Summer 2005 – Final Exam

Thursday, July 28, 12:50PM, 201 PE Gee

Lecture materials Chapter 11-Achieving and Maintaining a Healthful Body

Weight Chapter 9 – Nutrients Involved in Bone Health 20 MC/TF questions See www.cwu.edu/~geed tomorrow for study guide Take Home essay question (turn in with final)

What is the role of American Society in Addressing the US Obesity Crisis?

1 page, double space, 12 pt font, 1” margins 10 pts: grammatically perfect, well thought out, clearly states

and defends position.

Bergman/Bennett – 40 MC/TF questions

The Vitamins

David L. Gee, PhDProfessor of Food Science and Nutrition

Central Washington UniversityFCSN 245 - Basic Nutrition

Dietary Supplement Use (USA)

$ 4,300,000,000 for vit/min in 1995$ 1,400,000,000 for herbs35-40% adults regular users

females > males 66% multi-vit/min 37% vitamin C 19% vitamin E Calcium supplements

Dietary Supplement Use: Pros

Supplements dietary deficiencies calcium folic acid

Useful for those with limited caloric intake Elderly Dieters children

Amounts used in some studies not attainable with dietary sources antioxidants

Relatively low cost

Dietary Supplement Use: Cons

False sense of security folic acid and pregnancy Supplement may a marker chemical and not the actual protective agent

Does not contain all potentially useful chemicals in foods Example: compounds found in plants that may be health promoting

(phytochemicals)

Toxicity almost only due to supplement useCosts significant

low income Heavy users of supplements (athletes) Certain supplements are expensive

Chondroitin sulfate – bone/cartilage: $30-50/mo SAMe – depression: $40-50/mo

The Discovery of Vitamins

The Germ Theory of Disease Scurvy: Disease of sailors Beri-Beri: Disease of poor Asians Rickets: Disease of poor Northern

European children Pellagra: Disease of poor corn

eating cultures

The Discovery of VitaminsThe Vitamin Theory of Disease

Scurvy: Disease of sailorsVitamin C deficiency

Beri-Beri: Disease of poor AsiansThiamin deficiency

Rickets: Disease of poor Northern European childrenVitamin D deficiency

Pellagra: Disease of poor corn eating culturesNiacin deficiency

Vitamin NomenclatureFat soluble “A” & Water soluble “B”“Vital amines” = vitamines =

vitaminsVitamin B “complex”

collection of water soluble vitamins that function as enzyme co-factors

Vitamin CVitamins D and EMistaken Vitamins

Vitamins: Definition

Organic compound found in foods

Required in small amountsRequired in the diet (essential)Proven to be required for health,

growth, and reproduction deficiency syndrome identified

Fat and Water Soluble Vitamins

Fat Soluble Vitamins (A, D, E, K)

Soluble in lipids and solventsExcess stored and not excretedExcess may be toxicDeficiency slow to develop

Fat and Water Soluble Vitamins

Water Soluble VitaminsB vitamins, CSoluble in waterexcess excreted in urine, little

storedgenerally less toxicdeficiency develops quickly

General Functions of Vitamins

HormonesVitamin D

calcium homeostasisVitamin A

cell division and development

General Functions of Vitamins

Non-specific chemical reactions

Vitamin E antioxidant

Vitamin C chemical reducing agent

General Functions of Vitamins

Coenzymes or Cofactorschemicals that assist enzymes

to function as catalysts B vitamins Vitamin C, A, K

Vitamin D: Types and Sources

Dietary sources: animal foods, fortified milk

Human Synthesis of Vitamin DSkin: cholesterol + sunlight

“Sunshine Vitamin” – UV-B rays Vitamin D3

5-10 minutes, arms and legs, mid-day sun

Liver & Kidney for activation 1,25-di-OH-D3

Vitamin D: Functions

Helps regulate blood calcium levels

Dietary calcium absorptionUrinary calcium excretionBone calcium metabolism

Vitamin D: Deficiency

Rickets bone deformities in children

Osteomalacia weak bones due to low calcium content Vitamin D deficiency Calcium deficiency multiple pregnancies

Vitamin D: Toxicity

5 times the RDA chronically calcification of soft tissue toxicity due to excessive vitamin supplementation

Calcium

FunctionsBone Structure (99%)Regulator of Metabolism (1%)

nerve impulse transmission muscle contraction blood clotting etc.

Calcium

Regulation of Blood Calcium 10 mg/dl of blood

hypocalcemia & hypercalcemia abnormal muscle cramping nerve irritation

Controlled by: vitamin D, parathyroid hormone, calcitonin

Calcium RDA

1998 RDA’s 1300 mg/d : children & teens 1000 mg/d : adults 1200 mg/d : older Americans

Usual intakes are low

Osteoporosis

Brittle, weak bones due to loss of total bone mass (minerals and protein)

Prevalence 11% of > 65 yrs 22% of > 65 yrs in 20 yrs 24 million fractures/yr 200,000 hip fractures, 1/6 fatal

Normal Bone

Osteoporotic Bone

Changes in the spine with osteoporosis

Other osteoporosis fact:National Osteoporosis Foundation - 2003

10 million with osteoporosis 18 million with low bone density

1 in 2 women will develop osteoporosis sometime in their life (1 in 8 men)

Osteoporosis

Risk FactorsGenetics

Family History Ethnicity Caucasian > Asian > Blacks

Osteoporosis

Risk FactorsGender

associated with declines in estrogen production

post-menopause anorexia, female athletes

Undertreatment of Osteoporosis in Men with Hip Fracture.

Arch. Int. Med. (Oct. 2002)

10 million Americans with osteoporosis 2 million are men

Of 110 men hospitalized with hip fracture 4.5% received treatment for osteoporosis 1 year mortality was 32% Average age 80 yrs

Of 253 women hospitalized with hip fracture 27% received treatment for osteoporosis 1 year mortality was 17% Average age 81 yrs

Osteoporosis

Risk FactorsChronic Calcium Deficiency

Lack of Exercise

Prevention of Osteoporosis

ExerciseDietary Calcium“Rule of 300”

300 mg/d from plant sources 300 mg/d from each serving of dairy

Prevention of Osteoporosis

Other factors that may increase calcium loss high caffeine intake high protein intake high alcohol intake cigarette smoking

Prevention of Osteoporosis

Calcium SupplementsCalcium carbonate

least expensive Tums poor absorption

Calcium citrate/malate (CCM) expensive, well absorbed

Prevention of OsteoporosisAdequate amounts of vitamin D

avoid excessesHormonal replacement in high

risk womenIf you have a family history of

osteoporosis: Get a bone scan

Folic Acid

DRI (RDA): 1998 400 ug/d (180-200 old RDA) 600 ug/d pregnancy (400)

Typical folate intake: 200 ug/dDietary Sources

foliage: fruits & vegetables

Folic Acid

Functions“single carbon metabolism” DNA synthesis (cell division) other reactions

Folic Acid

DeficiencyMegaloblastic Anemia

large abnormal red blood cellsElevated blood homocysteine

CHD risk factor

Folic Acid

DeficiencyNeural Tube Defects

spina bifida - lower body paralysis

required early in pregnancyGrain fortification (1998)

will add 100-200 ug/d to diet

Iron

Functions:HemoglobinMyoglobinIron enzymes

catalase electron transport system

Iron Deficiency

Iron deficiency anemia fewer, smaller, paler red blood cells fatigue

5-10% of US premenopausal women

up to 40% of population in developing countries

Iron Deficiency CausesBlood loss

menstrual blood loss parasites and bleeding ulcerations

Inadequate dietary intakeRDA men = 10 mg/dRDA women = 15 mg/dUS usual intake 6 mg/1000 Cal

Dietary Sources of IronHeme Iron

meats (Hb & Mb) 20-30% absorbed

Non-heme Iron plants inorganic iron 1-10% absorbed vitamin C increases absorption iron cookware

Iron Overload Toxicity

Children (accidental poisoning) Men and post-menopausal

womenGenetic “defect”

improved iron absorptionExcess iron is a pro-oxidant.

oxidized LDL-C tissue injury

Iron Overload Toxicity

May occur in 10% of menTreatment

avoid iron containing supplements

avoid excess vitamin C supplements

bleeding or blood donation

Final Advice from Your Nutrition Professor:

Eat your vegetables! And fruits and whole grains too!

Watch your weight! Easier to maintain your weight than to

lose weight you’ve gainedEverything in moderation!

You can have your cake and eat it too!

Enjoy your food and your good health!