Note Exam 180 minutes 120 multiple choice questions-120 points -4 short answer question-60 points multiple choice-lecture 7a onwards short answer-whole Nutrition 263 course

Short answer Atherosclerosis- obesity decreases HDLc and increases LDLc leading to plaque development Hypertension-plaque development in atherosclerosis narrows the blood vessels and reduces the ability of the blood vessels to vasodilate thus increasing pressure Type 2 diabetes-obesity leads to increased plasma free fatty acids concentration which reduces insulin sensitivity thus triggering type 2 diabetes

Short answer nitrosamines- attack pancreatic beta cells thus eliminating insulin production and secretion and thus resulting in type 1 diabetes Cow’s milk under the age of 1 year- casein precipitates attack on pancreatic beta cells thus eliminating insulin production and secretion and thus resulting in type 1 diabetes

Lecture 9a 14 March 2011 Disorders of the Upper GI tract

Mouth Chewing Impaired due to: -sedation and pain Solution -mechanical soft diet food selection or pureed foods what is the difference?

Mouth Chewing Solution -pureed foods -can be boring -bore factor may be overcome by commercially available thickeners- candidates?

Mouth Chewing Solution -pureed foods -make more appealing by: variety colour serve foods at right temperature seasonings and spices supplement with nutritious liquids like milk, instant breakfasts, or liquid formulas

Mouth ulcers -caused by? Solutions -moist soft textured foods and eliminate spicy, salty and acid foods -example of each of these food types?

Inflammation of throat and lips -nutritional approaches-see mouth ulcers Reduced flow of saliva: -moisten foods with sauces and gravies -problem with this? -avoid salty foods and snacks (examples) that dry mouth -give sugarless candy

Dysphagia -difficulty swallowing -aging, neurological disorders, developmental disabilities and strokes -muscles cannot not push food back to back of throat or push foods down the esophagus into stomach

Achalasia -cardiac sphincter does not open up-it fails to relax -food backs up until sphincter opens or there is regurgitation

Indications of dysphagia -pain on swallowing, weight loss, feeling food is sticking in mouth -tendency to hold food in mouth rather than swallowing, -choking or coughing during meals, -frequent throat clearing, drooling or change in voice quality

Dysphagia Dietary interventions -mono-texture meals -mildly spiced and moderately sweet foods served at room temperature -avoid sticky foods and foods that break into small pieces when eaten -avoid true liquids – thickened liquids are better (eg milkshakes and puddings)

Dysphagia Dietary interventions -posture- sit up, feet flat on floor, head tilted slightly forward to avoid choking -tube feedings –intestinal tubes may be better than stomach tubes to avoid aspiration

Esophageal reflux -eat small meals and drink liquids one hour before or after a meal -limit foods that weaken cardiac sphincter (fat,alcohol,caffeine) -lose weight -avoid cigarettes -during reflux avoid acidic foods like citric acid juices, tomatoes, spices,very hot or very cold foods

Nausea and vomiting Nausea -avoid foods and aromas that make one nauseous -do not overeat -drink cold or carbonated liquids upon first sensation of nausea -eat carbohydrate-rich, low fat foods before getting out of bed in morning -if cyclical avoid food at critical times -ginger or peppermint teas provide relief for some people -relax after eating

Vomiting -if resolves clear fluids to replace water and electrolytes -otherwise iv feedings

Gastritis Except as tolerated avoid -alcohol and caffeine -decaffeinated coffee -pepper and spicy foods -fatty and greasy foods -any other offending agent -B 12 (injection or prescription nasal spray) as indicated

Ulcers Post-onset - eat slowly, chew well -avoid overeating and any foods than irritate the ulcer e.g. -alcohol and caffeine -chocolate -pepper and spicy foods

Class activity Design a diet for the pathology/problem of your choice than meets the dietary principles of adequacy, variety, moderation, nutrient density, energy control, and balance