Fundamentals of Nutrition Notes
Fundamentals of Nutrition Notes HN 2310D-Online
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Chapter 5 Carbohydrates 09242015 51 Structures of Carbohydrates Learning objective 0 Identify the major types of carbohydrates and give examples of food sources for each Structures of Carbohydrates Carbohydrates oComposed of carbon hydrogen oxygen 0 General chemical formula CH20n Simple forms 0 Monosaccharides O Disaccharides Complex forms 0 Oligosaccharides O Polysaccarides Plants main source 0 Produce glucose by photosynthesis from carbon air oxygen air hydrogen water and energy sun Monosaccarides Simplest form of carbohydrate Carbon 6 carbon 12 hydrogen and 6 oxygen molecules but in a slightly different con guration Glucose 0 Also called dextrose 0 Most abundant monosaccharide 0 Typically consumed in other forms eg disaccharide polysaccharide Fructose 0 Found in many sweet items eg fruit honey highfructose corn syrup Galactose o In diet usually found linked with glucose to form lactose Sugar alcohols o Derivatives of monosaccharides 0 Used as sweeteners in gum candies dietetic foods Sorbitol Mannitol Xylitol Pentoses O 5 carbon sugars Ribose part of RNA Deoxyribose part of DNA Disaccharides Contain 2 monosaccharides linked together via condensation reaction which forms 1 molecule water 0 Alpha Bonds Found in maltose amp sucrose Easily broken down by intestinal enzymes 0 Beta Bonds Found in lactose Not easily broken down by intestinal enzymes Maltose O Glucose Glucose 0 Found in malted alcoholic beverages O Formed in small intestine from digestion of longerchain polysaccharides Sucrose O Glucose Fructose 0 Found in plants such as sugar cane sugar beets maple tree sap 0 Common forms are brown white and powered sugars Lactose O Glucose Galactose 0 Found in milk amp milk products 0 Lactose intolerance Results from insuf cient lactase production lactase needed to break beta bonds Leads to intestinal gas bloating cramping and discomfort when undigested lactose metabolized into acids and gases by colonic bacteria Oligosaccharides Complex carbohydrates that contain 310 simple sugar units 0 Cannot be digested by human enzymes 0 Metabolized by colonic bacteria l produce intestinal gas 0 Enzyme preparations eg Beano break down oligosaccharides before reach large intestine Examples raf nose stachyose 0 Found in onions cabbage broccoli legumes eg kidney beanssoybeans Polysaccharides Complex carbohydrates with many glucose molecules Digestibility determined by type of bonds alpha or beta 0 Starch 0 Major digestible dietary polysaccharide 0 Cooking increases digestibility of starches by making them soluble in water 0 Storage form of glucose in plants two ways Amylose a Straight unbranched chain of glucose molecules linked by alpha 14 bonds 0 Alpha 14 bonds broken by amylase l produced in mouth amp pancreas a Used to make modi ed food starch a thickener agent in foods eg salad dressings instant pudding Amvlooectin n Branched chain of glucose molecules linked by alpha 16 bonds straight chains with alpha 14 bonds 0 Alpha 16 bonds broken by intestinal enzyme alphadextrinase Alpha 14 bonds broken by amylase n Causes more rapid rise in blood glucose than amylose because more sites ends available for enzyme action a Retains water to form stable starch gel used to thicken sauces gravies Amvlose vs Amvooectin n Alpha 14 bonds Amylose bonds between glucose molecules that result in a linear shape a Alpha 16 bonds Amylopectin bonds between glucose molecules that result in branching Glycogen 0 Storage form of carbohydrate in humans and animals Glucose units linked by alpha bonds More highly branched than amylopectin broken down quickly Stored in liver and muscle cells Storage amount in uenced by dietary intake Liver glycogen maintains blood glucose levels Muscle glycogen supplies glucose to muscle during exercise lndigestible Polysaccharides 0 Total ber Dietary ber Functional ber Dietary ber occurs naturally in foods Functional ber added to foods to provide health bene ts Nutrition Facts panel only includes dietary ber 0 Fibers are made of Nonstarch polysaccharides with beta bonds In Cellulose n Hemicelluloses OOO n Pectins n Gums n Mucilages Noncarbohydrate component Lignins 0 Since they contain beta bonds not broken down by intestinal enzymes 0 Instead fermented by colonic bacteria to produce shortchain fatty acids amp gases Most readily digested pectins gums mucilages Yied 1525 kcalg 0 Body adapts to higher ber intake Decreased bloating gas discomfort O Insoluble Fibers Not easily dissolved in water Not easily metabolized by colonic bacteria Decrease intestinal transit time Decrease constipation Reduce risk for diverticular disease colon cancer Include a Cellulose skin of fruits and vegetables legumes celery whole grains n Hemicelluloses whole grains amp cereal bers some vegetables I Lignins seeds of fruits bran layer of whole grains 0 Soluble Fibers Viscous Fibers Dissolve in water become gellike Metabolized fermented by colonic bacteria Delay gastric emptying Lower blood cholesterol amp blood glucose level May reduce risk of cardiovascular disease amp diabetes Include a Pectins fruits thickener in jams amp jellies I Some hemicelluloses oat bran n Gums amp Mucilages legumes seaweed psyllium 52 Carbohydrates in Foods Learning objective List alternative sweeteners that can be used to reduce sugar intake Simple carbohydrates in foods Monosaccharides O Glucose corn syrup honey 0 Fructose fruit honey some soft drinks highfructose corn syrup 0 Galactose dairy products as part of lactose Disaccharides O Maltose sprouted seeds some alcoholic beverages O Sucrose granulated sugar brown sugar most sweets O Lactose dairy products Complex carbohydrates in foods Oligosaccharides oLegumes OVegetabes eg onions cabbage broccoli Polvsaccharides Starch oLegumes O Tubers OGrains used in breads cereals pasta Wheat rye corn oats barely rice Polysaccharides Fiber Whole grains Legumes Tubers Fruits amp Vegetables Psyllium Seaweed Functional ber available as supplement CO 00000 Nutritive Sweeteners Can be metabolized to yield energy 0 Simple sugars monosaccharides disaccharides 0 Sugar alcohols Contribute energy 153 kcalg but are absorbed amp metabolized more slowly than sugars Do not promote dental caries because not readily metabolized by bacteria in mouth May cause diarrhea if consumed in large quantities Often added during processing notnaturally occurring in foodsbeverages 0 High fructose corn syrup commonly used by food industry because similar to sucrose in sweetness but less expensive 0 Examples in foods 0 sugar sucrose brown sugar confectioner s sugarpowdered sugar turbinado sugar invert sugar glucose sorbitol levulose polydextrose lactose mannitol honey corn syrup or sweeteners high fructose corn syrup molasses date sugar maple syrup dextrin dextrose fructose maltose caramel fruit sugar NonNutritive alternative Sweeteners Noncaloric or very low calorie sugar substitutes for individuals with diabetes or those trying to losemaintain weight 0 Safety determined by FDA 0 Indicated by Acceptable Daily Intake ADI guideline Amount of sweetener an individual can safely consume daily over a lifetime mgkg body weightd Based on animal studies amp set 100x less than level at which no harmful effects noted in animal studies 0 Considered safe for use by adults children pregnant women 0 Examples 0 Saccharin Sweet N Low 300x sweeter than sucrose Not useful in cooking because heating causes bitter taste No longer considered to possibly cause cancer Uses a Various products including tabletop sweetener jams chewing gum canned fruit candy dessert toppings salad dressings O Aspartame NutraSweet amp Equal 180200x sweeter than sucrose Not useful in cooking because loses sweetness when heated Some reports of adverse reactions eg headaches dizziness seizures nausea Should be avoided by those with phenylketonuria PKU a Disease that interferes with phenylalanine metabolism Uses a Various products including beverages gelatin desserts chewing gum cookies toppings amp llings of baked goods 0 Neotame 700013000x sweeter than sucrose General purpose sweetener Heat stable can be used in cooking amp as a tabletop sweetener Contains phenylalanine but not a problem for individuals with PKU Uses a Various products including baked goods non alcoholic beverages chewing gum confections frostings frozen desserts gelatin pudding jams jellies syrups O Acesulfamek 200x sweeter than sucrose Heat stable can be used in baking Uses n Various products including chewing gum powdered drink mixes gelatins puddings baked goods tabletop sweeteners candy throat lozenges yogurt nondairy creamers soft drinks 0 Sucralose Splenda 600x sweeter than sucrose Only sweetener made from sucrose n Substitute 3 chlorines for 3 hydroxyl groups on sucrose Heat stable used in cooking amp baking Uses a Various products including tabletop sweetener soft drinks chewing gum baked goods syrups gelatins frozen dairy desserts jams O Tagatose Naturlose Almost as sweet as sucrose Can be used in cooking amp baking Prebiotic effect fermented by bacteria in large intestine lsomer of fructose I Should be avoided by those with fructose metabolism disorders Uses a Cereals diet soft drinks frozen yogurt fatfree ice cream soft amp hard confectionary products frosting chewing gum O Stevia PuraVia amp Truvia 100300x sweeter than sucrose Derived from Amazon rain forest plant FDA recently approved use in beverages Can be purchased as dietary supplement Blended with can sugar and sold as quotSun Crystalsquot O Luo han guo Monk fruit in the Raw amp Nectresse 150300x sweeter than sucrose Heat stable can be used in cooking amp baking Classi ed by FDA as generally recognized as safe GRAS Uses tabletop sweetener currently 53 Recommended Intake of Carbohydrates Learning objective Describe recommendations for carbohydrate intake Total Carbohydrate Intake Recommendation 0 RDA for adults 130gday digestible carbohydrate 0 To supply adequate glucose for brain and central nervous system without having to rely on ketosis 0 Food and Nutrition Board recommends 4565 total energy intake from carbohydrates 0 Various diet programs are much different than recommendations Carbohydrate food sources 0 Should come mainly from berrich fruits vegetables whole grains 0 Little should come from added sugars caloric sweeteners Added Sugar Recommendation Varies according to organization Key is to limit consumption 0 Dietary Guidelines Limit to 6 total energy intake 0 World Health Organization WHO Limit to 10 total energy intake 0 Food and Nutrition Board Limit to 25 total energy intake 0 American Heart Association Limit to half of daily discretionary calorie allowance Moderating Intake of Added Sugars 0 At the Supermarket o Read ingredient labels Identify all the added sugars in a product Select items lower in total sugar when possible 0 Buy fresh fruits or fruits packaged in water juice or light syrup rather than those packed in heavy syrup 0 Buy fewer foods that are high in sugar such as prepared baked goods candies sugared cereals sweet desserts soft drinks and fruit avored punches Substitute vanilla wafers graham crackers bagels English muffins diet soft drinks and other low sugar alternatives 0 Buy reduced fat microwave popcorn to replace candy for snacks o In the Kitchen 0 Reduce the sugar in foods prepared at home Try new low sugar recipes or adjust your own Start by reducing the sugar gradually until you ve decreased it by 13 or more 0 Experiment with spices such as cinnamon cardamom coriander nutmeg ginger and mace to enhance the avor of foods 0 Use homeprepared items with less sugar instead of commercially prepared ones that are higher in sugar 0 At the Table 0 Reduce use of white and brown sugars honey molasses syrups jams and jellies 0 Choose fewer foods high in sugar such as prepared baked goods candies and sweet desserts 0 Reach for fresh fruit instead of cookies or candy for dessert and betweenmeal snacks 0 Add less sugar to foods coffee tea cereal and fruit Cut back gradually to a quarter or half the amount Consider using sugar alternatives to substitute for some sugar 0 Reduce the number of sugared soft drinks punches and fruit juices you drink Substitute water diet soft drinks and whole fruits Dietary Fiber Recommendation 0 Al adequate intake 14g1000 kcal 0 Women 25gday 0 Men 38gday Al aimed to reduce risk of cardiovascular disease diverticular disease other chronic diseases Carbohydrate Intakes 0 Worldwide 7080 total energy intake 0 Mostly from whole grains fruits vegetables legumes 0 Typical North Americans 0 50 total energy intake total carbohydrates Mostly from white bread soft drinks cookies cakes doughnuts sugars syrups jams potatoes 0 145 total energy intake added sugars Mainly from sweetened beverages 0 Insufficient ber intake 2550 less than recommended Possible lack of knowledge concerning berrich foods confusing food labeling 54 Functions of Carbohydrates in the Body Learning objective List the functions of carbohydrates in the body Digestible Carbohydrates Functions 0 Provide energy 4kcalq O Source of energy for all body cells most digestible carbohydrates broken down to glucose Red blood cells and central nervous system cells use glucose almost exclusively Muscle cells and other body cells use some glucose but fatty acids too 0 Spare protein as an enerqv source 0 Adequate carbohydrates required to allow amino acids to be used to build body tissues and perform vital functions With inadequate carbohydrate amino acids used to synthesize glucose gluconeogenesis If needed the body will break down protein in muscle and other organs to get amino acids 0 American diets typically high in protein so sparing protein is not a concern except for carbohydrate diets amp energyreduced diets and during starvation Prevent ketosis O Occurs with low carbohydrate intake lt50100gday Hormone insulin decreases leading large amount of fatty acids to leave adipose tissue to provide energy for body cells Ketones ketone bodies form result of incomplete metabolism of fatty acids 0 Brain and central nervous system can adapt to using ketones for energy when inadequate dietary carbohydrate 0 Excessive ketone production May result from poorly controlled diabetes diabetic ketoacidosis due to inadequate insulin or insulin resistance Severe ketosis can lead to coma or death What about Ketogenic Diets Ketosis promoted by some weight loss programs because suppresses appetite and increases water loss 0 Low carbohydratehighfat diets eg Atkins 0 Potential to lead to dehydration electrolyte imbalances if not carefully monitored 0 Therapeutic ketogenic diets O Epilepsy can reduce seizures when medications do not work 0 Some metabolic disorders research is ongoing lndigestible Carbohydrates Functions 0 Promote bowel health 0 0 Fiber adds bulk to feces eases bowel movements prevents constipation Low ber intakes resulting in straining during defecation can lead to Hemorrhoids Diverticular disease Diverticulosis Diverticulitis Consumption of high ber foods amp this vitamins minerals phytochemicals present in these foods May reduce risk of colon cancer because of various nutrients present not speci cally due to ber content 0 Reduce obesitv risk 0 Bulk of high ber foods limits energy intake may contribute to satiety Satiety no longer having desire to eat Enhance blood glucose control O Soluble bers ow glucose absorption from small intestine decrease insulin release from pancreas Reduce cholesterol absorption 0 High soluble ber intake inhibits absorption of cholesterol and reabsorption of bile acids from small intestine Reduces risk of cardiovascular disease amp gallstones 55 Carbohydrate Digestion amp Absorption Learning objective Explain how carbohydrates are digested and absorbed Carbohydrate Digestion Starts with food preparationcooking O Softens tough brous tissues of vegetables fruits whole grains 0 Starch granules swell with water aids digestion 0 Mouth 0 Salivary amylase Breaks starch into smaller polysaccharides an disaccharides Minor role because food is not in mouth for long 0 Teeth also grind food into smaller particles which increases surface area for digestion Stomach o Inactivation of salivary amylase O No digestion of carbohydrates 0 Small Intestine O Disaccharides digested to monosaccharides by speci c enzymes Maltose starch breakdown Glucose Glucose by Maltase Sucrose sweetened foods Glucose Fructose by Sucrase Lactose milk products Glucose Gaactose by Lactase O Polysaccharides further digested by pancreatic enzymes released into small intestine Pancreatic amylase Dextrinase 0 Cannot break down indigestible carbohydrates 0 Large Intestine O Indigestible carbohydrates dietary bers resistant starch Fermented by bacteria to acids and gases Excreted in fecal waster O Intestinal diseases may interfere with carbohydrate digestion eg lactose Leads to bloating atulence diarrhea Carbohydrate Digestion Overview 1 Mouth Some starch is broken down to polysaccharide and disaccharides units by salivary amylase 2 Stomach Salivary amylase is inactivated by the acidity in the stomach No further digestion occurs in the stomach 3 Pancreas Pancreatic amylase and dextrinase are secreted into the small intestine to break polysaccharides from starch into disaccharides 4 Small intestine Enzymes in the wall of the small intestine break down the disaccharides into monosaccharides 5 Liver The absorbed monosaccharides are transported to the liver by the portal vein 6 Large intestine Some soluble ber is metabolized into acids and gases by bacteria in the large intestine 7 Rectum and Anus Insoluble ber escapes digestion and is excreted in feces Carbohydrate Absorption in Small Intestine Glucose and galactose actively absorbed with sodium 0 Requires ATP Fructose absorbed by facilitated diffusion 0 Carrier used no energy ATP required 0 Slower process than active transport Carbohydrate Absorption Monosaccharides leave small intestine via portal vein for transport to liver 0 ln liver fructose and galactose converted to glucose 0 From liver glucose circulates to body cells where used for energy 0 If blood glucose levels adequate glucose stored as glycogen in liver or muscle 0 If glycogen storage capacity exceeded glucose converted to fat for storage in adipose tissue 0 56 Health Concerns Related to Carbohydrate Intake Learning objectives Describe the regulation of blood glucose Describe health risks caused by low or excessive intakes of carbohydrates Explain the cause of effects of and dietary treatment for lactose intolerance Describe the regulation of blood glucose conditions caused by blood glucose imbalance Glycemic Index and Glycemic Load Glycemic Index GI 0 Ratio of blood glucose response of a given food versus a standard eg glucose or white bread 0 In uenced by Starch structure amylose or amylopectin Fiber content Food processing Physical structure eg surface area Temperature Protein and Fat content 0 Based on 50g carbohydrate serving of food Not necessarily typical amount of food consumed Glycemic Load GL 0 Accounts for glycemic index amount carbohydrate consumed Better re ects food s effect on blood glucose than just measuring glycemic index 0 Limitations of glycemic index and glycemic load 0 Neither took indicates blood glucose response to mixed meals People usually eat highglycemic foods with low glycemic foods eg cereal amp milk macaroni amp chesse bread amp peanut butter Very High Fiber Diets Fiber intakes less than 5060 gday especially combined with low uid intake can result in hard dry stools 0 Can lead to painful elimination hemorrhoids rectal bleeding intestinal blockages in severe cases 0 May decrease absorption of some minerals eg zinc iron 0 May lead to inadequate calorie consumption in children elderly amp malnourished individuals 0 May lead to greater fullness and thus reduce food intake High Sugar Diets Most of sugar consumed in diets comes from sugar added during food processing 0 Lowfat and fatfree snacks usually made with extra sugar to maintain acceptable taste texture O In children and adolescents milk consumption typically decreases as sugarsweetened beverage consumption increases Leads to lower calcium and vitamin D intakes can negatively in uence bone health 0 Provide empty calories 0 Can contribute to weight gain and obesity if total energy intake consistently greater than energy needs 0 Associated with increased risk for low HDL cholesterol high LDL cholesterol and triglycerides Purported link between highsugar diets and hyperactivity in children not supported by scienti c evidence 0 Can lead to dental cavities 0 Oral bacteria metabolize sugars into acids that dissolve tooth enamel and cause decay if I m in I 1 Lu let i 5 i G39qu lama m3 A T77 P39E q V w F nll a J r Eganif Tull i n i39 u 15 E f lrl r l n 5quot r7 9 liay t i i s 1quot if HLE l39ilmirul tuxmin I39lnl i rh39r39 Lactose Intolerance Primary lactose intolerance O Caused by lactase insuf ciency not enough lactase Common worldwide higher prevalence in Asian African American or LatinoHispanic individuals than Caucasians 0 Symptoms with consumption of lactose Abdominal pain bloating gas diarrhea 0 Dietary management Can take lactase tablets withbefore consumption of milk products to reduce symptoms Most people with lactase de ciency can tolerate 121 cup of milk with meals Hard cheese yogurt and acidophilus milk are well tolerated because lactose has been converted to lactic acid 0 Secondary lactose intolerance O Caused by damage to lactaseproducing cels Seen with conditions of small intestine eg Crohn s disease or severe diarrhea 0 Symptoms with consumption of lactose Abdominal pain bloating gas diarrhea Problems with lactose consumption are often temporary and go away once intestine recovers from damage and lactase production returns to normal Regulation of Blood Glucose 39 Hum i llrlnlllliii iliigaigimi quotSal lf Fasting blood glucose typically varies from 70100 mgdl 0 Maintenance of blood glucose levels within normal range important Hyperglycemia 0 High blood glucose gt 126 mgdl while fasting Hypoglycemia 0 Low blood glucose lt 50 mgdl Liver regulates 0 How much glucose from a meal released into blood 0 How much glucose stored as glycogen Pancreas adrenal glands and pituitary gland release hormones that regulate blood glucose u 7 71 4 iquot quotquotl i Hln a 539 mil 3 ill Lli nljrijga EL w Q m I litiiimm Linn i iiuwlt Iliumlam giliimiw plain ling lililwilii39h mil illijuinr lmim intramural truism mummi limit gliuuigm agili39iilxraiaiiiiiimuw gllriiuiimwgrimii Filmde Lilac liigi39mm glngm jhiriizihliwill mini halalElm mill Elwin lily HI Iiigr lawman ill lilltii39ig l ih Epimsr i m glam iiwr lmli lmrnnim gl lljill ifllEm h l39 li limllEgllu39rii l39llllgll ilw hylligliwr ruinEpimphnl ii intramczi gill ll l lg llWEiih Etinl39mll glands Liter llll lii sjquot lnzcmlmil Vgut mgilgfngsiis y the iii m39igr li gs gingle mg inim m ll igpquot mum39l jirill illl39IEJlI39 organsi rtmtlli human Ftluilm gland Lli39i ilil39l39lllll iEE glucose uptak I llleiilf n inmates 5F mnhilimljnn Inmate miipiw flitfutquot and miliriljng imm x gimme output Ill3rquot Iiir13quot o Insulin o Hormone made by pancreas o Promotes movement of glucose from bloodstream into body cells leads to decrease in blood glucose 0 Promotes glycogen synthesis Storage of excess glucose as glycogen O Decreases lipolysis Breakdown of fat Glucagon o Hormone made by pancreas O Stimulates breakdown of glycogen in liver into glucose 0 Increases gluconeogenesis Production of new glucose O Leads to increase in blood glucose 39tmnsga t quot39 7 in l calls quot 39 1395 LP nzrrms C meIE ifa ecsF gluing ir mj g lyf nyv Glucam JEQ39 bi in N rn liiz i H a m cu bl 51192552 quot7 F n g 39i39 quot quot Eatw GLUEZDSE quot fifl t f l with IlaF Ei39tzri39mg39y39 lncrwlmcl I f p i Panicragi I HE39SEli39s ginst cm l In response to eating 0 Insulin released when eating begins Greater amounts released as blood glucose levels rise with carbohydrate ingestion O Leads to return of normal blood glucose levels 0 In between eating occasions O Glucagon released with decreased blood glucose levels 0 Leads to normalization of blood glucose levels Insulin lowers blood glucose when high and glucagon increases blood glucose when low 0 quotFightor ightquot reaction 0 Hormones epinephrine adrenaline and norepinephrine released from adrenal glands Lead to breakdown of glycogen in liver to increase blood glucose levels Released in large amounts in response to perceived threat 0 Promotes quick mental and physical reactions 0 Other hormones O Cortisol and growth hormone Decrease glucose use by muscle Metabolic Syndrome Group of factors that increase risk of type 2 diabetes cardiovascular disease CVD o Insulin resistance glucose intolerance O Abdominal obesity 0 High blood triglycerides 0 Low HDL cholesterol 0 Elevated blood pressure 0 Treatments include lifestyle modi cation 0 Weight loss 0 Decreased simple carbohydrate and dietary fat intake 0 Increased physical activity Hypoglycemia Can occur with or without diabetes 0 In people with diabetes can occur with Use of too much insulin Low food intake Exercising without increasing carbohydrate intake 0 Symptoms o Hunger shakiness irritability weakness headache Diagnosis requires 0 Classic symptoms of hypoglycemia 0 Blood glucose lt 50 mgdl 0 Treatment 0 Regular meals with balance of protein fat carbohydrates including ample ber 0 Substitute highprotein snacks for highcarbohydrate snacks 0 Spread carbohydrate intake throughout the day 0 Limit caffeine and alcohol Medical Perspective Diabetes Mellitus Diabetes Mellitus o Affects gt 8 North Americans 0 Types of diabetes 0 Type 1 diabetes 0 Type 2 diabetes most common 0 Gestational diabetes 0 35 North American adults may be prediabetic 0 Blood glucose levels higher than normal but not enough for diabetes diagnosis Diabetes Mellitus Diagnosis 0 A1C hemoglobin A1C O Re ects average blood glucose levels over previous 3 months Higher percentage means blood glucose levels have been higher Fasting plasma glucose 0 Measures fasting blood glucose levels 0 Requires not eating or drinking anything fasting for at least 8 hours prior to test 0 Oral glucose tolerance test OGTT 0 Measures blood glucose levels before and 2 hours after special glucose drink consumed after 8 hour fast Diabetes Svmptoms Type 1 diabetes 0 Classic symptoms of hyperglycemia Increased hunger excessive thirst excessive urination weight loss 0 Other symptoms Exhaustionfatigue blurred vision 0 Type 2 diabetes 0 May be asymptomatic ie not show any symptoms Gestational diabetes 0 Often asymptomatic Type 1 Dia betes Can occur at any age but usually diagnosed in children Caused by autoimmune attack on pancreas genetic predisposition O Body s immune system destroys insulinproducing cells in pancreas Results in insufficient insulin production for glucose uptake by cells Excess glucose not taken up by cells excreted in urine 0 Treatment 0 Medications lnsulin therapy required via insulin injections or insulin pump 0 Diet Regular meals and snacks n Individualized plan for ratio of carbohydrateproteinfat Meet overall nutritional needs balance calorie intake with expenditure Carbohydrate counting and diabetic exchange system are tools to help regulate dietary intake 0 Exercise Can lower blood glucose levels but need to carefully monitor for hypoglycemia Type 2 Diabetes 0 Most common type of diabetes Characterized by insulin resistance 0 Cells become resistant to action of insulin lnsulin production may be low normal or high but cells less responsive to it 0 Results in decreased uptake of glucose by body cells 0 Risk factors 0 Genetic predisposition 0 Ethnicity LatinoHispanic African American Asian Native American Paci c Islander especially gt 45 years old 0 Obesity 0 Physical inactivity 0 Metabolic syndrome 0 Treatment 0 Diet Energycontrolled meet energy needs Regular meals Moderate alcohol 1 drinkd may increase HDL reduce CVD risk I Must consume with meals to avoid hypoglycemia 0 Regular exercise Enhances uptake of glucose by muscle cells 0 Combined diet and exercise plan is important 0 For overweight or obese individuals even modest weight loss can improve blood glucose control 0 Medications Not always necessary but many people need them to help control blood glucose levels Oral medications n Reduce glucose production by liver In Increase insulin synthesis by pancreas a Slow intestinal absorption of glucose n Decrease insulin resistance 0 Insulin injections advanced cases When oral medications no longer normalize blood glucose levels Diabetes Complications o Shortterm o Ketosis in type 1 diabetes High ketone levels in blood from incomplete fat breakdown Can lead to dehydration ion imbalance coma death 0 Longterm 0 Cardiovascular disease CVD o Kidney disease 0 Nerve disease neuropathy Constipation or diarrhea Amputation eg toes ngers feet limbs o Blindness O Infections Diabetes Control and Complications Trial Findings 0 Can delay onset of CVD and nerve disease complications with aggressive treatment that keeps blood glucose in normal range lli vi i L High Stiltm E mp lm um a39i riilii r riqg E39hli il js39 ri i lIE lmiia tillailgiiil39mic ei Fileiil h1iIIEEIEii llh aim ghill l 139ihg h l h iiHmiza muitim Mimi1L ayuq lglnm il in rm1 illfli hunger mid anti I1I 5i39lil MI HE luhih W lgi l Elna2 lintJilin l 39ih ll Iii nfil39li i umasmuflnr imsy IiiilllFieIEF digESE HE F39EI ihfli lll Eiiii39ld i39Eujia llnlfizgii 39nr Himm Liting Hiring ii t l ii l l i 39l All Gestational Diabetes Occurs in 210 all pregnancies o Treated with dietary therapy and insulin 0 Usually resolves after delivery Increases maternal risk for 0 Developing type 2 diabetes later in life 0 Developing gestational diabetes in subsequent pregnancy Increases child s risk for developing type 2 diabetes Diabetes Decreasing Risk 0 Lifestyle modi cations can decrease risk of developing type 2 diabetes and gestational diabetes 0 Maintain healthy body weight and gain appropriate weight during pregnancy 0 Stay physically active ll 11 1 r rill 7 n I cull Lilldriijiwitzw I wii lm mummy5 Emma gentEli pn jiwii iLmn Ellieail Ham HiyaEm Fliii 39lii39 iLga i illi liyilgi39 Mglq limfliak Egai aglurmihg mamrm HM ailnpi li39h E mially vigillily Er LIE Himala i Wining u i I1 Igliil i IiI IaI IE I lJ IEi Emits dam will L i Mi39j39diliflrE inji 39 lfi lieincur n llil EilllEilillilmi ii39i I mEr Mill 1 IlaIi lnwuili i illri Fair1 Miri I Eirnlin yagulmr hm Hi m39j Elima a HENIll InfraEllith iiiil il iil g39ili 39wii Htl iiirzglfi39ihiinl Alli 0 Follow Dietary Guidelines 0 Get regular screeningtesting of fasting blood glucose Especially for those with family history of diabetes or history of gestational diabetes Medical Perspective Diabetes Mellitus Learning objectives Describe the types of diabetes and dietary treatments for diabetes Describe dietary measures to reduce the risk of developing type 2 diabetes Diabetes Mellitus o Affects gt 8 North Americans 0 Types of diabetes 0 Type 1 diabetes 0 Type 2 diabetes most common 0 Gestational diabetes 0 35 North American adults may be prediabetic 0 Blood glucose levels higher than normal but not enough for diabetes diagnosis Diabetes Mellitus Diagnosis 0 A1C hemoglobin A1C O Re ects average blood glucose levels over previous 3 months Higher percentage means blood glucose levels have been higher Fasting plasma glucose 0 Measures fasting blood glucose levels 0 Requires not eating or drinking anything fasting for at least 8 hours prior to test 0 Oral glucose tolerance test OGTT 0 Measures blood glucose levels before and 2 hours after special glucose drink consumed after 8 hour fast Diabetes Symptoms Type 1 diabetes 0 Classic symptoms of hyperglycemia Increased hunger excessive thirst excessive urination weight loss 0 Other symptoms Exhaustionfatigue blurred vision 0 Type 2 diabetes 0 May be asymptomatic ie not show any symptoms Gestational diabetes 0 Often asymptomatic Type 1 Diabetes 0 Can occur at any age but usually diagnosed in children Caused by autoimmune attack on pancreas genetic predisposition O Body s immune system destroys insulinproducing cells in pancreas Results in insuf cient insulin production for glucose uptake by cells Excess glucose not taken up by cells excreted in urine 0 Treatment 0 Medications lnsulin therapy required via insulin injections or insulin pump 0 Diet Regular meals and snacks n Individualized plan for ratio of carbohydrateproteinfat Meet overall nutritional needs balance calorie intake with expenditure Carbohydrate counting and diabetic exchange system are tools to help regulate dietary intake 0 Exercise Can lower blood glucose levels but need to carefully monitor for hypoglycemia Type 2 Diabetes 0 Most common type of diabetes Characterized by insulin resistance 0 Cells become resistant to action of insulin lnsulin production may be low normal or high but cells less responsive to it 0 Results in decreased uptake of glucose by body cells 0 Risk factors 0 Genetic predisposition 0 Ethnicity LatinoHispanic African American Asian Native American Paci c Islander especially gt 45 years old 0 Obesity 0 Physical inactivity 0 Metabolic syndrome 0 Treatment 0 Diet Energycontrolled meet energy needs Regular meals Moderate alcohol 1 drinkd may increase HDL reduce CVD risk I Must consume with meals to avoid hypoglycemia 0 Regular exercise Enhances uptake of glucose by muscle cells 0 Combined diet and exercise plan is important 0 For overweight or obese individuals even modest weight loss can improve blood glucose control 0 Medications Not always necessary but many people need them to help control blood glucose levels Oral medications n Reduce glucose production by liver In Increase insulin synthesis by pancreas a Slow intestinal absorption of glucose n Decrease insulin resistance 0 Insulin injections advanced cases When oral medications no longer normalize blood glucose levels Diabetes Complications o Shortterm o Ketosis in type 1 diabetes High ketone levels in blood from incomplete fat breakdown Can lead to dehydration ion imbalance coma death 0 Longterm 0 Cardiovascular disease CVD o Kidney disease 0 Nerve disease neuropathy Constipation or diarrhea Amputation eg toes ngers feet limbs o Blindness O Infections Diabetes Control and Complications Trial Findings 0 Can delay onset of CVD and nerve disease complications with aggressive treatment that keeps blood glucose in normal range Hzmrmma lial lialm 39I39IIiIFIiIIIELIE E mp lm um a39iuirilili r liqg tli IIEiili iia tilinlgiiil39miu ei filltiillfii illhi39 ElihuEFL Iiiili39i aim hills rm FlCUEEE39EJ LEEREL tI H iiHuthl39l i39l Il iig l Misti1L tin 39LIli5391Iquotl il Frigqninrm mire hunger ii ri Izltil39liiliiIiulll HEW an W lgi luau2 lll39hilil39l l 39il l Emmi Eur imaswu ii discaye Eid y dinmug HEM climatei Hiim i39 ia a Iii iag ii i39nr Himm LIEUH Hiring mustanga irllmgginitiir 91h Gestational Diabetes Occurs in 210 all pregnancies o Treated with dietary therapy and insulin 0 Usually resolves after delivery Increases maternal risk for 0 Developing type 2 diabetes later in life 0 Developing gestational diabetes in subsequent pregnancy Increases child s risk for developing type 2 diabetes Diabetes Decreasing Risk 0 Lifestyle modi cations can decrease risk of developing type 2 diabetes and gestational diabetes 0 Maintain healthy body weight and gain appropriate weight during pregnancy 0 Stay physically active Inaaii lm magma Emmi gemsEli P i i ildi 39 Ellishi1 Main Hiyak1 Elii 39lii39h li 39liI1 It39igi39 Magm hq iak Manciniling F irfdiJHifi Mali Winning aware39ial ly 1 iIEIEE Er lib iwaw iilliigll tuiij Emmi ling ui In aii Emmiulnar mm grinemquot EELqu IiiH E 39i i rs Iri witlmsaiiaiuma in Himrh iwii 1 I IIi martini illrii Rahal iquotiquot I1 Eirnlin myulmr digmm Iiiizlnuj Eli 2533 HENIii IHELE39E39IEiEI39 Hiram glimpse HE39fTIifitgl hiim n ll 0 Follow Dietary Guidelines 0 Get regular screeningtesting of fasting blood glucose Especially for those with family history of diabetes or history of gestational diabetes CHAPTER 1 11 Nutrition Overview Nutrition 0 Science of food 0 The nutrients and the substances therein their action interaction and balance in relation to health and disease 0 Process by which the organism ie body ingests digests absorbs transports utilizes and excretes food substances Nutrient o Substances essential for health that the body cannot make or that it makes in quantities too small to support health 0 Chemical substance in food that contributes to health 0 Nourish us by providing Energy Materials for building body parts Factors to regulate necessary chemical processes in the body 0 6 Classes EnergyYielding Nutrients Carbohydrates Lipids Fats and Oils 0 Proteins Amino Acids NonEnergyYielding Nutrients Vitamins WaterSoluble FatSoluble amp Major 0 Minerals Trace Some Questionable Minerals 0 Water 0 To be considered an essential nutrient a substance must have these characteristics It has a specific biological function Removing it from the diet leads to a decline in human biological function such as the normal functions of the blood cells or nervous system Returning the omitted substance to the diet before permanent damage occurs restores to normal those aspects of human biological function impaired by its absence 0 3 functional categories Primarily Provide Energy kcal Most carbohydrates 0 Proteins Most lipids Important for Promote Growth Development amp Later Maintenance 0 Proteins Lipids 0 Some vitamins 0 Some minerals Water Regulate Body Processes and Keep Body Functions Running Smoothly Proteins Some lipids Some vitamins 0 Some minerals Water Most foods made up of energyyielding nutrients and water 0 Macronutrients Needed in gram quantities in the diet Fat protein and carbohydrates 0 Micronutrients Needed in milligram or microgram quantities in the diet Vitamins and minerals 0 Alcohol is rich in energy but is not a nutrient Carbohydrates o Composed mainly of the elements carbon hydrogen oxygen 0 Sources Fruits Vegetables Grains Beans Sugars 0 Simple Carbohydrates Small carbohydrate structures Sugar readily usable form of carbohydrates Table sugar sucrose Blood sugar glucose 0 Complex CarbohydratesPolysaccharides Large carbohydrate structures Starch in grains storage form of carbohydrate in foods Glycogen stored in our muscles Fiber indigestible carbohydrate that forms structure of plant cell walls 0 Glucose Comes from simple carbohydrates and starch Major source of energy in most cells Provide an average of 4 calories per gram kcalg Lipids 0000 O Body is forced to made glucose from proteins when too little carbohydrate is to supply sufficient glucose Compounds Composed of Carbon Hydrogen Oxygen Fats solid at room temperature Oils liquid at room temperature Yield more energy per gram than carbohydrates 9 calories per gram Insoluble in water but can dissolve in certain organic solvents ether amp benzene Triglyceride Major form of fat in foods Key energy sourceMajor form of energy stored in the body Composed of 3 fatty acids attached to a glycerol molecule 0 Fatty acids long chains of carbon flanked by hydrogen with an acid group attached to the end opposite glycerol Saturated vs Unsaturated Lipids Based on the chemical structure of their dominant fatty acids Helps determine difference whether lipid is solid or liquid at room temperature amp it s effects on health Plant oils 0 Contain mostly unsaturated fatty acids 0 Liquid at room temperature Animal fats Rich in saturated fatty acids 0 Solid at room temperature Unsaturated fats tend to be healthier than saturated fats Saturated fats raise blood cholesterol 0 Can clog arteries and eventually lead to cardiovascular disease Linoleic acid and AlphaLinolenic acid Essential nutrients Must be supplied by our diets Roles 0 Structural components of cell membranes 0 Helping regulate blood pressure and nerve transmissions Supply by eating a few tablespoons of vegetable oil daily and eating fish at least twice weekly 0 Trans fatty acids Unsaturated fats that have been processed to change their structure from the more typical cis form to the trans form Found primarily in 0 deep fried foods french fries o baked snack foods cookies 0 solid fats shortening Large amounts in the diet pose health risks Should be minimized Proteins o Composed of Carbon Oxygen Hydrogen Nitrogen 0 Main structural material in the body Major part of bone and muscle Important components in blood cell membranes enzymes and immune factors 0 Can provide energy on average 4 calories per gram Body uses little protein to meet its daily energy needs 0 Hemoglobin protein found in red blood cells 0 Amino Acids protein building blocks used to build body proteins 0 Form when Amino acids bond together 20 common amino acids are found in food 0 9 of which are essential nutrients for adults 0 1 additional amino acid is essential for infacts Vitamins 0 Wide variety of chemical structures 0 Can contain Carbon Hydrogen Nitrogen Oxygen Phosphorus Sulfur amp others 0 Main function enable many chemical reactions to occur in the body Some reactions help release energy trapped in carbohydrates lipids and proteins 0 Provide no usable energy 0 13 vitamins divided in 2 groups Fatsoluble A D E and K o More likely to accumulate in excessive amounts which can cause toxicity Watersoluble C Bvitamins thiamin riboflavin niacin vitamin B6 pantothenic acid biotin folate and vitamin B12 More likely to be destroyed by cooking Excreted much more readily Organic Compound contains carbon atoms bonded to hydrogen atoms Inorganic Compound does not contain carbon atoms bonded to hydrogen atoms Minerals 0 O O 0000 O O Structurally very simple amp inorganic substances Function in the body as groups of one or more of the same atoms or as parts of mineral combinations Hydroxyapatite found in bones calcium and phosphorus containing compound Do not destroy in cooking because they are elements Can leak into cooking water and get discarded if that water is not consumed Yield no energy for the body Required for normal body function Play key roles in the nervous system skeletal system and water balance 2 Groups Major minerals needed daily in gram amounts 0 Sodium potassium chloride calcium and phosphorus Trace minerals need in amounts of less than 100 mg daily 0 Iron zinc copper and selenium lrorganic Nutrient needed in the largest quantity Has numerous vital body functions Acts as a solvent and lubricant Medium for transporting nutrients to cells Helps regulate body temperature Beverages and food supply water The body makes some water as a byproduct of metabolism thtochemicals and Zoochemicals O O O Physiologically active compounds Not considered essential nutrients in the diet Provide significant health benefits Reduced cancer risk Block the development of cancer Phytochemicals plant components in fruits vegetables legumes and whole grainschemicals from plants Zoochemicals components in animalschemicals from foods of animal origin Foods rich is such are referred to as functional foods Provides health benefits beyond those supplied by the traditional nutrients it contains The food offers additional components that may decrease disease rick andor promote optimal health 4 categories 0 Conventional Foods unmodified whole foods 0 Fruits Spices Dairy products Vegetables Nuts Fish Herbs Modified Foods fortified enriched or enhanced foods 0 Calciumfortified orange juice 0 Omega3enriched bread 0 Breakfast bars enhanced with ginkgo biloba 0 Cheese made with plant sterols Medical Foods food formula or supplement used under medical supervision to manage a health condition 0 Phenylalaninefree formulas for phenylketonuria o Limbrel for osteoarthritis o Axona for Alzheimer diease o VSL3 for ulceractive colitis Special Dietary Use Foods foods that help meet a special dietary need 0 Infant formula for infants 0 Lactosefree foods for lactose intolerance o Sugarfree foods for weight loss 0 Glutenfree foods for celiac disease Most reliable way to obtain the potential benefits diet rich in fruits vegetables legumes and wholegrain breadscereals 000000 12 Energy Sources and Uses Humans obtain the energy needed to perform body functions and do work from carbohydrates fats and proteins After digesting and absorbing energyproducing nutrients the body transforms the energy trapped in carbohydrate protein fat and alcohol into other forms of energy in order to do the following 0 Build new compounds O O O Calorie Move muscles Transmit nerve impulses Balance ions within cells Often used to express the amount of energy in foods Amount of heat energy it takes to raise the temperature of 1 gram of water 1 degree Celsius A kilocalorie kcal equals 1000 calories Amount of heat energy it takes to raise the temperature of 1000g1 L of water 1 degree Celsius calorie also used to mean kilocalorie Any values given on food labels in calories are actually in kilocalories Kilocalories Heat measure Kilojoules Work measure Calories in food can be measured using a bomb calorimeter or estimated by multiplying the amount of carbohydrates proteins fats and alcohol in a food by the physiological fuel values Fuel values adjusted to account for the extent to which foods can be digested and substances that human cannot digest considered estimates 0 Carbohydrate 4 kcalg 0 Fat 9 kcalg 0 Protein 4 kcalg 0 Alcohol 7 kcalg of energy intake grams x fuel value total kcal x 100 13 The North American Diet Energy intake 0 Proteins 16 o Carbohydrates 50 o Fats 33 s are estimates and vary slightly from year to year amp person to person s are in a healthy range but many people are eating more than they need to maintain a healthy weight Animal sources meat seafood dairy products and eggs supply about 23 of the protein intake for most North Americans plant sources provide only about 13 0 Other parts of the world plant proteins from rice beans corn and other vegetables dominate protein intake About 12 of the carbohydrates in North American diets comes from simple carbohydrates sugars the other half comes from starches pastas breads and potatoes 0 Most need to reduce their sugar intake and increase their intake of starch and fiber 60 of dietary fat comes from animal sources and only 40 from plant sources many North Americans are consuming far more saturated fat and cholesterol than is recommended 0 Improve our diets by focusing on rich food sources of vitamin A vitamin E iron potassium and calcium and by reducing sodium intake Nutrient intake varies in some demographic groups which means these individuals need to pay special attention to certain nutrients o For example older adults often get too little vitamin D and women of childbearing years frequently have inadequate iron intake Improve their nutrient intake by moderating intake of sugared soft drinks and fatty foods and eating more fruits vegetables wholegrain breads and reducedfat dairy products Vitamin and mineral supplements also can help meet nutrient needs but cannot fully make up for a poor diet in all respects Influences on Diet 0 Major health problems caused by Poor diet Excessive energy intake Not enough physical activity 0 Daily food intake complicated mix of the need to satisfy hunger and social amp psychological needs 0 Areas where food is plentifulfairly easy to access Selection is guided by appetite psychological desire to eat certain foods and reject others Appetite and food choice depend onFactors that affect food choices 0 Food flavor texture and appearance preferences 0 Culture knowledge beliefs religion and traditions shared by a group or social network of people Lifestyle Routines and habits Food cost and availability Environment Food marketing Health and nutrition concerns knowledge and beliefs 000000 14 Nutritional Health Status Wellnourished person 0 Daily protein fat and carbohydrate intake 450g1lb 0 Daily mineral intake 20g4tsp 0 Daily vitamin intake 300mg 15tsp Body cells not concerned with which food supplied a nutrient but rather that each nutrient be available in the amounts needed to func on Body s nutritional health is determined by sum of it s status with respect to each nutrient o 3 categories of nutritional status Desirable nutrition 0 State in which the body tissues have enough of the nutrient to support normal functions as well as to build and maintain surplus stores that can be used in times of increased need Achieved by obtaining essential nutrients from a variety of foods Under nutrition 0 Nutrient intake does not meet nutrient needs causing surplus stores to be used 0 Once nutrient stores deplete and tissue concentrations of essential nutrient fall sufficiently low body s metabolic processes slow down or even stop 0 Subclinical Early stage of nutrient deficiency no overt signs or symptoms that can be detected or diagnosed Sign a feature that can be observed such as flaky skin Symptom a change in body function that is not necessarily apparent to a healthcare provider such as feeling tired or achy Over nutrition 0 Consumption of more nutrients than the body needs o In the short run may only cause a few symptoms such as intestinal distress from excessive fiber intake 0 In the long run levels of some nutrients in the body may increase to toxic amounts 0 Most common type in industrialized nations is excess intake of energyyielding nutrients often leads to obesity 0 Malnutrition refers to either over nutrition or under nutrition neither is conducive to good health Health objectives for the Year 2020 O O O O O 0000 Increase the proportion of adults who are at a healthy weight Reduce the proportion of children adolescents and adults who are obese Reduce household food insecurity and in doing so reduce hunger Increase the contribution of fruits and vegetables to the diets of the population aged 2 years and older Increase the contribution of whole grains to the diets of the population aged 2 years and older Reduce consumption of calories from solid fats and added sugars Reduce consumption of sodium in the population aged 2 years and older Increase consumption of calcium in the population aged 2 years and older Reduce iron deficiency among young children females of childbearing age and pregnant women Increase the proportion of adolescents and adults who meet the objectives for aerobic physical activity and for musclestrengthening activity Increase the proportion of children and adolescents aged 2 years through 12th grade who view television or videos or who play video games for no more than 2 hours a day Assessing Nutritional Status 0 A nutritional assessment help determine how nutritionally fit you are Performed by a physician aided by a registered dietitian Include an analysis of 0 Numerous background factors known to affect health 0 Medical history current and past diseases and surgeries body weight and current medications 0 Family medical history for genetic components Anthropometric assessments o Involves measuring various aspects of the body 0 Easy to obtain and are generally reliable Height WeightWeight changes Body circumferences waist hips arm Skinfold thickness indicator of body fatness and body composition 0 Biochemical assessments 0 Include the measurement of the concentrations of nutrients and nutrient byproducts in the blood urine feces and of specific blood enzyme activities 0 Clinical assessments o Healthcare providers search for any physical evidence of dietrelated diseases 0 Focuses on potential problem areas identified from the dietary assessment 0 Dietary assessments o Examines how often a person eats certain types of food food frequency 0 Examines the types of foods eaten over a long period of time food history 0 Examines typical intake such as foods eaten in the last 24 hours or several days Environmentalassessments 0 Based on background data 0 Provides information on the person s education economic background martial status and housing condition Information is important because with lower education and income comes a greater risk of poorhea h Limitations of Nutritional Assessment 0 Many signs and symptoms of nutritional deficiencies are not very specific May be caused by poor nutrition or by other factors unrelated It can take a long time for the signs and symptoms of nutritional deficiencies to develop which may also be vague Often difficult to establish a link between one s current diet and their nutritional status A long time may elapse between the initial development of poor nutritional health and the first clinical evidence of a problem Example high saturated fat increase in blood cholesterol Example insufficient calcium intake osteoporosis later on in life Importance of Being Concerned about Nutritional Status 0 Recent study found that women who followed a healthy lifestyle had 80 reduction in risk of heart attacks Consumed a healthy diet varied rich in fiber low in animaltrans fat and included some fish Avoided becoming overweight Regularly drank a small amount of alcohol Exercised for at least 30 minutes daily Did not smoke o More complete approaches include 0 O No illicit drug use 78 hours of sleep Adequate water intake Regular physical activity Minimal emotional stress Positive outlook on life Close friendships Regular consultation with healthcare professionals 10 of North American teenager energy intake is from soft drinks contributes to poor calcium intake later increases risk of osteoporosis Getting NutritionRelated Advice The Nutrition Care Process Consult physician or registered dietitian before purchasing dietary supplements RD completed rigorous baccalaureate degree program by Academy or Nutrition and Dietetics at least 1200 hours of supervised practice and has passed registration examination Trained to provide scientifically valid nutrition advice Nutrition Care Process Conduct a nutritional assessment Asks questions about your food and nutrition history and anthropometric biochemical clinical dietary and environmental assessment data Diagnose nutritionrelated problem 0 Uses your nutrition history and assessment data to determine your specific nutritionrelated problem Create an intervention Formulates a diet plan tailored to your needs as opposed to simply tearing a form from a tablet that could apply to almost anyone that addresses the root cause of your nutrition problem with the goal of relieving the signs and symptoms of your diagnosis Monitor and evaluate progress Schedules followup visits to track your progress answer questions help keep you motivated and perhaps reassess rediagnose and modify your intervention Family members may be involved in the diet plan when appropriate The dietitian will consult directly with your physician and readily refer you back to your physician for those health problems a nutrition professional is not trained to treat Genetics and Nutrition 0 Genetic endowment affects almost every medical condition 0 Digestion Nutrients supplied are broken down absorbed into the bloodstream and transported to cells Genetic material deoxyribonucleic acid DNA that is inside the nucleus of cells directs how the body uses the nutrients Foods amp Humans contain the same nutrients but proportions differ 0 Genes In cells they dictate the type and amount of nutrients that will be transformed and reassembled into the body structures and compounds Direct growth development and maintenance of cells Contain codes that control expression of traits Such as height eye color and susceptibility Currently 1000 tests to determine whether a person has genetic mutations that increase the risk of certain illnesses o Nutritional Diseases with a Genetic Link Chronic nutritionrelated diseases are influenced by interactions among geneticnutritionallifestyle factors 0 Examples diabetes cancer osteoporosis Family history is one of the most important risk factors in the development of many nutritionrelated diseases Although some individuals may be genetically predisposed whether they actually develop the disease depends on lifestyle choices and environmental factors that influence the disease Heredity is not necessarily destiny individuals can exert some control over the expression of their genetic potential 0 Such as o Eating a nutritious diet regular exercise weight under control and getting medical treatment 0 Becoming obese smoking abusing alcohol 0 Genetic Profile The more relatives with transmitted disease and the more closely the relation increases the risk Assessing risk 0 Create a family tree of illnesses and deaths via compiling facts on biological relatives siblings parents auntsuncles and grandparents Highrisk conditions having more than one firstdegree relative with a specific disease especially if before age 5060 0 Gene Therapy In the process of developing therapies which correct damaged DNA that causes some genetic disorders Typically Isolate normal DNA package it into molecular delivery vehicle disabled virus and inject it into cells affected by the disease 0 Inside cell normal genetic material begins functioning and restores cells 0 Genetic Testing Analyze person s genes to determine the likelihood of developing certain diseases Valuable for families afflicted by certain illnesses Help people who are healthy now to predict the illnesses they will probably develop May provide opportunities to replace genes that encourage diseases with those that do not Could help couples wanting children make more informed choices Help healthcare providers develop health and nutrition care plans that delay onset of diseases Help healthcare providers diagnose diseases earlier and more accurately and prescribe individualized medicalnutrition therapies Experts recommend anyone considering to have genetic counselor 0 Analyze family history 0 Evaluate risk of developing or passing along disease 0 Help determine whether testing is worth time and effort Help consumers take a more proactive role in protecting their heahh Most cases 0 Genetic susceptibility does not guarantee development of the disease 0 No way to cure a specific gene alteration only the problems that result can be treated Faced possibilities Job and medical insurance discrimination Unnecessary radical treatment Seemingly hopeless diagnosis Depression because cure is out of reach 0 At home testing misleading results making unsafe health decisions if no guidance from professional finding company has not kept information confidential 0 Genetic analysis for disease susceptibility is becoming more common as the genes that increase the risk of developing various diseases are isolated and decoded 15 Using Scienti c Research to Determine Nutrient Needs Scientific Method a testing procedure designed to uncover facts and detect and eliminate error 0 O Phenomena are observed Questions are asked and hypotheses are generated to explain the phenomena Research is conducted lncorrect explanations are rejected and the most likely explanation is proposed Research results are scrutinized and evaluated by other scientists Research conducted in an unbiased scientific manner is published in a scientific journal The results are confirmed by other scientists and by more experiments and studies 0 Scientific Theory or Law scientifically acceptable explanation of phenomena and how the phenomena are related to each other Perspective on the Future 0 Nutritional genomics examines how the foods you eat affect your genes and how your unique genetic profile affects the way your body uses nutrients phytochemicals and zoochemicals
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