C787 Study Guide 2020 PDF

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Study guide for C787 course. Outlines the important information that you need to know for the exam....

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C787 Study Guide “Readings” link to course reading materials. *****To view a “Chapter” reading you must be logged into your student portal. Unit 2: Nutrition to Support Wellness (Cohort 1) Reading: Macronutrients -Identify the differences between macronutrients and micronutrients Macronutrients: are carbs, lipids & proteins. Provides energy needed for growth, thermoregulation, physical activity, pregnancy/lactation. Needed in larger amts than micronutrients Micronutrients: vitamins/minerals in small amts for good health/development. Play various roles in cell metabolism. Deficiencies cause widespread health prob -Differentiate basic S/S for the following diseases: obesity, marasmus, kwashiorkor, anorexia nervosa, bulimia nervosa, pellagra. Obesity: excess consumption. Increased risk for CAD, some cancers & type 2 diabetes. Puts stress on knee/ankle joints. Is an energy imbalance, where energy intake exceeds energy expenditure. Influenced by genetic/environmental factors. Marasmus: general deficiency of macronutrients. Also called protein-calorie malnutrition. Kwashiorkor: primarily attributed to deficiency of dietary protein. s/sx include fatigue, irritability, lethargy, poor growth, apathy, edema, decreased muscle mass, large belly, diarrhea, dermatitis, change in hair, infections. Can lead to coma/death. Anorexianervosa: restricted intake. Body weight @ or < 85% of normal. Intense fear of wt gain, distorted perception of body wt. 3rdmost common condition of adolescents. Common comorbid conditions: OCD, depression, anxiety, social phobia. Can lead to decreased micronutrient intake, which leads to death. Bulimia nervosa: binge eating f/b purging (vomiting or misuse of laxatives/diuretics). Can lead to obesity. Pellagra: Deficiency of Niacin (Vit B3). Characterized by “4 D’s of Pellagra:” dermatitis, diarrhea, dementia & death. Reading: Micronutrients Identify diseases/illness related to specific vitamin deficiencies (vitamin A, vitamin C, vitamin D, iron,iodine, etc.). Vit C Deficiency(Scurvy): Early signs are bleeding gums/pinpoint hemorrhages under skin, rough scaly skin, hardening of arteries or massive bleeding can happen & lead to death. Vit D Deficiency(Rickets): bone formation impaired. Bow legged appearance Vit A Deficiency: leads to blindness. Even mild deficiency causes diarrhea & URIs

Iron Deficiency (Anemia) Iodine Deficiency: leads to physical/mental developmental delays.Arboflavinosis lack of riboflavin

Reading: Malnutrition identify the differences between kwashiorkor and marasmus Kwashiorkor: Adequate calories, not enough protein. Often occurs in areas of famine, low food supply, low education levels. Often tropical regions w/ diet high in starch/low in protein. Early RX has+ results. Without RX, is fatal Marasmus: means to “waste away.” Is acute form of malnutrition. Deficiency of BOTH calories AND protein. Most severe form of childhood malnutrition. Body fat stores used for energy & then muscle is broken down for body fuel. Person appears as skin/bones w/ lg eyes, bald head, aged/gaunt appearance. Once severe muscle wasting occurs, death is imminent. Have below norm body temp. Reading: Treating Malnutrition Identify effects of and treatments for malnutrition. Pyhsical factors- poor appetite, poorly fitting dentures, affecting the ability to chew foods, loss of tase and smell, disability and disease e.g. stroke, cancer dysphagia and Parkinson’s Lifstyle factors- ability to maintain their nutritional intake may include reduced income, isolation and loneliness, religious and cultural beliefs, lack of food choices, e/g/ people resident in care homes may have reduced variety menus, or the effects of reduced mobility in relation to shopping or preparing food Psychological factors – confusion, depression, bereavement or dementia, which can affect a persons ability to desire to prepare food Meds should be reviewed. Parkinson’s drugs, co-beneldopa, may cause dry mouth and alter taste. Clpidogrel (for stroke or MI) can cause dyspepsia and diarrhea and irbestatrit and antihtn may cause n/v/ Malnutrition Universal Screening Tool *MUST* BMI – 18.5 RISK for malnuturtion loss of 10% or more of normal body weight in 3-6mths is malnutrition risk Acute illness resulting in no nuturaionl intak for more than 5 days 2 or > high risk of malnutrition A “food first” approach is usually the first step towards tx or reventing malnutrition. – high nutritional value, add snacks, reducing portion size to encourage completion of meals, may

prescribe (ONS) oral nutritional supplments – ONS may be stopped when the following conditions apply -DI is meeting requirements -Wt has increase to target BMI is within healthy range condition has changed- eg. Swallowing condition recovers 0 no longer tolerat them due to taste fatigue Key points: 1 in 4 addults affect by malnutrition on admission to hospital screening should be completed upon initial contact and rescreening Malnutritional mgt should look at with a “food first” approach ONS should be prescribed to monitor its effectives and stop/ as required. Reg monitoring Reading: Chapter 1: Applying Nutrition Science to Public Health (PLEASE ACCESS THE CHAPTER THROUGH THE UNIT 2 COURSE MATERIAL IF THE LINK DOES NOT WORK FOR YOU)

What changes were made when DRIs were established in the late 1990s? DRI replaced RDA’s. DRI’s are specified on age, gender, and life stage, and cover more than 40 nutrient substances. They rely on best scientific evidence. Overtime and vary on cycle stage or gender. The Reference values for ht/wt are from NHANES III. DRI”s differ from the original RDA’s in that they incorporate in the concpets of disease prevention, Upper level of intake and potential toxcicity, in non traditiaonl nutrients. More relationships of phytochemicals, herbals, botanicsl and helath these 2 can incorporate into the recommendations. DRI’s are a set of at least for nutrient based reference values these are est av require. (EAR) upper intake level (UL) adequate intake (AI) and RDA. What do the acronyms signify? Pg 22 DRI- set of at least for nutrient based reference values these are estimated average requirements UL- upper intake level- highest level of continued daily nutrient intake that is unlikely to pose an adverse health effect EAR- Estimated average requirement- median intake to meet requirements. Not all nturients have ERA. The ERA is used to calculate the RDA RDA- RDA= ERA + 2 std deviation of the requirement. If there is not ERA there can no no RDA, I there is the case an AI is provided. It is important to mee the RDA or AI without exceeding the UL AI-adequate intake can bse used as a guide for intake but not used for all applications a EAR is used for/ Describe how these numbers are developed and how they are used to guide nutritional

recommendations for people and populations. Identify the types of dietary fats (including trans-fats) and recommendations regarding their consumption. What is the DASH diet and what level of sodium has been shown to reduce high blood pressure? Dietary Approach to Stop Hypertension (DASH) Reduce sodium intake below the current recommendation of 100 mmol/day and the DASH diet lowered BP Reading: MyPlate Method Understand the MyPlate tips including recommended proportions of grains, fruits and vegetables and other food groups. Make half your plate fruit and veggies Move to low-fat and fat-free milk or yogurt - Focus on whole fruits Vary your protein routine -Vary your veggies Drink and eat less sodium, saturated fat, and Make half your grains whole grains added sugars Reading: Healthy.gov Dietary Guidelines 2015: Recommended Shifts Chapter 2 What recommendations would you make to a pregnant patient regarding folate and why? To prevent neural tube defects Provide examples of whole grains versus refined grains and how could a patient better meet the recommendation for consumption of whole grains? Whole-Grain Flour - Contains all 3 parts of the grain kernel, bran, endosperm, and germ., denser texture, higher nutrient content, Fiver and B vitamins, shorter shelf life Refined Flour -Contains only endosperm, finer texture, Has a lower nutrient content, lacking fiber and B vitamins, though some vitamins and minerals are added back in via enrichment.  Has a longer shelf life

Identify at least 4 ways to modify a diet creating a healthier eating style/pattern. Define nutrient-dense and give examples of nutrient-dense foods. Foods rich in nutrients for the number of calories contained in each item Fatty fish, dark leafy greens

Identify foods that are typically high in sodium and strategies to reduce sodium in the diet. AMDR = Acceptable Macronutrient Distribution Range

What are AMDRs for carbohydrates, fats and proteins? https://health.gov/dietaryguidelines/2015/guidelines/appendix-7/ AMDR = Acceptable Macronutrient Distribution Range 1-3

4-8

4-8Males

9-13 F

9-13M

14-18F

Carb % AMDR 45-65 45-65 45-65 45-65 45-65 kcal Protein AMDR 5-20 10-30 10-30 10-30 10-30 % Fat % AMDR 30-40 25-35 25-35 25-35 25-35 Reading: Nutrient Recommendations: Dietary Reference Intakes (DRIs)

14-18M

45-65 10-30 25-35

What recommendations would you make to an older adult patient regarding vitamin B12 and why? Reading: Sample 2-Week Menu Reading: How to Understand and Use the Nutrition Facts Label 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. DV% means daily value. It is based on the serving and the percent of value for that day, within that food item. 5-20 Rule: 5% or less means nutrient is not a good source for daily value. (5% is low) 20% or more is ideal (20% is high) *Less than 5% should be fats, saturated fats, cholesterol, and sodium *20% or more should be fiber, vitamins, and minerals

Reading: Interested in Losing Weight? How do you calculate BMI from weight (lbs) and height (inches)? BMI= 703 x weight/height^2 Example: 703(196/64^2)=33.63 (BMI

What 4 things does a healthy weight loss plan consist of? hat 4 things does a healthy weight loss plan consist of?  A reasonable, realistic weight loss goal

 A reduced calorie, nutritionally-balanced eating plan  Regular physical activity  A behavior change plan to help you stay on track with your goals

Unit 3: Healthy Nutritional Choices

(Cohort 1)

Reading: Chapter 10: Importance of Public Health Nutrition Programs in Preventing Disease “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? Coronary Heart Dx, some cancers, and stroke How much of the total healthcare expenditures is spent on preventative approaches to preventable disease? 15 Billion$ Define and provide examples of prevention strategies: Primary, Secondary, Tertiary. Primary promotes healthy behaviors:  Nutrition and weight management classes in the community center  Environmental changes to provide nutrition choices in school cafeterias and vending machines  Fruits and veggies matter campaign to increase the availability of fresh fruits and vegetables from farmer markets  Seek to expand the positive potential of health  Vetting information on food labels  In media remains an effective means of communicating nutrition issues to the public  Programs to promote physical activity and fitness good nutrition and smoking cessation  Legislation and regulations can be ratified to endorse more complete food and nutrition labeling

Secondary screening, early detection, and diagnosis of disease :  Screening  Follow up education  Counseling  Health referrals  Therapeutic Lifestyle changes  Program involving self care would be an education and awareness program

Tertiary Treatment and rehabilitation:  Prevention of further disability and any secondary conditions that might result from initial health problems  Medical nutrition therapy MNT  Supplementation in feeding strategies to prevent wasting  Rehabilitation through diet, exercise, and stress management.  Goal is to restore the individual to optimal health level of function given the constraints of disease

What are some factors that contribute to overweight and obesity (modifiable and nonmodifiable)? Non modifiable are age, race, and gender Modifiable are diet and physical activity

How much weight loss (percent of total body weight) has been shown to improve health risks associated with overweight and obesity? 10% In terms of cancer prevention, what are the benefits of a diet high in fruits and vegetables? 3-5 servings of vegetables and 2-4 servings of fruit per day

Identify government agency sponsored dietary recommendations for management of chronic kidney disease. NIDDK: National Institute of Diabetes and Digestive and Kidney Disease  I fresh food more often. Sodium is added to many packaged foods  You spices herbs and sodium free seasonings in place of sa lt  Check the nutritional facts labels on food packages for sodium it daily value of 20% or more meats the food is high in sodium  try lower sodium versions of frozen dinners and other convenient foods  try lower sodium versions of frozen dinners and other convenient foods rinse canned vegetables beans meats and fish with water before eating  Do not use salt substitutes  Eat small portions of proteins

What are anthropometric measures? Anthropometric measures is used for growth and body composition. The most used is linear growth and recumbent length and standing height. Weight along with height can calculate BMI. The other measurement used to assess body composition are skin folds and curcumfrence of weist and arms.

What are the National Cholesterol Education Program (NCEP) recommendations for cholesterol consumption and healthy cholesterol levels that reduce cardiovascular disease

risk? Optional LDL 190 Total 240 HDL 60 High Therapeutic lifestyle changes TLC  Reduce in takes of saturated fat to 7% of total calories and decreasing cholesterol to 200 milligrams per day  Total fat from calories can be in the 25 to 35% range as long as saturated in trans fatty acids are kept low  Encouraged to use plant stanols and sterol's in their diet 2 grams per day small amounts of plant sterol's and phytosterols occur naturally in pine trees and foods like soy beans, nuts, grains, and oil  Increasing soluble fibers to 10 to 25 grams per day is also recommended with weight reducing and increasing physical activity

An underweight patient would be at risk for what conditions or diseases? malnutrition, vitamin deficiencies, or anemia. osteoporosis from too little vitamin D and calcium Video: What is a calorie What is a calorie? to be able to measure the energy we consume and use. That energy is released during digestion, and stored in other molecules that can be broken down to provide energy when the body needs it. It's used in three ways :  about 10% enables digestion  about 20% fuels physical activity  and the biggest chunk, around 70%, supports the basic functions of our organs and tissues. That third usage corresponds to your basal metabolic rate. a number of calories you would need to survive if you weren't eating or moving around calories the average person requires each day: 2000 for women and 2500 for men

What percent of calorie intake goes to digestion, physical activity and basal metabolic rate or (basic functions)? 10% What are the average recommended daily calorie intakes for men and women? 2000 for women and 2500 for men

How does fiber in food affect caloric intake? Reading: Chapter 2: "Current Epidemiology of Obesity in the United States" Are obesity rates on the rise, decreasing or staying about the same? -Increase in US Obsesity has plateaued among women and girls, Increase in men and boys Low income children have decreased in a few dates Increase A.A na dhispanice women, more than 50% of AA women are obse and 40% Hispanic women Is obesity a disease or a result of poor lifestyle choices? Disease Reading: Chapter 8: "Intervening to Change the Public's Eating Behavior" How is body weight related to diabetes risk? Obesity is the primary cause of DM2 to those genetically predisposed

What is insulin-resistance and how is it related to the pathology of Type 2 diabetes? Severity of risk increases with degree of adiposity (or state of being fat)

Reading: Getting to the Root Cause to Treat Eating Disorders Explain what is understood about common underlying causes of eating disorders such as anorexia, bulimia and binge-eating disorder. the root cause involved untreated and unresolved trauma. Additionally, trauma, when left unresolved, can also contribute to the development of other psychiatric disorders and even physical diseases. types of trauma that can be associated with eating disorders including neglect, sexual assault, sexual harassment, physical abuse and assault, emotional abuse, emotional and physical neglect (including food deprivation), teasing, and bullying (Brewerton 2007), including PTSD and borderline personality disorder. There are several forms of therapy available to treat eating disorders. Cognitive-behavioral therapy (CBT) with prolonged exposure is the most recognized and effective methods in treating eating disorders, and many forms of trauma-related disorders. Eye movement desensitization and reprocessing (EMDR) has also been shown to be effective especially in combination with CBT. Some types of medications can also be beneficial in treating mood and anxiety disorders associated with trauma and eating disorders but are best used in combination with therapy.

Reading: Chapter 3: "Early Care and Education" Reading: Weight Management Describe key components of a successful weight management plan and how you could make recommendations to a potential patient to help them be successful in weight gain prevention and/or weight loss (See also Unit 2, “Interested in Losing Weight?”)

Reading: Health-Promoting Components of Fruits and Vegetables in the Diet What are dietary phytochemicals, specifically antioxidants, and how are they protective against disease? Phytochemicals are bioactive non-nutrient plant compounds in fruits, vegetables, whole grains, and other plant foods that have been hypothesized to reduce the risk of major chronic diseases. phytochemicals have been identified in fruits, vegetables, whole grains, legumes, and nuts, but a large percentage of them still remain unknown. Phytochemicals may contribute to their antioxidant activities.

Unit 4: Nutrition and Physical Activity (Cohort 2) Reading: "Physical Activity and Health" at CDC Identify exercise recommendations for populations - children, adults, adults with weight loss goals. What recommendations would you give a patient who would like to increase their physical activity level? Benefits include improved thinking or cognition for children 6 to 13 years of age and reduced shortterm feelings of anxiety for adults. Regular physical activity can help keep your thinking, learning, and judgment skills sharp as you age. It can also reduce your risk of depression and anxiety and help you sleep better. To maintain your weight: Work your way up to 150 minutes a week of moderateintensity aerobic activity (for example, 30 minutes a day, 5 days a week). To lose weight and keep it of: You will need a high amount of physical activity unless you also adjust your diet and reduce the amount of calories you’re eating and drinking. For older adults, multicomponent physical activity is important to improve physical function and decrease the risk of falls or injury from a fall. Multicomponent physical activity is physical activity that includes more than one ty...