HNF260-LectureNotes.pdf HNF 260
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HNF 260 Lecture Notes 11014 Nutrition the science of food nutrients and substances and their action interaction and balance in relation to health and disease 0 process by which the organism ingests absorbs transports utilizes and excretes food substances 0 important for general health and chronic disease prevention Leading causes of death heart disease over 85 cancer under 85 lung stroke Nutrients chemicals that we need to consume in order to live and row 9 some provide energy building blocks vital for growth amp maintenance metabolism 41 essential nutrients for the basis of a healthy diet Carbohydrates Lipids Proteins o Vitamins Minerals 0 Water Essential nutrients must be obtained from an external source because we can t make it ourselves or we can t make enough Decline in health if not in diet Return of substance to diet enables recovery Must have an identi able biological function Different species have different essential nutrients Phytochemicals plant derived compounds that may provide signi cant health bene ts 0 Examples lycopene tomato resveratrol grapes red wine Zoochemicals food components that come from animal products and are bene cial to human health Fiber thread lament from which a vegetable tissue or mineral substance if formed strong Probiotics supplement containing live bacteria that is taken orally to restore bene cial bacteria to the body 0 Example in yogurt Carbohydrates major source of fuel for the body should be 4565 of diet Glucose needed by the brain red blood cells muscle 0 4 kcalg Simple monosaccharide Complex disaccharide two monosaccharides together Starch form in which plants store carbs Glycogen form in which animals store carbs o stored in liver and in muscle 0 once this is built up then we store energy as fat Lipids 9 kcalg 2035 of energy should come from lipids fats and oils water insoluble sat fat is solid at room temp unsaturated fat is liquid at room temp Triglyceride glycerol and 3 fatty acids not water soluble energy storage 0 Fatty acid structures saturated no bonds monosaturated 1 double bond polyunsaturated 2 double bonds 0 Essential fatty acids n6 and n3 Proteins C H O and N some sulfur 4 kcalg 1035 of daily intake 0 Main structural in body muscle blood cell membranes enzymes Composed of amino acids 9 essential for adults infants are different Vitamins required for many enzyme reactions contains a variety of elements including C H O N P and S o 13 essential vitamins 4 fat soluble A D E K 9 water soluble need very small amounts of energy not a source of food energy vitamin A is toxic in excess 0 water soluble vitamins are less toxic overdoses unusual Minerals inorganic compounds no carbon make bone calcium phosphorus stimulateregulate chemical reactions enzymatic reactions o 16 minerals required 7 needed gt 100 mg a day 9 needed lt 100 mg a day 0 not a source of energy 0 not destroyed by processing Water solvent temperature regulation body is 60 water major nutrient in body 0 muscle is 72 water 0 need 1115 cups a day in food and as a uid 0 most important nutrient in terms of daily intake Kcal amount of heat to raise the temperature of a kg of water 1 degree centigrade 1 kcal 418 kilojoules measure of work Human body composition 0 57 water 0 25 fat 0 13 protein muscle 0 5 minerals mostly bone also in cells 0 lt1 carbs trace of vitamins Current diet status 0 focus on foods rich in ber vitamin D calcium K n3 fatty acids iron vitamins reduce consumption of energy sugar fat Na alcohol 11314 Calorie calculations Fat 9 kcalg Carb 4 kcalg Protein 4 kcalg Hunger physiological need to eat Appetite psychological desire to eat Restaurant eating 45 of food dollars are spent on meals outside the home Nutritional Health Status optimal nutrition the best desired 0 malnutrition under and over nutrition subclinical undernutrition early stage de ciency no overt signs or symptoms 0 severe de ciencies signs and symptoms become apparent Healthy People 2010 10 year targets for the US on health promotion and disease prevention attain high quality longer lives free of preventable disease achieve health equality eliminate disparities improve health of all groups 0 create environments that promote good health 0 promote quality of life health development and healthy behaviors 11514 Assessing nutritional health of individuals 0 medical and family history ABCDEs of nutrition assessment 0 Anthropometric height weight skinfold thickness 0 Biochemical urineblood lipids cholesterol pH 0 Clinical blood pressure heart rate skin observation eyes ears 0 Dietary questionnaire frequency of fruits and vegetables 0 Environmental living situation socioeconomic situation Limitations of nutritional assessments Takes a long time for signs to develop 0 Signs of nutrient de ciency not very speci c 0 Disease state may require longterm poor nutrition cardiovascular disease cancers Continuing Survey of Food Intakes by Individuals CSF performed by the USDA Looks at food and nutrients consumed by the population as a whole 0 1 day food dairy on a large population sample National Health and Nutrition Exam Survey NHANES performed by the National Center for Health Statistics and Centers for Disease Control CDC 0 looks at the health and nutritional status of children and adults in the US 0 targets atrisk populations elderly children socioeconomic geographic interviews and physical exams Historical Landmarks in Nutritional Science 0 16005 iron used to treat anemia 17005 citrus fruits cured scurvy 18005 discovered that foods contained CHO fats protein Ca P Na K Cl Fe 0 18905 determined energy value of foods 2000 kcalday 1912 discovered compounds in food vital for life vitamins 19305 WWI many soldiers had poor energy due to nutritional status 0 1943 rst published RDAs 11714 Nutrition Research 0 initial observations 0 develop a hypothesis to explain observation 0 cause and effect or correlationsassociations 0 simple and complex relationships 0 design experiments collect data test hypothesis 0 if results of replicated experiments con rm the hypothesis then have a theory follow up experiments Epidemiologic studies observations on populations not asked to change their behaviors alter food intake or undergo any treatment 0 can identify correlations o examples NHANES and Framingham Heart Study Types of epidemiologic studies ecologic studies look at subject on a population level quotview from 30000 feet upquot 0 example studies that found lower cancer rates in Asian communities that consume a lot of sh cohort studies gather data on a large group of healthy people and then follow that group over many years 0 example 121000 female RNs followed from 1976 on to asses risk factors for cancer and cardiovascular disease 0 case control studies compare people who have the condition cancer to a group of people who don t have cancer controls Intervention studies testing for causeeffect relationships in humans or animals or cultured cells 0 control groups and experimental groups bias present 0 Hawthorne effect being in a study can in uence another persons behavior 0 Placebo effect observable effect of treatment seems to arise because the participant expectsbelieves the treatment will work bodymind o Researcher bias researcher inadvertently affects the outcome expecting a certain result Human subject studies controlled study where treatment is applied Freeliving vs clinical studies 0 Random assignment to experimental and control groups Singleblind and doubleblind 0 Knowledge of who is in the experimentalcontrol groups 0 Placebos have the control group consume or experience something that seems just like the real treatment Evaluating Nutritional Claims 0 Primary source and peerreviewed journals Credibility of researchers 0 Who paid for the research Grants from companies industry groups federal agencies 0 Design of experiment 0 Do Public Health organizations agree with the ndings Evaluating Nutrition Claims Supplements 0 Need to be cautious few have been scienti cally tested for efficacy may or may not work amount and potency may not match what is on the label 0 Nutrient content claim listing the content 0 General well being claim or structuralfunctional claim 0 Disclaimer ALWAYS required 0 Claims are not approved by the FDA but shouldn t be misleading Dietary Supplement Health and Education Act of 1994 0 Weak regulation classi es supplements as foods Pharmaceuticals manufactures must show ef cacy before selling 5 major foods Dairy Protein Vegetables Fruits Cereals Grains o variety allows us to get many different phytochemicals in our diet Moderation control portion size 0 strategies smaller portions don t eliminate foods just eat less pay attention to appetite eat when hungry stop when satis ed sit and enjoy meals Nutrient density provide large amounts of a nutrient relative to the number of calories Nutrient contentRDA or AL contribution to nutrient needs Caloriesdaily calorie need EED contribution to energy needs 0 if a foods contribution to nutrient needs is much greater than its contribution to its energy needs than it is nutrient dense Energy density caloric caloriesmass of food 0 high energy density nuts fried foods cookies snacks 0 low energy density high in water often high in ber such as fruits vegetables soups stews oatmeal 0 may help feel full without a lot of kcal weight control adults can bene t by reducing the energy density of their consumed foods RDA rst in 1943 periodically reviewed by the Food and Nutrition Board 0 before 1993 RDAs were based on the amount of nutrient needed to prevent a de ciency disease 0 now are higher including amounts of nutrient to help prevent chronic diseases such as cancer 0 set of standards Dietary Reference Intakes DRIs EARs estimated average requirements RDAs recommended dietary allowances Als adequate intakes EERs estimated energy requirements ULs upper intake limits EARs estimated need for the average individual within a speci c agegender group 0 50 0 based on use of a speci c functional biochemical or physiological marker to assess nutrient adequacy RDAs intake of a nutrient needed to meet with needs of nearly all individuals within an agegender group 9798 of the population 2 standard deviations above EAR 0 often EAR 12 multiplier can vary 0 cant get an RDA unless have EAR and a functional marketassay for the nutrient Als estimate of needs that is used when there is not enough info to establish an EAR and RDA for a nutrient have some info on amount needed to maintain good health but no functional measure 0 based on amount needed to maintain good health 0 Calcium vitamin D vitamin K omega 3s omega 6 K have ALs ULs max level of daily intake of a nutrient that is unlikely to cause adverse health effects to almost all people 9798 0 Not a goal for intake but a ceiling EERs average calorie intake 0 Calculated based on person s age gender height weight and PA level 0 Average amount of food energy a person will need to consume in order to maintain energy balance a constant weight Food Labeling regulated by the FDA early 705 Goal to assist customers 0 Required on all processed foods 0 Not required for fresh fruits vegetables bulk foods fresh seafood prepared foods 0 Labels must include serving size tota kcaI kca from fat tota grams fat sat fat trans fat cholesterol sodium tota carbs dietary ber sugars vitamin A vitamin C calcium iron may have other nutrients listed 0 Protein is optional only required on food targeted to children under4 Health claims controlled by the FDA are required 0 Presence of allergens required tree nuts milk eggs sh shell sh peanuts soybeans wheat Uses RDs and DRVs Daily Values based on estimated needs for a person consuming 2000 kca a day 0 DV for vitamins and minerals arises from RD DVs for protein carbs total fat sat fat cholesterol sodium K and ber are based on Daily Reference Values DRV Nutrient sources 0 Rich source 20 or more of DV 0 Good source 1019 of DV Health Claims on Food Labels 0 Must have signi cant scienti c agreement they are true 0 Must use may or might as quali ers o 2002 quotquali ed health claimsquot lesser level of scienti c agreement must say quotthis evidence is not conclusivequot StructureFunction Claims on Food Labels and Dietary Supplements describe how a nutrient affects human body structure without focusing on disease risk reduction 0 example iron builds strong blood 0 FDA does not approve or authorize manufacturers are responsible New Attempts to Label Food 0 Food makers and the Grocery Manufactures Association are standardizing labels for the front of the package quotNutrition Keysquot 0 Calories sat fat sodium sugars 12414 DRls were released to prevent undernutrition Dietary Guidelines for Americans were developed out of concern of overnutritition Shape all federal food nutrition education and info programs 0 Guide consumers about healthy diet and lifestyle choices 2010 Dietary Guidelines 0 4 major action steps 0 Balancing calories to manage weight reduce intake increase PA 0 Reduce intake of bad food 0 Diet that is nutrient dense and energy balanced 0 Use of foodpattern modeling 0 Increased focused on reducing obesity 0 Use of evidencebased reviews 0 Focus on broader environmental and societal aspects 0 Cooking skills local foods fresh vs canned foods sustainability Balancing calories to manage weight 0 Portion control consuming fewer kcal if weight is a concern 0 Increasing PA 0 Reducing sedentary behaviors PA Guidelines 0 30 min a day 0 60 min a day to prevent weight gain 0 6090 min a day for weight loss 0 avoid inactivity overweight disease disability 0 lower risks for heart disease cancer diabetes depression 0 aging issues for exibility falls sprains fractures Reduce intake of Sodium examples pizza pasta cold cuts hot dogs bacon cheese chicken beef 0 under 2300 mg a day 0 under 1500 mg a day for hypertension and diabetes benefits fewer strokes heart attacks healthcare costs Reduce saturated fats trans fats and cholesterol sat fats less than 10 kcal cholesterol reduce to less than 300 mg a day 0 no trans fats Reduce Solid Fats and Added Sugars Solid fats cheeses creams whole milk ice cream some meats bacon sausage poultry skin cookies crackers doughnuts pastries croissants Added sugars soda calorie dense few nutrients they contribute to 35 of the calories in the American Diet 0 no more than 515 should be consumed examples grainbased desserts pizza soda replace with vegetables fruits cooked dry beans and peas whole grains nuts fatfree or lowfat milk and milk products Reduce intake of Re ned Grains such as white bread re ned our cereals crackers 0 increase intake of Whole Grains Reduce intake of Alcohol 0 up to 1 drinks per day for women 0 up to 2 drinks per day for men Increase intake of Fruits and Vegetables aim for vegetable variety Fiber 0 from grains whole wheat and beans 0 no ber in animal foods meat dairy no ber in fatty foods fried oil sauces no ber in re ned white our sugar Increase intake of Lowfat and fatfree dairy seafood foods rich in potassium ber calcium and vitamin D Replace choose a variety of protein sources such as plant proteins replace meats high in solid fats with leaner meats replace some meat with seafood replace solid fats with oils whenever possible Build Healthy Eating Patterns 0 nd a sustainable way of eating that provides the needed nutrients at a healthy kcal level monitoring what you eat to assess the health of your diet Principles for making sustainable changes 0 be realistic make small changes over time o be adventurous try new foods regularly be exible balance some sweet and fatty foods with PA 0 be sensible include favorite foods in smaller portions 0 be active include PA in daily life Food Pyramid introduced in 2005 by the USDA MyPyramid introduced in 2005 by the USDA individualized recommendations to agegenderPA some emphasis on PA 0 includes activity moderation personalization proportionality variety gradual improvement My Plate introduced in 2011 0 created through food modeling 0 focuses on foods over nutrients uses visual of a plate half the plate should be vegetables and fruits half the grains should be whole grains 0 indicates protein not just meat as a protein source 0 for adults fatfree or low fat milk Vegetarian Diets religious practices philosophical reasons ecological reasons or health related reasons Pescaterian eats sh no meat Ovolacto vegetarian eats eggs and milk but no meat poultry or sh Lactovegetarian includes milk 0 Vegan only plant products 0 Dietary supplements may be needed 0 Increased intake of beans peas processed soy products nuts and seeds to provide protein 0 Soy milk forti ed with calcium and vitamin D 12714 MyPlate Recommendations 0 No single food is required for good nutrition 0 No single food group satis es all the essential nutrients in adequate amounts 0 Fruit juice should account for less than half of your total fruit intake 0 Keep meat portions under control 3 oz is 1 serving deck of cards thick 0 Fish twice a week 0 Reduce quotempty caloriesquot Discretionary calories people who consistently eat nutrientdense foods may be able to meet most of their nutrient needs without consuming their full allowance of kcals needed to maintain weight 0 Eat more nutrientdense foods Select a few foods with added fats or sugar Consume some alcohol Decide not to use the discretionary calories weight loss Peristalsis ring of contraction that propels materials through the GI tract Segmentation back and forth action that breaks apart food small intestine Mass movement peristaltic wave that contracts over a large area of the large intestine to help eliminate fecal waste Sphincters ringlike muscles open and close like valves control ow of contents Mouth taste chewing of food saliva some enzymes amylase lysozyme lingual lipase released esophagus transports food to stomach The Swallowing Process Bolus food is pushed toward the pharynx and moves into it o Epiglottis prevents food from entering the trachea Bolus is then pushed towards the stomach o Epiglottis then returns to its normal position Stomach holds about 46 cups of food for 14 hours three layers of muscle Gastric secretions HCI and pepsinogen to start digesting proteins 0 Pepsinogen needed for digestion of protein 0 Mucus o Intrinsic factor important for vitamin 812 absorption 0 Every cell has a lifetime of 4 days 0 Very low pH environment acidic o Kills most harmful bacteria and viruses 0 Inactivates injected proteins 0 Dissolves dietary minerals o Activates pepsinogen to pepsin o Mixing of food and liquid into chyme Pyloric sphincter releases chyme very slowly into small intestine which is control by gastric inhibitory peptide hormone Small intestine one inch in diameter surface area is 200 square meters Duodenum 10 inches Jejunum 4 feet lleum 5 feet Intestinal villi cells live 36 days Food remains in small intestine for 310 hours Where most absorption is happening Cells lining the small intestine Goblet cells make mucus Endocrine cells make hormones Enterocytesabsorptive cells produce digestive enzymes absorb nutrients Accessory Digestive Organs Liver rst organ after gut to see most nutrients Makes bile makes 16 cups a day stored in gall bladder o Empties into the duodenum through the common bile duct 0 Emulsi es fats to aid lipid absorption 0 Bile is recycled enterohepatic circulation Pancreas functions as an exocrine gland Pancreatic juice contains sodium bicarbonate and enzymes to help digestion o Pancreatic amylase pancreatic lipase several proteases Endocrine gland makes insulin and glucagon and peptide hormones Large intestine 2 12 inches in diameter 35 feet long cecum on lower right 5 parts Ascending transverse descending and sigmoid colon Water some minerals undigested ber and starches arrive here 0 Food remains in large intestine up to 72 hours Electrolytes are absorbed here 0 Fiber arrives in colon and also starches Colon fermentation of some undigestible ber and starch prebiotics such as insulin and resistant starch Probiotics such as yogurt and miso Bacterial ora over 400 species 10 times as much bacterial cells here as cells in the human body bene cial bacteria 0 llleocecal valve 0 Synthesize vitamin K and biotin a Bvitamin 12914 HormonesGI Regulation Gastrin produced in stomach stimulates GI motility o Stimulates other stomach cells to release acid and pepgnogen CCK produced in small intestine SI when chyme enters stimulates release of pancreatic enzymes 0 Causes gall bladder to contract and release bile o Sphincter of Oddi relaxes o More CCK is released in response to fat intake Secretion produced in SI when chyme enters stimulates release of pancreatic bicarbonate Gastric inhibitory peptide released by SI slows release of gastric content into duodenum slows stomach motility Enterocytes absorptive cells originate in the Crypt Migrate up the villi as the cells mature Get shed into the lumen when they become damaged in 25 days 0 Cells that are quickly replaced needs a constant supply of nutrients Nutrient absorption 0 Passive diffusion diffuse across membrane from SI and go to the absorption cells example fats water and some minerals Facilitated diffusion uses a carrier protein example fructose Active transport uses ATP example amino acids glucose Endocytosis enter example liquids and compounds After absorption 0 Most nutrients go into the bloodstream o Capillaries hepatic portal vein liver general circulation Most fats and fatsoluble vitamins go into the lymphatic system 0 Lacteals in villi larger lymphatic vessels thoracic duct 0 Lymph connects to bloodstream at a large vein near the neck 0 Nutrients are transported by general circulation Diarrhea major issue for children in developing countries 0 Causes 0 Intestinal infection rotavirus or bacteria or parasites by poor sanitation or toxin damage enterocytes such as uids and electrolytes lost in the stool 0 Consumption of unabsorbed substances that attract water in the colon 0 Treatment 0 Increase uid intake like water with some electrolytes and glucose 0 Reduce intake of poorly absorbed substances o Prompt treatment for infants or older adults to prevent dehydration Ulcer in stomach or duodenum weakening of mucous coating Causes 0 Helicobacter pylori 0 Heavy use of aspirinibuprofen 0 Excessive acid production in the stomach Symptom pain between meals Treatment antibiotics and antacids don t smoke limit alcohol and coffee Stomach cancer is the second most common cause of cancer deaths worldwide Acid Re ux heartburn gastroesophageal re ux disease GERD when more than 2 times a week Malfunction of esophageal sphincter Acid backs up from the stomach to the esophagus so pain in upper chest Can result in ulceration to the esophagus and increased cancer risk Treatment 0 Medication and lifestyle changes Smaller meals Avoid offending foods less fatty meals Stop smoking limit alcohol intake Do not lie down after eating 0000 13114 In ammatory Bowel Diseases Ulcerative Colitis in ammation in the large intestine Crohn39s disease in ammation of entire GI tract usually ileum and ascending part of the colon Swelling scar tissue formation Cellular damage nutritional de ciencies dye to poor absorption 0 Anemia osteoporosis need careful nutritional monitoring Immunesuppressive drugs surgery to remove damaged parts of intestine Irritable Bowel Syndrome More common in women Related to stress and diet 0 Symptoms can be mild or severe irregular bowel function ab pain bloating o Abnormal GI motility lower pain threshold for bloating Work with a dietician to identify the problem foods and plan a diet to minimize symptoms Food allergies immune system hypersensitivity immune response can be mild to lifethreatening Food intolerances nonallergic food hypersensitivity inability to digest certain food components Immune response gluten sensitivities sensitivities to MSG sul tes food coloring agents additives GI discomfort Intestinal gas from swallowed air and the breakdown of undigested carbs by the bacteria of the colon people produce 14 pints each day 0 large amounts of has can produce bloating and pain enzyme preparations will help Constipation dif cult or infrequent bowel movements slow movement of fecal matter through the colon extended time in colon increase uid reabsorption hardening of the feces causes and correlations not enough ber in diet ignoring normal urges to defecate use of antacids calcium and iron supplements aging slower GI processes in the elderly pregnancy 0 correlated to diabetes IBS depression 0 treatment 0 plenty of dietary ber 0 increased consumption of water and uids 0 laxa ves OOOOO Celiac disease immune disorder that affects GI tract less than 1 has it 0 reaction to gluten genetic link diagnosed by a blood test con rmed by biopsy of SI gluten proteins cause damage to absorptive cellsvilli 0 GI symptoms gas bloating pain weight changes anemia autoimmune diseases fatigue 0 Will go away if glutenfree diet 0 Poor absorption of nutrients malabsorption 0 Primary vs secondary nutrient de ciency 0 Long term increased GI cancer risk Hemorrhoids swollen veins in the rectum and anus itching pain bleeding 0 Causes 0 Added stress and pressure to the vessels prolonged sitting 0 Low ber diet and straining to make bowel movements 0 More common in pregnancy or obesity 0 Aging half of people 50 have hemorrhoids 0 Treatment 0 Check with physician bleeding can indicate cancer 0 Warm compresses to reduce pain or sitting in a tub of warm water 0 Adequate ber and uid 0 Surgical removal in some cases Diverticulosis outpouching of colon walls Diverticulitis in ammation due to pathogenic bacterial and trapped food particles Gallstones formation of crystals from cholesterol and pigments in bile often no symptoms unless a gallstone blocks the bile ducts Causes 0 Excess weight high blood insulin genetic predisposition advanced age reduced gallbladder activity altered composition excess 0 Prevention 0 Maintain healthy weight avoid rapid weight loss choose plant over animal protein eat a high ber diet choose unsaturated fats Treatment 0 Surgical removal oral medications 2314 Metabolism the network of chemical processes within the body Anabolic pathways build compounds and require energy Catabolic pathways breakdown compounds and release energy Chemical reactions enable cells to 0 Release and use energy from carb fat proteins and alcohol Synthesize one substance from another 0 Prepare waste products for excretion Adenosine Triphosphate ATP used by human cells to drive chemical mechanical electrical and osmotic processes 0 High energy food sources are oxidized to carbon dioxide and water with the transfer or some of the food energy to ATP respiration Rapid recycling of ATP 0 body contains about 100 g at any time o sedentary adults uses 40 kg of ATP per day 0 30 kg of ATP burned in one hour of strenuous exercise Glycolysis convert glucose to pyruvate end product with production of small amount of ATP oxygen not required pyruvate oxidation in mitochondria produces large amounts of ATP requires oxygen and yields carbon dioxide and water Carbs produced by plants through photosynthesis used as fuel for muscle during intense exercise stored in body as glycogen 4 kcalg RDA is 130 grams for brain and CNS 4565 of daily energy Sugars simple carbs monosaccharides and disaccharides Polysaccharides complex carbs oligosaccharides starches and dietary ber Monosaccharides Glucose dextrose blood sugar primary fuel for red blood cells primary fuel for CNS in corn syrup and homey o Fructose in fruits and honey Galactose part of lactose milk Sugar Alcohols o Sorbitol Xylitol Mannitol o Derivatives of monosaccharides In plants naturally but also manufactured ln sugarless candies and gum low sugar foods Lower energy value than sugar Smaller impact on blood glucose levels Doesn t promote tooth decay OOOOO 0 Can be bad in larger doses bloating diarrhea laxative effect Disaccharides must be digested in the small intestine to form monosaccharides Maltose not much in foods in alcohol sometimes in sprouted seeds produced in gut during digestion of starches maltase enzyme breaks it down Sucrose table sugar in sugar beets sugar cane maple syrup sucrase enzyme breaks it down Lactose dairy products lactase enzyme breaks lactose down Oligosaccharides 310 monosaccharide units linked together in legumes whole wheat and some vegetables lnulin Raffinose Stachyose Don t have the enzymes to digest these Fermented by the bacteria in the colon In human breast milk Polysaccha rides Starches digestible polysaccharides corn wheat rice fruits vegetables Amylose long linear chain Amylopectin branched chain more in food more rapidly digested absorbs and traps water in foods Glycogen how we store ca rbs Fiber indigestible lack enzymes to digest ber to passes into large intestine with water sugar units connected by beta glycosidic bonds 0 lnsoluble and soluble o 25 g per day for women 38 grams per day for men 0 advantages of consuming production of healthful compounds during the fermentation of soluble ber insoluble fiber s ability to increase in bulk soften stool and shorten transit time through the intestinal tract Soluble ber dissolves in water pectins gums mucilages some hemicelluloses fruits and vegies slows glucose absorption fermented by microorganisms in colon increases viscosity slows gastric emptying Insoluble ber doesn t dissolve in water cellulose Iignin most hemicelluloses provides bulking action 0 more effective peristalsis helps prevent constipation Lignin type of indigestible ber multiringed alcohol and stringy stuff in celery and broccoli stems Sweetners nutritive and nonnutritive nutritive having calories mono and disaccharides HCFS high fructose corm syrup sugar alcohols added sugars should contribute less then 6 of total kcal should be less than half of discretionary calories Phenylketonuria PKU rare condition in which a baby is born without the ability to properly break down phenylalanine amino acid Functions of Digestible Carbs energy spare protein prevent ketosis incomplete breakdown of fatty acids Functions of lndigestible Carbs o promoting bowel health constipation hemorrhoids diverticulosis diverticulitis reducing obesity risk fullness and satiety enhancing blood glucose control soluble bers reducing cholesterol absorption soluble bers Carb Absorption monosaccharides absorbed glucose active transport that requires energy glucose and Na go in then Na pumped out as K goes in fructose facilitated diffusion no energy needed Health Concerns Related to Carbs very high ber diets above 5060 grams 0 high ber low uid constipation hemorrhoids blockage 0 decreased absorption of certain minerals high sugar diets 0 increase risk of weight gainobesity and dental cavities lactose intolerance 0 primary decreased lactase production o secondary associated with disease that damage the lactaseproducing cells 0 glucose intolerance hypoglycemia hyperglycemia Functions of Dietary fecal bulk aid weight control 0 associated with colon health soluble ber slows glucose absorption inhibit cholesterol and bile acid absorption Dietary Fiber lntake whole grains fruits veggies legumes 2538 grams a day 0 14000 g dietary ber1000 kcal need to look at food labels Moderate Sugar lntake empty calories 0 upper limit for total diet sugar is lt25 of diet energy 0 goal of lt6 of energy from added sugars currently 16 of energy intake 0 much comes from pop cookies candy pies or added during processing Issues with high sugar diet quality dental cavities glycemic index Regulation of Blood Glucose 0 normal concentration regulated by liver 70100 mgdL insulin in pancreas facilitates transfer of glucose from blood into cells lowers blood glucose glucagon cortisol epinephrine norepinephrine and growth hormone o raise blood glucose Type 1 Diabetes Mellitus insulin producing cells in pancreas are destroyed autoimmune disease 0 insulin therapy required for life diet must be coordinated with insulin carb counting increased risk for CVD blindness and kidney disease Type 2 Diabetes Mellitus insulin resistance insulin production may be low normal or high progressive disease 0 most common type 0 treatment diet PA medications Metabolic syndrome insulin resistance or glucose intolerance high blood glucose abdominal obesity 0 high blood triglycerides high LDL low LDL 0 increased in ammatory proteins 2514 Lipids more energy per gram than either proteins or carbs 9 kcalgram 0 water insoluble fats solid at room temp oils liquid at room temp 2035 of daily calories 0 3 types triglycerides phospholipids sterols Triglycerides most common type of lipid 3 fatty acids and glycerol Fatty acids long chain of carbon atoms with a carboxyl group one end and a methyl at the other end 0 long chain 12 carbons beef pork lamb plant oils lymphatic system 0 medium chain 812 carbons coconut oil palm kernel oils circulatory system 0 short chain fewer than 8 carbons dairy circulatory system Saturation all single CC bonds straight carbon chains Unsaturated one or more CC double bonds monosaturated polyunsaturated Trans fatty acids in polyunsaturated oils increases risk of heart disease Packing if the fatty acids pack together tightly then they will be solid at room temp what affects packing shape of fatty acids length of fatty acid Saturated fatty acids single bonds exible packed together well solid Unsaturated fatty acids natural fats and trans fat Essential fatty acids linoleic acid omega 6 alphalenolenic acid omega 3 Triglyceride function provide energy insulate and protect the body temp maintenance aid in absorption and transport of fatsoluble vitamins Phospholipids hydrophilic and hydrophobic emulsi ers Lecithins in egg emulsi es fats phospholipid property used in baking in making emulsions like mayo Sterols precursor of steroid hormones bile acids and vitamin D body makes it Lipid Digestion lingual and gastric lipases act in stomach break apart triglycerides CCK released from intestinal cells to stimulate release of bile Pancreatic lipase secretion stimulated by CCK Bile acids and lecithin emulsify lipids into micelles Triglycerides phospholipids and cholesterol enters are hydrolyzed by acids lipases Result of digestion monoglycerides and free fatty Lipids Absorption Fatty acids monoglycerides and cholesterol cross the intestinal cell membrane Within intestinal cells get triglycerides phospholipids and cholesterol enter photosynthesis These products combine with protein to form chylomicrons Chylomicrons enter lymphatic system and then to blood 2714 Chylomicron lipoproteins that transport triglycerides from SI to cells Formed in intestinal absorptive cells Large lipid droplets with phospholipid coat proteins and some cholesterol Apolipoproteins Recognized by receptor on cells Lipoprotein lipase on target cells transfers triglycerides from the chylomicron to these tissues Chylomicron are removed from blood within 210 hours after a meal VLDLs short and medium chain fatty acids absorbed from meal go to liver via portal vein Liver assembles these fatty acids into new triglycerides Also contain cholesterol phospholipids and protein Secreted into blood Transfer triglycerides to body cells including adipose and muscle As the VLDLs give up their triglycerides they become LDLs LDL uptake by cells LDL is cholesterol rich LDL receptors are present in liver and tissues that need cholesterol Cholesterol used in cell membranes and for synthesizing estrogen testosterone and vitamin D Endocytosis removes LDL from blood ingested into cell Excess LDL remains in blood Increased LDL levels Oxidation damage by free radicals Atherosclerosis Oxidized LDL is taken up by macrophages Cholesterol lled macrophage accumulated on vessel walls and build up to form plaques Plaque is further built up by connective tissue smooth muscle cells and calcium pick up cholesterol from circulation to be removed by the liver Scavenges cholesterol from dying cells and other sources Blocks oxidation of LDL Higher levels of HDL help prevent coronary disease Lipoproteins triglycerides phospholipids cholesterol and protein Essential fatty acids alphalinolenic acid and linoleic acid are converted to other forms By elongation adding carbons to the chain By desaturation adding new double bonds Long chain forms EPA and DHA regulates gene expression and ep heHalceruncUon Produces hormones like compounds with somewhat opposing effects Eicosanoids help regulate BP blood clotting in ammation immune responses and labor N6 fatty acids increase blood clotting and those from n3 fatty acids decrease blood clotting Food fatssatiety avor o Fats and proteins remain in stomach longer than carbs Fats and proteins stimulate cholecystokinin release 0 Many avors are fat soube Fat Intake 2035 Mediterranean diet is 40 mostly monounsaturated fats No more than 10 energy from polyunsaturated fatty acids 0 Limit saturated fats lt10 of energy 0 Keep trans fat as low as possible 0 Monounsaturated fatty acids may be consumed for avortastesatiety bene ts 0 Watch energy intake easy to over consume high fat foods Recommendations for Polyunsaturated fatty acid and cholesterol intake 0 Omega 6 17 g for males 12 for females 5 of kcal Omega 3 16 g for males 11 for females 12 of kcal 0 Eat sh 2 times per week Cholesterol keep as low as possible lt300 mg with goal of lt200 mg if CVD high risk Omega 6 and Omega 3 imbalances o 10x more ratio diet n6 and n3 in diet 0 American have 20x more n6 They complete 0 Omega 6 increase in ammation immune response clotting Omega 3 decrease in ammation immune response clotting Imbalance may play a role in arthritis Exam 2 21214 Proteins vital for life needed for regulation of body processes 0 Composed of amino acids contain nitrogen 0 Each protein has a speci c function and is made of different amino acids arranged in a speci c order 20 amino acids 0 Amino acids linked by peptide bonds Amino acids 0 Not essential Alanine glycine glutamic acid glutamine proline serine tyrosine arginine asparagine aspartic acid cysteine o Glutamine tyrosine arginine are conditionally essential 0 Essential Histidine lsoleucine Leucine Valine Lysine Methionine Phenylalanine Threonine Tryptophan o If any are not present in sufficient amounts in our body protein synthesis will STOP 0 We make the nonessential amino acids by converting one amino acid type to another Transamination synthesizing nonessential amino acids thru transfer of a NH2 group requires vitamin B6 0 Transfer of NH2 from an existing amino acid to another molecule to create a new amino acid Deamination removing NH2 group as rst step of catabolism when excess amino acids are used for energy Animal proteins complete or quothigh qualityquot 90 100 digestible o All 9 essential amino acids 0 Exception gelatin is incomplete Plant proteins incomplete or quotlower qualityquot about 70 digestible 0 Many are low in one or more of the essential amino acids 0 Exception quinoa and soy are complete proteins Limiting amino acid amino acid present in smallest supply in the diet relative to the need that the body has for that amino acid Limiting amino acids in plant proteins vegetarians o Grains low in lysine and threonine good source of methionine o Beans legumes low in methionine good sources of lysine and threonine 0 Corn low in lysine and tryptophan Complementary proteins two protein sources that make up for each other s inadequate supply of essential amino acids Biological value how efficiently the protein in a food is converted into body tissue protein egg white has the highest Protein ef ciency ratio amount of weight gain by a lab animal eating a standardized amount of a protein compared to a reference protein milk protein casein Chemical source amount of each essential amino acid in a gram of a protein divided by the ideal amount in a gram of a reference protein usually egg protein Protein digestibility corrected amino acid score multiplies chemical score by digestibility used on nutrition labels to calculate amounts of protein 0 Zero for proteins lacking an essential amino acid Protein turnover 0 Proteins are constantly being broken down and resynthesized 0 Adults synthesize and degrade about 300 g of proteins per day and consume 6595 g of protein in diet 0 If de cient for a day or two in an amino acid won t be an issue Protein digestion cooking denatures proteins 0 Stomach cells in stomach wall produce gastrin which causes HCI secretion from parietal cells and pepsinogen secretion from chief cells in the stomach wall 0 Pepsinogen is activated to pepsin which starts digestion of proteins 0 Chyme moves to the small intestine where protein and fat cause CCK secretion 0 CCK stimulates pancreas to secrete trypsin chymotrypsin and carboxypeptidase which digest proteins to free amino acids dipeptides and Tripeptides Protein Absorption 0 Free amino acids dipeptides and Tripeptides are absorbed into the intestinal cells Amino acids go via the portal vein to the liver 0 46 month old can absorb some proteins undigested o lmmunoglobulin from breast milk help newborn immune systems to develop 0 Functions of proteins 0 Every cells has proteins cell structure enzymes hormones o Fluid balance maintain osmotic balance between extracellular space and blood low blood protein leads to edema 0 Supporting acid base balance 0 Neurotransmitters o Immune function antibodies are proteins 0 Transporters o Substrate for glucose synthesis gluconeogenesis 0 Energy 4 kcalg Edema protein sign of malnutrition swelling Protein needs 0 For an adult at maintenance need enough dietary protein to match losses in urine feces skin hair nger nails sweat blood loss o If growing pregnant lactating body building need additional protein 0 Measure protein about 16 nitrogen need by nitrogen balance 0 Nitrogen intake and losses equal bad protein intake Positive nitrogen balance nitrogen intake lower nitrogen excretion higher 0 Growth pregnancy recovery stage after injuryillness increased lean body mass increase secretion of insulin growth hormone or testosterone Nitrogen equilibrium intake and excretion of nitrogen equal Negative nitrogen balance nitrogen intake high nitrogen excretion low 0 Inadequate protein intake or energy intake fevers burns infection bed rest de ciency of essential amino acids increased protein loss increase secretion of thyroid hormone and cortisol RDA for protein 0 08 g of complete proteinkg ideal body weight for adults 0 08 20 gkg for recovery 0 6595 g a day 0 AMDR 1035 of energy as protein High protein diets o Satiety o 2 times RDA can bene t athletes body builders recovery 0 sat fat B6 iron zinc 0 diabetes and impaired kidney function should avoid protein 0 need to increase uid intake so no dehydration 0 single amino acid supplements can be harmful imbalance toxicity Value of food vs supplements as protein sources 0 soy nuts legumes contain phytochemicals and protein 0 cod protein appears to prevent obesity linked muscle insulin resistance Food allergies immune system recognizes a food protein as foreign antigen 0 causes immune system to overreact 0 reaction can be severe anaphylaxis Kwashiorkor edema with maintenance of some subcutaneous fat ssue 0 moderate energy de cit with severe protein de cit 0 disease of the rstborn 0 poor quality maize or rice based diet de cient in lysine 0 mild to moderate weight loss growth impairment rapid onset fatty liver big stomach Marasmus skin and bones appearance with little or no subcutaneous fat tissue 0 severe energy and protein de cient o famine areas of drought political unrest 0 severe growth impairment develops gradually 21914 Vitamins essential organic compounds fatsoluble Vitamins A D E K 4050 absorbed o watersoluble B vitamins and Vitamin C gt90 absorbed 1 oz for every 150 lbs of food consumed not energy source but facilitates energy yielding reactions assist in biochemicalphysiological reactions Absorption of fatsoluble dependent on ef ciency of bile production pancreatic lipase formation intestinal absorption 0 4050 are absorbed can be hampered incystic brosis celiac Crohn s pancreatic diseases Transport of vitamins Fatsoluble o packaged for transport through lymphatic system 0 carried by chylomicrons and goes to liver Watersoluble o delivered directly to bloodstream Storage of vitamins Fatsoluble A D E are not readily excreted C can be Stored in liver or adipose tissues Watersoluble Lost rapidly Should consume daily but may go 10 days before de ciencies become bad OO39OO Vitamin Toxicity 0 Vitamin A is most toxic careful with supplements Vitamin D may be toxic if consumed in very large amount as a supplement 0 Other vitamins you need very large amounts Vitamin A de ciency leading cause of nonaccidental blindness in children in developing countries 0 Major public health issues in developing countries 0 Impairment of immune system and illness Retinoids active formspreformed of Vitamin A Retinal retinol and retinoic acid 0 Liver sh oils forti ed dairy products and eggs Carotenoids pigments in fruits and vegetables some Vitamin A precursors Provitamin A and can be converted Dietary precursors of retinoids Dark green and yellow orange vegetables and fruits Vitamin A precursors from plants 0 Only certain carotenoids can become vitamin A Provitamin A compounds can be converted to retinal o Alphacarotene o Betacarotene 0 Beta crytoxanthin RDA Vitamin A needs 0 Amount required to maintain adequate liver stores in Vitamin A 0 Men 900 micrograms of Retinal Activity Equivalents RAE Women 700 micrograms of RAE Preschool students are at risk 0 People with fat malabsorption or liver disease may have low vitamin A Retinal Activity Equivalents measure of Vitamin A activity based on the capacity of the body to convert provitamin carotenoids to active Vitamin A Preformed vitamin A retinoids Accounts for 6575 of our average intake of Vitamin A in the US 0 Liver sh sh liver oils forti ed milk products eggs butter forti ed margarines forti ed breakfast cereals Provitamin A carotenoids Dark green and deep yellow orange vegetables and fruits Carrots broccoli sweet potatoes cantaloupe winter squash spinach peaches kale Absorption of carotenoids plant foods Poorly absorbed 560 absorbed Fraction of the carotenoids absorbed are converted to retinal or retinoic acid in the intestinal cells 0 Small amount of carotenoids gets absorbed directly into the bloodstream Absorption of retinoids animal foods Retinyl esters o Are fatty acids bound to a retinoid o Are absorbed as part of chylomicron 0 Not active until fatty acid removed Retinoic acid 0 Absorbed via special carrier proteins 0 Fatty acid attached then goes to chylomicron and lymphatic system Storage Carotenoids are stored in liver skin and adipose tissue 0 Need to be converted to retinoids in liver Retinoids are stored primarily in liver are released into blood as needed on a retinol binding protein 0 90 of the Vitamin A in the body is stored in liver can store 1 year o Excretion small amount of Vitamin A is excreted in the urine carotenoids are excreted in bile Major functions of Vitamin A 0 Growth reproduction development 0 Embryonic development bone remodeling 0 Protein synthesis and cell differentiation 0 Gene expression 0 Epithelial cell health and replacement 0 Promotes differentiation of mucussecreting cells 0 Vision helps maintain a clear cornea rhodopsin retina o Immune function maintains epithelium need Vitamin A Vision 0 11cis Retinal binds to opsin to form rhodopsin 0 light causes photoisomerization of 11 cis retinal and all tarns retinal and opsin are formed 0 causes a signal to brain to tell us what we see 0 night blindness is a symptom of Vitamin A de ciency retinoic acid is also needed for eye health maintains health of eye cells Cell differentiation and protein expression 0 each form of Vitamin A has its own speci c cellular receptor protein retinoic acid helps transform unspecialized cells into specialized cells 0 retinoid acid is important in health of epithelial cells Vitamin A 0 gene activation over 500 different genes acne treatment 0 sebocytes in skin layer produce sebum fatty substance Carotenoids o antioxidant role 0 associated with lower risk of cataracts and macular degeneration of the eye and with lower risk of CVD Vitamin A de ciencies 0 night blindness is an early symptom xerophtthalmia irreversible blindness high intake of carotenoids appears to reduce risk macular degeneration keratinization o follicular hyperkeratosis skin changes 0 keratinization of mucous membrane of eye 0 growth retardation increased susceptibility to infection Vitamin A Toxicity Acute gastrointestinal upsetsnausea headaches dizziness muscle uncoordination Chronic liver damage hair loss bonemuscle pain loss of appetite dry skin hemorrhages coma fractures Teratogenic spontaneous abortion birth defects fetal malformation o Terato monster genic to produce 0 Don t need to worry about getting too much from vegetables 0 Carotenoids are not likely to be toxic 0 Conversion to active Vitamin A is slow and inefficient 0 As intake of carotenoids increases the absorption efficiency decreases 22114 Vitamin D o Synthesized in the skin when exposed to sunlight quotConditionalvitaminquot Acts as a hormone 0 made in one part of the body and acts in another 0 controls cellular functions 0 kidney intestine and bones formed in skin from a cholesterol precursor Food sources fatty sh cod liver oil forti ed dairy products forti ed soy and OJ some forti ed breakfast cereals supplements 0 Requirement sunlight 23 times a week for 1015 min 15 ugday with an UL of 100 ugday 0 D2 comes from mushrooms D3 is the animal version Vitamin D MetabolismStorage Hydrooxylated on carbon 25 in the liver to form 25OHvitamin D and can circulate in the blood bound to protein for weeks 0 Kidney full activates it Calcitrol is a form of Vitamin D 0 Transport by Vitamin D binding protein 0 Travels with chylomicron stored in fatty tissues Absorption and Transportation of Vitamin D Absorbed via micelles 0 Put into chylomicrons and transported via the lymphatic system then bloodstream 0 Bound to a vitamin D carrier protein in the blood Storage of Vitamin D Adipose tissue and some in liver Excretion of Vitamin D o In bile and lost in feces Small amount excreted in urine How is Vitamin D related to calcium levels 0 Storage of calcium in the blood 0 Parathyroid glands produce parathyroid hormone PTH Stimulates the kidney 1 25OH vitamin D Active vitamin D increases calcium absorption in small intestine When blood calcium levels rise 0 Hormone calcitonin is created and stops creation of PTH and slow creation of active Vitamin D which prevents blood calcium from raising too high Parathyroid Hormone increases mobilization of calcium from bone by stimulating synthesis of osteoclasts Active Vitamin D increases calcium absorption from diet by increasing calcium binding protein synthesis in intestinal cells Other functions of Vitamin D 0 Target many other cellstissues Gene control 200 different genes affected by Vitamin D 0 Cell proliferation differentiation apoptosis 0 May be protective against Multiple Sclerosis and some cancers Rickets vitamin D de ciency in children bowed legs enlargement of ends of long bones deformities of ribs poorly formed teeth growth retardation weakened muscles increased Calcium in stool Osteomalacia vitamin D de ciency in adults softening of bone bone pain compressed vertebrae mostly in women kidney disease and GI problems at risk populations 0 elderly shutins people with fat malabsorption symptoms kidney failure dialysis patients multiple pregnancies Vitamin D toxicity can be very toxic UL 100 ugday and 510x of RDA can be toxic Comes from excess supplementation Signs and symptoms 0 Hypercalcemia abnormally high calcium levels 0 Calcium deposits in soft tissues including heart and kidneys o Kidney stones 0 Hardening of blood vessels hypertension Who is at risk for de ciency Elderly Those who stay indoors People living in northern latitudes Dark skinned individuals because they need more sunlight Breastfeeding without supplementation People with fat malabsorption syndromes Celiac disease in ammatory bowel disease Vitamin D resistance Vitamin D nutritional status in the US lt30 increased risk for Rickets and bone fractures 3050 inadequate for bone and overall health in healthy individuals gt50 inadequate for bone and overall health in healthy individuals gt125 adverse effects to such high levels gt150 nmolL Vitamin E different types Tocopherols alpha beta gamma delta Tocotrienols also alpha beta gamma delta alpha tocopherol is most active wheat germ oil sun ower supplements gamma tocopherol is less active vegetable oils corn oil margarine dressings dietary sources plant oils and whole grains canola oil avocado almonds Vitamin E needs RDA is 15 mgday of alpha tocopherol Daily value is 30 IU about 20 mg Absorption and transportation of Vitamin E 0 2070 absorption passive diffusion via micelles and assembles into chylomicrons returns to liver and sent back out by lipoproteins and goes to body tissues 0 associated with phospholipids in cell membranes Vitamin E storage 0 90 stored in adipose tissue Vitamin E excretion bile feces urine skin Vitamin E function 0 problem of free radicals o Destructive chain reactions 0 Strong oxidizing agents electronseeking 0 Very damaging to membranes DNA 0 Cell membranes subject to high level of oxygen such as lung and RBC are at greatest risk Create reactive oxygen species 0 Are used strategically by white blood cells to attack infectious agents Need to control 0 Antioxidant o Stops lipid peroxidation caused by free radicals o Suppresses damaging chain reactions o Is regenerated with assistance of vitamin C 0 Vitamin E de ciency Hemolytic anemia rare in humans premature breakdown of red blood cells fat malabsorption diseases and cystic brosis 0 Preterm infants and smokers 0 lmmune function impairment Neurological changes in spinal cord and peripheral nervous system 0 Loss of muscle coordination and re exes Impaired vision and speech 0 Lab rats causes inability of female to carry pregnancy to term and infertility in males Vitamin E toxicity 0 Can cause hemorrhaging and mess with Vitamin K 0 Exercise caution if taking aspirin or anticoagulants Upper limit is 60 times the RDA and 1000 mg natural sources Vitamin E 0 Possible relationship to chronic disease prevention Reduces risk of heart disease by reducing oxidation of LDL Reduces in ammation Vitamin K Menaquinones K2 synthesized by bacteria in colon 10 from sh oils and meats 90 0 Phylloquinones K1 0 From plants green leafy vegetables broccoli peas green beans 0 Most biologically active 0 Main dietary form Vitamin K needs 0 Al 0 Women 90 micrograms daily 0 Men 120 micrograms daily 0 DV 80 micrograms Vitamin K absorption and transportation Absorbed in small intestine then into chylomicrons lymphatic system and blood 0 Transported via VLDL LDL HDL to cells in the body Stored in the liver 0 Excreted by bile and small via urine Vitamin K functions 0 Synthesis of blood clotting factors by liver 0 Conversion of preprothrombin to prothrombin clotting factor 0 Converts vitamin Kdependent protein to Gla protein able to bind calcium 0 Vitamin K must be reactivated once used 0 Bone metabolism poorly understood Vitamin K de ciency 0 Rare o Newborns given Vitamin K injections within 6 hours after delivery 0 longterm antibiotic use can interfere with Vitamin K synthesis impaired fat malabsorption can cause de ciencies Megadose Vitamin A and Vitamin E can affect Vitamin K absorption 0 No toxicity Supplementation is not a substitute for a poor diet 0 Some individuals may bene t from certain supplements 0 Things to look for o No more than 100 DV 0 USP certi cation 0 Diet and supplement combined shouldn t exceed ULs 0 Check for super uous ingredients 22414 Watersoluble vitamins Absorbed in early part of SI 0 Storage in body tissues is minimal 0 Excess is secreted through the kidney in urine 0 Lower risk of toxicity than fatsoluble Easily destroyed during cooking 0 Heat light oxidation air pH changes 0 Leach into cooking water Food source for watersoluble vitamins Grainsenriched vs whole 0 Important source of many B vitamins Bvitamins form coenzymes Cofactors in energy metabolism and bind to key enzymes allowing the enzyme to perform its work like building or breaking molecules Needed for metabolism to be active Whole grains and Forti ed grains 0 Milling of grains causes loss of vitamins and minerals 0 Removal of the germ or embryo of seed Thiamin Vitamin B1 De ciency Beriberi quotI cant I cantquot 0 Can develop in only 14 days without thiamin in diet 0 Weakness loss of appetite weight loss memory loss never damage GI and cardiovascular impairment 0 Form of it is found in some alcoholics diminished thiamin absorption increased thiamin excretion Absorbed in small intestine through active absorption depends on sodium 0 Transported in blood RBC Stored in muscles brain liver kidneys Excess ltered in kidney and excreted in urine 0 No upper limit for RDA Generally consume adequate amounts 0 Functions as coenzyme for DNA synthesis Thiamin pyrophosphate TPP coenzyme of thiamin and transketolase Used in metabolism of carbs and branchedchain amino acids 0 Used in glycolysis and citric acid cycle 0 Used in decarboxylation reactions Transketolase enzyme that converts glucose to the 5carbon sugars of DNA and RNA Ribo avin Vitamin B2 0 Yellow colored 0 Absorption in small intestine by a active transport and facilitated diffusion Transported by protein carriers in blood Stored in liver kidneys heart 0 Excess excreted in urine Stomach acid releases it from bound forms 0 No upper limit for RDA Generally intake adequate amounts 0 25 of intake is through milk products 0 Light sensitive store in opaque containers to have vitamin activity Rarely see de ciency in milk and enriched grains Ribo avin De ciencies Aribo a vinosis o Affects mouth skin red blood cells 0 In ammation of throat mouth tongue Cracking at corners of mouth 0 Moist scaly skin Anemia fatigue confusion headaches 0 Similar symptoms occur with de ciencies in the other B vitamins De ciency is rare 0 Symptoms develop after 2 months of de ciency Adolescent girls and elderly at higher risk Alcoholism poor diet maIabsorption disorders increase risk 0 Cancer diabetes heart disease can worsen a de ciency Ribo avin coenzymes both avins FAD avin adedine dinucleotide FMN avin mononucleotide Used in oxidationreduction reactions Used in many metabolic pathways energy metabolism fatty acid breakdown electron transport chain Used in formation of other compounds Niacin Vitamin B3 0 Two forms Nicotinic acid and Nicotinamine Can make our own niacin using tryptophan Meat sh poultry nuts grains forti ed our and cereals Heat stable and little is lost in cooking 0 Upper Limit 35 mgday Niacin coenzymes forms 0 NAD Nicotinamide adenine dinucleotide NADP Nicotinamide adenine dinucleotide Used in over 200 reactions 0 O O O Catabolism of proteins carbs and fat Electron and hydrogen acceptor in glycolysis and citric acid cycle Alcohol metabolism Fatty acid synthesis Niacin De ciency Pellagra Symptoms O O O O Widespread damage in the body Rough skin rash on sunexposed skin Dementia diarrhea dermatitis Death if untreated Coenzyme A essential for formation of acetylCoA from the breakdown of the major nutrients Pantothenic Acid Vitamin B5 Part of coenzyme A Get from wide variety of food sources Absorbed in small intestine Transported through the body bound to red blood cells Minimal storage stored as coenzyme A No Upper limit Generally consume adequate amounts Biotin Vitamin B7 Free biotin as biocytin in foods Some bacterial synthesis occurs in the large intestine Eggs are a good source No Upper limit Generally consume adequate amounts Biotin Functions Coenzyme for 5 different carboxlylase enzymes in the body Needed for amino acid conversion to glucose Creation of oxaloacetate starting material for gluconeogenesis Breakdown of amino acids for energy Binds to proteins that stabilize DNA Biotin De ciencies 1 in 112000 de ciency in enzyme that converts biocytin and biotin 0 symptoms skin rash hair loss convulsions low muscle tone impaired growth 0 treat with biotin supplement Due to medications anticonvulsants Due to malabsorption in serious intestinal diseases Regular ingestion of gt12 raw eggs per day Vitamin B6 Pyroxidine 3 compounds Pyridoxal Pyridoxine Pyridoxamine 100 mgday Upper limit irreversible never damage De ciency rare Food sources meat sh poultry whole grains nuts Vitamin B6 Functions Coenzymes participate in numerous metabolic reactions PLP is a coenzyme for gt100 reactions Amino acid metabolism 0 Release of glucose from glycogen Heme synthesis 0 Neurotransmitter synthesis 0 Synthesis of niacin from tryptophan Support of immune function gene expression regulation anticancer Folate B9 Folate in food usually has multiple glutamates Folic acid found in supplements and forti ed our contains only one glutamate Active transport and passive diffusion Some stored in liver and rest released into the blood and delivered to the body 0 Excess is metabolized and excreted in urine and bile Upper limit 1000 ug most people get more than RDA 5080 bioavailability Sensitive to heat oxidation and UV 0 Food sources liver legumes leafy greens avocadoes oranges forti ed grains milk potatoes Folate function DNA Synthesis Folate coenzymes used in the synthesis and maintenance of new cells or rapidly growing cells Folate converted to tetrahydrofolic acid THFA THFA is needed for amino acid metabolism and interconversion Used in formation of neurotransmitters such as dopamine 0 May enhance effects of antidepressants Folate or 812 De ciencies Megaloblastic or Macrocytic anemia 0 Red blood cells have 120 day life span and susceptible to de ciency 0 New DNA can t be formed 0 Cell division hampered o Gland immune cells are affected Neural tube defectsspina bi da o Maternal folate de ciency during the rst 2128 days after conception o Anecephaly absence of brain Vitamin B12 Cobalamin Plants can t make 812 get it from animal products or forti ed foods No Upper limit About 50 absorption from food Food sources meat sh poultry eggs dairy forti ed grains De ciency rare in meat eaters Meat eaters have 23 years of storage in liver Vegans need supplements or pregnant especially nursing vegans De ciency o Pernicious anemia looks like folate de ciency anemia but also get nerve degeneration mental problems visual problems GI disturbance loss of bowelbladder control Death within 25 years of diagnosis 812 Complex Absorption Process HCI and pepsin in gastric juice release 812 from food in stomach Rprotein secreted in saliva binds to 812 as it passes through the stomach and carries it to the small intestine where proteases release 812 again Intrinsic factor a glycoprotein from parietal cells in stomach binds 812 and carries it to the ileum where it is absorbed Transcobalamin ll carries 812 to liver and bone marrow 812 stored in liver 8ie recycling little loss in urine Vitamin 812 Function Needed for normal folate function Needed for DNA synthesis with folate Formation of the amino acid methionine and of SAM a methyl donor important for DNA and RNA regulation ChoHne Recognized as an essential nutrient in 1998 No coenzyme function so not a 8vitamin From diet and synthesized but synthesis not adequate Absorbed from SI through transport proteins Some excreted most excess converted to other useful molecules single carbon group donors 35 gday Upper Limit Food sources free choline in foods as part of phosphatidylcholine aka lecithin De ciency shy body odor due to breakdown products low blood pressure vomiting sweating GI problems Choline Function Component of phospholipids needed for cell membranes Needed for synthesis of myelin protective sheath around nerves 0 Choline needs high during infancy pregnancy Precursor for neurotransmitter acetylcholine Involved in liver export of VLDL lipoproteins Source of methyl groups for many reactions Lowers Creactive protein levels heartprotective No de ciency disease but liver and muscle damage observed in adults fed cholinede cient diets Vitamin C ascorbic acid Most animals can synthesize vitamin C from glucose except primates guinea pigs and a few other species Absorbed from small intestine active transport 0 Intake efficiency decreases at high intake eves usually 7090 Body can store up to 2 g ascorbic acid in a variety of tissues Scurvy at lt300 mg storage 2 gday Upper imit GI issues kidney stones Smokers need more Least stabe vitamin easiy lost in storage processing and cooking Food sources citrus fruits peppers green vegetables best other fruits and veg also have Vitamin C Vitamin C Roles Oxidationreduction agent 0 Electron donor oxidized and reduced forms 0 Cofactor for metaoenzymes keeps bound metal in reduced state 0 Antioxidant properties Important role in collagen synthesis 0 Needed for assembly of collagen triple helix 0 Burn patients need additional Vitamin C to build new coHagen 0 Creation of OH proine and OH ysine defective synthesis leads to scurvy and in Used in synthesis of neurotransmitters and some hormones Vitamin C in meas assists Iron absorption by conversion to Fe 2 ferrous iron Immune function white blood cells carry more Vitamin C than any other cell type Vitamin C deficiency Scurvy Prevents the normal synthesis of collagen Widespread damage to connective tissues in the body 0 Apparent after 2040 days 0 Fatigue Pinpoint hemorrhages around hair follicles Gum and joint bleeding Impaired wound healing Bone pain and fractures Diarrhea Psychological problems in advanced stages 0 Death 0 May help reduce risk of cancer and heart disease OOOOOO Vitaminlike Compounds 0 Carnitine 0 Animal foods and also made in our liver 0 Transport of fatty acids into the mitochondria 0 Removal of toxic compounds in people with inborn errors of metabolism 0 Taurine 0 Synthesized in body from sulfurcontaining amino acids 0 Also consumed in meat products 0 Functions not well understood but involved in many vital processes 31014 Minerals essential inorganic elements 0 7 major minerals Na K Cl Ca P Mg S 0 gt100 mg required day 0 Trace minerals Fe Zn Cu Mg l Se Ch Fl Mb As Bo Ni Si Va 0 lt100 mgday Amount in body highest to lowest Calcium Phosphorus Potassium Sulfur Sodium Chloride Magnesium lron Bioavailability and absorption of Mineral Minerals obtained from animal food sources are usually more bioavailable than plant sources 0 Agricultural practices and food processing can affect the amount of minerals in foods 0 Physiological need for a mineral often determines its absorption efficiency 0 Minerals of similar molecular weights and valence charges can compete for absorption affecting each other s uptake 0 Individual mineral supplements can create a serious imbalance Components of food can in uence mineral absorption 0 Phytic acid in wheat grain ber binds strongly to some minerals yeast breads are better than unleavened for mineral bioavailabilty enzymes in the yeast improve the mineral bioavailability o Oxalic acid in leafy green plants reduces bioavailability o Polyphenols in tea chocolate wine can lower bioavailability of minerals Vitamins can enhance bioavailability of some minerals 0 Vitamin C enhances iron absorption 0 Vitamin D enhances calcium phosphorus and magnesium absorption Gastric acidity HCI makes minerals more bioavailable by dissolving them and converting to a form more easily absorbed Mineral Transport 0 Many minerals have speci c binding proteins to carry them in the blood and even in cells while others travel freely 0 Trace minerals are often very reactive and toxic in their free form and so usually have speci c carrier proteins Mineral Functions 0 Cofactors to assist enzymes Mg Se Cu 0 Components of body compounds Fe in heme Transmission of nerve impulses and cell signals Na Ca K 0 Water balance Na K Ca P Body growth Ca P Roles at cellular tissue organ and whole body levels Mineral De ciencies 0 Calcium 23 of people do not meet requirements 0 K Mg also fall short of DRI recommendations 0 Trace minerals Fe Zn most likely to be de cient Mineral toxicities Excess can be toxic Particularly true of trace minerals iron zinc Sodium Na 0 Main solute in extracellular uids outside cell 0 Active transport coupled transport with glucose and other compounds some amino acids bile acids Excess excreted by kidneys lost in urine feces perspiration Almost all the Na in our diet comes from salt NaCl Only about 1015 of the sodium in our diet is added as salt during home cooking and at the table 7580 from food processing and restaurants 0 Salt or Nacontaining food additives 10 of our intake is of sodium that naturally occurs in foods 0 500 mg of saltday from unprocessed foods 0 Only 200mgday needed to maintain normal physiological function uid balance muscle contraction nerve transmission 2300 mg Upper limit Sodium Functions Helps absorption of glucose and some amino acids in SI Muscle and nerve function Electrolyte uid balance Sodium De ciency Hyponatremia endurance athletes headache nausea fatigue muscle cramps Main issue with Na is the association with hypertension heart disease and stroke 0 AMAWHO goal of reducing sodium by 50 to reduce hypertension by 20 Na over 2gday can cause calcium loss in urine 0 Kidney stones 0 Reducing sodium food taste preferences for amount of salt can change over time re ecting your typical diet Potassium K Plantbased foods are rich sources Fresh or dried fruits vegetables milk whole grains beans and salmon Unprocessed foods are best sources higher potassium lower sodium No Upper limit Well absorbed 90 in both small and large intestines Excess excreted by kidney K is the major cation INSIDE the cell Maintaining membrane potential Fluid balance nerve impulses contracting muscle heart function K intake is associated with lower blood pressure Potassium Levels 0 Low blood potassium hypokalemia is life threatening o weakness fatigue irritability constipation irregular heartbeat 0 Increase in blood pressure and risk of stroke 0 At risk if take diuretics to treat hypertension they deplete potassium from the body 0 Eating disorders low food intake vomiting laxatives all deplete K Alcoholics Athletes may lose extra K in sweat focus on Krich foods 0 High blood potassium hyperkalemia is also life threatening 0 Almost never occurs in healthy people excess would be excreted 0 Poor kidney function a buildup of K in blood a irregular heartbeat or cardiac arrest Use of supplements is harmless if kidney function is normal 0 No Upper Limit 0 GI upset in excessive amounts Chloride Cl 0 Al 2300 mgday UL 3600mgday parallels Na 0 Almost all comes from table salt NaCl 0 Passively absorbed in small and large intestine excreted by kidneys Chloride Functions Main anion of the extracellular uid 0 With Na maintains extracellular uid volume 0 Aids in transmission of nerve impulses Component of HCl stomach acid Acidbase balance in body Not a nutrition issue under normal conditions De ciencies with long bouts of vomiting loss of HCl weakness lethargy anorexia Most people get much more than needed as NaCl Phosphorus P 0 Important roles in bone mineralization enzyme activity phosphorylation present in ATP phospholipids DNA and RNA 0 85 of the phosphorus in body is found in the bones and teeth as calcium phosphate Remainder in cells and outside cells as phosphate PO4239 o Phosphate PO4239 is the main anion inside cells o 70 absorption upper small intestine both active transport and diffusion Active Vitamin D enhances absorption of phosphate and magnesium in the small intestine as well as calcium as we learned earlier Bioavailability in grains and legumes is poor phosphorous is mostly in an undigestible phytate form Yeast can break down the phytates so yeast breads have enhanced P bioavailability 34 gday Upper limit 1000 1700 mgday o Toxicity rate 0 Food sources milk cheese meat baked goods grains eggs nuts sh soft drinks De ciency unlikely except in cases of extreme starvation o Ricketslike symptoms bone demineralization o Anorexia weakness irritability joint pain Magnesium Mg 0 Found in green leafy vegetables 0 present in Chlorophyll 0 plants are the richest source 45 of intake tap water if hard 0 We absorb 4060 vitamin D facilitates Mg absorption 0 Up to 80 absorption efficiency if intake is low 0 60 stored in bones rest in muscle and other tissues 0 Mg levels largely regulated by the kidneys only small amounts of Mg stored in body but sufficient to last for days RDA based on balance of intakeexcretion o 310 and 400 mgday for women and men 0 Our average intake is often below this De ciency o lrregular heartbeat weakness muscle spasm disorientation nausea seizures 0 Impaired nerve function 0 Affects PTH vitamin D and calcium Risk of osteoporosis Magnesium Functions Stabilizes ATP binds to phosphate groups 0 Functions in over 300 magnesiumdependent enzyme reactions 0 Mg needed for ATP DNA and RNA synthesis 0 Works with calcium in muscle contractionrelaxation Sulfur S 0 Most of sulfur in body found as components of the amino acids methionine and cysteine 0 Also in other organic compounds like thiamin biotin and even insulin 0 There is no Al RDA or UL for Sulfur o No de ciency or toxicity symptoms 0 Protein intake supplies suf cient sulfur for our bodies 0 Sulfur shortage would be seen only in states of protein de ciency Calcium Ca 0 Food sources Dairy 50 foods made with dairy leafy greens forti ed juices and cereals tofu 25 gday Upper limit 7001200 mg De ciency kidney stones kidney failure decreased absorption of other minerals Hypocalcemic tetany muscle spasms under low Ca Calcium Functions 0 Ca functions in blood clotting transmission of nerve impulses by controlling release of neurotransmitters release of insulin muscle contraction and regulation of cell metabolism via calmodulin 0 Ca may help lower blood pressure reduce risk of colon cancer and recently suggestions have surfaced that Ca may lower the skforobesty Calcium supplements Calcium carbonate is 40 Ca antiacids need gastric acid for absorption Ca citrate 21 Ca is less dependent on gastric acid secretion With supplement doses above 15 gday risk of hypercalcemia lf take Ca supplement take with or just after meal 0 Do not take at the same time as other mineral supplements competition with Zinc lron Magnesium Calcium Absorption Transportation Storage Excretion 99 of Calcium is stored in the bones and teeth 0 Amount absorbed depends upon body needs 0 may be as high as 75 pregnancy infancy or less than 25 0 Absorption most ef cient in upper small intestine where pH is still low enough to keep Ca2 in solution 0 Blood calcium levels are regulated tightly 0 Active vitamin D promotes and regulates Ca absorption 0 Concentration of blood and cell calcium controlled by PTH calcitonin vitamin D and osteoclast activity Calcium and Bone Metabolism Bone remodeling ongoing process of rebuilding and repair 0 Osteoblast builds bone 0 Osteoclast dissolves bone bone reabsorption o Osteocytes take up and release calcium from blood 0 During growth osteoblast activity is greater than osteoclast activity 0 Physical activity weight bearing activities and estrogen stimulate osteoblasts Always have balance of osteoblastosteoclast activity to repair bone Osteoporosis Bone Loss 0 Somewhat low bone mass osteopenia 0 Very low bone mass osteoporosis o Kyphosis Dowager s hump Diagnosis 0 DEXA bone scan 0 Prevention 0 Bone building nutrients 0 Active lifestyle with weightbearing activities 0 Not smoking 0 Drug therapy Estrogen and genetic factors are involved 0 Affects at least 10 million women in US 0 Beyond 30 years of age we start to lose bone mass 0 Beyond 75 years of age hip fractures increase 0 Estrogen up to 20 loss of bone in the rst 57 years after menopause DASH Diet Dietary Approaches to Stop Hypertension Lots of Fruits and vegetables 0 Low fat dairy Low saturated fat total fat amp cholesterol 0 Rich in magnesium potassium calcium protein amp ber 0 This eating plan signi cantly lowers blood pressure as effective as some common blood pressure drugs 31414 Trace Minerals Identi ed as dietary essentials only recently except iron and iodine Dif cult to measure amounts in the body 0 Dif culty to demonstrate de ciency o Interact with each other 0 Content of plant depends to some extent on content of mineral in soil 0 Animal foods generally better sources Iron Fe 0 Heme iron Fe2 o In meats o Hemoglobin myoglobin oxygen carriers 0 Nonheme iron Fe3 o In enriched bakery products green leafy veg o 23 times less bioavailable than heme iron Factors affecting iron absorption Body s iron needs and stores 0 Form of iron in foods eaten hemenonheme total amount consumed 0 Dietary composition Factors that negatively affect nonheme bioavailability Phytic acid whole grains legumes Oxalic acid leafy greens a poor absorption from cooked spinach less than 1 Polyphenols coffeetea a can reduce iron absorption up to 70 0 High ber Factors that enhance nonheme bioavailability Acidity Fe3 a Fe MFP factor a eat Meat Fish or Poultry at the same meal 0 Vitamin C a 14 cup OJ doubles iron absorption 12 cup OJ increases absorption 6fold Iron Absorption and transport Tightly controlled regulates amount of iron absorbed prevents iron toxicity 0 Important because only 10 of iron in the body is lost per day 0 Limited ability to excrete excess iron 0 Instead we prevent excess absorption 0 Protective feature prevents iron toxicity 0 Iron recycling 0 Transport proteins Ferritin Transferrin and others Ferritin binds iron and stores it in mucosal cell 0 Iron is transferred to bloodstream and binds to Transferrin Mucosal block unneeded iron is excreted when absorptive cells are sloughed off after several days lron Functions Oxidationreduction reactions Fe2 saFe3 0 Useful but can lead to creation of free radicals 0 To protect very little free iron in body mostly in heme or bound to carrierstorage proteins 0 Oxygen transport aHemoglobin and Myoglobin o Ironcontaining enzymes 0 Energy metabolism cytochromes in electrontransport chain and an enzyme in the Citric acid cycle 0 Drug and alcohol metabolism in liver P450 enzymes 0 Enzyme cofactor 0 Synthesis of neurotransmitters Needed for production of immune cells lron needs 0 45 mgday Upper Limit 0 Food sources meat and seafood forti ed cereals green leafy vegetables beans Vegetarians should take in 18 x the RDA due to the lower bioavailability of nonheme iron 0 Most widespread trace mineral lron De ciency Iron de ciency anemia Most widespread mineral de ciency worldwide 0 At risk premature infants young children females of childbearing age pregnant women vegetarians 0 Can affect intellectual development in child 0 Blood donation more than 24x per year 1 pint 200250mg iron 0 Need several months to get up to previous lron level lron Toxicity Nausea stomach irritation diarrhea impaired absorption of other trace minerals Children toxicity due to overconsumption of chewable vitamins 200 mg can be fatal Hemochromatosis ineffective mucosal block 0 Iron deposits in heart liver 0 Untreated a Liver disease heart failure Frequent blood transfusions High levels of iron a free radical production a suggested link to heart disease and cancer ltan 40 mgday Upper limit Typical intake meets guidelines Food sources red meat and seafood nuts beans wheat germ whole grains Phytic acid in wheat 70 from animalbased foods Absorption Transportation Storage Excretion Metallothionine a protein that binds and temporarily stores Zn in intestinal cells Mucosal block similar to Iron Absorption reduced when large amounts of nonheme iron are in GI tract Carried through bloodstream on albumin protein then transported to liver Not stored excess zinc excreted via feces small amounts in urine amp sweat Func ons Over 100 different metalloenzymes require zinc DNA and RNA synthesis taste acuity immune function helps prevent macular degeneration quotZinc nger proteins cellmembrane proteins Vitamin A D receptors In pancreatic digestive juices a zinc recycling De ciency Overt de ciency common when poverty limits food choices North America mild or marginal de ciencies Hair loss loss of appetite delayed growth and sexual maturation dermatitis immune dysfunction birth defects infant mortality etc o Toxicity loss of appetite nausea vomiting intestinal cramps diarrhea impaired immune function reduction of copper absorption CopperCu 10 mgday Upper limit Toxicity GI symptoms risk of liver damage accumulation of Cu in liver and brain cirrhosis and neurological damage 0 Typical intake 10001600 mg meets guidelines 0 1270 absorption ef ciency 0 Food sources dried fruits whole grains tap water meat 0 70 animalbased foots and in variety of foods Copper Absorption o In small intestine and carried by the protein albumin to liver and kidneys In liver Cu attaches to protein ceruloplasmin a ceruplasmin brings Cu to cells 0 Very little stored in body excess excreted through bile a feces CopperFunc ons Component of several metalloenzymes Iron oxidation in enterocytes a low Cu results in iron de ciency anemia Superoxide dismutase enzymes a eliminates superoxide free radicals protects cells from damage Cytochrome C oxidase electron transport chain Connective tissue formation Copper De ciency and Toxicity De ciency rare anemia low WBC osteopenia loss of skin and hair pigmentation melanin cardiovascular changes impaired immune function Toxicity Wilson s disease genetic disorder excess Cu storage Manganese Mn 0 11 mgday Upper limit 0 Typical intake 26 mg meets guidelines 0 510 absorption ef ciency 0 Food sources plant foods whole grain cereals nuts legumes leafy greens tea very little in meat and dairy Manganese Functions Cofactor for many metalloenzymes Carbohydrate metabolism gluconeogenesis collagen formation antioxidant defense system etc 0 Shares functional similarities with Zinc and Copper Manganese De ciency and Toxicity Deficiency Rare only a few cases ever reported 0 Nausea vomiting poor growth skeletal abnormalities impaired carbohydrate and lipid metabolism abnormal reproductive function 0 Toxicity neurological impairment Parkinson slike symptoms lodine I 0 One function synthesis of Thyroid Hormone 1100 ugday Upper limit Toxicity Enlargement of thyroid decreased thyroid hormone synthesis occasionally hyperthyroidism autoimmune thyroid issues thyroid cancer lodine Foods Saltwater seafood seaweed iodized salt and dairy products 0 12 tsp iodized salt meets RDA Processed foods often use uniodized salt 0 Sea and specialty salts are usually uniodized Bioavailability Goitrogens compounds in raw veggies and some other foods decrease uptake of iodine and also inhibit iodine use by thyroid gland cooking destroys Goitrogen activity lodine De ciency Disorders 0 Endemic goiter enlargement of thyroid gland on neck 0 TSH hormone stimulates thyroid enlargement in attempt to more efficiently trap lodine Over time slowed metabolism ands serious complications 0 Endemic cretinism abnormalities to offspring during development that affect brain development and physical growth 0 Severe mental retardation loss of hearing and speech muscle spasticity very short stature Selenium Se 0 400 ugday Upper limit get adequate amount daily Toxicity nausea diarrhea fatigue hair loss brittle nails skin rash impairment of sulfur protein metabolism 0 Food sources seafood meats grains and cereals selenium content of grains varies with local soil content Selenium Absorption Most comes in through amino acids Selenomethionine Selenocysteine 50100 absorption in SI 0 Transported by carrier proteins high levels in a number of organs Selenium levels maintained through kidneys amp excretion Selenium Functions 0 Component of over 25 different enzymes and proteins 0 Antioxidant defense network 0 Glutathione peroxidase contains selenium prevents cell membrane damage Lower cancer incidence with selenium o Thyroid function Thyroid metabolism T4 a T3 immune function etc Selenium De ciency Thyroid issues increased risk of certain cancers Keshan disease a cardiac disorder associated with heart failure uid accumulation in the lungs Chromium Cr 0 Foods sources meats liver sh eggs whole grain products broccoli dried beans nuts dark chocolate 0 No Upper limit no toxicity data 0 Little is absorbed bioavailability difficult to asses Accumulates in bones liver kidneys skin Excreted in feces Chromium Functions 0 Enhances insulin function 0 May prevent metabolic syndrome insulin resistance 0 May enhance insulin action and help normalize blood sugar levels Chromium De ciency and Toxicity Not well established 0 No Upper Limit Weight loss glucose intolerance nerve damage Fluoride F Not essential but helpful in preventing dental caries Sources uoridated water tea seafood and seaweed Al 3 mgd adult women 4 mgd adult men UL 10mgday 8090 absorption in stomach and SI Stored in teeth and skeleton Promotes remineralization of tooth enamel Fluoride toxicity rare but lifethreatening Molybdenum Mo Dietary sources plantbased foods soil dependent RDA 45 mgd UL 2000 mgd Functions cofactor in several metalloenzymes Nickel Vanadium Boron Silicon Arsenic Ultratrace minerals Ultratrace amounts in body Do not yet have clearly de ned essential physiological functions Nickel metabolism of amino acids fatty acids vitamin B12 and folic acid 0 Chocolate nuts legumes whole grains Vanadium mimics insulin action 0 Shell sh mushrooms parsley Boron cell membrane function steroid hormone metabolism 0 Legumes fruits vegetables potatoes wine Silicon bone formation 0 Root vegetables whole grains Arsenic amino acid metabolism DNA function 0 Fish grains cereals Exam 3 Energy balance Energy intake vs Energy expenditure 0 Positive balancenegative balance Creeping weight gain 0 1 kcal amount of energy to raise the temp of 1 kg of water 1 degree C Bomb calorimeter measures kcals Gross Energy Values Protein 56 kcalg Carbs 42 kcalg Lipids 93 kcalg Physiological Fuel Values Protein 4 kcalg Carbs 4 kcalg Lipids 9 kcalg Alcohol 7 kcalg BMR amount of energy expended at rest in fasting state 6070 total energy use In uenced by lean body mass body surface area nutrition pregnancy caffeine tobacco Decreases when losing weight 0 Resting metabolic weight nonfasting 6 higher than BMR PA 2035 of total energy use Thermic effect of food cost of digesting absorbing and metabolizing food 0 510 of total energy use Nonexercise activity thermogenesis NEAT calorie expenditure that accompanies PA other than volitional exercise adaptive thermogenesis o Fidgeting shivering etc 0 Response to cold temperature conditions 0 Response to overeating some excess energy expenditure 0 Adaptive response involving the sympathetic nervous system 0 Brown fat Direct Calorimetry measures heat released from the body Indirect Calorimetry measures oxygen consumption and carbon dioxide release 0 Very expensive Estimating energy requirements BMR For women 09 kcal kg body weight hour 0 For men 10 kcal kg body weight hour Physical activity contribution Sedentary add 2040 of BMR 0 Moderate activity add 5565 of BMR 0 Heavy activity add 80100 of BMR TEF thermic effect of food 10 of BMR PA 0 The estimate for total energy expenditure BMR PA TEF estimates Adult men EER 662 953 x age PA x 936 x WT 726 x HT Adult women EER 354 691 x age PA x 936 x WT 726 x HT WT weight in kg lbs 22 HT height in meters inches 394 Eating Behavior Regulation Hunger physiological need for food Appetite psychological need for food Satiety brought about when either drive is ful lled o Hypothalamus controls hunger o Sympathetic nervous system activity blood glucose levels hormone secretions o Ghrelin Leptin Endorphins etc Hunger physiological need for food 0 Controlled in part by interactions of the gut liver and central nervous system 0 Hypothalamus integrates regulation of food intake 0 Vagus nerve sympathetic nervous system 0 Blood glucose is one signal to regulate feeding Stimulates Neuropeptide Y agoutirelated peptide endorphins ghrelin and glucocorticoids o Inhibits o CCK secreted by intestinal cells Slows gastric emptying increases pancreatic secretions contract gall bladder and helps you feel satiated o Insulin along with glucose regulation helps you feel satiated o Leptin hormone produced by our fat cells Leptin Fat cells produce the hormone Leptin Larger fat cells produce more Leptin Leptin travels via blood to hypothalamus to decrease food intake Insulin Insulin goes up with an increase in blood sugar after a meal Insulin travels via blood to hypothalamus to decrease food intake 0 Larger fat cells become less responsive to insulin so see increase in blood insulin Healthy body weight concept originated from exam of Life Insurance Data on frame size gender weight and height 0 Healthy BMI 185249 Overweight 25299 Obese gt30 Obesity Health Risks Risk factor for type 2 diabetes 10 of adults 0 About a third of the obese population is type II diabetic Increased risk for CVD stroke hypertension 0 Type II diabetes increases risk of CVD amp stroke 34x Increased risk forjoint problems surgical risk and some cancers Measurement of Body Fat Underwater weighing 0 Measures density Air Displacement o BodPod measures your volume using pressure differences Bioelectrical impedance measures resistance calculates body fat 0 Low voltage current run through body 0 Fat resists current water conducts Skinfold measurement 0 Estimate of subcutaneous fat DEXA Dualenergy Xray absorptiometry measures bones dens y Fat numbers 0 Women 2135 0 Men 8 24 Body Fat Distribution Android apple waist gt40 inches for men and gt35 for women more health risk Gynoid pear less health risk Theory fatty acids metabolized from abdominal tissues go directly to liver leads to insulin resistance Why are only some people obese Research with identical twins suggests that genetic background accounts for 40 of body weight Normal weight parents 10 chance of obesity one overweight parent increases chances to 40 and both parents obese increases chances to 80 Environment plays an important role in obesity 0 Gene pool largely unchanged but epigenetics may be important 0 Socioeconomic status is a clear factor Genetic predisposition AND a conductive environment Set point concept too simplistic Treatment of Obesity Dieting can be problematic better to focus on active lifestyle Body resists weight loss drop in basal metabolism Only 5 of people who follow commercial weight loss programs lose weight and maintain the weight loss after 5 years Weight gain between 2544 years of age is very common 0 Gain of over 20 pounds is considered unhealthy Weight loss ofjust 10 may reduce disease risks related to obes y o Prediabetic high blood lipids high blood pressure can all improve Increased physical activity without any weight loss may also reduce disease risks 0 Shift in body composition First step should be to PREVENT further weight gain Energetics of Body Fat Loss Goal should be to lose fat not water or muscle One pound of adipose tissue contains 3500 kcal 7700 kcalkg adipose tissue A de cit of 500 kcalday is necessary to lose onepound of adipose tissueweek o Decrease food intake by 250 kcal AND 0 Increase energy expenditure by 250 kcal o 250 kcal One hour of walking at 4mph Sound Weight Loss 0 Control intake increase physical activity and acknowledge that a lifetime of changes in habits will be necessary 0 Need to meet nutrient needs follow MyPlate for balance variety and moderation Expect slow loss 0 Meet your habitstastes o Minimize hunger dif cult if intake lt 1000 kcal Use common foods 0 Fit social situation 0 Change problem eating habits Use plan that will improve overall health 0 See a physician if have existing disease or plan to rapidly lose weight by decreased intake or large increase in activity Control of Energy IntakeWeight Loss 0 First control intake to prevent further weight gain 0 Plan to lose no more than 12 pounds of body fat per week 0 This will require a reduction of 5001000 kcalday 0 Do not try to consume lt1000 kcalday Control portion size select lower fat foods and read food labels 0 Look for nutrientdense foods Regular PA 0 Very important for general health and especially for weight loss and weight management Sustained aerobic exercise and weight training 0 Increases energy expenditure 0 Preserves lean body mass 0 Maintains basal metabolic rate Behavior modi cation essential component to weight loss and maintenance individualized approaches Stimulus control shopping plans activities holidays and parties eating behavior Reward Selfmonitoring Cognitive restructuring Portion control Fad Diets 0 Promote quick weight loss 0 Note a quick 5b drop won t be loss of fat more typically a loss of water and glycogen stores 0 Limited food selections Celebrity testimonials Curealls Expensive supplements often recommended 0 No attempt to change eating habits permanently Critical of scienti c community 0 quotDoctors don t want you to know about this new and effective way of losing weightquot Low Carb Diet AtkinsSouth Beach 0 Limits food intake 0 Limited carbs no sugars little to no grains inadequate fruits and vegetables 0 Most of intake ends up being eggs meat cheese High Fat 0 Caloric intake is low hard to keep calories high on just fat and protein 0 Signi cant weight loss in rst week waterglycogen Often see lower blood lipids due to decrease in caloric intake 0 Weight loss increases insulin sensitivity 0 Not sustainable for longterm too restrictive Low Fat Diets Pritikin Diet 10 fat intake 0 Focus on lowenergy density foods Exercise recommendations Healthy weight loss but not very sustainable 0 Need to change lifestyle NOT diet and then resume previous habits Professional Assistance Diet Pharmaceuticals not effective by themselves 0 Meridia removed from US market cardiovascular risk Reduced reuptake of serotonin and norepinephrine increase satiety o Amphetamines Act on neurotransmitters in the brain reducing appetite addictive Increased heart rate blood pressure insomnia heart palpitations o Orlistat Overthecounter as Alli lipase inhibitor Prevents the absorption of fats about 30 reduction in fat intake from food Unpleasant gastrointestinal side effects oily leaky loose stools o Amylase inhibitors block carb digestion fermentation in colon a gas diarrhea 0 Very low calorie diets Optifast liquid diet 400800 kcalday Presurgical under medical supervision 0 Surgery Problems 812 needs intrinsic factor calcium needs acid severe diarrhea after sugar Only for people with a BMI of at least 40 for 5 years Disordered Eating and Body Image Unrealistic media representations of body shape and body size Widespread photoshopping of models Dove campaign A wish for social acceptance Stress levels in teens and young adults Compounded by the fact that eating is a necessity Dieting to become thin may lead to an eating disorder Genetic connection to eating disorders Yes 0 Compared to fraternal twins identical twins have a higher chance of developing an eating disorder 0 More than 50 percent of the risk for developing a disorder is because of genetic risk factors Food linked to personal emotions comfort release of natural opioids endorphins reward Disordered eating experienced by most of population from time to time usually no longterm physiological effects holidays occasional binge Eating disorders up to 5 of the population Psychological and physiological disturbances Anorexia nervosa psychological denial of appetite Bulimia nervosa bingeing and purging Bingeeating disorder binges followed by guilt Eating disorder not otherwise speci ed NOS Orthorexia nervosa extreme focus on healthy eating Development of an Eating Disorder 1 Attention to hunger and satiety signals limitation of energy intake to restore weight to a healthy level 2 Some disordered eating habits begin as weight loss is attempted such as very restricted eating 3 Clinically eating disorder recognized Anorexia Nervosa most serious eating disorder 510 more common in females 5 million cases in US 0 Depression is common due to the desire for acceptance 0 Lack of appropriate coping mechanisms 0 Characterized by an intense fear of obesity and weight gain 0 Begins with a simple diet and leads to semistarvation Depletion of nutrients including potassium damaging to heart function 0 Heart problems 0 Suicide 0 Diagnostic Criteria 0 Denial of hunger and underweight o Irrational intense fear of gaining weight 0 Excessive loss of body weight lt 85 of expected weight or BMI lt 175 0 Loss of menstrual cycle amenorrhea for 3 consecutive months Pro le of Anorexia Nervosa Occurs in 1 out of every 200 adolescent girls in North America 0 Occurs in 510 times as many women as men 0 Typically develops in adolescence while experiencing physical changes associated with puberty 0 False body perception o Tend to view themselves as much larger than they actually are 0 Often from middle or upper socioeconomic groups with an overbearing mother and high expectations Finds security in control is obsessive competitive Preoccupation with food 0 Lack of menses for girls amenorrhea Warning Signs of Anorexia Abnormal eating habits eating very little food Hiding and storing food 0 Prepare large meals for others but not eating them 0 Withdrawals from friends and family 0 Critical of self and others 0 Sleep disturbances and depression 0 As many as 7 die of suicide within 10 years 0 25 recover within 6 years 0 Amenorrhea o Leads to bone metabolism problems 0 Destined for osteoporosis Physical Changes during Anorexia quotSkin and bonesquot appearance Lowering of body temperature 0 Lower basal metabolic rate 0 Due to low energy intake 0 Appearance of Ianugo and loss of hair 0 Lanugo ne downy hair that stands on end to trap air for insulation 0 Iron de ciency anemia and other nutrient de ciencies Rough dry scaly skin 0 Low white blood cell count 0 Weakened immune system Constipation amenorrhea Treatment Anorexia Nutritional Increase food intake to raise the BMR Prevent further weight loss Restore appropriate food habits Hospitalization if under 75 of expected weight Goal weight gain Psychological 0 Cognitive behavioral therapy 0 Determine underlying emotional problems Reject the sense of accomplishment associated with weight loss 0 Family therapy support group 0 25 recover within 5 to 6 years Many never fully recover from anorexia nervosa 0 May return to a normal body weight but still have anorexic tendencies Bulimia Nervosa A psychological con ict 50 have major depression Preoccupied with food Involves episodes of bingeing followed by attempts to purge o Binges occur 2 timesweek for at least 3 months 0 Purging behavior involves vomiting excessive exercise or use of laxatives Recognize behavior is abnormal often try to hide it Many not diagnosed Cycle of rigid food intake and binges Pro le of a Bulimic Young usually female adults May be predisposed to becoming overweight Usually at or above normal weight Tried frequent weightreduction diets Impulsive and thinks of food constantly Allor none thinking 0 quotl succumbed and ate one cookie I m a failure and might as well bingequot Often from disengaged or detached families Secret lives of Bulimics Many are not diagnosed Hide their binge and purge habits quotFood rulesquot Single binge can consist of 10000 to 15000 kcal Binge consists of convenient high sugar high fat foods Purge by vomiting in hopes that food does not get absorbed Purging ineffective and unhealthy feelings of guilt depression low selfesteem 3375 of all energy is absorbed even after vomiting 90 of all energy is absorbed when laxatives are used Can show up as hypergymnasia excessive exercise Health Problems with Bulimia Vomiting causes the most problems Demineralization of teeth dental caries Drop in blood potassium Swelling of the salivary glands Ulceration of the stomach and esophagus Constipation Due to lack of ber Treatment of Bulimia Nervosa Decrease episodes of binging and purging Psychotherapy to improve selfacceptance 0 Establish healthy normal eating habits Group therapy 0 Possible antidepressant drugs 0 50 recovery rate others struggle for the rest of their lives EDNOS Eating Disorders Not Otherwise Speci ed Broad category of eating disorders 0 Some may start out with anorexia nervosa and develop characteristics of bulimia nervosa or vice versa 0 Women who may meet all criteria for anorexia nervosa but sustain menses 0 Women who may meet all criteria for anorexia nervosa but maintain normal weight 0 People who meet all criteria for bulimia nervosa but who binge less than 2 times a week 0 Diagnosis for BN binge at least 2 times a week for at least 3 successive months 0 People who chew and spit out food Baryophobia the fear of becoming heavy parents worrying about children being overweight 0 Children are given a lowfat restricted diet in hopes to ward off obesity or heart disease 0 Detrimental to children affects growth and development Selfimposed restrictive diets by young adults to avoid obesity 0 Problem due to lack of appropriate nutrition information Treat for Baryophobia Nutrition education 0 Making sure the child young adult get the nutrition required for proper growth 0 Education on the appropriateness of sweets and fats in the diet Orthorexia obsession with healthy eating o It is normal to be concerned about diet health and body weight 0 Weight normally uctuates Treat physical and emotional problems early Discourage restrictive diets Correct misconception about foods 0 Thin is not necessarily better 32814 Female Athlete Triad 1 Energy de cit disordered eating andor overtraining 2 Amenorrhea missing 3 period cycles 3 Osteoporosis irreversible bone loss Leptin and estrogen needed Treatment psychological medical nutritional Need physician dietician psychologist coach family friends 0 Reduce preoccupation with food weight and body fat 0 Increase meals and snacks gradually Rebuild body to healthy weight at least 25 increase 0 Establish regular menses Decrease training by 1020 0 Calcium supplementation Bene ts of Exercise 0 Healthy People 2020 increase proportion of adult meeting the 2008 physical activity guidelines for Americans 0 Adults should be physically active 0 150 minutesweek of moderate activity or 75 minutes week of vigorous activity Double this for additional health bene ts 0 Strength training 2 timesweek Bene ts of PA Strong bene ts 0 Lower risk of early death CV diseases diabetes hypertension colon and breast cancers Prevent weight gain and facilitate weight loss when combined with diet Prevent falls reduce depression and better cognitive function with aging Moderate bene ts Weight maintenance after weight loss Lower risk of hip fracture Increased bone mineral density Improved sleep quality Lower risk of lung and endometrial cancers Characteristics of a Good Fitness Program Combines Aerobic Resistance and Flexibility Duration 0 Frequency o lntensity Rating of Perceived Exertion RPE V02max Metabolic equivalents METs Progression Consistency 0 Variety Energy Sources for Intense Exercise 0 ATP immediately useable energy in muscle for 24 seconds of muscle contraction o Phosphocreatine initial resupply of ATP reforms ATP and ADP 10 seconds to a minute made from amino acids Carbohydrates major for shortterm highintensity and medium exercise Anaerobic state 0 Glucose is only energy source to supply ATP Glycolysis to pyruvate converted to lactate Glycogen stores 0 Shortterm energy 0 2 ATP per glucose Aerobic Pathway 0 Needs adequate 02 0 ATP supply slower but greater 0 Glucose metabolism to C02 H20 36 ATP Depletion of muscle glycogen over time causes muscle fatigue Depletion of liver glycogen a hypoglycemia Fat main fuel for prolonged lowintensity exercise 0 Fat metabolism provides more energy than carbohydrates but is less efficient 9 vs 4 0 Training affects muscle use of fatty acids Protein minor fuel source during exercise 5 more in endurance 15 0 Energy comes from the branched chain amino acids 0 Directly or via gluconeogenesis Eating more protein than what the body needs will not increase muscle mass Specialized Functions of Skeletal Muscle Fiber Types 0 Slowtwitch type 1 endurance aerobic high oxidative metabolism capacity 0 High density of capillaries mitochondria myoglobin Fasttwitch type 2 aerobicanaerobic mix high intensity 0 Type A moderate oxidative aerobicanaerobic like swimrun 0 Type X lower oxidative metabolism capacity anaerobic like sprints Effects of Aerobic Exercise and Training Increases red blood cell production to deliver oxygen Increases total blood volume Increases the number of capillaries in muscle tissue Strengthens the heart muscle Increases the number and size of mitochondria Increases muscle glycogen stores and myoglobin content Increases triglyceride storage in muscle Dietary Advice for Athletes Energy Needs Carbohydrate Needs 710gkg body weight marathoners on high end of the range Boosting Glycogen Stores carbohydrate Glycogen Loading Fat Needs 1525 of kcal emphasize monosaturated Protein Needs 1217 gkg body weight Vitamin and Mineral Needs 0 Iron de ciency causes impaired performance 0 Calcium and the Female Athlete Triad Maintaining Normal Blood Glucose Level For activity lasting longer than 2030 minutes 0 Blood glucose is an important source of fuel Intake of 07 g of carbs per kg per hour is helpful during strenuous endurance activity 0 Delays fatigue Energy Needs for Athletes Estimate needs by monitoring weight and body fat Desirable body fat for male athletes 5 18 Desirable body fat for female athletes 1728 If weight falls increase intake If body fat increases cut back intake and maintain activity Proteins Higher needs than RDA Should not exceed 35 of total kcals or 2 gkg body weight Protein supplements are not necessary Carbohydrate Loading 0 For events lasting longer than 6090 minutes Maximizes glycogen stores Tapering off exercise while increasing CHO intake Water is incorporated with glycogen Fluid Needs for Endurance Exercise Fluids lost through sweat need to be replaced 0 Dehydration 0 Heat exhaustion heat cramps heatstroke Fluid Intake 0 Goal is to lose no more than 2 body weight 0 Thirst a late sign of dehydration 0 Replace uid before during and after exercise Water Intoxication Sports drinks recommended for activity gt 60 minutes in duration 0 For events gt 60 min sports drinks can help maintain blood glucose level and blood volume 0 Carbohydrates and electrolytes Vitamins and Minerals 0 Slightly higher needs for vitamin E and C antioxidant properties 0 Thiamin ribo avin vitamin B6 potassium magnesium iron zinc copper and chromium needs may be needed at higher amounts role in metabolism or sweat Because of the high caloric needs of athletes extra vitamins and minerals needs are easily met by diet especially by increasing intake of fruits and vegetables 0 Calcium can be an issue for females Female Athletic Triad 0 Iron Iron Needs 0 Iron de ciency will noticeably detract from performance Hemodilution or sports anemia expansion of blood volume at the start of a training regimen can affect iron serum levels in blood tests this doesn t indicate a true de ciency True anemia in athletes 15 of males 30 of females 0 Women at additional risk of anemia because of menstruation Focus on ironrich foods Depleted iron stores can take months to replenish Food Intake Before During and After Preexercise meal 0 High carbohydrate nongreasy nongas producing and easily digested 0 Low ber less than 25 fat moderate in protein 0 24 hours before event 0 Fueling during Exercise 0 Carbohydrate replenishment during events longer than 60 minutes improves performance 0 Recovery meals 0 Within 30 minutes and 2 hours after exercise 0 115g carbohydrate per kgbody weight Ergogenic Supplement substance or treatment intended to improve exercise performance directly Useful in some circumstances 0 Creatine sodium bicarbonate baking soda to counter lactic acid buildup and caffeine Possibly useful still under study 0 HMB decreases protein catabolism glucosamine branched chain amino acids glutamine Dangerous andor illegal Anabolic steroids growth hormone blood doping GHB ephed ne 4214 Favorable pregnancy outcome longer than 37 weeks gt 56 lbs usually 75 lbs Preterm before 37 weeks lt55 lbs medicalnutrition problems 0 40 times more likely to die within rst 4 weeks than fullterm baby Small for gestational age full term weighing less than 55 lbs Suboptimal maternal nutrition 0 Poor temperature regulation blood glucose control predisposition to developing more body fat and less lean body mass in childhood Conception when sperm meets the egg Zygote ovum egg and sperm form a zygote 30 hours after fertilization rst cell division 0 On about the 4th day the zygote has 64 or 128 cells and arrives in the uterus o Implants by day 10 3 cell layers of the zygoteearly embryo Endoderm digestive system liver pancreas Mesoderm skeleton muscles heart blood vessels Ectoderm skin nervous system sensory organs Embryo 2 weeks after conception until end of 8th week 0 About size of pea but heart and liver begin to function Fetus 8th week until birth 0 Rapid growth 90 of growth in last 20 weeks 0 Length increases 20x weight increases 3500x Stages of Gestation o 3 trimesters of 1314 weeks 0 3842 weeks is normal 0 Critical period time window when cells will develop to form a particular body tissue or organ 0 Most occur in the rst trimester o Nutritional de ciencies certain pathogens toxin exposure during critical period can interfere with normal development 0 Severe physical or mental abnormalities or spontaneous abortion miscarriage usually before 20 weeks 0 Nutritional de ciencies later in pregnancy will also affect fetal development but in less catastrophic ways 0 Low birth weight low nutrient stores abnormal organ function mental abnormalities prematurity 0 Nutrient de ciencies and excesses have negative effects on the fetus Nourishing the zygoteembryofetus Zygote absorbs nutrients secreted by glands in the uterus and digests some of the uterine lining Placenta amp umbilical cord develop in early embryo stage 0 Placenta takes up nutrients from maternal blood synthesizes fatty acids cholesterol glycogen o Placenta makes hormones that direct maternal nutrients to the fetus 0 Blood of mother and fetus not in contact 0 Blood in umbilical cord goes to the portal vein and to the liver in fetus o Placenta at birth 15 lbs Nutrient Needs in Pregnancy 0 Energy extra 350 kcal in 2nol trimester and 450 kcal in 3ml 0 Nutrients for new cells protein essential fatty acids DHA Zinc Folate Vitamin B12 Iron Nutrients for bone and tooth development Calcium and Vitamin D Neural Tube Defects are associated with folate de ciencies Very early in development and may not be aware of pregnancy Second trimester weeks 1428 organs continue to grow mom deposits fat to support lactation Third trimester weeks 28 to 3842 fetus weight is 203 lbs critical time for fetal growth 0 26 weeks good chance of surviving if both lungs not fully developed and iron and bone calcium are low Diet and Exercise Plan For Pregnancy Greatly increased nutrient needs but only slightly increased calorie needs 0 Extra 350kcal in second trimester and extra 450kcal in third trimester Prenatal vitamin and mineral supplements 0 Physical Activity 0 Bene ts 0 Recommendations Nutritionrelated Factors Affecting Pregnancy Outcome 0 Maternal prepregnancy weight Maternal weight gain 0 Pattern of maternal weight gain 0 Young maternal age 0 Maternal eating patterns Maternal health 0 Pregnancy history Prenatal care Sociocultural factors Contamination of food supply 0 Lifestyle Nutrition Needs to Support Pregnancy Energy no signi cant increase in rst trimester 0 300 kcalday in 2nCI and 450 kcalday in 3rd trimester 20 increase 0 Appropriate weight gain is o 24 pounds in 1st trimester 0751 pound weekly in second and third trimester 0 Total weight gain of around 2535 pounds Protein increase by 2025 gday 50 above RDA Carbs 175 mgday 35 above RDA Vitamins increase by up to 30 except B6 45 and folate 50 don t exceed Vit A Minerals 0 Iron needs are increased to 27 mgday RDA 18 mgday Mother s blood volume increases by 50 0 RBC increasing by 20 o Creates a physiological anemia hemodilution similar to sports anemia but true anemia is also a problem Fetus needs to store iron breast milk is low in iron fetus needs 46 month supply of iron 0 Mother absorbs iron more efficiently during pregnancy but often need a supplement to achieve the 27 mgday Food Plan for Pregnant Women 0 23 servings dairy calcium D ribo avin protein 0 3 servings meatlegumes heme iron in meat protein min vitamins 3 servings vegetables phytochemicals min vitamins o 2 servings fruit phytochemicals min vitamins 6 servings cerealbread folic acid added to ours o Prenatal supplements vitamins A C D E thiamin ribo avin niacin B6 812 folic acid calcium iron zinc Maternal and Infant Death Rate US is 25 0 Factors inadequate nutrition low SES closely spaced births teen pregnancy inadequate prenatal care lifestyle factors prenatal ketosis body weight and weight gain caffeine aspartame listeria infection Health Issues During Pregnancy Heartburn constipation and hemorrhoids 0 Due to relaxation of muscles in uterus and gut and pressure from expanding uterus Management Smaller more frequent meals getting adequate ber Edema Often associated with hypertension Morning sickness Management Smaller more frequent meals stay away from nausea triggers Anemia Gestational diabetes More of an issue with overweight mothers family history of diabetes Larger baby 1215 pounds a indicator of gestational diabetes Pregnancy induced hypertension 0 Preeclampsia to Eclampsia dangerous to kidneys of mother and fetus Treatment drugs bed rest to keep blood pressure down Other Factors Affecting Pregnancy Outcome Maternal sociocultural factors 0 Role of Expanded Food and Nutrition Program EFNEP Women Infants and Children WIC Supplemental Nutrition Assistance Program SNAP Maternal food supply Environmental contaminants Foodborne illness Caffeine Food additives Alcohol 0 Fetal alcohol spectrum disorders most severe damage occurs in the rst 1216 weeks of pregnancy 0 Fetal alcohol syndrome mental retardation and other effects 0 Consumption during breastfeeding alcohol is transmitted to the baby through breast milk Drugs Herbal and botanical products Nicotine and carbon monoxide Birth vaginal vs Cesarean section differences in bacterial colonization of gut 0 Iron de ciencies in mothers Fetus and placenta share a blood supply so wait a few minutes to cut the umbilical cord to allow time for some of that blood to return to the newborn 4914 First 1000 days of a child s life are the most critical pregnancy through a child s 2nCI birthday 0 Intellectual development and lifelong health 0 Potential and vulnerability Infant growth and development 0 By 46 months of age weight doubles By 1 year weight has tripled length increases by 50 0 Weight doubles again between the lst and 5th year Growth in height ends when epiphyses fuse By age 1920 0 The ends of the long bones close epiphyses fuse No further growth possible Organ development 0 Brain 75 complete by age 2 610 years is adult size 0 Digestive tract 46 months 0 Most organ systems at adult capacity by late childhood Assessment of growth 0 Height and weight 0 Brain growth head circumference vs age Growth is the best indicator of childhood nutritional status 0 Low weight for height sign of acute malnutrition 0 Low weight for age sign of chronic malnutrition Adequate diet later may not compensate for early growth loss 0 Low zinc is linked to poor growth 0 Girls reach peak rate of growth before men Low growth rate Physical abnormalities or illness 0 Cleft palate heart problems valve defect hole between chambers infections diarrhea intestinal problems Nutrition problems Feeding problems Can also be due to poor parentinfant interaction 0 Infants need physical contact and eye contact Diet restriction is never recommended for infants under 1 year of age even for those with high BMI 0 Most obese infants become normalweight preschoolers without diet restriction o If energy intake limited growth of CNS and other organ systems may be hampered Infant s nutritional needs Human milk or formula for the rst year Supplemented with solid food at 6 month of age High energy needs met by human milk or formula High protein needs met by human milkformula 15 gkg body weight Higher fat needs met by human milkformula 50 of calories Vitamin K given at birth injection Bacteria in colon that make vitamin K not established yet Vitamin D or sunshine Vitamin B12 if mom is a vegan Calorie Needs 03 months about 50 calories per pound per day needed Up until age 3 about 40 calories per pound per day needed Decreases as child grows Age 5 32 calories per pound Age 15 16 calories per pound Formula and human milk is 20kcaounce Breast milk or formula both satisfy calorie needs high in fat High energy needs due to rapid growth and metabolism rate Babies have high BMR they lose more heat from the skin due to higher body surface area 0 When small have larger surface area per mass than a larger individual Protein Needs Infants need 15 gkg higher needs than adults by mass Half should be from essential amino acids 0 For adults only 25 need to be essential amino acids 0 Low protein intake a stunted growth lifelong consequences Needs drop after infancy children need less than infants but still more than adults per mass Extra protein can be a problem for babies immature kidneys Breast milk or formula is ideal Cow milk has excess nitrogen and minerals for a newborn 0 These exceed the infant s immature kidney abilities especially nitrogen 0 NOT recommended under 6 months of age Fat Needs 4055 of total intake for babies 0 Energy source 0 Needed Avoid lowfat diets for children under 2 0 Reduce fat gradually to 3035 of calories between age of 2 to 5 Need at least 5 grams of the essential fatty acids per day 0 Essential fatty acids needed for nervous system and cell membrane development 0 Arachidonic n6 and docosahexaenoic acid n3 Cold water sh in the mother s diet for breastfed babies These are now added to formulas Carb Needs Lactose in milk 0 Other carbs added when solid foods begin 0 Gradually increase starch to 50 of caloric intake limit simple carbohydrates 0 Fiber 0 No ber recommendation for children under 1 0 After age 1 15 grams per 1000 calories consumed High ber diets not recommended Inadequate in calories lower mineral absorption Water Needs 0 Babies have a higher body percentage of water 0 Higher surface area evaporation higher metabolism inef cient kidneys 0 Need for uids 0 BUT water intoxication is an issue Limit supplemental uids to 4 oz per day Vitamin Needs 0 Injection of vitamin K o All babies hours after birth 0 Reduces the chance of vitamin K de ciency bleeding 0 Babies born with little stored vitamin K intestinal bacteria not yet established 0 Vitamin D supplements for infants added to formula 0 Vitamin B12 for babies breastfed by vegan moms Mineral Needs Prenatal iron stores are depleted by 46 months 0 Ironforti ed formula for bottle fed infants 0 Possible iron supplementation for breastfed infants 0 Introduction of ironforti ed solid foods at 6 months Zinc and iodide provided by formula and human milk Fluoride supplement after 6 months of age for cavity suppression Formula vs Breastfeeding Formula is considered an adequate nutritional replacement for breast milk But cow milk is not tolerated by infants Formulas must follow strict guidelines Cow s milk base usually contains lactosesucrose casein whey and vegetable oils Soy base contains soy protein 0 For babies allergic to cow s milk Forti ed with vitamins and minerals except uoride Special formulas available for PKU and other medical conditions Formula Prep Monitor safety and cleanliness Should not microwave hot spots develop risk of scalding baby Boil cold water using hot tap not recommended due to risk of lead particularly in older homes and communities Feeding Technique Spit up is normal Feeding should last about 20 minutes 0 Initial milk foremilk lower in fat 0 Later milk hind milk higher in fat Burp every 10 minutes to release air Monitor infant for signs of satiety don t overfeed Newborns feed every 24 hours Place babies on their backs after feeding quotBack to Sleepquot info campaign since 1994 SIDS sudden infant death syndrome Flathead syndrome Feeding Skills the baby can do Grasp and transfer objects by 67 months Hold bottle play with food by 810 months Selffeed and drink from a cup by around 1012 months Gains in independence O Feeding Babies and deciding when to introduce solid foods Nutritional need Physiologicalcapabilities Physical ability 0 Control head movement and sit alone with support 0 Extrusion re ex weakens o Chewing motion 0 Solid foods replete iron stores need for vitamin D and uoride Readiness for solid food Nutritional needs especially iron Physiological capabilities o Maturation of pancreas that will allow baby to digest starch Physical ability 0 Ability to hold head up sit up with support 0 Weakening of Extrusion re ex o Extrusion re ex makes it difficult to take solid food 0 Ability to make chewing motion 0 Allergy prevention 0 Baby s gut is relatively open eating foods too early can cause allergic responses age of 6 months 13 lbs drinking more than 32 oz of formula daily 0 Needs more energy First Foods 0 First Ironforti ed cerealsrice cereal low allergenic potential 0 Introduce one food at a time wait a week before introducing a new food 0 Then strained foods and meats iron 0 Introduce vegetables before fruit due to sweetness of fruits 0 Do not introduce mixed food right away 0 Monitoring for allergic reactions Offerjuice in a sippy cup not bottle and limit amounts prevent early childhood caries no more than 202 per feeding 6 oz per day 0 No cow s milk until 1 year of age Feeding Solids Use babysized spoon 0 Hold infant comfortably Small dab of food on the tip of the tongue let baby take it Calm approach 0 Only a few bites at rst What not to feed an infant Allergenic foods eggs nuts peanuts chocolate 0 Honey or corn syrup honey may contain Clostridium botuinum Highly seasoned foods 0 Foods with choking potential Cow s milk 0 Excessive apple or pearjuice Dietary Guidelines for infant feeding Build to a variety of foods 0 Pay attention to infant s appetite to avoid overfeeding 0 Infants need fat 0 Choose fruits vegetables grains but limit high ber foods 0 Sugar in moderation Sodium in moderation Choose foods containing iron zinc and calcium Potential Health Problems 0 Insufficient iron in the diet even in the US Entire food group absence from diet eg vegetables 0 Drinking raw milk 0 Drinking goat s milk this is low in folic acid 0 Not drinking from a cup by age 1 0 Continuing to bottle feed past 18 months of age Intake of gt100 of the nutrient standards 0 Drinking large amount of juice after 6 months Adding Solid Foods 0 Rate and sequence for introducing solid foods 0 One food at a time o Ironforti ed cereal is usually rst fruits and vegetables second 0 Foods to avoid Weaning from breast or bottle use of a cup 0 Learning to selffeed Children as Eaters 0 Role of government programs eg WIC Appetites 0 When what and how much to serve Food preferences Mealtime challenges 0 Food jags o Picky eaters Potential Nutritionrelated problems of the growing years Colic Gastroesphogeal re ux 0 Milk allergy Constipation o Diarrhea Ear infection 0 Dental caries early childhood caries Obesity Hyperactivity 42114 Foodborne Illness In the US Foodborne pathogens cause an estimated 48 million illnesses 128000 hospitalizations and 3000 deaths yearly In developed nations estimated 13 of population contracts a foodborne illness each yeara 20 million deaths 80 of foodborne illnesses the exact pathogen is not known Individuals with increased risk 14 of the population 0 People with weakened immune systems HIV cancer transplant patients users of immunesuppressing medications Pregnant or lactating women Infants and small children The elderly Most cases are unreported and undiagnosed Symptoms often mild enough that affected people don t seek medical care 0 GI effects nausea vomiting diarrhea intestinal cramping But can be very serious for the young old and people with long term illness 0 Blood poisoning seizures organ failure chronic complications death Why Do Foods Make Us Sick Centralized farming and processing contribute if contamination occurs many people can be affected with cases widely distributed across the country Restaurants cafeterias foodservice can be sources of problems but unsafe food handling in the HOME is a cause too mishandling of food quotrarequot meats Routes of Contamination 0 Animal or human feces sanitation problems farm animal wastes in agriculture not washing hands before food prep insects Contamination by an infected individual food handling while ill Crosscontamination uncontaminated food contacts a contaminated food Preservation of Food extending a food s shelf life by slowing the rate at which microorganisms bacteria mold yeast and enzymes in food cause spoilage 0 Traditional methods drying adding salt or sugar smoking fermenting In the last 200 years Pasteurization sterilization canning aseptic processing refrigeration freezing irradiation chemical preservation Methods that Decrease Water Content to Deter Microbial Growth 0 Drying raisins Salting salted sh Sugaring candied fruit 0 Smoking smoked sh Methods that lncrease Acidity or Alcohol to Deter Microbial Growth Fermentation and pickling sauerkraut kimchi pickles cheese yogurt wine Acids added to food during processing ascorbic acid acetic acid Methods that Use Heat to EradicateReduce of Microbes o Pasteurization milk juice 0 Sterilization aseptic cartons of milk soup Canning beef stew Methods that Slow the Rate of Microbial Growth Refrigeration eggs 0 Freezing meat Methods that lnhibit Microbial Growth Chemical preservatives added to foods sodium nitrate in cured meat sodium benzoate in beverages salad dressings condiments Irradiation raspberries Food Irradiation uses radiant energy to limit the growth of insects and pathogens in foods Energy can come from gamma rays Xrays or electron beams This does NOT make food radioactive Irradiated food considered safe by the FDA and other agencies Breaks down chemical bonds cell walls DNA in pathogens Approved to be used on raw meats dried seasonings produce wheat eggs potatoes Radura symbol must be present on all irradiated foods Has not been adopted to a large extent in the US some other countries including Canada use this technology widely Why are Microbes so harmful Effects seen within a few hours after eating Some microbes can invade intestinal wall get into blood produce infection Or multiply in colon producing toxins that damage colon cells May take days to a week a makes it hard to trace to a particular food How to Avoid Microbes at the Store Select your frozen and perishable items last Place meats in separate plastic bags from produce and other foods Buy only pasteurized milkcheese Buy only what you need minimize how long you keep foods in your refrigerator Avoiding Microbes at Home Wash hands thoroughly warm soapy water for 20 sec Keep counters cutting boards equipment clean and sanitized Prepare raw meat separately 0 Things that have touched raw meat should not touch the cooked meat or other foods 0 Use refrigerated ground meat within 12 days 0 Use frozen meat within 34 months o Thaw foods in refrigerator or with cold running water or in the microwave not at room temperature on the counter Avoid coughing and sneezing over food Cleanwash fruitsvegetables thoroughly 0 Eat food right after preparing store quotleftovers within 2 hours 0 When in doubt throw it out What to do with Leftovers Keep cold foods cold lt40 F Hot foods hot gt140 F Reheat leftovers to 165 F Refrigerator at lt40 F Norovirus accounts for many foodborne infections 0 Infection commonly perceived as quotstomach uquot Major outbreaks on cruise ships in nursing homes hospitals 0 Arise from fecal contamination perhaps in water food handling Contaminated shell sh contaminated fruits vegetables 0 Multiply in host a diarrhea and vomiting 12 days after exposure fever chills No treatment available just need to ride it out 0 Very infectious Prevention wash hands and cook food properly Rotavirus major cause of diarrhea in children Hepatitis A liver damage 1550 days until effects some carriers can be unaffected but then pass it to others Salmonella most common foodborne pathogen infection rate has not declined in 15 years use clean cutting boards 0 40000 reported casesyear in US 0 Foods commonly contaminated chicken eggs unpasteurized milk alfalfa sprouts Salmonella infection almost any kind of food or beverage can carry the bacteria that causes salmonella infection meat and eggs are common Bacteria travels to small intestine and lining severe cases gets to blood 0 Symptoms 1272 hours nausea vomiting fever diarrhea ab cramps o 47 days illness can be mild or severe most people recover without treatment Treatment oral or injected usually for 2 weeks Campylobacter very widespread in poultry illness appears 25 days after ingestion bacterial toxin 1 of 5 cases international travel 47 of raw grocerystore chicken tested positive in 2011 screening Birds are able to carry Campylobacter without becoming ill Heatsensitive a killed if food is cooked properly Prevention prompt refrigeration thorough cooking and hand washing prevention of rawtocooked carryover Bacterial toxin destroys the mucosal surfaces of small and large intestine enterotoxin Escherichia Coli found normally in the intestinal tract Most strains are harmless Symptoms appear 18 days after ingestion in worst cases can cause kidnev damage or failure 510 hemolytic uremic syndrome Some speci c strains of E colare problematic and toxic E coli 0157H7 Shiga toxin produced by several strains STEC o STEC is found in the guts of ruminant animals usually do not make animals sick Many illnesses from undercooked fastfood burgers in 19905 Prevention through cooking pasteurization irradiation Shigella Sonnei spread via fecaloral route Most common in salads and sandwiches that involve lots of hand contact in prep 0 Contaminated elds contaminated water ies landing on food Common in daycare centers diapers a wading pools play fountains Symptoms include abdominal cramps diarrhea fever bloody stools Appears in 13 days CAREFUL HAND WASHING IS A MUST Staphylococcus Aureus common on skin of 25 of people Has the ability to make seven different toxins that are frequently responsible for food poisoning o Fastacting Onset 1 to 6 hours lasts 13 days o Toxin is heatresistant remains hazardous even after food is cooked Contaminated milk and cheese are the most common way of contamination Staphylococcus is salt tolerant and can grow in salty foods like ham 0 Foods at highest risk of contamination with Staph and subsequent toxin production are those that are made by hand and require no cooking 0 Examples sliced meat puddings some pastries and sandwiches Listeria Monocytogenes 1 in 5 die hospital care Sickness may occur not until weeks later hard to nd the source 0 Listeria is a hardy germ that can even grow on foods that are refrigerated Listeria can contaminate many foods that we don t usually cook like deli meats soft cheeses raw milk smoked seafood and sprouts Some foods we might not suspect can be contaminated with Listeria and cause sickness and outbreaks such as cantaloupe and celery 0 Babies can be born with listeriosis if their mothers eat contaminated food during pregnancy Clostridium botulinum botulism rare but serious lowacid canned goods that have not been properly processed Small amounts often in honey a infant botulism 65 of cases Bacteria produce harmful neurotoxins small amounts can be fatal a muscle paralysis a respiratory paralysis Toxin can be destroyed by heat boiling boil homecanned foods for 10 minutes Clostridium perfringens raw meat and poultry common foodborne illness cafeterias and catered meals common Vibrio such as cholera contaminated water or contaminated undercooked shell sh Yersinia enterocolitica raw or undercooked pork Protozoa parasite Cryptosporidum 1993 Milwaukee water system Giardia Cyclospora cayetanensis raspberries Toxoplasma gondii Amoebiasis Chicago World s Fair 1933 1000 cases 58 deaths Roundworms parasite Trichinosis undercooked pork wild game Tapeworms raw beef pork sh crabs mollusks Prions remain infectious after cooking Mad Cow disease Bovine spongiform encephalopathy BSE CreutzfeldtJacob disease vCJD in humans Scrapie in sheep Spread through BSEcontaminated cattle feed 0 Cause of spread the practice of putting anima byproducts in feed especially nervoussystem tissues 0 Now outlawed in US 0 No imports of meat from countries with BSE reports 0 Ban on use of potentially infectious tissues brain intestines etc in human foods Mycotoxins toxins produced by certain fungi that can grow on foods that are improperly stored A atoxins fungus that can be found on corn wheat rice nuts spices Liver toxicity and carcinogenic Ergot fungus that can grow on inappropriately stored grains Nervous system and hallucinations o lmpicated in the Salem Witch trials Toxins from Algae Shell sh poisoning can be a problem in areas with algae population explosions red tide US and Canada quarantine areas with algal blooms and prohibit shell sh harvesting until they are established to be safe to eat Natural Toxins in Food Nature has provided plants with an abundant array of natural toxicants Potential for harm exists but actual harm rarely occurs 0 Diversity in diet avoids problems that could otherwise occur Ex Goitrogens in cabbage family plants thyroid enlargement Toxins of concern Poisonous mushrooms Solanine in potato shoots green areas on potatoes Licorice Nutmeg Cyanide in lima beans and fruit pits Herbal supplements of undocumented bene t Food additives substances added to foods to produce a desired effect 0 Longer shelf life 0 Greater nutritional value 0 Greater food safety 0 More appealing color 0 To limit spoilage salt sugar citric acid 0 To enhance or maintain nutritional value of foods iron B vitamins To enhance or maintain color and avor of food 2000 approved avor enhancers To contribute functional characteristics to food texture acidity pectin To prevent undesirable changes increase stability maintain freshness To increase safety of foods Pure Food and Drug Act 1906 rst federal law regulating food motivated by the historical use of some very unsafe substance that were being used as additives in foods Intentional food additives added directly to food to meet a goal listed on food labels Incidental food additives indirectly nonintentionally added as a contaminant eg sanitizers pesticide residues 0 In food production processing packaging transport or storage 0 m on food labels 0 Regulated by the FDA since it is hard to ban 0 Benzene formed from reaction of certain preservatives and vit C o Bisphenol A BPA in lining of cans and some other food containers GRAS generally recognized as safe List manufacturers don t have to prove safety to things on this list several hundred additives Salt sugar caffeine many spices Some additives have been reviewed and removed from list safrole and a number of color additives Most chemicals on GRAS have not been reviewed 0 Factors expense history of use lack of evidence of toxicity 0 Synthetic chemicals are recognized as the same as the naturally obtained form Safety of Additives Since 1958 new additives have required rigorous lab testing prior to release 0 Need to prove safety disclose how it is manufactured and show that the additive achieves its intended purpose in foods riskbene t As a result relatively few new additives have been introduced 0 Stevia and Splenda sweeteners are recent additions Requires testing on 2 animal species usually mice and rats 0 Determine the highest dose that produces no observable detrimental effects NOEL no observable effects level 0 Scale to determine the corresponding human dose 0 Divide the dose by 100 to establish a margin of safety Delaney Clause if it is shown to cause cancer even at very high doses it is taken off the market 0 Contrast with de minimus rule less than one cancer per million people over a 70year lifetime Approval of a New Food Additive by the FDA 0 Must identify the new additive Give its chemical composition 0 State how it is manufactured Specify method of measurement 0 Proof of intended purpose 0 Proof of safety 0 Can only use the minimum amount necessary to achieve desired effect 0 Cannot be used to deceive ie to mask rancid taste hide defective ingredients cover up poor manufacturing processes Common Food Additives Acid or Alkaline agents lactic acid for a tart taste Anticaking agents powdered sugar to absorb moisture Antimicrobial agents salt sugar sodium benzoate calcium propionate nitrates to preserve color and avor and inhibit botulinum formation 0 Antioxidants ascorbic acid vitamin C vitamin E sulfrites BHA BHT Colors only a few arti cials remain carotenoids to salmon o Emulsi ers and gums lecithin pectin carrageenan xanthan gum 0 Fat replacers or arti cial fats olestra mouthfeel of a fat Flavors salt sugar spices sweeteners arti cial avors MSG Humecants Leavening agents yeast baking soda 0 Nutrient supplements added minerals or vitamins Stabilizers Sul tes sulfurbased used as antioxidants and preservatives in foods Commonly in beer wine and processed potatoes 0 1 in 100 people have sensitivity 0 Shortness of breath or GI symptoms 0 Food labels indicate sul te presence 0 Can t be on food that are consumed raw except for grapes o It destroys thiamin not allowed in enriched grains MSG often in Chinese foods tomato parmesan cheese mushrooms 0 Chinese restaurant syndrome dizziness headache sweating high BP 1020 minutes after indigestion Not allowed in baby foods lndirect Food Additives Acrylamide formed when starchy foods are cooked at high temperatures french fries BPA from plasticlined food cans certain water containers 0 Microwave packaging Dioxins coffee lters bleached paper products Methylene chloride from coffee decaffeination process 0 Growth hormones in livestock o Antibiotics in livestock Persistence extent to which the contaminant lingers in the environment or in the body Bioaccumulation contaminants that are absorbed by the body and do not readily get excreted or broken down higher levels or toxins accumulate in organisms further up in the food chain Environmental Contamination of food 0 Mostly risks appear small 0 All sh have trace amounts of mercury Pesticides help to ensure the survival of crops but residues are left in the environment and some of our food Regulated Health risks are thought to be small for healthy adults higher risks for infants and children 0 Approved by EPA 0 Assessment of danger residue levels environmental harm necessity alternatives 0 Tolerance levels set based in part on potential effects in development and childhood Pesticides Monitored by the FDA 0 Measures amounts in samples of foods and livestock Makes sure it is used only on approved crops Ensures levels are below established tolerance levels 0 Total Diet Study or quotMarket Basket Studyquot estimate of pesticide residues in food as they are usually eaten washed peeled cooked o More than 200 foods from grocery stores 10000 samples 4x per year 0 Analyzed for pesticides also for essential minerals industrial chemicals heavy metals radioactive materials 0 Fresh vegetables fruits dairy 0 Domestic and imported o Con rms average pesticide intake as less than 1 of what is considered acceptable Pesticides outside the US 0 May not have the same regulations Loophole in federal regulations 0 lets US companies manufacture and sell overseas pesticides that are banned here 0 these foods then may return here to our food supply 0 quotCircle of poisonquot Federal inspectors sample imported foods and refuse entry if they contain banned pesticides but sampling not 100 screening 0 US Canada and Mexico work together to establish consistent pesticide policies Minimizing Pesticide Risk Things to consider for personal exposure 0 How much of a given food do you eat 0 What pesticides were used 0 How much 0 When was the food last sprayed Does the pesticide get broken down 0 Was the produce wellwashed or peeled Things to consider for the environment 0 How toxic is the pesticide to a variety of organisms 0 Current worry about honey bees How readily does the pesticide accumulate in living organisms How persistent is the pesticide in the environment 0 How does the pesticide distribute in the environment Good practices as a consumer o Trim fats from meats remove skin from poultry and sh 0 Select fruits and vegetables that do not have holes 0 Wash produce in running water use scrub brush 0 Cut away peel on citrus fruits rather than biting it Discard outer leaves of leafy vegetables Peel waxed fruits and vegetables 0 Eat a variety of foods to minimize exposure to any one pesticide Consider buying organic produce Organic food way agricultural products are produced Processed organic 100 Organic quotOrganicquot at least 95 of ingredients quotMade with Organicquot at least 70 of organic ingredients 0 Allowed biological pest management compositing manure applications crop rotations Not Allowed synthetic anything antibiotics sewage sludge as fertilizer GMOs irradiation Why Purchase Organic Foods 0 lower energy use per acre 0 less environmental impact 0 Lower pesticide exposure 0 Study with children urine samples dramatic reduction in markers of pesticide exposure after 5 days of organic diet 0 possible reduction in risks to human health Genetically Modi cation since 1972 we have the ability to insert individual genes into a plant 0 Plant Breeding has been used for 100 s of years Selective Breeding 0 Banned from much of Europe Asia and Africa Genetically Modi ed Food Plants Herbicide resistance HT 0 Plant pesticides insect resistant crops Bacillus thuringiensis BT Where Could GM be useful Bioforti cation especially of staple crops 0 Alter amino acid pro le in grains corn to yield higherquality complete proteins 0 Increase vitamin mineral or phytochemical levels in produce 0 Lower phytate production to increase mineral bioavailability Reduce allergenicity of peanuts or other foods 0 Select plants that have signi cant increase in a micronutrient that will improve the health of people 0 The yield disease resistance and drought tolerance of the crop MUST be at least equal to that of the typical crop planted in that area of the world Ease of Food Production 0 Dairy a Lactaseproducing cows that make lactosefree milk Caffeinefree coffee beans rather than chemical treating to remove the caffeine Manufacture of vaccines pharmaceuticals industrial proteins Regulation of GM Foods 0 FDA responsible for safety of foods for human and animal consumption 0 USDA determining whether crops are safe to grown EPA determining whether pesticides introduced into foods are safe for consumption and the environment Stearidonic Soybean Oil Monsanto genetically engineered soybeans to make Stearidonic acid 0 Can be legally added to foods Arguments Opposing GM Foods Ethical and moral issues quotplaying Godquot Imperfect technology Environmental concerns quotgenetic pollutionquot Crop vulnerability of genetically identical plants Loss of gene pool Pro t motive will bene t industry more than the world s poor and hungry Unproven safety for both people and livestock Potential for increased allergens Potential for decreased nutrients Insuf cient product tracking and labeling Potential for overuse of herbicides on herbicideresistant crops Increased consumption of pesticides development of resistance Lack of oversight Arguments in Support of GM Ethical and moral issues promoting bene ts of scienti c advancement The precise nature of DNA technology The potential to use unproductive lands increase crop yields reduce loss to pests reduce costs of farming reduce plowing and erosion The ability to ght pests and diseases selectively on a caseby case basis Economical bene ts providing improved foods to developing na ons Safety argument GM products are very similar to the original food Potential for increased nutrient content Product tracking ability to track if problems arrive Reduced use of pesticides or predictable pesticide loads on foods Safety Concerns of GM Allergens Unintended gene ow to other crops disruption of ecosystems Loss of genetic diversity crop vulnerability Insuf cient regulation and oversight Opposition to GM Foods General distrust of new technology 0 Ethical concerns about moving genes from one species to another quotplaying Godquot 0 Developed by US multinational company with patents too much corporate control 0 Patent infringement lawsuits against farmers legal worries 0 Terminator genes 0 Fear that corporate pro ts will drive decisions overshadowing ethical considerations 0 If there is no direct bene t to the consumer opposition more likely o Roundup ready plants increase pro ts for farmers but provide no direct bene t to consumers 0 Nutrient enhanced foods may be more warmly accepted HarvestPlus agency seeking to reduce hidden hunger and provide micronutrients to people though the staple foods they eat 0 Use of bioforti cation 42214 Food Availability and Access 0 There is enough food produced worldwide to provide each person with 2720 kcalday nearly 7 billion people worldwide 0 Yet 1 in 6 people are food insecure o 2 billion people suffer from micronutrient de ciencies hidden hunge Malnutrition including too much food accounts for over 12 the world39s disease burden quotNutrition transitionquot movement of people across the world to a Westernstyle diet 0 higher in meat dairy sugar fat 0 lower in whole grains and vegetables Health Consequences of Food Insecurity Declines in both physical and mental activity 0 Growth slows or ceases Muscle and fat wasting Immune system weakens increased disease susceptibility Health problems due to micronutrient de ciencies o Vit A iodine iron zinc Bvitamins most likely to be de cient Increased death rates Food Insecurity in the US 15 of households are food insecure Closely linked to poverty less than 22113 for a family of four 0 Lower consumption of nutrientdense foods 0 Nutrientpoor diets can impair physical and mental health status 0 Obesity 13 of the population live at or below the poverty guidelines 0 13 of the poor are children 0 22 of all children in US lived in poverty in 2010 o More related to politics and socioeconomics than scarcity of food 0 Food Rent Heat Programs to Increase Food Security in the US 0 The Great Depression 19305 spread of peagra niacin de ciency and rickets Creation of federally funded soup kitchens work programs 0 Aid for lowincome families 0 National School Lunch program for low income 1946 0 Food Stamp program for low income 0 School Breakfast program for low income 1965 o For seniors community meals and mealsonwheels 0 Women Infant and Children program WIC 1972 0 Food coupons formula breastfeeding education up to the age of 5 years Minnesota Starvation Study around WWII Conscientious objector volunteers 1800 kcalday for 6 months a fraction of their 3200 kcal EED exercise walking 22 miles per week a gradual loss of 25 of body weight 0 Goal to learn how to treat famine victims and people coming back from Prisoner of War camps Targeted weight loss 25 bsweek Psychological changes severe emotional distress irritability depression hypochondria poor concentration lack of ambition lack of sexual interest socia withdrawal 0 Physical changes fatigue muscle soreness hunger pains obsession with food decrease in HR body temperature and muscle tone white cell count went down sperm count went down 0 Need to bring someone back gradually from starvation re feeding can precipitate dangerous electrolyte imbalances Undernutrition in Poor Countries 0 Poor sanitary conditions 0 Exposure to extreme weather conditions Regular exposure to infectious diseases and parasites malaria etc Lack of energy producing nutrients De ciency in Micronutrients Children disproportionately affected Rural and economicallypoor area subsistence farming Famine isolated situation war and political unrest crop failures extreme shortage of food massive starvation in a population Is there Enough Food to Go Around Yes just problems getting it to those who need it But Increasing growth of population more people than there is money increase in poverty big gaps between the rich and poor big gaps between developed and developing countries 7 billion people and 34 are in developing countries 9 million by 2050 Next generation 9 of 10 infants will be born in the poorest parts of the world
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