Energy Balance PDF

ENERGY BALANCE ATP Generation from Food Energy Energy stored in carbohydrates, fats, and proteins is converted into ATP through metabolic reactions. These processes involve: 1. Breaking down macronutrients to release energy 2. Using released energy to synthesize ATP Components of Energy Expenditure Total energy expenditure (TEE) consists of: 1. Basal Metabolism (60-75% of TEE) Includes involuntary bodily functions like breathing, circulation, and temperature regulation Measured as Basal Metabolic Rate (BMR) or Resting Metabolic Rate (RMR) 2. Physical Activity (15-30% of TEE) Includes planned exercise and daily activities Non-Exercise Activity Thermogenesis (NEAT) accounts for most activity-related energy expenditure 3. Thermic Effect of Food (TEF) Energy required for digestion, absorption, and storage of nutrients Approximately 10% of daily energy intake Storage of Excess Dietary Energy Excess energy is stored as: 1. Glycogen: In liver and muscles when carbohydrate intake is sufficient 2. Triglycerides: In adipose tissue Stored in fat cells called adipocytes Adipocytes grow or shrink based on fat accumulation Measuring Energy Expenditure Methods for measuring energy expenditure include: 1. Direct Calorimetry Measures heat produced by the body Requires an insulated chamber Expensive and impractical for everyday use 2. Indirect Calorimetry Measures oxygen use and carbon dioxide production Requires breathing into a mouthpiece, mask, or ventilated hood 3. Doubly Labelled Water Uses isotopes of oxygen and hydrogen No equipment required Measures total energy expenditure but cannot determine specific components Factors Influencing Energy Expenditure Energy expenditure is affected by: 1. Body weight and composition 2. Gender 3. Age 4. Growth rate (in children) 5. Body temperature 6. Thyroid hormone levels 7. Energy intake 8. Physical activity level Genetic Influence on Body Weight 1. Genetics plays a significant role in determining body weight. 2. Twin studies have shown that approximately 70% of the variation in Body Mass Index (BMI) can be attributed to genetic factors. 3. Genetic factors influence: Metabolic rate Body fat distribution Appetite regulation 4. Over 50 genes have been identified that are associated with obesity. 5. The FTO gene is one of the most well-studied obesity-related genes. It affects: Food intake Satiety Energy expenditure 6. Despite genetic predisposition, environmental factors and lifestyle choices still play a crucial role in determining an individual's weight. 7. Gene-environment interactions can influence how genetic factors are expressed, potentially affecting body weight regulation. Short-term and Long-term Regulation of Body Weight The slides do not provide detailed information on short-term and long-term regulation of body weight. Metabolic Mechanisms Influencing Energy Expenditure 1. Basal Metabolic Rate (BMR) Affected by body weight, gender, growth rate, and age Can be altered by body temperature and thyroid hormone levels 2. 3. Thermic Effect of Food (TEF) Varies based on macronutrient composition of meals High-fat meals have lower TEF compared to high-carbohydrate or high-protein meals 4. Non-Exercise Activity Thermogenesis (NEAT) Accounts for the majority of energy expended for activity Varies greatly between individuals 5. Adaptive thermogenesis Low-energy diets may depress resting metabolic rate by 10-20% HYPERTENSION Sodium and Potassium Intake in Canadian Diet Sodium intake: Average Canadian consumes 3400 mg/day, which is more than double the adequate intake. ○ 1700mg/day Potassium intake: Average Canadian consumes 2900-3100 mg/day, which is below the adequate intake. Normal blood pressure is 140/90 Functions of Sodium, Chloride, and Potassium Sodium Maintains fluid balance Aids in nerve impulse transmission→ action potential Assists in muscle contraction Helps maintain blood pressure Chloride Maintains fluid balance Forms hydrochloric acid in the stomach Aids in nerve impulse transmission Potassium Maintains fluid balance Aids in nerve impulse transmission Assists in muscle contraction Helps regulate heart rhythm Recent Changes to DRIs for Sodium and Potassium Sodium Adequate Intake (AI): 1500 mg/day for adults Chronic Disease Risk Reduction (CDRR): 2300 mg/day for adults Potassium Adequate Intake (AI): 3400 mg/day for adult males, 2600 mg/day for adult females Causes and Consequences of Electrolyte Deficiency Causes Excessive sweating Prolonged vomiting or diarrhea Kidney disease Certain medications (e.g., diuretics) Consequences Sodium deficiency (hyponatremia): Nausea, headache, confusion, seizures Potassium deficiency (hypokalemia): Muscle weakness, irregular heartbeat Chloride deficiency (hypochloremia): Weakness, dehydration Causes and Consequences of Electrolyte Toxicity Causes Excessive intake from diet or supplements(decreases food intake) Kidney disease(reabsorption) Certain medications Consequences Sodium toxicity (hypernatremia): Increased blood pressure, edema Potassium toxicity (hyperkalemia): Irregular heartbeat, cardiac arrest Chloride toxicity (hyperchloremia): Metabolic acidosis Other Electrolytes in the Body Calcium Magnesium Phosphate Bicarbonate Essential Hypertension No identifiable cause Accounts for 90-95% of hypertension cases Secondary Hypertension Caused by an underlying condition (e.g., kidney disease, hormonal disorders) Accounts for 5-10% of hypertension cases Risk Factors for Hypertension Age (>65 years) Family history Obesity Physical inactivity High sodium intake Low potassium intake Excessive alcohol consumption Smoking Stress Dietary Factors Influencing Blood Pressure High sodium intake: Increases blood pressure Low potassium intake: Increases blood pressure High alcohol consumption: Increases blood pressure Adequate calcium and magnesium intake: May help lower blood pressure DASH diet: Lowers blood pressure Reducing Sodium Content in Canadian Diet Choose fresh, whole foods over processed foods Read nutrition labels and choose lower sodium options Use herbs and spices instead of salt for flavoring Limit consumption of high-sodium foods (e.g., processed meats, canned soups) Gradually reduce salt in cooking and at the table Dietary Strategies for Preventing Hypertension 1. Follow the DASH (Dietary Approaches to Stop Hypertension) diet: Rich in fruits, vegetables, and low-fat dairy products Includes whole grains, poultry, fish, and nuts Low in red meat, sweets, and sugar-sweetened beverages 2. Reduce sodium intake to less than 2300 mg/day 3. Increase potassium intake through fruits and vegetables 4. Maintain a healthy body weight 5. Limit alcohol consumption 6. Increase physical activity 7. Ensure adequate intake of calcium and magnesium WEIGHT LOSS Disconnect Between Exercise Science and Psychology Regarding Weight Loss The disconnect noted in exercise science and psychology revolves around the misconception that exercise alone will lead to significant weight loss. Many people believe that increasing physical activity will directly correlate with losing weight, but research shows that the relationship is more complex. Exercise can improve health markers such as cardiovascular fitness and mental well-being without necessarily resulting in weight loss. This disconnect often leads to frustration when individuals do not see expected changes on the scale despite their efforts in physical activity. Physiologic Reasons Why Diets Don’t Work Diets often fail for several physiological reasons: Metabolic Adaptation: When caloric intake is reduced, the body may lower its metabolic rate to conserve energy, making further weight loss more difficult. Hormonal Changes: Dieting can alter levels of hormones such as leptin (which regulates hunger) and ghrelin (which stimulates appetite), often leading to increased hunger and cravings. Nutritional Deficiencies: Restrictive diets can lead to inadequate nutrient intake, which may cause fatigue, decreased energy levels, and hinder overall health. Psychological Factors: The stress of dieting can lead to binge eating or disordered eating patterns, counteracting weight loss efforts. "Shut Down" Mechanism in the Body with Some Diets The "shut down" mechanism refers to the body's response to severe caloric restriction or extreme dieting practices. When the body perceives it is in a state of starvation, it activates survival mechanisms that slow metabolism and conserve energy. This can result in: Decreased Energy Levels: The body prioritizes essential functions over energy expenditure. Increased Fat Storage: Hormones like cortisol may rise, promoting fat storage rather than fat loss. Loss of Muscle Mass: The body may start breaking down muscle tissue for energy when it is not receiving adequate nutrition. Relationship Between Enjoying Food and Absorbing Nutrients Enjoying food is closely linked to better nutrient absorption. When individuals have a positive relationship with food: Mindful Eating: They are more likely to eat slowly and savor their meals, which enhances digestion and nutrient uptake. Reduced Stress: Enjoyment reduces stress around eating, which can otherwise hinder digestion and nutrient absorption. Variety in Diet: Enjoying food often leads to a more varied diet, ensuring a broader range of nutrients is consumed. Four Factors Involved in Chronic Disease as Part of the “Big Picture” Chronic diseases are influenced by multiple interconnected factors: 1. Genetics: Genetic predispositions can affect an individual's risk for various chronic conditions. 2. Environment: Access to healthy foods, safe spaces for physical activity, and socio-economic factors play significant roles. 3. Behavioral Factors: Lifestyle choices such as diet quality, physical activity levels, smoking, and alcohol consumption contribute to chronic disease risk. 4. Psychosocial Factors: Mental health issues, stress levels, and social support systems can influence health outcomes. Benefits of Exercise Outside of Weight Loss Exercise provides numerous benefits beyond weight loss: Improved Mental Health: Regular physical activity can reduce symptoms of anxiety and depression. Enhanced Cardiovascular Health: Exercise strengthens the heart and improves circulation. Better Sleep Quality: Physical activity promotes better sleep patterns. Increased Strength and Flexibility: Regular movement helps maintain muscle mass and joint flexibility, reducing injury risk. Weight Focused Approach Perspective The Weight Focused Approach (WFA) emphasizes weight loss as the primary goal of dietary interventions. This perspective assumes that individuals have control over their body size and promotes calorie restriction and increased physical activity to achieve weight loss. WFAs often involve strict dietary rules and can lead to weight stigma, which negatively impacts the psychological well-being of higher-weight individuals. This approach has been criticized for its association with increased stress, anxiety, and avoidance of health-promoting behaviors due to the pressure of meeting weight-related goals24. 2. Nutrition Therapy Techniques in Non-Weight-Focused Approaches Non-Weight-Focused Approaches (NWFAs) prioritize overall health and well-being rather than weight loss. Common techniques include: Intuitive Eating: Encouraging clients to listen to their internal hunger and fullness cues rather than following external dietary rules. Mindful Eating: Fostering awareness of the eating experience, promoting enjoyment, and recognizing emotional triggers related to food. Health at Every Size® (HAES®): Advocating for health improvement without focusing on weight loss, promoting body acceptance, and encouraging joyful movement. Self-Care Practices: Supporting clients in developing a positive relationship with food and their bodies, emphasizing self-acceptance and body positivity134. 3. Five Practice Approach Categories The study identified five categories of practice approaches used by dietitians: 1. Solely Weight-Focused: Emphasizes weight loss through calorie restriction and physical activity. 2. Moderately Weight-Focused: Incorporates some elements of weight loss but also considers other health factors. 3. Fluctuating Between Approaches: Alternates between weight-focused and non-weight-focused strategies depending on client needs. 4. Weight-Inclusive: Focuses on overall health without prioritizing weight loss, promoting body acceptance. 5. Weight-Liberated: Rejects the concept of weight as a measure of health entirely, focusing solely on health behaviors25. 4. Descriptive Labels for Practice Approaches Descriptive labels used in the study include: Weight-Focused: Approaches that prioritize weight loss. Weight-Inclusive: Emphasizes health improvement without focusing on weight. Weight-Liberated: Completely disregards weight as a health indicator. These labels help categorize dietitian practices based on their focus regarding client outcomes related to body size25. 5. Commonly Used Nutrition Therapy Techniques for Higher Weight Clients Dietitians working with higher-weight clients typically employ techniques such as: Mindful Eating: Encouraging awareness of eating habits and emotional connections to food. Intuitive Eating: Fostering a natural relationship with food by listening to internal cues. Nutritional Education: Providing information about balanced diets without calorie counting or restrictive practices. Behavioral Strategies: Helping clients develop sustainable eating habits that promote overall well-being rather than focusing solely on weight loss123. 6. Differences Between Approaches Weight-Focused Approach Prioritizes weight loss as a primary goal. Often involves calorie restriction and structured meal plans. Can lead to negative psychological effects due to stigma. Combined Approach Fluctuates between weight-focused and non-weight-focused strategies based on client needs. May address both health behaviors and weight management. Non-Weight-Focused Approach Emphasizes overall health, well-being, and body acceptance. Focuses on intuitive eating, mindful practices, and client-centered care without pressure for weight loss24. 7. Other Nutrition Therapy Assessment Techniques Other assessment techniques may include: Motivational Interviewing: A client-centered counseling style that helps clients explore their motivations for change without judgment. Food Journaling: Encouraging clients to track their eating habits to identify patterns without focusing solely on caloric intake. Health Behavior Assessments: Evaluating lifestyle factors such as physical activity levels, stress management, and sleep quality that contribute to overall health. These techniques aim to create a holistic understanding of a client's relationship with food and their health behaviors134. 8. Limitations of the Study The study has several limitations: 1. Sample Diversity: The majority of participants were women (94.8%) and predominantly white (82.2%), limiting generalizability across different demographics. 2. Self-reported Data: Reliance on self-reported information may introduce bias in responses regarding practice approaches. 3. Focus on Canadian Dietitians: Findings may not be applicable to dietitians practicing in other countries or cultural contexts WEIGHT MANAGEMENT Health Problems More Common in Overweight and Obese Individuals Overweight and obese individuals are at higher risk for several health problems, including: Heart disease High blood cholesterol High blood pressure Stroke Diabetes Gallbladder disease Sleep apnea Respiratory problems Arthritis Gout Certain types of cancers These conditions not only increase the risk of illness but also contribute to premature death. Additionally, obesity has been linked to poor wound healing, surgical complications, and increased incidence and severity of infectious diseases. Weight Stigmatization and Its Consequences Weight stigmatization refers to negative attitudes, beliefs, and behaviors directed towards individuals who are perceived as carrying excess weight. The consequences of weight stigmatization include: Low body satisfaction Low self-esteem Depression Social isolation Increased thoughts about and attempts at suicide Discrimination in college admissions, job market, workplace, and public transportation Negative self-image and feelings of inadequacy These psychological and social problems can have immediate and long-lasting effects on an individual's quality of life, often manifesting before any physical health issues arise. Consequences of Being Underweight Being underweight can lead to several health risks: Reduced energy reserves, which can be disadvantageous during illness or periods of food scarcity Increased risk of early death Compromised immune system function Electrolyte imbalances Decreased muscle mass Delayed sexual development in adolescents Increased risk of health complications for babies born to underweight pregnant women Higher risk of malnutrition, especially in the elderly Characteristics of a Well-Planned Low-Calorie Diet A well-planned low-calorie diet typically includes: Moderate fat content (1 hour): The body increasingly relies on fat oxidation while maintaining some carbohydrate use for higher intensity efforts. 5. Effect of Intensity on Sources of Energy Used for Exercise The intensity of exercise also influences energy sources: Low Intensity: Primarily uses fat as an energy source. Moderate Intensity: Utilizes a mix of carbohydrates and fats. High Intensity: Relies heavily on carbohydrates due to the need for quick energy production through anaerobic pathways. 6. Physiological Changes in Response to Exercise Regular exercise induces several physiological changes, including: Improved cardiovascular efficiency (increased heart size and stroke volume). Enhanced respiratory capacity (increased lung volume and efficiency). Increased muscle strength and endurance due to hypertrophy. Improved metabolic function (enhanced insulin sensitivity and glucose metabolism). Better hormonal balance (increased levels of beneficial hormones like endorphins). 7. Comparison of Energy Needs: Athletes vs. Non-athletes Energy needs differ significantly between athletes and non-athletes: Athletes: May require an additional 2,000–3,000 kcal/day depending on their sport's demands. Some athletes may need up to 6,000 kcal/day to maintain their weight during intense training periods. Non-athletes: Generally have lower energy requirements based on their daily activities and lifestyle. 8. Comparison of Macronutrient Needs: Athletes vs. Non-athletes Macronutrient needs also vary: Carbohydrates: Athletes: Require between 3 to 12 g/kg body weight per day to maintain glycogen stores. Non-athletes: Should consume carbohydrates as 45%–65% of total energy intake. Fats: Athletes: Should aim for about 20%–25% of total energy from fats. Non-athletes: Should consume fats as 20%–35% of total energy intake. Proteins: Athletes: Require between 1.2 to 2.0 g/kg body weight per day for muscle repair and growth. Non-athletes: Generally need around 0.8 g/kg body weight. 9. Comparison of Micronutrient Needs: Athletes vs. Non-athletes Micronutrient needs can differ based on activity levels: 1. B Vitamins: No difference in recommendations; both groups need adequate B vitamins for energy metabolism. 2. Antioxidants: Regular exercise increases free radical production; however, supplementation is generally not necessary as adaptation occurs with consistent training. 3. Iron: Athletes may require an EAR that is up to 30%–70% higher than non-athletes due to increased red blood cell production needs. 4. Calcium: Important for both groups; however, female athletes are at risk for conditions like the female athlete triad if they experience disordered eating patterns INDIGENOUS HEALTH 1. Define forced sterilization. Forced sterilization refers to the involuntary or coerced sterilization of individuals, often targeting marginalized groups, such as Indigenous peoples. This practice involves performing surgical procedures that prevent individuals from having children without their informed consent. In Canada, many Indigenous women have reported being subjected to forced sterilization, which reflects systemic racism and a violation of human rights and bodily autonomy. 2. Describe examples of anti-Indigenous racism. Examples of anti-Indigenous racism include: Discriminatory Healthcare Practices: Indigenous individuals may face biases in medical treatment, including denial of care or inadequate treatment based on racial stereotypes. Harmful Stereotypes: Indigenous peoples are often portrayed negatively in media and society, leading to prejudiced assumptions about their health behaviors or lifestyle choices. Cultural Insensitivity: Health services may lack cultural competence, failing to respect Indigenous traditions and practices, which can alienate patients. Racial Profiling: Indigenous individuals may experience profiling in various settings, including hospitals and clinics, leading to mistrust and reluctance to seek care. 3. Explain why the current system in place for reporting incidents of racism doesn’t work and how we can improve this system. The current system for reporting incidents of racism often fails due to several reasons: Lack of Trust: Many Indigenous individuals do not trust the authorities or systems in place to handle complaints effectively. Inadequate Follow-up: Reports may not be taken seriously or investigated thoroughly, leading to a perception that nothing will change. Insufficient Training: Those responsible for handling complaints may lack training in cultural competency and understanding of systemic racism. To improve this system: Establish Independent Oversight Bodies: Creating independent organizations that focus on investigating complaints can enhance accountability. Increase Cultural Competency Training: Training healthcare professionals on Indigenous issues and systemic racism can help them understand the importance of addressing complaints seriously. Enhance Transparency: Regularly publishing data on reported incidents and outcomes can build trust within communities. 4. List some of the stereotypes and labels that health care professionals give to Indigenous peoples. Some stereotypes and labels that healthcare professionals may apply to Indigenous peoples include: Substance Abuser: Assumptions that Indigenous individuals are more likely to abuse drugs or alcohol. Non-compliant Patient: The belief that Indigenous patients do not follow medical advice or treatment plans. Ignorant or Uneducated: Stereotypes suggesting that Indigenous peoples lack understanding of health issues or medical information. Culturally Inferior: Perceptions that Indigenous cultural practices are less valid than Western medical practices. 5. Describe the impact of the Canadian Medical Association’s (CMA) apology. The CMA's apology acknowledges the historical injustices faced by Indigenous peoples within the healthcare system. The impact includes: Recognition of Harm: It validates the experiences of those affected by systemic racism in healthcare. Encouragement for Healing: The apology opens pathways for healing between healthcare providers and Indigenous communities. Foundation for Change: It serves as a catalyst for discussions about reforming healthcare practices and policies to better serve Indigenous populations. 6. Explain why the CMA’s apology is important. The CMA’s apology is important because it represents a formal acknowledgment of past wrongs and systemic discrimination against Indigenous peoples in healthcare. It is significant for several reasons: Promotes Reconciliation: Acknowledging historical injustices is a crucial step toward reconciliation between Indigenous communities and healthcare institutions. Builds Trust: The apology aims to rebuild trust between Indigenous peoples and healthcare providers, encouraging more individuals to seek necessary medical care without fear of discrimination. Guides Future Actions: It sets a precedent for other organizations to recognize their roles in perpetuating systemic racism and encourages them to take steps towards meaningful change. 1. Describe the make-up of traditional Indigenous Food Systems. Traditional Indigenous Food Systems are characterized by a deep connection to the land, which informs sustainable practices and diverse dietary habits. These systems were historically based on: Biodiversity: A wide variety of plant and animal sources, including wild game, fish, fruits, nuts, and vegetables. Ecological Knowledge: Transgenerational knowledge of seasonal food sources and sustainable harvesting techniques. Cultural Significance: Food is intertwined with cultural practices, spirituality, and community identity, serving not just as sustenance but also as a means of social cohesion and cultural expression. Nutritional Quality: Traditional diets were typically high in protein, fiber, and micronutrients while being low in fat, sugar, and salt, contributing to better overall health outcomes prior to colonization. 2. Explain why nutrition-related conditions disproportionately affect Indigenous Peoples. Nutrition-related conditions disproportionately affect Indigenous Peoples due to several interrelated factors: Colonial Disruption: Historical dispossession from traditional lands disrupted food systems and access to traditional foods. Food Insecurity: Many Indigenous communities face high levels of food insecurity due to economic disparities and limited access to healthy food options. Socioeconomic Factors: Higher rates of poverty, unemployment, and lower educational attainment contribute to poor nutritional outcomes. Environmental Degradation: Loss of biodiversity and environmental changes have reduced access to traditional food sources, leading to reliance on processed foods that are often unhealthy. 3. Describe which type of food labelling were better understood for some Indigenous populations. Interpretive food labelling systems, such as traffic light labels and health star ratings, were found to be better understood among some Indigenous populations compared to standard nutrition information panels. For example: In studies involving Māori participants in Aotearoa (New Zealand), these interpretive systems facilitated healthier food choices more effectively than traditional labels. Culturally tailored labels also showed greater effectiveness in increasing the selection of healthier food items among Indigenous shoppers compared to generic labels. 4. Describe the most frequent findings of studies evaluating dietary outcomes for Indigenous children. Studies evaluating dietary outcomes for Indigenous children frequently reported: Reduction in Unhealthy Foods: Many interventions led to decreased consumption of high-fat and high-sugar foods and beverages. Improved Nutritional Intake: There were improvements in the intake of fruits, vegetables, and essential nutrients among children participating in school-based nutrition programs. Anthropometric Outcomes: While many studies did not show significant changes in body mass index (BMI), some reported reductions in overweight prevalence among Indigenous children following interventions. 5. Describe effectiveness of voluntary vs forced food fortification of folate. The effectiveness of voluntary versus forced food fortification of folate shows that: Forced Fortification: Mandatory fortification policies tend to result in more consistent improvements in folate levels across populations compared to voluntary measures. This is because they ensure that all individuals receive the necessary nutrients regardless of dietary choices. Voluntary Fortification: While it can be beneficial, reliance on voluntary fortification often leads to uneven uptake, particularly among marginalized groups who may not have access to fortified products or may not choose them. 6. Describe how food and beverage pricing policies are effective at improving diet quality. Food and beverage pricing policies can improve diet quality through: Subsidies for Healthy Foods: Implementing subsidies for fruits and vegetables encourages higher consumption by making these foods more affordable. Taxes on Unhealthy Options: Taxing sugary drinks or unhealthy foods disincentivizes their purchase while promoting healthier alternatives. Behavioral Change: Price reductions lead to increased purchases of healthier options; for instance, a study found that a 20% discount on fruits and vegetables significantly increased their purchase rates among Indigenous populations. 7. Describe why public campaign strategies are not a preferred strategy of public health advocates. Public campaign strategies are often not preferred by public health advocates because: Limited Impact on Behavior Change: Campaigns alone may not lead to significant changes in dietary behaviors without accompanying structural changes in food environments. Resource Intensive: They can require substantial resources without guaranteed outcomes, making them less efficient compared to policy-level interventions that address systemic issues. Cultural Relevance: Campaigns may lack cultural sensitivity or relevance for Indigenous communities if not developed in partnership with those communities. 8. List the 8 features identified as critical to the success of health promotion and public health research in Indigenous communities. The eight critical features identified for successful health promotion and public health research in Indigenous communities include: 1. Community Engagement: Active involvement of Indigenous communities in all stages of research and intervention design. 2. Cultural Competence: Understanding and integrating cultural values into health initiatives. 3. Collaboration with Local Organizations: Partnering with Indigenous organizations enhances trust and relevance. 4. Capacity Building: Empowering communities through training and resources for sustainable health initiatives. 5. Focus on Holistic Health: Addressing physical, mental, emotional, and spiritual well-being collectively. 6. Long-term Commitment: Sustained engagement rather than one-off projects ensures lasting impact. 7. Adaptability: Flexibility in approaches based on community feedback and changing needs. 8. Evaluation Frameworks: Establishing culturally appropriate metrics for evaluating success. 9. Describe some of the food differences between the 2019 Canada’s Food Guide and the 2007 Food Guide for First Nations, Metis and Inuit. Some key differences between the 2019 Canada’s Food Guide and the 2007 Food Guide for First Nations, Métis, and Inuit include: Emphasis on Traditional Foods: The 2019 guide places greater emphasis on incorporating traditional foods into diets as part of a healthy eating approach. Visual Representation: The new guide uses a plate model rather than a pyramid structure, promoting balanced meals visually without specific servings from each food group as seen in previous guides. Cultural Sensitivity: The updated guide acknowledges the importance of cultural practices around food preparation and consumption more explicitly than earlier versions did. Pregnancy and lactation: Describe prenatal growth and development: Prenatal development involves three stages: Germinal stage: From conception to two weeks, where the zygote forms and implants in the uterus. Embryonic stage: From weeks 3 to 8, when critical organ systems begin to form, making it a vulnerable period. Fetal stage: From week 9 to birth, marked by significant growth and maturation of organ systems. Describe how body weight and physical activity change during pregnancy: Weight gain: Pregnant women gain 11.5–16 kg on average, depending on pre-pregnancy BMI. Physical activity: Light-to-moderate exercise is encouraged to support cardiovascular health, reduce pregnancy discomforts, and prepare for labor. Describe the nutrition-related discomforts of pregnancy: Morning sickness: Nausea, especially in the first trimester. Heartburn: Caused by hormonal changes and pressure on the stomach. Constipation: Due to reduced motility of the digestive tract. Describe the nutrition-related complications of pregnancy: Gestational diabetes: Elevated blood sugar levels that require diet control. Pre-eclampsia: High blood pressure with protein in the urine, requiring medical attention. Describe what can be done during the preconception period to improve pregnancy outcomes: Ensure a balanced diet rich in folate to prevent neural tube defects. Achieve a healthy weight and address chronic conditions. Avoid harmful substances like alcohol and tobacco. Describe how energy needs change during pregnancy, compared to nonpregnancy: Energy requirements increase by 350–450 kcal/day in the second and third trimesters to support fetal growth. Describe how macronutrient requirements change during pregnancy, compared to nonpregnancy: Protein: Increased needs for fetal and maternal tissue development (~71g/day). Carbohydrates: Increased to maintain energy supply (~175g/day). Fats: Adequate intake of omega-3 fatty acids is essential for brain development. Describe how fluid requirements change during pregnancy, compared to nonpregnancy: Fluid needs rise to about 3 liters per day to support increased blood volume and amniotic fluid production. Describe how micronutrient requirements change during pregnancy, compared to nonpregnancy: Folate: Essential for preventing neural tube defects (~600 µg/day). Iron: Supports increased blood volume and fetal development (~27 mg/day). Calcium: Maintains maternal bone health and fetal skeletal development (~1,000 mg/day). Describe how food and supplements together meet the nutritional needs of pregnancy and the impact of malnutrition during pregnancy: Balanced meals with a variety of nutrients and prenatal vitamins ensure adequate nutrient intake. Malnutrition can lead to preterm delivery, low birth weight, or developmental issues. Describe pre-existing health conditions that influence pregnancy outcomes: Diabetes, hypertension, or thyroid disorders can complicate pregnancy. Close monitoring and medical management are crucial. Describe some environmental toxins that may pose a risk to the fetus: Mercury in fish can affect neurological development. Alcohol and tobacco increase the risk of miscarriage and birth defects. Describe the purpose of the Canadian Prenatal Nutrition Program (CPNP): Provides support for at-risk pregnant women, promoting maternal and infant health. Offers services like nutrition counseling, food supplements, and breastfeeding support. Describe the hormones involved in breast milk production and release: Prolactin: Stimulates milk production. Oxytocin: Triggers milk ejection or "let-down" reflex. Describe how the nutritional needs of lactating women differ from nonlactating women: Caloric needs increase by 500 kcal/day for milk production. Higher intake of fluids, protein, calcium, and certain vitamins is necessary. Infant nutri Here’s a more detailed explanation for each question: 1. Compare the energy and macronutrient needs of newborns with those of adults (detailed): Energy: Newborns: Need about 100 kcal/kg/day because of rapid growth, high metabolic rate, and immature organs. The energy supports growth, thermoregulation, and activity. ○ Example: A 4 kg newborn would need around 400 kcal/day. Adults: Require 25–30 kcal/kg/day, depending on activity levels, as their growth is minimal, and their metabolism is slower. ○ Example: A 70 kg adult may need ~2,100 kcal/day. Protein: Newborns: Protein intake is critical for tissue synthesis, muscle growth, and enzymatic activity (~1.5 g/kg/day). Breast milk or formula ensures a high-quality protein supply. Adults: Require less protein (~0.8 g/kg/day), as growth has ceased and tissue maintenance is the primary need. Fats: Newborns: Need about 50% of their calories from fats. Fat is the primary energy source in breast milk and supports brain development, especially through DHA and ARA (long-chain polyunsaturated fatty acids). Adults: Need about 20–35% of calories from fats. Adults rely less on fats as their primary energy source. Carbohydrates: Newborns: Lactose is the main carbohydrate in breast milk and formula, supplying glucose for energy (~40% of total calories). Adults: Require 45–65% of their calories from carbohydrates, including complex carbs for sustained energy. 2. Compare the fluid needs of newborns with those of adults (detailed): Newborns: Newborns need 150–170 mL/kg/day because: ○ Their body is composed of ~75% water (higher than adults). ○ They have immature kidneys, which are inefficient at conserving water. ○ They lose water more rapidly through evaporation and stool. ○ Example: A 4 kg newborn needs about 600–680 mL/day, typically provided through breast milk or formula. Adults: Adults need 30–35 mL/kg/day (or ~2–3 liters per day). Adults have a lower water percentage (~50–60%) and more developed kidneys, so their fluid requirements are lower per kilogram. 3. Compare the micronutrient needs of newborns with those of adults (detailed): Iron: Newborns: Rely on stored iron from the womb, which lasts ~6 months. They need 0.27 mg/day initially and 11 mg/day after 6 months when solids are introduced. Breastfed babies may need iron supplements if deficient. Adults: Men need 8 mg/day; women (18–50 years) need 18 mg/day due to menstrual losses. Vitamin D: Newborns: Need 400 IU/day of supplementation as breast milk is low in vitamin D. Adequate levels prevent rickets. Adults: Need 600–800 IU/day, depending on age and sun exposure. Calcium: Newborns: Require ~200–260 mg/day to support rapid bone growth. Adults: Need 1,000 mg/day to maintain bone health. Other Micronutrients: Newborns require higher amounts of certain nutrients (e.g., zinc, iodine) per kilogram to support brain development and enzyme functions, whereas adults require less per kilogram. 4. Describe how to assess the growth of an infant (detailed): Growth assessment involves tracking key metrics over time: 1. Weight: ○ Newborns lose 5–10% of birth weight in the first week but regain it by 2 weeks. ○ Weight doubles by 4–6 months and triples by 12 months. 2. Length: ○ Increases by ~25 cm in the first year. 3. Head Circumference: ○ Monitored to assess brain development. 4. Growth Charts: ○ Use WHO or CDC growth charts to evaluate weight-for-age, length-for-age, and weight-for-length percentiles. 5. Feeding and Developmental Milestones: ○ Regular feeding, reaching milestones, and healthy appearance support growth assessment. 5. Describe the advantages of breastfeeding for infant and mother (detailed): For the Infant: Nutritional Benefits: Contains ideal proportions of macronutrients and micronutrients. Immunity: Provides antibodies (e.g., IgA) to protect against infections. Gut Health: Promotes beneficial gut bacteria through bioactive components. Disease Prevention: Reduces risks of obesity, type 2 diabetes, and allergies. For the Mother: Hormonal Benefits: Releases oxytocin, helping the uterus contract and reducing postpartum bleeding. Cancer Protection: Lowers risks of breast and ovarian cancer. Convenience: Breast milk is always available and at the right temperature. 6. Describe the mental health and other risks associated with breastfeeding (detailed): Mental Health Risks: Postpartum Depression: Mothers may feel overwhelmed by the demands of exclusive breastfeeding. Anxiety: Difficulty breastfeeding (e.g., low milk supply) can lead to feelings of failure or guilt. Physical Risks: Sore Nipples: Improper latch or frequent feeding can cause pain. Engorgement: Painful swelling due to milk buildup. Mastitis: Inflammation or infection in the breast. Other Considerations: Work-Life Balance: Returning to work can make breastfeeding challenging. Social Pressure: Societal expectations can be a source of stress. 7. Describe the advantages and disadvantages of bottle feeding (detailed): Advantages: Nutritional Control: Parents can measure and ensure the baby is getting enough. Inclusivity: Allows other caregivers to participate in feeding. Convenience: Easier for mothers with health issues or low milk supply. Fortification: Infant formulas are fortified with nutrients like iron and vitamin D. Disadvantages: Immune Protection: Lacks antibodies and immune factors found in breast milk. Digestive Issues: Formula-fed babies may experience constipation or gas. Cost: Formula is expensive and requires sterilized equipment. Bonding: May reduce the unique skin-to-skin bonding experience of breastfeeding. Children nutri 1. Discuss the quality of the diet of Canadian children and youth. The diet quality of Canadian children and youth has notable deficiencies: Low intake of essential food groups: Many children do not consume enough fruits, vegetables, milk, and whole grains. Excessive intake of harmful nutrients: Saturated fat intake is too high, and sodium intake is described as "very high." Reliance on fast food: Approximately 20% of children aged 4–13 consume fast food on any given day. Trends over time: While consumption of sugary drinks and high-energy beverages decreased from 2004 to 2015, the overall diet quality remains concerning. These factors contribute to poor nutrient intake and potential long-term health risks(Week+9+Lecture+16-+Nutr…). 2. Describe the trends in obesity and chronic disease among adolescents. Increase in obesity rates: The percentage of overweight children doubled between 1978 and 2004, though rates have stabilized in recent years. Chronic disease risks: Overweight children are at a higher risk of developing heart disease, diabetes, and hypertension earlier in life. Metabolic syndrome prevalence: A study of Ontario youth found that about 6% had metabolic syndrome, characterized by a large waist circumference and at least two other risk factors (e.g., high blood pressure, high triglycerides). Psychosocial effects: Obese adolescents often face bullying, social rejection, and low self-esteem, which can lead to a cycle of inactivity, overeating, and emotional struggles(Week+9+Lecture+16-+Nutr…). 3. Explain how children develop their eating habits. Role of environment: Eating habits are influenced by family mealtime practices, exposure to diverse foods, and the eating environment (e.g., absence of screens during meals). Social learning: Children are more likely to try new foods if they see parents or peers eating them. Food jags: Children often experience phases where they prefer only certain foods, which can impact dietary variety. Continuously offering other foods is recommended to encourage acceptance. Parental modeling: Caregivers should lead by example and encourage shared meals in a positive atmosphere(Week+9+Lecture+16-+Nutr…). 4. Describe the best indicator of adequate nutrient intake in children. Growth monitoring: Tracking growth using weight-for-age, length-for-age, and BMI-for-age charts is the most reliable way to assess whether children are meeting their nutrient needs. Healthy growth patterns: Children growing consistently along their growth percentiles are likely receiving adequate nutrition. Falling below the third percentile (underweight) or exceeding the 97th percentile (obesity) may indicate dietary imbalances(Week+9+Lecture+16-+Nutr…). 5. Compare the energy, macronutrient, and micronutrient needs of infants and children with those of adults. Energy needs: Infants and young children have higher energy needs relative to body weight compared to adults because of rapid growth and development. ○ A 2-year-old needs about 1,000 kcal/day, increasing to 1,600 kcal/day by age 6. Macronutrients: ○ Fat: Infants need 30–40% of energy from fat (1–3 years) and 25–35% (4–18 years), compared to the lower recommendations for adults. ○ Protein: A 2-year-old requires 13g/day, increasing to 19g/day by age 6. Adults need more total protein but less relative to body weight. ○ Carbohydrates: The recommended range (45–65% of energy) is similar to adults, but children’s diets must emphasize whole grains, fruits, and vegetables. Micronutrients: Children require specific amounts of key nutrients like calcium (700–1,000 mg/day) and vitamin D (15 µg/day) to support growth and bone health, which differ from adult needs(Week+9+Lecture+16-+Nutr…). 6. List the signs of readiness a child shows before introducing solids. Can sit up without support and maintain good neck control. Shows interest in food, including opening their mouth when food approaches. Can hold food in their mouth without immediately pushing it out with their tongue. Can pick up food and attempt to put it in their mouth. Shows they don’t want food by turning their head away or leaning back(Week+9+Lecture+16-+Nutr…). 7. Describe the principles and advantages of Baby-Led Weaning (BLW). Principles: Skips purées and spoon-feeding, allowing the baby to self-feed finger foods. Babies are introduced to family meals and encouraged to eat independently. Parents follow the baby's cues for hunger and satiety, trusting the baby to regulate their intake. Advantages: Promotes motor skill development and self-regulation of appetite. Encourages exposure to a variety of textures and flavors, potentially reducing picky eating. Aligns with family meals, making mealtime inclusive and less costly. Research shows no increased risk of choking compared to traditional methods(Week+9+Lecture+16-+Nutr…). 8. Describe the fundamentals, including the parent’s and child’s role, in the Division of Responsibility. Parent’s Role: Decide what, when, and where food is served. Provide structured meals and snacks in a pleasant environment. Avoid pressuring the child to eat certain foods or amounts. Child’s Role: Decide whether and how much to eat from what is offered. Learn to listen to their body’s hunger and fullness cues. This approach helps prevent feeding issues and supports healthy growth and eating behaviors(Week+9+Lecture+16-+Nutr…). 9. Describe how allergens should be introduced and how allergies should be managed. Introducing allergens: ○ Introduce allergens (e.g., peanuts, eggs) after 4 months but not before. ○ Introduce one new food at a time and monitor for reactions. ○ For high-risk babies, early introduction under medical guidance may help prevent allergies. Managing allergies: ○ If a reaction occurs, an elimination diet and food challenges can identify the allergen. ○ Continuously offering tolerated allergenic foods helps maintain tolerance. ○ Severe allergies may require emergency plans and epinephrine injections(Week+9+Lecture+16-+Nutr…). 10. Describe strategies to ensure children receive a balanced, nutritious diet. Variety and balance: Include whole grains, fruits, vegetables, lean proteins, and dairy products daily. Structured meals: Serve meals and snacks at consistent times. Avoid frequent snacking outside of these times. Role modeling: Parents should eat the same healthy foods they serve to encourage acceptance. Fun introductions: Offer new foods at the beginning of meals when the child is hungrier, and present them positively. Patience: Continue to offer foods a child initially rejects, as preferences can change over time. Importance of breakfast: Encourage breakfast to improve nutrient intake and cognitive performance throughout the day Teen nutri How growth and body composition are affected by puberty Puberty's Role: Begins between ages 9–12 and involves physical, social, and psychological changes that significantly influence nutritional needs and intakes. Growth Patterns: ○ Adolescents grow about 28 cm (11 inches) and gain 40% of their skeletal mass during this period. ○ Girls gain approximately 24 kg (53 lbs) between ages 10–17, while boys gain 32 kg (70 lbs) during the same span. ○ Growth spurts occur earlier in girls (ages 10–13) than boys (ages 12–15). Body Composition Changes: ○ Boys experience an increase in lean muscle mass and bone density, resulting in a reduced percentage of body fat. ○ Girls see an increase in fat deposition, particularly after menarche, leading to about twice as much adipose tissue and two-thirds as much lean tissue as males by age 20. Impact of Nutrition: ○ Nutritional deficiencies during childhood and adolescence can lead to poor growth and delayed sexual maturation. ○ Heavier and taller children tend to enter puberty sooner than their shorter, lighter peers(Week+10+Lecture+17-+Nut…). Energy, macronutrient, and micronutrient needs related to growth and sexual maturation Energy Needs: ○ Adolescents require more energy than adults due to rapid growth. ○ Boys need 2,200–3,150 kcal/day, and girls need 2,100–2,400 kcal/day. Macronutrient Needs: ○ Protein: Required for tissue growth at 0.85 g/kg/day. ○ Carbohydrates: Should account for 45–65% of daily intake to meet energy needs. ○ Fat: Should contribute 20–35% of total calories for energy and hormone production. Micronutrient Needs: ○ Calcium (1,300 mg/day): Critical for bone growth; up to 90% of adult bone mass is formed during adolescence. ○ Iron: Needed for hemoglobin production and muscle development. Girls require more due to menstruation. ○ Zinc: Supports protein synthesis and sexual maturation. ○ B Vitamins: Increased needs for energy metabolism and red blood cell production. ○ Vitamin A: Deficiencies observed in Canadian boys (9–13) and adolescent girls, likely due to low intake of vegetables and fruits(Week+10+Lecture+17-+Nut…). Changes to improve a typical teen’s diet Reduce Empty Calories: Limit consumption of high-fat, high-sugar, and high-sodium snacks. Encourage Nutritious Substitutes: Replace soft drinks with milk or fortified plant-based beverages to increase calcium, vitamin D, and other nutrients. Include Fruits and Vegetables: Promote their inclusion in meals and snacks to improve intake of fiber, vitamins A and C, and folate. Family Meals: Encourage frequent family meals, as they are associated with better diet quality and emotional well-being(Week+10+Lecture+17-+Nut…). Challenges faced by young and older adolescents Young Adolescents: Struggle with inconsistent eating patterns due to emotional changes and shifting independence. Peer pressure often dictates food choices. Older Adolescents: Face time management challenges while balancing school, work, and social life, leading to irregular meals and reliance on convenience foods. Body image concerns and media influence further complicate food choices(Week+10+Lecture+17-+Nut…). Eating competence and its benefits Definition: Being positive, comfortable, and flexible with eating, while reliably obtaining personally enjoyable, nourishing food. Benefits: ○ Lower BMI and higher self-esteem. ○ Reduced likelihood of disordered eating. ○ Greater consumption of fruits and vegetables. ○ More frequent participation in family meals(Week+10+Lecture+17-+Nut…). Role of parents in feeding adolescents Key Practices: ○ Set regular mealtimes and provide balanced meals. ○ Support teens' independence in food choices while offering guidance. ○ Avoid focusing on weight and instead promote body positivity. Parental Support: Should include educating teens about nutrition, creating a pleasant meal environment, and encouraging involvement in meal planning(Week+10+Lecture+17-+Nut…). De-Jongh Gonzalez et al., 2024 study methodology Focus: Examined the relationship between food parenting practices, weight status, and mental health in adolescents. Measured Factors: ○ Food Parenting Practices: Autonomy support, child involvement, meal routines, and coercive control. ○ Mental Health Indicators: Weight concerns, self-esteem, and anxiety. ○ Sociodemographics: Gender, age, parental education, marital status, household income, and race/ethnicity(Week+10+Lecture+17-+Nut…). Main results of the De-Jongh Gonzalez et al., 2024 study Adolescents’ mental health indicators were related to food parenting practices, but weight status was not. Key Findings: ○ Girls reported higher weight concerns and lower self-esteem than boys. ○ Parental autonomy-promoting practices were associated with improved mental health outcomes. ○ Anxiety led to fewer food-related rules being implemented by parents, possibly to reduce stress(Week+10+Lecture+17-+Nut…). Planning vegetarian diets for teens Components: ○ Include legumes, whole grains, nuts, seeds, and fortified products for protein, iron, calcium, and vitamin B12. ○ Emphasize variety to ensure balanced nutrition. Risks: Vegetarian diets may lack essential nutrients like iron, zinc, and vitamin B12, particularly if poorly planned(Week+10+Lecture+17-+Nut…). Impact of appearance and performance concerns on nutrition Body Image Issues: Girls often restrict calories to lose weight, while boys may overeat or misuse supplements to build muscle. Athletic Pressures: Adolescent athletes may adopt unhealthy practices like extreme dieting or dehydration to meet performance goals. These behaviors can interfere with normal growth Older ppl nutri How young adults can preserve their health Dietary Habits: Emphasize whole grains, lean proteins, healthy fats, and nutrient-dense fruits and vegetables. Lifestyle Choices: Maintain regular physical activity, avoid smoking, and moderate alcohol intake to reduce the risk of chronic diseases(Week+11+Lecture+19-+Nut…). Macronutrient recommendations for older adults vs. younger adults Energy Needs: Decline due to a 2–3% decrease in basal metabolic rate (BMR) per decade after age 20. Protein Needs: Remain constant at 0.8 g/kg/day, though higher intake may help prevent muscle loss. Fat and Carbohydrates: Recommendations remain unchanged, but fiber requirements decrease slightly(Week+11+Lecture+19-+Nut…). Micronutrient recommendations for older adults vs. younger adults Increased Needs: Calcium (1,200 mg/day) and vitamin D (20 µg/day for adults over 70) to prevent osteoporosis. B12 Supplementation: Recommended due to reduced absorption in older adults. Iron Needs: Decrease in postmenopausal women but remain the same for men(Week+11+Lecture+19-+Nut…). Planning a nutritious diet for older Canadians Incorporate foods rich in nutrients but low in calories, such as fortified dairy, whole grains, and colorful fruits and vegetables. Address barriers like limited mobility by including easy-to-prepare or meal-delivery options(Week+11+Lecture+19-+Nut…). 24-Hour Movement Guidelines for Canadians over 65 Recommendations: ○ At least 150 minutes of moderate-to-vigorous activity weekly. ○ Muscle-strengthening activities twice a week. ○ Minimize sedentary behavior(Week+11+Lecture+19-+Nut…). Factors impacting older Canadians’ ability to eat well Barriers: Physical limitations (e.g., dental issues), social isolation, and economic constraints. Solutions: Use ready-made meals, senior meal programs, or shared meal preparation(Week+11+Lecture+19-+Nut…). How loneliness contributes to poor health in the elderly Loneliness increases the risk of depression, cognitive decline, and poor dietary habits. Those who live alone often lack motivation to prepare or eat balanced meals(Week+11+Lecture+19-+Nut…). Community nutrition programs for seniors Examples: ○ Meals on Wheels: Provides nutritious, affordable meals. ○ Congregate Dining: Encourages social interaction and meal-sharing. Resources: Emergency food supplies and support from senior centers EATING DISORDERS 1. Categories of eating disorders described by the APA: ○ Anorexia Nervosa: Characterized by extreme restriction of calorie intake, intense fear of gaining weight, and a distorted body image. Subtypes include the restricting type and binge-eating/purging type. ○ Bulimia Nervosa: Recurrent episodes of binge eating followed by inappropriate compensatory behaviors such as purging, fasting, or excessive exercise. ○ Binge-Eating Disorder: Recurrent binge-eating episodes without compensatory behaviors. Often linked to feelings of shame or guilt. ○ Avoidant/Restrictive Food Intake Disorder (ARFID): Avoidance of food based on sensory characteristics or fear of adverse consequences, not related to body image concerns. ○ Otherwise Specified Feeding and Eating Disorder (OSFED): Includes significant eating disorders that don’t meet criteria for other specific categories(Week 11 Lecture 20- Eat…). 2. Genetic factors influencing eating disorders: ○ Gene Variations: Impact proteins involved in appetite regulation, food intake, and energy balance. ○ Key Genes: Include serotonin receptors, melanocortin-4-receptor, and dopamine-related genes. ○ Epigenetics: Research suggests environmental influences may alter gene expression, predisposing individuals to eating disorders(Week 11 Lecture 20- Eat…). 3. Psychological factors influencing eating disorders: ○ Low Self-Esteem: Negative self-evaluation and feelings of worthlessness. ○ Trauma: Experiences such as bullying, abuse, or significant loss can contribute. ○ Perfectionism: A tendency towards rigid self-control and unrealistic standards(Week 11 Lecture 20- Eat…). 4. Society’s body ideal and eating disorders: ○ Media Influence: Cultural emphasis on thinness, especially in Western societies, pressures individuals to conform to unrealistic ideals. ○ Children’s Impact: By age seven, many children have engaged in dieting behavior due to societal messages(Week 11 Lecture 20- Eat…). 5. Psychological issues characterizing anorexia nervosa: ○ Fear of Weight Gain: Even when underweight, individuals may fear becoming fat. ○ Distorted Body Image: They perceive themselves as overweight despite being underweight(Week 11 Lecture 20- Eat…). 6. Behaviors associated with anorexia nervosa: ○ Food Restriction: Avoiding calorie-dense foods and consuming minimal amounts. ○ Excessive Exercise: Often used as a compensatory behavior. ○ Preoccupation with Food: Spending excessive time thinking or talking about food(Week 11 Lecture 20- Eat…). 7. Body changes due to anorexia nervosa: ○ Physical Symptoms: Severe weight loss, muscle wasting, and lanugo hair growth. ○ Hormonal Changes: Reduced estrogen or testosterone, leading to menstrual irregularities and bone density loss(Week 11 Lecture 20- Eat…). 8. Treatment for anorexia nervosa: ○ Multidisciplinary Approach: Combines psychological counseling, nutritional therapy, and medical monitoring. ○ Hospitalization: Necessary for severe cases to stabilize weight and prevent complications(Week 11 Lecture 20- Eat…). 9. Psychological issues characterizing bulimia nervosa: ○ Body Dissatisfaction: Individuals feel they are overweight despite normal weight. ○ Fear of Losing Control: Concern over binge-eating episodes creates feelings of guilt and shame(Week 11 Lecture 20- Eat…). 10.Behaviors associated with bulimia nervosa: ○ Binge-Purge Cycle: Alternating between overeating and compensatory behaviors like vomiting or laxative use. ○ Dieting: Cycles of restriction and overeating are common(Week 11 Lecture 20- Eat…). 11.Body changes due to bulimia nervosa: ○ Dental Erosion: Caused by stomach acid from repeated vomiting. ○ Electrolyte Imbalance: May lead to cardiac arrhythmias or muscle weakness(Week 11 Lecture 20- Eat…). 12.Treatment for bulimia nervosa: ○ Therapy: Cognitive-behavioral therapy to address disordered thoughts and behaviors. ○ Nutritional Counseling: Encourages a balanced diet and healthy eating patterns. ○ Medication: Antidepressants may help reduce symptoms(Week 11 Lecture 20- Eat…). 13.Eating disorders in men vs. women: ○ Prevalence: Eating disorders are less diagnosed in men due to cultural biases. ○ Differences: Men may develop eating disorders later and often aim for muscularity rather than thinness(Week 11 Lecture 20- Eat…). 14.Impact of eating disorders during pregnancy: ○ Health Risks: Increased likelihood of miscarriage, preterm birth, and low birth weight. ○ Developmental Concerns: Babies may have delayed growth, intellectual challenges, and social difficulties(Week 11 Lecture 20- Eat…). 15.Impact of eating disorders in children: ○ Symptoms: Delayed growth, lanugo hair, and nutritional deficiencies. ○ Prognosis: Early intervention can help children catch up in growth and prevent long-term complications(Week 11 Lecture 20- Eat…). 16.Eating disorders in athletes: ○ Prevalence: Higher in sports emphasizing weight or aesthetics (e.g., gymnastics). ○ Types: Includes Anorexia Athletica and the Female Athlete Triad (disordered eating, amenorrhea, osteoporosis)(Week 11 Lecture 20- Eat…). 17.Relationship between diabetes and eating disorders: ○ Diabulimia: Involves skipping insulin doses to induce weight loss. ○ Risks: Long-term complications include blindness, cardiovascular disease, and kidney failure(Week 11 Lecture 20- Eat…). MALNUTRITITION Malnutrition is defined by the World Health Organization (WHO) as “deficiencies or excesses in nutrient intake, an imbalance of essential nutrients or impaired nutrient utilization.” It can manifest as undernutrition or overnutrition. **Undernutrition** specifically refers to inadequate nutrient consumption, which may be due to poor appetite or increased nutrient needs, leading to negative impacts on body tissues, functional ability, and overall health. This condition can be complicated by acute illnesses, infections, and diseases that cause inflammation. **Lasting effects of malnutrition include**: - Muscle and fat loss - Weakness - Increased risk of falls and pressure injuries - Cognitive impairment - Weakened immune system - Organ damage - Mental health issues and poor quality of life - Impaired growth and development ## Malnutrition in a Canadian Context Malnutrition is a significant issue in Canada, often going undetected and untreated. Its consequences include: - Increased hospital stay lengths and readmission rates. - Burden on healthcare services, leading to higher expenditures; in 2017, costs associated with malnutrition resulted in an additional $2 billion in healthcare spending. - Particularly affects older adults and children, increasing their vulnerability to diseases and complications. **Prevalence in Canada**: - 1 in 3 children and 1 in 2 adult patients are malnourished upon hospital admission. - After discharge, 1 in 4 adult patients lose weight. - 1 in 3 adults aged 65+ living in the community are at nutrition risk. - 1 in 2 residents in long-term care homes are malnourished. ## Causes of Malnutrition Malnutrition can arise from various factors including: - **Nutritional deficiencies**: Low intake of essential nutrients due to poor diet or malabsorption issues. - **Chronic diseases**: Conditions that lead to increased metabolic demands or decreased appetite. - **Social factors**: Economic barriers that limit access to nutritious food. - **Psychological factors**: Mental health issues that affect eating habits. ## Sarcopenia: Definition and Diagnosis Sarcopenia is defined as “a progressive and generalized skeletal muscle disorder involving the accelerated loss of muscle mass and function (muscle strength), associated with increased adverse outcomes such as falls, functional decline, frailty, and mortality.” It can manifest acutely during illness or hospital admission or develop gradually over time. **Diagnosis of sarcopenia includes**: - **Muscle strength measurement**: Typically assessed using grip strength tests. - **Muscle mass assessment**: Techniques include dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), CT scans, or MRI. - **Physical performance evaluation**: Tests like gait speed, timed walks, or the Short Physical Performance Battery. ## Differentiating Sarcopenia, Malnutrition, Cachexia, and Frailty 1. **Malnutrition**: Characterized by reduced muscle mass with normal muscle strength. It responds positively to nutritional interventions. 2. **Sarcopenia**: Involves loss of both muscle mass and strength. Nutritional therapy may not fully reverse the condition. 3. **Cachexia**: Severe weight loss and muscle wasting associated with chronic diseases such as cancer or HIV/AIDS. It includes metabolic changes that are not solely reversible by nutrition. 4. **Frailty**: A state of vulnerability characterized by unintentional weight loss, exhaustion, weakness (low grip strength), slow walking speed, and low physical activity. It often coexists with sarcopenia. ## Causes and Treatment of Sarcopenia ### Causes: - **Nutritional factors**: Low protein intake, energy deficiency, micronutrient deficiencies. - **Inactivity**: Sedentary lifestyle or prolonged bed rest leading to deconditioning. - **Chronic diseases**: Conditions affecting mobility or appetite. ### Treatment: The treatment of sarcopenia typically involves a combination of nutritional support (increased protein intake) and physical activity (resistance training) to help rebuild muscle mass and strength. Malnutrition Screening Tools There are various screening tools for malnutrition; however, each has limitations: 1. **Mini Nutritional Assessment (MNA)**: - **Strengths**: Comprehensive; includes dietary intake assessment. - **Limitations**: Maybe too lengthy for some settings. Not suitable for all pat 2. **Malnutrition Universal Screening Tool (MUST)**: - **Strengths**: Simple; quick to administer. - **Limitations**: Does not account for specific dietary needs.requires training 3. **Subjective Global Assessment (SGA)**: - **Strengths**: Clinically relevant; considers medical history. - **Limitations**: Requires trained personnel for accurate assessment. 4. **Nutritional Risk Screening (NRS)**: - **Strengths**: Focuses on hospitalized patients; effective for acute care settings. - **Limitations**: Less applicable outside hospital settings. It is complex 5. **Food Frequency Questionnaire (FFQ)**: - **Strengths**: Useful for assessing dietary patterns over time. - **Limitations**: Relies on self-reporting; may not accurately reflect actual intake.limited to specific populations The INPAC pathway outlines a systematic approach for identifying and managing malnutrition in both pediatric and adult patients through: 1. Initial screening for malnutrition risk upon admission. 2. Comprehensive assessment by a dietitian if risk is identified. 3. Development of individualized nutrition care plans based on assessment findings. 4. Regular monitoring and adjustment of care plans as needed. Continuity of care recommendations emphasize the importance of: - Effective communication among healthcare providers regarding patient nutritional status. - Follow-up assessments post-discharge to monitor ongoing nutritional needs. - Patient education on nutrition management to prevent recurrence of malnutrition. Nutrition guidelines for Long-Term Care Homes include: 1. Providing individualized meal plans that meet residents' dietary requirements. 2. Ensuring meals are appealing and culturally appropriate to encourage consumption. 3. Regularly assessing residents' nutritional status to adapt care plans accordingly. 4. Implementing strategies to enhance social dining experiences to improve food intake among residents. These guidelines aim to improve the overall health outcomes of residents while addressing the specific challenges posed by aging populations within long-term care settings.

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