FNU 220: chapter 17 (EXAM 4) *textbook
viscous fiber
- "Sticky" type of soluble fiber found in oats, barley, and flax, psyllium enriched cereals, legumes, some fruits. - Responsible for fiber-related physiological effects of decreased LDL
weight loss: - 1/2 lb/ week (kcal deficit) - 1lb/ week (kcal deficit) - 2lb/week (kcal deficit)
- 1/2: 300 - 1: 500 - 2: 1,000
phenotypic manifestation (physical signs) of insulin resistance
- hyperpigmentation of the skin at the back of the neck - "buffalo bump" (fat accumulation at the base of the neck) - double chin
Pharmacotherapy for type 2 diabetes
- metformin - oral antihyperglycemic drugs
ways to manage carb intake
- plate method based off MyPlate - counting grams per meal and snack
interventions for: - central adiposity -dyslipidemia - hypertension -elevated glucose
- reduce weight and fat mass -achieve an optimal lipid profile - normalize blood pressure - reduce fasting blood glucose and increase insulin sensitivity
environmental factors that can cause cancer (list them)
- tobacco - smoke - infectious agents - radiation - chemicals - carcinogenic agents in food (epithelial tissues are most exposed to these)
what effects blood glucose?
- types of food - timing of foods eaten - beverages consumed - amounts of food -response to insulin secretion if available
metabolic syndrome may be diagnosed is 3/5 indicators are present (list all 5)
-large waist circumference - elevated blood triglyceride - low high-density lipoprotein cholesterol - elevated blood pressure - elevated fasting blood pressure
good sources of stanols and sterol esters
-wheat germ and bran -peanuts and almonds -veg. oils
the goal of clinical management of metabolic syndrome is to reduce the risk of _______________ ________________ and progression to ________________
....atherosclerotic diseases and progression to diabetes
areas affected by cardiovascular disease
1) heart (coronary heart disease) 2) brain (cerebral vascular disease leading to stroke) 3) blood vessels in the legs (peripheral arterial disease)
5 primary mechanisms of antihyperglycemic medications
1) stimulate the pancreas to produce more insulin 2) increase the response to insulin at cell receptor sites; 3) decrease amount of glucose released by the liver; 4) reduce digestion of polysaccharides to delay absorption of glucose from the gut into the blood; and 5) increase glucose excretion by kidneys
weight loss of ______-______lb per week is recommended
1/2-1 lb
a minimum of ______ minutes of moderate intensity or higher physical activity (30 minutes, five days a week) is recommended for weight loss
150 minutes
normal BMI
18.5-24.9
overweight BMI
25-29.9
Obesity BMI
30.0-34.9 (class 1) 35.0-39.9 (class 2)
severe obesity BMI
40 or above (class 3)
Screening for metabolic syndrome is recommended beginning at age ____ for asymptomatic adults or earlier for individuals who are
45; ...overweight and have one additional risk factor, such as smoking or physical inactivity
the American Diabetes association recommends that adults should be screened for type 2 diabetes or prediabetes if they are _____ years old, or earlier if they are overweight, have certain conditions
45; then be screened every 3 years after
the amount of carbohydrate allowed per meal is based on body size and activity level and typically ranges from _____ g for women (3 servings) to ____ g for men (4 servings per meal)
45g for women 60g for men
screening for CVD should occur every _____ years at age 20
5 years
normal A1C level high A1C level
6% 25%
life expectancy is shortened by ___-___ years
6-19 years
plate method for diabetes
9-in. dinner plate is divided in half. the first half is filled with about 1 cup of nonstarchy, low-carbohydrate vegetables (asparagus, broccoli, green beans, salad greens, zucchini). the other half is divided again. One quarter is used for a serving of a lean protein source (3 oz skinless chicken, lean beef or fish, eggs, cheese, tofu). the other quarter is used for a serving of a carbohydrate food (grains and starchy foods such as corn, brown rice, potato, whole grain bread, pasta)
underweight BMI
<18.5
Insulin, injected intramuscularly, is required in type 1 diabetes and is used in type 2 diabetes when a1c is ________ or blood glucose _______ mg/dL.
>10%; >300mg/dL
lipid-lowering medications are prescribed when LDL is ________ mg/dL
>190 mg/dL and at lower levels (70-189 mg/dL) if the individual has an increased 10-year risk score or diabetes
BMI needed for bariatric surgery
>35
prediabetes
A condition in which blood glucose levels are higher than normal but not high enough for the diagnosis of diabetes. It is characterized by impaired glucose tolerance, or fasting blood glucose levels between 100 and 125 mg/dL
insulin resistance
A condition in which cells "resist" the action of insulin in facilitating the passage of glucose into cells.
cardio-protective diet
A diet that emphasizes plant foods (vegetables, fruits, grains, especially whole grains, and legumes), appropriate fats, and fish, along with smaller amounts of lean meat and dairy
type 2 diabetes
A disease characterized by high blood glucose levels due to the body's inability to use insulin normally, or to produce enough insulin. This type of diabetes was called adult-onset diabetes and non-insulin-dependent diabetes in the past.
type 1 diabetes
A disease characterized by high blood glucose levels resulting from destruction of the insulin-producing cells of the pancreas. This type of diabetes was called juvenile-onset diabetes and insulin-dependent diabetes in the past
meal replacements
A nutritionally balanced beverage, meal bar, or packaged meal used to replace a meal in weight managemen
eating plan
A plan for timing of meals and snacks and types and amount of foods eaten to achieve nutrition goals
Hyperinsulinemia
A state of excess levels of insulin circulating in the blood. It is common among persons with metabolic syndrome and type 2 diabetes and is caused by the pancreas trying to compensate for insulin resistance of cells
the diagnosis of diabetes requires con-firmed glucose intolerance verified by either a... (types of tests)
A1C test, fasting plasma glucose tests, or an oral glucose tolerance test.
Dyslipidemia
Abnormal blood levels of cholesterol and/ or triglycerides resulting from altered lipid metabolism
patient centered care
An approach to care that is respectful of and responsive to the patient's preferences, needs, and values and ensures that the patient's values guide all clinical decisions
diabetes self-management education and support
An ongoing process of individualized education and support to facilitate the knowledge, skill, and ability necessary for prediabetes and diabetes self-care and quality of life.
metabolic obesity
Body weight set point shifts to a higher level due to alterations of the energy balance system.
examples of cardio-protective diets
DASH and mediterranean diet
HDL: good or bad cholesterol? LDL: good or bad cholesterol?
HDL: good LDL: bad
ischemia
Inadequate blood supply to a local area due to partial or complete blockage of a blood vessel.
cognitive behavioral therapy
Programs designed to build knowledge, modify beliefs and attitudes, and integrate new behaviors through a combination of skills training and analysis of behavior and thought processes over a period of several weeks. Key features are cognitive restructuring and stimulus control
Comorbidity
The presence of one or more diseases or conditions in addition to the primary disease or disorder
carcinogenesis
The process by which normal cells are transformed into cancer cells. It includes activation, initiation, promotion, progression, and invasion and metastasis. Dietary constituents can modify the process at several points along the continuum
energy gap
The required change in energy expenditure relative to energy intake necessary to restore energy balance
obesogenic environment
The sum of influences that promote overeating and minimize physical activity and lead to weight gain and hinder weight loss.
Pharmacotherapy
Treatment of disease through the use of drugs
Metabolic Syndrome (Syndrome X)
a constellation of metabolic abnormalities that increases the risk of type 2 diabetes and cardiovascular diseases. It is characterized by insulin resistance, abdominal obesity, high blood pressure and triglyceride levels, low HDL cholesterol, and elevated fasting glucose or impaired glucose tolerance. Also called syndrome X, insulin-resistance syndrome, and the dysmetabolic syndrome
Atherosclerosis
a disease of the arterial blood vessels (arteries) in which the walls of the blood vessels become thickened and hardened by cholesterol and calcium-containing plaque
example of a genetic factor that would increase the risk of an individual having a metabolic syndrome
a family history that includes type 2 diabetes, hypertension, and early heart disease
Therapeutic Lifestyle Changes (TLC)
a higher intensity dietary approach for reducing risk of cardiovascular disease with defined targets dietary changes, physical activity, and weight reduction
hyperglycemia
abnormally high levels of glucose in the blood
plant stanol and sterol esters are...
an essential component of plant cell membranes that resembles the chemical structure of animal cholesterol. When eaten, they block particles responsible for cholesterol transport, which results in less cholesterol absorption
Small dense LDL particles contain more...
apolipoprotein B that makes it more available for binding to the lining of arteries and entry into the endothelium and therefore more atherogenic
Explain: "Cancer development is age-associated but not age-dependent"
as people age, it becomes more likely that some insult or error will damage RNA or adversely affect the DNA replication process, and ultimately cause cancer. In healthy, resilient individuals, initiation may be repaired and subsequent cancer avoided or delayed
what begins to grow in childhood and adolescence of people who have CVD?
atherosclerotic lesions; Lesions remain asymptomatic until the thickening wall reduces blood flow leading to ischemia
hedonic obesity
body weight maintained above set point due to sustained overeating
Macrovascular changes (atherosclerosis in large vessels) are accelerated by diabetes, resulting in earlier onset of...
cardiovascular diseases
the underlying cause of metabolic syndrome is not entirely clear, but it is thought to result from...
central adiposity and insulin resistance
_______________ supplementation along with _____________ may reduce insulin resistance
chromium; biotin
promotion
damaged DNA divides during a lag period, potentially over 10-30 years
after six months, the rate of weight loss usually....
declines and weight plateaus, due in part to a decline in metabolic rate—the body's physiological response to protect against starvation
LDL function
delivers cholesterol to cells for storage and synthesis of hormones; however, different subtypes of LDL ("large-fluffy" vs. "small-dense") behave differently
Cancers can originate in any cell, but the majority develop in __________ ____________, where cells replicate at a high rate
epithelial tissue (ex. skin, lungs, prostate, breast, colon and rectum, uterus, pancreas, oral cavity, esophagus, stomach, and urinary tract)
cancer is caused by ___________ and _________________ factors
exogenous (environmental) and en-dogenous factors
when are weight loss medications used as an adjunct to diabetes therapy?
for those who are obese and have a comorbid condition
activation
from inactive or quiescent state
possible causes of metabolic obesity
genetic and environmental influences; including food experiences in infancy and childhood
Diabetes is a chronic disease associated with abnormally high levels of.....
glucose in the blood
Oral antihyperglycemic drugs are added if...
glycemic goals are not reached in 6-12 weeks of lifestyle interventions
_______________ and ___________________ are early biomarkers for CVD
hyperlipidemia and hypertension
initiation
injury or insult to DNA by a carcinogen such as free radicals, toxin, virus, or radiation
primary prevention
maintaining and healthy state
computerized tomography (CT) scan
measures calcium deposits in arteries and produces a coronary artery calcium (CaC) score. It can measure coronary artery disease before signs and symptoms occur
Self-monitoring of blood glucose (SMBG)
measures glucose blood levels through the use of a glucometer and is part of everyday life for people with diabetes
exercise facilitate the uptake of glucose by...
muscle cells; therefore, individuals with type 1 diabetes must learn to reduce their insulin dose and increase carbohydrate intake to minimize blood glucose swings during and after exercise
bariatric surgery is reserved for...
patients with clinically severe obesity who meet criteria (BMI ≥40 or ≥35 with high risk for obesity-related morbidity or mortality, and generally after other therapy has been tried for six or more months without success)
phenotypes (i.e., observable traits that result from interactions between genetics and the environment) reflect...
present, past, and ancestral environments and help explain individual variation in why some people are obese yet "metabolically healthy" and some people are normal weight, but laboratory tests indicate they are "metabolically obese
Roux-en-Y procedure
produce malabsorption by bypassing a section of the small intestine
Lowered blood cholesterol results in....
reduced formation of new plaques and reduced size of existing plaques lining arterial walls
metformin
reduces blood glucose by decreasing the amount of glucose released by the liver and increases glucose uptake by the muscles; is typically prescribed as an adjunct to lifestyle change for newly diagnosed type 2 diabetes and those with prediabetes and BMI >35
secondary prevention
reducing risk factor and delaying advancement to overt disease
Microvascular damage to capillaries in the back of the eye results in... (+ kidneys, and feet)
retinopathy and eventual blindness; in the kidneys, it causes nephropathy leading to reduced kidney function and renal failure requiring renal dialysis, and in nerves, it causes neuropathy and loss of feeling in hands and feet
HDL function
scavenges excess LDL cholesterol and transports it to the liver for recycling and removal from the body
gut microbiome influence the release of...
several metabolite and hormones (predominantly short-chain fatty acids, serotonin, peptide YY, ghrelin, and ligands) that communicate from the gastrointestinal tract to the appetite regulatory centers in the brain through nerve signaling pathways, or through blood circulation
Invasion and Metastasis
spread to other tissues and organs
surgical procedures reduce stomach size and restrict intake by...
stapling, banding, insertion of balloon, or vertical sleeve gastrectomy
possible remission
successful treatment or reversal
African Americans with very high BMIs and very high levels of insulin resistance can have very low levels of...
triglycerides, even though they have a significantly higher prevalence of cardiovascular disease and diabetes compared to Whites (may lead to underdiagnosis)
True or false: people who use behavioral strategies to support weight loss and maintenance tend to be more successful
true; examples of these behavioral strategies are: consistently controlling caloric intake [through restricted intake of certain types or classes of food (low carb), limiting fast food, eating all foods but in limited quantities, counting calories, or limiting percentage of daily energy from fat], exercising more often and more strenuously, tracking weight, and eating breakfast
progression
uncontrolled growth of cancer cells
____________ ______________ is used to assess central adiposity and it allows further stratification of risk beyond BMI
waist circumference
statins
widely used and work by blocking the enzyme (hMG-Coa) responsible for making cholesterol in the liver resulting in LDL cholesterol reductions of 30 to <50 percent. they also stabilize plaques, making them less prone to rupturing and forming clots that can block arteries. Statins also reduce arterial inflammation, which contributes to atherosclerosis
why is bariatric surgery also referred to as "metabolic surgery"?
y impacts the mechanisms of metabolic and hedonistic obesity and has been shown to result in improvement or resolution of obesity-related comorbidities (e.g., lower blood glucose, better lipid profile, lower blood pressure, reduced cardiovascular disease risks, and increased mobility)