidelines/2015/guidelines/appendix-7/ o Protein: 5- o Carb: 45- o Total Fat: 30- **o
- Understand recommended intakes. Ex. Calcium for adult versus older adults** **o
- What recommendations would you make to an older adult patient** regarding vitamin B12 and why? **o
- Identify healthy menu choices based on MyPlate** **o
- Look at a food label such as those pictured here -** https://www.fda.gov/Food/LabelingNutrition/ucm274593.htm and explain to a fictional patient or family member the meaning of serving size, how DV relates to %DV, the meaning of the “footnote”, why there are upper and lower limits of
some nutrients, why some nutrients are listed without a %DV and how to spot added sugars in foods. o
29. How do you calculate BMI from weight (lbs) and height (inches)? o BMI = weight (kg) / height (m)² 30. What 4 things does a healthy weight loss plan consist of? **o
- “It appears that the increasing trend of overweight and obesity will likely** overtake tobacco as the leading preventable cause of mortality in the United States” What are the primary diseases associated with poor diet and lifestyle? **o
- How much of the total healthcare expenditures is spent on** preventative approaches to preventable disease? o 3% 33. Define and provide examples of prevention strategies: Primary, Secondary, Tertiary. o Primary: prevention strategies, or health promotion, encourage health- enhancing behaviors by giving individuals, families, and communities ways to reduce risk factors associated with disease and injury. o Secondary: includes risk appraisal and screening to emphasize early detection and diagnosis of disease. o Tertiary: involves treatment and rehabilitation and is defined as the reduction in the amount of disability caused by a disease to achieve the highest level of function. 34. What are some factors that contribute to overweight and obesity (modifiable and non-modifiable)? o Modifiable: sedentary lifestyle, overeating, high stress levels o Non-modifiable: genetically determined traits (e.g., age, gender & race- ethnicity). 35. What are the Dietary Guidelines for Americans (DGAs) key recommendations? o Follow a healthy eating pattern across the life span. o Focus on variety, nutrient density, and amount. o Limit calories from added sugars and saturated fats, and reduce sodium intake. o Shift to healthier food and beverage choices. o Support healthy eating patterns for all. 36. How much weight loss (percent of total body weight) has been shown to improve health risks associated with overweight and obesity? o 10% reduction in total weight has consistently been shown to improve health and decrease risk (move the decimal point). 37. What is the relationship between cholesterol (dyslipidemia) and cardiovascular disease and how can this be managed through diet? o Hyperlipidemia increases fatty deposits in arteries and the risk of blockages. The American Heart Association recommends limiting saturated fat to 5 to 6 percent of daily calories and minimizing the
o Limit your intake of red meat and dairy products made with whole milk. Limiting fried food and cooking with healthy oils, such as vegetable oil.
38. What is the relationship between hypertension and cardiovascular disease and how can this be managed through diet? o High-salt diets increase blood pressure and the risk of heart attack and stroke. 39. What is the relationship between type 2 diabetes and cardiovascular disease and how can this be managed through diet? o Studies report a positive association between hypertension and insulin resistance. o Patients with diabetes often have unhealthy cholesterol levels which can lead to blocked arteries. 40. In terms of cancer prevention, what are the benefits of a diet high in fruits and vegetables? o Fruit and vegetables are rich in fiber, vitamins, minerals, antioxidants and phytochemicals, which help to protect your body against cancer. 41. What are seven risk factors for type 2 diabetes? o Overweight/obese, older than 45yrs, family history, high cholesterol, PCOS, sedentary lifestyle. 42. Which populations are most at risk for developing osteoporosis and how can these populations protect themselves through nutritional interventions? o Women (mainly after 30), smokers, heavy drinkers, underweight patients, family history, diets low in calcium and vitamin D, anorexic patients. 43. Identify government agency sponsored dietary recommendations for management of chronic kidney disease. o “ National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) o Reducing protein, sodium intake (if BP is high), potassium, Phosphorus o Depending on patient stage of kidney disease and treatment, may need to limit fluid. 44. What are anthropometric measures? o Anthropometric measurements are a series of quantitative measurements of the muscle, bone, and adipose tissue used to assess the composition of the body. o The core elements of anthropometry are height, weight, body mass index (BMI), body circumferences (waist, hip, and limbs), and skinfold thickness. 45. What are the National Cholesterol Education Program (NCEP) recommendations for cholesterol consumption and healthy cholesterol levels that reduce cardiovascular disease risk? o The National Cholesterol Education Program (NCEP) recommends that adults aged 20 years or older have their cholesterol checked every 5 years. Less than half of young adults who have these risk factors don't get cholesterol screening even though up to a quarter of them have elevated cholesterol.
46. What are the major risk factors for cardiovascular disease?
