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FDNS Exam 5 Study Guide

by: Bridget Ochuko

FDNS Exam 5 Study Guide FDNS 4050

Marketplace > University of Georgia > FDNS 4050 > FDNS Exam 5 Study Guide
Bridget Ochuko
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These notes reflect the lecture slides and commentary during lecture. We focused on adult nutrition and intervention for conditions, including notes from a movie shown and notes from a guest lecture.
Nutrition Life Span
Alex K. Anderson
Study Guide
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This 27 page Study Guide was uploaded by Bridget Ochuko on Monday November 9, 2015. The Study Guide belongs to FDNS 4050 at University of Georgia taught by Alex K. Anderson in Fall 2015. Since its upload, it has received 57 views.


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Date Created: 11/09/15
FDNS Exam 5 Study Guide 11/10/2015 ▯ Eating Disorders and their Management ▯ Introduction  Eating disorders are psychiatric disorders with significant medical and psychosocial complications that affect approximately 5 million Americans. Primarily adolescent girls and young women  A number of factors can drive individuals to develop an eating disorder  Much more common among females than males  Core of treating eating disorders: the individual must own up and realize that they have an eating disorder  Unlike other conditions, eating is a necessary bodily function in order to survive o Individuals with an eating disorder may have difficulty admitting that they have a problem ▯ Eating Disorders (ED) or Disordered Eating (DE)?  Disordered eating is fairly common o 65% DE o 10% ED o 75% total unhealthy relationship with food/physical activity  Most everyone engages in some type of disordered eating (65-70%) o Example: binge eating  Eating disorders are actually the disorder that can negatively affect one’s life o Common problem but we tend not to talk about it or pay attention to it ▯ Continuum of Weight-Related Concerns and Disorders  Clinically significant eating disorders: anorexia, bulimia, or bing eating  Body dissatisfaction leads to dieting behaviors which leads to disordered eating and ultimately clinically significant eating disorders ▯ Etiology and Course of Eating Disorders  Eating disorders have multifactorial etiologies which include: o Sociocultural o Genetic o Family o Personality factors: excessive exercise, self-esteem, body image  Environmental factors: o Food availability and accessibility:  Obesity paradox: those who are food insecure are obese because they eat calorie dense foods o Media influences o Societal and cultural norms o Food availability and accessibility  Family factors: o Family dynamics  Mother’s weight has a big influence on child’s weight mentality  Weight-related behaviors of parents and siblings  Feeding behaviors reinforced during childhood and adolescence  Interpersonal factors: o Peer norms and behaviors: wanting to fit in o Abuse experience: common in women young girls who were sexually abused as children to develop eating disorders because it is the one way she can control her body  Personal factors: biological, psychological, knowledge, attitudes, and behaviors ▯ Dieting Behaviors  Dieting and unhealthy weight control behaviors may increase chance of future overweight or obesity  Effective nutrition messages should focus on lifestyle changes  Adolescents with low levels of body satisfaction are more likely to use unhealthy weight control behaviors and participate in less physical activity ▯ Disordered Eating Behaviors  Anorexic or bulimic behaviors—with less frequency or intensity = unable to do a formal diagnosis  Most frequently used behaviors: o Vomiting o Laxatives o Fasting or extreme dieting o Excessive exercise  Three Main Eating Disorders: o Anorexia nervosa: characterized by extreme weight loss, poor body image, and irrational fears of weight gain and obesity o Bulimia nervosa: characterized by recurrent episodes of rapid uncontrolled eating of large amounts of food in a short period of time frequently followed by purging o Binge-eating disorder: characterized by periodic binge eating not followed by vomiting or use of laxatives  Two types of anorexia o Restricting anorexia: the individual does not eat or eats very little o Non-restricting: the individual eats and then purges themselves; might binge eat prior to the purge; what the individual eats is much smaller than what purging bulimics eats  Two types of bulimia o Purging: as soon as the individual binge eats, they will find a way to purge the food: either through laxatives or vomiting o Non-purging: binge eat for some time, then go days without eating  Bulimics tend to have normal weight or could even be overweight  Binge eaters must binge eat at least twice a week for a substantial amount of time ▯ Prognoses  Anorexia Nervosa: o ~10% to 15% die from the disease o Deaths related to:  Weakened immune system  Gastric ruptures  Cardiac arrhythmia  Heart failure  Suicide o Early diagnosis and treatment improves chances for recovery o Recovery rates:  <50% fully recover  ~33% show improvement  ~20% chronically affected  Bulimia Nervosa: o ~2-3% die from disease o Recovery rates:  ~48% full recovery  ~26% improvement  ~26% chronicity ▯ Treating of Eating Disorders  A multidisciplinary team approach  Team may consist of: o Physician o Dietitian o Nurse o Psychologist o Psychiatrist o Social worker  Anorexics goal is to first restore their weight, then normalize their eating behaviors  Bulimics first step in recovery is to normalize eating habits, and then educate them  Emphasize that physical activity is for health, not weight  Typical approaches to treatment: o Setting depends on client’s medical stability, motivation to participate in treatment, social support situation, and other factors  Level 1: Outpatient  Level 2: Intensive Outpatient  Level 3: Partial Hospitalization/Full-Day Outpatient Care  Level 4: Residential Treatment Center  Level 5: Inpatient Hospitalization  Goal of eating-disorder treatment programs: o Restore body weight o Improve social and emotional well-being o Normalize eating behaviors  Core components of programs: o Treatment of medical comorbidities o Restoration of body weight to normal o Nutrition education and counseling o Individualized psychotherapy o Family therapy o Group therapy  Goal of Treatment from RD Perspective: o First goal is nutritional rehabilitation o End goals include:  Help client make peace with food, eating, weight, and physical activity  Promote eating and physical activity for health and not weight  Assist client in moving towards “intuitive eating” ▯ Eating Disorders among Adolescents  Eating disorders—a continuum ranging from body dissatisfaction to clinically significant eating disorders  Parents, peers, educators, and health care providers should take and important role to help decrease prevalence of eating disorders ▯ Preventing Eating Disorders  Programs that focus on changing weight-related attitudes of youth and promoted healthy weight-control strategies were found to be more effective  Effects have lasted up to 2 years  Characteristics of successful eating disorder prevention programs: o Target high-risk groups o Target adolescents > 15 years of age o Information provided by trained interventionists o Multiple sessions o Integrated interactive learning ▯ ▯ Adult Nutrition ▯ Definition of Adulthood in the Life Cycle:  Early adulthood—ages 20-39 years o Involve becoming independent and leaving the parental home o In the 20s, planning, buying, and preparing food are newly developing skills o In the 30s, renewed interest in nutrition “for the kids’ sake”  Midlife—ages 40-54 years o Period of active family responsibilities o Managing schedules and meals becomes a challenge o Time of reviewing life’s accomplishments and recognition of mortality  “Sandwich” generation—the 50’s o Many are multigenerational caregivers: juggle roles of caring for children and aging parents, while maintaining a career o Health concerns frequently are added  Chronic disease  Managing identified risk factors to prevent diseases  Later adulthood—age 65+ o Transition to retirement o More leisure time- greater attention to physical activity and nutrition o Food choices and lifestyle factor, especially for those with chronic disease ▯ Importance of Nutrition  The span of years between ages 20 and 64 is a time when the future course of health and wellness are influenced by: o Diet o Physical activity o Smoking/drinking o Body weight  How do food and nutrition enhance life? o Nutrition and exercise are among the main lifestyle factors that reduce risk of the onset and severity of 5 of the 10 leading causes of death:  Cancer  Heart disease  Stroke  Diabetes  Liver disease ▯ Health Disparities among groups of Adults  Some population groups have a higher prevalence of chronic diseases than others  Some groups have a genetic disposition for certain diseases  Genetics and environment interact ▯ Physiological Changes of Adulthood  Growing stops by the 20’s  Bone density continues until 30  Muscular strength peaks around 25 to 30 years of age o Decline in size and mass of muscle and increase in body fat  Dexterity and flexibility decline  Hormonal and Climacteric Changes o Women  Decline of estrogen leads to menopause  Increase in abdominal fat  Increase in risk of cardiovascular diseases and accelerated loss of bone mass o Men: gradual decline in testosterone level and muscle mass  Body Composition Changes in Adults o Bone loss begins around age 40 o Positive energy balance resulting in increase in weight and adiposity; decrease in muscle mass o Fat redistribution- gains in the central and intra-abdominal space, decrease in subcutaneous fat o Fat redistribution associated with increased risk of chronic disease  Hypertension  Insulin resistance  Diabetes  Stroke  Gallbladder disease  Coronary artery disease ▯ Continuum of Nutritional Status  Nutritional health can be viewed as a continuum from: “healthy” and resilient state to a “terminal state”- body system shut down and life ceases ▯ Estimating Energy Needs in Adults  Estimating energy needs based on BMR + TEF + Activity o Basal Metabolic Rate (BMR): daily BMR expenditure = 60-75% for involuntary processes o Thermic Effect of Food (TEF): metabolism of food ~10% o Activity thermogenesis: most variable component which accounts for 20-40% of total energy needs  Double labeled water (DLW) o Subjects are given a dose of “tagged” water o Excretion of isotopes in saliva and urine is used to calculate average energy utilization over several days o Used to determine estimated energy requirements (EER)  Indirect Calorimetry o Measurement of heat given off and utilized for the body’s metabolic processes o Indirect Calorimetry determines REE which is nearly = to BMR o The respiratory quotient (CO2/ O2) is used to estimate 24 hour energy expenditure  Mifflin-St. Jeor Energy Estimation Formula: validated and more accurate than old Harris-Benedict equation o Formulas are different for males and females o Weight must be in kilograms o Height must be in centimeters  “Ballpark” caloric levels o Simple calculation:  Weight maintenance = 15 calories per pound  Weight loss = 13 calories per pound  Weight gain = 17 calories per pound Energy Adjustments for Weight Change  1 lb of body fat = 3500 calories  Weight loss must be done gradually in order for the body to get used to it  Recommendation = lose about 1lb per week o Each day, must cut at least 500 cals/day in order to lose 1 lb per week o A combination of decrease intake and increased use (exercise) is one approach to use  Ideally, important not to cut out all 500 calories because it could affect micronutrient intake  At least 200 cals can come from exercise  A positive balance of just 100 extra calories per day will result in gain of 10 lbs in a year ▯ Macronutrients  Nutrients that produce energy: carbs, protein, fat  Carbohydrate recommendation is based on the DRI which is 130 g for both men and women  Protein recommendations are based on the RDA of 0.8 g/kg body weight  Grams of fat per day are not determinable but rather are recommended in terms of AMDR o Add on intake of fat based on carbohydrate and protein intake  Most fat should be unsaturated, limit saturated (7%) and trans fat intake (<1%)  Nutrient Recommendations o When looking at AMDRs, make sure to take into account certain risk factors and distribute calorie intake accordingly o AMDR’s:  Fat: 20-35% of calories  Carbohydrate: 45-65% of calories  Protein: 10-35% of calories ▯ Micronutrients  Most vitamin and mineral requirements for healthy people remain the same as they move throughout each life stage group ▯ ▯ Risk Nutrients  Certain nutrients exceed or fall short of recommendations: o Fiber o Vitamins A, D, and E o Folic acid o B12 o Choline o Calcium o Magnesium o Potassium o Sodium  Vitamin A and Sodium o In the US we exceed these nutrients ▯ Dietary Recommendations  Dietary guidance systems focus on: o Consuming greater amounts of:  Fruits, vegetables, fiber, and low-fat dairy product  Limiting saturated fat intake, trans fats  More nutrient rich foods, less sugar  Keeping sodium low  Regular physical activity o Energy intake balanced with energy expenditure = healthy weight  2010 Dietary Guidelines and MyPlate: o Enjoy food but choose wisely and eat less o Select a variety of foods o Get the most nutrition out of their calories o Stay within daily calorie needs o Consider shifting to a plant based diet ▯ Beverage Intake Recommendations  Recommendations in dietary guidance systems: o Consume fewer or smaller portions of beverages containing fats and added sugar o Plan beverage intake as part of total calorie intake o Make beverage choices that fit into the dairy, vegetable, and fruit groups  Alcohol o 61% of US adults drink alcohol o Nations vary on alcohol consumption guidelines  “If you drink, do so in moderation” o Recommendation: 2 drinks a day for men and 1 drink a day for women  Difference due to body composition and the ability to produce ADH o Varies between countries o A drink contains roughly 13-15 grams of alcohol or 0.5 oz of ethanol ▯ Water  Water should be considered one of the most important nutrients because humans can survive only days without it compared to weeks or months without food  Water should be our primary source of fluid o Every 1000 calories, should drink at least 1 liter of water o Intake Recommendations:  Based on median total water intake  Upper level for water intake not set but toxicity can occur  Total for adults:  Men = 3.7 liters  Women = 2.7 liters  Other fluids: o Diuretic effects of caffeine  While caffeine does act as a diuretic, the DRI committee concluded caffeine-containing beverages contribute to the total daily water intake ▯ Dietary Supplements and Functional Foods  Dietary supplements indicated: pregnancy, certain illness, low calorie or nutrient restricted diets  Survey data indicates that 44% of adult males and 53% of adult females take vitamin or mineral supplement nearly everyday o In America, those that take supplements tend to be food secure  Functional foods: term used for food products that have a physiological benefit or reduce the risk of chronic disease beyond basic nutritional functions o Functional food during adult years helps protect us a lot  Fermented foods considered functional foods because they have other health benefits ▯ Physical Activity Recommendations  Healthy eating and increased physical activity are the featured duo for combating obesity  Any physical activity is better than none  Physical activity helps to manage weight and reduce disease risk factors  At least 150 minutes/week of moderate intensity physical activity  Muscle strengthening activities 2 times a week  Regular physical activity leads to changes in body composition with reduced fat mass and increased lean mass  Even without caloric restriction, aerobic physical activity results in decrease of adiposity  Promotion of Physical Activity: Healthy People 2020 Objectives o Reduce proportion of adults who engage in no leisure-time physical activity o Increase proportion of adults who meet federal guidelines for aerobic physical activity and muscle-strengthening activity  Diet and Physical Activity: o Physical activity is supported by a general healthful diet o Competitive sports may have increased nutrient needs o Nutritional ergogenic aids:  Caffeine, sports drinks, protein powders, energy and gel bars  Few improve performance, may be harmful ▯ Nutrition Intervention for Risk Reduction  Many types of interventions o Individual counseling o Multi0component programs o Policy and system changes  A Model Health-Promotion Program: Sisters Together ▯ Public Food and Nutrition Programs  SNAP- food stamps  Government extension programs  Meals on Wheels  Soup kitchens and shelters for homeless ▯ Overall  Adults need: o Variety of healthful foods o Knowledge to guide food choices o Positive attitudes about food and eating o Balance with discipline  The message is to follow the principles of variety, moderation, and balance in choosing a diet ▯ ▯ Movie  When obese, hearts are much larger because they have to work so much harder to circulate blood around the body  The thickened wall causes the heart to be virtually ineffective over time  When enlarged, fat could accumulate around the heart  If too much blood plaque forms, it completely blocks the arteries to the heart  Early life experiences in the development of obesity has major consequences much earlier than we should see particularly in the arteries  High blood pressure is directly related to heart attacks and strokes  Hormones released from fat cells interact with heart and other organs that can affect them negatively  Deposit fat into visceral depot (readily mobilized, burned quickly)  Women rely on calories from hips and thighs to help with breastfeeding or retaining a pregnancy  Both males and females tend to store fat inside their abdomen, underneath the skin, liver, and stomach  Greater number of liver transplants due to cirrhosis- a stiff, diseased liver that is a result of fat being stuck on the liver due to obesity o Could be the leading reason soon that we’re doing liver transplants  If an obese person has normal liver fat, they can be relatively metabolically healthy  Once an obese person loses weight, the liver returns back to its original status with no fat ▯ ▯ Conditions and their Management during Adulthood ▯ Introduction  Life-style conditions, the leading causes of death in US adults, are the focus  Topics include: o Cancer o Cardiovascular diseases o Overweight and obesity o Diabetes o Metabolic syndrome o HIV/AIDS  Focus for adult nutrition is on weight management throughout the life cycle  Reduce risk of overweight and obesity: o Exercising at least 30 min/day for 5 days a week o Monitoring diet: limit saturated fat o Educate children on ways to be healthy in the future ▯ Overweight and Obesity  Over 1/3 of US adults are obese o Obesity results from long-term energy-in/energy o Obesity and overweight vary across age, gender, race, and income categories o The rate continues to increase for both overweight and obesity  Minorities have a higher risk of overweight and obesity  Low income families have higher risk of obesity due to food insecurity  30-34% of people in Georgia are obese  Central adiposity: distribution of body fat is a more important indication of health issues than BMI o Increased waist circumference = increased risk o Age, sex, and cultural differences  The Dietary Guidelines for Americans recommend weight reduction for those who are even mildly overweight ▯ Etiology of Obesity  Complex and chronic conditions  Stemming from numerous interacting factors: physiological, individual, and environmental  Overweight and obesity have multiple causes—not just over consumption  Loss of appetite control may be due to disturbances in hormonal controls of hunger and satiety o Adulthood is the time when diseases appear and medications can alter appetite  Environmental factors can contribute  Large waist circumference increases risk for diseases associated with obesity ▯ Exceptions for Use of BMI  BMI measures don’t accurately represent healthy weights of people who are: o Athletes with increased muscle mass o With decreased muscle mass o Dense, large bones o Dehydrated or over-hydrated  Body composition gives a better estimate of risks for a particular person  Underwater/hydrostatic weighing: gold standard for body composition measurements o Has its short comings because the individual’s weight must be measured in water by the displacement of water when submerged (volume): pregnant women cannot do this, difficult for elderly  DEXA: uses radiation to measure body composition o Determines whether excess weight is muscle mass or body fat  Air-displacement Plethysmograph: displacement of air o Bod Pod ▯ Bariatric Surgery  Candidates for bariatric surgery are those whose: o BMI > 40 o BMI > 35 with co-morbidities  Must be highly motivated for aftercare guidelines  Are at risk for micronutrient deficiencies  Pregnancy not advised for up to one year after because there is risk of micronutrient deficiencies Cardiovascular Disease  Diseases related to the heart and blood vessels  Associated with atherosclerosis o Consists of coronary heart disease o Cerebral vascular disease o Blood vessels in the legs  Hyperlipidemia and Hypertension—important factors in the progression of CVD  Prevalence of Cardiovascular disease (CVD) o Over 82 million adults o Men develop at younger age o Women catch up after menopause o Racial and ethnic differences occur  CHD—number 1 cause of death in US adults: progress is being made in reducing the deaths  CHD and stroke are characterized by atherosclerosis,-hardening of arteries, due to plaque buildup  Arteries narrow increasing risk of: o Myocardial infraction, which leads to the shut off of blood to heart (heart attack) o Stroke leads to blood shut off to cerebral artery of the brain  Cardiovascular Disease Risk: o Three modifiable health behaviors:  Poor nutrition  Lack of physical activity  Smoking  Etiology o Begins when substances like cholesterol, fatty acids, and calcium accumulate over injured arterial wall cells o Increased levels of homocysteine, inflammatory diseases, abnormal blood clotting factors, etc.  Effects: o Buildup of plaque and lesions leave less room for blood flow o Results may be:  Decreased blood flow to heart  Reduced energy  Decline in organ function  Inability to perform activities of daily living  Shortness of breath  Chest pain  Risk: o Dyslipidemia: increased LDL and decreased HDL cholesterol, increased triglycerides) o High blood pressure o Lifestyle factors o Obesity o Diabetes o Infection and inflammation  Nutrition Assessment o Food and nutrition history o Nutrition knowledge o Physical activity o Anthropometric measurements o Laboratory values o Medical and social histories  Primary Prevention o Principles of cardio-protective diet:  Emphasize plant foods  Appropriate fats  Fish and lean meat  Dairy  Following the DASH diet  Reducing overall sodium intake  Increasing physical activity  Moderation in alcohol consumption  Medical Nutrition Therapy o Therapeutic Life Changes(TLC)  Recommend for high risk individuals  Diet and lifestyle change is the cornerstone of therapy  Developed by the third NCEP Expert panel  Need to consider addition of stains if LDL increases  Nutrition Interventions o National Cholesterol Education Program  Total fat intake from 25-35% of calories  Dietary cholesterol <200 mg/day  CHO from 50-60% calories  Dietary fiber 20-30 g/day  Weight reduction for overweight and obese  >200 cal/day spent for physical activity ▯ Metabolic Syndrome  Seen in 1/3 of US adults  Metabolic abnormalities that increase risk of type 2 diabetes including: o Abdominal obesity o Increased blood insulin o Fasting glucose o Increased triglyceride levels o Increased blood pressure o Decreased HDL  Diagnosis made when individual has three of the symptoms ▯ Diabetes Mellitus  Definition: fasting blood glucose levels >125 mg/dL, hemoglobin A1c > 6.5%  Type 1: minimal or no production of insulin by pancreas; daily insulin injections required  Type 2: body’s inability to use insulin; most common type  Prevalence o ~25.6 million adults in US o ~79 million have pre-diabetes  Correlates with overweight and obesity  Most often people over 40 years  Increasing in younger adults and children o Higher in racial and ethnic minorities  Etiology o Type 1 = progressive autoimmune disease o Type 2 caused by insulin resistance + insulin deficiency o Adverse effects of high blood glucose:  Increased blood triglycerides  Increased blood pressure  Affects arterial walls  Screening and assessment needed  Nutrition assessment needed  Interventions o Clinical goals:  Normalize blood glucose and glucose metabolism  Prevent or slow the progression of diabetes complications  Treatment focus is to empower the person with diabetes to self-manage  Medical Nutrition Therapy: o Diet flexibility and individualization o May also need to add antihyperglycemic drugs o Use herbal remedies with caution ▯ Cancer  Definition: a group of diseases in which genes malfunction, resulting in unregulated cell growth and tumor formation  Carcinogenesis: the process by which normal cells are transformed into cancer cells  Etiology: o There are multiple stages o Initiation and progression of cancer linked to the following factors: environmental exposures, lifestyle, dietary constituents (promotion or inhibition) o 1.6 million people a year are diagnosed o Nearly 600,000 die from cancer o Majority of cancers develop in epithelial tissue o White women, black men—highest rate of new cancers  Risk Factors: o Smoking linked to 30% of cancers o Nutrition-related risks:  Obesity and insulin resistance  Increase alcohol consumption  Decrease intakes of fruits, vegetables, and calcium  To minimize these risks:  Maintain or reach healthy weight  Eat 2 ½ cups of fruits and vegetables daily  Limit processed and red meat  Alcohol in moderation, if at all  Exercise ▯ HIV/AIDS  US: over 1.1 million (13 years and older)  HIV is now a chronic condition managed by drug therapy  HIV infection raises energy requirements by 10%  Weight maintenance and adequate protein stores—increases survival  Nutrition Interventions o Maintain weight and nutritional status o Consume adequate protein and other nutrients o During early phase, adequate nutrient intakes to increase immune function and decrease susceptibility to infection o Choose calcium-rich foods and vitamin D to prevent progressive bone loss o Dietary strategies to manage symptoms of drug therapies o Even the best nutritional advice and self care cannot restore immune function o Nutritionally adequate diets can:  Help weight maintenance  Avoid depletion of nutrient stores  Increase level of control and sense of well-being ▯ ▯ ▯ ▯ ▯


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