fsn exam 2 study guide

Gut Health

• Characteristics of an enzyme
• Function of major/accessory organs of the digestive system
• Digestion and absorption of macronutrients
• Diet and lifestyle modifications for GI complications
  • GERD
  • Decrease spicy, acidic foods
  • Sit upright
  • Eat smaller meals, rather than large meals
  • Avoid caffeine
  • Ulcers
  • Eat more probiotics
  • No smoking or drinking
  • Increase vitamins and minerals
  • Gallstones
  • Increase fiber
    • Fiber can lower total cholesterol levels
  • Decrease alcohol
  • Avoid excess calories and excess fats
  • Diarrhea
  • Increase fluids, electrolytes
  • BRAT diet
  • Constipation
  • Increase fiber
  • Increase fluids
  • Physical activity

Diabetes and Obesity

• Health risks associated with excess body fat
  • Visceral fat is located deep within the central abdomen
  • Raises the risks of:
    • Hypertension
    • Heart Disease
    • Stroke
    • Diabetes
  • Subcutaneous fat is located on the surface on the skin; more on the lower body, such as hips, thighs, butts
• BMI uses weight and height to measure how healthy you are
  • However, it doesn’t take into account muscle mass and genetic blueprint
  • BMI is not accurate for athletes or bodybuilders
• Hormonal regulation of hunger/satiety
  • Leptin is hormone produced by fat, adipose tissue
  • Increases energy expenditure
  • Tells us that we’re full
  • Suppress hunger
  • Ghrelin is hormone produced in the stomach
  • Stimulates hunger
  • Reduces energy expenditure
• Treatments of Obesity
  • Roux-en-Y Gastric Bypass
  • Cuts and bypass the midsection of the small intestine
  • Reattach to the new, small stomach pouch
  • Stomach size is reduced to large egg
  • Restriction of large amounts of food:
    • Reduce the actual size from about 400 mL to a mere 15-20 mL
  • Malabsorption of nutrients:
    • Malabsorption of fats and carbohydrates which further adds to the efficacy of the procedure
  • Vertical Sleeve Gastrectomy
  • The left side of the stomach is surgically removed
    • Sort of like the shape of a banana
    • Can’t drink or eat a lot at a given time
    • Decrease ghrelin secretion (since ghrelin is produced in the stomach)
  • No “rerouting” or reconnecting the intestines. Simpler operation than the gastric bypass
    • So, no interference in absorption or digestion
  • Only causes restriction of food, no malabsorption
  • Has been shown to resolve diabetes within days after surgery without weight loss
  • Adjustable Gastric Banding
  • Purely a restrictive procedure
  • Requires implant of band but no surgical resectioning of the stomach or intestines
  • The band is an inflatable balloon connected to a port that is implanted under the skin
  • Complications: erosion and slippage
• Hormonal regulation of blood glucose
  • Insulin
  • Produced in pancreas
  • Comes from beta cells
  • Produced when blood sugar is high
  • Signal body to receive glucose
  • Considered growth hormone because it promotes glycogen storage (stored glucose), protein, and fat synthesis
  • Glucagon
  • Produced in pancreas
  • Comes from alpha cells
  • Produced when blood sugar drops
  • Tell body to break down glycogen storage (glycogenolysis)
  • Stimulate lipolysis (lip - fat, olysis - break down)
  • Epinephrine
  • When blood sugar is low
  • When we need the instant energy
• Type 1 vs Type 2 Diabetes Mellitus
  • Type 1
  • Born with type 1
  • Forever
  • No insulin is produced
  • Type 2
  • Diagnosed with because of obesity, aging, and inherited factors
  • Forever, but therapeutic ways and lifestyle approaches we can implement
  • Ineffective insulin, insulin resistance, insulin deficiency
• Diet and lifestyle modifications for diabetes
  • Total Carbohydrate Intake
  • Consistent CHO Diet
  • Carbohydrate Sources
  • Glycemic effect of a good needs to be considered
  • Avoid foods and beverages with added sugar
  • Dietary fat
  • Saturated fat: <7% of total kcals
  • Cholesterol: <200 mg/day
  • Protein
  • Consider normal kidney function
  • 15-20% of total kcals
  • Alcohol Use in Diabetes
  • Moderation or none at all

Energy Balance and Weight Management

• Positive vs Negative energy balance
  • Negative energy balance: weight loss
  • Calorie intake is lower than calorie output
  • Needs more calories than provided by diet, body breaks down fat stores
  • Positive energy balance: weight gain
  • Calorie intake is greater than calorie output
  • Body stores excess dietary fat in adipose cells
• Energy expenditure
  • Basal Metabolic Rate (50-65%)
  • Energy burned at rest
  • Energy that is used to keep our organs healthy
  • Circulate blood
  • Exchange oxygen and carbon dioxide
  • Things we don’t control or feel but require a lot of calories
  • Non Exercise Activity Thermogenesis (NEAT)
  • Technically physical activity but not really
  • Physical activity they don’t know that they’re doing, but still burning calories
  • Standing
  • TEF (5-10%)
  • Calories used to absorb, digest, and metabolize nutrients
  • Physical activity (25-50%)
• Body Mass Index
  • (Weight (lbs) / height (in) ) * 703
  • Underweight
  • BMI < 18.5
  • Healthy weight
  • BMI 18.5 - 24.9
  • Overweight
  • BMI 25 - 29.9
  • Obesity
  • BMI 30 - 39.9
  • Extreme obesity
  • BMI >= 40
• Diet and lifestyle modifications for weight loss and weight gain
  • Weight loss
  • Calorie reduction (3500 kcal)
  • High-volume, low energy dense foods
  • Don’t forget lean protein and fats
  • Increase PA
  • Behavior modification
    • ABC’s
    • A: Antecedent
    • B: Behavior
    • C: Consequence
  • Weight gain
  • Additional 500 kcals/day
  • Increase consumption of energy-dense foods
  • Nutritious beverages
  • Snacks throughout the day
  • May need to be less active
• Health implications of fad diets
  • Low Carb (Atkins, South Beach, Paleo)
  • High in saturated fat, ketosis, strain on kidneys, nutrient deficiencies
  • Low Fat (Macrobiotic, Pritikin, Ornish)
  • High carb, need some fat for absorption of A,D,E,K
  • What about gluten?
  • Higher in fat, lack vitamins/minerals/fiber, restricting variety
• Disordered eating
  • Abnormal or potentially harmful eating patterns
  • Restrictive eating
  • Following fad diets
  • Compulsive or binge eating
  • Irregular eating patterns
  • Ignore hunger cues and satiety
• Eating disorders
  • Psychological illness involving specific abnormal eating; diagnosed by criteria
  • Anorexia Nervosa: self-imposed starvation resulting in malnutrition and low body weight
  • BMI 17.5 or less
  • Effects: amenorrhea, accelerated bone loss, constipation, white hairs on skin, shrunken breasts/buttocks
  • Bulimia Nervosa: cyclic overeating and caloric restriction; binging and purging
  • Difficult to identify by appearance
  • Effects: scrapes/bite marks on knuckles, enamel erosion
  • Binge-Eating Disorder
  • Isolation
  • Feels depressed, ashamed, guilty, disgusted after episode
  • Night Eating Syndrome
  • 50% or more of calories consumed
  • Sleep disturbances

Cardiovascular Disease

• Atherosclerosis
  • Plaque build-up in artery walls
  • Fatty streaks, cholesterol, calcium deposits
  • Blood flow is restricted
  • Rough buildup increases likelihood of clots - thrombus
• Role of lipoproteins
  • High-density Lipoprotein
  • “Good” cholesterol
  • Transports lipids to liver for disposal
    • Scavenge body for fat and take it to liver for disposal
  • Low-density Lipoprotein
  • “Bad” cholesterol
  • Transports lipids out to tissues; contributes to plaque in arteries
  • Very-low-density Lipoprotein
  • Transports mostly triglycerides out to body cells for use
• Classifications of blood lipid levels
  • Saturated Fat
  • Solid at room temperature
  • Animal foods (fatty meats, whole fat dairy, lard) and oils (coconut, palm)
  • Increases LDL cholesterol
  • Unsaturated Fat
  • Liquid at room temperature
  • Plant and animal foods (avocadoes, fish, nuts, seeds)
  • Decreases LDL cholesterol
  • Trans Fat
  • hydrogenated/partially hydrogenated oils
  • Processed and convenience foods
  • Increases LDL cholesterol
  • Decreases HDL cholesterol
  • Avoid trans fat
• Diet and lifestyle practices that influence risk of cardiovascular disease
  • Increase risk of CVD
  • Saturated fat
  • Trans fat
  • High sodium
  • Excess sugar
  • Excess kcals
  • Excess alcohol
  • Decrease risk of CVD
  • Polyunsaturated fat
  • Monounsaturated fat
  • Fiber
  • B vitamins
  • Antioxidants
  • Moderate alcohol
• Hypertension
  • Silent killer because there might be no symptoms
  • Persistent elevated blood pressure
  • Normal = <120/<80
  • Prehypertension = 120-139 (systolic) or 80-90 (diastolic)
  • Hypertension = >=140 (systolic) or >=90 (diastolic)
  • Risk factors
  • Family Hx
  • Age
  • Race/ethnicity
  • Obesity
  • Lack of PA
  • High sodium diet
  • Cigarette smoking
  • Excessive alcohol consumption
  • T2DM

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