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Cholesterol Review• Cholesterol is a waxy fat-like substance. It is used to make

Bile, the production of Vit D, hormones and is found in every cell. Your body produces all you need. Cholesterol in your body comes from what your body makes PLUS what you eat. • All foods from animals contain some cholesterol. This includes

meats, such as beef, pork, lamb, chicken, and fish. It also includes dairy products, such as milk, cheese, and ice cream. Organ meats, such as liver, are especially high in cholesterol.

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• HDL/LDL/VLDL are carriers of cholesterol. “Good or bad cholesterol” is not true. It’s all the same cholesterol, it’s just “good or bad” determining on where it is carried (or stored) to within the body.

• The degree of lipid in a lipoprotein affects its density—the lower the density of a lipoprotein, the more lipid it contains relative to protein. The higher the density of a lipoprotein, the less lipid it contains relative to the protein.

Lipoproteins

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HDL are lipoproteins that carry it to “good places” – to the liver, which secretes the cholesterol in bile or converted to bile salts and excreted from the body.

LDL/VLDL are lipoproteins that carry cholesterol and Tg to “bad places” – deliver cholesterol to cells in the body and can build up on the artery walls.

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Triglycerides Triglycerides are type of fat found in the blood. (the

storage form of fat) Dietary fat and excess calories are converted to triglycerides. They travel to the bloodstream to be used for energy or stored as body fat. If you regularly eat more calories than you need (especially CHO and fat) you will likely have high Tg.

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What makes Total Cholesterol?

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How to Lower LDL Exercise Eat more Fiber Eat fish or take fish

supplements Eat vegetable protein and

nuts/seeds vs animal protein Lose excess weight (5-10%) Consume plant sterols

How to Raise HDL Don’t smoke Lose excess weight Exercise Choose healthy fats: MUFA,

PUFA Lose excess weight (5-10%) Alcohol in moderation

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Energy BalanceCH 6

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Measuring Energy calorie

◦ The amount of heat necessary to raise 1 g of water 1º C◦ 1,000 cal = 1 kcal

Too small of a unit to measure so:1 Calorie = 1 kcal

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Forms of Energy Thermic effect of food is the greatest energy output:

◦ Circulation◦ Respiration◦ Digestion◦ Absorption◦ Chemical energy :◦ Electrical energy:◦ Mechanical energy:◦ Thermal energy:

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Energy BalanceTotal overall energy balance depends on intake in relation to output

Energy IntakeThe main source of energy for all body work is food. This is supplemented with stored energy in the body tissue.

Sources of Stored Energy1. CHO: Glycogen (12-48hr reserve in liver and muscles)

2. Fat: Adipose tissue

3. Pro: Muscle mass

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The Body’s Total Energy Requirements Depend on:

1. REE/RMR

2. Physical Activity

3. Thermic Effect of food

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REE: Resting energy expenditureRMR: Resting Metabolic rate

The sum of all internal working activities of the body at rest.60% - 75% of body’s total expenditure

BEE: Basal energy expenditure Difficult to maintain, used in clinical practice. Will be slightly lower than REE/RMR

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Factors That Influence RMR:

• Lean Body Mass

• Growth Periods

• Body Temperature• Fever increases BMR by 7% by each 1ºF

• Hormonal Status

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Ways to Measure RMR

1. Indirect Calorimetry• Metabolic cart• MedGem/BodyGem

2. *Mifflin-St.Jeor equation or Harris Benedict equation

3. Thyroid Function test• Measure TSH• Not expressed in kilocalorie amount but is a gauge for

normal metabolic function

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• Thyroid is regulated by TSH made in the pituitary. TSH stimulates thyroxine.

• Blood test to determine TSH levels• Hypothyroidism:

• Does not produce enough Thyroxine• Metabolic rate is significantly lower than normal• Levothyroxine (synthroid)

• Hyperthyroidism: • Produces too much Thyroxine• Metabolic rate is significantly higher than normal• Antithyroid medication - Tapazole

Thyroid

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Physical ActivityPart of TEE

• Accounts for work or recreation• Highly variable• PA factor

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Thermal Effect of Food

TEF: Activities of digestion, absorption transport and storage of food. • The energy expenditure is approximately

10% of the foods energy content.

Ex: 600 calorie meal would take ~60kcal to digest

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Energy Requirements BEE

TEF

RMR = BEE + TEF

TEE = RMR + TEF + Physical Activity

* There are 3500kcal in one pound*

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Assignment1. Find your BMR using the general formula (p.84)

2. Find your TEE using the Mifflin-St.Jeor equation (p.85)

3. Without changing your PA, how many calories per day would you need to consume to lose one pound in two weeks?

4. What is your BMR if you have a fever of 102.6 F?

5. What are the two ways to lose or gain weight?

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Energy Needs and Life Cycle◦ Most rapid growth occurs during childhood? and adolescence?

◦ With adulthood, energy needs level off.

◦ Gradual decline as the aging process continues.

◦ There is an average decline of BMR of 1-2% per decade.

◦ A more rapid decline occurs at 40 for men and 50 for women.

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Weight Management Ch15

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Obesity Epedemic34.2% of adults in the US are overweight33.8% are obese5.7% are extreme obese16.9% of children and adolescents between 2 and 19 yo are obese

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Body Composition Four body compartments that make up the total body:

1.Muscle 2. Fat 3. Water 4. Bone

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Body Fat Methods

Body fat calipers Hydrostatic weighing Bioelectrical Impedance Anaylsis Dual Energy x-ray Air Displacement plethysmography – BOD POD

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Obesity: 20% above a desired weight for height

Overweight: body weight is above a population’s weight for height standard

BMI: Tool to see if your bodyweight falls in normal/overweight category

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BMI = Wt (kg)/Ht (m)² OR BMI= Wt (lb) x 703/Ht (in) ²

*ACSM “above average” 7-15% for 20-29 yo M and 14.5-22% for 20-29 yo F

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Adult BMI Chart

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Hamwi Method for Ideal Body Weight

Men: 106 lb for the first 5 feet then add or subtract 6 lb for each inch above or below 5 feet.

Ex: 6’2” = 106 + 84 ± 10% IBW = 171-209

Women: 100 lb for the first 5 feet then add or subtract 5lb for each inch above or below 5 feet.

Ex: 5’7½” = ± 10% IBW:

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Considerations for Ideal Body Weight

1. Frame Size:

2. Individual Variation

3. There is a biological need for fat: survival, reproduction◦ Minimum required for health: 5% men 12%women

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Body Frame Estimate: Height (cm)/wrist circumference (cm)

EX: IBW: 190# M Wrist circumference: 22.1cm What is his frame size? What is his IBW with frame size considered?

Male RatioSmall ˃10.4Medium 10.4 – 9.6Large ˂ 9.6

Body weight calculations

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Obesity: A National Epidemic

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Obesity and Health A National Epidemic What is to blame?

◦ Marketing?◦ Media and social images?◦ Lack of exercise?◦ Obesogenic environment?◦ Poverty?

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Health Implications• HTN• Hypercholesterolemia• DM• CHD• Cancer

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Causes of Obesity• Input vs. Output

3500kcal = one pound• Physical Activity• Genetics• Hormonal• Physiological• Psychological• Environmental Factors• Family Reinforcement

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Set Point Theory

• Researchers confirmed after wt gains or losses, the body adjusts the metabolism to restore the original wt

• Energy expenditure ↑ after wt gain and ↓ after weight loss

• Explains why it is so difficult for an overweight person to maintain weight losses

• It is possible for a person to change their “set-point” weight but it takes time and effort

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◦ Leptin: Released from the fat tissue to regulate satiety, food intake and bdwt

◦ Early-Onset Obesity – Lack the leptin receptor. 3%

◦ Ghrelin – Appetite stimulate secreted from the stomach◦ Investigations of the use of ghrelin antagonist

Hormonal

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Genetic and Family Factors Strongest factor

Potential body fat to carry

Family reinforcement

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Physiological Factors Fat cells

Critical period in childhood

BMR, PA, LBM

Women store more fat during pregnancy and menopause

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Psychological Factors Stress and comfort food

Societal pressure

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Environmental Factors Energy-dense food availability Convenience foods Portion Sizes ↓ in Food Preparation and Skill Physical Activity Screen Time↓ physical requirement in household chores

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Extreme Practices for Weight Loss

Fad diets

Fasting

Specific Macronutrient Restrictions

Drugs◦ Fen-phen, meridian, orlistat

Surgery◦ Gastric restriction, lipectomy

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Sound Weight Management Program

Detect Problem Behaviors Record and analyze food intake Plan a behavior management strategy Set realistic goals Find a negative energy balance Make it nutritionally adequate Know the food groups! Don’t reinvent the wheel. Use choosemyplate.gov

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The Non-Diet ApproachPersonalizedMust be motivatedMany factors considered

◦ Food◦ Exercise◦ Stressors◦ Family support

Goal: 1 – 2 lbs. or 1% of BW/week

◦ It’s a marathon, not a sprint

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Disordered Eating Patterns of eating that may lead to a full blown eating disorder

◦ Anorexia Nervosa◦ Bulimia Nervosa◦ Binge Eating Disorder◦ Orthorexia

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Children and Weight Loss Goal: Weight Maintenance Physical Activity is key Get kids involved with cooking and learning Roles for building a healthy eater

◦ Parent: What is served and When◦ Child: Whether to eat and how much