Download pdf - Final Exam Review Fall 2014

FINAL REVIEW

Intro to Nutrition

73 questions, 200 points

Multiple choice true / false & matching

2.75 hours to take the exam

Essential

A necessary nutrient that can be obtained only from the diet

Vitamins Minerals

Water Carbohydrates

Lipids Protein

Nutrient Density

A high proportion of micronutrients and fiber with a low proportion of calories, saturated fat and sugar

Energy Yielding Nutrients

Protein

Fat

Carbohydrate

Energy Yielding Nutrients

Protein 4 cal/g

Fat 9 cal/g

Carbohydrate 4 cal/g

Leading Causes of Death

diabetesheart

disease

cancer stroke

Whole Foods

whole fruits, vegetables,

grains, grass fed meats,

eggs

Refined carbohydrates, processed oils,

packaged products

DRI

• SATURATED FAT: < 10% of total calories

• AHA < 7%

• TRANS FAT: as low as possible (<1%)

• CHOLESTEROL: < 300mg

FAT: 20-35% total calories

• ADDED SUGAR: < 5% of total calories

CARBOHYDRATE: 45-65% of total calories

• or 0.8g/kg

PROTEIN: 10-15% upper limit 35%

RDA and EER

Phytochemicals

Biologically active substance in plants

May protect against chronic disease

• React with unstable molecules to prevent damage to DNA, proteins and cell membranes

Anti-oxidants (most)

Supplement forms can be dangerous!

Fruit vs Vegetable

Fruit

• entire plants with seedsVegetable

• seeds, stems, flower, leaves, stem, root

Food Groups

The USDA divided food into groups and subgroups to standardize foods based on their nutrients.

• Mouth

• Stomach

• Intestines

• Liver

• Gallbladder

• Colon

Digestion and Absorption

Digestion:

Breakdown of

nutrients

Absorption:

passage of

nutrients from the

digestive tract to

the bloodstream

Digestion & Absorption

Storage Organs – when we eat too

much

CHO Glycogen Fat

Fat Fat

Protein Fat

N

o

t

e

Carbohydrate Recommendations

Carbohydrates

45-65%

Added sugar

< 5%

Fiber

Women: 25 grams

Men: 38 grams

Simple Carbohydrates

monosaccharidesdisaccharides

Carbohydrates

fiber

Simple Carbohydrates

Complex Carbohydrates

glycogen

Blood Sugar

Blood sugar : results in insulin secretion by the pancreas

Blood sugar : results in glucagon secretion by the pancreas

Wheat Kernel

A: Husk - removed

B: Bran - most of fiber

C: Endosperm - starch

D: Germ - nutrients/

protein

What happens during refining?

Diabetes

Typ

e I Autoimmune disease

Pancreas does not secrete insulin

Onset in childhoodTyp

e II Insulin resistance

Pancreas secretes enough insulin

Typically adult-onset, now seen in children

Lipids

P

LIP

IDS Triglycerides (TG)

≈95% of all lipids in foods and the human

body

Phospholipids For example, lecithin

SterolsFor example, cholesterol

Lipids: Functions

LIP

IDS

Triglycerides (TG)

Energy

Protect organs

Phospholipids

Emulsifiers

Cell membranes

Sterols

Cholesterol

Hormones

Cell membranes

Lipids: Recommendations

Fat

10-35%

Sat Fat

DRI

< 10%

AHA

< 7%

Trans Fat

< 1%

Cholesterol

< 300 mg

Fatty Acids

Essential Fatty

Acids

• Omega - 6

• Omega - 3

* Most Americans consume more omega-6 FAs than omega-3 FAs

Lipoproteins

LDL

Transport cholesterol and other lipids to body tissues

HDL

Carry cholesterol from body cells to the liver for disposal (scavenges cholesterol)

Trans Fatty Acids

Trans fats are a byproduct of hydrogenation

Proteins

1. Genes determine the sequence

2. String of amino acids

3. Peptide bond

4. Not a straight chain

5. Shape determines function.

Proteins

Antibodies

Enzymes

Connective Tissue (muscle, ligament, etc)

Hormones

Acid Base Balance

Buffers

Protein

Uncoils

In Stomach

Image Credits: Protein by AzaToth, digestive tract from Wikimedia Commons

bloodstreamintestinal cellsintestines

amino

acid

Enzymes are released from the

pancreas and intestinal lining

enzyme

enzyme

enzyme

enzyme

amino

acid

Wasting

• When the amine group has been removed, it

means the amino acid has been wasted

CHINA STUDY

Dr. T Colin Campbell found in his research that protein intake is associated with an increased risk of cancer.

As amounts of animal protein were increased in the diet in individuals in rural China, the incidence of cancer increased.

Vegetarian/Vegan Diet

• A healthy vegetarian diet is associated with a

lower risk of chronic disease

• Both a vegetarian diet and a meat eater’sdiet should include a wide variety of fruits and

vegetables and whole grains

• A vegan diet needs to be supplemented with

Vitamin B12

• Mutual supplementation is the combining of

plant foods to form complete proteins

Vitamins

Water Soluble

Dissolve in water

Easily absorbed & transported

Not stored extensively

Rarely toxic from food

Fat soluble

Does not dissolve in

water

Needs fat to be absorbed

Stored in the body

Can be toxic from food

Vitamin A

1. Vision

2. Growth and maintenance

1. Needed by the body linings and skin

2. For growth of bones and teeth

3. Immune defenses

Can be toxic from food (Vitamin A potentially the most toxic)

Beta - carotene

Precursor to Vitamin A

Not toxic from foods

Supplements are not recommended

Can turn the skin orange

* Plant source

Other Fat Soluble Vitamins

Vitamin D

Vitamin E

Vitamin K


Vitamin DRegulate blood calcium

Vitamin EAntioxidant / works with Selenium

Vitamin KForms blood clotting and bone proteins

* Given to infants a birth because they do not have vitamin K producing bacteria


Vitamin D - deficiency

Vitamin E - deficiency

Vitamin K - deficiency


Vitamin D - deficiencyRickets

Vitamin E - deficiencyErythrocyte hemolysis in premature infants

Vitamin K - deficiencyFractures and bleeding

Vitamin K

K1: Synthesis of blood clotting proteins

K2: Synthesis of bone proteins

The Gatekeeper and the Traffic Cop

Vitamin D: Gatekeeper

Vitamin K: Traffic Cop


Vitamin D - SEVERE deficiencyRickets

Low levels of Vitamin D associated with Osteoporosis

Autoimmune diseases (RA, type 1 DM)

Some cancers (colorectal, breast, prostate)

Hypertension (high blood pressure)

Water Soluble Vitamins

Vitamin C Important in the formation of collagen

Deficiency results in scurvy

Anti-oxidant

Boosts iron absorption

Supports the immune system

But has not been proven to prevent the common cold

Need is greater in smokers


B - vitaminsCoenzymes

Energy metabolism

Act in conjunction with one another

VITAMINS don’t provide energy!


B - vitamins Thiamin

Deficiency results in Beriberi

Niacin

Deficiency results in Pellagra

Toxicity - niacin flush

Tryptophan converts to niacin

Niacin is sometimes prescribed to manage blood lipids

Riboflavin

Destroyed by UV light - opaquecartons for milk

Neural Tube Defects

Spina bifida

Folate

Neural Tube Defects

almost 25% drop

in the national

incidence of neural

tube defects

All enriched grain

products are fortified

with folic acid

Pernicious Anemia

A result of Vitamin B12 deficiency

A lack of intrinsic factor will decrease absorptionMain cause

Elderly most at risk

Vegans are also at risk of B12 deficiency, but not as common Vitamin B12 is only found in animal

sources

* B12 function to maintain nerve sheaths

Food Preparation & Storage

• Close lids tightly

• Eat soon after chopping

Vitamin C&E can be oxidized

• Avoiding boiling and soaking cut vegetables

Vitamin C & Bs, minerals leached

• Avoid cooking at too high of a temp and too long

Vitamin C, folate & thiamin heat intolerant

Supplements

Not tested for safety or efficacy by the FDA

Healthy individuals do not need supplements

Best source of vitamins & minerals is from food

Sodium and Potassium

– Sodium and potassium are important in fluid and

electrolyte balance

–- Sodium is associated with high blood pressure

– Most of excess sodium is from processed foods

Potassium Sources

–Potassium occurs in high amounts in melons, bananas,

potatoes and dark leafy greens

IronIron absorption

•Heme (23%)

•Non- heme (2-20%)

Increase absorption (non-heme)

•Vitamin C

•MFP

Inhibit absorption (non-heme)

•Tannins, phytates

•Calcium, phosphorus

Iron

heme

hemoglobin

Iron Deficiency

• Iron deficiency can lead to anemia

• Women in their childbearing years

are most at risk

CalciumMost Abundant Mineral in the Body

Bone

Nerve transmission

Transport of ions

Blood pressure

Blood clotting

Muscle contraction

Image by Pbroks13 on Wikimedia Commons

Calcium - Osteoporosis

• Loss of bone mineral density

• Not achieving peak bone mass increases

the risk of developing osteoporosis

• If you do not achieve peak bone mass - you

cannot catch up later in

life

• Ca & Vit D intake,

gender, genetics,

physical activity

contribute to risk

Iodine

• Part of thyroxine

• helps to regulate metabolism

•Deficiency can result in goiter

Selenium

antioxidants

Vitamin C

Vitamin E

Selenium

Overweight & Obese

• 65% of Americans are

overweight

•35% of Americans are

obese

Central Obesity

• Visceral Fat

• more active

• contributes more to

blood lipids than

subcutaneous fat

• Apple shape

• Higher risk of heart

disease, diabetes and

stroke

BMI: Body Mass Index

Risk for heart disease, hypertension, diabetes, stroke

Determine risk: BMI, Waist, Disease Profile, Activity Level

Can be overweight and healthy!

Hunger & Satiety

Hunger: physiologic need for food/ energy

Appetite: psychological desire for food

Satiety: feeling of fullness

Hunger is a greater drive than satiety

Stretch receptors in the stomach send a signal to the brain satiety

Calorie

Unit of food energy

Energy Expenditure

Energy In:

Food + beverages

Energy Out:

Physical Activity BMR TEF

Risk Factors and Disease

Association causation

High LDL/Low HDL

Atherogenic Diet

Hypertension

Genetics

Male, increasing age

Heart Disease & Smoking

Smoking is a powerful risk factor for heart diseaseDirect damage to the heart

Increases blood pressure

Damage to artery wall

• Smoking

• Aging

• Hyperlipidemia

Fatty streak

• Body responds

• Inflammation

• LDL oxidation

Plaque

• Smooth muscle

• macrophages

• Lipoproteins

Atherosclerosis

Complex Inflammatory Process

Heart Disease Risk Factors

smoking

atherogenic diet

Physical inactivity

High LDL

Low HDL

Hypertension

Abdominal obesity

Atherogenic Diet

Heart Disease

Risk

High sat fats

High trans fats

Low fruits &

vegetables

Low whole grains

Hypertension

Elevated Blood Pressure Ideal resting blood pressure is 120/80

Can’t feel when BP is too high

increased volume

increases pressure

narrow vesselsincreases pressure

Risk Factors: ASO, kidneys, obesity, genetics

DASH diet lowers BP more than decreasing sodium intake alone

Hypertension Recommendations

Consume a DASH diet High in whole grains

High in fruits and vegetables (8-12 servings)

Minimal processed foods

Moderate amounts of lean meats

Minimize saturated fat, no trans fat

Increase exercise

Lose weight

Cancer Development

Carcinogensmok

eDNA

Damage.

Cells multiply

.

Promoters. Metastasis.

Exposed to carcinogens daily

Not all carcinogens cause damage

Anti-oxidants quench free radicals

Body can repair cell damage

Damage not repaired -> cell self-destructs

Pregnancy

Underweight Infant

Most potent indicator

Infant’s Future Health

Pregnancy

Mother is Overweight

Infant is Overweight

Greater chance of

NTDs

Pregnancy

Mother is Overweight

greater risk for mother of

Hypertension, DM, drug

induced labor, C-section

Preparing for Pregnancy

Lo

w B

irth

We

ight

Lower IQ

Short Stature

40X more likely to die 1st year

Preparing for Pregnancy

Hig

h B

irth

We

igh

tLarger size

2X more likely to have NTD

Nonpregnant

Pregnant

Lactating

Folate

100%

Supplementation is recommended for prevention

400 ug of folic acid daily

Folatedeficiency

Abnormal spinal cord

development

Neural Tube Defect

Nonpregnant

Pregnant

Lactating

Calcium

100%

Calcium Absorption

Doubles

During Pregnancy

Nonpregnant

Pregnant

Lactating

Iron

100%

Iron supplementation is recommended

during pregnancy

Fetus needs a store of iron for the first 3-6 months of life

Iron supplementation is recommended during pregnancy

FETAL ALCOHOL SYNDROME

Irreversible brain damage

Growth retardation

Mental retardation

Facial abnormalities

Vision abnormalities

Image by Kimery Davis on FlickrCC

Features of Fetal Alcohol Syndrome

Fetal Alcohol Syndrome is the

most common cause of

preventable mental retardation

in the world.

Carbohydrate

Lactose

Easy to digest

Enhance Ca

absorption

Lipids

Main energy source

EFAs

Protein

Easily digested

Lactoferrin- iron

Image from Wikipedia

Breastmilk

Vitamins

Vitamin C High

Vitamin D

Low

Minerals

Ca highly absorbable

Low in sodium

High in zinc and iron


Immune Factors

Anti-viral agents

Anti-bacterial agents

Less prone to GI disorders

Colostrum contains antibodies


Immune Factors

Breastfed babies are less prone to develop stomach and intestinal disorders

during the first few months of life


Less sun exposure

More sunscreen

More clothes

Vitamin D supplementation recommended

More

need f

or

vitam

in D

Vita

min

D is

low

in b

reast m

ilk

Pickles & Ice cream?

CR

AV

ING

SNot a

physiologic need

Hormone induced

Changes in taste and smell

Increase blood sugar in mother

Larger babies

Increased insulin &

blood sugar in infant

Increase risk of

childhood obesity

European Journal of Obstetrics, Gynecology and Reproductive Biology. Vol. 183, Dec 2014.

maternal junk food

diet

food addiction

later in life

Laboratory rat from Wikipedia

The FASEB. Journal vol. 27 no. 3 1275-1284. March 2012.

Image by ozgurmulazimoglu from Wikipedia

Commons

Nurs

ing

Bott

le S

ynd

rom

e

Prolonged sucking on a bottle

Severe tooth decay

Avoid feeding juice and soda to infants

Diet changes the most during the 2nd year of

life. Transitioning from an infant to a toddler.

Toddler Nutrient Needs

Protein

Carbs

Fiber

Fatty acids

Vitamins

Minerals

Food Allergy

Recognized as foreign

Immune response

Food Intolerance

Not an allergy

Unpleasant symptom

Food Aversion

Intense dislike

Grow out

Too Little Too much

• Recommendation stays the same

Protein

• Same: adequate amounts are important!

Fiber

• AHA diet

Fat

• Recommendation decreases

Vitamin A – absorption increases with age!

• Recommendation increases

Vitamin D

• Same: adequate hydration important!

Water

• Recommendation decreases –

Iron - iron status improves

• Recommendation increases – absorption decreases

Calcium

Physical Activity in Elderly

Ph

ysic

al A

ctivity

Allows for consumption of more nutrients

Decreases mental losses

Increases physical strength independence

Gain independence

48 million cases of foodborne illness

3,000 deaths annually

• Not all E coli are dangerous

• Lives in our intestines with about 500 other bacteria

• Infections with 0157:H7 can be fatal

• Bloody diarrhea, intestinal cramping, dehydration

E Coli

Food Safety

Bacteria grow at 40 - 140 degrees

Wash dishes with warm soapy water and rinse at 140 degrees, air dry or with rinse with dilute bleach or use dishwasher

Food should be put away or thrown away after 2 hours

Wash hands with warm soapy water

Rinse fruit and vegetables for 30 seconds

Don’t wipe counters with same sponge you cleaned dishes with

Preserving Foods

Freezing

• At 0 degrees minimal nutrient losses

Canning

• Some nutrient losses

• Protects from most microbial growth

Drying

• Commercial drying eliminates spoilage and helps prevent nutrient losses

• Home drying may result in some nutrient losses

Natural and Artificial Flavors

Citromax Flavors

Pe

sticid

es

Control insects, weeds, diseases

4.5 billion lbs of pesticides/year

Linked with birth defects, tumors in

animals

Organisms can become more resistant!

Pros Cons

Not nutritional superior

High cost

25% of organics have pesticides

Benefits environment

Limits pesticide resistance

Minimize pesticide exposure

GMO Pros

GMO Cons

THE END