Exam

please check registrar’s final version of the exam schedule

180 minutes

120 multiple choice questions-120 points-4 short answer question-60 points

multiple choice-lecture 7a-12c inclusiveshort answer-whole term

NoteNutrition 2106-Fall 2014- Principles of Nutrition in Metabolism

Nutrition 2101-Nutritional Assessment-Theory-Fall 2014

Nutrition 2107- Introduction to Sports Nutrition-Winter 2015

Nutrition care plan/essay

Due on time please-if problems please ensure I know in advance

Lecture 11a 24 MARCH 2014 Arthritis and Dermatitis

Osteoarthritis (OA) 

-involves swelling of the joints 

-overweight – causes wear of cartilaginous surfaces

 -such wear results in loss of chondroitin

sulphate and glucosamine which are carbohydrate polymers

Rheumatoid arthritis (RA) -autoimmune attack that in part involves loss of chondroitin sulphate and glucosamine

Nutrition approaches to Arthritis 

-appropriate nutrition and exercise may prevent weight gain thus avoiding that cause of osteoarthritis 

Nutrition approaches to Arthritisnutraceuticals

-chondroitin sulphate 

-glucosamine 

-both of these nutraceuticals are meant to replace lost chondroitin sulphate and glucosamine

                                             -both readily available over the

counter (OTC) and are useless

Nutrition approaches to ArthritisNutraceuticals

-fish oils reduce arachidonic derived pro-inflammatory eicosanoids while producing anti-inflammatory eicosanoids in RA but not OA  -evening primrose oil, blackcurrant oil, and borage oil reduce arachidonic derived pro-inflammatory eicosanoids while producing anti-inflammatory eicosanoids in RA but not OA -review pathways involved for nutraceutical oils

Class activity-what is the best nutritional approach to arthritis? Why?

Dermatitis 

Atopic (eczema) 

-skin inflammation that is due to an immune response

 -can be due to a food allergy

 -solution -avoid food allergen

Dermatitis-nutraceutical

-fish oils reduce arachidonic derived pro-inflammatory eicosanoids while producing anti-inflammatory eicosanoids   -evening primrose oil and borage oil reduce arachidonic derived pro-inflammatory eicosanoids while producing anti-inflammatory eicosanoids   -as with RA many of these trials include subjects that are on anti-inflammatory prescribed drugs- what is the impact of this?

Dermatitis

Sebborheic (scaly)

-can be due to biotin deficiency 

solution: avoid biotin deficiency 

- can be due to riboflavin deficiency 

solution: avoid riboflavin deficiency

 

Scaling eczema-like dermatitis  

-can be due to linoleic or -linolenic acid deficiency

-this may be a problem with long term TPN

 

Nutritional remedy for dermatitis (types above) in general 

-topical application of retinoids (similar in structure to vitamin A)

 -reduces dermatitis

 -avoid linoleic or -linolenic acid deficiency

Dermatitis herpetiformis  -causes skin lesions pruritic-itching 

vesicular-vesicles 

papular-solid elevation of the skin   - all of these lesions are consistent with

coeliac disease and are relieved by a gluten-free diet

Lecture 11b

24 MARCH 2014 Colitis, Migraine and Respiratory

Colitis

Inflammation of the colon

Diarrhea is an issue since the inflamed colon is incapable of its normal water management function- i.e. removing water from the faeces

Complete bowel rest helps

Ulcerative colitisTreatment Complete resection (removal) of colon

No nutritional implications but may be diarrhea initially

This diarrhea is transient and apparently self-correcting

Evening primrose oil may have some limited success for this type of colitis in terms ofstool consistency but this contradicts self-correcting diarrhea

Diversion colitis

Surgical diversion process by which the distal colon is left intact but without the stool stream

This results in abdominal cramping with mucoid or bloody diarrhea

Infusion of salt solution containing short chain fatty acids(scfa) (2-4 carbon fatty acids) into rectal remnant is a remedial measure but complete reanastomosis is the only complete cure

Migraine

Dural blood vessels become dilated and the pulsatile blood flow through these vessels distends and irritates the highly pain sensitive dura mater

-this would explain the throbbing nature of migraine headaches

-inflammatory component to migraine headache has been proposed

Nutritional management of migraineRiboflavin administration

Metabolites of riboflavin participate in overcoming the mitochondrial defect that that plays a role in migraine pathogenesis Avoiding foods-Certain foods in certain persons trigger migraines -however this is highly individual with one food or group of foods affecting a particular person but not another

Nutritional management of migraine

However dietary restriction of a food or food groups may upset the principles of adequacy, moderation, variety, nutrient density, energy control, and balance

Migraine

Foods contributing to migraine:

Citrus foodsTea(flavonoids)CoffeePorkChocolateMilkNutsVegetablesCola

Migraine

-food components affecting vascular tone and causing migraine (highly individual):

tyramine, phenylalanine, phenolic flavonoids, alcohol, food additives (sodium nitrate, monosodium glutamate), aspartame, caffeine

Migraine

-foods thought to trigger migraines subsequent to hypoglycemia are:

chocolate, cheese, citrus fruits, bananas, nuts, cured meats, dairy products cereals, beans, hot dogs, pizza, food additives coffee, tea, cola drinks, alcoholic drinks such as red wine, beer or whiskey distilled in copper stills

Migraine -solution to all this is trial and error elimination

of foods including meticulous record keeping

Respiratory Acute respiratory failure

Need sufficient energy and protein to support lung function and prevent infections without overtaxing the compromised respiratory system

Fluid and sodium restrictions may be necessary to ease pulmonary edema  

Respiratory 

Acute respiratory failure

Overfeeding causes increased carbon dioxide which results in additional respiratory requirement-therefore reduce kcal to an appropriate level(energy to support lung function and prevent infections without overtaxing the compromised respiratory system)

 

Respiratory 

Aspiration pneumonia

Potentially lethal lung infection

Nasogastric feeding or gastrostomy or jejunostomy which allows the lower esophageal sphincter to remain closed

-all this helps to reduce aspiration risk

Respiratory 

Chronic obstructive pulmonary disease (COPD)

Emphysema and chronic bronchitis are the two most common examples of chronic

obstructive diseases

COPD patients frequently experience:-weight loss, protein energy malnutrition (PEM) and infections due to anorexia

-poor food intake and high energy expenditure both due to laboured respirations

Respiratory Chronic obstructive pulmonary disease addressed by:

Weight loss (caloric restriction combined with appropriate exercise levels)

Malnourishment- gradual re-feeding as tolerated

-easy to eat foods in small meals to improve food tolerance- enteral feeding may help

-need fewer kcal from carbohydrate due to carbon dioxide issue

Avoid overfeeding –carbon dioxide load issue

Respiratory Cystic fibrosisLaboured breathing- increased kcal and protein and do not restrict fat

Enzyme replacements for pancreatic impairment

Multivitamin including fat soluble vitamins

Table salt to overcome electrolyte losses due to sweating

Additional fluids to liquefy thick secretions and prevent dehydration

Maintain appropriate height to weight ratio

Lecture 11c

24 MARCH 2014 Ulcers, Pruritis

Ulcers Generally refers to peptic ulcer-an erosion of top layer of cells from the lining of the esophagus stomach or small intestine Ulcers may also develop in the mouth, upper esophagus and large intestine

Ulcers and NutritionPatient should:

-relax during meals, eating slowly, chewing thoroughly,

-avoid overeating, alcohol, caffeine and caffeine containing beverages, decaffeinated tea and coffee, and except as tolerated pepper-containing and spicy foods Evening primrose has been proposed to help but this proposal is subject to problems such as small subject numbers and poorly controlled studies

Pruritis 

-this is itch  -can result from liver and kidney disease, cancers, parasites, aging and dry skin, and contact dermatitis

Pruritis and Nutrition -nutritionally address each of diseases generating the pruritis, address life cycle issues (aging and dry skin frequently go together) or address aging or dry skin separately as appropriate  -contact dermatitis can be dealt with as per earlier mention of dermatitis  -Evening primrose oil has had controversial success in this regard (i.e. pruritis)