Nutrition risk

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  • Poor nutrition is a major problem in older Americans. Inadequate intake affects approximately 37 to 40 percent of community-dwelling individuals over 65 years of age (Ryan et al., 1992). In addition, the vast majority of older Americans have chronic conditions in which nutrition interventions have been demonstrated to be effective in improving health and quality-of-life outcomes. Eighty-seven percent of older Americans have either diabetes, hypertension, dyslipidemia, or a combination of these chronic diseases (NCHS, 1997).

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  • Nutritional Status Assessment Full nutritional status assessment is reserved for seriously ill patients and those at very high nutritional risk when the cause of malnutrition is still uncertain after initial clinical evaluation and dietary assessment. It involves multiple dimensions, including documentation of dietary intake, anthropometric measurements, biochemical measurements of blood and urine, clinical examination, health history, and functional status. For further discussion of nutritional assessment, see Chap. 72.

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  • The latest research shows that the foods we choose to eat—or not to eat—may increase our life span or the quality of our lives. Not a day goes by, it seems, without feature news stories about food and its impact on health. The message that we can reduce our chances of developing cancer, high blood pressure, diabetes, and other diseases by maintaining a healthy weight, decreasing the fat and calories in our diets, eating more vitamin- and mineral-rich fruits and vegetables, and getting fit is becoming a familiar one.

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  • It has been recognized for many years that states of nutrient deficiency are associated with an impaired immune response and with increased susceptibility to infectious disease. In turn, infection can affect the status of several nutrients, thus setting up a vicious circle of under nutrition, compromised immune function and infection.

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  • Starting in the spring of 2009, a fast recovery in global equities and a rise in house values in many economies (the euro area and Japan are exceptions) were accompanied by a reduction in corporate bond spreads and other risk premia (Graphs II.1 and III.2, top panels), though some risk measures have meanwhile risen again in the context of the Greek sovereign debt crisis. Reported VaR figures show that risk as measured by potential losses from banks’ trading positions remains high (Graph III.2, bottom left-hand panel).

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  • Cardiovascular disease, including coronary heart disease, strokes and diseases of other arteries, is a major cause of early death and disability. For many years the major markers of disease risk have been well recognised: these include high blood cholesterol levels and smoking. But it has also been recognised that these markers do not account for all cardiovascular risk. Furthermore, treatments that are highly effective in altering these markers, for instance the ‘statin’ drugs used to lower cholesterol, do not remove risk entirely: typically they reduce it by about 30% or less.

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  • Intravenous nutrition (IVN), also known as parenteral nutrition (PN), involves the administration of nutrients, electrolytes, minerals and fluid directly into patients’ veins. It is used in patients whose gastrointestinal absorption of food and/or fluids is inadequate, unsafe or inaccessible. Infusing a mixture of nutrients and fluid, however, is not without risk.

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  • The Animal Production and Health Section of the Joint FAO/IAEA Division of Nuclear Techniques in Food and Agriculture recognises that the trend towards intensification of livestock production in developing countries presents both opportunities and challenges. The potential opportunities are the flow-on benefits to the producers and local economy while the potential challenges are the flow-on costs to the environment, animal health and welfare.

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  • Nutritional History A nutritional history is directed toward identifying underlying mechanisms that put patients at risk for nutritional depletion or excess. These mechanisms include inadequate intake, impaired absorption, decreased utilization, increased losses, and increased requirements of nutrients. Individuals with the characteristics listed in Table 72-3 are at particular risk for nutritional deficiencies.

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  • Physiologic Characteristics of Hypometabolic and Hypermetabolic States The metabolic characteristics and nutritional needs of hypermetabolic patients who are stressed from injury, infection, or chronic inflammatory illness differ from those of hypometabolic patients who are unstressed but chronically starved. In both cases, nutritional support is important, but misjudgments in selecting the appropriate approach may have disastrous consequences.

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  • Although PN was initially relatively expensive, its components are often less expensive than specialty enteral formulas. Percutaneous placement of a central venous catheter into the subclavian or internal jugular vein with advancement into the superior vena cava can be accomplished at the bedside by trained personnel using sterile techniques. Peripherally inserted central catheters can also be placed within the lumen in the central vein, but this technique is usually more appropriate for non-ICU patients.

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  • The additional material includes a new Background section, intended to provide a broad overview of breast cancer for non-clinicians; a new Topic 1, Primary care and the management of women at high risk; and a new Topic 8, Management of advanced, recurrent and metastatic disease. The topic areas and numbers therefore differ from the original Manual. Material in the Evidence sections of the topic areas is based on systematic reviews of research evidence carried out by the NHS Centre for Reviews and Dissemination.

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  • A second potential source of the discrepancies may come from how the exposure or lack of exposure to environmental tobacco smoke is determined. Studies have shown that people can recall recent exposure very well but that remembering the duration and degree of distant exposure (such as whether their grandparents or baby-sitter smoked) is difficult. Yet one study examined this issue and found that women tended to underestimate their exposure, an effect which would decrease the observed risk.

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  • For some doctors in affluent countries the first question about prevention of coronary heart disease (CHD) nowadays is whether to write a prescription for one of the statins (simvastatin, pravastatin, fluvastatin, atorvastatin, etc) which inhibit an early step of cholesterol biosynthesis in the body (see p 7). Tables are available to show whether the 5- or 10-year risk justifies the cost of long term statin medication, but the relation of diet and CHD is still of primary importance for the majority of people. What we eat is bound up with the aetiology of CHD.

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  • TIGTA’s audit work is concentrated on high-risk areas and the IRS’s progress in achieving its strategic goals. To identify FY 2012 high-risk areas for audit coverage, TIGTA uses a risk- assessment strategy within its core business areas. The Assistant Inspectors General for Audit advise the Deputy Inspector General for Audit on the major risks facing the IRS in their respective program areas and annually propose a national audit plan based on perceived risks, stakeholder concerns, and follow-up reviews of previously audited areas with significant control weaknesses.

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  • Prostate cancer is the most common male cancer diagnosed in Western populations. Autopsy studies have shown that with increasing age, the majority of men will develop microscopic foci of cancer (often termed “latent” prostate cancer) and that this is true in populations that are at both high and low risk for the invasive form of the disease (1). However, only a small percentage of men will develop invasive prostate cancer. The prevalence of prostate cancer is, thus, very common; but to most men, prostate cancer will be only incidental to their health and death....

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  • Nutrition is an important lifestyle factor that contributes to our general feeling well. Recently, it has even further suggested, based on a number of epidemiological studies, that our diet is also associated with the risk of developing a number of chronic diseases, such as diabetes type II, cardiovascular diseases, osteoporosis, many types of cancer, just to name few. Thus, a balanced nutrition is firmly interwoven with many aspects of our long-term health, including the prevention of diseases, albeit this is typically rather associated with the medicinal areas.

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  • Early feeding may modify the risk of both type 1 (T1D) and type 2 diabetes (T2D) later in life. The information generated so far is, however, controversial. When evaluating studies on the impact of early feeding on risk of later diabetes, the data have to be assessed critically and possible confounding factors have to be considered. The study design may induce biases and there are considerable differences in early feeding practices across various countries and cultures. Accordingly it may not be possible to generalise observations based on one population.

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  • Other adjustments include the incorporation of body mass index, the use of finasteride, percentage free PSA and [-2]pro-PSA. It should be noted that the results of the Cancer Risk Calculator for prostate cancer may not be applicable to all men as most participants in the PCPT were Caucasian, and results may not be applicable to men of other races. In addition, most men in this study underwent a sextant prostate biopsy. This has now been largely superseded by an increase in the number of systematic biopsies taken routinely (Heidenreich et al. 2010).

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  • Next, we examine predictability in both benchmark returns and fund risk loadings. Consider the dogmatist who believes in such a predictability structure (PD-2). This investor would experience a nontrivial utility loss of 15.1 basis points per month (1.8%/ year) in December 2002 if forced to hold the optimal portfolio of the ND. The utility loss is even larger over the course of all 276 monthly investments. This loss averages 21.1 (39) basis points per month over expansions (recessions).

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