Nutrition Exam 2

food insecurity

having limited or uncertain access to enough safe, nutritious, acceptable food

contributing factors to food insecurity

poverty, unemployment, disability, geographic location, high healthcare costs, and limited access to affordable housing

4 levels of food security

high: no problems accessing food

marginal/moderate: worry about food running out, but little or no change in food intake

low: reduced food quality, variety, or desirability; little or no reduction in quantity

very low: disrupted eating patterns, skipped meals, or reduced food intake

How do we measure food insecurity?

US Household Food Security Survey Module (HFSSM)

• uses questions about the previous 12 months

consequences in food insecurity:

nutrient deficiencies, weight gain, poorer diabetes control, mental health problems, and unhealthy eating behaviors

explain the cycle of food insecurity and chronic disease

financial limitations worsen dietary quality and disease management, while the medical expenses further strain the food budget

Purpose/Who it helps of SNAP

Eligible low-income households purchase groceries using EBT benefits

What can you buy on SNAP

Fruits and vegetables, meat, fish, dairy, bread, cereals, snack foods, nonalcoholic beverages, and seeds or plants that produce food.

Purpose/Who it helps of WIC

Eligible pregnant, postpartum, and breastfeeding women, infants, and young children

Purpose/Who it helps of TANF

Temporary financial assistance for eligible families with children

Purpose/Who it helps of Older Americans Act nutrition programs

congregate meals and home-delivered meals for older adults

Purpose/Who it helps for Head Start/Early Head Start

services supporting young children’s development and family well-being

What is normal BMI?

18.5-24.9

What is overweight BMI?

25.0-29.9

What is Obesity Class I BMI?

30.0-34.9

What is Obesity Class II BMI?

35.0-39.9

What is Obesity Class III BMI?

40 or greater

describe obesity

a chronic, relapsing, multifactorial disease

What are the waist circumferences for male and female where above these numbers there is indicated greater obesity-related disease risk (aka very high risk)?

male: 40 in

female: 35 in

What determines obesity risk?

waist circumference and BMI

ideal evidence based intervention for weight loss

diet + exercise + behavior therapy

weight loss rate

1-2 lb/wk

daily calorie reduction

500-1,000 kcal

initial intervention duration

6 months

weight loss with health benefits

approx. 10% of body weight

very low calorie diet

below 800 kcal/day: requires medical monitoring

ways to ensure appropriate portions

measuring portions, choosing preportioned foods, reducing energy density, and replacing some high-calorie ingredients with veggies

the key idea is that ________ and ________ matter, not simply labeling a food or diet as healthy

total energy intake

long-term adherence

What do you need to worry about regarding GLP-1 meds?

you must monitor for inadequate nutrition and constipation in patients taking GLP-1s

• they still need nutritionally adequate meals, hydration, physical activity, and attention to nutrient and fiber intake

Are plant-based burgers healthy?

well it does not automatically mean lower-calorie, lower-fat, or healthier

• typically have calorie and fat contents similar to an 80% lean beef burger with higher sodium and substantial processing

How many minutes of moderate-intensity activity and how many days a week does a patient need?

30-45 minutes, 5 days a week

saturated fats

butter, fatty meats, full-fat dairy

• raises LDL cholesterol

trans fats

some commercial baked goods, shortening, foods contained partially hydrogenated oils

• raises LDL, lowers HDL, promotes inflammation

monounsaturated (MUFA) fats

olive oil, avocado, almonds, peanuts

• can lower LDL when replacing saturated fat

polyunsaturated (PUFA) fats

salmon, walnuts, flaxseeds, sunflower and soybean oils

• can lower LDL when replacing saturated fat

saturated fat should be under _____ of total daily calories and you should minimize _____fats

10%

trans

omega-3 vs omega-6

omega-3 is fatty fish, walnuts, chia, flaxseed and is important for cardiovascular health

omega-6 are vegetable oils and are beneficial for replacing saturated fat

med diet

Emphasizes olive oil, fish, nuts, legumes, fruits, vegetables, and whole grains. Associated with improved cardiovascular health

DASH diet

Emphasizes fruits, vegetables, whole grains, low-fat dairy, lean proteins, and sodium restriction. Particularly useful for hypertension.

• sodium of less than 1500 mg/day

traditional low-fat diet

Your lecture describes 23–35% of calories from total fat, 7–10% from saturated fat, and less than 1% from trans fat.

what foods improve cardiovascular health

whole grains

nuts

fatty fish

low-fat dairy

refined grains

no alcohol

if pts have elevated triglycerides, what should they do

increasing dietary fiber from whole grains, nuts, seeds, fruits, and vegetables while reducing refined grains

phytosterols have about a ______ LDL reduction when having 2g/day

8-10%

target A1c

below 7%

target AACE

less than or equal to 6.5%

medical nutrition therapy for type 1 diabetes

Consistent carbohydrate intake and carbohydrate counting are important

insulin to carb ratios may be used

medical nutrition therapy for type 2 diabetes

no universally ideal distribution of carbs, protein, and fat

dietary goals are individualized; insulin users may also need carb counting

Carbs

starches and grains

fruits

milk and yogurt

beans and legumes

Low GI

less than or equal to 55

medium GI

56-69

high GI

greater than or equal to 70

stuff with low GI

apples, pear, strawberries

chickpeas and beans

plain yogurt

peanuts, cashews

broccoli, peppers

stuff with medium GI

quick oats

brown/wild rice

whole-wheat or pita bread

honey

couscous

stuff with High GI

white bread

mashed potatoes

doughnuts

soda, sweet tea

pretzels, corn chips

high GI meaning

fast glucose rise

• meaning it measures how quickly carb raises glucose, not how much carb is in a serving

one carbohydrate choice = ___ grams

15

when are artificial sweetners good

when they replace sugar-containing foods or drinks without the patient compensating by consuming extra calories elsewhere.

t/f: routine vitamin and mineral supplementation has no clear benefit in patients without deficiences

true

t/f: routine antioxidant supplementation with vitamins E, C, and carotene is not recommended

true

t/f: evidence is insufficient to recommend chromium, magnesium, or vitamin D routinely to improve glycemic control

true

with patients with diabetes, they need ____ minutes of moderate to vigorous aerobic activity weekly

150

• activity spread over at least 3 dats, with no more than 2 consecutive days without exercise

• strength training at least twice weekly

atypical/extraintestinal findings for GI symptoms

iron-deficiency anemia resistant to oral iron

osteopenia or osteoporosis

dental enamel hypoplasia

dermatitis herpetiformis

neurologic or psychiatric changes

delayed puberty or fertility problems

Non-celiac gluten sensititvity vs celiac

NCGS has no characteristic celiac injury, not typically a strong heriditary basis, and does not have increased risk of associated autoimmune conditions. it is determined someone has it once ruling out CD and other causes

how is celiac disease diagnosed?

serology

small-intestinal histology

HLA-DQ genetic testing

what grains contain gluten?

Wheat, barley, rye, triticale, malt, semolina, farina, graham flour, and foods containing these ingredients.

FDA gluten-free labeling threshold

less than 20 ppm

Rome III criteria for IBS

Recurrent abdominal pain or discomfort at least three days per month over the last three months, associated with at least two of the following:

- Improvement with defecation.

- Change in stool frequency.

- Change in stool appearance or form.

alarm symptoms that need further medical evaluation instead of just starting an IBS diet

Unexplained weight loss or malnutrition.

Progressive abdominal pain.

Pain that wakes the patient from sleep.

Rectal bleeding.

Anemia or other abnormal laboratory findings.

FODMAP

Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols.

• carbs that may be poorly absobed and fermented by intestinal bacteria, producing gas and contributing to bloating, abdominal discomfort and changes in bowel havits

oligosaccharides

wheat, onions, garlic, certain beans

disaccharides

milk, soft cheese, regular yogurt

monosaccharides

apples, pears, honey (excess fructose)

polyols

sugar-free gum containing sorbitol, some fruits

How is a low-FODMAP diet used?

Elimination: Temporarily reduce high-FODMAP foods to see whether symptoms improve.

Reintroduction: Add FODMAP groups back systematically to identify triggers.

Personalization: Maintain the least restrictive diet that adequately controls symptoms.

other IBS management strategies

importance of the patient–pharmacist relationship, moderate-to-vigorous physical activity approximately 3–5 times per week, and psychosocial treatments for patients whose symptoms are linked to stress.

_____ of cancer deaths are estimated to be preventable through lifestyle modification

1/3-2/5

risk factors for cancer

tobacco use

obesity

physical inactivity

alcohol

poor dietary patterns

HPV infection

World Cancer Research Fund (WCRF) recommendations

eat mostly plant foods

• veggies, fruits, whole grains, legumes, and fiber-rich foods. limit energy dense foods and avoid sugary drinks

limit red meat; avoid processed meat

• red meat: beef, pork, and lamb. processed: bacon, sausage, and hot dogs

maintain a healthy weight and be active

red meat limit

18 oz/wk

• 1 3 oz serving is about the size of a deck of cards

t/f: eating sugar makes cancer grow faster

false

t/f: artificial sweeteners cause cancers

false

t/f: antiperspirants cause cancer

false

t/f: herbal products can cure cancer

false

t/f: ancer is always inherited

false

what percentage of cancers are associated with inherited harmful mutations

5-10%

5 nutrition goals during cancer treatment

Meet calorie and nutrient needs.

Maintain a healthy weight.

Prevent muscle loss.

Manage nutrition-related side effects.

Improve quality of life.

what to do if a cancer patient cannot tolerate regular exercise?

gentle activity such as 10 minutes of stretching or PT for patients with significant limitations