Nutrition 3

List possible causes of fatty liver

-Defects(欠陥) in metabolism -Excessive alcohol ingestion -Exposure to various drugs and toxins In case unrelated to alcohol, insulin resistance(reduced sensitivity to insulin in liver, muscle, and adipose cells) is the primary risk factor; thus, fatty liver frequently accompanies diabetes mellitus. metabolic syndrome, obesity. -Protein-energy malnutrition -Long-term total parenteral nutrition Alcohol/ drug abuse Obesity Diabetes

Describe risk factors for gallbladder disease, treatment, and diet to reduce risk

Risk factors -Ethnicity -Aging -Obesity -High Cholesterol Diet -Diabetic -Pregnancy -Gender

Discuss appropriate nutrition support for a patient with cirrhosis

Table 20-6 p539

Describe typical insulin regimens for individuals with type 1 and type 2 diabetes, including types of Insulin and means of administration.

Type 1 diabetes is best managed with intensive insulin therapy, which typically involves 3 or 4 daily injections of several types of insulin or the use of an insulin pump. [Insulin pump] programmed Continuously: low amounts of rapid-acting Mealtime: bolus doses of rapid-acting Intermediate or long-acting meets basal insulin needs Before meal: rapid or short-acting Simpler regimens: twice-daily injections Mix of intermediate & short acting Three or more injection - greater flexibility [Type 2] -Insulin only or Insulin + antidiabetic drugs -Many patients need only 1 or 2 daily injections Morning: Intermediate + rapid- or short-acting Dinner or bed time: Intermediate or long-acting Only bedtime: intermediate or long-term acting Doses and timing are adjusted according to the results of blood glucose self-monitoring

Describe the absorption process of water-soluble and fat-soluble nutrients

Water soluble nutrient (and smaller products of fat digestion) are released directly into the bloodstream by way of the capillaries Fat soluble nutrients (fat-soluble vitamin and larger fats) require some packaging before the are released

Outline general intake recommendations for macronutrients, alcohol and micronutrients for diabetics

[Macronutrients] -Depends on food preferences and metabolic factors i.e. insulin sensitivity, blood lipid levels, and kidney function -Carb 45-65% of total kcal/ RDA 130 g/day -Fat 20-35% of total kcal -Protein 10-355 total kcal/ RDA 0.8 g/kg body weight -Fiber AI 21-38 g/day [Alcohol] -Similar to general population -One drink and two drinks per day -Drink with foods to avoid hypoglycemia -Should avoid(pregnant women, individuals with advanced neuropathy, abnormally high triglyceride levels, a history of alcohol abuse) [Micronutrients] -Same as for the general population -Vitamin and mineral supplementation is not recommended unless nutrient deficiencies develop; those at risk include the elderly, pregnant or lactating women, strict vegetarians, and individuals on kcal-restricted diets

chronic complications of diabetes and explain how these develop through the disease process.

[Macrovascular] -Stroke -Heart disease and hypertension -Peripheral vascular disease -Foot problem(foot ulcers, gangrene(death tissue)) [Microvascular] -Diabetic eye disease(retinopathy and cataracts) -Renal disease -Neuropathy -Foot problem

Describe the development of portal hypertension, gastro esophageal varices, ascites and hepatic encephalopathy

[Portal Hypertension] Rise of blood pressure within the portal vein -The restricted blood flow within the liver result in a greater volume of portal blood. [Gastroesophageal Varices]: Vessels become enlarged and gorged(むさぼり食う) -Vulnerable to rupture(破裂しやすい) [Ascites]: Fluid accumulation in abdomen -Critical liver damage -Consequence of portal hypertension, sodium, and water retention in the kidneys, and reduced albumin synthesis in the diseased liver. [Hepatic Encephalopathy]: Abnormal neurological functioning -Elevated ammonia levels

Identify the various types of lipoproteins in the body

[VLDL]: made primarily by liver cells to transport lipids to various tissues in the body, composed primarily of triglycerides [LDL]: derived from VLDL as cells remove triglycerides from them -LDL carry cholesterol and triglycerides from the liver to the cells of the body and are composed primarily of cholesterol [HDL]: transport cholesterol back to the liver from peripheral cells; composed primarily of protein

Define Diabetes Mellitus, name the common symptoms of this disorder, and differentiate between type 1 and type 2 diabetes

Body likes Blood sugar 70~110 A group of metabolic disorders characterized by hyperglycemia and disordered insulin metabolism Elevated blood glucose(hyperglycemia) and disordered glucose metabolism Glycosuria, Polyuria, Polydipsia, weight loss, Thrush or genital itching, excessive hunger(polyphagia), blurred vision, increased infections, fatigue, slow healing Type 1 diabetes(Juvenile diabetes) : diabetes that is characterized by absolute insulin deficiency, usually resulting from the autoimmune destruction of pancreatic beta cells -Auto destruction of pancreatic cells -Genetic susceptibility not as much as type 2 -Develop during childhood -No insulin Type 2 diabetes: diabetes that is characterized by insulin resistance coupled with insufficient insulin secretion -Most common in over 40s in white population -Over 25s in black and South Asia population -Decreased sensitivity to insulin and/or decreased insulin production -Obesity linked in 90% of cases -Strong genetic link -Prevalence increases with age Table 21-2 p.555

Explain meal plans for individuals with diabetes using carbohydrate counting or the exchange system

Carbohydrate-counting techniques are simpler and more flexible than other menu-planning approaches and are widely used for planning diabetes diets. The user of the plan need only be concerned about meeting carbohydrate goals and can select from any of the carbohydrate-counting food groups when planning meals Although encouraged to make healthy food choices, the individual has the freedom to choose the foods desired at each meal without risking loss of glycemic control. Some people may need guidance about consuming a diet that improves blood lipids or energy intakes Advanced cab counting requires some training and should be attempted only after an individual has mastered more basic methods [Food list system] Although the food list system may be helpful for individuals who want to maintain a diet with specific macronutrient %s, it is less flexible than carb-counting and offers no advantages for maintaining glycemic control

Describe medical interventions and dietary adjustments necessary for women with diabetes who becomes pregnant and pregnant women who develop diabetes

Careful management of blood glucose levels before and during pregnancy may prevent complications in mother and infant Women with diabetes who become pregnant may need to adjust their insulin therapy or medication, consume meals and snacks at similar times each day, and consume an evening snack to prevent overnight ketosis Women with gestational diabetes may need to restrict energy and/ or carb intakes to maintain appropriate glucose levels; insulin or an antidiabetic drug may be prescribed to help them maintain glycemic control

Discuss the different etiologies of hepatitis

Damage to liver tissue -Infection with specific virus (A,B,C,D,E) A: spread via fecal-oral(糞口) transmission B: Blood or needles/ Sexual contact/ From mother to infant C: Blood or needles -Excessive alcohol intake -Fatty liver disease -Autoimmune disease -Exposure to some drugs -Herbal substances -Toxic chemicals

Describe acute complications of diabetes and explain how these develop through the disease process.

Acute Complication [Diabetic ketoacidosis-Type 1]: Hyperglycemia is accompanied by ketosis and acidosis -Severe lack of insulin -Body breaks down fat for energy -Leads to increase fatty acids in blood(Ketones) -Blood pH become acidic -Leads to death if untreated [Hyperosmolar hyperglycemic syndrome-Type 2]: Severe hyperglycemia & dehydration & mental impairments -No acidosis -Leads to death if untreated [Hypoglycemia]: Most often results from inappropriate disease management -Headache -Sweating -Impaired vision -Dizziness -Fast heartbeat -Hunger -Shaking -Irritability -Anxiety -Weakness/fatigue

Discuss the value of oral anti - diabetic agents in the treatment of type 2 diabetes

Antidiabetic drugs prescribed for type 2 diabetes improve hyperglycemia by various modes of action

1.Explain the significance of Mr. Levitt's elevated ammonia levels. What signs may indicate that he is undergoing mental decline?

Hepatic Encephalopathy

Describe the function of the Liver and Gallbladder

Liver 1. Makes Bile: Breaks down fat 2.Processes, stores, and distributes nutrients 3. Stores fuel: known as "Glycogen" 4. Filters waste -Filtering waste and poisons: toxic substances into safer ones -Processing nutrients: Protein, fats, carbs -Storing fuel Gallbladder -Storing bile Problem: Gallstones(inflammation) 90% cholesterol

Discuss the relationship between metabolism and body temperature and describe the possible effects of accelerated metabolism on health.

98.6F Effects -Wasting of body organs and loss of weight -loss of viral lean tissue

Describe the development of Cirrhosis

As the disease progresses, the scarring becomes more extensive, leaving fewer areas of healthy tissue. A cirrhotic liver is often shrunken in size and has an irregular, nodular appearance. Cirrhosis is characterized by impaired liver function and may eventually result in liver failure. The chief causes of cirrhosis in the U.S. are chronic hepatitis C infection and alcoholic liver disease, followed by nonalcoholic fatty liver disease and chronic hepatitis B infection. Additional causes include other types of chronic hepatitis, drug-induced liver injury, some inherited metabolic disorders, and bile duct blockages, which cause bile acids to accumulate to toxin levels in the liver.

1.What medical condition makes it difficult to interpret his present weight? Describe the development of that type of problem in liver disease, and explain how the diet is usually adjusted for such a patient.

Ascites Fatty liver, Fibrotic liver, Cirrhosis Amount of Sodium

Discuss the concerns related to body weight for individuals with type2 diabetes

Because excessive body fat can worsen insulin resistance, weight loss is recommended for overweight or obese individuals who have diabetes Even moderate weight loss(5 to 10 percent of body weight9 can help to improve insulin resistance, glycemic control, blood lipids levels, and blood pressure Weight loss is most beneficial early in the course of diabetes, before insulin secretion has diminished Not all persons with type 2 diabetes are overweight or obese. Older adults and those in long-term care facilities are often underweight and may need to gain weight. Low body weight increase risk of morbidity(病的な状態) and mortality(死亡) in these individuals

Describe the aspects of mechanical and chemical digestion

Chewing - salivary amylase(starch→maltose) In stomach mechanically digest foods & chemically digest with hydrochloric acid and enzyme pepsin "protein→large peptide"

Provide physical activity guidelines for type 1 and type 2

Children: at least 60 min of physical activity each day Adults: at least 150 min of moderate-intensity aerobic activity per week, spread over at least 3 days of the week They should also perform resistance exercise at least twice weekly unless contraindicated by a medical condition that increases risk of injury Aerobic and resistance exercise can improve insulin sensitivity

Discuss the glycemic index and glycemic load specifics foods to diet planning for healthy and diabetic individual

Glycemic index(GI) -A ranking of carb foods based on their effect on blood glucose levels after ingestion; low-GI foods are those with a lesser glycemic effect whereas high-GI foods have a greater glycemic effect. High-fiber, minimally processed foods, which typically have lower glycemic effects than do highly processed, starchy foods, are among the foods frequently recommended for persons with diabetes

Discuss consequences of fatty liver

Fatty liver can reverse Asymptomatic and causes no harm Other cases -Inflammation(steatohepatitis) -Liver enlargement(hepatomegaly) If liver damage and scarring develop, fatty liver may progress to "cirrhosis", "liver failure", "liver cancer" Abnormal liver enzyme levels -Elevated ALT and AST -Increased triglycerides, cholesterol, and glucose

State the goals of diabetes treatment, and explain how laboratory tests are used to monitor progress toward these goals

Normal Glucose levels(70~110) Self-Monitoring of blood glucose [Continuous Monitoring} [Intermittent Monitoring] Long-term Glycemic control [Glycated Hemoglobin(HbA1C) -Reflects blood glucose over previous 3 months -Goal is less than 7 Diet management -Goal of BMI b/w 20-25 -Eat regular meals -Cut down on high sugar foods (processed) -Cut down on bad fats -Increase fruits and vegetables -Limit salt -moderate alcohol -Watch carbohydrate intake Medication -Antidiabetic drugs: Sulfonylureas help your pancreas make extra insulin -Insulin injection Type 1: cannot use pills, only injection Type 2 could be type 1