2:45-3:15 pm on thursday (28 th november). meet with quality assurance external reviewers for the...

2:45-3:15 PM on Thursday (28th November).

Meet with quality assurance external reviewersfor the school of professional studies.

Nutrition transfer student volunteers please email me and Marcy [email protected]

indicating whether you are year 1 or 2 andwith you willingness to do so- your help is verymuch required and appreciated. Thank you!!!

Winter 2013

Final exam 15 questions-short answer-point form covering whole term5 Q on diabetes and atherosclerosis10 Q on blood pressure, stroke, and kidney disease-10 points each- 3 hours-no choice on questions

The

Lecture 12- 26 November 2013

KIDNEY DISEASE

Outline of todays talk

I. Pathology

II. Socioeconomic factors contributing to ESRD

III. Elementary nutritional approaches to be taken to avoid and treat ESRD including foods available to those at risk

IV. First Nations and other Cape Breton individuals at risk

V. How is nutritional assessment made for kidney disease?

VI. How would one assess from a nutritional perspective the socioeconomics, pathology and success of

nutritional interventions relative to ESRD?

Kidney DiseaseI. Pathology

Types of Kidney Disease

glomerular diseasenephrotic syndromenephritic syndrome



glomerular diseasenephrotic syndrome

-loss of glomerlular barrier to

proteinnephritic syndrome

-inflammation of capillary loops of glomerulus



Diseases of the tubules and interstitiumacute renal failurepyelonephritisnephrolithiasis

Focus on end stage renal disease


Types of ESRD

Diseases of the tubules and interstitiumacute renal failure

sudden reduction in glomerular filtration rate-pre-, intrinsic and post- renal flow drops

pyelonephritisnephrolithiasis


Diseases of the tubules and interstitiumpyelonephritis-urinary tract infection

nephrolithiasis-kidney stones

End stage renal disease (ESRD)I. Pathology

End-stage renal disease

inability to produce waste products, maintain fluid, and electrolyte balance and produce hormones

diabetes

ESRD

I. Pathology

End-stage renal disease-associations

diabetes (types I and II)

glomerulonephritis

hypertension

End stage renal diseaseI. PathologyWhat are the risk factors?End-stage renal disease

Obesity and all its sequelae leading to metabolic syndrome

genetics and dietary risk factors for type I diabetes

End stage renal disease

I. PathologyWhat are the risk factors?

Glomerulonephritisinfection- immune

system requires adequate balanced

nutrition

End stage renal diseaseI. PathologyWhat are the risk factors?

Hypertension-damages tissues

-all causes of hypertension

Socioeconomic factorsFood and hence nutritional choices depend on:

Personal preference-protective factors(preventative)-absence is a risk factor

type I and type II diabetes-review

infection-review

hypertension-review

Socioeconomic factors

Food and hence nutritional choices depend on:

Habittype I and type II diabetes-review

infection-review

hypertension-review

Food and hence nutritional choices depend on:Ethnic heritage or tradition

type I and type II diabetes-review

infection-review

hypertension-review

Social interactionrelate social interaction to ethnic heritage or tradition


Availability of food

• type I and type II diabetes-review• infection-review• hypertension-review

Convenience of food



Economy of food

• type I and type II diabetes-review

• infection-review

• hypertension-review


Positive and negative associations





Emotional conflict





Values-how does this apply to:





Body image





Advertising-who is responsible for encouraging or not encouraging




More on socioeconomic factors

Prestige-occupational-

lower the occupation the greater the risk of ESRD-why?

low occupational fathers tend to have low or lower occupational kids

could be a number of generations before population end-stage renal disease risk is reduced


Prestige-occupational-

higher the occupation the less the risk of ESRD-why?

high occupational fathers tend to have high or higher occupational kids

could be a number of generations before population ESRD risk is increased among descendants of initial high

occupational fathers


Prestige

-societal perceptions-dictate ability of people to change their social rankings

-education-eg university professors and astronauts have a lot of sophisticated

education and they are rated highly-however this is no guarantee that there is no risk of ESRD


Power-based on societal perceptions to some extent

Income-also based on societal perceptions of the importance of the job to society


Wealth-based on education-lower classes tend to be less well educated and therefore less able to take advantage of the societal perceptions that improve one’s socioeconomic status including wealth

Education- lower classes tend to be less well educated and therefore less able to take advantage of the societal perceptions that improve one’s socioeconomic status including the benefits arising from that education


Social stratification

-ancestry-diabetes, infection, blood pressure

-gender-diabetes, infection, blood pressure

-race- diabetes, infection, blood pressure

-ethnicity- diabetes, infection, blood pressure


Social stratification-mobility-diabetes, infection, blood pressure

-mental and physical activity-mental patients-may be marginalised by society-what impact does this have onthe risk of ESRD?

physical activity



physical activity-ESRD risk lowered by chronic aerobic activity-caution with elevated blood pressure- blood pressure increases during aerobic exercise

- benefit with exercise comes after blood pressure is lowered in rest and during exercise- this is a training effect



physical activity-impact on type I and II diabetes

-impact on infection


Class-uppers-lower uppers-upper middles-average middles-working class-lower class

How might each of these classes have an impact risk or presence of ESRD?


Global economy-globalisation- impact on:• type I and type II diabetes-review• infection-review• hypertension-review

Government-nutrition policies affect risk of ESRD-how?



Business-promotion of globalisation-why would business promote globalisation?

Psychology-susceptibility to business tactics such as?- impact on the risk of ESRD?

History-one’s habits and childhood socioeconomic status

Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk

Planning a healthy diet

To do this bear in mindAdequacy

BalanceEnergy controlNutrient densityModerationVariety


Prevention-eat foods in accordance with:



Post-onset-eat foods in accordance with


IV. First nations and other Cape Breton individuals at risk.

Aboriginals

Retired

Unemployed

Genetics

Others?

How is nutritional assessment made for ESRD-prevention and cure?Nutrient intake analysis


How is nutritional assessment made for ESRD-prevention and cure?

Nutrient intake analysis

FLUID-WHY?SODIUM-WHY?POTASSIUM-WHY?CHLORIDE-WHY?GLUCOSE-WHY?CALCIUM-WHY?PHOSPHOROUS-WHY?

How is nutritional assessment made for ESRD- prevention and cure?

Daily food record/Diary

what are potential problems with this approach regarding ESRD?


Retrospective data

-24 hour recall

-food frequency questionnaire

both 24 hour recall and are used to cross check one another-how would this apply to ESRD


Anthropometry-


How is nutritional assessment made for ESRD--prevention and cure?

Nutrition focussed physical exam:



Skin testing-applicable

• type I -review• infection-applicable?• hypertension-applicable?


Biochemical analysis


How is nutritional assessment made for ESRD--prevention and cure?

Biochemical analysis

FLUID-WHY?SODIUM-WHY?POTASSIUM-WHY?CHLORIDE-WHY?GLUCOSE-WHY?CALCIUM-WHY?PHOSPHOROUS-WHY?


CLASSIFYING MALNUTRITION

obesity is the main issue here

thin individuals are much less at risk than obese persons

VI. GROUP DISCUSSION-HOW WOULD ONE ASSESS FROM NUTRITIONAL PERSPECTIVE THE SOCIOECONOMICS, PATHOLOGY AND SUCCESS OF NUTRITIONAL INTERVENTIONS RELATIVE TO ESRD ?

2:45-3:15 pm on thursday (28 th november). meet with quality assurance external reviewers for the...

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