Lecture Notes NUTR 300
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NUTR 300 Nutrition for Today muscle movement nerve function Water Composed of H 0 Important for a wide variety of body processes o fluid balance and nutrient transport nerve impulses body temperature regulation removal of wastes muscle contraction chemical reactions 00000 Why is Nutrition Important Current leading causes of death are httpwww cdc 00 vlniurvwisaarspdf1 0L CDAaeGrpUS2009apdf common risk factors for these chronic diseases include smoking family history of disease sedentary lifestyle Therefore nutrition is important 1 To reduce the incidence of nutrition reated diseases 2 To promote optimal health and wellness 92412 Vocabulary for today Nutrition Chronic disease E Kirk PhD RD Carbohydrates Proteins Lipids Minerals Water NUTR 300 92612 Nutrition for Today Why does nutrition matter Reading p 2032 Learning Objectives 0 Understand some terminology associated with nutritional assessment learn some new vocabulary Historical background Vitamin discoveries paved the way for dietary recommendations Early 1900s USDA made recommendations for protein intake 1941 Food and Nutrition Board FNB of the Institute of Medicine was established and created the first set of RDAs RDAs were revised 9 times since 1941 last in 1989 1994 Joint effort by the FNB and Health Canada initiated to establish Dietary Reference Intakes DRs DRs released between 19972011 New areas Expand on the traditional RDA values Set standards for nutrients that do not have RDA values Dietary standards for healthy people only For preventing deficiency diseases and reducing chronic diseases Dietary Reference Intakes Example lDlRS for iron adult males 0 EAR B rrigiday 0 RDA 8 rrngfday 0 Al none 39 UL 45 rngfday Used to exarriiria lilltelit iouud that intake is adequate Z 39 in a popo39latl39onV 1 LI sad to eXalquotl39l i ne likelihood of ll 1 excess or toxicity tirn 4J La age W Red J J ir riieni EAR Used to egtltarr1inel likelihood that intake 39 w7 L H is Eldf3CllLl E1TO when no Qw RDA is G for 1 nutrient Allowance FtDA Used as a goal to elp 3 I ire adequate E JF XF Ifalak 0 E TDD 39rid r w39dual39 1 NUTR 300 Nutrition for Today Malnutrition Too much or too little of a particular nutrient or energy Undernutrition Too little energy or too few nutrients Overnutrition Too much energy or too much of a given nutrient Primary deficiency A direct consequence of inadequate intake Secondary deficiency a person cannot absorb enough of a nutrient Subclinical deficiency few or no symptoms are observed 92612 Vocabulary DRI RDA AI UL EER AMDR E Kirk PhD RD Standardized serving size o Daily value Based on a 2000 kilocalorie diet 0 Ingredients in descending order from most abundant to least abundant by weight 0 Start at serving size and servingcontainer Check calories Limit total fat down to sodium lt5 Get enough of these nutrients Vitamins Calcium Iron etc gt20 39gt quotquot Grams of fat x caloriesgram x x 150 100 Fat Things to Dav attention to on a food label Serving size and calories per serving Sugar content o Adding calories rather than nutrients Caories from fat and which types of fat o Total fat in diet should remain below 35 Sodium content Signs and symptoms of foodborne illness Lecture 4 Food Safety 0 Generally gastrointestinal O OOOOOOO Strategies for preventing food borne illness Nausea and vomiting Diarrhea Bloody stools Intestinal cramps Headache Lethargy Loss of appetite Fever 0 Purchasing food 0 Pay attention to the sell by dates on perishable foods 0 Don39t buy foods in damaged containers 0 Check eggs don39t buy cracked Food preparation Wash hands 20s and kitchen surfaces often 0 Separate foods to prevent cross contamination 0 Cook foods to their proper temperature 0 Chill foods to prevent microbes from growing Foods should be cooked thoroughly to kill micro organisms Food storage and reheating O 0 0 0 Danger zone is between 40 F and 140 F Just right temperature for microbial growth Refrigerator should be between 32 F and 39 F Frozen foods should be thawed slowly in the refrigerator Leftovers should be stored in the refrigerator for a limited period of time 0 Eat in sanitary environment Food Pesticides Dirty Dozen buy these organic 0 OOOOO Clean 0 OOOOOOO Apples Celery Strawberries Peaches Spinach Nectarines 15 Lowest in pesticides Onions Corn Pineapples Avocado Asparagus Sweet peas Mangoes Eggplant OOOOOOO OOOOOO Grapes Sweet bell peppers Potatoes Blueberries Lettuce Kalecollard greens Ca ntaloupe Kiwi Cabbage Watermelon Sweet potatoes Grapefruit Mushrooms Lecture 5 Food Security Food Securitv able to obtain sufficient nutritious food Buy nutrition rich foods Maintain energy balance Low food security food intake is adequate but food quality variety andor desirability reduced Very low food security food intake is not always adequate due to lack of food access and availability lack of foodmay not be able to feed family Food insecuritv unable to obtain sufficient nutritious food quality may be low but food is still available see def on tophatmonocle 0 Inadequate physical social or economic access 0 Globally poverty war natural disaster 15 of US households 0 23 children in US live in food insecure homes 0 Average 44week spent on food in US o Average of 30week if food insecure Factors 0 Income o Poverty 16 of families living below poverty line Not always unemployed families 0 40 who seek food assistance are in fact employed 0 Ethnicity o Black and Latino families at higher risk than other ethnicities Head of household o Households headed by single moms as higher risk 0 Location of home o Urban and rural households are at greatest risk urban o Food desert location with poor or no access to affordable andor nutritious food Consequences of Food lnsecuritv Mothers o At risk for malnutrition if they deny themselves food in order to feed their children 0 Children o Most signi cant long term effects exacerbates problem of food insecurity if child continues to struggle throughout life School difficulties Standardized tests and absences Behavioral problems 0 Older adults o Poverty rates highest among older women and those living alone Lecture 6 Digestion o Gastric juices digestive enzyme and acid creates pool of liquid that continues mixing to bring down the food 0 Endocrine cells o Gastrin produced in the stomach in response to food Stimulates production of HChydrochoric acid parietal cells 0 Pepsinogen chief cells a protein digesting enzyme made by chief cells o Activated by HCI to form pepsin Food mixes with hydrochloric acid and some enzymes in the stomach o Begins denaturing of proteins within food 0 Surface cells secrete large amounts of mucus which protects the stomach lining from stomach acid 0 The mixture of partially digested food is called chyme 0 Small intestine o Duodenum 1 ft long Chyme enters into the duodenum 0 Secretin and CCK released 0 Pancreatic juice bicarbonate and digestive enzymes buffers acidity from the stomach enter the duodenum via the common bile duct 0 Produced by the liver Stored in the gallbladder 0 Secreted into the duodenum via the common bile duct o Jejunum 8 ft long 0 lleum 12 ft long Large intestine stores undigested food materials and absorbs water short chain fatty acids electrolytes and certain vitamins o Bacteria reside in the large intestine intestinal microbiota Further digest certain food molecules fermentation 0 Use of ber and other non digested food constituents by bacteria in the colon Yield CO2 H2 CH4 and short chain fatty acids o Highly muscular o 5 ft long on average o quotcolonquot Where Does Absorption Happen Mouth o Water alcohol Stomach o Water alcohol 0 Small intestine o Carbohydrates proteins fats Lecture 7 Digestion and Absorption Small Intestine 0 Made up of folds o On top of folds nger like projections villi Covered by cells called epithelial cells see the outside world le skin Aka Enterocytes mucosal cells absorptive lining cells 0 Completely spread out at surface area 2500 sq ft o Folds villi and microvilli increase the surface area of the small intestine How is Absorbed Food Transported 0 Absorbed food molecules pass into capillaries within villi 0 Capillaries merge into the hepatic portal vein which carries blood to the liver Water soluble nutrient 0 Proteins carbs medium chain fatty acids B vitamins vitamin C minerals 0 Travel through the microvilli through the epithelial cells and then to the liver Fat soluble nutrient Long chain fatty acids fat soube vitamins Secreted into the lymphatic system via lacteals in the villi Contents of lymphatic system enters blood circulation at thoracic duct Digestive Disorders 0 Heartburn and Gastroesophageal Re ux Disease GERD o Heartburn caused by hydrochloric acid in the esophagus o GERD is painful persistent heartburn Causes Hiatal Hernia overweight pregnancy cigarette smoking alcohol use chocolate citrus spicy or fried foods Treatment smaller meals stop smoking don39t lie down after eating avoid offending foods antacids neutralize HCI inhibit pepsin production Occurs in the esophagus 0 Ulcers o Peptic ulcers areas of the GI tract that have been eroded by HCI and pepsin Causes the bacterium Helicobacter pylori chronic non steroida anti in ammatory use advil tylonol etc Treatment antibiotics antacids Symptoms pain 13 hours after eating 0 Food allergies and intolerances o Food allergy an allergic reaction to a good caused by a reaction of the immune system Common allergenic foods wheat milk eggs soy sh nuts Symptoms vary Lecture 8 Carbohydrates o Increases intestinal transit time slows down elimination delayed gastric emptying results in lower blood glucose levels Food sources fruits vegetables rice bran psyllium seed Insoluble Fiber Ex Cellulose 0 Function o Increase fecal bulk o Promotes softer larger stool and regularity o Reduces diverticula pouches off the muscular wall of the large intestine o Decrease intestinal transit time speeds up elimination o Food sources whole grains vegetables Cellulose primary structural molecule of plants o Long unbranched chains of glucose o Linked together in such a way that they cannot be digested by humans Oligosaccharides In between 310 sugar units Ex Raf nose stachyose Food sources beans legumes Undigested oligosaccharides may be fermented by bacteria in large intestine Leads to gas Plants store glucose as starch Amylose Linear molecular structure 0 Amylopectin Contains branch points on molecular structure Animals store glucose in the form of dlvcooen Many more branch points therefore molecule is larger overall 0 Enzymes can free many glucose molecules simultaneously for a quick release of glucose 0 Glucose is stored as glycogen in muscles and liver tissue Ca rbohvdrate Dioestion Most chemical digestion of carbohydrates occurs in the small intestine Pancreatic amylase o Enzyme produced in the pancreas and secreted into the small intestine o Digests complex carbohydrates to maltose Mouth Lecture 9 Proper response to what hormonal changes occur after a meal 0 insulin increases glucagon decreases Islets spherical collection of cells Exists in the pancreases Beta cells insulin producing cells talks to multiple cells 0 Majority cell type in islets Alpha cells glucagon producing cells talks to liver o Distribution is around the outside of the islet New glucose from non carbohydrate sources ie protein 0 Cannot convert fat into glucose Gluconeogenesis in a starved state no input of carbohydrates starts to breakdown protein in body and breakdown of muscle tissue Ketogenesis production of ketones reduce body39s demand for glucose Happens due to lack of carbohydrates 0 Blood glucose has dropped 0 Risk o Certain tissues are reliant on glucose for energy brain and red blood cells Homeostasis steady blood glucose level Blood glucose is high o Beta cells secrete more insulin glucose is taken out of blood stream and into cells 0 Increases glucose uptake by cells 0 Promotes glycogen synthesis Storage 0 Reduces gluconeogenesis production of glucose reduces new glucose formation 0 Net effect lowers blood glucose levels Blood glucose is low hypoglycemia alpha cells secrete more glucagon production of glucose from the liver and into the blood stream o Enhances gluconeogenesis increases new glucose formation o Net effect raises blood glucose levels Glvcemic Index quotrankingquot of a food39s potential to raise blood glucose and insulin levels 0 Compared with 50g glucose or white bread 0 Varies with food preparation methods raw cooked etc o Cooking can make carbohydrates more available Food39s fat and ber affect absorption o Slow gastric emptying Lower GI 0 Foods Beans fresh vegetables whole wheat bread High in ber less processedre ned 0 Less dramatic uctuations in blood glucose 0 Possible risk reduction for heart disease and colon cancer ie chronic diseases Lecture 10 Blood Glucose Regulation o Type 1 diabetes diabetic ketoacidosis Lack of insulin inhibits normal carbohydrate metabolism Excess of ketones in blood May lead to coma or death if not treated with insulin electrolytes and uids Type 2 diabetes mellitus 9O quotAdult onset diabetesquot outdated Non insuin dependent diabetes o Can create insulin but cannot respond to it Defective insulin receptors on the cells o Insulin resistance o Hyperglycemia Pancreases over secretion of insulin to compensation o Leads to beta cell failure This failure is what begins type 2 diabetes Risk o Highly associated with obesity esp centrally obese o Maintaining a sedentary lifestyle no exercise o Genetic link Having a parent brother sister grandparent etc Symptoms o Increased urination polyuria Direct result of hypoglycemia excess of glucose in circulation o Fatigue o Blurred vision o Slow healing wounds Goals o Maintain blood glucose levels in the normal range Prevent complications of diabetes o Maintain lipid and lipoprotein pro les in a heart friendly range o Keep blood pressure down Tools o Oral hypoglycemic medications o Insulin therapy if large amounts of beta cells have died o Diet plans Carbohydrate counting Exchange lists o Exercise Dietary goals o High carbohydrate Whole grains fruits vegetables Sucrose and sucrose containing foods should be eaten in context of a healthy diet Total carbohydrate content of mealsnack more important than source or type Protein 1520 of calories Lecture 11 Protein Protein macronutrient Much of the body is made of protein 0 Contain C H O and Nitrogen o Distinguishing factor from carbohydrates presence of nitrogen Regulate and maintain body functions 0 Supply energy 4kcag Shape is very important folded differently based upon amino acids o Collagen type of structural protein Consist primarily of long straight polypeptides rope ike o Hemoglobin Has polypeptides folded into a spherical structure adapted to hold oxygen atoms o Enzymes Proteins specially shaped to hold two molecules together or split a molecule apart 0 Primary structure the number and sequence of amino acids in a single petide chain Sources 0 Meat poultry sh 1 oz 7g Diary 1 cup 8 g Beans 05 cups 7g Nuts seeds 1 oz 7 g Grains 1 svg 3 g Protein svnthesis 1 Cell signaling 0 Cell signaling communicates the need to synthesize a protein to the nucleus 2 Transcription Transcription of a gene in the nucleus results in the synthesis of a strand of mRNA 0 quotMaking messenger RNA from DNA 3 Translation 0 Making protein from mRNA Proteins in the Diet 0 Provide the 9 essential amino acids o For protein synthesis all essential amino acids must be available 0 Provide the nonessential amino acids Protein Digestion Begins in stomach Hydrochloric acid 0 Breaks down protein structure denatures 0 Activates proenzyme not active yet pepsin o Pepsin breaks down proteins into short polypeptides and amino acids Lecture 12 Protein Intake amp Recommendations Dailv Recommendations for protein intake 0 RDA 08 grams of proteinkg of healthy body weight o 154 b 22kglb 70kg o 70 kg x 08 g protein kg healthy body weight 56 g Most adults should have 08 grams of protein per kilogram of body weight 0 Proper protein intake depends on 0 Activity level o Age o Health status Ex A sedentary adult requires no more than 08 g protein kg of body weight An athlete in training may require up to 17 gkgd An infant requires 12 to 15 gkgd Increased in athletes 17 gkgd Increased lean body mass Additional protein needs for recovery Small amount of protein used for energy during activity Nitrooen balance studv determines protein needs 0 Nitrogen in nitrogen out nitrogen balance o In and out should be equal Positive nitrogen balance o A person consumes more nitrogen than is excreted Retaining protein in their diet o Often found in kids o Needed for periods of growth pregnancy recovery from illness or protein de ciency Negative nitrogen balance o A person excretes more than is consumed o Results from starvation consumption of very low energy carbohydrate diet 20gday low severe illness infections serious burns or injuries o Needs to be corrected not desirable High Protein Diet 0 Protein itself isn39t harmful Intake of animal protein is high in saturated fat and cholesterol o Increases risk for heart disease if high protein amounts are consumed Excessive intake of red and processed meats has been linked with colon cancer 0 Burden on the kidney o Big issue for people susceptible to kidney disease o In healthy adult low burden on kidneys Lecture 13 Lipids Remade into triglycerides for storage End Products of fat digestion Fatty acids 0 Monoglycerides Cholesterol 0 Phospholipids lnhibitino oancreatic lioase to lose weight 0 Side effects 0 0 0 0 Gas with an oily anal discharge Loose stools or diarrhea More frequent bowel movements Hard to control bowel movements Lipids and Heart Disease atherosclerosis Lipoproteins Chylomicrons o Dietary lipids mostly triglycerides o Comes from small intestine 0 Deliver fatty acids o Taken up by the liver 0 Very low density lipoprotein VLDL 0 Contains the greatest percentage of lipid primarily triglyceride 0 Low density lipoprotein LDL o Carries the most cholesterol 0 High density lipoprotein HDL Lipids and Heart Disease atherosclerosis Prevalence Heart disease number 1 cause of death in men and women o Risk increases as age increases 2039 yo 142 men 97 women 4059 yo 39 men 37 women 6079 yo 72 men 72 women 80 yo 80 men 87 women 0 Cancer number 2 Risk Factor for Heart Disease High LDL cholesterol bad cholesterol Low HDL cholesterol good cholesterol Hypertension Family history Obesity Diabetes Gender 0 Women relatively protected if premenopausal Systemic in ammation Lifestyle o High fat diet saturated and trans fat o Smoking o Infectious agents o lnactivity sedentary lifestyle Blood Vessel 0 Anatomy o Adventitia fatty outside tissue o Media smooth muscle cells allows artery to contract or dilate o Endothelial cells cobble stone path cells that line every vessel healthy vessel smoothnothing sticks Unhealthy vessel evolution of an atherosclerotic plaque 0 Tear in artery wall Lecture 15 Energy Production and Utilization Metabolism o During digestion chemical reactions break down proteins lipids and carbohydrates o Tissues or cells are broken down for repair or replacement or for energy 0 Releases energy Carbohydrates Fats lipids Proteins Catabolic Pathways Glycogenolysis Lipolysis Proteolysis Substrates Glycogen Triglycerides Proteins Glycolysis Beta oxidation Deamination and transamination Substrates Glucose Fatty Acids Amino Acids Glucose Metabolism If blood glucose high energy storage glycolysis and glycogenesis o Stimulates insulin o Anabolic process If blood glucose low generate glycogenolysis gluconeogenesis o Stimulates glucagon o Catabolic process Glycolysis used for energy production in all cells 0 Anaerobic metabolism glycolysis 0 Without oxygen 0 Produces pyruvate Aerobic metabolism o With oxygen 0 Generates more ATP Tissue exclusively dependent on glucose as fuel 0 Ex Red blood cells Tissues almost exclusively dependent on glucose as fuel 0 Ex Brain o Can use ketones if glucose is absent but not inde nitely All tissues and cell use glucose for enerov Brain no storage of glucose 0 Liver store glycogen Muscle store glycogen Adipose tissue stores as triglyceride Energy from Fat Catabolic Pathways Lipolysis dietary and adipose triglycerides are hydrolyzed by lipase enzymes to yield one glycerol and 3 fatty acids Free fatty acids are used for energy 0 Beta oxidation process by which fatty acids can be used for energy Lecture 15 Energy Production and Utilization Metabolism Anabolic Pathway Lipogenesis Making fatty acids from non fat substances such as carbohydrates amino acids and alcohol 0 Occurs when consuming excess calories o Fatty acids combine with glycerol to form triglycerides o Occurs mainly in liver cells Fatty acids Adipose tissues stored in triglycerides Muscle tissue stored as triglycerides and made into ATP 0 Liver triglycerides and VLDL Energy from Protein 0 The body prefers using carbohydrates and fat for energy 0 Protein is reserved for metabolic functions that cannot be performed by others 0 Building and repairing body tissues 0 Proteins are used for fuel primarily during low total energy or carbohydrate intake 0 Liver uses amino acids in gluconeogenesis and in energy production Amino Acids Protein synthesis make proteins Fat synthesis sent from liver via VLDL Liver urea glucose fat Muscle protein synthesis Hormones Regulate Metabolism Insulin is the primary anabolic hormone 0 increases in the blood after eating 0 Activates storage enzymes 0 Signals cellular uptake of glucose fatty acids and amino acids Catabolic Hormones Glucagon epinephrine and cortisol o Respond to increased energy needs Reduced intake andor increased expenditures o Trigger the breakdown of stored triglycerides glycogen and body protein for energy How do feeding and fasting affect metabolism 0 Fed state anabolic Fasted state catabolic Metabolism during feeding Bloodstream is enriched with glucose fatty acids and amino acids o Excess glucose Oxidized Stored as liver and muscle glycogen Lecture 16 Alcohol Facts of Alcohol Acts as a sedative and depressant Can interfere with brain function and sleep 0 Can impair gross and ne motor skills 0 Chronic intake o May inhibit intellect impair memory lead to permanent changes in brain structure and function Ethanol Energy source 7 kcalg 4 6 total calories in Western societies Psychoactive drug genetic predisposition to addiction Toxin liver disease 0 US 50 women and 70 men drink alcohol 3 women and 15 men classi ed as heavy drinkers Provides 5 total energy of US diet but can contribute up to 50 in heavy drinker Types of Drinking Moderate drinker o 1 drink per day women 0 2 drinks per day men 0 Binge Drinker o 4 or more drinks per 2 hours women 0 5 or more drinks per 2 hours men 0 Heavy drinker 0 Chronic consumption of more than 1 drink per day women o Chronic consumption of more than 2 drinks per day men quot1 Drinkquot 0 Beer 12 oz 0 Hard Alcohol 15 oz 1 shot 0 Wine 6 oz Alcohol Absorption 0 Via simple diffusion in stomach and jejunum 2 39 part of the small intestine 80 Depends on o Amount and speed of alcohol consumption 0 Presence or absence of food o Gender health status genetics 0 Distributed wherever water is found in the body 0 Moves easily through the cell membranes Alcohol Metabolism 0 Some ethanol is metabolized by the stomach cells 0 Majority of ethanol is metabolized by the liver No storage must be oxidized immediately takes priority Lecture 16 Alcohol Unregulated metabolism gt95 completely oxidized 0 Alcohol is oxidized primarily by the liver 0 1 Alcohol dehydrogenase ADH Pathway used to metabolize low to moderate concentrations of alcohol 0 Moderate and binge drinkers Occurs in the cytosol of liver and stomach cells Yields energy 0 Alcohol dehydrogenase Ethanol acetaldehyde toxic to body Acetaldehyde dehydrogenase Acetaldehyde acetic acid 0 Used to synthesize fat 0 2 Microsomal ethanol oxidizing system MEOS Pathway used to metabolize high concentrations of alcohol 0 Heavy drinkers Occurs in liver cells when ADH pathway cannot meet metabolic demand of alcohol Rate of metabolism 714 ghour for 70 kg person 0 Takes about 1 hour to completely metabolize 1 beer Depends on Gender 0 Due to body size and muscle mass 0 Genetics Body composition 0 le muscle mass height weight etc 0 Food o If present slows down rate of absorption 0 Physical condition Alcohol content Alcohol Metabolism Changes other Metabolic Pathways 0 Decreased gluconeogenesis production of glucose by the liver 0 Decreased lipid oxidation generation of energy from fats Promotes triglyceride synthesis o Increases fat accumulation in liver over time Alcohol Metabolism is a priority Where 0 Stomach and liver When alcohol is over consumed 0 Rate of oxidation fairly stable o Excess alcohol released into blood 0 Re ected in blood alcohol content Bene ts of Alcohol Consumption Lecture 18 Vitamin C amp Fat Soluble Vitamins Vitamin C quotAscorbic acidquot 0 Synthesized by most animals create within the body not by humans Water soluble o Must be consumed on a regular basis Abundant in fruits and vegetables 0 RDA women 75 mgday and men 90 mgday Functions of Vitamin C Antioxidant activity 0 Collagen synthesis 0 Iron absorption 0 Biosynthesis o Hormones o Neurotransmitters o Bile acids 0 Immune functions De ciency of Vitamin C 0 Scurvy 0 Signs appear after 2040 days 0 Symptoms include bleeding gums loose teeth weakness wounds that fail to heal depression o Who39s at risk Scurvy is associated with poorly balanced diets nutrient de cient affecting 0 People with poor food intake o Drug users 0 Alcoholics 0 Elderly or kids Smokers and passive smokers Fat Soluble Vitamins Different Forms of Vitamin A Pre formed o Retinoids retinal retionol retinoic acid Body can convert retinol to retinal in a reversible fashion Body can convert retinal to retinoic acid reaction is irreversible Retinal cannot be generated from retinoic acid 0 Found in animal products 0 Pro Vitamin A o Carotenoidsbeta carotene Responsible for vibrant color in plants 0 Can be converted to retinoid form 0 Found in plant products 0 Abundant in beef liver and vibrant vegetables Lecture 18 Vitamin C amp Fat Soluble Vitamins Cell membranes Free radical highly reactive molecule that wants to steal electrons from other molecules quotchain breaking antioxidant 0 Required for normal nerve and muscle development o Enhances immune system function May protect against disease linked with free radicals Heart disease Various cancers Diabetes Arthritis Cataracts Alzheimer disease Parkinson disease De ciency 0 Rare 0 Consequences of de ciency o Hemolytic anemia Red blood cell rupture due to too little vitamin E to protect membranes against damage o Nervous system damage Staggered gate 0 Susceptible populations 0 Premature infants 0 People with Toxicity 0 Uncommon 0 Possibly interferes with vitamin K actions 0 Interacts with anticoagulants Aspirin Coumadin 0 High doses associated with excessive bleeding Type the document title Vitamin K Fat soluble Sources Dark green leafy vegetables vegetable oils bacteria in our gut o Form Phylloquinone Recommendations women 90 microgramsday and men 120 microgramsday De ciency Blood fails to clot bleeding hemorrhaging o Fat ma absorption reduces vitamin K absorbed 0 Long term antibiotic use Kills intestinal gut bacteria o Newborns lack intestinal bacteria Toxic No known side effects from consuming large amounts of vitamin K Bone Functions protection movement hematopoiesis production of blood cells mineral homeostasis Types 0 Cortical external compact 80 of the skeleton o Trabecular internal spongy 20 of the skeleton Bone Remodeling and Osteoporosis Osteoporosis quotporous bonequot 0 Characterized by low bone mass and structural deterioration of bone tissue Leads to bone fragility and an increased susceptibility to fractures o Hip spine and wrist although any bone can be affected 0 Major health threat for an estimated 44 million 55 of people 50 years and older 0 1 in 2 women and 1 in 4 men over 50 will have an osteoporosis related fracture Bone loss occurs without symptoms o First sign may be a fracture due to weakened bones o A sudden strain or bump can break a bone Causes 0 Resorbed cavity too large o Formation does not match resorption Newly formed packet of bone too small o Formation does not match resorption Factors 0 Unmodi able biological o Sex Trace Minerals 0 The type of iron in foods 0 Amounts of stomach acid for digestion o Decreases with age Dietary factors Excretion 0 No excretory pathway not selectively excluded Very small daily iron losses 0 Mainly via cell sloughing GI tract skin menstruation Function of Iron 0 Component of hemoglobin o Carries oxygen in erythrocytes 0 Component of myoglobin o Carries oxygen in muscle cells 0 Coenzyme involved in energy metabolism of carbohydrates fats and proteins Helping regulate our immune system 0 Iron de ciency leaves one more susceptible to disease Iron De ciency Iron de ciency anemia 0 Reduction in the production of red blood cells and therefore oxygen carrying capacity 0 Red blood cells become microcytic small hypochromic pale Pale and frail 0 Red blood cells don39t look the same as they would in a folate or vitamin B12 de ciency 0 Consequences of de ciency Fatigue Pale skin Brittle nails Impaired work performance Impaired memory Dif culty breathing Poor growth 0 Depressed immune function 0 Global health problem o Kids born iron de cient have poorer performance in schools long term Changed neurological processing of children OOOOOOO Iron Toxicity 0 Causes o Accidental iron overdose acute Most common cause of poisoning deaths in children Causes stomach irritation nauseam vomiting diarrhea dizziness confusion Water and Electrolytes Water 0 Essential for life 0 Required for uid and electrolyte balance and many metabolic reactions 0 Compromises 5070 of the body o Lean muscle tissue contains 73 water o Fat contains 20 water Not water soluble Distribution 0 Intracellular uid 0 Within the cell 23 of body uid Extracellular uid 0 Outside the cell 13 of body uid o lntercellular uid lls in spaces between or surrounding cells 0 lntravascular uid is the water in the blood and lymph Functions of Body Fluids 0 Solvent 0 Dissolves a variety of substances for transport Dissolved substances solutes Blood transports solutes in the body 0 Water soluble substances Amino acids glucose vitamins minerals medications o Fat soluble substances attached to water soluble proteins 0 Body temperature regulation 0 Water absorbs any excess heat Blood moves heat away from core 0 Cools body Body secretes uids via perspiration sweating Evaporation of water from the skin cools the skin and blood 0 Protect and Lubricate Tissues o Cerebrospinal uid protect the brain and spinal cord 0 Amniotic uid protects the fetus o Synovial uid lubricates joints 0 Saliva moistens food for ease of swallowing and transport Daily Water Balance 0 Body water gains least to most o Metabolic water ingested moist foods ingested beverages Body water loss least to most 0 Feces expired air perspiration urine Water Recommendations 0 Women 27 liters for adults 0 Men 37 liters for adults 0 Actual needs vary with age body size health status physical activity level environment 0 Rule of thumb Water and Electrolytes Results from prolonged vomiting diarrhea or sweating with only water replacement Muscle cramps nauseavomiting dizziness shock or coma Due to neurological changes Potassium 0 Muscle contractions and transmission of nerve impulses High potassium intake helps to maintain a lower blood pressure 0 Found in fruits vegetables milk grains meats dried beans 0 Associated with lower blood pressure 0 Imbalance o Hyperkalemia Can occur in patients with kidney disease 0 Can alter normal heart rhythm resulting in a heart attack and death 0 Hypokalemia Can occur in patients with kidney disease or diabetic ketoacidosis or when taking certain diuretic medications Loss of appetite muscle cramps confusion constipation alterations in heart rate Achieving and Maintaining a Healthful Body Weight Increased risk of chronic disease 0 Waist circumference Men gt40 in 0 Women gt35 in Weight Control Gaining or Losing Weight Whether a person gains or loses weight depends on 0 Genetic factors Set point theory Proposes that each person39s weight stays within a small range set point for their adult lives 0 The body compensates for changes in energy balance and keeps a person39s weight at their set point 0 Childhood weight Environmental factors in childhood can in uence Food choices Activity levels 0 quotscreen timequot 0 Later adult behaviors Childhood overweight increases the risk of heart disease and premature death as an adult o Lifestyle choices Dietary choices 0 Overeating dietary fat promotes storage as adipose tissue Overeating carbohydrate or protein will also lead to weight gain o But energetically more costly to store as fat than fat itself 0 Important to maintain a balanced diet combining fat carbohydrate and protein Social factors Family or cultural traditions Holidays and celebrations Easy access to high fat foods Less physically active lifestyles Societal expectations of the quotperfectquot body o Energy balance Energy intake is kcal from food and beverages Energy expenditures is energy expended at rest and during physical activity Energy balance 0 Occurs when energy intake energy expenditure 0 Body weight tends to be stable during this time Positive energy balance 0 Occurs when energy intake is greater than energy expenditure 0 Body weight tends to increase during this time Our Relationship with Food amp Eating Disorders 0 4 characteristics 0 Distortion of body image 0 Obsession with body size 0 Pre occupation with dieting and thinness o Refusal to eat enough food to maintain a minimally normal body weight 0 Symptoms 0 Extremely restrictive eating practices Sef starvation o Intense fear of weight gain o Amenorrhea no menstrual periods for at least 3 months 0 Lanugo formation extra hair on the body to compensate for lack of insulating tissue 0 What the scale says is tied to sef esteem 0 Individuals assume that everything will change once they reach their goal weight which continuously decreases Being thin and not eating is interpreted as true signs of power and success 0 2 types 0 Restricting type o Bing eating purging Followed by guilt and shame Health consequences 0 Reproductive problems 0 Loss of bone mass Bulimia Nervosa Frequent episodes of binge eating followed by purging and intense feelings of guilt or shame o Recurrent binges at least 2xweek for gt3 months 0 Regular purging vomiting laxatives exercise fasting 0 Over concern with body weight and shape 0 Statistics o Affects 1 4 of women 0 Male to female ratio between 16 to 110 o 1 of patients will die within 10 years 0 Symptoms o Fluctuations in body weight o Swollen or puffy face 0 Sores around mouth o Irregular bowel function Health consequences o Dehydration In ammation of the salivary glands and esophagus Abdominal pain bloating Broken blood vessels in the eyes Erosion of tooth enamel and decay from stomach acid OOOO Our Relationship with Food amp Eating Disorders Other sources of disordered eating EDNOS eating disorders not otherwise speci ed Excluding a food group 0 Only eating at certain times 0 Only eating certain texturescolors 0 Note eating certain combinations Binge eatind disorder 0 Recurrent binge eating without the use of compensatory purging behaviors Who39s at Risk 0 Anyone with 0 Poor body image 0 Pressure from others Grades Appearance Performance 0 Relationship issues family partner work etc 0 Athletes Athletes and Disordered Eating Sports that place athlete at risk 0 Subjective scoring of performance Gymnastics dance gure skating diving o Emphasis on low body weight Distance running cycling cross country skiing 0 Weight class sports Rowing wrestling variety of martial arts Female Athlete Triad 3 interrelated conditions o Menstrual dysfunction Low body weight and body fat disrupt reproductive hormones causing irregular or loss of menstruation o Disordered eating Inadequate diet andor compensatory practices that cause low body weight and body fat 0 Osteopenia Cessation of menstruation leads to low bone density and increased risk of stress fractures Mental health behaviors o Frequent commends about weight or shape 0 Focus on thinness o Prefer to be alone 0 Perfectionism o Need for a very structured schedule Eating behaviors o Decrease in food intake at meals Nutrition through the Lifecycle Pregnancy and the 1st year of life Pregnancy and breastfeeding Pre conception 0 Pregnancy 0 Nutrient needs of momfetus 0 Postpartum o Nutrient needs of momneonate Breastfeeding and food introduction 0 Bene ts for baby and mom Planning for preonancv 0 50 of all pregnancies are unplanned Minimize harmful practices prior to conception 0 Smoking alcohol drugs heavy caffeine intake 0 Assure adequate vitamin and mineral intake at least 8 weeks before conception and throughout pregnancy 0 Healthy dietary intake 0 Prenatal multivitamin and mineral supplement Good Nutrition before Conception can help us avoid Neural tube defects 0 Related to inadequate level of folate o Affects the embryo in the rst few weeks o Adequate folate before conception can reduce the risks 400 micrograms per day in addition to food folate Teratogens o Substances that cause birth defects Alcohol Vitamin A in very high doses acne medication Accutaneroaccutane Other possible hazards o Smoking caffeine medications o May contribute to low birth weight Nutrition Goals During Pregnancy 0 To support fetal growth and development To provide the mother with nutrients she needs o Can help reduce risk of some pregnancy reated disorders Gestational diabetes Pre ecampsia pregnancy induced hypertension Stages of Preonancv A full term pregnancy lasts 3842 weeks 15 trimester conception to 13quot week Most vulnerable time of development Development of organs limb buds facial features and the placenta Nutrition through the Lifecycle Pregnancy and the 1st year of life 0 600 microgramsday for pregnant women in addition to food foalte 0 Vitamin B12 0 Vitamin C 0 Vitamin A 0 Vitamin D 0 Minerals 0 Calcium 0 Iron Increased need for red blood cells increases the need for iron by 50 Fetal need for iron increases in 3 trimester 0 Fetus takes maternal iron 0 lron de ciency anemia is a concern in mother Inadequate intake increase rate of low birth weight preterm birth still birth and death I Recommend foods high in heme iron meat sh and poultry iron rich legumes iron forti ed foods with vitamin C rich foods or iron and vitamin C supplements o Zinc o Sodium o Iodine Fluids durino Prednancv The need for uids increases 0 3 liters per day Increases in the mother39s blood volume Regulating body temperature Production of amniotic uid to protect and cushion the fetus Nutrition Reated Concerns during Pregnancy 0 Nutrition reated problems during pregnancy can include 0 Morning sickness Nausea and vomiting associated with pregnancy 0 75 of all women will experience in the 1 trimester 0 Can occur at any time often lasts all day 0 Usually resolves after 1 trimester Recommendations 0 Avoid offending foods or smells Eat smaller meals more frequently 0 Consider changing brand of prenatal supplement Cravings and aversions Heartburn Constipation Gestational diabetes Hormones synthesized by the placenta decrease the action of insulin OOOO Breastfeeding o Caloric needs increasing also vitamin DB6 niacin zinc vitamin E and others Physical ability o Disappearance of extrusion re ex 0 Develop pincer grasp o Head and neck control 0 Ability to sit up with support Other cues o High interest in what39s on parent scaregiver39s plates First Foods Introduce one food at a time Wait 3 days to 1 week before introducing a new food Do not introduce mixed food No cow39s milk until 1 year of age Start with o Avocado sweet potato squash banana applesauce pears apricots ground quinoa or millet What Not to Feed an Infant Cow39s milk especially ow fat or fat free or goat39s milk Allergenic foods o High allergens wheat dairy eggs seafood nuts and soy Honey or corn syrup 0 May contain clostridium botulinum spores Highly seasoned foods Choking potential foods 0 Popcorn raisins grapes stringy meats candy hot dog pieces hard raw fruits and vegetables Excessive fruit juice How to Introduce New Foods Repeated exposures may be needed Allow the child to initiate and guide feeding interactions Respond early and appropriately to hunger and satiety cues Nutrition and the Lifecycle The Later Years Life Expectancy at Birth 0 Average life expectancy 78 years old 0 Women on average live longer than men Factors That In uence Nutritional Status in Older Adults 0 Physiological 0 Ability to produce vitamin D diminishes o Sensory perception Declined odor tactile and visual perception Dysgeusia Abnormal taste perception can be secondary to disease or medication use 0 GI function Saliva and mucus production decreases xerostomia Loss of teeth Dif culty swallowing dysphagia Production of gastric juice is reduced HCI achorhydria 0 Limits calcium iron folate and vitamin B12 absorption 0 Reduced intrinsic factor production Peristalsis decreases 0 Muscular contraction that aids in movement of food through GI tract Vitamin B12 absorption decreases Lactose intolerance o Musculoskeletal System Body Composition Bone mass density decreases Lean mass decreases sarcopenia Fat mass increases Metabolism decreases Strength exibility and agility decreases o Nervous System Appetite regulation is altered Decreased appetite 0 Declining dental health 0 Decrease in thirst Ability to smell and taste decreases o Changes to Organ Function Kidneys 0 Less able to concentrate and excrete waste Liver 0 Less ef cient breaking down drugs Pancreas 0 Less able to control blood glucose Bladder Control may decline with aging Psychosocial 0 Isolation
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