NTR 108 Exam 3 Study Guide PDF

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Exam 3 Study Guide NTR 108 Exam Date: 5/10/2019 Week 11 - Part A Functions of Water

Osmosis

Sources of Water

 Fluids

Fluid Requirements

Fluid and Electrolyte Balance

Method to maintain fluid and electrolyte balance ● Maintains fluid balance via the thirst mechanism (dry mouth) ● Thirst is stimulated with the desire to drink fluids when there is low blood volume, low blood pressure and increased concentration of sodium Body Water Gain ● Fluid volume in blood is increasing ● Electrolyte concentration outside of cells is decreasing compared to the concentration found inside of the cells ● Net movement of water is into the cells ● Urine becomes lighter in color Where does body water even go? ● ●

Production of urine by the kidneys contributes to the greatest amount of water loss There is insensible water loss which happens during breathing or evaporation of water from the skin when you aren’t even sweating

Overhydration ● Water intake exceeds water loss ○ Therefore dilutes body cells and causes neurologic symptoms ○ Decreased electrolyte concentration in the blood ● Hyponatremia ○ Occurs when too much water is consumed in a short period of time ■ Can also cause swelling of tissues Dehydration ● Occurs when fluid loss exceeds fluid intake ○ Factors: intense physical activity, diarrhea, vomiting or abuse of diuretics ● Elderly adults and children are at the highest risk for dehydration ● You can estimate body fluid deficit by measuring the loss of body weight, increase in osmotic pressure of serum (weight yourself before and after exercise) Heat Related Illness ● The first stage of heat-related illness caused by dehydration ● Characterized by heavy sweating and moderately elevated body temperature ● Heat stroke = body reaches 104-degrees or higher of internal temperature ● A good example is overweight football players practicing in a humid environment Cell water content ● Size of intracellular and extracellular shares of body water depend on: ○ Concentration of ■ Sodium ■ Potassium ■ Chloride ■ Phosphorous ● Na,K-ATPase is an enzyme that uses metabolic energy to transport the electrolytes sodium and potassium from one side of the plasma membrane to the other

Week 11 - Part B Functions of Sodium ● Increases extracellular fluid volume because extracellular of NA is higher than intracellular ○ NA is also osmotically active ● Increases absorption of some nutrients Sodium in Foods ● Added to food for safety and popularity ● Most sodium is found in breads, meats (top 2 popular), soups, sauces and snack foods ● AI = 1500 mg/d at 19-50 years old, but the median intake is more than double that Bioavailability ● BIO = The fraction of ingested nutrient that is absorbed and available to the body ● BA of sodium is very high because sodium is absorbed in the intestine ● Sodium deficiency is rare Dietary Patterns (Sodium and Potassium) ● High sodium to potassium ratio increases intake of hypertension ● Lower sodium and increase potassium and hypertension might be stopped ● To optimize intakes, consume more fruits and vegetables and limit processed food ○ Optimal intakes can lead to lower blood pressure ● AI = 4700 mg/d for ages 14 and older ○ Only 1.4% of us meet this guideline and usually, end up taking only 2600 mg/d Chloride (CL) ● Most chlorine intake is from NaCL which is added ● Cl is an anion and absorbed in the small intestine and colon ● Extracellular concentration of Cl is higher than intracellular ● Component of gastric juice’s HCL ● AI = 2300 mg/d ○ Avg. consumption is 5400 so deficiency is rare ○ UL is 3600 Phosphorous ● Rda = 700 mg/d for adults, but median intake is 950-1650 mg/d ● Comes from dairy, bakery products, sodas and meats Week 12 - Part A Objective: Preconception nutrition, maternal diet during pregnancy, and maternal diet during lactation Life (developmental) stages

Pregnancy

Proper Nutrition Prepregnancy Obesity Risk

Prepregnancy Underweight Risk

Gestational Weight Gain

Guidelines for Gestational Weight Gain ● Underweight (BMI30) - 11-20 lb ● Carrying twins after having normal preconception BMI - 37-54 lb

Additional Weight Gain Recommendations ● All overweight and obese women should be advised to not lose weight during pregnancy ● There should be no loss of body weight since the fetus might be deprived of essential nutrients ● Women who do not gain enough weight are at risk of having a baby who is small for their gestational ge and has a low birth weight Constipation and morning sickness ● Symptoms from pregnancy can prevent adequate weight gains such as vertigo, constipation, gastroesophageal reflux, nausea and emesis ● First line therapy for constipation includes increasing exercise and dietary fluids ● Morning sickness is found to be a protective factor for pregnancy loss ○ Try to avoid it by avoiding poorly tolerated foods and oral supplements Gestational Diabetes ● Type of diabetes that occurs in previously nondiabetic women during pregnancy ● Impacts 10-18% of all pregnancies in the USA ● Risk factors: Pregnancy overweight and obese BMI, high GWG (gestational weight gain) ● After the baby is delivered, the mother is put at risk for type 2 diabetes 5-10 years after delivery ● Prevention: proper screening, controlling blood sugar and following healthy habits ● Treatment: focuses on medicaion, diet and physical activity

Lactation ● Breastfeeding poses many advantages over formula feeding ● Women who do this experience uterine contractions and suppressed ovulation ○ Typically return to prepregnancy weight quicker ● Gives maternal antibodies to newborns ● Inadequate nutrition and hydration can interfere with breastfeeding ○ Recommendation: consume a nutrient-dense diet with adequate calories and fluid ● Lactating women need more energy, proteins and fluids ● You don’t need as much iron during lactation Age and Conception ● The older the mother is the more likely there might be gestational diabetes and down syndrome ● Decreases the risk of iron deficiency anemia in mother ● Women younger than 20 and older than 35 might have hypertension during pregnancy Week 12 - Part B New Born Babies ● Premature babies born before 38 weeks have low birth weight ○ High risk for health problems such as lung immaturity, liver immaturity, low body stores of fat and other nutrients ● Infants who weigh less than 5.5 lbs at birth are small for gestational age ○ High risk for morality during infancy and health problems Infants and Toddlers Infants

First year after birth

Toddlers

1-3 years of age

Macronutrient needs Daily

Infants

Young

Protein, g per day Protein, g/kg per day

9.11-11.0 1.6-2.2

46-56 0.8

Energy, kcal per day Energy, kcal/kg per day

570-743 100-120

2403-3067 30-40

Water, liter per day Water, ml/kg per day

0.7-0.8 150-170

2.7-3.7 25-30

Vitamin Needs

Milk ●

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Colostrum = first milk made by the breast ○ Contains antibodies and factors that promote growth of healthy microbiome ○ Mature milk is then produced Mature milk is produced after (several days after baby’s delivery)

Infant Nutrition ● Dietary recommendations are based off of the nutrient composition of breast milk ○ Ex: carb RDA is based off of lactose content of human milk ● Infants need about 2 ounces of fluid per pounds of body weight ● 40-50% of energy should come from dietary fat ● No more than 20% of energy should come from dietary protein ● Infants should be ingested with Vitamin K ● Breastfed infants are given Vitamin D until 6 months ● Solid foods provide additional calories/nutrients ○ Foods can be good sources of iron Advice to risk food allergies and prevent choking, digestive problems, bacterial infections ● 6 month olds ○ Begin with pureed foods before advancing to soft foods → then go to textured foods ○ Avoid seasoning foods with salt or spices ○ Introduce one food at a time for 4 days in a row ○ Do NOT give honey or corn syrup until they are 1 Toddler Nutrition ● 30-40% of total energy intake should be dietary fat ● Recommends the intake of fruit juice be limited to a maximum of 6 fluid ounces per day for children years 1-6 ● How to promote healthy eating habits ○ Provide small portion sizes ○ Prepare and serve food in fun ways ○ Include children in food shopping and preparation ○ Don’t reward them with dessert

○ Children cannot choose or prepare their own snacks Preschool and school-age nutrition ● School age children need less protein than toddlers ● Diets need to provide energy to support daily activities ● Dietary total fat intake should be reduced to 25-35% of total energy intake ● Beverages should not contain caffeine or added sugars ● Calcium intake is a problem ○ 60% of US children consume less than 2 servings of dairy a day ● Iron deficiency is a problem ○ Can adversely impact energy, attention span, and a child’s ability to learn ○ Try to eat meat for heme iron BMI ● 8% of children aged 2-5, and 17% of 2-19 years old are obese ● Rates have stabilized but not declined ● 70% of obese children become fat adults Allergies ● Immune response to a protein ● Peanut and tree allergies are the leading cause of anaphylaxis ● Scientific research has shown that peanut allergy can be prevented by introducing peanuts early in life

Week 13 - Part A Body composition after you turn 8 years old ● Fat-free mass and fat-free soft tissue mass increase until 20-39 years old ○ Plateau during ages 40-59 years old and then eventually decreases as you get older ● Body fat percentage peaks at 60-79 years old ● Men have higher fat-free mass than woman ● Women have more fat mass and percentage of body fat Puberty ● When secondary sex characteristics develop ● With puberty, girls tend to gain more body fat and less muscle mass than boys Adolescent Nutrient Needs ● Carb intake should be 45-65% of total energy intake ● Dietary total fat should be 25%-35% of total energy intake ● Rda for Protein is 0.85 g per kg body weight per day ● Calcium RDA increases to 1300 mg/day ● Vitamin A RDA increases to 700-900 micrograms ● Folate ○ Pregnant women are advised to consume 400 mcg of synthetic folate to prevent neural tube defects Iron Requirements ● Values are based on studies of serum ferritin concentration ● Iron RDA is 11 mg/d for years 14-18 but goes back to 8 at ages 19 or greater

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○ This is because fat-free mass has slowed or stopped Females: if they are not pregnant, mg/d is 15 (ages 14-18) and increase to 18 mg/d from years 19-50 Women are advised to consume foods containing heme iron such as meats, poultry, and seafood

Nutritional concerns of adolescence ● Cigarette smoking and alcohol consumption interferes with proper nutrient metabolism ● Male and female adolescents are at risk for developing eating disorders ● Adolescents do not consume recommended amounts of vegetables, fruits, and whole grains ● If adolescents reduce their glycemic load, they might have less acne Obesity ● Estimated energy requirements (EER) tends to increase in females until age 19 and in males until age 14-18 years old ● Adolescents have a higher risk of obesity because of their decrease in resting energy expenditure ○ In addition, peer and media influence make them fatter ● Child with a BMI at or above the 95th percentile for the age and gender is considered obese ● 17% of US children ages 2-19 are obese ● High BMI can cause insulin resistance and type 2 diabetes ● Obesity can be treated Adolescent Pregnancy ● Teen pregnancy can result in them needing more of certain nutrients such as calcium ○ Might have low birth weight when having the baby Mixing Alcohol and Pregnancy ● Alcohol contains ethanol, which is a teratogen (causes fetal harm) ○ You CANNOT consume ethanol! ● Fetal alcohol syndrome can cause the baby to have malformations of the face, congenital anomalies, limbs, heart and the nervous system Alcohol in general ● Alcohol cannot be consumed my pregnant women, breastfeeding women or anyone taking medication ● Moderate consumption is defined as 1 drink a day, or two drinks a day for men ● Fatty foods in the stomach can slow down alcohol absorption ● Liver takes 1.5-2.0 hours to metabolize one drink of alcohol ● Alcohol depresses the central nervous system ● Alcohol is not recommended to be drinken for supposed health benefits Moderate alcohol vs. abstinence ● More alcohol can make you more sensitive to insulin and lower your risk for type 2 diabetes ○ Found by some observational studies ○ Randomized controlled trials confirmed this as well Adverse effects of alcohol ● Alcohol can cause congenital anamolies

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Moderate-heavy alcohol consumption is a risk factor for colorectal cancer Damages body organs and increases mortality Severe liver disease = cirrhosis (severe scarring and disruption of liver struvture) Patients with cirrhosis are very likely to have protein-calorie malnutrition (>65%) ○ Reasons: anorexia, nausea, vomiting, alcohol drinks lack protein ○ Intestinal villous atrophy Small intestine absorbs nutrients ○ Villous atrophy can cause gastrointestinal bleeding Decompensated cirrhosis goals are to: ○ Avoid weight loss and nutrient deficiencies

Thiamin ● Coenzyme form is required for the healthful metabolism of carbs and branched chain amino acids ● Deficiency is wernicke-korsakoff ● You need more thiamin when you drink more since it also impacts its absorption Week 13 - Part B Body composition after you turn 8 years old ● Fat-free mass and fat-free soft tissue mass increase until age 20-39 years ○ Plateau during age 40-59 years then ○ Decrease during older adulthood ○ Body fat peaks at 60-79 years ● 20 to 25 years

70 to 75 years

Water

61%

53%

Mineral mass

6%

5%

Fat

14%

30%

Water needs of older adults ● AI for water remains the same throughout adulthood ● Older adults: ○ The decreased renal concentrating capacity that causes increased obligatory urine ○ Decreased extra-renal losses of water ○ Thirst is not as reliable but more foods consumed that have high water content Energy needs of older adults ● Older adults have less of an energy requirement because they have a lower BMR ○ BMR = energy needed to maintain basic functions Macronutrients for older adults ● RDA = 130 grams per day from toddlerhood through older adulthood ○ Minimum requirements for the brain - need more for daily activities ● RDA = protein for sedentary adults is 0.8 g per kg

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Recommended energy from protein is 10%-35% of total energy intake Fat = 20-35% of energy intake

Recommendations about fiber intake ● AI for years 19-50 is 25 g/day for women and 38 g/day for men ● When you are older than 50 years, fiber AI is only 21 for women and 30 for men (g/day) ● Fruit and vegetables are excellent sources of dietary fiber, and legume are particularly high ○ Consume different types of dietary fiber Vitamin A ● RDA stays the same for all ages ● Fractional absorption increases in older adults ● Recommendation: increase consumption of fruits and vegetables that are high in carotenoids ○ Avoid toxicity and do not consume vitamin A supplements Vitamin B12 ● Cofactor for enzymes required for DNA synthesis and fatty acid metabolism ● Deficiency = anemia and neurologic disease ● Food Sources: animal products and B12 fortified foods ● You can also be treated with B12 injections ● Decreased HCL in gastric juice can eventually lead to decreased fractional absorption of B12 ● Decreases intrinsic factor production decreases fractional absorption Calcium ● Fractional absorption of calcium is reduced as you age ○ Resistance to vitamin D becomes more prevalent as you age ● RDA for calcium is therefore higher ● Taking daily dietary supplements containing 1200 mg calcium and 800 IU vitamin D decreases the risk of hip fracture and mortality for patients dwelling in institutions Iron ● ●

Iron RDA stays the same for all ages RDA for iron is lower for women after they have gone through menopause

Dietary Supplements ● Having too many supplements can have direct toxic effects ○ Can also interfere with medications ○ Compete with essential nutrients for absorption in to the body ● For older adults, consult doctor before deciding to do so Mortality and Morbidity ● Life expectancy = average time a person can expect to live ○ Or average number of years of life in a defined population ● Life expectancy has increased to 78 years in USA ● Leading causes of death in USA cause morbidity (can’t do the things you usually do)

BMI and Diabetes ● When you are older and have a higher BMI, there is a greater risk for type 2 diabetes ● ⅓ of older adults are classified as obese Therapy for Knee Osteoarthritis ● Interventions that use lifestyle modification to lose body weight lessen pain and disability ● Weight loss also decreases hip bone mineral density and leg muscle volume Unintentional changes in BMI ● For older adults, being underweight may actually be more risky than being overweight ○ This is a mastering nutrition question ● Since old people have bad teeth, they lose weight from not eating ● Dementia patients tend to lose body weight ○ Mastering Nutrition Changes in Body function during older adulthood ● Salivary production, smell, taste and visual perception decline with age ● Respiratory disease and Parkinson’s impair smell ● Poor vision makes it harder to old people to get to the supermarket ● Dysphasgia = difficulty swalloing ○ Creamy soups, apple sauce and yogurt are tolerated well ○ Another Mastering Nutrition Week 14 - Part A Disordered Eating ● Unusual eating behaviors done to control body weight ○ Don’t continue long enough to make someone seriously ill ○ Genetic factors are a possible contribution to eating behaviors ● Individual’s BMI does not contribute to disordered eating behaviors ● Not as severe as an eating disorder Eating Disorders ● Clinically diagnosed psychiatric disorder characterized by disturbed view of body image and eating behaviors ● More severe than “disordered eating” and can cause negative impact to body functions Examples of Eating Behaviors ● Anorexia Nervosa ○ Extremely low body weight achieved through starvation ○ Those who have this are fearful of gaining weight and end up having nutrient deficiency ● Bulimia nervosa ○ Binge and Purge disease ○ Extreme overeating followed by making yourself purge right after ● Binge eating disorder ○ Binging on food but not purging ○ Common in men and women ○ Associated with low self-esteem, depression and excessive body weight gain

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To help combat eating disorders, a team approach works best (physician, psychologist and a nutritionist) ● Night-eating syndrome ○ When majority of calories are consumed between 8 pm and 6 am ○ Characterized by insomnia and depression ○ Combines an eating disorder, sleep disorder and a mood disorder ○ Associated with obesity ● Body dysmorphic syndrome ○ When people are overly obsessive with their body and how they look ○ Muscle dysmoprhia is an example of this ■ Disordered eating behaviors and excessive exercise ● Sports Energy Deficiency ○ When active men and women do not get enough calories to meet their needs for energy ○ Female Athlete Triad ■ Characterized by three conditions ● Low energy availability/level ● Amenorrhea (menstrual disruption and dysfunction) ○ Not severe enough to be an eating disorder ○ Menstrual cycle disruption is from not eating enough ■ Gymnastics is a common sport for this to occur due to recommendation for lower body weight Week 14 Part B Physical Activity (benefits) ● Helps reduce the risk of certain chronic health conditions ● Can help improve sleep patterns, improve immune function ● Does not eliminate the risk of diabetes and heart disease ● Helps improve weight loss when combined with a moderately restrictive diet...