DTR Exam prep- Basic and normal nutrition

Calorie needs during pregnancy

+340 2nd trimester +452 3rd trimester

Macros and fluid for infants

0-6 mo = 550 cals per day, 9.1 g of p, minimum 30 g F Fluid can be calculated 1.5 ml per cal or based on bw (between 125-155 ml per kg of BW) 6-12 mo = 700 cal per day, 13.5 g of P, 30 g of fat

Normal weight gain pattern for women w/ normal BMI in pregnancy

1 lb per week by 2nd trimester.

Fluid intake for adults

1 ml per cal or 35 ml per kg of BW

Increased risk women in pregnancy

15<35 & fail to gain 4lbs per mo 2nd half of preg. or who have had less than 12 months between pregnancy .

Growth rates for childhood - height and weight

2 + = 4.5-6.5 per year lbs, 2.5-3.5 inches per year 1-3 yr growth rates slow and pick up around 7-10yr Final growth spurt in adolesence

When to be concerned in infant growth, child and adolesence chart looking at percentiles

2 major percentiles up or down need to be further evaluated.

How many cals per oz of breast milk or formula?

20 kcal per oz.

NTR assessment tools

24 hr recall food frequency food record diet history

How much do energy needs decline in geriatric pop.

3% per decade

Physical activy recs

30 mins of moderate activity most days of the week to reduce chronic diseases, 60 mins moderate- vigorous activity to promote weight loss or manage weight. To sustain 60-90 most days of the week.

Calorie needs during lactation

330 1st 6mo 400 6+

Adult macros , cholesterol, fiber

45-65 C, 20-35 F, 10-35 P Cholesterol- <300 mg *265 discretionary cals (sugar, alcohol, fats, oils) Fiber = M- 38, F= 25, over 50 yrs= 30 M , 21 W

Potential ntr risk factors for pts.

<3 servings of veg a day. <2 serving of fruit/day dairy intolerance or <2 serving of dairy a day >20 oz of soft drinks (excess sugar and fat intake) <2 servings of protein unhealthy bmi family history of cvd or metabolic disorders - issue w/ food choices & food resources (food insecure)

Secretin

A hormone secreted by the small intestine (duodenum) in response to low pH (e.g., from stomach acid). It promotes the release of bicarbonate and water from the pancreas to act as a buffer. Inhibits gastric acid secretion and stomach emptying. Stimulated by presence of food in stomach and smell or sight of food.

What do childhoods ntr depend on?

Age, activity level, gender, genetic predistpostion

Trans-fat

An unsaturated fat, formed artificially during hydrogenation of oils, containing one or more trans double bonds. Shown to increase risk of HD

Micronutrient def. to consider for geriatric pop

Basic GI can cause def. in vit b12. Consult if conserned for thalassemia Vit D (calcium too post menopausaul) Fluid intake as thirst mechanism decreases with age Sarcopenia (loss of muscle due to lack of physical activity and aging)

Factors influencing metabolic rate

Body size, age, gender, hormones, caffeine, nicotine, alcohol

saturated vs unsaturated fats

Both are lipids - saturated have NO double bonds, are saturated with hydrogen, are animal based, solid at room temperature. Longer shelf life. unsaturated - have double bonds, are plant based, liquid at room temperature. Less stable.

How is DRI more specific than RDA?

Broke nutrient recs into 3 different categories- EAR, AI & UL EAR- Estimated average requirements - meet needs of 50% of pop. Adequate intake- It is assumed this value is sufficient enough for healthy individuals, used if not enough data exists to make specific recs. UL- upper limit- some can lead to toxicity.

Protein metabolism and utilization

Broken down into AA sent to tissues via portal bloodstream. Oxidized to produce co2 and water = heat and energy. Can't be stored.

What hormones regulate digestion?

CCK- cholecystokinin Secretin Gastrin

Essential micros for children & adolesents ?

Calcium and phosphorus for bone development Iron for women once menstration

Oil with both types of fats

Canola (61% mono , 32 % poly)

Macronutrients

Carbs, fat and protein that are needed in large quantities and contribute to overall energy pool of body.

Deficient in vitamin A? Excess?

Causes blindness when deficient, in excess is toxic and can cause liver damage.

24 hr recall pro and cons

Cons = client error & may not be a usual day, time consuming for professional to analyze Pros = gather info for Meal patterning, food group intake, counseling tool.

Integumentary system

Consists of the skin, mucous membranes, hair, and nail

What is needed for fetal nervous system in pregnancy

DHA omega -3 FA

DRI

Dietary Reference Intake- used to help determine peoples adequacy of diet.

What data is obtained during ntr screening? Purpose

Dietary intake, psychosocial/behavioral factors related to diet, knowledge and readiness to change, ntr related consequences of current health condition and any problem areas to help find solutions. Purpose = find most efficient baseline

What are the extra Protein needs for during pregnancy?

For growth of baby, placenta, amniotic fluid & blood volume- extra 10g per day

Difference between breast and formula?

Formula has more protein and iron than human milk but lack antibodies that breast does.

Gallbladder and bile's role in excretion

Gallbladder stores and concentrates bile, produced by liver. Bile is secreted into SI from bile ducts in gallbladder in response to fats in digestive tract. Bile emulsifies fat, breaking down into smaller ones. Alkalizes chyme as it moves from acidic stomach to intestines.

Botanical that interferes w/ warafin

Ginkgo biloba and garlic supplements may change clotting time. Black cohosh may cause blood clotting.

Endocrine system

Glands secrete hormones that regulate processes such as growth, reproduction, and nutrient use (metabolism) by body cells.

Blood sugar is controlled by these 4 hormones.

Insulin- made in beta cells of pancreas & increases cell permeability to glucose. Glucagon- made in alpha cells of pancreas, encourages breakdown of glycogen to produce glucose (glycogenolysis) Glucocorticoids- encourage breakdown of proteins to produce glycogen (gluconeogenesis).

Excess in macros cause?

Lead to obesity, type 2 diabetes, CVD and metabolic syndrome.

Where is primary location for lipid metabolism?

Liver

What major organs are involved in excretion?

Liver, skin, kidneys, lungs, large intestine and gallbladder.

Explain liver and large intestines' role in excretion?

Liver- breaks down chemicals or other toxins that enter body. LI- collects waste from body transports food to be expelled.

RDA for protein for healty adults

M= 56, W = 46

MDS

Minimum data set federally mandated standardized form for a ntr assessment. Included in pt med chart and assesses physical, social, psychosocial, and emotional status.

How is food moved during digestion?

Moved through esophagus and intestine via peristalsis.

Documented medical charts

NTR most likely in dietary section or progress notes within chart. Minimum data set should be referenced All in blue/ black ink , correct mistake w/ single line through text or initial changes based on facility protocol.

1st step of ntr care process

Ntr assessment = assess pt ntr requirements based on diet intake, physical traits (anthropometrics) , biochemical data, med history adn psychosocial factors.

section AC of the MDS & section K

Overview of pt med history followed by list of ?'s pertaining to pt eating patterns and behaviors. K = detailed explanation of pt oral & ntr status. Into on dietary intake, weight fluctuations, taste capablities and use of tube feeding devices.

Explain the 4 ways absorption happens.

Passive diffusion- No energy need, high to low concentration Facilitated diffusion- transporter or carrier protein to move particles across membrane. Active transport- energy needed and carrier protein, against concentration gradient (low to high). Pinocytosis- Allows large particles to be absorbed in small quantities. Ex = immunoglobulins in breast milk

Supplementation during pregnancy

Prenatal iron may be needed during 2 & 3rd preg. -should be taken between meals w/out milk, tea or coffee (hinder absorption) -Food matrix of meal including ca content can interfere w/ absorption, Vit c aids it. - 600 ug of folate to reduce nueral tube defects. Women under age 18 need about 1300 ca, over need 1000 ug during pregnancy and lactation

Food frequency pros and cons

Pros- inexpensive, easy to administer and complete, assess current and past diet, quick overview of major dietary issues Cons- doesn't assess meal patterning, use in clinical setting does not yield data about absolute intake for individuals.

Food record pros and cons

Pros= fairly valid measure of meal patterning and ntr intake. No memory, portions can be measured prior to consumption, used as counseling tool. Cons= self-reported, time consuming, pts must be motivated and literate, staff needs to be skilled in ntr analysis, act of recording foods can influence foods consumed for client

Diet history

Pros= no literacy, appropriate for most pts, assess typical intake in interview, gather info about meal patterning, frequency, food group intake and counseling tool. Cons= dependent on skilled interviewer, truthful answers, time consuming

B/F growth rate for adolesence

Rapid growth until puberty. G- early as 9-10 grow 3-3.5" per year M- 3.5-4 per year , begin around 10.5-11 yrs

What is the disease called in kids when deficient in vitamin D and calcium?

Rickets- leads to impairment in bone mineralization

CCK (cholecystokinin)

Secreted by proximal small bowel and stimulates pancreas to secrete enzymes. Slows gastric emptying, stimulates gull bladder contraction and colonic activity. May regulate appetite.

Where does majority of digestion and absorption occur?

Small intestine - 100 cm, most is complete by middle of jejunum

Carb metabolism and utilization.

Starts in mouth, primarily in intestines. In liver, simple sugars are converted to glucose for use or glycogen to be stored. Glucose only energy source used for brain, Glucose is oxidized in cell to produce energy, CO2 and water

BMI info and consideration for children

Tall children may have higher BMI underweight w/ BMI < 5th %ile normal = 5-84% over= 84-94%ile obese = 95%ile

How to determine adolesence progress

Tanner staging

Kidneys role in excretion.

The kidney removes nitrogenous waste (urea), excess water and salts.

T/F Blood sugar increases during catabolic stress

True

T/F Growth hormones are insulin antagonists

True

Hydrogenation

Unsaturated fat is hydrogenated, adding hydrogen turning to saturated fats. Increases shelf life

What is responsible for how food flows through esophagus

Upper and lower sphincter

Typical supps or geriatric pop

Vit d, B6, b12, folate

Micronutrients

Vitamins and minerals that act as coenzymes, co-catalysts and buffers in metabolism. Needed in small quantities, support healthy immune system, tissue repair, growth and development in children and overall health and well-being.

Phytochemicals

a naturally occurring substance found in plants that act as natural defense system. Shown to reduce risk of diseases such as cancer and CVD.

Why would child be Failure to Thrive

acute or chronic illness, restricted diet, poor diet choices, chronic constipation = decreased app.

What do adolescents ntr requirements depend on?

age, size, gender, BMI, activity level and medical history

Micronutrient needs for babies, BF and formula

around 6 months of age, iron is needed BF= vit D formula w/ bottled or well water need added floride

Jainism ntr

avoid meat, poultry eggs, dairy, fish, and root veg.

BMR

basal metabolic rate- minimum amount of energy needed to keep body alive (body temp, breathing, heartbeat) Lean body mass is primary factor in determination.

DRI contraindications

based off of healthy normal children, may not be applicable for disease states or conditions.

What do hindus not consume

beef- many are lacto-ovo (dairy and eggs allowed)

Fat metabolism and utilization

broken down into monoglycerides, diglycerides, glycerol and FAs. Need carbs for complete oxidation, end products can be used as fuel or stored in adipose/liver.

What happens when deficient in macro and micro?

can disrupt metabolism, exacerbate disease states, lower immune system and lead to poor wound healing.

Peristalsis

coordinated muscle contraction and relaxation to propel food.

Protein needs for geriatric pop

don't increase unless disease related or condition to not put extra stress on kidneys.

Constipation in geriatric pop and reccs

due to decreased gastric motility and reduced hydrochloric acid secretion in stomach. May decrease app = unintentional wt loss. Adequate fluid can reduce= 1500 ml per day or 30-35 ml per kg of bw

Epinephrine

encourages release of liver and muscle stores of glycogen to produce glucose (glycogenolysis) & decreases release of insulin from pancreas.

How to prevent spina bifida

folic acid (before and during)

What influences rate of stomach emptying

food matrix- food rich in protein and carbs empty from stomach at same rate. Complex carbs and fats take longer. Overall takes about 2-6 hrs

Infant birth weight regain

full term should regain birth weight by day 10-14 , double 5-6 & triple by 12 mo.

NTR requirements for adolescents during rapid growth?

generally = 60-80 per kg

What type of clients need further screening potentially

homeless, pregnant, prescribed meds, excessive alcohol or tobacco, physical disabilities that limit ability to feed

What do rastafarian people avoid

meat, seafood and canned goods

What else besides ntr is included in clinical data?

medical history, current medical info, use of meds, therapies, surgeries, past medical info, life stresses and daily routine. - all can alter ntr

2 types of unsaturated fats

monounsaturated- 1 double bond polyunsaturated- more than 1 double bond

Infant birth weight normal, low and extremely low

normal = 2500-4000 grams low BW= <2500 extremely low = <1000

Examples of monounsaturated fats

olive, canola, peanut, sunflower, avocado

What type of fat are omega 3 fatty acids?

polyunsaturated , must come from dietary sources

Eating behaviors that increase risk of ntr risk.

poor app. depression, stress, eating disorders, chronic diseases frequent fast food >3x a week skip meals several x a day hypocholesteremia or hyperlipidemia amenorrhea or anemia digestive disorders like celiac Excessive or inadequate PA

Gastrin

produced in the stomach and stimulates stomach acid (gastrin) and motility.

What foods do you avoid if kosher

shellfish and pork - ensure butchered properly , acceptable cuts of meat

lower esophageal sphincter

stops food from moving from stomach back into esophagus and causing heartburn or reflux related symptoms. Age, weight and diet can interfere w/ function causing uncomfortable symptoms that can be managed by meds.

Examples of polyunsaturated fats

sunflower, corn, soybean, flaxseed, walnuts ad fish

Sarcopenia

the loss of muscle mass, strength, and function that comes with aging- fat mass and visceral fat increase

What root should not be used if you have liver disease

valerian root