CDR Exam Questions and Complete Solutions Graded A+

CDR Exam Questions and Complete Solutions Graded A+ Grades of Meat - Answer: Prime, choice, select, standard - determined at slaughter - grading based on maturity of animal, marbling of fat, color and texture of lean - standard grades have the least marbling; prime the most Meat Cuts - determine the method of cooking - Answer: Most tender cuts come from the least used muscles - loin, backbone (pork chops - loin) Medium tender meats come from the shoulder - chuck Least tender meats come from the most used muscles - flank, brisket Safe Minimum Internal Temperatures - Answer: 145' F - pork, beef, veal, lamb, steaks, roast, fish 160' F - ground beef, ground veal, ground lamb 165' F - turkey, chicken, duck Smoke Points - should be above 400' F - Answer: Temperature to which fat can be heated before puffs of smoke occur - safflower oil 513' F - soybean, canola, corn, palm, peanut, sunflower, sesame, olive oil 375' F - lard 375' F - shortening 365-370' F - butter 350' F Dry Heat Methods of Cooking - no water involved, for tender cuts of meat, near the backbone (loin, sirloin) - Answer: Frying, broiling, roasting, grilling Moist Heat Methods of Cooking - water involved, less tender cuts with more connective tissue (bottom round, chuck, brisket) - Answer: Braising, simmer, steam, stewing Cream in order of decreasing percentages of fat - Answer: Heavy or thick >36% fat Medium 30-36% fat Whipped cream 35% fat Light or thin 18-30% fat Sour cream >18% fat Half and half no less than 10.5% fat Wheat Flours - Answer: Graham, whole wheat - entire grain, use freshly ground, spoils quickly due to fat in germ Bread (hard wheat) - strong gluten; 11.8% protein All-purpose (blend of hard and soft wheat) - less gluten; 10.5% protein Pastry (soft wheat) - weaker gluten; 7.9% protein Cake (soft wheat) - least and weakest gluten, more starch; 7.5% protein Causes in Variations of Cakes - Answer: Yellowing: alkaline batter (excess soda) Fallen center: excess sugar, excess fat, excess baking powder, inadequate mixing, oven temp too low, open door during early baking Tough, dry crumb: too much flour or egg, too much mixing, too little fat or sugar, over-baking Coarse texture: too much baking powder or sugar, over temp too low, inadequate mixing Poor volume: too little baking powder, improper level of sugar or fat Overrun in Ice Cream - Answer: The increase in volume from freezing and whipping - determined by weight; should be 70-80% Gelatin - an incomplete protein - Answer: Has no tryptophan, low in methionine and lysine Emulsifiers as Additives - Answer: Monoglycerides, diglycerides, lecithin, disodium phosphate Types or Domains of Learning: Cognitive - Answer: Acquisition of knowledge or subject matter (factual information) Types or Domains of Learning: Affective - Answer: Acquisition of attitudes and values, growth in feelings or emotions Types or Domains of Learning: Psychomotor - Answer: Acquisition of muscular skills (exercises, food preparation) Behavior Modification Methods: Positive Reinforcement - Answer: Encourages repetition of a given behavior - should be specific and immediate; meaningful attention from superiors Behavior Modification Methods: Avoidance Learning - Answer: Learn to escape from unpleasant consequences - avoid future criticism by improving future performance Behavior Modification Methods: Extinction - Answer: Reduce undesired behavior - absence of reinforcement following undesired behavior (ignore) - if extinction is repeated, behavior will eventually disappear Transtheoretical Stages of Change - Answer: Pre-contemplation: unaware or not interested in making a change - "I did not know salt had any effect on my blood pressure" Contemplation: thinking about making a change in the near future - "I was looking at the salt contents in the foods I have at home" - "I know what to do but..." Preparation: decides to change and plans the change - "I bought a cookbook on low salt cooking" Action: tries to make the change - "I removed the salt shaker from the kitchen table" Maintenance: sustains the change for six months or longer - "I found a website that helps me plan family low sodium meals" Interviewing Steps - Answer: Preparation: collect background information (age, weight, height, diet history) and establish objectives for collecting the information during the interview. Be sure to clearly define the purpose and goals of the interview BEFORE the interview Build rapport: first step when meeting with the client, engage with them and make sure they feel comfortable Collect data: begin with open-ended, non-judgmental questions - open-ended: broad, gives freedom in responding; gives you a chance to listen and observe; takes more time but is less threatening - closed: more restrictive; limits answers; gives you control; takes less time - primary - introduces new topics: secondary - obtain more info, follow-up - neutral: preferred - do not reveal your bias; leading: reveals your bias - funnel sequence: begin with broad open questions and proceed to more restrictive ones Closing: summarize for client to check accuracy; tell client what will be done with the information and when he will be contacted for teaching Non-verbal Communication - Answer: Kinesics - physical communication >> direct eye contact - attentiveness >> lowering eyes, look away - preoccupation >> arms folded across chest - dislike, avoidance >> clenched fists - anxiety, anger; crossing and uncrossing legs - anxiety Paralinguistic - how the client's message is delivered >> hesitations, stuttering - sensitivity, anxiety >> whispering - difficulty in disclosing Proxemics - personal space >> moves away - discomfort; moves closer - seeking more interaction >> sits behind or next to an object - seeks protection CBT Cognitive-Behavioral Therapy - Answer: >> Cognitions are thoughts or perceptions at a particular moment in time. They can influence our behaviors and feelings. Cognitive change may effect a desired behavior change - self-talk or internal dialogue: "I have no will power. I look fat" - client change talk: when clients verbalize their reasons that favor the targeted behavior change "I want to lose weight to feel better" >> Based on an assumption that behavior is learned and can be unlearned as the client learns new and adaptive responses >> Focuses on identifying behaviors and thoughts that have a negative impact on desired behaviors and goals and apply strategies to change those >> The aim is to introduce changes in the cognitive or thought process that maintain a behavior that needs to be changed Motivational Interviewing - Answer: Helps clients recognize and begin to resolve their concerns and problems. The goal is to increase motivation so that clients are able to express the rationale for the changes that need to be made. People make behavioral changes only when they are ready to change. It is a client-centered method for enhancing intrinsic motivation, guides rather than directs, and does not give advice to the client a. Principles - express empathy (suggests acceptance), compassion, evocation (summons feelings) - develop discrepancy - between where he is and where he wants to be - avoid arguments and confrontation - roll with resistance - acknowledge reluctance to change and ambivalence; offer new information or alternatives to consider - support self-efficacy - reinforce hope and optimism b. MI: client autonomy means that decisions are left to the client Electronic Health/Medical Records (EHR/EMR) - Answer: Enter, store, retrieve and manage information related to health care HIPAA - Answer: Maintains privacy of PHI (protected health information). Patients' rights to their own health information, privacy and confidentiality. Patients must be notified if their medical information is to be shared outside of the care process, or it protected information (address, email, income) is to be shared The Patient Centered Medical Home (PCMH) - Answer: Focuses on the relationship between the patient and their personal physician. The physician takes responsibility for all aspects of the health care. The RDN should be considered part of the medical home treatment plan Telehealth Services - Answer: Use of electronic information and technologies to support long-distance clinical health care, patient and professional education, public health administration, remote patient face-to-face services, via live video conferencing, store and forward telecommunication services (clinical data, images, sound, video) which can then be retrieved by another site for clinical evaluation Telenutrition - Answer: RDN uses information and technologies to implement the NCP with clients at a remote location within provisions of their state license as applicable. Medicare Part B allows some services provided by RDNs to be offered via telehealth including MNT, diabetes self-management training Academy of Nutrition and Dietetics Health Informatics Infrastructure (ANDHII) - Answer: Tracks nutrition care outcomes and advances evidence-based nutrition practice research Altmetrics - Answer: Presentation of amount of activity from Twitter, Facebook, science blogs, mainstream news and other sources over time Food and Nutrient Analysis Software and Database - Answer: 1. USDA National Nutrient Database for Standard reference: major source of food composition 2. FNDDS Food and Nutrient Database for Dietary Studies: use to analyze data from dietary surveys 3. FDA Total Diet Study Database Data on foods, minerals, chemicals 4. Dietary Supplements Database NIH Food and Nutrition Management Software: for institutional use - Answer: Computrition, CBORD, Dietary Manager, ChefMax Meta Analysis - Answer: A formal, defined system that combines the results of numerous small studies to increase the strength of belief in the observed effect Studies of similar design, have defined inclusion and exclusion criteria, and are published peer-reviewed studies QUOROM - Answer: Has proposed quality standards for the review and monitoring of systematic reviews and meta-analysis of randomized trials PRISMA - Answer: Randomized control trials that are an evidences-based minimum set of items for reporting in systematic reviews and meta-analyses. Focuses on the reporting of reviews evaluating randomized trials, but can also be used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventions MOOSE - Answer: Meta-Analysis of Observational Studies in Epidemiology CONSORT - Answer: Common criteria for clinical trials Descriptive Research - Answer: a. describes state of nature at a point in time b. generates hypotheses regarding determinants of a condition or disease c. provides baseline data and monitors changes over time d. establishes associations among factors, but does NOT allow causal relationships to be determined e. types of descriptive research >> qualitative research - often precedes other research -- purpose: to explore a phenomenon of interest as a prelude to theory development (what specific dimensions are associated with being an effective counselor) -- generates narrative data (rather than numerical data or numbers) collected through interviews, observations, questionnaires; may use focus group - Delphi >> case report, case study or case series - report of observations on one subject or more than one subject -- describes quantitatively the experiences of a group of cases with a disease or condition in common -- helps identify variables important to the etiology, care, or outcomes of a particular condition >> surveys - research designed to describe and quantify characteristics of a defined population; defined time frame; pinpoints problems >> correlation studies or ecological studies -- compare frequency of events (or disease rates) in different populations with the per capita consumption of certain dietary factors (correlation between fish consumption and breast cancer incidence) Analytical Research - Answer: a. tests hypotheses concerning the effects of specific factors of interest and allows casual associations to be determined b. includes clinical trials, follow-up studies, case control studies c. types of analytical research >> experimental model - uses experimental and control groups -- target populations are randomly chosen to be in either group, randomization is dividing people into treatment or control groups without bias -- experimental group receives the program or treatment -- control group does not receive the treatment or may receive a placebo -- compute the differences between two groups -- program is successful if the experimental group has improved more than the control group -- difficult to run - may not be enough people for control group; may not feel it is ethical to deny a service -- clinical nutrition studies: RCT (randomized control trial) with comparison placebo control group is the gold standard. This is considered the best for evaluating medical treatments, and intervention with one or more treatments In the experimental model of analytical research, clinical nutrition studies in the form of RCTs can have different designs: - Answer: 1. Parallel design 2. Crossover design 3. Two period crossover design Parallel Design - Answer: Participants are randomly assigned to a particular treatment group and remain on that treatment throughout the study Crossover Design - Answer: Each participant serves as his own control A major advantage of this design is that variability is reduced because the measured effect of the intervention is the difference in that participant's response TO the intervention and control. This decrease in variance allows use of a smaller sample size. This design is generally longer, but each is "exposed" to all treatments Two Period Crossover Design - Answer: Each would receive either intervention or control (A or B) in the first period, and the alternate treatment (A or B) in the second period Quasi-Experimental Design - Answer: Time series - series of measurements at periodic intervals before the program begins and after the program ends. It shows whether measurements before and after the program are a continuation of previous patterns or whether they indicate a noteworthy change Cohort Studies - Answer: a. cohort - any group whose members have something in common b. cohort of healthy people followed through time to see if they develop a specific disease c. sometimes called incidence studies tracking the frequency of new cases (newly diagnosed) of a disease d. carried out over a long period of time (longitudinal), and prospective (future-oriented). Retrospective cohort studies use existing data and look back for a relationship between exposure factors and outcomes Case Control Studies - Answer: Focus on a specific disease a. those with the disease are compared with a group without the disease, but otherwise similar in characteristics b. both groups recall past behaviors, to study how the groups differ Cross-Sectional Studies/Prevalence - Answer: a. one time data collection counting all of the cases of a specific disease among a group of people at a particular time b. snap-shot look at one point in time; describes current, not past or future events Analysis of Variance (ANOVA) - Answer: Tool used to evaluate validity a. asks whether the difference between samples is a reliable one that would be repeated b. used when several (three or more) products compete against one another c. compares the variance between groups with the variance within groups d. answers: are there one or more significant differences ANYWHERE among the samples Precision - Answer: The amount of variation that occurs randomly. Less random variation results in greater precision in the measurement and greater reliability Sensitivity and Specificity - Answer: Use is protocol involves screening for a particular condition; evaluates the cut-off value being used Sensitivity - proportion of afflicted individuals who test positive Specificity - proportion of non-afflicted identified as non-afflicted Nominal Variables - Answer: Non-ordered variables that fit into a category with no special order (gender, race, marital status, present or absent) Rank Order Variables - Answer: Ordinal scale variables that are observations compared with each other and put in order, perhaps from best to worst, or state of disease from 1 to 4 Numerical Discrete Variables - Answer: Data with numbers (number of clinic visits) Numerical Continuous Variables - Answer: Underlying continuous scales (blood pressure) Gluconeogenesis - Answer: Conversion of non-carbohydrate sources into glucose (from glycerol and amino acids) Thyroxine - Answer: Regulates metabolism and rate of oxidation 1. influences physical and mental growth 2. stimulates liver glycogenolysis, gluconeogenesis - raises blood sugar Total Energy Expenditure (TEE) - Answer: The sum of the energy used for... 1. basal energy expenditure or basal metabolic rate (BEE/BMR) 2. energy expenditure in physical activity (EEPA) 3. thermic effect of food (TEF) Basal Energy Expenditure (BEE) or Basal Metabolic Rate (BMR) - Answer: Minimum amount of energy needed at rest in fasting (amount needed to carry out involuntary work of the body, activity or internal organs, internal temperature) a. affected by extremes in environmental temperatures - tropical climate 5-10% increase b. caffeine, alcohol, nicotine stimulate metabolic rate 7-15% Thermic Effect of Food (TEF) - Answer: Diet-induced thermogenesis (DIT), or the calorigenic effect of food (about 10% of total energy expenditure) a. energy needed to digest, absorb and assimilate nutrients b. greater after consumption of carbohydrate and protein than after fat Energy Expended in Physical Activity (EEPA) - Answer: Highly variable a. activity thermogenesis (AT) Basal Metabolic Rate (BMR) - Answer: a. measured in the morning when reclining, awake, relaxed, at normal body temperature, at least 12 hours after last meal, and several hours after strenuous activity b. measures oxygen consumed c. affected primarily by: >> sex - women have 5-10% lower BMR than men >> age - highest BMR 0-2 years of age; older adults - less activity, less lean body mass, more body fat: decreased BMR >> body composition, body surface area >> endocrine glands - thyroid d. measured by PBI - protein bound iodine - measures activity of thyroid gland 1. hormones: thyroxine (T4), triiodothyronine (T3) 2. when PBI is elevated, BMR is elevated 3. measures energy metabolism; measures level of thyroxine produced 4. not a nutritional assessment parameter e. higher during periods of growth, pregnancy, lactation, fever (7% increase for each degree rise in temperature), some diseases f. increased by exercise g. basal energy expenditure (BEE) - calculated BMR 1. includes age, sec, body surface area (height, weight) Protein Bound Iodine (PBI) - Answer: Measures activity of thyroid gland 1. hormones: thyroxine (T4), triiodothyronine (T3) 2. when PBI is elevated, BMR is elevated 3. measures energy metabolism; measures level of thyroxine produced 4. not a nutritional assessment parameter Resting Metabolic Rate (RMR) - Answer: Energy expenditure measured under similar conditions to BMR, after a short rest and controlled intake of caffeine and alcohol a. more frequently measured than the BMR; greater than the BMR by 10-20% b. of the predictive equations: Mifflin - St. Joer predicts within 10% of indirect calorimetry (use with normal weight and obese individuals; use ABW for underweight, overweight and obese) Sorbitol - Answer: An alcohol from glucose; absorbed more slowly than glucose by passive diffusion; converted into fructose; excess may cause diarrhea Carbohydrates in order of sweetness - Answer: Fructose, invert sugar, sucrose, glucose, sorbitol, mannitol, galactose, maltose, lactose Amino Acids with Sulfur - Answer: Cysteine, cystine, methionine Essential (indispensable) Amino Acids - Answer: Amino Acids that must be taken in from the diet since our body cannot produce them TV TILL PMH - threonine, valine, tryptophan, isoleucine, leucine, lysine, phenylalanine, methionine, histidine During catabolic stress, these AA are conditionally essential: - Answer: Arginine and glutamine AA that is a precursor for serotonin and niacin - Answer: Tryptophan AA converted to tyrosine - Answer: Phenylalanine AA converted to cysteine - Answer: Methionine Safflower Oil - Answer: Most polyunsaturated Canola Oil - Answer: Most unsaturated Linoleic Acid as an Essential Fatty Acid (Omega-6) - Answer: Absence will create a specific deficiency disease Lack of this essential fatty acid creates eczema, poor growth rate, and petechiae (red, purple skil spots) If this essential fatty acid replaces CHO - a decrease in LDL cholesterol and an increase in HDL cholesterol will be seen Safflower oil is the best source of this essential fatty acid a-Linolenic as an Essential Fatty Acid (Omega-3) - Answer: Serves as a retinol function and brain development; deficiency results in neurological changes - numbness, blurred vision Comes mainly from fish oils (EPA eicosapentaenoic acid, DHA docosahexaenoic acid) walnuts, flaxseed, canola Decreases hepatic production of triglycerides (inhibits VLDL synthesis); little effect on total cholesterol levels Saturated Fats in order of Predominance - Answer: Coconut oil > palm kernel > cocoa butter > butter > palm oil > canola oil Medium-chain triglycerides (MCT) are SFAs between 6 and 12 carbons - they are naturally found in milk fat, coconut oil and palm kernel oil Monounsaturated Fats in order of Predominance - Answer: Olive > canola > peanut > sunflower > coconut (MCT source) Polyunsaturated Fats in order of Predominance - Answer: Safflower > corn > soybean > cottonseed > sunflower > palm kernel What types of fats are in butter in order of predominance? - Answer: SAT > MUFA > PUFA What types of fats are in margarine in order of predominance? - Answer: PUFA > MUFA > SAT Fat-soluble vitamins - Answer: Vitamins A, D, E, K Water-soluble vitamins - Answer: B vitamins (B1: thiamin, B2: riboflavin, B3: niacin, B5: pantothenic acid, B6: pyridoxine, B7: biotin, B9: folate, B12: cyanocobalamin) and vitamin C Vitamin A Properties - Answer: >> Fat-soluble, stored in liver >> Carotene-precursor, provitamin (nutrient changed into vitamin) converted in mucosal cells >> Toxic level: 10,000 IU Vitamin A Functions - Answer: Skin, vision Vitamin A Sources - Answer: >> Yellow, orange fruits >> Dark green leafy vegetables >> Cantaloupe >> Fish >> Liver >> Carrots >> FORTIFIED SKIM MILK >> Apricots >> Sweet potato Vitamin A Deficiencies - Answer: >> Night blindness (nyctalopia), is reversible (detected using dark adaptation test) >> Corneal damage (xeropthalamia), not reversible >> Bitot's spots on conjunctiva >> Dry, scaly skin (hyperkeratosis) Vitamin D Properties - Answer: >> Cholesterol is precursor UV light >> Fat-soluble >> 7 dehydrocholesterol --> D3 cholecalciferol --> D2 Vitamin D Functions - Answer: Calcium and phosphorus metabolism Vitamin D Sources - Answer: >> Sunlight >> Egg yolk >> Fortified milk >> Ergocalciferol Vitamin D Deficiencies - Answer: >> Rickets >> Osteomalacia Vitamin E (Tocopherol) Properties - Answer: >> Fat-soluble >> One of the least toxic vitamins >> UL 1000mgs Vitamin E Functions - Answer: >> Antioxidant >> Resists hemolysis of RBCs Vitamin E Sources - Answer: >> Vegetable oils (cottonseed) >> Whole grains >> Green vegetables >> Almonds Vitamin E Deficiencies - Answer: Hemolytic anemia Vitamin K Properties - Answer: >> Synthesized by bacteria in lower intestinal tract >> No toxicity symptoms >> Fat-soluble Vitamin K Functions - Answer: >> Forms prothrombin in liver: aids blood clotting >> Given pre-surgery >> Calcium metabolism Vitamin K Sources - Answer: >> Spinach >> Kale >> Broccoli >> Green leafy vegetables Vitamin K Deficiencies - Answer: >> Hemorrhage >> Affected by: mineral oil, antibiotics, anticoagulants Vitamin B1 (Thiamin) Properties - Answer: >> Water-soluble >> Lost as temperature of pH rises >> Heat stable in acid Vitamin B1 (Thiamin) Functions - Answer: >> Oxidation of CHO >> An increase in CHO leads to an increased need of this vitamin >> Metabolism of pyruvate Vitamin B1 (Thiamin) Sources - Answer: >> Grains >> Wheat germ >> Pork >> Liver Vitamin B1 (Thiamin) Deficiencies - Answer: >> Beriberi >> Muscle weakness >> Foot drop >> Memory loss >> Tachycardia >> Decreased erythrocyte transketolase >> Increased plasma pyruvate Vitamin B2 (Riboflavin) Properties - Answer: >> Lost in UV light Vitamin B2 (Riboflavin) Functions - Answer: >> Energy release from protein >> Red blood cell production Vitamin B2 (Riboflavin) Sources - Answer: >> Liver >> Kidney >> Meat >> Milk Vitamin B2 (Riboflavin) Deficiencies - Answer: >> Growth failure >> Cheilosis - cracked lips >> Angular stomatitis - mouth corner cracks, sore throat >> Magenta tongue Vitamin B3 (Niacin) Properties - Answer: >> Precursor is tryptophan >> Essential in all cells for energy production and metabolism Vitamin B3 (Niacin) Functions - Answer: >> Metabolism of CHO, protein and fat Vitamin B3 (Niacin) Sources - Answer: >> Protein >> Peanuts >> Ready-to-eat cereals >> Chicken >> Rice >> Yeast >> Milk Vitamin B3 (Niacin) Deficiencies - Answer: >> Pellagra >> Dermatitis >> Diarrhea >> Dementia >> Beefy, bright red tongue >> Symmetrical, pigmented rash in sunlight Vitamin B9 (Folate) Properties - Answer: >> Water-soluble >> Para-aminobenzoic acid (PABA) is precursor >> Zinc-dependent Vitamin B9 (Folate) Functions - Answer: >> DNA synthesis >> Forms RBCs in bone marrow >> Prevents neural tube defects Vitamin B9 (Folate) Sources - Answer: >> Fortified dry cereal >> Liver >> Kidney >> Green leafy vegetables >> Citrus fruits >> Lentils >> Beans Vitamin B9 (Folate) Deficiencies - Answer: >> Megaloblastic macrocytic anemia >> Diarrhea >> Fatigue >> Irritability >> Dyspnea Vitamin B6 (Pyridoxine) Properties - Answer: >> INH (isoniazid antibiotic) acts as an antagonist Vitamin B6 (Pyridoxine) Functions - Answer: >> Coenzyme in AA metabolism: deamination --> transamination >> Increase in protein, increase in this vitamin Vitamin B6 (Pyridoxine) Sources - Answer: >> Meat >> Wheat >> Corn >> Yeast >> Pork >> Liver >> Ready-to-eat cereals Vitamin B6 (Pyridoxine) Deficiencies - Answer: >> Seizures >> Anemia >> Dermatitis >> Glossitis >> Peripheral neuropathy Vitamin B12 (Cyanocobalamin) Properties - Answer: >> Contains cobalt >> Bound by intrinsic factor in gastric juice Vitamin B12 (Cyanocobalamin) Functions - Answer: >> Coenzyme in protein synthesis >> Forms RBCs Vitamin B12 (Cyanocobalamin) Sources - Answer: >> Liver >> Meat >> Milk >> Kidney >> Eggs >> Fish >> Cheese Vitamin B12 (Cyanocobalamin) Deficiencies - Answer: >> Macrocytic megaloblastic anemia >> Pernicious anemia - after gastrectomy or removal of ileum due to the lack of intrinsic factor Vitamin B5 (Pantothenic Acid) Functions - Answer: Coenzyme A - energy synthesis of fatty acids Vitamin B5 (Pantothenic Acid) Sources - Answer: >> Animal foods >> Grains >> Legumes Vitamin B5 (Pantothenic Acid) Deficiencies - Answer: >> Rare deficiency >> Parethesia in feet Vitamin C (Ascorbic Acid) Properties - Answer: >> Most easily destroyed >> Structure like glucose >> Antioxidant >> Needs acid pH >> Destroyed by heat, alkaline pH and oxidation Vitamin C (Ascorbic Acid) Functions - Answer: >> Changes proline into hydroxyproline into collagen which strengthens intercellular substances >> Wound healing >> Aids in iron absorption Vitamin C (Ascorbic Acid) Sources - Answer: >> Citrus fruits >> Potatoes >> Papaya >> Dark green, yellow vegetables Vitamin C (Ascorbic Acid) Deficiencies - Answer: >> Scurvy >> Poor wound healing >> Bleeding gums >> Petechiae Vitamin B7 (Biotin) Properties - Answer: >> Synthesized by intestinal bacteria >> Inactivated by avidin (protein in raw egg white) Vitamin B7 (Biotin) Functions - Answer: >> Coenzyme in fatty acid synthesis >> Converts pyruvate to oxaloacetate in gluconeogenesis Vitamin B7 (Biotin) Sources - Answer: >> Liver >> Kidney >> Egg yolk >> Yeast Vitamin B7 (Biotin) Deficiencies - Answer: >> Muscle pain >> Dermatitis >> Glossitis Myo-Inositol Properties - Answer: >> In plants as phytic acid related to sugar >> Contains phosphorus vitamin-like factor Myo-Inositol Functions - Answer: >> Binds calcium, zinc, iron membrane structure Myo-Inositol Sources - Answer: >> Outer husks of cereal grains >> Leafy green vegetables Calcium Properties - Answer: >> Most abundant mineral >> Regulated by parathyroid hormone >> Vitamin D, acid, lactose aid absorption >> Calcitonin lowers serum calcium by inhibiting bone resorption Calcium Functions - Answer: >> Blood clotting >> Cardiac function >> Nerve transmission >> Smooth muscle contractility Calcium Sources - Answer: >> Dairy products >> Leafy vegetables >> Legumes Calcium Deficiencies - Answer: >> Hypocalcemia leads to tetany Phosphorus Properties - Answer: >> Second most abundant mineral >> Part of DNA, RNA, ATP Phosphorus Functions - Answer: >> Phospholipids transport fat through lymph and blood >> Bone and teeth Phosphorus Sources - Answer: >> Meat >> Milk >> Poultry >> Eggs >> Fish >> Cheese Phosphorus Deficiencies - Answer: Rare Iron Properties - Answer: >> Trace mineral >> Part of hemoglobin >> Food iron: ferric >> Absorbable: ferrous >> Stored: ferritin Iron Function - Answer: Oxygen transport Iron Sources - Answer: Heme Iron >> Animal foods >> Meat >> Fish >> Poultry Non-heme >> Cereals >> Vegetables Poorly absorbed; absorption aided by gastric juice, vitamin C. Calcium helps if oxalates are present Does not aid in absorption >> Egg >> Tea >> Milk >> Cheese Iron Deficiencies - Answer: >> Pale tongue >> Fatigue >> Anemia >> Spoon-shaped nails >> Pale conjunctiva (mucous membranes lining eyelid) Magnesium Properties - Answer: >> Part of chlorophyll >> 50% in bone, 50% in cells Magnesium Function - Answer: >> Protein and fatty acid synthesis >> Stabilizes structure of ATP >> High protein, calcium and vitamin D increases need Magnesium Sources - Answer: >> Most foods >> Milk >> Bread Magesium Deficiencies - Answer: Rare - tremors Zinc Properties - Answer: >> Trace mineral >> Excess leads to copper or iron deficiency Zinc Function - Answer: >> Increases taste acuity >> Enhances insulin action >> Stabilizes DNA, RNA >> Cell division Zinc Sources - Answer: >> Meat >> Liver >> Eggs >> Fish >> Phytates and copper decrease absorption Zinc Deficiencies - Answer: >> Reduced immune function >> Alopecia >> Poor wound healing >> Hypogeusia Iodine Properties - Answer: >> Trace mineral >> Part of thyroxine Iodine Sources - Answer: >> Seafoods >> Iodized salt Iodine Deficiencies - Answer: >> Gioter Fluoride Properties - Answer: >> Trace mineral Fluoride Function - Answer: >> Teeth and bones Fluoride Sources - Answer: >> Soil >> Water Fluoride Deficiencies - Answer: >> Dental caries Copper Properties - Answer: >> Trace mineral >> Attached to protein >> Ceruloplasmin Copper Functions - Answer: >> Hemoglobin synthesis >> Aids iron absorption Copper Sources - Answer: >> Liver >> Kidney >> Shellfish Copper Deficiencies - Answer: Rare >> Microcytic anemia >> Neutropenia >> Wilson's disease - low serum copper, genetic absence of liver enzyme Selenium Properties - Answer: >> Cooperates with vitamin E >> Trace mineral Selenium Function - Answer: >> Antioxidant >> Tissue respiration Selenium Sources - Answer: >> Soil >> Grains >> Meat >> Fish >> Poultry >> Dairy Selenium Deficiencies - Answer: >> Myalgia >> Cardiac myopathy Manganese Properties - Answer: >> Trace mineral Manganese Functions - Answer: >> Central nervous system Manganese Sources - Answer: >> Whole grains >> Legumes >> Nuts Manganese Deficiencies - Answer: >> Unlikely Chromium Properties - Answer: >> Absorption enhanced by vitamin C, niacin >> Ultra-trace mineral Chromium Sources - Answer: >> Yeast >> Oysters >> Potatoes >> Liver Chromium Deficiencies - Answer: >> Insulin resistance Cobalt Properties - Answer: >> Exists with B12 >> Stored in liver Cobalt Functions - Answer: >> Maturation of RBCs Cobalt Deficiencies - Answer: >> Related to B12 deficiency Sulfur Properties - Answer: >> Part of AA cysteine and methionine Sulfer Functions - Answer: >> Component of organic molecules Sulfer Sources - Answer: >> Meat >> Fish >> Eggs >> Poultry Choline Properties - Answer: >> Component of lecithin Choline Functions - Answer: >> Transports lipids as acetylcholine Choline Sources - Answer: >> Fat in eggs >> Milk >> Liver >> Soybeans Formula for mEq to mg - Answer: mEq = (mg/atomic weight) x (valence electrons) Atomic Weight and Valence Electrons of Na+ - Answer: AW: 23; Valence: 1 Atomic Weight and Valence Electrons of K+ - Answer: AW: 39; Valence: 1 Atomic Weight and Valence Electrons of Ca++ - Answer: AW: 40; Valence: 2 Normal Ranges of Serum Sodium - Answer: 136-145 mEq/L Normal Ranges of Serum Potassium - Answer: 3.5-5 mEq/L Normal Ranges of Serum Calcium - Answer: 4.5-5.5 mEq/L Normal Ranges of Serum Magnesium - Answer: 1.5-2.5 mEq/L Normal Ranges of Serum Chloride - Answer: 96-106 mEq/L Normal Ranges of Serum Phosphorus - Answer: 3-4.5 mg/dL Difference between Osmosis and Diffusion - Answer: Osmosis: FLUID moves from LESS to MORE concentrated side of membrane Diffusion: PARTICLES move from MORE to LESS concentrated side of membrane Normal levels of pH - Answer: 7.4 Normal levels of HCO3 - Answer: 24-28 Normal levels of pCO2 - Answer: 35-45 Weight Gain Guidelines for Normal Weight Pregnancy - Answer: 25-35 lbs with a BMI of 18.5-24.9 Weight Gain Guidelines for Underweight Pregnancy - Answer: 28-40 lbs with a BMI of <18.5 Weight Gain Guidelines for Overweight Pregnancy - Answer: 15-25 lbs with a BMI of 25-29.9 Weight Gain Guidelines for Obese Pregnancy - Answer: 11-20 lbs with a BMI of >/= 30 Normal Weight Gain During First 3 Months of Pregnancy - Answer: 1lb/month; 1lb per week thereafter What Makes a Woman at Risk During Pregnancy? - Answer: >> Failure to gain 4 lbs (1.8kg/month) in last half of pregnancy >> <16 or >/=35 years of age >> <12 months between pregnancies >> Pregnant adolescent - high risk - needs extra iron, calcium, zinc Normal Birth Weight - Answer: g Low Birth Weight - Answer: Less than 5.5 pounds or 2500g Very Low Birth Weight - Answer: Less than 3.3 lbs or 1500g Extra Low Birth Weight - Answer: Less than 1000g Calories for 0-6 Months Old - Answer: 520F; 570M Calories for 7-12 Months Old - Answer: 676F; 743M Human Milk vs. Cow's Milk - Answer: Lower in protein; Higher in CHO and fat Weight for Length/Stature - Answer: (Birth - 24 months, young children 2-5) >> identifies under/over nutrition, or within normal limits >> detects short term changes in nutritional status >> used to distinguish between stunting and wasting >> <5th may reflect acute illness or wasting; >95th may reflect over-nutrition Stature/Length for Age - Answer: (0-24 months recumbent length, 2-20 years height) >> defines shortness/tallness >> reflects long term nutritional status; determines extent of stunting >> affected by long term nutritional stress or chronic illness >> <5th short stature Weight for Age - Answer: (Birth-24 month and 2-20 years) >> NOT used to classify under/over weight >> short term marker of growth; affected by acute nutritional stress or illness >> CANNOT distinguish between stunting and wasting because it does not include height >> Further evaluation needed if below 5th or above the 95th percentile BMI for Age Percentiles - Answer: Starting at age 2 and is age and sex specific >> Underweight <5th >> Healthy weight 5th-84th >> Overweight 85th-94th >> Obese greater than or equal to 95th or BMI greater than 30 Protein Needs for Adults - Answer: Greater than or equal to 19 year old males: 56 grams Greater than or equal to 19 year old females: 46 grams Effects of Insulin on Blood Glucose Levels - Answer: Decreases blood sugar >> Released by BETA cells of pancreas - increases cell permeability to glucose; fosters glycogenesis (creation of glycogen) and lipogenesis (creation of adipose tissue) Effects of Glucagon on Blood Glucose Levels - Answer: Increases blood sugar >> Released by ALPHA cells of pancreas - induces glycogenolysis (breakdown of glycogen to glucose) Effects of Glucocorticoids on Blood Glucose Levels - Answer: Increases blood sugar >> Induces gluconeogenesis which requires pyridoxine (breakdown of protein to glucose) Effects of Epinephrine on Blood Glucose Levels - Answer: Increases blood sugar >> Released by the adrenal medulla >> Stimulates sympathetic nervous system >> Stimulates liver and muscle glycogenolysis (glycogen --> glucose) >> Decreases release of insulin from pancreas during catabolic stress; blood glucose rises Effects of Growth Hormone, ACTH (adrenocorticotropic) on Blood Glucose Levels - Answer: Acts as an insulin antagonist; Increases blood sugar End Products of Metabolism - Answer: Energy (ATP), CO2 and water Glycolysis - Answer: Occurs in cytoplasm - purpose is to produce pyruvate for the Kreb's cycle by breaking down glucose, with or without oxygen, into pyruvate or lactate >> Aerobic glycolysis - end product is pyruvate >> Anaerobic glycolysis - end product is lactate Step 1 of Glycolysis - Answer: Glucose enters the cell aided by insulin; combines with phosphorus in presence of magnesium to form glucose-6-phosphate; proceeds to pyruvate Glucose --> Glucose-6-phosphate --> Pyruvate Step 2 of Glycolysis - Answer: Glucose-6-phosphate may lead to synthesis of glycogen >> liver glycogen releases glucose to blood to maintain normal blood glucose levels; process requires glucose-6-phosphatase. Muscle cells do NOT have this enzyme (muscle glycogen is only used by that muscle) Step 3 of Glycolysis - Answer: Glucose-6-phosphate also proceeds through the pentose shunt (side-channeling of glucose) >> This does not require ATP >> Ribose (part of RNA) is produced >> NADPH is also produced which is essential for the synthesis of fatty acids (NADPH has niacin) Step 4 of Glycolysis - Answer: Pyruvic acid can proceed to form lactic acid, used for muscle contractions when energy needs exceed supply of oxygen (oxygen debt) >> Only a small amount of lactic acid is produced >> Cori cycle: lactate is released from tissue, transported to liver, and converted back to pyruvate Step 5 of Glycolysis - Answer: Most of pyruvic acid is converted to form acetyl CoA (active acetate). Pyruvate is the MAIN substrate for energy production within Kreb's cycle. >> Required: thiamin (TDP), niacin (NAD), riboflavin (FAD), pantothenic acid (CoA), magnesium, lipoic acid TCA cycle - Answer: Tricarboxylic acid cycle, Kreb's cycle, citric acid cycle (occurs in mitochondria) Step 1 of TCA Cycle - Answer: Acetyl CoA comes from pyruvic acid (CHO), oxidation of fatty acids, and degradation of carbon skeleton of certain AAs. Acetyl CoA is the intermediate breakdown products of CHO, protein and fat. Fatty acids enter as a two carbon fragment. Step 2 of TCA Cycle - Answer: Cycle produces 90% of body's energy as ATP; (also CO2, water) Step 3 of TCA Cycle - Answer: CHO is the fuel needed to keep the cycle going. Oxaloacetetic acid is the main CHO fuel and is formed from pyruvic acid and some AAs. It reacts with acetyl CoA to form citric acid which starts the cycle. If there is not enough oxaloacetic acid coming in from CHO to maintain the cycle efficiently, acetyl CoA coming in from fat cannot be handled properly and is diverted to form ketone bodies. Step 4 of TCA Cycle - Answer: Alpha ketoglutaric acid (from AAs through gluconeogenesis) needs thiamin for decarboxylation How much ATP does a full oxidation of 1 molecule of glucose yield? - Answer: 38 ATP Branched Chain AAs - Answer: Valine, leucine, isoleucine NPU (Net Protein Utilization) - Answer: Measures the amount of protein actually used >> N intake - N output (nitrogen retained)/ N intake Vitamin A Absorption Aids - Answer: >> Bile salts >> Pancreatic lipase >> Fat Vitamin D Absorption Aids - Answer: >> Hydroxylated in liver, then in kidney; needs bile salts, acidity of chime >> Accompanies Ca and P absorption Riboflavin Absorption Aids - Answer: >> Phosphorus Vitamin B12 Absorption Aids - Answer: >> Ileum, stomach secretions (HCL, intrinsic factor) Iron Absorption Aids - Answer: >> HCL >> Calcium (binds oxaloacetate) Folate Absorption Aids - Answer: >> Zinc dependent, cleaves polyglutamate to monoglutamate >> Folic acid in fortified foods and supplements is present as monoglutamate SGA (Subjective Global Assessment) - Answer: (History, intake, GI symptoms, functional capacity, physical appearance, edema, weight change) MNA (Mini Nutritional Assessment) - Answer: (Evaluates independence, medications, number of full meals consumed each day, protein intake, fruits and vegetables, fluid, mode of feeding); 65 years of age and older NSI (Nutrition Screening Initiative) - Answer: (Elderly nutrition and improved nutritional care) DETERMINE: basic checklist - identifies factors placing people at nutritional risk LEVEL I: screen those who need more comprehensive analysis LEVEL 2 screen used w/ potentially greater medical or nutritional problems - RDN involved GNRI (Geriatric Nutritional Risk Index) - Answer: (Serum albumin, weight changes) MST (Malnutrition Screening Tool) - Answer: (Acute hospitalized adult population) recent weight loss, recent poor dietary intake NRS (Nutrition Risk Screening) - Answer: (Medical-surgical hospitalized) % weight loss, BMI, intake, >70 years MUST (Malnutrition Universal Screening Tool) - Answer: (BMI, unintentional weight loss, effect of acute disease on intake for more than 5 days) Hamwi Formula - Answer: Estimates desirable body weight Women: 100lbs for first 5' + 5lbs for each additional " Men: 106lbs for first 5' + 6lbs for each additional " ** For small frames (-10%); for large frames (+10%) Amputations: entire leg 16% of body weight, lower leg with foot 6%, entire arm 5%, forearm with hand 2.3% >> Adjusted IBW = (100 - % amputation)/100 x IBW for original height Spinal cord injury: quadriplegic reduce by 10-15% of table weight; paraplegic reduce by 5-10% of table weight % Weight Change - Answer: Stresses significance of weight change; assess nutritional risk Usual weight - actual (current) weight/usual weight x 100 Significant weight loss: 10% loss within 6 months Assessment of Energy Requirements: Based on Activity Factors and BEE - Answer: BEE x 1.2 - sedentary BEE x 1.3 - active BEE x 1.5 - stressed Megestrol Acetate - Answer: Appetite stimulant Dextroamphetamine (Adderall) - Answer: Appetite suppressant, anorexia, nausea, weight loss Orlistat - Answer: Decreases fat absorption by binding lipase; vitamin/mineral supplement Marinol - Answer: Appetite stimulant Oral Contraceptives - Answer: Decrease folate, B6, C Loop Diuretics - Answer: Deplete thiamin, potassium, magnesium, calcium, sodium, and chloride Thiazide Diuretics - Answer: Decrease potassium and magnesium, enhance renal absorption of calcium Methotrexate (Chemotherapeutic Agent) - Answer: Decreases folate Lithium Carbonate (Antidepressant) - Answer: Increases appetite, weight gain; Maintain consistent sodium and caffeine intake to stabilize levels. If sodium or caffeine are restricted, lithium excretion decreases, leading to toxicity. Lithium and sodium are absorbed at the same sites in the kidneys; Low sodium intakes will lead to the retention of lithium. >> 2gm sodium diets may be too low for individuals on this medication Anticoagulants (Warfarin Sodium) - Answer: Antagonizes vitamin K (consistent intake is essential); avoid Ginkgo biloba extract (GBE), garlic, ginger (may increase bleeding); avoid high dose vitamin A, E Propofol - Answer: Administered in oil, consider fat calories, 1.1 cals/cc, check TG >> Important for tube feedings! Cyclosporine (Immunosuppressant) - Answer: Hyperlipidemia, hyperglycemia, hyperkalemia, hypertension Isoniazid (Treats TB) - Answer: Depletes pyridoxine, peripheral neuropathy, don't take with food, interferes with vitamin D, calcium, phosphorus >> Calcium supplements are needed with this medication Elavil (antidepressant) - Answer: Leads to weight gain Vitamin B6 and Protein - Answer: Decrease effectiveness of L-dopa (levodopa) which controls symptoms of Parkinson's disease >> Take this drug in the morning with limited protein (as protein competes with drug for absorption sites) Tyramine - Answer: Hypertension if taken with MAOI (monoamine oxidase inhibitor) >> Restrict aged and fermented foods -- Avoid hard, aged cheese (cheddar, swiss), sauerkraut, some sausages, luncheon meats, tofu, miso, chianti wine. Limit sour cream, yogurt, buttermilk >> Buy, cook and eat fresh foods Health Risk Appraisal HRA - Answer: Survey categorizing a population's general health status (used in worksites, government agencies as a health education or screening tool) Incidence vs. Prevalence - Answer: Incidence: (number of new cases of a disease over a period of time/total number of people at risk) x 100,000 Prevalence: (total number of people with a disease during a period of time/average number of people) x 100,000 PPFPs - Prepared and Perishable Food Programs - Answer: nonprofit programs that link sources of unused, cooked and fresh foods with social service agencies that serve the hungry Nutrition Surveys - Answer: Examination of a population group at a particular point of time; cross-sectional exam that determines prevalence of condition or characteristics at a specific time Nutritional Surveillance - Answer: A continuous collection of data that identifies problems, sets baseline, sets priorities, detects changes in trends and uses height, weight, hematocrit, hemoglobin and serum cholesterol to measure Nutrition Screening Initiative (NSI) - Answer: Promote nutrition and improve nutritional care for the elderly to identify nutritional problems early >> DETERMINE checklist - identifies factors placing people at nutritional risk - increases awareness of factors that influence nutritional health - disease, tooth loss, economic hardship, reduced social contact, multiple medications, involuntary weight loss/gain, needs assistance in self-care, elder years above age 80 >> LEVEL I screen identifies those who need more comprehensive assessments >> LEVEL II screen provides more specific diagnostic info on nutritional status (RDNs most involved in level II) NNMRRP (National Nutrition Monitoring and Related Research Program) - Answer: Includes all data collection and analysis activities of the federal government related to measuring the health and nutritional status, food consumption, attitudes about diet and health >> Jointly run by USDHHS and USDA PedNSS (Pediatric Nutrition Surveillance System) - Answer: Run by USDHHS Low income, high risk children, birth - 17 years, emphasis on birth - 5 years Height, weight, birth-weight, hematocrit, hemoglobin, cholesterol, breast-feeding Monitors growth and nutritional status, infant-feeding practices PNSS (Pregnancy Nutrition Surveillance System) - Answer: Run by USDHHS Low income, high risk pregnant women Maternal weight gain, anemia, pregnancy behavioral risk-factors (smoking, alcohol), birth-weight, COUNTS # OF WOMEN WHO BREAST FEED Identify and reduce pregnancy-related health risks NHANES (National Health and Nutrition Examination Survey) - Answer: >> Ongoing (repeated) survey to obtain info on health of American people >> Evaluated clinical, chemical (hemoglobin, hematocrit, cholesterol), anthropometric, nutritional data (24 hour recall, food frequency lists) NHANES III - Answer: Oversampling of adults greater than or equal to 65 with NO upper age limit WWEIA- What We Eat In America - Answer: Dietary component of NHANES - aka NFNS National Food and Nutrition Survey >> Two days of 24 hour dietary recall data with times of eating occasions and sources of foods eaten away from home >> USDA conducts over-sampling of adults greater than or equal to 60, African Americans, Hispanics USDA Nationwide Food Consumption Surveys (NFCS) - Answer: >> To obtain info on food intake >> Evaluates: protein, calcium, iron, thiamin, riboflavin, vitamins C, A >> Diets rated good if intakes equaled or surpassed RDA; rated poor if less than 2/3 of RDA for 1 or more nutrients BRFSS (Behavioral Risk Factor Surveillance System) - Answer: Adults 18+ telephonic nutrition assessment by HHS >> Telephone interviews collect info on height, weight, smoking, alcohol use, food frequency for fat, fruits, and vegetables, preventable health problems, diabetes YRBSS (Youth Risk Behavior Surveillance System) - Answer: >> Grades 9-12 >> Assesses smoking, alcohol use, weight control, exercise, eating habits >> Prevalence of health risk behaviors among young people BRFSS and YRBSS - Answer: Both can monitor changes in health risk behaviors over time and can better target health promotion efforts to populations most at risk Health and Diet Survey - Answer: FDA + HHS >> Telephone survey of randomly selected adults >> Tracks self perception or relative nutrient intake levels, use of food labels, knowledge of fats and cholesterol, prevalence of supplement use, awareness of diet and disease (high blood pressure and sodium intake) TANF (Temporary Assistance for Needy Families) - Answer: States determine the eligibility of needy families and the benefits and services those families will receive >> Helps needy families achieve self-sufficiency, time-limited, helps foster economic security and stability USDA Commodity Food Donation/Distribution Program - Answer: >> Provides food to help meet nutrient needs of children & adults >> Strengthens agricultural market for American farmers' products >> Food is given to elderly feeding, NSLP, and other supplemental food programs. >> Includes CSFP and TEFAP CSFP Commodity Supplemental Food Program - Answer: >> Administered by state health agencies >> Monthly commodity canned or packaged foods >> Improves health of low income elderly at least 60 years of age >> States may require that participants be at nutritional risk TEFAP The Emergency Food Assistance Program - Answer: >> Quarterly distributions of commodity foods by local, public or private nonprofit agencies, food banks, soup kitchens, homeless shelters >> Supplements diets of low income households for short term hunger relief NSLP (National School Lunch Program) - Answer: USDA Food and Nutrition Service (FNS) >> Entitlement program to improve nutrition of children, especially from low income families; utilizes surplus production of foods >> Cash grants and food donations; dollars reimburse schools on basis of numbers of meals served >> Implement the Dietary Guideline into the Lunch and Breakfast Programs >> Lunch must provide on average over each school week 1/3 of the recommended intake for protein, vitamins A and C, iron, calcium NSBP National School Breakfast Program - Answer: >> Entitlement program, meals must meet federal Dietary Guidelines >> Breakfast must provide on average over each school week: 1/4 daily recommended levels for protein, calcium, iron, vitamin A, vitamin C ASP Afterschool Snack Programs - Answer: >> Run by the USDA >> Provides healthy snacks >> Cash subsidies for each snack served, same eligibility as NSLP SMP Special Milk Program - Answer: >> Run by the USDA >> Provides milk to children in schools and childcare institutions who do not participate in other Federal meal service programs >> Reimburses schools for milk served SFSP (Summer Food Service Program) - Answer: >> USDA School Lunch >> Entitlement program, purpose is to initiate, maintain or expand foodservice programs to children when schools is not in session >> Reimburses providers for meals served at a central site, 18 and younger >> Administered by FNS, state educational agencies, public or private nonprofit residential summer camps CACFP (Child and Adult Care Food Program) - Answer: >> Run by the USDA >> Supports public and non-profit food service programs for family day care centers, neighborhood houses, homeless shelters, nonresidential adult daycare centers >> Reimburses operators for meal costs, provides commodity foods and nutrition education materials >> Meals must meet guidelines; must offer free or reduced-price to eligible >> Eligibility standards same as NSLP FFVP (Fresh Fruit and Vegetable Program) - Answer: >> Introduces children to fresh fruits and vegetables; helps to develop eating habits that improve health, prevent obesity and subsequent chronic disease >> Free to children at eligible elementary schools who operate the NSLP WIC Special Supplemental Nutrition Program for Women, Infants and Children - Answer: >> Run by the USDA >> For pregnant, postpartum, breast-feeding women; infants and children up to 5 >> Provides food for low income mothers at nutritional risk (abnormal weight gain, history of high risk, LBW, underweight, overweight, anemia) >> Risk: weight, height, head circumference in infants, hemoglobin, hematocrit >> Provides food, nutrition education, referrals to other agencies >> Health exam is required >> Must meet income standards, be at nutritional risk, and in need of foods offered >> Foods provided include: iron-fortified formula, cereal, milk, cheese, fruit juice >> NOT an entitlement program: cap on the amount of federal dollars allocated >> Priorities: pregnant and breast-feeding women, infants up to 1 year >> WIC FMNP Farmers' Market Nutrition Program: coupons to purchase fresh, locally grown foods at farmers' markets >> EBT - electronic benefits transfer card EFNEP (Expanded Food and Nutrition Education Program) - Answer: >> Run by the USDA >> Provides grants to universities that asses in community development >> Trains nutrition aides to educate the public >> Improves food practices of low income homemakers with young children >> Works with small groups; teaches skills needed to obtain a healthy diet (how to budget, meal planning, shop, cook) >> Does not provide food Maternal and Child Health Block Grant - Answer: >> Run by USDHHS >> Under Title V of the Social Security Act >> Fosters public health nutrition programs at the state and local levels >> Provides training, consultation, funding >> Women of child-bearing age, infants, children; state eligibility requirements Healthy Start - Answer: >> Run by USDHHS >> Reduces infant mortality and improves health of low income women, infants, children and families NSIP Nutrition Services Incentive Program - Answer: >> Run by AoA; Administration on Aging >> Developed services to foster independent living; cash and commodities to state agencies >> OAA - Older Americans Act Nutrition Program (formeraly ENP Elderly Nutrition Program) run by the USDHHS Title III - provides 1 hot meal each day, 5 days/week, provides 1/3 recommended intake - eligibility: all aged 60 and older plus spouse, regardless of income - Congregate Meals - ambulatory; transportation essential for rural elderly - Home delivered meals - Meals on Wheels - must be homebound - Counseling, nutrition education, referrals, social interaction SNAP (Supplemental Nutrition Assistance Program) - Answer: >> Run by the USDA >> Largest food assistance program: entitlement >> Assists low income with monthly benefits; net income must be at or below certain % poverty level; income limits vary by household size and are adjusted to the cost of living. Nutritional risk is not a consideration >> Designed to increase their purchasing power; not for non-food items >> figures are adjusted to reflect cost of food in Thrifty Food Plan or June of preceding year - least costly of USDA four food plans >> SNAP nutrition education program: provided to program participants >> EBT - electronic benefits transfer card CMS (Centers for Medicare and Medicaid Services) - Answer: >> Run by USDHHS >> Medicare - health insurance program for people over 65; of any age with end stage renal disease; employers and employees pay - Part A: hospital insurance - Part B: optional insurance for supplementary benefits >> Medicaid - federal law administered by states - Payment for medical care for all eligible needy: all ages, blind, disabled, dependent children Wellness Visit AWV - Answer: >> Provided by ACA (Affordable Care Act) to Medicare beneficiaries >> RDs are listed as an eligible medical professional who may screen and counsel Medicare beneficiaries IBT Intensive Behavioral Therapy - Answer: >> Benefit for obese in Medicare Part B >> Coverage is granted only in primary care setting, BMI must be >30, continued treatment contingent on weight loss assessed at the seventh month of treatment. Can only be provided by a physician CHIP (Children's Health Insurance Program) - Answer: >> Under Social Security Act, partnership between federal and state governments >> Expands health coverage to uninsured children whose families earn too much income to qualify for Medicaid but too little to afford private coverage Headstart - Answer: >> Run by USDHHS >> Helps low income children; ages 3-5 >> Introduces new foods, teaches good food habits >> Child's participation in food activities is important NETP Nutrition Education Training Program - Answer: >> Run by the USDA >> Amendment to School Lunch Act >> Provides nutrition education training to teachers and school foodservice personnel SFMNP Senior Farmers Market Nutrition Program - Answer: >> Run by the USDA >> Cash grants to states to provide low income seniors (greater than or equal to 60 years) with coupons to be exchanged for eligible foods at farmers' markets, roadside stands, community supported agriculture programs (CSA) >> Fresh, nutritious, unprepared fruits, vegetables, herbs and honey >> May be limited to specific and locally grown foods >> Nutrition education and information is provided (how to select, store, prepare) Primary Prevention Programs - Answer: Reduced exposure to a promoter of disease (early screening for risk factors like diabetes) HEALTH PROMOTION Secondary Prevention Programs - Answer: Recruiting those with elevated risk factors into treatment program (setting up an employee's gym) RISK REDUCTION Tertiary Prevention Programs - Answer: As disease progresses, intervention to reduce severity, manage complications REHABILITATION EFFORTS GI Disorders: Ulcers - Answer: >> Diet: as tolerated, well-balanced, avoid late night snacks >> Omit: cayenne and black pepper, large amounts of chili powder, avoid excess caffeine and alcohol GI Disorders: Hiatal Hernia - Answer: >> Diet: small, bland feedings >> Omit: avoid late night snacks, caffeine, chili powder, black pepper GI Disorders: Dumping Syndrome - Answer: Occurs when holding capacity of the stomach decreases so food is dumped into the intestines >> Follows a gastrectomy (Billroth I, II) >> When rapidly hydrolyzed CHO enters the jejunum, water is drawn in to achieve osmotic balance causing a decrease in blood pressure, rapid CHO digestion and absorption resulting in an elevated blood sugar and then reactive hypoglycemia >> Results in anemia from either B12 or Folate deficiencies >> Treatment: frequent small, dry feedings, fluids before or after meals (to slow passage), restrict hypertonic concentrated sweets, give 50-60% complex CHO, protein at each meal, moderate fat, B12 injections may be needed. Lactose may be poorly tolerated due to rapid transport Gastric Surgery (Billroth I - Gastroduodenostomy) - Answer: Attaches the remaining stomach to the duodenum and can result in dumping syndrome Gastric Surgery (Billroth II - Gastrojejunostomy) - Answer: Attaches the remaining stomach to the jejunum. When food bypasses the duodenum, the secretion of secretin and pancreozymin by the duodenum is reduced (these hormones normally stimulate the pancreas, so there is now little pancreatic secretion >> Calcium (most rapid absorption in duodenum) and iron absorption (requires acid) are adversely affected - steatorrhea (fatty stool) as a side effect Anemia (B12 and Folate Deficiencies) - Answer: B12 - lack of intrinsic factor and bacterial overgrowth in loop of intestine being bypassed interfere with B12 absorption (pernicious anemia diagnosed using the Schilling test) Folate - needs B12 absorption for transport inside the cell; also from poor folate intake and low serum iron (cofactor in folate metabolism) GI Disorders: Gastroparesis - Answer: Delayed gastric emptying usually due to surgery, diabetes, viral infections, obstructions Results in moderate to severe h