Chp 1: Intro to Nutrition 1. What is the definition of nutrition? Why are nutrients important? a. Nutrition encompasses i. science of food and nutrients they contain ii. their action in relation to health and diseases iii. mechanical process iv. study of human behavior related to food b. nutrients are important for: i. buildinIf you want to learn more check out Can a scholarly, systematic method of inquiry be applied to address the problem?
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g new molecules ii. metabolism iii. transportation iv. movement v. growth and repair vi. reproduction 2. What are the four leading causes of death that are diet-related? a. heart diseases b. cancers c. chronic lung disease d. strokes 3. Define Malnutrition and associated terms under it. a. Malnutrition – caused by improper, too little, too much or wrong kind of nutrient i. Undernutrition ii. Obesity and overweight iii. Deficiencies iv. Allergies 4. What are essential nutrients? How many are there? What are the 4 categories of essential nutrients? a. Essential nutrient – a nutrient that can’t be synthesized by the body b. Approximately 40 essential nutrients c. Categories i. Vitamins ii. Dietary minerals iii. Essential fatty acids iv. Essential amino acids 5. How food energy is measured? What is the energy yield from each macronutrient? a. By calories (small calorie) - Approximate energy needed to raise the temperature of ONE GRAM (1g) of water by ONE DEGREE CELCIUS (1C) b. Energy yield: i. Carbs: 4 cal/g ii. Fats: 9 cal/g iii. Proteins: 4 cal/g iv. Alcohol (not a nutrient): 7 cal/g c. Kilocalorie (large calorie) - Approximate energy needed to raise the temperature of ONE KILOGRAM (1kg) of water by ONE DEGREE CELCIUS (1C) d. 1kcal = 100cal 6. Are dietary supplements good? a. Yes, but food has much more than the 6 nutrients needed 7. Five characteristics of a nutritious diet. a. Adequacy – get enough of the 6 nutrients b. Balance – eat essential vitamins, nutrients, etc. for balance ???? may lead to deficiencies if not balanced c. Calorie control – focus on amount of energy intake; energy input = energy output d. Moderation – limit bad food; bad food may improve energy, but lasts for a short timee. Variety – good to change diet; rainbow of food 8. What are the macronutrients, their role in the human body? a. They give energy and building components for body structures b. EX: proteins, lipids, carbs 9. What are the micronutrients, their role in the human body? a. Don’t give energy, but act as regulators in the metabolism process b. EX: organic vitamins, inorganic minerals 10. What is the 6th nutrient? (other 5 are proteins, lipids, carbs, organic vitamins, inorganic minerals). What’s the function of it? a. Water b. Doesn’t give energy, but is involved w/metabolism and transportations c. Human body is ~60-80% water 11. What affects food choices? a. Top 3: i. Taste ii. Price iii. Convenience b. Other factors: i. Ads ii. Availability iii. Comfort iv. Preference v. Associations (like may have some bad experiences with the food, vice versa) vi. Region vii. Peers Chp 2: Nutrition as a Science 1. How old is nutrition science as a discipline? a. First vitamin was discovered in 1897 – thiamin (B1) b. Nutrition science combines biology, biochem, physiology and genetics 2. Describe the studies on rats performed by Dr. Casimir Funk regarding beriberi disease and brown rice. a. 1st round i. White rice ???? rats w/beriberi ii. Brown rice ???? rats w/no symptoms b. 2nd round i. Rice bran ???? no symptoms ii. White rice + isolated chemical from rice bran ???? no symptoms c. Vitamin B1 = isolated chemical d. Rice bran has many fibro nutrients 3. What is a whole grain? a. Contains the rice bran, hull and white rice 4. Describe the different steps of the Scientific Method. What are some challenges to the scientific method? a. Observe & questions – identify problem and a specific question b. Hypothesis & prediction – make hypothesis and prediction that can be tested/measured c. Experiment – design study and conduct research to collect relevant data d. Results & interpretation – summarize, analyze and interpret e. Peer Review & Publish f. Challenges i. 1 experiment doesn’t conclude anything ???? needs to be repeated many times ii. Science is based on theories that can be challenged or changed 5. What are the four types of nutrition science research we discussed? Be ready to identify the type of study, when given the experimental design. a. Case study i. Based on 1 person ???? good for observations or clinical teaching 1. Not good for stats bc too few subjects ii. Fails to show causality b. Epidemiological i. Based on a population group ii. Shows correlation but not causality between diet and diseases iii. Good for stats bc large population c. Intervention/blind i. Actively “treat” subjects; intervene ii. Able to establish causality iii. With humans, it’s called a Clinical Trial iv. Stat strength depends on number of subjects 1. More the better d. Laboratory i. Studies on animals, cultures or humans ii. Highly under controlled space iii. Can establish strong cause and effect 1. Designed to determine biological mechanism of nutrients 6. In study designs, a. Why would a researcher use a control group? - as a base line for comparison b. What is the placebo? - anything that seems to be a "real" medical treatment -- but isn't. c. What is a blind experiment? Double-blind? i. Blind experiment – researcher knows who’s getting the placebo or real thing ii. Double-Blind – neither the researcher or subject know what’s the placebo iii. Why should an experiment be blinded? 1. to prevent research outcomes from being 'influenced' by the placebo effect or observer bias d. Relatively speaking, should a sample size be small or large to get better data? i. More subjects ???? better correlation ???? most reliable e. What’s the difference between correlation and cause? i. Correlation is when two or more things or events tend to occur at about the same time and might be associated with each other, but aren't necessarily connected by a cause/effect relationship. Chp 3: Nutrition Standards and Guidelines 1. Define the following terms: a. DRI (Dietary Reference Intakes) i. Specific standard intake for each nutrient ii. Based on vast reviews of scientific evidence b. RDA (Recommended Dietary Allowance) i. Daily amount of a nutrient that apply to almost all healthy people (98%); based on science, life stage and gender c. EAR (Estimated Average Requirement) i. Average daily nutrient intake estimated to meet 50% of healthy individuals – based on gender and life stage d. AI (Adequate Intake) i. Use when there’s no scientific proofii. Average amount of a nutrient that a group of healthy people consumes in a specific stage of their life + gender e. UL (Tolerable Upper Intake Level). i. Above a certain level of consumption, nutrient is able to produce toxic effect ii. People who take supplements are at a greater risk f. Who do the DRI’s apply to? i. Healthy people 2. How DRI values are established? Balance study. a. Balance study – measure input of nutrient x (amount of intake) and output (excreted); when the input and output is equal ???? body is saturated ???? optimal amount of nutrient b. Study on gender and same age to generalize, given different amounts of nutrient x and examine amount of nutrient that is excreted 3. DRI values on macronutrients a. (EER, Estimated Energy Requirement) i. Average dietary energy intake (kcal/day) that will maintain healthy body weight for an individual at particular age, gender, height ii. Too much energy ???? weight gain b. AMDRs, Acceptable Macronutrient Distribution Ranges) i. Tells us about the optimal contribution of each nutrient should provide for energy 1. CHOs: 45-65% kcals 2. Fat: 20-35% kcals 3. Protein: 10-35% kcals 4. Describe the composition of the diet in terms of macronutrients. What percent of calories should come from carbs, fat and protein? a. CHOs: 45-65% kcals b. Fat: 20-35% kcals c. Protein: 10-35% kcals 5. What does % Daily Value tell us? a. Compares the nutrient content of the food to the amount recommended for daily consumption b. Applies to “average person” 2000-2500cal c. Doesn’t change much if there is a new discovery 6. Which foods should Americans consume more of, according to MyPlate and the DGA 2015? Which foods should Americans reduce consumption, according to MyPlate and the DGA 2015? a. Inc. i. Seafood ii. Whole grains iii. Fat-free dairy iv. Fruits/vegs b. Dec. i. Salt (<2300 mg/day) ii. Saturated fat (<10% of calories/day) iii. Avoid trans fats iv. Added sugars (<10% of calories/day) v. Refined sugars c. Control total calorie intake d. Increase physical activity e. Moderate alcohol consumption 7. How many minutes of exercise should you get per week? a. 150min per week or 30min for 5 daysChp 4: Planning a Healthy Diet 1. Describe the concept of nutrient density, and be able to identify the most nutrient dense food among several choices. a. Nutrient DENSE food; vegetables rank the highest in nutrient density i. Nutrient density = measure of the nutrients per calorie ii. Formula: (#vitamins/minerals)/#calories 2. What is the HEI (Healthy Eating Index)? a. Below 51 is very poor; 100 is perfect b. 58/100 – current American diet compared to 63.8/100 – 1999-2000 c. Americans need to choose less of X and more of Y + reduce calorie intake i. Americans are eating too much grains and protein and not enough veggie, fruits or milk 3. Describe the concept of discretionary calorie (DC) a. “left over calories,” after getting necessary nutrients, that you can spend on less healthy food b. DC = (calories needed to maintain weight) – (calories needed to supply nutrient) i. EX: 2000cal – 1733 cal = 267cal remaining on less healthy foods 4. USDA Food Guide (food groups). a. Fruits b. Veggies c. Grains d. Proteins e. Milk + milk products f. Oils 5. USDA recommendation for daily physical activity. a. 2 ½ hours of moderate activity (30min a day) each week 6. How does MyPlate differ from MyPyramid? a. MyPyramid i. Give consumers MyPyramid’s basic messages about healthy eating and physical activity, which apply to everyone b. MyPlate i. features practical information and tips to help Americans build healthier diets. It features selected messages to help consumers focus on key behaviors ii. Balance calories iii. Enjoy your food, but eat less iv. Avoid oversized portions v. Minimize discretionary calories 7. What are the food categories (‘food groups’) included in MyPlate? a. Grains b. Veggies c. Fruits d. Milk +milk products e. Proteins f. Oils Chp 4: Food Labels 1. Who regulates food labels and what is required to be on them? Who are exempted from labelling? a. Controlled by the FDA b. Requirements: i. Front 1. Name and address of company 2. Name of products3. Nutrient claims 4. Net weight, measure or count 5. Approved health claims ii. Side 1. Serving size and number of servings 2. Calorie information per serving in grams (g) or milligrams (mg) 3. % Daily Values based on 2000cal energy intake 4. % Daily Values for selected nutrients 5. Calories per gram reminder 6. Ingredients in descending order of weights used in product c. Exemptions: i. Very small companies (less than 10 employees) ii. Plain coffee, tea, spices iii. Prepared and sold by same establishment iv. Original fruit/vegetable v. Some fresh meats 2. What nutrition information is required on the food label? a. Nutrition facts panel b. Ingredients c. Allergens 3. What does the order of ingredients on the Ingredients List tell you? a. Ingredients toward the top have been used more than those at the bottom 4. Be ready to read a Nutrition Facts Panel, Ingredients List, and Allergen Statement and answer questions about the content of that food. 5. What are the top 8 food allergies in the U.S.? a. Milk b. Eggs c. Peanuts d. Tree nuts (almonds, cashews, walnuts) e. Fish f. Shellfish g. Soy h. Wheat 6. How should we use %DV numbers on food labels? a. As a way to monitor balance of nutrients 7. What are the three types of nutrient content claims allowed on food packages? Define each type and give an example. a. Nutrient Content Claims – characterize the nutrient contents of a food; i. EX: 1. free/without/no 2. Low/little/few 3. Less/fewer/reduced 4. Light or lite 5. Good source of … 6. High/rich b. Structure-Function Claims – characterize the relationship between a nutrient (or other food substance) and its role in the body i. EX: 1. “Boosts the immune system” 2. “Builds strong bones”3. “Supports heart health” c. Health Claims – characterize the relationship between a nutrient (or other food substance) and a disease or health-condition. i. EX: 1. Soluble fiber and risk for heart disease 2. Sodium (low content) and hypertension 3. Calcium, Vitamin D, and osteoporosis 4. Soy protein and risk of coronary heart disease Chp 6&7: The Human Body / Digestive System 1. What is a Cell? a. Basic, smallest unit of life, self-contained living entity 2. Be able to list the organization of cells. a. Cells b. Tissues c. Organs d. Organ systems i. Circulatory ii. Nervous iii. Respiratory iv. Digestive v. Skeletal vi. Muscular e. Organism 3. Know to important cell structures; a. Microvilli – absorbs nutrients in the intestines b. Membrane – encloses cell’s contents c. DNA – instructions for life d. ER – instructions for genes that are translated into proteins e. Mitochondria 4. What is the function of genes? a. Direct protein production b. Complete set of genes in each cell c. Mutations caused by influence of nutrients and environment 5. What are the different types of body fluids? What’s the role of them? a. Blood: travels in arteries, veins, capillaries and plasma b. Lymph: travels in own vessels c. ECF: outside cells in tissues(extra=outside) i. Fills space between cells ii. Lymph moves from bloodstream into tissue spaces (ECF), then into lymphatic system, returns to bloodstream iii. Slide 24/25 d. ICF: fluid inside cells (intra=inside) i. Keeps shape of cell ii. Place for cell reactions to take place e. Role: Supply energy, O2, nutrients and water; Deliver supplies and pick up waste 6. What are the components of blood? a. RBC, WBC, platelets 7. Know the circulation of blood and how it’s routed. a. Circulation i. All blood circulates to the lungs1. Picks up O2 2. Releases CO2 ii. Blood returns to hearts 1. Circulated to rest of body iii. Blood passes through intestines 1. Picks up nutrients 2. Fats travel through lymph 3. Routed to the liver iv. In body tissues, RBC give up O2 and absorb CO2 v. The air sacs give up CO2 and absorb O2 b. Blood is routed through the body flow (slide 17) i. Lungs ii. Heart iii. Liver iv. Intestines v. Kidneys vi. Pelvis and legs 8. What is a hormone? Give examples a. Hormone = chemical messengers secreted into the blood by an organ (gland) that promotes a response in another organ i. EX: insulin and glucagon 1. Insulin: secreted after eating and removes glucose from blood by stimulating uptake of glucose and stored in liver as glycogen 2. Glucagon: responds to low blood glucose levels and stimulates releasing glucose to blood ii. EX: leptin and ghrelin 1. Leptin: hormone made by fate cells, decrease appetite, help burn fat in adipose tissue 2. Ghrelin: hunger hormone, increases appetite, released primarily in stomach, signals hunger to brain, influences metabolism of fat tissue 9. What is the function of the nervous system? a. regulates and coordinates all body activities i. Brain and spine receive and integrates information from sensory receptors (sight, hearing, touch, smell, taste and others) ii. Sends instructions to muscles and glands iii. Hormones carry messages to brain and help regulate appetite 10. What are the 2 parts of the nervous system? a. CNS: spinal cord and brain b. PNS: all other neural elements 11. What hormones does the hypothalamus secrete? What does It control? a. Secretes leptin (satiety) and ghrelin (hunger) b. Controls thirst and hunger; also when you’re full c. Stimulation of GI tract 12. Know the concept of flight or fight. a. Neurotransmitters: Epinephrine and norepinephrine b. Metabolism is sped up c. Organ response i. Eyes dilate ii. Heart beats faster iii. Liver epinephrine released iv. Stomach “butterflies” v. Quicker breaths 13. What’s the function of the immune system? a. Protect us from infection 14. Know the lines of defenses a. 1st line of defense (skin) i. Skin and mucous membranes 1. Skin – dead cellular layer 2. Mucous membrane – contain lysozymes (break down bacteria) 3. Cell with cilia filter pathogens 4. Immune response if passes through this line of defense b. 2nd line of defense (immune system) i. WBC (leukocytes) protect against illness and foreign invaders 1. Phagocytes – scavenger cells and first to defend body tissues; the engulf invader 2. Lymphocytes – T-cells and B-cells a. B-cells create antibodies to defend against bacteria, viruses and invaders 15. Antigen & antibody a. Antigen = foreign substance that trigger immune response b. Antibodies = substances that bind to specific antigens and tag them for destruction 16. Define digestion, absorption and metabolism. a. Digestion: process by which food is broken down into absorbable nutrients b. Absorption: uptake of nutrients by the cells of SI (small intestine) to be transported into the blood or lymph c. Metabolism: how the body processes it after that 17. Describe the entire process of digestion and absorption of food. Include each organ in the digestive system. a. Mastication (chewing) b. Swallowing; pharynx ???? epiglottis ???? bolus ???? sphincters ???? moves down esophagus through peristalsis c. Stomach churns bolus into chyme d. SI absorbs vitamins and most nutrients e. LI absorbs water and minerals f. Excretion through rectum and anus 18. What enzymes/digestive juices are produced by each organ and where whey are released in the GI tract. a. Mouth ???? salivary amylase + lysozymes b. Stomach ???? gastric juices c. SI ???? bile, pancreatic juice, bicarbonate, brush border enzymes, lactase, sucrose, maltase 19. Describe (briefly) the function of the enzymes and the end products. a. What is a digestive enzyme? How can you recognize an enzyme by the name? i. They are proteins that speed up the rate of a chemical reaction ii. End in -ase (EX: protease, lipase, carbohydrase) b. Where does most digestion occur? (which organ) i. SI c. Where are most nutrients absorbed? (which organ) i. SI d. Describe how the structure of the small intestine is designed to maximize nutrient absorption. i. Microvilli increase the surface area of the cell and are useful for absorption and secretion functions e. What mechanisms are present to propel food in the proper direction, and to prevent it from going the wrong direction? i. Peristalsis pushes food down the esophagus ii. Epiglottis cover airway to prevent food form entering lungs iii. Sphincters prevent acidic content of stomach to move up esophagus f. What is the main function of the large intestine? i. Absorb water and minerals 20. After nutrients are absorbed in the GI tract, where do they go? (two routes) a. Water soluble and small fat-soluble nutrients ???? enter directly to bloodstream b. Larger fats and fat soluble vitamins ???? carried by lymph system to blood c. Blood vessels directly transport all nutrients from intestines to liver 21. What is the purpose of the lymphatic system? a. To drain lymph from tissues and empty it back into the bloodstream 22. Explain the difference between active transport and simple diffusion. a. Simple diffusion: transfer of a substance across a semi-permeable membrane from an area of high concentration to an area of lower concentration; with the flow of a river b. Active transport: transfer of a substance across a membrane which is against the diffusion gradient (so from low to high concentration) and therefore requires energy from the cell; against the flow of a river Chp 8&9: Carbohydrates 1. What is the main function of carbohydrates in the human body? Know some other functions as well. a. Energy source (glucose – energy source for nerve cells, RBC and brain) b. Part of glycoproteins (mucus, connective tissue, cell-cell adhesion, immune system c. Ribose is part of DNA, RNA and ATP d. Spare proteins e. Prevent ketosis 2. What is the difference between a simple and a complex carbohydrate? a. How quickly it is digested and its chemical structure b. Simple sugars vs starches 3. List the 3 monosaccharides and the 3 disaccharides of nutritional importance and also their components and type of sugar. a. Monosaccharides i. Glucose (blood sugar) ii. Fructose (fruit sugar) iii. Galactose (milk sugar) b. Disaccharides i. Lactose (glucose + galactose) ii. Maltose (glucose + glucose) iii. Sucrose (fructose + glucose) 4. What is the difference between these starch, glycogen, and fiber? a. Starch ???? plant form of glucose b. Glycogen ???? animal form of glucose c. Fiber (cellulose) ???? component of cell wall, important dietary fiber 5. Know the difference between insoluble and soluble fiber. a. Soluble i. Dissolve in water and form gels (are viscous; thick consistency) ii. Not digested by humans 1. Fermented by bacteria in human colon iii. EX: oats, barley, legumes, citrus fruits, okra, apples b. Insoluble i. Do not dissolve in water (not viscous) ???? passes through GI tract relatively intact (retains shape and texture)???? Promotes movement of material through digestive system ii. Increases stool bulk, helpful for those with constipation or irregular stoolsiii. Eases elimination iv. EX: seed, whole grains, brown rice, veggies 6. What is a whole grain? Types of flour? a. 4 parts: germ, endosperm, bran and husk i. White: (refined, bleached, unbleached); germ and bran are removed ii. Whole-grain: retain all edible parts of grain kernel 7. Describe the process of digestion of carbohydrates. a. Where does carbohydrate digestion begin? The mouth b. What is the absorbable unit of carbohydrates? Starches ???? monosaccharides 8. After absorption, where do carbohydrates first travel in the body? Slide 8 a. Absorbed by microvilli and transferred to bloodstream, muscles and liver b. What happens there? i. Converts galactose into fructose and glucose 9. What is lactose intolerance? What causes it? Is it an allergy? Why or why not? What dietary changes may be necessary for someone with lactose intolerance? a. Lactose intolerant = Lack production of lactase in SI b. Genetics c. Not an allergy bc allergies are an immune system response d. Dietary changes: i. Usually NOT necessary to totally eliminate milk ii. Try small amounts of milk/dairy. 1. Increase gradually. Spread throughout the day. 2. Consume with a meal. iii. Yogurt and hard cheeses are better tolerated. iv. Lactaid milk has enzymes that makes it easier to digest 10. Briefly describe how blood glucose is regulated (stored in the body and later released on demand)? a. Role of insulin and glucagon. i. The insulin tells cells throughout your body to take in glucose from your bloodstream. ii. Glucagon signals your liver and muscle cells to change the stored glycogen back into glucose. These cells then release the glucose into your bloodstream so your other cells can use it for energy. b. What happens to carbohydrates in the body if you eat a lot at one time? Slide 16 i. Excess fatty acids, cholesterol ketone bodies ???? weight gain 11. What are the health benefits and detriments of sugars and starches? a. Benefits ???? energy b. Detriments ???? weight gain and disease 12. Describe how high fiber foods (whole grains, fruits and veggies) affect our chances of developing heart disease, diabetes, GI malfunction, and obesity. a. GI – Dietary fiber normalizes bowel movements by bulking up stools and making them easier to pass b. Heart diseases – improve cholesterol levels by lowering LDL (bad) cholesterol c. Diabetes – lower your risk for type 2 diabetes; if you have diabetes, it slows the absorption of sugar and improve your blood sugar levels d. Obesity – makes you feel fuller so intake of food is decreased 13. What are the recommended intake levels of total carbohydrates, sugars, and fiber? a. Carbs – 130g/day b. Sugars – 125g c. Fiber – 25g 14. The difference between diabetes mellitus type 1 and 2. How do you manage diabetes? a. Type 1 i. Less common ii. Autoimmune iii. Younger people iv. Inject insulin because if taken orally it’ll be digested v. Pancreas creates little insulin but cell become resistant b. Type 2 i. Older people ii. Associated w/lifestyle iii. More common iv. Related obesity c. Management i. keep normal BGL (blood glucose level) ii. weight loss iii. 130g carbs minimum bc the need glucose iv. Nutrition therapy v. Activity 1. Too much exercise ???? Type 1 may lead to hypoglycemia a. Blood glucose drops below normal values b. Symptoms: weak, dizzy, trembling, sweating, anxious, hungry c. Usually caused by poorly managed diabetes medications, alcohol abuse 2. Type 2 can exercise as much as they want 15. The Glycemic Index. Is this the best test? a. GI index i. Tells how fast and how high a particular food can raise your blood glucose level ii. Higher index ???? the more it increases your blood sugar iii. Lower index is better b. No, the HbA1c test is better bc give an average of 3 months of glucose attached 16. What are ketone bodies and ketosis? a. Fat fragments combine w/each other; shift causes accumulation of normally scarce acidic products called ketone bodies b. Ketosis i. Accumulation of ketone bodies in the blood ii. Disturbs normal acid-base balance iii. Life threatening: deficiency of vitamins and minerals, loss of bone minerals, elevated blood cholesterol, impaired mood, other adverse outcomes iv. Isn’t all that bad 1. Provide a fuel alternative to glucose for brain and nerve cells when blood glucose is low 2. Therapeutic ketogenic diet with medication has reduced seizures in about half of children and adults w/hard to treat epilepsy Chapter 5 The Lipids 12. What is the definition of lipids? Their solubility in water and in organic solvents. a. A group of fatty substances including trigyceride and cholesterol that are soluble in fat, not water and provide rich source of energy and structure to cells b. Not soluble in water 13. Most of the lipids in our food are present in one form of lipid. Which one? a. As triglycerides 14. What are the roles of lipids in both the body and foods? a. Body i. Chief storage – stored in adipose tissue ii. Shock absorber for organs iii. Insulation iv. Main component of cell membrane v. Transport vitamins vi. Raw material for compounds (steroids, bile, vit D) vii. Provides essential fatty acids viii. Signals eicosanoids as hormones b. Foods i. Aromas and flavors ii. Tenderness iii. Contributes to feeling full iv. Concentrated calorie source 15. Triglycerides structure and function. a. Structure: Glycerol + 3 fatty acids = triglyceride connected by O2 b. Function: 16. Saturated vs unsaturated fatty acids, trans fats. Which foods contain them? a. Saturated = tightly packed ???? solid i. Foods: beef, lamb, pork, poultry, lard, butter, cheese b. Unsaturated = not packed well ????liquid i. Pont of saturation = where double bond is ii. Hydrogenation 1. Process of making unsat ????sat 2. Add H2 to double bonds; consequences a. Form trans fats b. Nutrient losses iii. Foods: oils, salmon, almonds, avocados c. Trans fats = where double bond becomes straight during hydrogenation i. Inc cardiovascular disease risk 1. Inc LDL 2. Dec HDL ii. Foods 1. Meat and dairy 2. Hydrogenated oils 3. Processed foods iii. Less than .5 trans ???? 0g on food label 17. How are fatty acids categorized? a. By length of chain i. Short (less than 6 C) ii. Medium (6-12 C) iii. Long (13-21 C) iv. Very long (more than 21 C) 18. Name the two essential fatty acids. What is their role in the body? a. Linoleic acid: omega 6 fatty acids i. Double bond on 6th carbon ii. EPA iii. DHA b. Linolenic acid: omega 3 fatty acids i. Double bond on 3rd carbon ii. Arachidonic acid c. Roles i. Raw material for eicosanoids ii. Fluidity of cell membrane iii. Growth + vision iv. Regulate gene expression v. Support immune cell functions 19. What are phospholipids? Their role, cell membrane a. Structure: Glycerol + 2 fatty acids + phosphorus molecule b. Function in membrane = phospholipid bilayer i. Emulsifies = keeps fats dispersed 20. Cholesterol, its role in the body. What foods contain cholesterol? a. Structure: ring of carbons b. Function i. Gives fluidity to cell membrane ii. Raw material for: bile acids, steroid hormones, vit D iii. Produced by liver; synthesis decreases w/more chol. from diet iv. Bile salts 1. Help fat digestion bc it’s an emulsifier 2. Made in liver, stored in gallbladder, and secretes into intestine 3. Salts break fats into smaller parts to be digested c. Foods: i. Animal foods (eggs, meat, poultry, fish and dairy foods) 21. Describe the difference between LDL and HDL in terms of the triglycerides, cholesterol and protein composition. a. Lipoproteins: proteins that act as emulsifiers; attract H2O and fat to help lipid passengers travel into watery body fluids i. VLDL = more fat than proteins ii. LDL = slightly more lipids iii. HDL = more proteins b. Triglycerides i. LDL (slide 60) 1. Made from VLDL in circulation after donating many triglycerides to body cells ii. HDL (slide 61)1. Transports cholesterol from peripheral tissues to liver for disposal (reverse cholesterol transport) 2. Cholesterols excreted as bile 3. HDL made in liver 22. What is a lipoprotein? List the four main types of lipoproteins. Where in the body are they synthesized? What is the function of each? Which is commonly called “good cholesterol” and which is called “bad cholesterol”? a. Lipoproteins: proteins that act as emulsifiers; attract H2O and fat to help lipid passengers travel into watery body fluids i. Chylomicrons (slide 58) 1. Hydrophobic faces inward 2. Hydrophilic faces outward 3. Made inside enterocytes a. Transports dietary fats to muscle and fat cell for energy source or storage material b. Chylomicrons remnants go to the liver ii. VLDL 1. Carries triglycerides and lipids, made in the liver, to body cells for their use iii. LDL 1. Made from VLDL in circulation after donating many triglycerides to body cells 2. iv. HDL 1. Transports cholesterol from peripheral tissues to liver for disposal (reverse cholesterol transport) 2. Cholesterols excreted as bile 3. HDL made in liver b. Lousy = LDL (made from circulation of VLDL) c. Happy = HDL (made in liver) aka good cholesterol 23. How lipids (TAG) are digested? What facilitates lipid digestion? Where in the digestive tract is most of the digestive enzyme activity? a. Mouth ???? salivary amylase ???? starches b. Stomach ???? little digestion by gastric lipase c. SI (most digestion activity) ???? pancreatic lipase i. Gallbladder (bile) + pancreas (pancreatic juice) 1. Bile emulsifies and helps become more alkaline 2. Pancreatic juice has bicarbonate, lipase and amylase ii. Lipase separates fatty acids from glycerol (slide 53) 24. How are lipids absorbed? After absorption, which system(s) carry the lipids in the body? How are lipids (and fat-soluble molecules) transported in the water-based blood? a. Intestinal villi take up digested, and emulsified by bile fat molecules (slide 54, 55) i. Proteins serve as a transport in watery environment ii. Packaged into chylomicrons iii. Goes into lymphatic system b/c fats cane be digested into blood 25. Dietary Recommendations a. What % of kcals should come from total, saturated, and trans fats? i. Fats = 20-35% kcals from fat ii. Sat fat = less than 10% kcals from sat fat iii. Trans = low as possible iv. Cholesterols = less than 300 mg/dayb. What should you consider when buying margarine? i. Buy soft instead of hard ii. Choose </= 2g sat fat iii. Avoid hydrogenated fats as 1st ingredient iv. 0g trans fats v. Try other oils 26. Blood cholesterols vs dietary cholesterol a. Blood cholesterol accumulates in arteries and ???? plaque formation b. Food cholesterol has little effect on blood cholesterol c. Recommendations i. Lower LDL w/unsat fats ii. Raise HDL w/physical activity iii. Mediterranean diet = lots of unsat fats Chapter 6 The Proteins 1. Describe the basics of the chemical nature of amino acids and proteins. What is the name of the bond linking amino acids in a polypeptide chain? The importance of the side “R” group of the amino acid. a. Polymers = long chains of similar OR same units called monomers i. Proteins are polymers made of amino acids b. Amino acids = monomers = protein building blocks i. Bonded through peptide bond (strand of AAs) ii. Peptide bone where C is bonded to N iii. AAs coil or fold c. R side chain changes electrical charge 2. What is an essential amino acid? a. Amino acids that either cannot be synthesized at all by the body or cannot by synthesized in amounts sufficient to meet physiological need 3. What is protein denaturation? How does it happen? a. Changing of a protein’s folded shape b. Happens: i. Digestion (stomach acid) ii. Cooking iii. Salts of heavy metals c. Denaturation permits digestive enzymes to make a contact w/peptide bonds and cleave 4. Digestion, absorption and transport of proteins a. Where does protein digestion start? i. Stomach 1. Strong acid denature protein in food a. Uncoil protein’s strands 2. Enzymes like pepsin attack peptide bonds b. Where does the bulk of protein digestion occur? i. Small intestine 1. Single amino acids and larger polypeptides are digested by pancreatic enzyme – trypsin 2. Peptidases breakdown rest that aren’t break down a. Located on surface of small intestine cells or inside intestine cells (dipeptidases, tripeptidases) c. What is the absorbable form of proteins? i. Amino acids ??? ii. Absorbed by cells of SI: d. Do absorbed amino acids enter the blood or the lymph? i. Peptides are digested into amino acids in enterocytes by cytoplasmic peptidases and exported from cell into blood 5. How are proteins synthesized? What is gene expression? a. Synthesized as a linear chain of AAs that folds into complex 3D shape i. Noncovalent and covalent bonds drive folding process b. Body turns on and off genes = gene expression i. On = protein made ii. Off = no protein made 6. What is protein turnover? a. Protein synthesis = protein degradation b. Amino acids conserved from degradation ???? raw material for new proteins c. Breakdown, recovery and synthesis process = protein synthesis 7. What are the functions of protein in the body? a. Providing structure and movement b. Building enzymes c. Building hormones i. Insulin, ghrelin, GH, glucagon, leptin d. Building antibodies e. Transports substances (hemoglobin and lipoproteins) f. Maintains fluid and electrolyte balance (proteins attract water) g. Maintains acid-base balance h. Blood clotting i. Provides energy and glucose 8. What are the fates of amino acids? a. Cellular uses of amino acids i. Build proteins ii. Make needed compounds (hormones, antibodies) iii. Break down amino acid to build a different amino acid b. Wasting of amino acids i. 1. Lack of energy from other sources (CHO and fats) ii. 2. Excess of protein in diet iii. 3. Too much amino acids from supplements iv. 4. Dietary protein of low quality v. To prevent waste, add CHO’s and fats along with dietary protein of good quality 9. Understand nitrogen balance a. Compares nitrogen lost by excretion with nitrogen eaten in food b. Nitrogen equilibrium i. Protein synthesis = protein degradation ii. EX: healthy college student and young retiree c. Positive nitrogen balance (gaining protein) i. Synthesis > degradation ii. EX: growing child, pregnant woman, building muscle d. Negative nitrogen balance (losing protein) i. Synthesis < degradation ii. EX: astronaut, surgery patient10. Protein quality a. What does protein quality measure? (two things) i. Amino acid composition (high quality protein) = dietary protein containing all essential amino acids; same amount humans need ii. Protein digestibility = depends on protein sources and cooking methods b. Generally speaking, which foods contain high quality protein? Which foods contain low quality protein? i. High (complete): animal foods (eggs, meat, fish, poultry, dairy, soy protein) ii. Low (incomplete): plant proteins (veggies, nuts, seeds, grains, legumes) c. Describe what is meant by ‘complementary proteins’. Do they have to be eaten together at every meal? i. Mix and matching plant proteins to ensure enough of each amino acid is eaten 11. What are the risks and/or benefits or consuming more protein than you need? a. More carbs in diet i. Average American 78 g/day ii. Weight loss iii. Heart diseases related to animal protein foods and processed foods iv. Bone loss v. Cancer vi. If oversupply of proteins (amino acids) 1. Amino acid is removed and used for residues (energy, glucose storage or fat storage) 2. No storage compound for protein 3. From article (slide 50) a. skeleton supplies buffer by active resorption of bone b. with net acid excretion, as well as ammonium c. excessive calcium loss because of its acidogenic content b. Too little carbs in diet i. marked acid load to the kidney ii. increases the risk for stone formation iii. decreases estimated calcium balance iv. may increase the risk for bone loss. v. Marasmus = severe depravation of energy, protein, vitamins and minerals 1. Wasting 2. Stunting 3. Slow metabolism 4. Growth stops 5. Digestive tract deteriorates vi. Kwashiorkor = inadequate protein intake and infections 1. Acute PEM 2. 18-24 months 3. Some wasting 4. Edema 5. Fatty liver12. Dietary recommendations a. How much protein does an average person need? i. .8g per kg of body weight (min 10% of total calories) b. What % of kcals should come from protein? i. 10-35% of kcals c. Do Americans get adequate protein in our diets, on average? i. We get more than needed 13. Which food groups (in general) provide protein? a. The legumes include such plants as the kidney bean, soybean, green pea, lentil, black-eyed pea, and lima bean. i. Bacteria in the root nodules can “fix” nitrogen from the air, contributing it to the beans. b. Plant and animal sources Chapter 7 The vitamins 1. What is a vitamin? What is a provitamin, a precursor? a. Vitamin = essential, noncaloric, organic nutrient needed in tiny amounts in diet b. Precursor/ Provitamin = transformed into active vitamins by the body 2. Compare and contrast fat-soluble and water-soluble vitamins: solubility, digestion/absorption, transport, storage, toxicity, deficiency. a. Fat soluble i. Vit. A, D, E, K ii. Follow the same path as large fats iii. Require bile for absorption iv. Absorbed into the lymphatic system v. Many require proteins for transport in the blood. vi. Excess STORED in the liver and adipose tissue. vii. Not easily excreted: build up in tissues. viii. Easy to reach toxic levels from supplements (not food). b. Water soluble i. Vit. C and B ii. Absorbed directly into the blood stream. iii. Do not require proteins for transport in the blood. iv. Excess EXCRETED by kidneys 1. Easier to develop deficiency than ADEK. 2. Harder to develop toxicity than ADEK. 3. Know the major functions, sources, signs/symptoms of deficiency and toxicity of vitamins (fat soluble and water soluble) a. Fat Soluble i. Vit A 1. Functions: vision, gene regulation, cell differentiation, immune, reproduction and growth, antioxidant 2. Sources: whole fat milk, liver, fish, eggs, butter, fortified margarine, deep orange/yellow, dark green leafy veggies 3. Deficiency: night blindness, blindness, problem in developing countries, stored in liver 4. Toxicity: turn orange from too much beta-carotene, supplements (bone/birth defects, and complications) ii. Vit D 1. Functions: blood calcium and phosphorus level regulation, gene regulation and cell maturation, bone growth/maintenance 2. Sources: egg yolk, oily fish, fortified milks, cereals, sun 3. Deficiency: osteomalacia (bone less mineralized ???? soft bones), osteoporosis (more bone breakdown???? dec density), rickets 4. Toxicity: rare; hypercalacemia (damages soft tissue) iii. Vit E 1. Functions: antioxidant (prevents damage to PUFAs), may reduce heart disease risk, cell membrane structure 2. Sources: veggie oils, seeds, nuts, margarine, egg yolk, liver; destroyed by heat (frying) 3. Deficiency: rare, fat malabsorption diseases, RBCs spill open, neuromuscular dysfunction in spine and eye 4. Toxicity: rare; interfere w./blood clotting meds iv. Vit K 1. Functions: blood clotting, synthesis of bone proteins 2. Sources: made in GI tract by bacteria (1/2 of needs), dark green leafy greens, veggie oils, liver, milk 3. Deficiency: fat malabsorption, interence from antibiotics, newborns w/sterile GI get single dose of vit K 4. Toxicity: jaundice, opposes anticlotting meds b. Water soluble i. Vit C 1. Functions: maintain CT (collagen synthesis), antioxidant, protect iron from oxidation, immunity 2. Sources: fruits and veggies, white potatoes; heat light and O2 destroy vit C 3. Deficiency: Scurvy, weakness, anemia, bleeding, skin hemorrhages, slow wound healing, fractures 4. Toxicity: rare to see ii. Thiamin (B1) 1. Functions: energy metabolism, nerve conduction, occupies site on nerve cell membrane 2. Sources: bread, milk, meats, chicken, fish, peas 3. Deficiency: Beriberi (wet/dry edema), weakness, appetite loss, nerve degeneration 4. Toxicity: none iii. Riboflavin (B2) 1. Functions: part of coenzyme active in energy metabolism 2. Sources: beef liver, enriched cereal, yogurt/milk, 3. Deficiency: glossitis (smooth purple tongue), Cheilosis (crack at corners of mouth) 4. Toxicity: none iv. Niacin (B3) 1. Functions: energy metabolism; helps convert carbs to glucose and metabolizing fat 2. Sources: tuna, chicken, enriched cereal, pork, mushrooms 3. Deficiency: Pellagra (flaky skin rash) 4. Toxicity: “niacin flush” (dilation of capillaries), liver injury, impaired glucose tolerance v. Panthothenic Acid (B5) 1. Functions: synthesis of lipids, neurotransmitters, steroid hormones and hemoglobin 2. Sources: animal foods (fish, liver, poultry, dairy) 3. Deficiency: fatigue, irritability, vomiting, pain 4. Toxicity: very rare vi. Pyridoxine (B6) 1. Functions: AA reactions2. Sources: meats, fish and poultry (protein rich foods); potatoes; leafy greens and some fruits 3. Deficiency: anemia, greasy dermatitis, weak immune 4. Toxicity: >2g/day: numb feet, loss of sensation, can’t walk/work vii. Biotin (B7) 1. Functions: cofactor for enzymes in metabolism of carbs, fats and proteins 2. Sources: 3. Deficiency: 4. Toxicity: may damage DNA viii. Folate (B9) 1. Functions: synthesize DNA, AA, new cells, makes RBCs w/B12 2. Sources: leafy greens (spinach, turnips, eggs) 3. Deficiency: megaloblastic anemia (large immature RBCs), smooth red tongue, neural tube defects (NTD) 4. Toxicity: masks vit B12 -deficiency symptoms ix. Cobalamins (B12) 1. Functions: maintain nerve sheaths, metabolism and maturation of erythrocytes, intrinsic factor 2. Sources: animal products 3. Deficiency: pernicious anemia (large immature RBCs), numbness, memory loss 4. Toxicity: none 4. What is an antioxidant? Which vitamins can act as antioxidants? What roles do antioxidants have in the body and in health promotion? a. Antioxidant = fights free radicals that damage DNA and collagen b. Vit A, C and E, beta carotene, selenium, copper, manganese, zinc, phytochemicals 5. What is meant by the “interdependence” of the B vitamins? a. Presence of 1 vit B may affect absorption, metabolism and excretion of another b. Deficiency of 1 vit B may affect the functioning or deficiency of another 6. What are the two main roles of the family of B vitamins? a. Function as part of COENZYMES to activate it i. Energy Metabolism b. Build new cells 7. Deficiencies of which B vitamins can cause anemia? Who is at risk for these deficiencies? a. Vit C, pyridoxine (B6), folate (B9), cobalamins (B12) b. Elderly, patients, long drug use, smokers 8. What is the general relationship between alcoholism and the B vitamins? a. Reduces vit B concentrations 9. What does folate have to do with spina bifida? a. Taking folate prevents spina bifida and neural tube defects 10. What is special about B12 food sources, B12 absorption, and storage? a. Food sources: animal foods provide a balanced diet b. Absorption: must be attached to intrinsic factor to be absorbed c. Storage: stored in liver 11. What’s the difference between enriched and fortified? a. Enriched = adding nutrients lost during process b. Fortified = vitamins/minerals have been added that weren’t there Chapter 8 Water & Electrolytes Water: 1. Functions of water a. Solvent – transport vehicle for nutrients and wastes ▪ cleansing agent – toxic substances removed with urine by kidneys b. Helps w/metabolic reactions c. Maintains body fluids and electrolyte balance d. Maintain blood volume e. Lubricant (digestive and respiratory tract, tissues moistened w/mucus) f. Cushion (for joints, spine, internal organs, fetus) g. Coolant (maintain temp by sweating) 2. Sources of water a. Ingested foods and liquids (preformed water) b. Metabolic water produced during dehydration synthesis of anabolism c. Water and beverages (near 100% water) d. Fruits and veggies (90%) e. Meats and cheeses (50%) 3. Water loss, intake and thirst. Dehydration: how the body maintains water balance? a. Dehydration = too much water lost from body and not replaced; threatens survival ▪ Signs: thirst, weakness, exhaustion, delirium and death ▪ Elderly at risk b. Thirst = conscious desire to drink and regulated by mouth, hypothalamus, nerves and pituitary gland ▪ Low water intake = blood becomes concentrated, dry mouth ???? hypothalamus starts drinking and kidneys conserve water ▪ High water intake = stomach expands and stretch receps signal to stop drinking ▪ If thirsty ???? you’re dehydrated 4. Water recommended intake (what factors influence water intake?) a. Water needs vary; depends on: ▪ Diet and activity ▪ Environment, humidity, air ▪ Temperature b. 2-3L (8-12c) for a 2000kcal expenditure c. Total water AI (males) = 3.7L/day (13 cups) d. Total water AI (females) = 2.7L/day (9 cups) 5. What fluids should you drink? a. Water and noncaloric beverages b. Avoid large quantities of sugar-sweetened drinks c. US tap water is safest and cleanest in world d. Bottled water 6. What are electrolytes? How does the body regulate electrolytes? a. Electrically charged ions that carry electrical current in water ▪ Sodium, calcium, potassium, chlorine, phosphate and magnesium, acids and bases, some proteins b. Electrolytes affect ▪ Amount of water in body ▪ Acidity of blood (pH) ▪ Muscle functionc. Can lead to dehydration (low levels) or overhydration (high levels) 7. What are the 2 types of water? a. Hard ▪ Calcium and magnesium b. Soft ▪ Sodium ▪ Hypertension ▪ Dissolves heavy metals 8. What is water intoxication? What’s the effect of it? a. Gallons of water plain water in a few hours b. Blood is dangerously diluted Major Minerals and Trace Minerals 1. What is the importance of inorganic elements? a. They retain chemical identity when exposed to heat, acid or mixing but lost when leached into water 2. What does bioavailability mean? a. How much of the nutrient is being absorbed 3. Understand pH and acid-balance principle a. pH i. range from 0-14 ii. 7 is neutral (pure water) iii. Acidic is less than 7 iv. Alkaline is more than 7 v. All species have optimal pH vi. Human blood pH = 7.35-7.45 b. Acid-base balance i. Minerals can inc pH (calcium, magnesium, sodium, potassium, sulfur, selenium) ii. Minerals can lower pH (sulfur, phosphorus, forms of iron) iii. Kidneys = control pH balance by excreting more/less acid (H ions) iv. Lungs = secrete more/less CO2, when dissolved in blood ???? forms acid (carbonic acid) v. Buffers = molecules that gather up or release H ions to correct pH; body proteins and some mineral salts 4. Identify the major and trace minerals in the human body. Roles of the minerals in the body. Consequences of their deficiency. Toxicity. Food sources. a. Major i. Calcium 1. Functions: Bone and teeth formation, blood clotting muscle contraction and relaxation, nerve transmission 2. Sources: dairy, fish bones, fortified orange juice and cereals, legumes, green leafy veggies 3. Deficiency: rickets, osteomalacia, tetany 4. Toxicity: kidney stones, constipation, interferes with other mineral absorption ii. Phosphorus 1. Functions: bone and teeth formation, energy metabolism, DNA and RNA and acid base balance 2. Sources: high protein foods 3. Deficiency: unlikely but can cause bone loss, loss of appetite, and weakness 4. Toxicity: bone resorption- loss of calciumiii. Magnesium 1. Functions: coenzyme in metabolism muscle and nerve action, helps with thyroid secretion 2. Sources: whole grains, nuts, legumes, green veggies, seafood, cocoa 3. Deficiency: tremor, spasm, low serum level after GI losses or renal losses from alcoholism and convulsions 4. Toxicity: nausea, vomiting, diarrhea iv. Sodium 1. Functions: major extracellular fluid control of water balance, acid base balance, muscle contraction 2. Sources: table salt, processed foods 3. Deficiency: fluid shifts, acid base imbalancing, cramping 4. Toxicity: hypertension in salt sensitive people a. AI adults: 1,500 mg b. UL: 2,300 mg (1 tsp of salt) c. Recommendation: i. <2,300 mg for most adults ii. <1,500 mg for 51+ years old, all African Americans, and people with hypertension, diabetes or kidney disease. v. Potassium 1. Functions: major intracellular fluid control 2. Sources: fresh fruits and veggies, meats, whole grains 3. Deficiency: irregular heartbeat, difficulty breathing, muscle weakness 4. Toxicity: cardiac arrest vi. Chloride 1. Functions: acid base balance, hydrochloric acid, digestion 2. Sources: table salt, processed foods 3. Deficiency: hypochloremic alkalosis with prolonged vomiting and diarrhea 4. Toxicity: rare vii. Sulfate 1. Functions: essential constituents of cell protein, hair, skin, nails, vitamin, and collagen structure, high energy sulfur bonds in metabolism 2. Sources: meat, eggs, cheese, milk, nuts, legumes 3. Deficiency: rare 4. Toxicity: rare b. Trace i. Iodine 1. Functions: Part of hormone thyroxine made by thyroid gland; Thyroxine regulates body’s metabolic rate, body temp, reproduction, growth, heart function 2. Sources: Fortified salt, seafood, NOT sea salt 3. Deficiency: goiter (big thyroid from lack of I2), cretinism (irreversible mental/physical retardation) 4. Toxicity: ii. Iron 1. Functions: Oxygen transport (heme) & storage (myo), cofactor of enzymes involved in energy metabolism 2. Sources: meat, fish, poultry, legumes, enriched grains/cereals, leafy greens, iron skillet 3. Deficiency: iron deficiency vs iron deficiency anemia a. Deficiency signs i. Fatigue, apathy, and cold pale skinb. Mental symptoms of Anemia (21) i. Impaired productivity, work change in behavior ii. Pica (craving for nonfood substances) 4. Toxicity: Fatigue, mental depression, ab pain, infection, liver failure, bone damage, diabetes and heart failure iii. Zinc 1. Functions: Growth and Development, Wound Healing, cofactor, affect, behavior and learning 2. Sources: shellfish, beef, poultry, liver, diary, bioavailability low in plant sources (high concentrations) 3. Deficiency: growth retardation, slow sexual maturation, impaired immune, hair and appetite loss 4. Toxicity: oversupplementation; vomiting, headaches, exhaustion, stop iron absorption in GI tract iv. Selenium 1. Functions: Protects vulnerable body molecules against oxidative destruction, Works w/vit E to limit formation of free radicals, Assist thyroid hormone in regulation of metabolism 2. Sources: meats, seafood, nuts, most veggies 3. Deficiency: inc cancer risk 4. Toxicity: Hair loss and brittle nails, Diarrhea and fatigue, Bone, joint and nerve abnormalities v. Fluoride 1. Functions: teeth development and growth, stops bacteria metabolism 2. Sources: water fortification, foods and drinks made w/tap water, toothpaste and at dentist 3. Deficiency: dental decay 4. Toxicity: fluorosis = spotty teeth 5. Name some other trace minerals a. Iodine, iron, zinc, selenium, fluoride, chromium, copper, manganese, molybdenum, cobalt, nickel 6. What are contaminant minerals? a. Dangerous minerals b. Heavy minerals: lead, mercury, cadmium c. Sources: soil, water and air pollution d. They displace other nutrients from their active sites in the body Chapter 9A – BMI, Obesity & Weight Management 1. How prevalent is obesity/overweight in the United States? The last 50 years? a. About 2/3 of U.S. adults are overweight or obese; 1/3 of US children overweight or obese b. 50 years later, 69% of US adults are overweight/ obese; 17% of children are obese 2. Be able to define BMI, what it correlates to, interpretation and drawbacks of BMI a. Definition: measure of body fat based on weight and height; weight a. (lbs*703)/in2 b. Does it always correlates with body fatness and disease risk? a. No c. How do you interpret the BMI values? a. Underweight = <18.5 b. Normal = 18.5-24.9 (lowest risk of death c. Overweight = 25-29.9 d. Obese = >30 e. Morbid obesity = >35d. Drawbacks a. Fails to indicate HOW MUCH of a person’s weight is fat and WHERE that fat is located 3. What’re the three methods used to assess body fat? a. Waist circumference i. Indicates visceral fatness and health risks ii. Above a certain girth, disease risks increase b. Skin fold test c. Radiographic techniques i. Ex: Dual energy X-ray absorptiometry 4. What is the average body composition of men and women? a. Men i. 45% muscle ii. 25% organs iii. 15% fat iv. 15% bones b. Women i. 36% muscle ii. 24% organs iii. 27% fat iv. 13% bones c. Men % fat i. 12-20% ‘normal’ ii. 5-10% for athletes d. Women % fat i. 20-30% ‘normal’ ii. 15-20% in athletes 5. What affect body fat distribution? a. Age/gender i. Men have apple profile ii. Women have pear profile b. Moderate alcohol intake c. Higher levels of physical activity 6. What is visceral adipose fat? a. Fat collected within central abdominal area of the body poses greater risk of major chronic diseases than does subcutaneous fat of the abdomen, thighs, hips and legs b. Central obesity elevates the risk of death from all causes 7. Characteristics of fat cells (adipocytes) a. # of cells increases during teen years b. Cells never go away, but empty and re-fill i. Once too full, they divide and inc in # 8. Why excessive body fat increases the risk of chronic disease? a. Adipose tissue releases hormones adipokines. i. They help to regulate inflammatory processes and energy metabolism in the tissues. b. In obesity, the balance of adipokines is shifted that favor both tissue inflammation and insulin resistance. i. This contributes to the chronic diseases 9. What are some problems with obesity? a. Health: Higher risk for lots of chronic diseases and inflammation b. Social: Judgement and stereotyped by appearance, being lazy c. Psychological: feelings of rejections, shame, depression, failure 10. What is body’s energy balance? Where is this energy found? a. Change in energy = energy in – energy out i. Energy in = from foods and beverages ii. Energy out = basal metabolism, thermic effect of food and exercise 11. Define BMR and its factors, EER and thermic effect of food. a. BMR (basal metabolic rate) = amount of energy used daily while at rest i. Factors that affect the BMR (39 Chp 14) 1. Age; every decade decays 5% 2. Height; taller people spend more time 3. Growth; younger people uses more energy 4. Body composition 5. Stress/Fever 6. Environmental temps 7. Fasting/starvation 8. Malnutrition 9. Thyroxine; under production of this inc BMR + more production inc BMR b. EER (estimated energy requirements) i. Front page of textbook c. Thermic effect of food = caloric cost of digesting and processing different macronutrients in your diet 12. What are the components of energy expenditure? a. 50-65 BMR b. 25-50% exercise c. 5-10% thermic effects of food 13. How does the body tolerate rapid weight loss VS moderate weight loss? a. Gradual weight loss is preferred b. Rapid weight loss i. Fasting 1. Deprives tissue of nutrients 2. Overeating at times 3. Death ii. Body adjustments 1. Slows metabolism to save energy 2. Sacrifices lean tissue iii. Ketosis 1. Break down of fat molecules 2. Imbalances acid-base balance of blood ???? excessive mineral loss in urine 14. How does the body’s metabolism adjust in fasting/feasting? a. What are the sources of energy in fasting? a. Fasting i. glycogen ???? glucose ii. fat???? fatty acids ???? ketone bodies b. Feasting i. Carbs ????glucose ii. Fat???? fatty acids iii. Protein ???? amino acids c. During fasting, brain and nervous system uses ketone bodies as energy i. RBC only use glucose ii. Ketones can pass barrier and support brain iii. If you don’t eat carbs ???? uses proteins in muscle ???? glucoseb. What happens with excess of macronutrients (carbs, proteins, fats) in the body? a. Weight gain c. How is the energy stored in a fed state? a. Glycogen in muscles b. Glycogen in liver to help with blood vessels 15. How do you achieve and maintain healthy body weight? a. Eating patterns b. Exercise c. Behavior modification d. Achievable goals e. Keep records f. Safe weight loss i. ½-2lbs per week; no more than 2lbs/week ii. 10% body weight / 6months iii. 1 lb = 3500 kcals 16. What are the best food strategies for weight loss? a. Identify calorie excesses b. Eat low energy density food (cals/grams) c. Choose nutritious foods d. Drink water e. Eat small portions 17. How to maintain healthy weight? a. Exercise with a friend or group b. Support groups c. Healthy diet choices Chapter 9B – eating disorders 18. What are eating disorders? Incidence? a. Serious mental illnesses characterized by severe disturbances in eating and exercise behavior and potentially can be life threatening b. Incidence i. About 5 million people in US suffer from anorexia and bulimia nervosa ii. More than 8 million suffer from binge eating; 3 million men iii. Has steadily increased since the 50s 19. Possible causes and health consequences of underweight a. Signs i. Lethargy – no energy ii. Depression iii. Loss of muscle bulk iv. Loose, elastic skin b. Causes i. Malnutrition ii. Smoking habits iii. Substance abuse iv. Illness v. Eating disorders c. Health risks i. Inability to preserve lean tissue during a wasting diseases (cancer, digestive disorder) ii. Women: menstrual irregularities and infertility iii. Osteoporosis and bone fracture iv. Nutrient deficiencies are common v. Immune response is diminished 20. What causes eating disorders? a. Psychological (depression, low self-esteem, obsessive-compulsive disorder) b. Biological (genetic factors) c. Cultural d. Society’s influence i. Many causes to eating disorders 1. Pressure for thinness a. Distorted body image: normal healthy body as to fat b. These behaviors are nonexistent in cultures where body leanness is not central to self-worth ii. Media messages 1. Miss America beauty pageant: thinner women over years have won 2. Magazines and media convey message that to be happy, beautiful and desirable, one must first be thin 21. Know the types of eating disorders a. Anorexia Nervosa i. Characteristics 1. Can’t recognize condition 2. Insists on being too fat 3. Stop menstruating 4. Moody 5. Chronically depressed 6. Blames external circumstances 7. Physical exhaustion 8. Insomnia ii. Physical perils: 1. same damage as classic severe malnutrition: growth ceases, osteoporosis, anemia, heart and kidney failure, damage to body and death iii. Treatment 1. Needs a multidisciplinary approach that addresses 2 areas of concern a. Restoring weight b. Psychological processes 2. Teams of physicians, nurses, psychiatrists, psychotherapists and dietitians involved 3. When starvation leads to sever underweight (<75% of ideal body weight) patient needs hospitalization b. Bulimia Nervosa i. Characteristics 1. More prevalent than anorexia nervosa 2. Obsessed by thoughts of food 3. Kept in secret, but aware of illness 4. Frequent binges and compensations (at least 2x a week for 3 months) 5. Sense of lack of control during episodes 6. Emotional insecurity ii. Cycle 1. Tension ????craving????binge eating????purging????shame/disgust????strict diet???? tensioniii. Physical and psychological perils 1. Fluid and electrolyte imbalances ???? death from heart and kidney failure 2. Vomiting -????irritation and infection of pharynx, esophagus and salivary glands; erosion of teeth and dental cavities 3. Correlation between addictive nature of binge eating and drug abuse iv. Treatment 1. Structured eating and exercise plan 2. Steady maintenance of weight 3. Consistently eating enough food to satisfy hunger (at least 1600 cal/day) c. Binge eating disorder i. Associated w/3+ of the following 1. Eating much more rapidly 2. Eating until feeling uncomfortably full 3. Eating large amounts of food when not physically hungry 4. Eating alone bc of embarrassment of quantity of food 5. Feeling disgusted w/oneself, depressed or guilty ii. Characteristics 1. Uncontrolled eating, kept in secret 2. Depression and other psychological problems 3. Awareness that eating pattern is abnormal 4. W/o compensatory behavior 5. Responds more rapidly to treatment Chapter 11– Dietary risk factors and disease 1. Explain the differences and characteristics of Chronic VS infectious disease a. Differences i. Cause 1. Infectious: Caused by bacteria, viruses, parasites and other microbes that can be transmitted from one person to another through air, water or food; by contact 2. Chronic: genetic, prior/current diseases, lifestyle ii. Duration 1. Infectious: slow or fast; depends on strain; many are resistant to antibiotics 2. Chronic: slow progression, long duration b. Examples i. Infections: influenza, malaria, TB, strep ii. Chronic: heart disease, hypertension, cancer, stroke, diabetes, obesity 2. What are the top 10 leading causes of death in the US? a. Heart disease b. Cancers c. Chronic lung diseases d. Strokes e. Accidents f. Alzheimer’s g. Diabetes mellitus h. Kidney diseases i. Pneumonia and influenza j. Suicide 3. How do micronutrient deficiencies impair the immune system? a. Impairs immune tissues first (cells can dec, leaving body vulnerable) i. Vit A = maintains healthy skin; cellular replication, antibody production. Anti-inflammatory response ii. Vit D = regulates immune cell responses iii. Vit C & E & selenium = protective against oxidative damage iv. Vit B6 and Zinc= maintains effective immune response v. Vit B12 ad folic acid = assist in cellular replication and antibody production 4. What’s the difference between acute inflammation and chronic inflammation? a. Inflammation = WBCs release oxidative products that kill microbes and heals wounds b. Chronic inflammation = i. long term inflammation ii. attacks healthy tissue 1. inflamed tissue produces free radicals, blood clotting factors and bioactive chemicals iii. root of many illnesses 1. heart disease 2. cancers 3. Alzheimer’s 4. Arthritis 5. What is oxidative stress and its causes? a. Imbalance between production of free radicals and ability for the body to counter (detoxify) their effects 6. What is the concept of risk factors? Give examples of risk factors for chronic diseases. a. They show correlation w/the disease and occur in clusters; may affect several diseases b. Risk factors put us at an increased risk for a disease, but does not necessarily cause it c. EXAMPLES i. Genetic ii. Nutrition iii. Environmental iv. Behavioral 7. How can a person estimate his/her risk? How can you reduce the risk? a. Estimation i. Search family’s medical history 1. Alcoholism 2. Cancer 3. Diabetes 4. CVD 5. Hypertension 6. Liver disease 7. Osteoporosis ii. Laboratory tests b. Reducing risk i. Get physical evaluation from your PCP ii. Know family history iii. Evaluate diet iv. Reduce/eliminate modifiable risk factors 1. Dietary 2. Physical activity 3. Smoking, alcohol 4. Stress8. What is the incidence of CVD in the US? a. Kills 1 million Americans per year b. More than 82 million men and women suffer from some form of CVD c. CVD s the leading cause of death among women d. More than 42 million US women have CVD 9. What causes atherosclerosis? What are the contributors to atherosclerosis? a. Hardening because of build of plaques ???? pumps blood harder ???? inc BP i. Deposits of plaque along walls of arteries, hardening of the arteries ii. Everyone has signs; advanced disease b. Plaque formation (inflammation????macrophages????mineralization) i. LDL particles oxidized ???? no longer metabolized by liver???? accumulate in branches of arteries ???? pro inflammatory action starts (WBCs)???? macrophages become foam cells ???? mineralization inc hardening the plaques c. Results i. Plaque ruptures ii. Blood clots 1. Thrombus 2. Embolus 3. Omega-3 fatty acids (raw material for hormones [eicosanoids]); pro/anti-inflammatory that fight plaque formation iii. BP – Aneurysm 10. What are the modifiable/non-modifiable risk factors for CVD? a. Nonmodifiable i. Age, gender, genetic inheritance b. Modifiable i. Diet, smoking, certain diseases and physical inactivity ii. LDL.HDL cholesterols 1. Higher the LDL????greater risk a. Most atherogenic lipoproteins iii. High blood triglycerides 11. Define metabolic syndrome and know the health risks a. A cluster of health risks that increase your risk of heart diseases i. low blood HDL cholesterol, ii. high blood pressure, iii. elevated fasting blood glucose (insulin resistance) iv. central obesity v. high blood TAGs b. Central obesity and insulin resistance are thought to be primary factors 12. What are the recommendations for reducing CVD risk? a. Estimate heart diseases risk b. Lifestyle changes i. Inc physical activity ii. Lose weight iii. Implement dietary changes iv. Reduce exposure to tobacco smoke 13. What kind of diet can reduce the CVD risk? a. Diet to reduce CVD risk i. Reduce fat intake; moderation 1. Sat and trans fats2. Replace w/unsat ii. Limit refined starches and added sugars iii. Eat fruits, vegetable and whole grains iv. Diet rich in omega-3 fatty acids v. Other dietary factors 14. What is hypertension? What is the normal BP? What is BP based on? What are the risk factors for hypertension? Effects of nutrition/lifestyle on hypertension? What is DASH diet? a. Hypertension = higher than normal BP b. Normal BP = 120/80 i. Systolic (120) = pressure during contraction ii. Diastolic (80) = pressure during relaxation c. BP is based on: i. Cardiac output = BP from contractions ii. Peripheral resistance = resistance blood encounters in the small arteries iii. BP inc when either cardiac output or peripheral resistance increases d. Risk factors i. Age (2/3 adults older than 65 have hypertension) ii. Genetics (African Americans higher prevalence) iii. Obesity (60% people w/hypertension are obese) iv. Salt intake v. Alcohol vi. Diet vii. Exercise e. Effects of nutrition i. Nutrition 1. Lowers BP (K, Ca, Mg) 2. Reduces inflammation 3. Lowers LDL cholesterol ii. Lifestyle 1. Decreases stress hormones 2. Redistributed water and eases transit of blood through small arteries f. DASH diet i. Diet rich in fruits, veggies and low-fat milk products w/reduced sat fat intake 15. How does cancer form? a. In genes by mutation b. DNA damaged by carcinogen i. Cellular repair or self-destruction ii. Immune system (well-nourished person destroys damaged cells) c. Cell loses ability to self-destruct i. Replicates uncontrollably d. Mass of abnormal tissue i. Benign (encapsulated tumor) ii. Malignant (metastasis, replicates fast) 16. Risk factors for cancer. How diet can affect cancer? a. Risk factors i. Genetic or microbial infections ii. Lifestyle and environmental exposure iii. Energy intake 1. Reduce calorie intake ????cancer rate falls iv. Obesity1. Obese women have higher levels of circulating estrogen – breast cancer risk v. Avoidance of hormone replacement therapy 1. May reduce breast cancer vi. Physical activity vii. Alcohol viii. Fat and fatty acids b. Diet effects i. Red meat 1. Nitrates added to keep meat red???? become carcinogenic 2. Cooking at high temps form carcinogens 3. Smoking, grilling the same effect ii. Minimize carcinogen formation 1. Roast or bake meats in oven 2. Wrap food in foil when grilling 3. Take care not to burn foods 4. Marinate meats before cooking iii. Increase in your diet 1. Fiber rich foods 2. Folate and antioxidant vitamins 3. Ca and vit D 4. Iron 5. Whole foods and phytochemicals iv. Dash diet: preventive medicine 1. Fruits and veggies a. More matters 2. Make only a few dietary changes at a time Chapter 12 – Food Safety 1. What are the FDA’s 6 main concerns about food safety? a. Microbial foodborne illness b. Natural toxins in foods c. Residues in food i. Environmental contamination ii. Pesticide residues iii. Animal drugs d. Nutrients in food e. Intentionally approved food additives f. Genetically modified foods 2. How do microbes in food cause illness in the body? a. Infection i. Salmonella bacteria or hepatitis viruses b. Intoxication i. Enterotoxins ???? act on mucous membranes ii. Neurotoxins ???? act on cells of the nervous system iii. The most common cause of food intoxication is the Staphylococcus aureus bacterium 1. they are heat-resistant and remain hazardous even after cooked iv. The deadliest is Clostridium botulinum 1. are heat-sensitive and can be destroyed by boiling 3. Main symptoms of foodborne illnesses (FBI)? a. Bloody stools b. Dehydration c. Diarrhea d. Fever e. Headache w/muscle stiffness and fever f. Numbness, weakness and tingling g. Rapid HR, fainting/dizziness h. Severe cramps 4. How does the food get contaminated? What foods are most at risk? How do we reduce contamination? a. Contamination i. Meat – during slaughter 1. Microbes in animals’ guts (E. coli) ii. Fruit & veggies– contamination of water/soil 1. Animal manure or human sewage run off can contaminate irrigation water or soil iii. Oysters, fish can be grown in bacteria contaminated water iv. Salmonella – infects hen’s ovary v. Transfer microbes from hand to food vi. Cross contamination between ready to eat food and un-cooked food b. Foods at risk i. Foods high in moisture and nutrients and chopped or ground are especially favorable hosts for microbial growth ii. Meat, ground meats, stuffed poultry iii. Undercooked eggs accounts for about 30% of U.S. Salmonella infections iv. Unpasteurized raw milk and raw milk products v. Seafood, filter-feeding shellfish (oysters, clams, mussels) vi. Raw produce, vegetable sprouts c. Reduce contamination i. Farm (workers trained what method to grow food)???? processing (workers trained how to prevent contamination – clean machine) ???? transportation (proper temp)???? retail (keep eye on cleanliness and temp)???? table (properly cooked and stored) 5. What are the most dangerous bacteria causing FBI? a. E. coli i. Found in intestines of healthy cattle ii. Shiga toxin 1. E. coli O157:H7 iii. Sources 1. Contaminated meat during slaughter 2. Contaminated water 3. Diarrheal stools iv. Effects 1. Severe bloody diarrhea and ab cramps, dehydration 2. Acute kidney failure in children 3. 6. What are the precautions you need to take to avoid FBI? a. In a grocery store a. Freshness dates (expiration, sell by, consume by) b. Inspect seal, wrappers, buttons, bulging, leakage, soiling, punctures c. Nerve buy dented cans d. Frozen foods should be completely frozen e. Buy fresh eggs and not cracked onesb. The four practices for individuals. a. Clean i. Keep hands clean ii. Wash fresh fruits and veggies iii. Keep kitchen clean b. Separate i. Keep meats away from other foods ii. Avoid cross contamination c. Cook i. Make sure it’s cooked + storing methods after cooking ii. Below 40 and above 140 is safe bc microbes can grow; in-between is perfect environment for microbes d. Chill i. Refrigerate foods quickly 1. After shopping 2. Leftovers ii. Don’t over stud refrigerator 1. Smaller containers get chilled faster iii. Keep fridge below 40F iv. More than 2 hrs in room temp or above 90F ???? throw away v. Refrigerator doesn’t kill microbes, just slows growing process Phytonutrients/Dietary supplements 1. Define of phytochemicals. Their role in the body. a. Phytochemicals = Non-nutrient components found in minute amounts in plant foods b. Role in body i. Help protect plants from germs, fungi, bugs and other threats ii. Compounds that confer color, taste, aroma and texture of foods iii. Bioactive food components that interact w/metabolic processes in body iv. Interact w/each other in synergy 2. What are some important phytonutrients? a. Carotenoids i. Act as antioxidants ii. Alpha and beta carotene (yellow/orange foods), lycopene (red fruits and lowers prostate cancer), lutein (eye nutrient) iii. Sources: greens b. Flavonoids i. Helps prevent cancer (catechins), reduce inflammation (hesperidin) and CVD/lung problems (quercetin) ii. acts as antioxidant and limits damage to brain cells by oxidation c. Resveratrol i. Acts as an antioxidant and anti-inflammatory d. Phytoestrogens i. Can behave like estrogen and can block the effects of natural estrogen 3. Know some foods that have phytonutrients a. Blueberries = dec development of dementia, superfood for brain, b. Chocolate = rich in flavonoids (antioxidants) c. Flaxseed = rich in ligans and chemical that can be converted to phytoestrogens, helps relieve constipation and digestive stressd. Garlic = medical purposes, inhibit cancer development, oposses allergies 4. What are the reasons for taking supplements? a. Correct overt deficiencies b. Support increased nutrient needs i. Breastfeeding women have inc needs to support themselves and their babies ii. Small intestine disease causes inc needs due to absorption problems iii. Women who lose a lot of blood each month (iron deficiency) c. Improve nutrition status and prevent deficiencies i. Vegetarians who avoid certain food groups d. Reduce disease risk i. Inadequate intake of some nutrients linked to inc disease ii. But some studies show that taking supplements also inc risk 5. Who needs supplements? a. Nutrient deficiencies b. Very low energy diets (<1500 kcals/day) c. Strict vegetarians d. People w/allergies or intolerance e. Certain stages of lifecycle (pregnancy, breastfeeding, infants, elderly) f. Digestive system diseases that cause malabsorption g. Medications that interfere w/specific nutrients 6. Why do people stray away from supplements? a. Toxicity i. Foods rarely cause nutrient imbalances or toxicities but supplements can and do b. People self-medicate vs going to doctor c. Some supplements interfere w/medications i. Especially certain botanicals d. False sense of security i. Don’t eat veggies bc I have a multivitamin e. Supplement absorption may interfere w/other nutrients i. Fe and Ca compete for absorption ii. Taken in unnatural form ???? may not be absorbed f. Still being studied g. Waste of money 7. How dietary supplements are regulated? What is required on a DS label? a. Regulation i. Regulated under different set of rules by the FDA 1. Manufacturer must ensure product is safe for marketing 2. FDA is responsible for taking action against unsafe products ii. Dietary supplements don’t need to be approved by FDA 1. FDA has little supplements b. Label requirements i. Other Ingredients ii. Lot number iii. Expiration date iv. Contact information v. DSHEA disclaimer: vi. Units/container vii. Supplement Facts viii. Serving size ix. Amount per serving x. % Daily Value 8. How do you choose a supplement? a. Talk with your doctor, pharmacist and/or RD b. Look for USP label c. Choose a type d. Read labels e. Look for your target needs f. Look at the quality g. Avoid marketing traps