CHP5 Nutrition
1. Please give examples of red meat, white meat and lean meat.
- Red meat: beef, lamb.
- White meat: chicken, turkey.
- Lean meat: ostrich, venison.
2. What is lean body weight and how does it differ from routine measurement?
Lean body mass includes the weight of all the following elements:
- Organs
- Skin
- Bones
- Body Water
- Muscle Mass
Lean body mass is calculated as the difference between total body weight and body fat weight, or more simply, the weight of everything except the fat. The range of lean body mass considered to be healthy is around 70% - 90% with women being towards the lower end of the range and men higher.
3. Why does vitamin B12 deficiency cause glossitis?
Parietal cells secrete intrinsic factor which is required for the absorption of vitamin B12. Vitamin B12 deficiency results in megaloblastic anemia and may present as glossitis. The appearance of the tongue in vitamin B12 deficiency is described as "beefy" or "fiery red and sore".
4. Is a dosage of 2.5 mg/day of methyltestosterone, as a component in some multivitamin formulae, safe in the long-term?
Yes.
5. What is the effect of sodium/potassium imbalance on the microminerals?
There are no evidence of sodium/potassium imbalance affecting microminerals. Microminerals include iron, zinc, copper, iodine, fluoride, chromium, cobalt, selenium, manganese, and molybdenum.
6. What is the role of fluoride in healing?
- It inhibits acid demineralization by reversing the flow of calcium and fluoride back into enamel from solution
- It promotes enamel remineralization as the flow of calcium and phosphate are redeposited into enamel = remineralization
- It is incorporated into the enamel making hydroxyapatite into fluorohydroxyapatite which is more acid resistant
- In large acid attacks, it is taken into plaque bacteria and inhibits their ability to metabolize sugar to make acid
7. ‘Do not drink [alcohol] during the daytime’. Please explain why this is not recommended.
‘Do not drink during the daytime’ is good advice in that it shortens the time available to drink and helps drinkers keep their consumption low. It is particularly useful advice to those who work in the wine and spirit trade.
8. What is the aetiology of ‘refeeding syndrome’?
The ‘refeeding syndrome’ occurs after feeding has restarted in severely malnourished patients. The features are:
- Fluid overload leading to heart failure sometimes producing acute pulmonary oedema. Sodium and water reabsorption in the kidney is increased by insulin, and the low serum albumin also contributes to the fluid overload.
- Hypokalaemia, hypomagnesaemia and hypophosphataemia occur as insulin stimulates cellular uptake of these ions.
- Cardiac arrhythmias are also prominent.
9. What is the Atkin’s diet?
The Atkins’ diet is a low-carbohydrate diet used to promote weight loss. The principle is that the body will switch from burning glucose to burning fat. Atkins did (in addition to the diet) recommend exercise and nutritional supplements. However, like all diets, although there might be short-term gains, permanent weight loss is rare and patients should be encouraged to maintain the recommended healthy intake of food (Table 5.1). In the long-term, the diet may increase the development of atherosclerosis.
10. What is meant by bariatric surgical procedures?
Bariatric surgery is a collective name for weight-loss surgery procedures that can help morbidly obese patients lose weight by making changes to their digestive system. These changes are often permanent, requiring commitment to life-long changes and adjustments to one's lifestyle.
Stomach operations include:
- Gastric banding: a band is placed laparoscopically around the upper part of the stomach (lap-banding), creating a small pouch and a narrow passage into the stomach.
- Roux-en-Y gastric bypass.
11. In a patient with marked obesity, is bariatric surgery better than a balloon inserted into the stomach?
There are no comparative data as they are two different treatments. Balloon insertion into the stomach is used for 6 months only to help obese patients lose weight. Bariatric surgery is used on morbid obese patients when all medical therapy has failed.
12. Does intravenous nutrition always have to be given via a central vein?
It is usual to give parenteral nutrition via a central catheter but there are specially formulated mixtures for use via a peripheral line. Peripheral parenteral nutrition is useful initially, as the catheter only lasts 5 days.
13. Why has there been an explosion of obesity in the young?
There is no single lifestyle factor. There appear to be number of causes, including taking less exercise, watching television and playing computer games, as well as an increase in food intake, particularly of fatty, sugary foods that are very rich in calories. The different degrees of overweight are shown in Table 5.2.
14. Are proteins mostly absorbed from the intestinal lumen into the blood as amino acids?
No, unlike carbohydrates, which are hydrolysed to monosaccharides and then absorbed, proteins are broken down to small peptides and only some amino acids prior to absorption.
15. What are ‘congeners’ in alcohol?
Congeners are biologically active chemicals (chemicals which exert an effect on the body or brain) and are often contained in alcoholic beverages, in addition to ethanol, the key biologically active ingredient of alcohol.
16. Cholesterol is synthesized in the body. What is the comparative role of diet and endogenous production in the level of serum cholesterol?
Cholesterol is synthesized in the body, mainly in the liver. The higher the amount of cholesterol in the diet, the lower the amount of cholesterol synthesized, and vice versa. Thus, it is difficult to significantly lower serum cholesterol by diet alone unless the diet is very restrictive. Familial hypercholesterolaemia is related to a reduction in the number of low-density lipoprotein (LDL) receptors.
17. We frequently read of the severe but ‘rare’ side-effect of myositis with statins. Do these drugs have more ‘common’ side-effects?
Gastrointestinal side-effects, including abdominal pain, flatulence, constipation, diarrhoea, nausea and vomiting, occur frequently but are often tolerated without complaint.
18. Is there a relationship between brain disease and alcohol intake? Does alcohol have a proven toxic effect on the brain?
Yes, alcohol has a toxic effect on the brain. It blocks chemical signals between brain cells (called neurons), leading to the common immediate symptoms of intoxication, including impulsive behavior, slurred speech, poor memory, and slowed reflexes. Wernicke–Korsakoff syndrome due to thiamine deficiency is seen in chronic abusers, as are epilepsy and dementia.
19. What is the difference between malabsorption and malnutrition and how can these be differentiated clinically?
Malabsorption is the term used to describe a failure of absorption of nutrients. Malnutrition is weight loss which, when severe, has a high mortality. It is usually due to poor dietary intake (e.g. in sub-Saharan Africa) or secondary to malignant disease in the West. Malabsorption, if severe, can lead to malnutrition but this is now relatively rare. In a patient with malnutrition, malabsorption must be excluded, usually on the patient’s history.
20. What are the health hazards of eating smoked foods such as meat or fish?
Smoked food as used by most probably has no health risk. The high incidence of gastrointestinal cancers in some countries, e.g. Japan, has been attributed to an excess consumption of smoked fish. This is because combusting wood, gas, or charcoal emits chemicals known as polycyclic aromatic hydrocarbons. Exposure to these so-called PAHs is known to cause skin, liver, stomach, and several other types of cancer in lab animals.
Besides, smoked food has a high sodium content because making it often involves salt brines, salt-curing and the addition of rubs. This salt increases the amount of sodium you ingest. Sodium is both a mineral and an electrolyte, and is essential for the water balance in your body. However, high levels of sodium in the blood are associated with high blood pressure, over hydration and cardiovascular disease. It can also cause problems if a patient already have kidney or heart disease, and people with these conditions should avoid smoked meats.
21. What are the benefits of royal jelly (from bees)?
1. Contains a Variety of Nutrients
Royal jelly is comprised of water, carbs, protein and fat. The full chemical makeup of royal jelly is unknown, but its positive effects on health are thought to stem from its unique proteins and fatty acids. These include nine glycoproteins collectively known as major royal jelly proteins (MRJPs) and two fatty acids, trans-10-Hydroxy-2-decenoic acid and 10-Hydroxydecanoic acid. Royal jelly also contains several B vitamins and trace minerals.
Some of the vitamins typically present in royal jelly include:
- Thiamine (B1)
- Riboflavin (B2)
- Pantothenic acid (B5)
- Pyridoxine (B6)
- Niacin (B3)
- Folic acid (B9)
- Inositol (B8)
- Biotin (B7)
- A few studies show increased lifespan and improved cognitive performance in rats treated orally with royal jelly.
- Royal jelly is sometimes included in topical skin care products to support maintenance of healthy, younger-looking skin.
- Animal research indicates that royal jelly may support increased collagen production and protection from skin damage associated with UV radiation exposure
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