DHN 212 Exam 3

Describe the general characteristics of vitamins

-organic nutrient
-do not provide energy (kcal)
-essential for life

List the fat-soluble vitamins

vitamin A,D,E,K

list the water soluble vitamins

vitamins B and C

What are some of the reasons why vitamins are important to health?

-bone health
-energy metabolism
-blood clotting
-growth and development
-RBC formation
-immune function
-antioxidant defense
-amino acid metabolism

What is a free radical and how do antioxidants work (simplistically)?

-substance with unpaired electrons
-protect cells by giving up electrons to free radicals

What nutrients act as antioxidants?

vitamins C,E,A

Define vitamin bioavailability

Amount of vitamin that is actually available for use by the body

What are factors that influence the bioavailability of vitamins?

-GI transit time
-health conditions affecting fat absorption
-food processing and preparation
-source of the vitamin

Contrast the effects of different food preparation techniques on vitamins - do you recommend boiling, steaming, microwaving, stir-frying vegetables?

-steaming do not come in contact with the water
-boiling lose some of the vitamins
-sauté oil can optimize bioavailability
-microwaving no water, cooks for short amount of time
-recommend steaming, sauté, and microwaving

What are the general characteristics of fat-soluble vitamins?

-often occur together with fat in foods
-require fat (and bile) for absorption
-concentrated and stored in tissues

vitamin A
(1.) the main forms of the vitamin
(2.) key functions of that vitamin (3.) at least three good food sources of that vitamin
(4.) what happens with a deficiency of that vitamin
(5.) what happens with a toxicity of that vitamin.

1.retinoids, beta carotene (preformed vitamin A)
2.vision, reproduction, cellular growth, immune system
3.eggs, fish, yellow/orange pigment foods, milk
4.night blinds, dry eye, poor growth, frequent infections
5.liver damage, carotenemia (yellowing of skin)

Vitamin D
(1.) the main forms of the vitamin
(2.) key functions of that vitamin (3.) at least three good food sources of that vitamin
(4.) what happens with a deficiency of that vitamin
(5.) what happens with a toxicity of that vitamin.

1.calciferol, ergocalciferol (D2 plant), cholecalciferol (D3 animal), 7-dehydrocholesterol (sun converts into D3)
2.bone health, immune system, reduce risk of chronic disease
3.fish, dairy products, egg yolks
4.rickets, osteomalacia
5.calcium deposits in soft tissues, poor growth

Vitamin E
(1.) the main forms of the vitamin
(2.) key functions of that vitamin (3.) at least three good food sources of that vitamin
(4.) what happens with a deficiency of that vitamin
(5.) what happens with a toxicity of that vitamin.

1.alpha tocopherol, gamma tocopherol
2.antoxidant
3.nuts, sunflower oils, soybeans
4.not common
5.not from foods, interfere with vitamin K in blood clotting, hemorrhage

Vitamin K
(1.) the main forms of the vitamin
(2.) key functions of that vitamin (3.) at least three good food sources of that vitamin
(4.) what happens with a deficiency of that vitamin
(5.) what happens with a toxicity of that vitamin.

1.phylloquinone(most active form), menaquinone, menadione, dark leafy greens
2.production of active blood clotting, necessary to make fibrin
3.green leafy vegetables, fish, liver, eggs
4.excessive bleeding, newborns given vitamin K shots
5.unknown, people on warfarin (blood thinner) should monitor vitamin K

What are the general characteristics of water-soluble vitamins?

-B vitamins timpani, riboflavin, niacin, vitamin B-6, pantothenic acid, folate, biotin, vitamin B12
-Vitamin C

All B-vitamins serve what common role?

serve as coenzymes in energy metabolism

Which vitamin(s) is deficient in the following conditions - scurvy, beriberi, pellagra, neural tube defects, megaloblastic anemia, pernicious anemia, nerve damage leading to paralysis?

-thiamin/beriberi
-niacin/pellagra
-folate/megaloblastic anemia, neural tube defects
-vitamin B12/pernicious anemia, pernicious anemia, nerve damage leading to paralysis
-vitamin C/scurvy

What are the classic signs of ariboflavinosis?

-glossitis, inflammation of the tongue
-chilosis, red dry cracks on lips
-skin rash, confusion/headaches

Why would someone be taking high doses of niacin and what are potential toxicity concerns?

-4 Ds, dermatitis, diarrhea, dementia, death
-megadoses used to treat high cholesterol. not from foods

What are two key functions of folate?

DNA synthesis and homocysteine metabolism

Describe why more healthcare facilities are testing for blood homocysteine levels.

high levels in the blood are risk for heart disease, cancer, dementia, etc.

List at least three food sources of folate.

-asparagus and papaya
-cereal grain enriched in folate acid

How much folate should women of childbearing potential consume?

400 ug/day

When does the neural tube close during pregnancy?

within 6-8 weeks of pregnancy

What are two concerns with excessive intake of folate?

too much may stimulate cancer cell growth and masks vitamin B12 deficiency

How is vitamin B12 important?

part of coenzymes needed for folate metabolism, homocysteine metabolism, and maintenance of myelin sheaths

Vitamin B12 is only found in \___ foods.

animal

What substance is required for B12 digestion and absorption? Where is it secreted?

intrinsic factor, secreted in stomach

What happens to B12 levels as you age?

as you get older the body makes less intrinsic factor. more likely to have a B12 deficiency

List three populations at an increased risk for a B12 deficiency and explain WHY each is at increased risk.

-vegans
-elderly
-people with gastritis, could result of viral/bacterial infection or GI disorder

How long does it generally take for paralysis to develop as a result of a B12 deficiency?

results in 5-10 years

Identify key functions of vitamin C to health

-connective tissue synthesis
-antioxidant
-immune system
-synthesis of neurotransmitters
-enhances iron absorption in GIT

List at least three food sources of vitamin C.

-fresh fruits and vegetables
-green leafy vegetables
-red bell peppers

What are two classic signs of scurvy?

-poor wound healing
-pinpoint hemorrhages
-bleeding gums
-bruises
-depression

What is the UL for vitamin C?

2000 mg/day (2g/day)

Would you recommend vitamin C for someone to fight the common cold? Why or why not? And, if yes, how much would you recommend?

yes, because shortens cold by one day, decreases severity of symptoms by 25%

List the six classes of dietary supplements

vitamin, mineral, herb, botanical, amino acid, metabolite

How are supplements regulated (or not)?

-DSHEA requires labeling and honesty on product
-FDA does not test or evaluate safety

When is the best time to take a multivitamin/multimineral?

take with food, full stomach retains pill and dissolves it with its churning action

What food/beverage would you recommend be consumed at the same time as an iron supplement to maximize absorption?

vitamin C, OJ, citrus fruits

What are the general characteristics of minerals?

• inorganic nutrients

• needed in small amounts

• classify as major. trace, or possible essential

What is the definition of a major mineral?

stored predominately in bones. calcium and phosphorus

Which mineral is found in the highest concentration on the human body?

calcium

Describe the most important functions of calcium.

-bone and teeth (mineralization of bone and teeth)
-muscle contraction
-blood clot formation
-nerve transmission

List at least three good food sources of calcium.

-cows milk, whole grain cereal, green leafy foods, dairy foods

What are three factors that influence calcium absorption and bioavailability?

-stomach acid secretion
-drinking on cup of milk
-high fiber/phosphorus intake

What happens if calcium intake is insufficient?

-vitamin D deficiency
-reduced stomach acid secretion
-chronic diarrhea
-fat malabsorption

Describe how the body responds when blood calcium levels are low

The hormone PTH (parathyroid hormone) is secreted from parathyroid glands

1. PTH then stimulates vitamin D activity

2. Increases activity of osteoclast cells (cells that break down bone)

3. Increase calcium retention in the kidneys (so not as much is secreted in the urine)

4. Increases calcium absorption in the small intestine Ultimately through those 4 actions blood calcium levels should RISE

Describe how the body responds when blood calcium levels are high

The hormone calcitonin is secreted from the thyroid gland

1. Inhibits vitamin D activity

2. Increases osteoblast activity (bone forming cells)

3. Decreases calcium retention in the kidneys (excrete more in the urine)

4. Decreases calcium absorption in the small intestine Ultimately through those 4 actions blood calcium levels FALL

When is peak bone mass achieved for most people?

around age 30

List four key modifiable risk factors for osteoporosis.

-following diets that contain inadequate amounts of calcium and vitamin D
-using medications such as steroids or some type of anticonvulsants
-being physically inactive
-smoking cigarettes
-consuming excessive alcohol

What recommendations do you have for a person at risk for osteoporosis?

• Proper diet and regular exercise

• Exposing skin to sunlight to form vitamin D

• Exercise Training (weight-bearing activities)

Describe the actions of ADH and renin/angiotensin/aldosterone.

-ADH, secreted from pituitary glands in response to dehydration, stimulates kidneys to conserve water
-renin/angiotensin/aldosterone, in response to low blood volume and falling BP, stimulates kidneys to conserve water and sodium/electrolytes

How have overweight and obesity rates changed in the US between 1988 and 2019?

-overweight has not changed that much over the last 20 years
-obesity drastically changed. 1990s 23% to 34%. extreme obesity 30% to 64%

List specific health problems associated with obesity.

-pulmonary disease
-gallbladder disease
-fatty liver disease
-male and female gynecologic abnormalities
-osteoarthritis (knees)
-certain types of cancer (hormonal)
-gout (toes/feet)
-pancreatitis
-coronary heart disease
-cataracts
-stroke
-hypertension

Be able to calculate a person's BMI

BMI \= weight (kg)/height (m)^2 * 703

identify if that person is underweight, normal, overweight, or obese class I, II, III.

-

What are major limitations of using only BMI to evaluate a person's health?

-does NOT account for body composition
-muscle weighs more than fat

subcutaneous fat

-layer underneath
-women have more in hips, butt, abdominal cavity

visceral fat

-fat embedded within abdominal cavities and vital organs
-more derimental

Which fat is more dangerous from a health standpoint?

visceral \= DANGER

List two ways that body fat can be measured.

-underwater weighing
-air displacement

What are healthy body fat percentages for males and females?

-men 13-21%
-women 23-31%

What can waist circumference tell you about a person's health?

-assesses android obesity
-greatest contributor to risk for chronic disease
-looks at visceral fat

Are males more likely to have an "apple" or "pear shape?"

apple shape

Are females more likely to have an "apple" or "pear shape?"

pear shape

Remember that if energy in is equal to energy out

a person should maintain their current body weight

What are the four components of energy output?

-basal metabolic rate (BMR)
-physical activity
-thermic effect of food
-non exercise activity thermogenesis (NEAT)

What factors influence how much energy a person burns during physical activity?

type of activity, duration, intensity, weight of person

What is the thermic effect of food and how significantly does it contribute to a person's energy output?

-small amount of energy required to digest, absorb, and metabolize nutrients
-5-10% of total energy output
-higher percentage\=burning more calories as heat

What is NEAT?

Nonexercise activity thermogenesis, is the energy expended during spontaneous physical activity that is not active muscular contraction characteristic of exercise.

What are examples of internal, individual, community, local, and global factors that influence a person's body weight?

-genetic factors
-psychological factors
-access to food
-caloric intake
-stress levels

Describe the set-point theory.

bodys fat content and body weight in genetically pre determined

A person who is obese is more likely to have more or less active "thrifty genes?"

more active

Contrast hunger and appetite.

-hunger is the psychological need to eat
-appetite is the desire to eat appealing food

Briefly describe how ghrelin and leptin influence food intake.

-grehlin stimulated/released from the stomach, stimulates hunger, appetites, and food intake
-leptin secreted from adipose tissue, tells the brain you are satiated

What dietary recommendations do you have for a person voluntarily trying to lose weight?

portion and calorie control, emphasize fruits and vegetables, self monitoring

What behavioral recommendations do you have for a person voluntarily trying to lose weight?

physical activity, stress management, sleep

How do weight-loss medications work?

-from a neural standpoint, reduces a persons appetite
-inhibit fat absorption

what is disordered eating

chaotic and abnormal food related practices

what is an eating disorder

physiological disturbances that lead to certain physiological changes and serious health complications

What are the three major types of eating disorders?

-anorexia nervosa
-bulimia nervosa
-binge eating disorder

List the risk factors for eating disorders

-female
-adolescent
-history of frequent dieting
-first-degree relative with an ED
-"ideal" body shape important
-poor self-image and low self-esteem
-perfectionist
-dysfunctional family
-occupation or sport that emphasizes lean body

Describe the general characteristics of anorexia nervosa (AN).

-self imposed starvation
-caloric intake well below BMR
-lose significant amount of weight quickly and nutrient deficient
-100-200kcal

What are three signs or symptoms of AN?

low self esteem, distorted body image, extreme thinness

Describe the general characteristics of bulimia nervosa (BN).

-repeated episodes of binge eating, followed by unhealthy behaviors to prevent weight gain
-5,000-10,000kcals
-done in private/later in the day

What are three signs or symptoms of BN?

-swollen salivary glands
-intestinal distress and irritation
-severe dehydration

Describe the general characteristics of binge eating disorder (BED).

-Recurrent episodes of binge eating, NOT followed by purging behaviors
-Individual often normal weight or overweight

What are three signs a person may have BED?

• Eating unusually large amounts of food in a short period of time

• Eating until uncomfortably full

• Eating when not hungry

• Eating fast during binge episodes

• Eating alone or in secret to avoid embarrassment

• Feeling ashamed about eating

• Dieting frequently, possibly without weight loss

describe diabulimia

-Person with diabetes (particularly type 1), restricts insulin in an effort to lose weight
-Blood glucose levels go up, and body weight goes down

describe orthorexia

-Extreme obsession with eating healthy foods
-Fear of eating unhealthy food

describe night eating syndrome

-Binge takes place after the evening meal and when person awakes from sleep during the night
-50% kcals during binge

describe muscle dysmorphia

-Unhealthy preoccupation with the bod being too small or not muscular enough
-Exercise obsessively
-More common in males than females
-Prevalence on the rise

What are the three components to the female athlete triad?

-Low energy availability
-Menstrual disturbances (menuria)
-Reduced bone mineral density

Describe treatment options for eating disorders.

-Multidisciplinary effort
-Out patient and in patient treatment options
-Innovative therapies, Cognitive behavioral therapy (CBT)
-Alternative therapies for eating disorder

What are examples of alternative therapies that may be beneficial as complementary treatment with eating disorders?

• Acupuncture

• Phototherapy

• Equine Therapy

• Meditation

• Biofeedback

• Relaxation Therapy

Where would you refer a UK student who may have an eating disorder?

Counseling center