Energy Balance and Obesity
Diet and Health
Pregnancy Nutrition
Lactation, Infants and Childhood Nutrition
Childhood and Adolescent Nutrition and Energy Balance
100

Mary is a 32-year-old female patient in your program; she is 62 inches (1.57m) tall and weighs 216 pounds (98.2kg). Calculate her BMI and classify her level of health. 

98.2/1.57^2 = 39.9 

Obese 

100

List the cut points for all of the blood lipid guidelines. 

Total Cholesterol: 

  • Desirable: less than 200 mg/dL
  • Borderline High: 200 -239 mg/dL
  • High (unhealthy): 240mg/dL and above

LDL Cholesterol: 

  • Optimal: less than 100m/dL
  • Near optimal: 100-129mg/dL
  • Borderline: 130-159mg/dL
  • High: 160mg/dL and above

HDL Cholesterol: 

  • Unhealthy: less than 40mg/dL
  • High (healthy): greater than 60mg/dL

Triglycerides: 

  • Unhealthy: 200-499mg/dL
  • Borderline: 150-199mg/dL
  • Healthy: less than 150 mg/dL
100

Define the critical period. 

  • Finate periord during development in which an adverse event occuring before or during leads to permanently impaired development.
  • All systems have a critical period (heart, brain, lungs)
100

Describe nutrition needs for lactation.

  • Additional 500kcal with 330kcal coming from the diet.
  • Adequate water intake.
100

Define the cut points of childhood growth using the growth curves.


  • Underweight: less than 10th percentile
  • Healthy: 10th – 85th percentile
  • Overweight: over 85th – 95th percentile
  • Obese: over 95th percentile
200

List the cut points for BMI, Waist Circumfrence, and Body Fat Percentage as a measure of obesity. 

BMI: 

  • Underweight: less than 18.5
  • Normal weight: 18.5 -24.9
  • Overweight: 25 – 29.9
  • Obese: greater than 30

Wasit Circumfrence: 

  • Men: >102cm (40 inches)
  • Women: >88cm (35 inches)

Body Fat Percentage: 

  • Males: >22% body fat; >25% in men 40+
  • Females: >32% body fat; >35% in women 40+
200

Define Metabolic Syndrome 

A cluster of risk factors: any 3 of the following

  • Central obesity based on waist circumference.
  • High triglycerides (>150mg/dL)
  • Low HDL (<40mg/dL)
  • Prediabetes or Diabetes
  • Hypertension
200

List weight gain recommendations, including timing of weight gain and total weight gain according to BMI, during pregnancy and components of weight gain. 

Recommendations: 

  • 2-4lbs total during the first trimester (weeks 1 to 13/14)
  • ½ to 1lb per week during the second and their trimester (2-4lbs/month)
  • Underweight (BMI < 18.5): 28-40lbs – increased risk for low-birth-weight infant
  • Normal (BMI 18.5-24.9): 25-35lbs
  • Overweight (BMI 25-29.9): 15-25lbs
  • Obese (BMI 30+): 11-20lbs

Components: 

  • Infant at birth ~ 7.5lbs
  • Mothers’ necessary fat stores ~ 7lbs
  • Increased blood supply and fluid volume ~ 4lbs each
  • Increased size of uterus & supporting muscles, breast size, and amniotic fluid ~ 2lbs each
  • Placenta ~ 1.5lbs
200

What healthy eating habits should be followed for toddlers and children?

Juice: 

  • No more than 4oz for children ages 2-3
  • No more than 4-6oz for children ages 4-5

Milk: 16-20 oz 

Timing: 4-6 times a day of meals/snacks 

Avoid: choking hazards, sodium, and added sugars.


200

List complications of obesity in children and adolescents


  • Abnormal blood lipids
  •  high blood pressure
  • high fasting insulin
  • asthma
  • sleep apnea
  • fatty liver
  • psychological & social disturbances.
300

Describe the etiological factors for obesity (7). 

  • Physiology – hormones, appetite control
  • Environmental cues – stress, portion sizes, exposure to foods
  • Genetic Heredity – genetic predisposition
  • Governmental, economic, and societal factors – school nutrition, advertising, fast food
  • Lifestyle choices – sleep, exercise, diet
  • Group or social influences – peer pressure, holidays, social outings
  • Physical environment – walkability, neighborhoods, food deserts
300

Describe how Saturated Facts, Unsaturated Fats, and excessive simple carbohydrate intake effects blood lipids. 


Saturated Fats (tropical oils and animal products): increased blood cholesterol and LDL (greatest effect on lowering LDL comes from removing saturated fats, followed by weight reduction and soluble fiber). 

Unsaturated Fats (Omega 3's and 6's & Peanuts, Olive Oil, Avocados, etc.): decrease cholesterol and LDL. 

Excessive CHO: decrease HDL cholesterol and increase triglycerides. 

300

Describe the impacts of gestational diabetes on the health of a pregnant person and the fetus.


  • 30-50% of women with GDM will develop Type II Diabetes later in life.
  • Hypertension
  • Macrosomia – large baby
300

Identify characteristics of breast milk that make it the ideal food for infants.

  • Immune Support
  • Easily Digested
  • Energy-Nutrient balance
  • Has a proper nutrient balance with high lipid levels – brain development.
  • Protects against other health risk.
300

Describe factors that contribute to obesity in this age group


Nutritional Factors: Frequently eating out, added sugars, food marketing, energy dense snacks, and irregular meal and snack times.

Lifestyle Factors: Insufficient sleep, sedentary activity, limited physical activity.


400

Identify the Health Benefits of Modest Weight Loss 

  • Decreased cardiovascular risk.
  • Decreased glucose and insulin levels.
  • Decreased blood pressure.
  • Decreased LDL, triglycerides, and increased HDL.
  • Decreased severity of sleep apnea.
  • Reduced symptoms of degenerative joint disease.
400

Identify the Blood Pressure Cut offs and Risk Factors for Hypertension. 

  • Normal BP: Less than 120 and less than 80 mmHg
  • Elevated BP: 120-129 and less than 80 mmHg
  • High BP Stage 1: 130-139 or 80-89 mmHg
  • High BP Stage 2: greater than or equal to 140 or greater than or equal to 90 mmHg

Risk Factors: smoking, obesity, sedentary lifestyle, poor diet, age, & genetics

400

List nutrition related concerns during pregnancy and strategies to cope or prevent them. 

  • Avoid swordfish and shark due to high levels of mercury.
  • Limit canned albacore tuna to 6oz/week and other fish to 120z/week
  • Avoid deli/lunch meats & hot dogs unless heated until steaming due to risk of Listeria.
  • Avoid smoked fish.
  • Avoid brie, feta, & blue cheese made from unpasteurized milk due to risk of Listeria.
400

What three nutrients are key to infant health?

  • Vitamin D: supplementation for breast–fed infants or those drinking less than 1L of formula per day.
  • Iron: adequate stores during months 4-6 but supplementation may be needed after this period of time.
  • Vitamin K: injection at birth
400

Identify possible environments/relationships in children and adolescents and how they can affect nutrient intake, meal patterns and health.

Family: 

  • Children learn from their families first – nutrition and physical activity.
  • Family meals matter – healthy eating patterns, healthy nutrient intake, etc.

Peers: 

  • Childhood: watching other children eat may increase intake of certain foods.
  • Teenagers: eating becomes social – eating out more often

School: 

  • Lunches provide at least 1/3 of a child’s needs for key nutrients.
  • Availability of produce, whole grains, low-fat dairy, and other foods for growth.
  • Competitive foods offered at schools.
500

List and Describe Lifestyle Strategies for Weight Loss

  • Gradual, sensible, and permanent changes
  • Build social support.
  • Focus on non-weight outcomes.
  • Alter your eating environment.
  • Eat regularly and consistently, consume fiber, low energy dense foods and high nutrient dense foods.  
500

List and describe specific dietary recommendations for reducing cardiovascular disease risk (how are they different from the dietary guidelines?). 

  • Saturated fats: (less than 10% of total kcal) reduced further to less than 5-6% for those with diabetes or elevated LDL.
  • Cholesterol: less than 200mg if diabetes or elevated LDL present
  • Trans fat: as low as possible
500

Describe the changes in Kilocalories, Protein, and Vitamin needs that occur during pregnancy. 

Kilocalories: 

  • 2nd trimester: 340kcal/day
  • 3rd trimester: 450kcal/day

Protein: 

  • 0.8g/kilo + additional 25 grams

Vitamins: 

  • Folate RDA: 1.5x higher
  • Calcium: 1000-1300mg/day (no RDA increase) 
  • Iron: absorption increases 3x (no increased RDA) -- avoid inhibitors and consume promotors. 
500

Describe the timing of the introduction of pureed foods, solid foods, allergens, water, and honey to an infant. 

Pureed Foods: 4-6 months 

Solid Foods: around 6 months - start with complementary, soft, and small pieces. 

Allergens: 

  • Should be introduced around 6 months at the same time that solids are being started.
  • Dairy, peanuts, tree nuts, fish, wheat, soy, and sesame
  • Dairy: yogurt & cheese
  • Peanut: thin peanut butter with water
  • Tree nut: thin nut butter with water

Water: 6 months

Honey: 1 year

500

Identify prevention and treatment strategies for overweight and obesity in children and adolescents. 

  • Monitoring beverage intakes, including juices, and avoiding sweetened beverages.
  • Eat 3 meals a day plus 1-2 snacks.
  • Follow MyPlate guidelines.
  • Don’t offer snacks too close to mealtimes.
  • Avoid grazing or eating while watching TV or using the computer.
  • Don’t use food as a reward or punishment.


*Slow weight gain -- do not restrict weight or encourage weight loss 

*Let child grow into weight as they get taller.  

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