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NTRI 2000 FINAL EXAM Study Guide

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by: Alyssa Anderson

NTRI 2000 FINAL EXAM Study Guide NTRI 2000

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This is the final draft of the study guide for the nutrition final Tuesday. It includes all the material we've covered from Week 1 to Week 15 (this week), as well as diagrams, charts, and pub quizz...
Nutrition and Health
Dr. Greene
Study Guide
nutrition, final
50 ?




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"Loved these! I'm a horrible notetaker so I'll be your #1 fan in this class"
Patrick Rodriguez DVM

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This 90 page Study Guide was uploaded by Alyssa Anderson on Tuesday April 26, 2016. The Study Guide belongs to NTRI 2000 at a university taught by Dr. Greene in Spring 2016. Since its upload, it has received 139 views.


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Date Created: 04/26/16
1 NUTRITION FINAL STUDY GUIDE Nutrition- the science that links food to diseases and focuses on the process of ingestion, digestion, absorption, transportation, metabolism, and excretion 1. Note: by age 65 you’ll eat around 70,000 meals (50 tons of food) 2. Food has a cumulative effect Nutrient- component of food that are indispensable to the functioning of the body 1. Provide energy 2. Building blocks 3. Support growth 4. Maintains/repairs body Essential Nutrient- nutrients our bodies can’t make or make in sufficient amounts that MUST be obtained from the diet and must have the following criteria: 1. A specific function in body 2. Omission of these lead to decline in the functions of the body 3. Replacing these restores normal function Malnutrition- any condition caused by a deficiency or excess of nutrient intake 1. The only thing that has a bigger effect on your health is tobacco 2. Many nutritionally-related diseases are chronic and take years to show up clinically Leading Causes of Death 1. Heart disease 2. Cancer 3. Lung Disease 2 Nutrition and Disease 1. Poor diet is a risk factor for many chronic diseases A. Cardiovascular Disease B. Some forms of cancer C. Hypertension D. Lover disease 2. These diseases account for about 2/3 of all deaths in North America 3. All of these deaths are linked with obesity 4. Obesity is the second leading cause of preventive death The Six Classes of Essential Nutrients 1. Carbohydrates (C, H, O)- macronutrient 2. Lipids aka fats (C, H, O)- macronutrient 3. Proteins (C, H, O, N)- macronutrient 4. Water (H, O)- macronutrient 5. Vitamins- micronutrient 6. Minerals- micronutrient NOTE: most energy comes from proteins, most carbohydrates, and most lipids Phytochemicals 1. Plant compounds that are thought to cause health benefits 2. Energy comes from the SUN through light 3. CO2 + H20 + light -> CHO + O2 (photosynthesis) 4. CHO + O2 -> CO2 + H2O + energy (metabolism) 5.example: carotenoids (such as in lycopene tomatoes) 6.example: resveratrol (such as in red wine and grape juice) Measure of Energy in Nutritions 1. calorie/Kcal 2. These are units that describe the energy contents of food 3. 1 kcal is the heat needed in order to raise the temperature of 1000 mL of water 1*C 4. 1 kcal = 1000 calories = 1 Calorie 3 Energy in Nutrients (4-9-4 rule) 1. Carbohydrates (4 kcal/gram) 2. Fat (9 kcal/gram) 3. Proteins (4 kcal/gram) 4. NOTE: alcohol is not a nutrient but a TOXIN. 7 kcal/gram Objectives for Our Society’s Diet (for those 2 years and older) 1. increase fruit intake/varriety 2. increase calcium levels in diets 3. increase vegetable intake/variety 4. increase amount of whole grains 5. reduce calorie intake 6. decrease levels of saturated fats/added sugars 7. decrease sodium levels 8. reduce iron deficiency (maintain healthy levels) Reasons to Select A Particular Food 1. Positive Association 2. Region/County 3. Social Pressure Wellness in College 1. Develop a plan A. Eating habits B. Food choices C. Weight control, especially when faces with unlimited food D. Exercise regularly 2. How to avoid the Freshman 15: A. Eat breakfast B. Plan ahead C. Limit liquid calories D. Stock the fridge with healthy choices 4 Why Do We Choose the Food We Eat? 1. Biological Drives- very complex A. Hunger- a physiological drive to eat B. Appetite- A psychological drive to eat C. Satiety- a feeling of being full, which halts the drive to eat 2. Cultural/Social Reasons A. Social needs B. Network of family and friends C. Food customs/cultures D. Cost of food E. Education/Knowledge F. Occupation and Income G. Routines/Habits H. Lifestyle/Health I. Nutrition concerns J. Benefits K. Food Marketing L. Food availability M. Food flavor, texture, appearance N. Preferences O. Psychological needs The Challenge of Choosing Foods 1. There are more foods to choose from than ever before 2. Ironically, this variety has made it more difficult to elect a nutritious diet 3. However, we now have more technology that helps live healthier lives, such as product websites, apps, and online calculators. When given the protein, carb, and fat count of a dish, know how to determine the calories in a dish and the percentages of the count based off the total. Food Philosophy: Consume a variety of foods balanced by a moderate intake of each food. 5 Characteristics of a healthy diet: 1. Adequacy 2. Balance 3. Moderation 4. Nutrient density 5. Energy content 6. Variation- choosing a number of different food groups. 7. NOTE: supplements don’t have every component you need. Phytochemical's are found in variety. No one food can meet your nutritional needs. Variety- tips for boosting phytochemical intake 1. Use veggies in main/side dishes 2. Use grain in side dishes 3. Opt for fruit-filled cookies 4. Get creative at the salad bar (go for the rainbow) 5. Eat fresh/dried fruit for snacks 6. Add vegetables to sandwiches 7. Try to eat vegetarian meals once or twice a week 8. Use different lettuces (romaine over iceberg) 9. Use fresh salsa for dips instead of something creamy 10. Eat whole grain cereals 11. Use herbs and spices such as ginger or rosemary over salt 12. Try to incorporate tofu, soy milk, and soybeans into meals Adequacy- obtaining all the essential nutrients in order to meet all the bodys need plus storage Balance- select food from 5 major food groups every day 1. Grains 2. Vegetables 3. Fruits 4. Milk/Dairy 5. Protein 6 Moderation- can refer to portion size (calories, diet composition) 1. Fats (saturated fast and trans fats) 2. Salt 3. Cholesterol (saturated fats) 4. Refined carbohydrates (added sugars) States of Nutritional Health 1. Your body’s nutritional health is determined by considering the nutritional state of each needed nutrient 2. Three categories: A. Desirable Nutrition B. Undernutrition 1. Intake of nutrient does not meet the body’s needs 2. If the body’s surplus is ned, health declines 3. It can take years to develop clinical symptoms C. Overnutrition 1. In the short run, it has few symptoms 2. If excess intake continues, nutrients may develop to toxic amounts (an excess in vitamin A can cause birth defects; excess in calories can lead to obesity, CV disease, diabetes, stroke, some cancers) 3. The amount of each nutrient needed to maintain a state of desirable nutrition is the basis for dietary intake recommendations 4. The state of undernutrition and overnutrition are both considered to be malnutrition 7 How is Nutritional State Measured? 1. It is done by a physician and/or a registered dietician 2. Determines background factors A. Family Health History B. Medical History C. Medication/supplements intake D. Social History E. Level of Education F. Economic Status 3. Assessments (ABCDEs) A. Anthropometric (height, weight, body composition, circumference) B. Biochemical (enzyme or nutrient by-product in blood and urine) C. Clinical (appearance of skin, eyes, hair, etc.) D. Dietary (food intake) E. Environmental (ability to purchase/prepare foods, education, etc.) 4. Limitations- a long time may elapse before symptoms can be diagnosed as clinical Specific Nutrient Standards A. The overarching goal of any healthy diet is to meet nutrient needs B. To do this we must determine what amount of each essential nutrient is needed to maintain health C. These standards are based on populations of healthy people The Scientific Method A. Used to gain knowledge B. Steps 1. Make observations and use knowledge of what is assumed to be true 2. Make a hypothesis (must be testable) 3. Preform experiments (epidemiological, case-control) 4. Report results (either support or refute hypothesis) C. The experiment must be independent of particular opinion D. The test must purposely test itself and criticize, correct, and improve itself 8 DRI- Dietary Reference Intakes A. The umbrella term for dietary standards B. Recommended Dietary Allowance (RDA) 1. Nutrient intake sufficient to meet the needs of 97%-98% of individuals in a specific stage of life 2. What if you consume more or less? Being 70% above or below the RDA for an extended time (3 times longer for some nutrients) can result in a deficiency or toxicity C. Adequate Intake (AI) 1. Nutrient intake set for any nutrient for which insufficient research is available for RDA 2. AIs are based on estimates of intakes that appear to maintain a defined nutritional state in a specific life stage D. Estimated Energy Requirements (EER) 1. estimated energy (in kcal) intake needed to match the energy use of an average person in a specific life stage 2. Needs to be specific, taking into account age, gender, height, weight, physical activity 3. Serves as a starting point for estimating calorie need E. Tolerable upper intake limit (UL) 1. Maximum chloric intake daily level of a nutrient that is unlikely to cause adverse health affects in almost all people in a specific life stage 2. Problems arise from using many fortified foods and excess doses of vitamins and minerals F.Daily Value (DV) 1. DV is the nutrient standard used on the nutrition facts portion of a food label 2. The percent DV for each nutrient is based on consuming a 2000 kcal diet 3. Set at or close to the highest RDA value or related nutrient standard 4. DVs have been set for vitamins, minerals, protein, and other dietary components 5. Allow intake comparison from a specific food to desirable (or maximum) intakes 9 Dietary Guidelines for Americans A. What is a healthy eating pattern? 1. Variety of vegetables 2. Fruits, especially whole fruits 3. Grains, half of which are whole grains 4. Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages 5. variety of lean protein 6. oils- high in monounsaturated fat and polyphenols (make sure not to buy olive oil in clear bottles because the sunlight will break apart the polyphenols) B. A healthy eating pattern limits: 1. Saturated fast and trans fats- less than 10% 2. Added sugars- less than 10% 3. Sodium- 2,300 mg C. Healthy also includes the physical activity guidelines for Americans (ages 18-64) 1. Avoid inactivity 2. Get at least 150 minutes per week of moderate exercise, but aim for 300 Recommendations for Food Choice A. How do we translate the science of nutrition into practical terms B. 1992: the plan was illustrated using a pyramid shape (Food Guide Period) C. 2011: a plate was used to illustrate a guide Levels of Organization 1. Chemical level (atoms combine to form molecules) 2. Cell level (molecules form organelles) 3. Tissue level 4. Organ level 5. Organ system level 6. Organism level 10 Food Labels (check out figures in book) A. What is required? 1. Name of product 2. Who the manufacturer is aka where it’s coming from 3. How much you’re buying (in ounces and in grams) 4. Ingredients (in order by weight) 5. Nutrition Facts a. Serving size b. Number of servings c. Calories d. Calories from fat e. Percent of daily value f. Fat (both saturated and trans) g. Cholesterol h. Carbohydrates (dietary fiber, sugar) i. Protein B. They can choose to add additional stuff on the packages, such as different levels of vitamins or nutrients, but don’t be fooled if the serving size is inconsistent C. The FDA is in charge of the nutritional claims 1. “good source” means 10-19% of daily value for nutrient 2. “excellent source” means one serving contains 20% or more of the daily value 3. “reduced” means at least 25% less per serving than in the referenced food 4. “low-____” means 3 grams or less in one serving 5. “____-free” means less than 0.5 grams in one serving Cell Metabolism 1. Entire collection of chemical processes involved in maintaining life 2. Biochemical reactions take place in the cell cytoplasm and organelles 3. Anabolic requires energy (we need this to grow) 4. Catabolic takes more molecules apart, releases energy 11 Multicellular Organisms A. Same tissue as a singular cell B. Whole body metabolism is similar to a cell’s Organ Systems A. Respiratory B. Cardiovascular C. Lymphatic D. Digestive E. Urinary Cardiovascular System A. Carries blood B. Regulates blood supply C. Transports nutrients, waste products, cells, gases D. Regulates blood pressure E. Plays a role in immune responses and body temperature F. Components 1. Heart- muscular pump for blood 2. Blood vessels- arteries leave the heart; veins enter the heart 3. Capillaries- exchange of nutrients, oxygen, waste products, and gases between blood and cells 4. Blood- made up of plasma, red and white cells, platelets 5. Portal circulation a. Artery to capillary to vein to portal vein to capillary to vein b. Nutrients absorbed by capillaries in the small intestine (go to the liver) 12 Digestive System A. Gastrointestinal Tract 1. Tube from your mouth to your anus 2. Responsible for the digestion and absorption of nutrients B. Accessory Digestive Organs 1. Salivary glands 2. Liver 3. Gall bladder (can be removed) 4. Pancreas C. Check out the digestive system figure in your book D. Check out the mouth diagram in your book E. Esophagus 1. Muscular tube connecting the pharynx (throat) to your stomach 2. Food moves by a series of coordinated constructions known as peristalsis 3. Esophageal sphincter a. Regulates the movement through the esophagus b. Must relax to allow food to enter the stomach c. Prevents back flow of food (unless necessary) F.Stomach 1. Large sac for holding food 2. Stomach contains gastric juice (water, hydrochloric acid, enzymes, and the intrinsic factor) 3. Muscle of stomach church gastric contents into chyme 4. Pyloric sphinter controls the rate of chyme entering the small intestine 5. What keeps the stomach from breaking down/digesting itself? a. Mucous- stomach is lined with a thick layer of mucous so gastric juice doesn't come into contact with the tissue of the stomach b. HCL and enzymes are primarily released only after eating 
 13 G. Small Intestine 1. Site of most of the digestion sand absorption of nutrients 2. Check out the diagram in your book 3. Intestinal hormones released (getting chyme ready) a. Secretin- released bicarbonate from pancreas b. Cholecystokinin (CCK)- releases digestive enzymes from pancreas and regulates the release of bile (made in the liver and is important to the digestion of fats) from the gall bladder into the small intestine 4. Because of folds in the mucosa, villi, and microvilli on cells, the surface area for absorption is huge 5. Capillaries absorb the water soluble compounds 6. Lymph vessels absorb the fat soluble compounds 7. Undigested food passes on the large intestine (colon) via the ileocecal sphincter 8. Look up the small intestine diagram in your book H. Large Intestine 1. Only a minor amount of carbohydrates, proteins, and fast escape the absorption and reach large intestine 2. No villi or enzyme (no digestion or major absorption) 3. Some absorption of water, some vitamins, some fatty acids, and the minerals sodium and potassium 4. Home to a large population of bacteria (over 500 species), yeast, and viruses 5. Look at large intestine diagram in your book 6. As water is absorbed, contents become semi-solid 7. Becomes feces (water, undigested fiber, tough connective tissue, bacteria, dead intestinal cells, and body waste) 8. Contractions occur as a mass movement 9. The rectum fills 10. Anal sphincters control waste management 11. TABLE 3.4 IN BOOK 
 14 I. Liver 1. Releases number of unwanted substances that travel with bile to the gallbladder 2. End up in the small intestine, eventually in the large intestine for excretion (you can’t live without a liver) J. Gallbladder 1. Organ attached to the underside of the liver 2. Bile storage, concentration, and secretion 3. Bile- released through common bile duct into the first segment of the small intestine that is essential for digestion and the absorption of fat 4. Enterohepatic circulation (hepatic = anything with the liver) - continual recycling of compounds like bile acids between small intestine and liver K. Pancreas 1. Has both endocrine and digestive functions 2. Manufatures hormones- glucagon and insulin 3. Produces “pancreatic juice”- a mixture of water, bicarbonate, and a variety of digestive enzymes Lymphatic System A. Brings fluid back to the cardiovascular system B. Fluid is lymph (plasma, white blood cells (and absorbed fat), lymph nodes C. Drains back into the CV system near the heart D. Remove foreign substances from blood and lymph E. Maintain tissue fluid balance F. Adds in fat absorption G. Forms white blood cells and provides defense against pathogens 15 Urinary System A. Kidneys, ureter, bladder, urethra B. Kidney 1. Produces urine, which is the modified ultra filtrate of he blood 2. Functional unit of kidney is the nephron 3. Nephron is involved in the processes of filtration, reabsorption, and secretion 4. Look at nephron/urinary system diagram in your book 5. Kidneys are used in the formation of vitamin D 6. Kidneys produce a hormone, erythrpoitin, that stimulates the production of red blood cells 7. Helps regulate blood pressure and fluid balance Nutrient Absorption A. Passive Absorption (diffusion)- concentration dependent B. Facilitated Absorption ( transport)- carrier or receptor dependent C. Active Absorption (transport)- carrier/receptor and energy dependent D. Phagocytosis/pinocytosis- form of active transport; often cancer cells take advantage of these cells in order to grow rapidly and feed off nutrients Digestive disease case Problem: An elderly woman sees her doctor and complains of pain 2 hours after eating, weight loss, nausea, vomiting, and loss of appetite. What condition does she have? An ulcer caused by helicobacter pylori, which is an excess of the bacterium which causes peptic ulcer disease. Barry Marshall and J. Robin Warren were awarded the Nobel Prize in Medicine in 2005 for discovering it. They did it themselves, then took antibiotics and were cured. What are the potential therapies? Antibiotics. 16 Diseases Related to the Digestive System A. Constipation 1. Difficult or infrequent evacuation of the bowels 2. Increase fiber consumption such as dried fruit to stimulate peristalsis 3. Drink adequate fluids, especially water 4. Relaxation/regular exercise 5. Probiotics/laxatives can lessen constipation (consult a health professional first) B. Irritable Bowel Syndrome (IBS) 1. As many as 25 million Americans suffer from this syndrome 2. Symptoms include cramps, easiness, bloating, irregular towel function, diarrhea and constipation, or alternating episodes of both 3. Visible abdomen distention 4. Hard to pinpoint exact causes, but possible that it’s caused by altered intestinal peristalsis or decreased pain threshold 5. Treat it through elimination diet, moderate caffeine, low-fat, small, frequent meals, stress reduction C. Celiac Disease and Gluten Sensitivity 1. Chronic, immune-mediated disease precipitated by exposure to dietary protein gluten 2. **Genetically predisposed people** 3. Found in certain grains, wheat, rye, barley 4. Affects about 1% of U.S. population 5. Flattens villi 6. Limits absorption of nutrients 7. Treatment should include a blood test for antibodies to gluten D. Gastroesophageal Reflux Disease (GERD) 1. Fancy way of saying heartburn 2. Half of North American adults experience occasional heartburn 3. Heartburn can damage the lining of the esophagus 17 Central Dogma of Biology A. DNA <—> RNA —> Protein B. There is an emerging field of genomics in nutrition C. Nutritional Genomics- interactions between nutrition and genetics 1. Important because there are variations in nutrient requirements 2. Studies the responsiveness to dietary modifications 3. Helps us understand the impact of food on the gene expression 4. Helps us know our susceptibility to nutritionally related diseases 18 Diagrams Stomach Digestive Tract Small Intestine Mouth 19 Large Intestine Urinary Tract Peristalsis 20 Carbohydrates A. Main fuel source for: 1. The brain 2. Nerve cells 3. Red blood cells (RBCs) 4. Exercising muscle B. Form of carbohydrates (for all cells) 1. Blood Glucose 2. Glycogen C. What’s the ultimate source of carbohydrates? The sun. D. Metabolism: H2O + O2 ——> energy + H2O + CO2 E. Simple Carbohydrates (Sugars) 1. Monosaccarides a. Mono = ONE sugar b. Basic unit of all carbohydrate structures c. Mainly glucose, fructose, galactose d. Check out the structures of the sugars (“not on test just good to know”) e. Dextrose- the major monosaccharide found in the body, called the blood sugar, and derived from the digestion of starches and disaccharides f. Fructose- converted to glucose and other compounds, also called fruit sugar. It is sweeter than the others; one dietary source is high-fructose corn syrup (in soft drinks it is made up of approximately 55% fructose and 45% glucose) g. Lactose- part of the disaccharide lactose (known as milk sugar) Image of the brain showing activity before and after consuming glucose and fructose 21 2. Disaccharides a. di = two, meaning there is chemical bonding of two monosaccharides b. *Glucose is always one of the 2 sugars* c. Maltose = glucose + glucose d. Lactose = glucose +fructose e. Sucrose = glucose + fructose F.Complex Carbohydrates (Starches and Fiber) 1. Called polysaccharides or starch 2. May contain 1000 or more glucose units 3. Found in grains, vegetables, and fruits 4. On food labels, “other carbohydrates” refers to starch content 5. Starches are found in plants, especially potatoes a. They are digestible by humans b. Amylose makes up 20% of starches c. Amylopectin makes up 80% of starches d. Glycogen 1. Identified in 1858 2. Highly branched, which is good for quick energy 3. 1800 kcal present in humans 4. 1400 kcals are stored in the muscle, but can be depleted (muscle fatigue/ “hitting a wall” 5. 400 kcals are stored in the liver, and can be depleted in 18 hours 6. It is also stored in the fat and brain Carbohydrates Conceptual Map 22 23 Carbohydrate availability A. Cooking- softens fibrous parts of plants B. Starch granules swell with water making it easier to digest C. Mouth- the enzyme salivary amylase helps break down starch (not very important) and starts digestion as well as in the esophagus D. Stomach- the acid inactivates amylase, so no further starch digestion E. Small intestine- the alkaline environment promotes CHO digestion through enzymes Enzymes A. The suffix -ase is used in biochemistry to indicate enzymes B. In the small intestine, pancreatic amylase breaks starches in sugars like di- and tri- saccharides C. Maltase, sucrase, lactase, dextrose (disaccharides) D. They are located in the brush border of the cells that line the inside of the small intestine 24 Lactose Intolerance- caused by a decrease in lactase production A. Lactase is high in infants then reduced in adults B. If the lactase production does not decrease, it’s called lactase persistence, which often develops in early childhood C. Symptoms include abdominal pain, gas, cramps, and diarrhea after consuming an amount of lactose D. NOTE: how much is consumed is KEY E. Highly associated with region/genetics Carbohydrate Absorption A. Monosaccharides go to intestinal cells via transporter proteins B. They are then absorbed by capillary into the liver via the portal vein C. In the liver, fructose and galactose are converted into glucose D. Glucose goes into the blood, is stored as glycogen, or converted into fat Functions of glucose in the body A. Supplies fuel (kcal) 1. In RBCs, the brain, and exercising muscle 2. Present in all cells B. Spares body proteins C. Maintains acid-base balance (pH) to prevent ketosis- a buildup of keno in blood from fat breakdown Blood glucose concentrations A. How do we regulate blood glucose? 1. Primary control- liver and pancreas 2. Secondary control- adrenal glands, brain, muscle B. High blood glucose- pancreas releases hormone insulin into blood C. Low blood glucose- pancreas releases hormone glucagon into blood D. Discovery of insulin- 1921; won the Nobel Prize of Medicine; before the 1920s, there was no cure 25 1. Experiment 1: removed the pancreas from a dog (practically gave the dog diabetes) which resulted in raised blood sugar, extreme thirst, frequent urination, and increasing weakness until finally, the dog died 2. Experiment 2: Scientists removed the pancreas, sliced it up, then froze it into a mixture of water and salts. When the pieces were half frozen, they were ground up and filtered. The extract was then injected into the diabetic dog and the its diabetes was temporarily reversed (aka blood glucose went down) Functions of Insulin A. The net effect is that it lowers blood glucose B. How? Promotes glycogen synthesis C. Where? Muscle, liver and fat, but more often muscle D. What does it do? Increases glucose uptake by the cells and reduces glycogenesis Glucagon action in the liver A. Causes the liver to breakdown liver glycogen into glucose and releases it into the blood (glycogenolysis) B. Causes the liver to synthesize glucose from noncarbohydrate precursors (glycogenesis) Blood glucose and the adrenal glands A. Adrenal gland is located on kidneys B. Releases epinephrine which causes quick conversion of glycogen to glucose in the liver Improper regulation of blood glucose concentrations A. Hyperglycemia- high blood glucose diabetes- type 1, type 2, gestational B. Hypoglycemia- low blood glucose reactive hypoglycemia, fasting hypoglycemia 26 Type 1 Diabetes A. Often begins in late childhood (also called juvenile diabetes) B. Generally associated with a decreased release of insulin from pancreas C. Immune system disorder (auto-immune disease) resulting in destruction of the insulin-producing cells D. Occurs when the body attacks beta cells thinking its a foreign cell E. Treated by insulin therapy- through pumps/shots, different types of insulins, NOT oral medications Type 2 Diabetes A. Most common form of diabetes, accounting for 90-95% of all cases B. Affects about 9% of the population in the United States C. Alabama ha the highest rate at 12.7% (Mississippi is 12.0%) E. Development- Why is it more prevalent in older folks? It is associated with obesity F. Genetics play a role in the development G. There is a stage before being diagnosed with Type 2 called “pre-diabetes” where the body becomes resistant to the effects of insulin so the body attempts to make more but fails. Then the pancreas produces less insulin which causes hyperglycemia. You can do a glucose tolerance test to assess glucose clearance. 1. Oral glucose tolerance test- 140 mg/dL but below 200 mg/dL 2. Fasting plasma glucose- above 100 mg/dL but below 126 mg/dL Diabetes outcome A. Increases the risk of cardiovascular disease, stoke kidney diseases, certain forms of cancer, and blindness B. Sometimes, complications lead to adult blindness and lower limb amputation Diabetes treatment A. If associated with obesity, attempt to lose weight B. In general, diet, exercise, oral medications, insulin, and bariatric surgery (shrinks stomach/ removes sections from the stomach) 27 Glycemic Index A. Ratio of the blood glucose response to a given food compared to a standard B. Based on 50 grams of carbohydrates C. Influenced by starch structure, fiber content, food processing and physical structure, and other macronutrients in food Carbohydrate need A. Recommendations vary widely B. RDA recommends 130 grams/day for adults C. Food and Nutrition Board: 45-65% of calories need to be from carbs D. High carbohydrate intake 1. Grains- 15 g/serving 2. Fruits- 18 g/serving 3. Milk- 12 g/serving E. Low carbohydrate intake 1. Nuts- 4 g/serving 2. Meat and eggs- 0 g/serving 3. Vegetables- 5 g/serving Glycemic Load A. Takes the glycemic index and multiples that amount of carbohydrates then divides it by 100 B. Can better predict blood sugar response C. More useful than glycemic index because it’s based on the serving Problems with high glycemic index/ load foods A. Very high glucose levels B. Chronically increased insulin levels C. Leads to high blood triglyceride levels and increased fat production D. A more rapid return of hunger after a meal, increased tendency for blood clots 28 Sweeteners A. Nutritive sweeteners- sugar, high fructose corn syrup, honey B. Sugar alcohol- sorbitol/xylitol which equals about 2.6 kcal/g and slows the metabolism to glucose C. High fructose corn syrup- made form corn, 55% fructose, cornstarch mixed with acid and enzymes, some glucose is converted to fructose, improved shelf-stability and food properties; average American consumes 60 lbs/year D. Alternative sweeteners yield no kcal, but are there safety issues? 1. GRAS- extensive research has demonstrated the safety of the 5 low- calorie sweeteners currently approved for use in foods in the U.S. 2. Equal- complaints of sensitivity such as headaches, dizziness, seizures, nausea, etc. 3. Acceptable daily intake is 50 mg per 1 kg of body weight, as stated by the FDA (14 cans of diet soda for average adult per day) 4. PKU NOTE: Artificial sweeteners are not associated with weight loss because they train us to enjoy sweet products which enhances our appetite for sweets. How much fiber do we need? A. AI is 25 grams/day for women B. AI is 38 grams/day for men C. AI has been set to reduce the risk of CV disease and perhaps diabetes D. DV is 25 grams for 2000 kcal diet E. Average U.S. intake: 14 grams/day for women, 17 grams/day for men How much is too much fiber? A. >60 grams/day B. Extra fluid needed C. May decrease availability of some minerals ` D. Unmet energy needs on children 29 Dietary Fiber A. Starches are digestible B. Fiber is not digestible 1. Therefore, it arrives at the colon intact 2. Why? Because we don't produce the correct digestive enzymes to break the chemical bonds that hold these polysaccharides together C. It is a group of polysaccharides D. Similar characteristics- made up of indigestible plant polysaccharides Types of Fiber A. Insoluble/non-fermentable fiber 1. Cellulose 2. Hemicellulose 3. Lignins B. Soluble/viscous fiber 1. Pectins, Gums, Mucilages 2. Fruit, vegetable, rice bran, psyllium seed C. Functional Fibers 1. Examples; inulin, oligofructose 2. *Added to food* 3. Resistant to digestion but fermentable 4. Stimulates the growth of beneficial bacteria (prebiotic) 5. Evidence based for designation Whole Grains 1. 9/10 people don't meet whole grain recommendation of 3 servings/day 2. Look beyond the label to the list of ingredients Food Labels 1. Don’t separate insoluble and soluble fiber 2. Total Fiber= dietary fiber + functional fiber (according to the Institute of Medicine) 30 Healthy benefits of adequate fiber in the diet 1. Insoluble fiber adds mass to the feces, preventing constipation 2. Constipation can increase the risk of developing hemorrhoids and diverticula 3. Soluble (fermentable) fibers 1. Attracts water 2. Delays the stomach from emptying which promotes satiety 3. Slows the glucose absorption from the small intestine which lowers the need for insulin 4. Inhibits the absorption of cholesterol and bile acids in bile, lowering blood cholesterol concentrations 5. Both soluble and insoluble fibers 1. Aid in body weight control 2. Reduce the risk of colon cancer Monounsaturated fatty acid structure figure- 1 double bond (MUFA) Polyunsaturated fatty acid structure figure- 2+ double bonds (PUFA) Composition of Fats A. Fats are complex B. Composed of both saturated and unsaturated fats C. Many different types/species of fatty acids (determined by chain length) 31 Lipids A. They do not dissolve well in water B. Types 1. Triglycerides a. Storage form of lipids in the body b. Fats and oils in food are typically triglycerides c. Triglyceride = glycerol + 3 fatty aids d. Fatty acids are a chain of carbon atoms flanked by hydrogen atoms and an acid group at one end. The omega side is the methyl side; the alpha side is the acid side e. Look at the figure of glyceride 2. Phospholipids 3. Sterols (cholesterol) 4. “Lipids”- generic term for fats and oils and other molecules a. “Fat”- lipid that is solid at room temperature b. “Oil “- lipid that is liquid at room temperature Essential Fatty Acids A. Our bodies can only make certain types of fatty acids B. Have a double bond after the 4th carbon from the omega end C. Therefore, omega-3 and omega-6 fatty acids are essential fatty acids 1. Omega-3 fatty acids- alpha linolenic acid (ALA) has a double bond after the 3rd carbon atom 2. Omega-6 fatty acids- linoleum acid (LA) has a double bond after the 6th carbon atom D. Different forms 1. Saturated fatty acids (SFA)- solid form 2. Unsaturated fatty acids (UFA)- liquid form a. Cis form- causes the backbone of a molecule to bend (looks like a C) such as oleic acid B. Trans form- straight line, such as eladic acid 32 Fats vs Oils A. These are the physical properties of triglycerides (TG) B. Depends on the makeup of the fatty acids C. For triglycerides to be oils, they must have short chain lengths and/or a lower degree of saturation D. For triglycerides to be fats, they must have long chain lengths and/or a higher degree of saturation Essential Fatty Acids A. Must be supplied by the diet to maintain health B. Omega-3 fatty acid (alpha-linolenic acid) 1. Primarily from nuts, seeds, fish oil, flax seed oil 2. Also found in canola, walnuts, mussels, crab, shrimp, and soybean oil 3. Recommended intake of about 2 servings of fish per week 4. Health related effects of DHA, EPA (omega-3) a. Decrease blood clotting b. Reduce heart attacks c. Decrease inflammation d. Excess may cause hemorrhagic stroke e. Other possible uses: lower triglycerides, rheumatoid arthritis, behavior disorders C. Omega-6 fatty acid (linoleic acid) 1. You need to have about 2-4 tablespoons a day 2. Functions: a. Supports immune system function and vision b. Help form cell membranes c. Produce eicosanoids, which are involved in practically all important functions in the body 3. Health Related Effects of archidonic acid (Omega-6) a. Increases blood clotting b. Increases inflammation responses 33 D. Signs and symptoms of essential fatty acids deficiency 1. Flaky, itchy skin 2. Diarrhea 3. Increased risk of infection 4. Stunted growth and reduced wound healing E. Use of omega-3 supplements in the U.S. 1. Most commonly used natural product (nonvitamin/nonmineral) in adults 2. About 37% of adults and 31% of children (last 30 days) 3. Side effects and risks a. From the FDA: GRAS-- "generally recognized as safe" b. Minor gastrointestinal upsets, including diarrhea, heartburn, indigestion, and abdominal bloating c. In high doses, can interact with blood thinners and drugs used for high blood pressure d. What about high levels of mercury, pesticides, or polychlorinated biphenyls (PCBs)? e. Omega-3 supplements do not appear to contain these substances Triglyceride A. Glycerol and 3 fatty acids B. Synthesis occurs stepwise by specific enzymes C. Diglyceride- the breakdown product of triglyceride consisting of two fatty acids bonded to a glycerol backbone D. Monoglyceride- the breakdown product of a triglyceride consisting of one fatty acid attached to a glycerol backbone Question- is it oil or fat? A primary saturated fatty acid is 26:0 (26 carbons and 0 bonds) A primary monounsaturated fatty acid is 8:1 (8 carbons and 0 bonds) 34 Phospholipid A. Structurally similar to triglyceride B. Except a fatty acid has been removed and replaced by a phosphate-containing group Lecithin- an emulsifier that is produced in the liver, then goes to the gallbladder, then to the small intestine Phospholipid functions A. Forms part of the cell membrane B. Is a component of bile C. It is an important emulsifier of fats in cooking 1. Egg yolk 2. Wheat germ 3. Peanuts 4. Soy beans 5. It is added to many foods in baking Cholesterol A. Has a multi-ring stricture B. Only found in animal products C. Sterols 1. Part of the cell membrane 2. Component of bile 3. Precursor of bile acids (begins digestion) 4. Making hormones such as estrogen and testosterone (sex hormones) 5. Precursor to Vitamin D 35 Digestion of fats A. Starts in the mouth with enzymes in saliva B. Continues in the stomach with enzymes C. Further digestion in the small intestine by emulsification and with enzymes 1. Small intestine = primary site of fat digestion 2. Fat is emulsified by bile into smaller particles 3. Forms small lipid droplet called micelles 4. Bile is recycled D. Enzymes that break down fats- lipases 1. There are salivary, stomach, and pancreatic lipases 2. They only work on fatty acids with short/medium chain lengths 3. The hormone cholecystokinin (CCK) stimulates the release of pancreatic lipase, which digests triglycerides into monoglyceride and fatty acids Fat absorption- take place in the mucosal cells- enterocytes A. In long-chain fatty acids 1. Monoglycerides and long-chain fatty acids diffuse into intestinal cells 2. The current view is that proteins mediate uptake through facilitated transport 3. Some of the transporters are stimulated by insulin (example: FATPs) 4. They are used to reform triglycerides in the mucosal cells (enterocytes) 5. They are packaged in chylomicron (a lipoprotein) 6. Then, they are taken into the lymphatic system B. In short-chained fatty acids 1. Diffuse into the enterocytes 2. Water soluble 3. Taken by capillary to liver via the portal vein 36 Digestion of Phospholipids A. Enzymes are released: 1. From the pancreas 2. From the cells of the small intestine B. Broken down to: 1. Glycerol 2. Fatty Acids 3. Remaining parts Digestion of Cholesterol A. Enzymes are released from pancreas B. Cholesterol is absorbed through specific transport proteins Check out this video of digestion and absorption of fats: 37 Transporting fats in a water environment A. Lipoproteins serve as transport vehicles for lipids B. We know a lot about them because they are associated with heart disease C. They go from the small intestine and the liver to the cells of the body D. Four classes of lipoproteins 1. Chylomicrons 2. VLDL- very low density lipoprotein 3. LDL- low density lipoprotein 4. HDL- high density lipoprotein Chylomicron A. Triglyceride is broken down into glycerol and fatty acids by lipoprotein lipase B. Fatty acids are taken up by the cells of the body 1. Diffusion 2. Facilitated Transport- protein mediated C. Most of the glycerol is taken up by the liver Chylomicron A. Triglyeceride is broken down into glycerol and fatty acids by lipoprotein lipase on the inside walls of capillaries B. After much of the triglyceride is removed from the chylomicron, it is called a chylomicron remnant C. It is removed from the circulation by the liver and its components recycled to make other lipoproteins or bile D. Large particle that carries dietary lipid E. Exogenous pathway for lipid metabolism 38 VLDL A. Carries lipids from the liver to tissues B. Endogenous pathway for lipid metabolism C. Liver packages lipid in a lipoprotein called VLDL D. Lipoprotein lipase breaks down the triglyceride in VLDL to release fatty acids E. Fatty acid uptake into cells by diffusion F.VLDL becomes LDL when the content of cholesterol is greater than that of TG G. LDL is a cholesterol-rich lipoprotein that transports cholesterol to tissues Transport of cholesterol from tissues to liver A. HDL is made by liver and intestine B. HDL picks up cholesterol from dying and other cells and transfers it out other lipoproteins C. HDL delivers the cholesterol to the liver 39 CV Disease and Lipids A. HDL- “good cholesterol” B. LDL- “bad cholesterol” C. But isn't cholesterol the same? D. The actual molecule is the same Atherosclerosis A. Clinical condition B. Artery wall thickens as a result of plaques C. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood CV Disease and Science A. Epidemiology is the study of the patterns, associations, and effects of health and disease in defined populations B. A meta-analysis refers to methods focused on contrasting and combing results from different studies, in the hope of identifying patters among them Optimal or desirable levels (KNOW THESE NUMBERS) A. Low LDL-C < 100 mg/dL B. High HDL-C > 60 mg/dL C. Low total cholesterol < 200 mg/dL D. Low triglycerides < 150 mg/dL A better measure of cholesterol: Non- HDL-C A. Provides an estimate of cholesterol in VLDL, IDL, LDL, and Lp(a) B. The difference between the total cholesterol and the HDL-C concentrations C. Lp(a) is an LDL like particle D. Takes into account all atherogenic particles Why all these recommendations? A. Idea is to reduce the levels of atherogenic particles, but why? B. Limit the built up of plaques 40 Current method to assess CVD Risk (AHA): ASCVD Risk Estimator A. Gender B. Age C. Race D. Total cholesterol levels E. HDL-cholesterol levels F. Systolic blood pressure How to raise HDL-C A. Consume fish (fatty fish B. Increase omega-3s (soy foods, green vegetables, nuts C. Eat more purple skinned fruits and juices D. Choose lower glycemic index/load foods 41 Raising HDL A. Physical activity (at least 43 mins/day, 4 days a week) B. Don’t smoke Storage of lipids in the body A. Adipose Tissue 1. White Fat or WAT (white adipose tissue) a. Usually one lipid droplet b. Large storage capacity for lipids (triglyerides) c. Source for fatty acids d. White fat does more than store fat; it secretes factors which lead to metabolic disease 2. Brown Fat or BAT (brown adipose tissue) a. Has LOTS of mitochondria- produces energy b. Abundant in newborns and hibernating animals c. Also found in adults d. Functions as a means of generating body heat so it burns energy B. Adipocytes 1. Cells that are up fat 2. Actual storage of energy Fat Rancidity A. Contains products of decomposed oils B. Breakdown of the C=C bonds by UV light and/or O2 C. Unpleasant odor and flavor D. Polyunsaturated fatty acid more susceptible E. Limited shelf life of food products Hydrogenated Fat A. Sometimes, food producers want the physical properties of the lipid B. Good for making pastries, biscuits, pie crust 42 Prevention of Rancidity A. Hydrogenation 1. Process used to solidify an oil 2. Addition of H to C=C double bonds C. Increases shelf life of food product B. Addition of vitamin E (antioxidant) C. Chemicals added such as BHA (butylated hydroxyanisol) and BHT (butylated hydroxytolune) D. Formation of trans fatty acid 1. Trans fat is very similar to the shape of a saturated fatty acid 2. Presents health risk similar to saturated fats In other tissues with oils, consider the smoke point A. Smoke point is the temperature at which oil starts to smoke B. It produces harmful chemicals Recommendations for fat intake A. No specific RDA for total fat intake in adults B. Food and Nutrition Board recommends 5% of your calorie intake comes from the total of both essential fatty acids (omega-3 and omega-6 fatty acids) C. 2015 Dietary Guidelines- intake of oils should be around 12% of total calories D. AHA- 25-30% of calories from fat but no more than 7% of calories come from saturated fat; no more than 1% come from trans fat E. DRI for omega-6 and omega-3- how much should you have of the essential fatty acids? There are no RDA’s but there are adequate intakes 1. Omega-6 for females 14-30 years in 12 g/day 2. Omega 3 for females 14-30 is 1.1 g/day 3. The ratio is 11:1. Is it a good ratio? a. A Typical western diet is 15:1 to 20:1 b. 4:1 ratio in total mortality from DC c. 2:5:1- beneficial for colon cancer and rheumatoid arthritis d. What ratio is best?? Closer to 1:1 seems best. 43 What fats/lipids/oils should you consume? 1. Replace extra virgin olive old for vegetable oils and butter 2. Seek out omega-3s through fish/seafood or nuts or green vegetables 3. Limit saturated and trans fat Fatty Acid Structure A. Alpha End B. Omega End Why is atherosclerosis harmful? A. Atherosclerosis is a clinical condition that leads to heart attack and stroke B. Artery wall thickens as a result of plaques (fat, cholesterol, calcium, and other substances found in the blood) What leads to atherosclerosis? A. Main cause is unknown B. Thought to be an inflammatory process C. Involves oxidation of LDL and the deposition of oxidized cholesterol Lipid changes associated with atherosclerosis A. Elevated LDL-C B. Low HDL-C C. Elevated cholesterol D. Elevated triglycerides Omega-6 to omega-3 ratios A. Consensus is that omega-3 fatty acids are good for your health B. Seek out foods with high amounts of omega 3 1. Flaxseed oil, soybean oil, canola oil 2. Fatty fish C. If more omega 3 consumption than the ratio will improve 44 PUB QUIZ #1 1. Name the type of carbohydrate that stimulates insulin secretion. Monosaccharides. 2. What is gluconeogenesis? The production of glucose that you produce when you fast and is released by the liver. 3. Name the monosaccharides in sucrose/maltose: Glucose and fructose. 4. T or F Fructose is considered lipogenic. TRUE 5. What is the sugar that is measured in “blood sugar”? Glucose. 6. What is lactase? And what happens if you don’t have enough lactase? Lactase is an enzyme (-ASE) that breaks down lactose and can lead to lactose intolerance/persistence. 7. Name the two organs that primarily control blood glucose? Liver and pancreas. 8. Write the general chemical structure for a carbohydrate. CHO. 9. Name 3 characteristics of functional fiber 1. Resistant to digestion 2. Fermentable 3. It is added to food 4. Stimulates the growth of beneficial bacteria (prebiotic) 10. What is in “other carbohydrates”? Starch content (complex carbs) 11. What does “Total Fiber” consist of? Dietary fiber + functional fiber. 12. What is in “Sugars”? Simple sugars. 45 13. What can influence glycemic index? The glycemic index is the ratio of a standard blood glucose, the food that you're eating, your structure, and the whole package of what you're eating. 14. In the experiment of insulin experiments, what happened to the dogs in which the pancreas was removed? The dogs got diabetes, the scientists tasted the urine (too sweet), and they drank a lot more water and peed excessively. 15. Name 2 food groups that are high in carbohydrates. Grains, Milk, Fruit 16. T or F fiber arrives at the colon intact. TRUE because it resists digestion. 17. What organ secretes glucagon? Glucagon is the hormone released from the pancreas by the alpha cells (insulin created from beta cells. 18. What hormone is released by the adrenal glands to rapidly control bladder functions? Adrenaline and the steroids aldosterone and cortisol. 19. What carbohydrate is stored in the liver? Glycogen. 20. Name the four organs that principally mediate insulins action. Pancreas, liver, stomach, adrenal glands. 46 PUB QUIZ #2 1. What property do all lipids share? They are hydrophobic. 2. Name an essential omega-6 fatty acid. Linolenic acid. 3. By what mechanism of transport would you expect this fatty acid (CH3(CH2)6COOH) to be taken up by cells? Since it is saturated and short, it will be taken up by diffusion and won't have to go through the lymphatic system. 4. T or F: Minor gastrointestinal upsets including diarrhea, heartburn, indigestion, and abdominal bloating is a side effect of omega-3 supplements. True. 5. What do you call a lipid that is solid at room temperature? Fat. 6. What is an adipocyte? An adipocyte is fat cell that can either be white or brown. It stores fat as well as secretes many substances that can lead to diseases later in life. 7. Lecithin is what type of lipid? A phospholipid. 8. What type of fat has lots of mitochondria? Brown fat because it burns energy. 9. What are functions of cholesterol? It keeps cell membrane fluid, makes bile, vitamin D, and sex hormones. 10. What does emulsify do to lipids? It helps dissolve the oils and aids in digestion. 11. What organ is the major site of fat digestion? The small intestine. 12. What is a meta-analysis? It is when you take a lot of studies and compare the conclusions drawn from all of them as a means of gathering information. 47 13. TG is broken down into which two molecules? Glycerol and fatty acids. 14. Why is HDL-C a key player in CV disease risk? It collects cholesterol which lowers it. 15. What is the function of a lipoprotein lipase and where is it found? On the inside walls of capillaries. 16. T or F: Protein mediated uptake is important in fatty acid transport in enterocytes. T. 17. What is a lipoprotein? A transporter for triglyceride and cholesterol. 18. How can you increase your HDL? Don't smoke, try to exercise, eat fish, and eat food with lower glycemic index. 19. Name two factors you should consider when choosing a vegetable oil? It’s smoke point, what types of fatty acids are in it, and if it has polyphenols and vitamins. 20. What are the desirable or optimal levels LDL-C < 100 HDL-C > 60 Total cholesterol < 200 Triglycerides < 100 21. A biotech company working on a new medication for a skin disease found in clinical trials for a skin disease found in clinical trials that the new drug stimulates the growth of brown fat. Should he be happy or frustrated? They should buy more stock so they can burn more energy which allows people to lose weight. 48 *Chemistry Exam 3* Protein Overview A. The body is made up of thousands of proteins B. They contain nitrogen, carbon, hydrogen, & oxygen C. General functions 1. Regulates & maintains body functions 2. Provides essential form of nitrogen (in the form of amino acids) D. In the developed world


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