MNT week two notes
MNT week two notes NUTR 342-31
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This 3 page Class Notes was uploaded by Olivia Notetaker on Saturday January 30, 2016. The Class Notes belongs to NUTR 342-31 at La Salle University taught by Professor Danowski in Fall 2016. Since its upload, it has received 63 views. For similar materials see Medical Nutrition Therapy in Nutrition and Food Sciences at La Salle University.
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Date Created: 01/30/16
MNT notes- week one January 25 - Bone o Organic = 1/3 of our dry weight o Inorganic = 2/3 of our dry weight o Hydroxyapaptite gives stiffness o Drawing Ca level won’t tell us the status of our bones! o Metabolically active means that they interact with other organ systems o Bones- give shape, protection, movement, reservoir for Ca and phosphorus o You want serum Ca to be 9-10.5 Hypercalciuria from hypercalcemia means excess Ca in urine o Osteocytes are needed for bone remodeling or if blood Ca is too low Used in weight bearing exercise o Bone- two parts: cortical and trabecular The ends are part of trabecular! o Girls reach peak growth around 16-18; men around 18-20 o Bone is organized in layers…cortical is similar to an onion with its layers - PTH in bone metabolism o Inhibits collagen, meaning you’re not building up bone at this point o Ca resorption by kidneys so there’s not Ca in urine o Vit D does the same process as PTH! - In Ca and Phosphorus homeostasis, the primary regulators, PTH, Calcitonin, and Vit D keep bones strong and regulate Ca and P when low - Calcitonin decreases Ca levels - Vit D increases Ca levels o Ergocalciferol = Vit D2 o Cholecalciferol = Vit D3 (in animal sources and sunlight) o 1-25 dihydroxyvitamin D is the active form o In fortified foods (milk and oj), fatty fish skin, fish oils o Need sun, liver & kidneys (convert vit D to active form), and diet to get vit D - Osteoporosis o Decreased bone mineral AND organic matrix o Bone strength reflects bone density (thicker; good bone mineralization) and bone quality (absence of trauma; if just walking and break a bone, it could be a sign) o Most common bone disease in humans o In late 20’s (25+) is where you start to “go downhill” in regard to bone strength o DXA, T-score, BMD, WHO, quantitative ultrasound of heel all help diagnose for disease o Healthy bone- small, normal holes; Bad= bigger, abnormally shaped holes o 80% of bone density is hereditary, 20% due to lifestyle o For the t-score for normal bone mineral density (BMD), you want it to be greater than negative one (0+) o Epidemiology- females lose BMD faster than men because estrogen drops post- menopause (post-menopausal white women are at greatest risk) o Do weight bearing exercise and get Ca and Phosphorus in diet to prevent this disease o Hip fractures can cause this because px become sedentary or get sick from hospital environment (also have a decreased appetite which may lower immune system) Elderly have harder time recovering…problem because nutritional needs are high but their appetite is low o Secondary etiology is due to another disease or drug issue (big in men) o Other risk factors for disease: alcohol, overuse of heparin, glucocorticoids, pregnancy IF not consuming enough Ca/P for both you and baby January 27 - Resorption- process of osteoclasts breaking down bone/losing Calcium o Remodeling - Reabsorption- getting back what is lost; process of absorbing something again - Osteoporosis o In prevention… avoidance of EXCESSIVE alcohol intake means binge drinking (5+ drinks a day) To lower caffeine, it should really be no more than 2 cups of caffeine/day Get sun exposer to activate vit D Order of which are most ideal: 1) Consume Ca rich foods (dairy, broccoli, asparagus); 2) Ca fortified foods (Oj, cereals); 3) Ca supplements (divide doses because body can only absorb 500mg at once, so do one dose in morning and one at night) o Ca highest in adolescents, then decreases after growing, then increases again because women post-menopausal o Vit D increases when older (70+) Not outside as much, not eating sources, lactose intolerances Biggest source- dairy Lots of people are low in this because we don’t go outside as much, beauty products have spf which block vit D 10-2 is best time of day to be out In cities tall buildings block the sun People get up when it’s dark and go to bed when it’s dark People may have lactose intolerances o Oligomenorrhea or amenorrhea= no period or very low/intermittent o Alcohol increases ca and mg losses because you have to urinate a lot when drinking o For medical management, do drug therapy to prevent further losses o Serum Ca interpretation does not reflect dietary intake because only 1% is from diet, other 99% from bones o Only use Albumin bound is there is low albumin (if it’s low, it can affect what the ca level is) o Bisphosphonates decrease bone resportion o Teriparatide regulates Ca levels - Paget Disease o 70% of people having this are asymptomatic o Nerve paralysis, cardiac issues, tooth loss- symptoms/indications - Rickets o Risk factors= vit/min deficiency o Limbs bow because when you start walking, weight causes bone to bow (in growing kids) o Formulas must have supplements in them to prevent this disease (if receiving less than 500ml/day) o Tx- does not reverse itself- still at risk for fractures Can get surgery/bracing to fix bowed, but it’s still not reversible through diet/medications - Osteomalacia- adult version of rickets o Due to lack of ability to convert vit D to active form (along with Ca deficiency and hypophosphatemia) o Renal disease and liver disease can lead to this Renal because kidneys help convert vit D to active form - Arthritis o Most common diagnosis (60+ yrs) o With risk factors, infections like Lime Disease can be an issue o Gout- problem in overweight men o Periarticular muscles are muscles near joints o Typing, tennis, football, baseball- repetitive joint stresses o Tx- NSAIDS- should be careful with these because overuse can cause PUD and GI issues o Can’t reverse process but want to prevent further damage o Rheumatoid is autoimmune- body attacks itself (more specifically, it’s attacking the synovial membrane) o An increase in antioxidants is very important for nutrition therapy o DHA and EPA- derivatives of omega 3’s in fatty fish Need 2.6-7.1 g/d to get anti-inflammatory properties Most oils have 30mg, so you’d need 8 pills a day to just get minimum!
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