Nutrition 577: Nutritional Problems in the U.STake-Home Final (100 points)

Due by 11:55 p.m. on Monday, December 17, 2018

 

Instructions: This is open-book, but must be completed individually. You may use your notes, readings, any other materials from this class, and online references, but please do your work. Post your completed work in the designated folder on Moodle by 11:55 p.m. on December 17, 2018. I will not accept work submitted after the deadline. Please put your last namein the title of the file that you upload to Moodleand your student IDat the top of each page in a header.

 

Put all of your answers in a blue font so that it is easy to distinguish.

 

1. (10 points) RESEARCH DESIGN

Use this abstract to answer the next set of questions. The abstract is from:

 

Am J Epidemiol. 2016 Mar 2. pin: kwv241. [Epub ahead of print]

Multiple Healthful Dietary Patterns and Type 2 Diabetes in the Women’s Health Initiative.

Cespedes EM, Hu FB, Tinker L, Rosner B, Redline S, Garcia L, Hinge M, Van Horn L, Howard BV, Levitan EB, Li W, Manson JE, Phillips LS, Rhee JJ, Waring ME, Neuhouser ML.

The relationship between various dietquality indices and risk of type 2 diabetes (T2D) remains unsettled. We compared associations of 4 dietquality indices-the Alternate Mediterranean Diet Index, Healthy Eating Index 2010, Alternate Healthy Eating Index 2010, and the Dietary Approaches to Stop Hypertension (DASH) Index-with reported T2D in the Women’s Health Initiative, overall, by race/ethnicity, and with/without adjustment for overweight/obesity at enrollment (a potential mediator). This cohort (n = 101,504) included postmenopausal women without T2D who completed a baseline food frequency questionnaire from which the four dietquality index scores were derived. Higher scores on the indices indicated a better diet. Cox regression was used to estimate multivariate hazard ratios for T2D. Pearson coefficients for correlation among the indices ranged from 0.55 to 0.74. Follow-up took place from 1993 to 2013. During a median 15 years of follow-up, 10,815 incident cases of T2D occurred. For each dietquality index, a 1-standard-deviation higher score was associated with 10%-14% lower T2D risk (P < 0.001). Adjusting for overweight/obesity at enrollment attenuated but did not eliminate associations to 5%-10% lower risk per 1-standard-deviation higher score (P < 0.001). For all 4 dietary indices examined, higher scores were inversely associated with T2D overall and across racial/ethnic groups. Multiple forms of a healthful diet were inversely associated with T2D in these postmenopausal women.

1. What was the goal of the study? Use your own words, not the words in the abstract.
2. What type of study was this?
3. What were the results? Use your own words.
4. What is a practical application of this study’s results?

 

Goal 2 pts	The primary purpose of the study was to find out the relationship that existed between type 2 diabetes and a variety of diet quality indices.
Type of Study 2 pts	The kind of study is a Cohort study because individuals who were affected with typeb2 diabetes were followed up with time and compared up with those who did not have the type 2 diabetes. It is also a meta-analysis because data from different research institutions were compared.
Results 3 pts	It was found out that the higher the scores that were shown by the patients, the better diet hence a lower risk for type 2 diabetes across all racial and ethnic groups, while a lower score indicated a higher risk for type2 diabetes hence a poor diet.   It was also seen that a 13% lesser type 2 diabetes was associated with 1- standard deviation higher score and this was seen in each dietary quality index.   When enrollment was carried out and an adjustment done on obesity and overweight, it was observed that the adjustment weakened, but it did not finish association to 7% decreased risk per standard deviation higher score.   It was also seen that type 2 diabetes in postmenopausal women was inversely associated with multiple forms of a healthful diet.
Practical application    3 pts	It can be used to establish the relationship between diabetes and dietary quality index Can be used to know how type 2 diabetes is related to multiple forms of healthful diet. It can be used to show how diet is related to type 2 diabetes.

 

2. (10 points) HEALTH DISPARITIES:

Refer to the Health Disparities class notes and readings for this section (https://scholar.harvard.edu/files/davidrwilliams/files/2013b_0.pdf).

1. What is individual racism? (see Williams and Mohammed in Final Exam Moodle folder)
2. What is institutional racism? (see Williams and Mohammed/Final Exam Moodle folder)
3. How can these forms of racism affect health outcomes?

 

Type of racism	Definition
Individual 3 pts
Institutional 3 pts	This refers to a type of racism that mainly occur in society as a whole and affect a large population of people. It can affect housing whereby some individuals have reduced access to housing; it can change the neighborhood and educational quality whereby some are exposed to poor educational services because of their race. Additionally, it can affect the employment opportunities whereby some few people have access to good jobs while others do not and can also change the desired resources in society.
How it can these forms of racism affect health outcomes 4 pts	·         They affect health in the sense that they develop policies that affect the environment making it hostile for the people who have been racially separated. ·         Racism also affects health by triggering negative stereotype whereby some people are taken to be a lousy group hence isolated from others, and this may make them depressed and affect health. ·         Racism also makes people develop negative discrimination whereby other groups are treated unjustly due to the race, and this affects their health. ·         Nevertheless, it has been shown by evidence from large and developed research centers that racial discrimination is the major causes of psychosocial stressors and this can lead to adverse effects on health and also causes a change in behavioral patterns that usually lead to increased risks of getting health problems.

 

 

3. (8 points) U.S. DIETARY GUIDANCE

Refer to lecture and the Dietary Guidelines for Americans website.

1. What are the Dietary Guidelines intended to be used for?
2. What are two changes in the 2015 Dietary Guidelinesthat differ from the 2010 Dietary Guidelines?

 

DG intended use 2 pts	·         They are intended to give the government a chance to speak in one voice when educating the public about proper dietary behavior for Americans who are of 2 years of age and above ·         It is also intended in helping the Americans to know how to make good decisions concerning food and physical exercises so that they can promote health and prevent the development of chronic diseases.
Two changes from 2010 to 2015 2 pts	The intake of sugars had reduced to reduce the risk associated with diabetes. The intake of calories was also reduced to eliminate the effects of obesity and overweight.

 

 

 

 

Nutrition Facts Information

1. What are two changes in the FDA’s proposed food label?
2. For the changes that you listed, do you support these changes and why/why not?

Two changes: 2 pts each	The FDA’s label new recommendations state that the claims on nutrients such as those of “low calories” are only to be used in specific and legalized circumstances. In the ingredient statement that is provided in the label, the allergens should also be clearly stated so that people can be aware.
Support/why or why not:  2 pts	I support this changes. This is because some companies use the “low calories” statement to lure people to buy their products while in the real sense they are of low quality. Additionally, if the allergens content of the products is known, then people can be able to understand what fits them and what they should avoid so that they cannot be affected.

 

 

 

4. (10 points) OBESITY
   1. List two measures of adiposity from class and/or readings that are used to assess the risk of chronic disease. For each step, list one pro and one con.

 

The measure (1 pt each)	Pros (1 pt each)	Cons (1 pt each)
Gold statement	It is a cadaver analysis hence more accurate than other methods.	It suffers from methodological error when data to be used in the study is collected.
BMI	It is an effective method because it can measure excess fat and not excess weight.	The effects such as ethnicity and muscle mass can affect the results obtained.

 

1. Briefly, describe one underlying mechanism in which obesity leads to one of the other chronic diseases that we discussed such as diabetes, CVD and cancer why (4 points)?

 

Obesity is in most cases associated with high levels of resistance to insulin, an elevated level of fibrinogen and C-reactive protein and usually have high pressure on the ability of their bodies to use insulin so as to control blood sugar levels correctly and all of these factors increase the risk of obtaining diabetes.

 

 

 

5. (10 points total) DIABETES

 

Modifiable risk factors (6 points)

1. List two modifiable risk factors associated with type 2 diabetes.
2. For each risk factor, provide brief information about the mechanism (why the risk factor increases or decreases the risk of type 2 diabetes or increases or reduces the risk of complications from type 2 diabetes).
3. For each risk factor, list a concrete method that can help reduce the risk of either diabetes or complications related to outcomes.

 

Modifiable risk factor 1 pt each	Mechanism information 1 pt each	Method to reduce 1 pt each
Physical inactivity	Lack of exercise causes the muscles to be unable to use insulin and glucose hence increasing the risk of diabetes.	Increase the amount of exercise done on a regular basis
Smoking	Smoking tobacco leads to increased levels of sugars in the body and also leads to high levels of resistance of the cells to insulin hence leading to type 2 diabetes	Reduce and even completely stop the smoking habit.

1. Fill in the following table for different types of diabetes(4 points)

 

	T1DM	T2DM	GDM
Onset 1 pt	Begins before age 40	Between age 45 and 64	24 to 28 weeks after pregnancy
Incidence & Prevalence 1 pt	The incidence of type 1 diabetes has been increasing by 2-5% in the whole world, and its central prevalence is 1 in 300 people of under 18 years.	The incidence of type 2 diabetes is that it occurs mostly on men, with an estimated number of 14million more men affected than women. Its prevalence increasessignificantly with age in both women and men.	It occurs mainly on pregnant women and obese people
Etiology (causes/origins) 1 pt	Occurs when the immune system of the body attacks and starts destroying the beta cells of the pancreas that produce insulin	Mainly occurs when a combination of lifestyle and genetics causes insulin resistance, and this causes the body to stop using insulin usually hence causing diabetes.	Occurs in cases of pregnancy in women where the placenta moves hormones to specific sites, and this leads to building up of glucose in the blood. In cases where the pancreas cannot make enough insulin to counter the high glucose levels, it leads to GDM
Risk factors (name 2) 1 pt	Family history has been the most significant risk factor whereby if a parent has diabetes then there is a high risk of the sibling in obtaining diabetes. Additionally, age can increase the risk of obtaining diabetes. Genetics is also a risk, whereby thepresence of specific genes increases the risk of getting diabetes	Weight can increase the risk of getting type 2 diabetes whereby the fatty tissues increase the resistance of cells to insulin. Family history also contributes to the risk whereby if a parent had diabetes, then the offspring also have higher chances of getting it.	GDM’s can be significantly increased by prediabetes, which is high sugar levels but not high enough to be called diabetes. A history where the parent had gestational diabetes can increase the risk of the offspring getting GDM diabetes. Hormonal disorders which include polycystic ovary syndrome also increase the risk.

 

 

 

 

6. (10 points) CVD
   1. List two modifiable risk factors associated with CVD.
   2. For each risk factor, provide information about the mechanism (why the risk factor increases or decreases either the risk of CVD or risk of complications from CVD).
   3. For each risk factor, list a concrete method that can help reduce the risk of either CVD or complications related to outcomes.

 

Modifiable risk factor 1 pt each	Mechanism information 2 pts each	Method to reduce 2 pts each
smoking	Smoking leads to an instant and also long-term increase in heart rate. Additionally, smoking reduces the amount of oxygen that reaches the heart and due to this, blood clots in the veins hence causing CVD. Additionally, smoking leads to the damage of the lining of the arteries and this causes the fats to accumulate hence blocking and narrowing the arteries leading to CDV.	The most effective way to prevent CDV caused by smoking is through reduced or quitting smoking.
overweight	Overweight is usually associated with obesity, and this leads to complications like high blood pressure and high cholesterol. High cholesterol blocks the veins making them narrow hence leading to cardiovascular diseases.	CDV that is caused by overweight can be reduced by eating a diet that is low in cholesterol. It can also be reduced by eating a diet that is rich in refined sugars. Diet rich in fibers can also significantly reduce the risk of CDV.

 

7. (10 points) CANCER
   1. If you had to focus on a single food group for cancer prevention (e.g., fruits and vegetables, grains, dairy, etc.), what would it be?
   2. Give at least three arguments for why this single group would be the most important to focus on.
   3. What is your recommendation for minimum/maximum consumption from that group? The group can have a positive or negative link to cancer.

 

Group 2 pts	Three Arguments 2 pts each	Consumption recommendations  2 pts
Fruits and vegetables	1. They are rich in antioxidants which are obtained from carrots, Brussels, and sprouts, and also squash and this helps reduce the risk of getting lung and mouthcancer.	The minimum amount of fruits and vegetables to eat in a day is 5 servings while the maximum is 15 servings. Useful results were obtained when 12 meals per day were used.
	2. Non-starchy vegetables which include spinach and also beans reduce the risk of getting stomach cancer.
	3. Ions like Mg that are obtained from fruits also help reduce the risk of getting cancer.

 

 

 

 

8. (2 points) OVERALL

 

If you could summarize your knowledge about the Nutritional Problems in the U.S. in ONE concise statement what would it be (do not use a run-on sentence please)?

 

Obesity is the major problem in the united states, and due to this, the government had formed many agencies that educate people on the effects and how to prevent obesity, hence curbing the problem before reaching medical attention.

 

 

STUDENT-GENERATED EXAM QUESTIONS FROM GROUP PROJECTS (30 pts)

 

 

9. (2 points) HFCS

 

1. What are two controversies of the impact of High Fructose Corn Syrup (HFCS) as a risk factor for obesity?(1 pt)

The significant debates that exist are whether HFCS is effective in weight reducing or they are just like the normal sugars.

There is also a significant argument about whether HFCS reduces obesity because it is observed that areas without HFCS have high rates of people with obesity.

 

 

 

1. Name two types of sugars?(1 pt)

Simple sugars which include glucose, galactose, and fructose

Table sugars which consist of sucrose

10. (6points) MICROBIOME

 

1. What are the different ways fecal microbiota transplantation (FMT) can be distributed to patients and what seems to be the most beneficial?(2 pt)

 

Fecal transplantation can be done by nasogastric tube installation of the fecal material and self-administered enemas.

The most beneficial method is the use of enemas because they are cheap and straightforward.

 

 

1. Name at least three factors that influence the microbiome? (2 pt)

The amount of exercise one does, whereby an increase in exercise increases the amount of microbiome in the gut.

The method of birth also determines the amount of microbiomewhereby those kids born by caesarian section and vaginally have bacteria that were introduced into their system. Breastfeeding also transmits bacteria into the body’s order from the mother.

The type of drugs taken also determine the amount of microbiome in the body whereby antibiotics usually kill some good bacteria in the body.

 

 

 

 

1. Describe the changes that bariatric surgery can have on the microbiome. (2 pt)

 

Bariatric surgery refers to a method that is used in the treatment of morbid obesity. When it happens, it increases the amount of microbiome present in the gut.

 

 

 

11. (2 points) Prebiotics/Probiotics

 

1. The use of probiotics does not have a significant impact on rebuilding the gut microbiota after antibiotic use (check whether you believe this statement is true or false).

 

___True                           _false___ False

 

1. The use of probiotics has a significant impact on reducing the need for antibiotics.

 

true___True                                ____ False

 

 

12. (4 points) Fetal Alcohol Syndrome

 

1. Pregnant Native American and Indigenous women between the ages of 18 and 45 years are at an increased risk of an alcohol-exposed pregnancy. What is (are) the best method(s) to prevent alcohol-exposed pregnancies in Native American populations?

 

Interventions, whereby women are taught about the effects of alcohol on their babies

Handouts which pregnant women can read and get informed.

Sample forms which women can be given where they can see what happened to the earlier women who use alcohol while pregnant and the effects they faced and this can make women afraid on the attempt to use alcohol while pregnant.

 

13. (12 points) General Questions

 

1. How could we improve the dietsof depressed institutionalized elderly?(3 pt)

 

By enhancing normal eating on the patients

By encouraging patients to eat more snacks

By making sure that depression checkups are done each time so that to know how they are progressing and any change they may need on their diet.

 

 

1. What are some specific consequences of antibiotic use by pregnant mothers?(3 pt)

Use of antibiotic during pregnancy causes unbalance in the bacterial environment of the mother and also the fetus. This may have adverse effects because it alters with the healthy growth and development of the baby and even the health status of the mother.

Use of antibiotics also alters the gut microbiota and also leads to change in the immunological changes in the intestine of the resulting offspring.

Antibiotics also lead to an alteration in the microbiome that is present in the vagina before birth, and this causes long-term effects on the microbial colonies that occur before the birth of a child.

 

 

1. African American mothers who delivered deficient birth weight preterm infants were more likely to report experiencing interpersonal racial discrimination during their lifetime than those African American mothers who gave normal weight infants at term. Analyses showed that this association persisted across what common risk factor?(3 pt)

Maternal stress is the most common risk factor, and this poses the importance of developing a course where these pregnant women can be taught how to cab with this.

 

 

 

 

 

 

 

 

 

1. How might food insecurity impact academic performance?(3 pt)

 

Food insecurity can have a long-lasting traumatic experience on the kids, and this may cause the kids to have antisocial behavior whereby they cannot even interact with other students to share academic information, and this affects educational performance.

Hunger trauma causes kids to lack focus in class hence affecting their education.

Food impacts the way children think, and if they are deprived of food, it may lead to a lack of proper function.

 

 

 

 

 

 

 

 

 

14. (4 points based on assessment) Final Question: Self-Assessment of Preparation and Participation.

 

Rate yourself for your preparation and participation in this class over the semester. For example, did you generally do the readings? Did you participate in small group discussions? Did you text or use the internet for non-class related reasons during class? Use letter grades (A, A-, B+, etc.) for your assessment. Provide a 1 sentence rationale for each category .A. this is because I was active in every activity that took place in class including group discussions, attending all the lectures and also reading all the notes.

 

Please be fair with yourself. For example, you do not have to have read every article before everysection to have generally been well-prepared for class, so do not mark yourself down if you occasionally did not do a reading before class. You also do not have to have talked in full-class discussions, as long as you were a regular contributor to small group discussions. Do not mark yourself down if you only participated in the small group discussions. I will also take this self-assessment into consideration when assigning your preparation/participation grade for this course.

 

PREPARATION

Letter Grade:

Rationale:

 

PARTICIPATION/ATTENTIVENESS

Letter Grade:

Rationale:

 
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