Nutr 251 Final Exam

recommendations to achieve healthy weight loss

- steady weight loss is the goal - .5 to 2 lbs per week - for appx 6 months (5-10% loss of body weight) - next 6 months, maintain loss - a 5-10% weight loss results in decrease in elevated blood pressure, total cholesterol, LDL cholesterol, triglycerides, insulin resistance increase in HDL cholesterol decreased risk of some kinds of cancer decreased pain in arthritis (hip and leg)

tracking growth

- takes 1-3 years for an infant to establish their own percentile - once established and on a healthy diet, percentile will be maintained - spurts and lags are normal - jumping up or down 2 or more percentiles could be an indicator of calorie excess/deficit, nutrient inadequacies, illness - head circumference is also measured to assess brain growth - brain grows faster in infancy, rapid growth ends at 18 months

anorexia nervosa: psychological and family therapy

- teach patient to accept healthy body weight - regain control of life - cope w tough situations - family therapy

energy needs during pregnancy

- additional kcal and nutrients required to support fetal growth, placental growth, maternal stores, increased maternal metabolism - physiological adaptations increase use of or absorption of some nutrients - emphasize nutrient dense foods - first trimester: + 0 kcal - second trimester: +340 kcal - third trimester: +452 kcal

limited fat stores can be caused by

- anorexia nervosa - marfan syndrome

water needs for infants

- babies need for water, per pound of body weight, is increased greater than older humans - increased surface area - proportionally have more body water - kidneys are only half as efficient - need can be meat by breastmilk or formula - too much can lead to water intoxication - limit supplemental fluids to 4 oz/day

babies born to obese women have an increased risk of

- birth defects, including neural tube defects or oral clefts - being stillborn or dying in first few weeks after birth - having high birth weights - being obese in childhood

stunted growth

- birth to 2 years- length for age is less than 5th percentile - 2-20 years- BMI for age less than 5th percentile

at risk of developmental problems

- birth to 2 years: head circumference for age is under 5th percentile or above 95th percentile

underweight

- birth to two years- weight for length less than 5th percentile - 2-20 years- BMI for age is less than 5th percentile

underwater weighing

- body weight is measured under water and in air - formula accounts for differences in density of fat and lean tissue - very accurate

obesity can be caused by

- brain tumors -ovarian cysts - hypothryroidism - order-willi syndrome

satiation

- causes us to stop eating - secretion of hormones during digestion promotes satiation - CCK, glucagon-like peptide-1 peptides YY

factors influencing body weight and composition: environment

- explains marked increase in obesity rates in last 50 years (genes are not altered this quickly) - couples and friends often behave similarly to foods - environmental factors define when eating is appropriates, what is preferable to eat, how much is eaten

transitional milk

- few days post delivery to 1 week - contains more fat, lactose, water-soluble vitamins and kcal than colostrum

placenta

- forms in uterus as a zygote develops into an embryo - umbilical cord provides connection between placenta and fetus - living organ: synthesizes fatty acids, cholesterol, and glycogen for fetus produces hormones that direct lateral nutrients to fetus, control fetal metabolism, promote the changes in the mothers body that support pregnancy

Thermic effect of food

- generally accounts for 5-10% of kcal consumed daily - energy used to digest, absorb, transport, store, and metabolize - varies by nutrient content (highest for protein) - also influenced by food composition and meal size

set-point theory

- genetically predetermined body weight or fat content is closely regulated - does not effectively explain the obesity epidemic

ideal does not equal healthy

- genetics influence body weight - muscle mass varies dramatically - bone structures differ - what we perceive as ideal often is not healthy

anorexia nervosa: nutrition therapy

- goal is to minimize or stop weight loss - must raise metabolic rate to normal - restore food habits - may need to take in 3000 to 4000 kcal daily - slow weight gain of 2 to 3 pounds weekly - supplement with multivitamin and calcium promote healthy attitude towards foo - teach eating based on hunger and satiety cues

binge eating disorder: treatment

- health risks are associated with clinical obesity, weight stigma, and weight cycling - usually, treatment is unsuccessful without professional help - nutrition therapy is the same as w bulimia nervosa - psychological therapy helps w identifying emotional needs and expressing emotion - self-help groups aim to help with recovery - antidepressants may be prescibed

physical and hormonal changes may result in some physiological concerns

- heartburn - constipation - nausea and vomiting - edema

obese pregnant women may experience

- high blood pressure - gestational diabetes - cesarean delivery

preeclampsia

- high blood pressure - protein in urine - headaches - blurred vision - changes in blood clotting - nervous system disorders - edema

The Satiety process

- hormones play a role in the regulation of hunger and satiety - long term satiety is promoted by body composition/ amount of body fat - several hours after eating macronutrient levels in the blood begin to fall: stored energy use begins, satiety signals diminish - cortisol and gherlin stimulate appetite/increase intake

infant feeding practices

- human milk and/or formula meets all infant requirements up until 6 months of age - breast or formula feeding is a personal choice with many considerations: - human milk is most ideal source of nutrients - breastfeeding for any amount of time is beneficial - human milk composition and bioavailability is engineered to meet infant requirements

fad diet risks

- often unhealthy and unrealistic eating plans - typical monotonous and/or restrictive - may lead to immediate (and even dramatic) weight loss but rarely long-lasting solution and may be harmful

let-down reflex

- oxytocin stimulate lobules in the breast to let down (release) milk from storage - prolactin stimulates additional milk production

settling point

- passive feedback between size of body stores and aspects of expenditure - settle into a stable weight range based on circumstances

pregnancy and physical activity guidelines

- physical activity in pregnancy has minimal risk - benefits most pregnant women - include well-rounded activity - consider pre-pregnancy level of activity - rate of perceived exertion is a more effective measure than heart rate - talk test to maintain blood flow to fetus

hunger

- physiological drive to find and eat food - controlled by internal mechanisms such as organs, hormones, hormone-like factors, and the nervous system

body mass index

- preferred height to weight standard - linked to body fat content - body fat influences health more than body weight - linked to longevity - easy to assess - applies to both men and women - less than 18.5 = underweight - 18.5-25 = healthy weight - 25-30 = overweight - above 30 = obese

carbohydrate needs for infants

- primarily lactose for infants - recommendations don't vary across age groups - aim for starch to reduce simple sugar intake - fiber remans important (AI for less than 1 year of age is 14 g/1000kcal

appetite

- psychological drive to eat - impacted by external factors

breastfeeding advantages for new mothers

- reduces uterine bleeding after delivery - promotes shrinkage of the uterus to its prepregnancy size - may decrease the risk of breast cancer (before menopause) and ovarian cancer - may promote maternal weight loss

android (abdominal) obesity

- related to: CVD, hypertension, T2DM - more common in males, those with high glycemic diets, high alcohol consumption, and smokers - waist circumferences: 740 in males, 735 in females

mature milk

- replaces transitional milk - thin and watery in appearance - 20 kcal/ounce - nutritionally complete for infant, except for vit d and iron

treatments of overweight, obesity, and underweight

- similar to treatment methods for any chronic disease - long-term requires lifestyle modification - diets have and end point = contribute to weight cycling

fetal alcohol syndrome (FAS)

- smaller than normal head circumference - reduced width of eye opening - low nasal bridge - short nose - no midline groove - thin upper lip

determining a healthy body weight

- start by examining BMI criteria - a healthy weight is considered a body weight that does not increase risk of developing weight-related health problems or disease - a range: depends on gender, height, muscle mass - should be realistic: achieved and sustained without restriction

lactation

physiological process of female mammals that occurs postpartum when the mother's breast secretes milk

contingency management

prepare for situations that may trigger overeating

a healthy pregnancy begins prior to conception

attain a healthy lifestyle prior to pregnancy - healthy pre pregnancy weight - adequate and balanced diet - include physical activity - avoid cigarettes/other toxic substances - take prenatal supplement ( high in folic acid and iron, be cautious if taking performed vit a, iron, zinc, selenium, vit B6, vit d, vit c)

small for gestational age

infants that weigh less than expected for gestational age

Positive energy balance

intake exceeds expenditure

negative energy balance

intake is less than expenditure

Energy Balance

intake matches expenditure

chain breaking

separate behaviors that occur together

desirable body fat

men: 8-24% women: 21-35% (reproductive function requires increased levels of body fat)

anorexia nervosa: treatment

multidisciplinary teams: - physicians - registered dietitians - psychologists - other health professionals - ideal setting is in a medical center: hospitalization is needed if weight falls below 75% - electrolyte imbalance and cardiac arrest can occur suddenly and cause death

what factors may increase BMR

muscle mass body surface area male gender body temperature secretions of thyroid hormone (hyperthryroidism) stress hormones growth stages caffeine, tobacco recent exercise

most common eating disorders include

obesity anorexia nervose bulimia nervosa binge-eating disorder - more common in females - higher mortality risk in males

factors that encourage excess body fat storage

aging female gender high calorie diet sedentary lifestyle weight history social and behavioral factors certain medications geographic location genetic characteristics

stimulus control

alter the environment to minimize stimuli for eating

healthy weight management and the non-diet approach

- the best treatment for obesity is prevention - success rate of individuals maintaining a weightless after one year is reported between 2-25% - those individuals who use improved health as a motivating factor are the most likely to be successful at losing weight and maintaining their loss - a weight loss of as little as 5-10 pounds can significantly improve health even if the person is till overweight

satiety

- the feeling of fullness following consumption of food - occurs after eating has stopped - suppresses further consumption - influences time between meals - regulated by hypothalamus - we often override signals of satiety - promoted by: sensory aspects of food knowledge food has been consumed chewing expansion of stomach and intestines effects of digestion, absorption, and metabolism decrease in hormone gherlin

preoccupation with weight and size may be detrimental to health

- the non-diet approach recognizes that media, diet industry, and some medical professionals have encouraged preoccupation with body size - results in exclusion of size, diversity, and healthier living

colostrum

- thin, yellow, immature milk - early milk rich in protein, minerals, and vitamin A - less lactose and fewer kcal - contains antibodies and immune system cells- provide infant with defense system - lactobacillus bifidus factor

national weight control registry

- tracking over 10,000 individuals who have maintained at least 30 lbs weight loss for one year or longer - variety in how members keep weight off, but members consistently report the following: eating breakfast daily weighing themselves 1x/ week watching <10 hours of tv per week exercising for 1+ hour a day

controlling energy intake

- weight-loss program is consider successful when those involved remain at or close to lower weights - currently, only surgical approaches to obesity treatment routinely show success - negative consequences of weight cycling: increased upper body fat diminished self-esteem decline in HDL cholesterol decline in immune system function - low-energy density approaches are the most successful long term eating strategy

factors that complicate pregnancy outcomes

- young maternal age - maternal eating patterns including restriction, vegetarian/vegan, eating disorders -maternal health - number of pregnancies and time between pregnancies - pre-natal care - pre-eclampsia/eclampsia - gestational diabetes - pregnancy induced hypertension impairs delivery of oxygen and nutrients to developing fetus

maternal lifestyle to avoid

- zero tolerance for drugs and alcohol - caution with herbals (including tea) - avoid smoking

fat needs for infants

-40-55% of kcal for an infant - important to meet EFA needs - meet energy requirements without being overfull - children over 2 have same recommendations as adults

overweight

2 to 20 years: BMI-for-age ≥ 95th percentile or BMI ≥ 30 (whichever is smaller)

embryo

2-8 weeks

folate pregnancy

600 mcg/d neural defects

fetus

9 weeks to birth period of very rapid development

leptin

- acts in the hypothalamus - signals brain to decrease intake - rises when body fat increases - leptin deficiency = constant hunger - secreted by adipose tissue - increase in adipose storage = increase in leptin levels

factors influencing body weight and composition: genetics

- 40-70% of weight differences are attributable to genetics - impacts body type, metabolic rate, and factors influencing hunger and Satiety - identical twins raised apart often have similar body weights

air displacement

- BodPod uses air displacement - determines body volume by measuring the volume of air displaced when. person sits in a sealed chamber for a few minutes - accurate alternative to underwater weighing

what factors may decrease BMR?

- Hypothyroidism - Restricted calorie intake - Less muscle mass and body surface area - Aging (declines 1-2% each decade after age 30)

Determing energy intake

- Kcal provided by food or beverage can be estimated by nutrient databases - actual kcal values derived directly using a bomb calorimeter - commonly use grams of energy-providing macronutrients ( carb grams x 4, protein grams x 4, fat grams x 9)

ghrelin

- acts in the hypothalamus - promotes intake: increase appetite, increases smell sensitivity, promotes energy storage

bulimia nervosa: presentation

- characterized by a cycle of bingeing and compensatory behaviors to undo or compensate for the binge - binge can be triggered by: hunger from recent dieting stress boredom loneliness depression - food is not enjoyed and may not even be tasted - 3000 or more kcal may be consumed - turned toward food when faced with problems - recognize their behaviors as abnormal - at or slightly above normal weight - frequently female and successful

anorexia nervosa: presentation

- characterized by weight loss, difficulty maintaining appropriate body weight, and often a distorted body image - physical changes also include development of fine hair covering the body (lanugo), dry/brittle nails, thinking of hair, discoloration of teeth, dry skin - may involve severe restriction, compulsive exercise, purging and/or binge eating

indirect calorimetry

- collects air expended during specified time period - considers oxygen consumed and carbon dioxide produced - doubly-labeled water can also be used (common in research)

eating behavior regulation - internal cues from hypothalamus

- communicates with endocrine system and nervous system - integrates internal cues of blood glucose levels, hormone secretions, and sympathetic nervous system

zygote

- conception to 2 weeks - nourishes itself by absorbing secretions from glands in the uterus

bulimia nervosa: physical effects

- demineralization of teeth - low potassium levels - swelling of salivary glands - stomach ulcers and tears in esophagus - constipation - toxic effects from ipecac syrup on heart, liver, kidneys

bulimia nervosa: nutritional therapy

- develop regular eating habits without restriction of energy intake - correct misconceptions about foods - self monitor: food intake internal sensations of hunger environmental factors that triggers binges thoughts and feelings accompanying binge-purge cycle

prevention of eating disorders

- discourage restrictive dieting, meal skipping, and fasting - encourage children to eat when hungry - promote good nutrition and regular physical activity - promote regularly eating meals as a family - provide information about normal changes during puberty - correct misconceptions - carefully phrase weight-related comments - don't overemphasize numbers on scale - increase self acceptance - encourage coaches to be sensitive to weight and body image - eliminate making weight - emphasize thinner is not associated with athletic performance - enhance tolerance for diversity - encourage normal expression of emotions - build respectful environments - provide some levels of independence, choice, responsibility, and self-accountibilty

weaning and self feeding

- drinking from a cup helps weaning - should be weaned from bottle by 18 months to prevent: overconsumption of beverages, childhood dental caries - self-feeding starts in late infancy and continue to develop until preschool - timetable of self-feeding: by age 1, can drink for cup without help, by age 2 can lift, tilt, and lower cup well and use spoon, By age 3 or 4, use fork, By age 4 or 5, use knife to cut soft foods

Intermittent fasting

- eating patterns with extended periods of time (16-48 h) with little or no energy intake with intervening periods of normal food intake - some evidence suggests that restricted feeding (8 hrs per day) reduces body weight, energy intake, and systolic BP - in those with T2DM, IF may result in similar HbA1c control compared to continuous restriction (concerns of hypoglycemia) - IF restricted to a 6hr period = improved metabolic measures without weight loss compared to kcal matched controls - most evidence is from short-term, small sample studies

bioelectrical impedance

- electrical current sent through body - takes less than 5 mins - based on the idea that fat resists the flow of electricity more than lean tissue - degree of resistance determines body fatness

nutritional needs during lactation

- energy and fluid considerations - 500 kcal above pre-pregnancy requirements - 300 from food sources, the rest can come from fat stores - variable base on length of time breastfeeding and BMI -increase fluid requirement - main component of milk - 32 additional ounces daily - nutrient needs vary over time: iron needs decrease, often with insufficient calcium consumption, continue with nutrient dense options

nutritious diet for successful pregnancy

- ensures appropriate fetal growth - improves likelihood of full-term development - increases mental, physical, and physiological capabilities - nutrient requirements during critical periods is key to fetal health

maternal food supply to avoid

- environmental contaminants: avoid swordfish, shark, king mackerel, tile fish, limit intake of other fish to less than 12 oz per week - foodborne pathogens - limit caffeine to 200 mg/day - food additives

estimated energy requirements

- equations based on evidence gathered through direct and indirect calorimetry - needs based on: - weight - height - sex - age - physical activity level

methods to assess weight status and measure body composition

- estimates associated with health and longevity - current recommendations to evaluate: total body fat location of body fat weight-related medical complications - underwater weighing - air displacement - skinfold thickness - bioelectrical impedance - dual energy X-ray absorptiometry (DXA)

regular physical activity

- expending 100 to 300 kcal/day above normal activity can contribute to weight loss along with regulation of kcal intake - duration and regularity are key - find activities that are enjoyable - add resistance exercise

peak growth during infancy

- nutrient needs per unit of body weight are at their highest - double brith weight by 4-6 months - triple brith weight by 1 year of age - length increases by 50% in 1 year - childhood growth is less linear with sporadic bursts

principles of the non-diet philosophy

- humans come in a variety of shapes and sizes - diversity is a positive characteristic of the human race - there is no one ideal body size, shape, or weight - self-esteem and body image are strongly linked - helping people feel good about their bodies can help motivate them to maintain healthy behaviors - appearance stereotyping is inherently unfair and based on superficial factors over which the individual has little or no control - er respect the bodies of others even though they may be quite different from out own - each person is responsible for taking care of his or her body - good health is not defined by body size - state of physical, mental, and social well-being - people of all sizes and shapes can reduce their risk of poor health by adopting a healthy lifestyle

bulimia nervosa: psychological and related therapy

- improve patient's self acceptance - help correct all-or-none thinking - cope with stressful situations - accept some depression and self doubt as normal

nutrients of concern include protein, essential fatty acids, zinc, folate, B12, iron

- increase in maternal red blood cells and fetal stores increase fluid volume, DNA synthesis, brain development - vit D and calcium for bone development (calcium needs do not increase- upregulation of absorption) - note that cravings do NOT reflect nutrient requirements (knowing how/what to eat is not instinctual)

energy and nutrient needs for infants

- infants have the greatest pound for pound need - BMR increases from birth to age 2 - pound for pound, infant and toddle kcal needs are 2-4x greater than adults - continues to rise slowly until puberty- large increase - continues to rise slowly until around age 30, then starts to decline

introduction of solid foods

- infants must show signs of interest and readiness - follows spoon visually - loss of extrusion reflex - able to self support head and neck - able to close mouth over spoon and chew - there is no benefit to the early introduction of solid foods - nutrient needs increased due to depletion of reserves and insufficiencies in human milk for growth at this stage - iron-containing foods important to meet iron requirements (iron fortified infant cereals, pureed meats)

rate and sequence of solid food

- introduce 1 single food ingredient at a time - wait 5-7 days before adding an additional food - iron and vit c are first nutrients required due to diminishing stores - protein- rich foods are introduced first 6-8 months - pureed meat, fish, chicken, beans. egg yolk, tofu - best to avoid egg whites and cow milk - when cows milk is introduced, whole milk is used until 2 years, reduced fat after 2 years - lumpy or chopped foods can be introduced when teeth appear

infant formula vs breast milk

- iron fortified infant formulas are safe, nutritious alternatives - attempt to match breastmilk as closely as possible

advantages of human milk for infants

- is nutritionally adequate for most full-term infants and is free of bacteria as it leaves the breast - supplies antibodies and immune cells - is easily digested - reduces risk of food allergies, especially to proteins in infant formals and cow's milk

babies born to underweight women have an increased risk of

- low birth weight - being born premature - lower nutrient stores

eclampsia

- maternal convulsions - coma - death of mother and fetus

malnutrition

- may occur in either over nutrition or undernutrition - eventually contributes to failing health - overweight/obesity do not prevent the possibility of malnutrition - the double burden of malnutrition: occurs at an individual, household, or population level

skinfold thickness

- measure fat layer directly under skin at multiple sites - accuracy can be good - dependent on trained technician

basal metabolic rate

- minimum amount of energy required in a fasting state to keep the resting body functioning - largest component of energy expenditure - accounts fo 60-70% of total energy expenditure - if a person is not fasting or rested, then we use the resting metabolic rate (about 6% higher than BMR) - expressed as the number of calories burned per unit of time (women is 0.9 kcal/kg per hour, men is 1.0 kcal/kg per hour)

gestational diabetes

- more common in those with a family history of diabetes - 9% of pregnancies - concerns include: large-for gestational age infant low blood levels at birth in infant increased risk of obesity later in life for the infant increased risk in both maternal and offspring development of T2DM later in life - recommendations include regular exercise and dietary pattern similar to that recommended for T2DM

DXA

- most accurate method - very expensive - not widely available - body fat, fat-free, soft tissue, and bone minerals assessed

binge eating disorder: presentation

- most common eating disorder in the US - eating large amounts of food frequently, rapidly, until feeling uncontrollably full, even when not hungry - alone bc of embarrassment - obesity and binge eating aren't necessarily linked - frequent dieting beginning in childhood or adolescence may be precursor - stress, depression, or anxiety can trigger binge

physical activity

- most variable component of energy expenditure - generally, increases kcal needs by 25-40% of BMR but may be much higher or lower

protein needs for infants

- need 1.5 g/kg/day - supports rapid growth - children and adolescents need 1.1 g/kg (20-40% more than adult needs on a pound by pound basis)

adaptive thermogenesis

- not a main component of expenditure, but may contribute a small amount - triggered by cold, overfeeding, trauma, starvation - non-voluntary physical activity or non-exercise activity thermogenesis (NEAT) (fidgeting, shivering, holding body upright) - varies by individual - may be dependent on brown adipose tissue (BAT) (specialized form of fat, generally limited in adults, higher in infants and hibernating animals)

limitations of BMI

- not necessarily appropriate for children, teens, older adults, and pregnant or lactating women - those with very high levels of lean tissues or those with less than 5' tall may have inaccurate categorization - still, overeat and overweight often coincide - for most, this is an accurate tool for health assessment

key features of a sound weight-loss program

1. control energy intake 2. performed regular physical activity 3. behavior modification

direct calorimetry

-estimates energy expenditure by measuring amount of heat released by the body - similar idea to bomb calorimeter - heat release is measured by placing person in insulated chamber surrounded by layer of water - change in temperature determines amount of energy person expended - expensive, complex, infrequently used

body uses energy for 3 main purposes

1. basal metabolic rate 2. physical activity 3. thermic effect of food (digestion, absorption, processing of ingested nutrients) - a minor form of energy output is thermogenesis (encompasses things like shivering, fidgeting)

low birth weight

under 5.5 lbs

pre-term

birth prior to 37 weeks gestation

diseases, disorders, and body weight

body weight and fatness can be affected by diseases, hormonal abnormalities, genetic disorders, and psychological disturbances

cognitive restructuring

change frame of mind regarding eating

optimal weight gain depends on pre-pregnancy weight

underweight- 28-40 lbs normal- 25-35 lbs overweight - 15-25 lbs obese- 11-20 lbs

periodic fasting

fasting lasting 2-21 days

critical periods

finale windows of opportunity for development of a tissue or organ

full term gestation

gestational period lasting 38-42 weeks begins when sperm and egg unite

breastfeeding

the action of feeding a baby from the the breast

self-monitoring

track food eaten, when, why, how you feel, physical activities, body weight