NS 1410 TTU Exam 3

Characteristics of Water Soluble Vitamins

Absorbed directly into the blood.

Travel freely.

Excess excreted in the urine.

Needed in frequent doses (1-3 days).

Characteristics of Fat Soluble Vitamins

Absorbed into the lymphatic system and then the blood.

Require a protein or lipid carrier for transport.

Can accumulate in liver or adipose tissue.

Needed in periodic doses (weeks or months)

Which vitamins are water soluble?

B-complex vitamins

Vitamin C (antioxidant)

Which vitamins are fat soluble?

Vitamins A, D, E, K

Factors that Promote Iron Absorption

Meat Factor (special factor in meat, fish and poultry that aids absorption of non-heme iron)

Stomach Acids (reduces ferric 3+ iron to ferrous 2+ iron which is more soluble in the alkaline environment of the small intestine)

Vitamin C Acids (reduces ferric 3+ to ferrous 2+ and forms a soluble iron-ascorbic acid complex in the stomach)

Factors that Impair Iron Absorption

Phytate (found in legumes, rice and whole grains)

Polyphenols (found in oregano, red wine, tea and coffee)

Vegetable proteins, fiber and calcium (soy, whole grains, milk)

Methods of Water Loss

Loss through urine, sweat, and exhalation.

Common Deficiencies in the U.S. and World.

Iron most common.

Underweight (having too little body fat to maintain health)

Increased risk of health problems (infection)

18.5-24.9 kg/m2

Normal

25-29.9 kg/m2

Overweight (having a moderate amount of excess body fat)

30-39.9 kg/m2

Obese (having an excess of body fat that affects health)

Significantly increased risk of health problems

>40 kg/m2

Morbid Obesity (body weight exceeding 100% or normal)

Very high risk of increased risk of health problems.

5 of the 9 leading causes of death in the U.S. are associated with obesity/morbid obesity.

Limitations to the BMI

Not an indication of body composition.

It may overestimate body fat in athletes and other who have a muscular build.

It may underestimate body fat in older persons and other who have less muscle/bone mass.

Heath Risks Associated with Low BMI

Increased risk of health problems (infections).

Health Risks Associated with High BMI

Increases risk of health problems and the leading cause of death is associated with obesity/morbid obesity.

Densitometry

Underwater weighing—gold standard (MOST accurate, but typically only used for research purposes)

Anthropometry

Measurement of skinfold thickness using skinfold calipers or body circumferences.

This is the least accurate measurement available.

Highly dependent on person taking measurement and degree of training.

Conductivity

Bioelectric impedance

Accuracy depends upon several factors.

Current hydration status makes results variable.

However, least invasive and fairly accurate.

Dual-Energy X-Ray Absorptiometry (DXA)

First developed to measure bone mineral content and density.

Absorption of water, fat mass and muscle mass differ.

Calculated of these body compartments determine % fat.

Very accurate assessment of body composition.

Near Infrared Reactance

Futrex

Fairly inaccurate

Bod Pod

Air displacement (plethysmography)

Expensive

Diseases Associated with Obestiy

Chronic obstructive pulmonary disease

Diabetes melitus

Heart disease, cancer, stroke are the leading deaths caused by obesity.

Fat distribution patterns and risk of chronic disease.

Measured by waist-to-hip ratio and waist circumference.

Apple shaped fat patterning—upper body

Men tend to store fat abdominally

Increased risk for chronic

Pear shaped fat patterning—lower body

No significant increased risk for chronic disease.

Women tend to store fat in the lower body.

What increases the risk for chronic disease?

Abdominal fat.

BMR increases with

More lean body mass, during stress, and periods of growth (childhood and pregnancy)

BMR decreases with

Age and during energy restriction (fasting or starvation)

Recommended weight loss rate and method

Gradual changes in energy intake (500-1000kcal/day deficit)

Regular and appropriate physical activity (30 min/day, 5 days/week)

Behavior modification technique

Safe and effective weight loss is about 1-2 pounds/week

Recommendations for weight gain

Limit fat (

Characteristics of fad diets

Fads that DO NOT result in long term, healthful weight changes.

Their rise in popularity is rapid (also their decline).

They have a special appeal or prestige.

They are or at least sound easy.

They relieve the dieter of all responsibilities and decisions.

They distort, or ignore, basic nutrition principles.

They seldom include a full variety of foods.

If it sounds too good to be true it probably is!

General information about weight loss diets and treatments for obesity including pros and cons.

Hypertension (High Blood Pressure)

Increased weight is usually in fatty tissue.

Tissue needs oxygen and nutrients to live, therefore increased # of capillaries, increased amount of blood needed, added pressure to heart and arteries to pump more blood farther.

Increased weight increases insulin levels (insulin associated with sodium and water retention)

Contributes to increased blood volume (increased weight associated with increased heart rate and reduced capacity of blood vessels to transport blood)

Diabetes

Obesity is the leading cause of this

Excess fat makes body resist action of insulin (maintains blood glucose).

Resistance of insulin leads to hyperglycemia (cells lack energy (can't get to it), increases peripheral resistance)

Dyslipidemia (Abnormal Blood Facts)

Usually from diet high in saturated fat (high LDL-C, low HDL-C, high triglycerides)

Leads to atherosclerosis (build-up of fatty deposits) (increases risk of CAD and stroke)

Coronary Artery Disease

Fatty deposits build up in artery walls

Less blood to the heart (angina occurs)

Complete blood block (heart attack)

Stroke

Atherosclerosis goes throughout the body (even arteries in brain)

Block blood flow in the brain

Obesity increases risk

Gall Stones

Deposits of cholesterol in gallbladder

Gout

Joint disorder

Osteoarthritis

Joint disorder (knees, hips, lower back)

Extra weight = extra pressure (wears away cartilage, joint pain and stiffness)

Sleep Apnea

Stop breathing at times when sleeping, and snore heavily.

Upper airway blocked—waking up at night.

Daytime drowsiness.

Cancer

A group of related diseases characterized by cells growing "out of control" Several associated with obesity

Women: breast, uterine, colon, gallbladder

Men: colon, prostate

Medications for Weight Loss

Act as appetite suppressants and may increase satiety.

Physician involvement critical; many weight-loss drugs have serious side effects.

Long-term safety of drugs being explored.

Bariatric Surgery

Surgical procedure that restricts stomach size and/or leads to decreased absorption of nutrients.

Benefits: Improvement in type 2 diabetes, sleep apnea

Risk: Several, including death

Only for morbid obesity

Serious surgery with varied outcomes and possible complications.

Often very successful.

Historically this was a last resort.

New research suggest that this surgery should no longer be a last resort, but rather be done BEFORE diabetes, CVD, etc. are severe.

Surgery Qualifications: BMI 35+ and at least 2 co-morbidity OR BMI 40+

Vertical Band Gastroplasty

Nearly 80% failure rate reported 10 years following vertical-band gastroplasty

Gastroplasty not favored

Poor weight loss maintenance

15-20% reoperation incidence

Gastric Banding

Uses a premeasured prosthetic device to restrict oral intake (circumference usually 0.5cm, some bands inflatable to adjust diameter by infusion of saline)

Weight loss results and complications are much better with flexible band.

Less consistent weight loss with gastric banding than with banded gastroplasty and gastric bypass.

Gastric Bypass

Combines gastric resection with a small amount of sub-clinical malabsorption.

Some malabsorption of iron and B12, but none reported with CHO, fat, or protein.

Roux-en Y preferred method of gastric bypass

Mean weight loss 35% of initial weight

Biliopancreatic Bypass (BPB)

Modest amount of gastric restriction with intestinal malabsorption.

Entire jejumum is excluded.

Average of 75-80% excess weight

Metabolic complications within first post-op year include: 30% anemia, 30-50% fat soluble vitamin deficiencies, 3-5% incidence of hospitalization for treatment of protein-calorie malnutrition.

Gastric Sleeve

NOT a bypass surgery because you don't bypass the duodenum.

Method of action and side effects of weight loss medications.

Many weight-loss drugs have serious side effects

Dangerous or ineffective supplements can be marketed and sold without meeting the FDA's strict safety and quality standards.

Insufficient evidence to support their use.

Stimulants speed up metabolic processes, are controversial, and may be dangerous (caffeine, phenylpropanolamine (PPA), and ephedra)

Protein supplements do not increase muscle growth or strength (potential side effects: Dehydration, compromised absorption of amino acids, gout, liver and kidney damage, and calcium loss)

Medications act as appetite suppressants and may increase satiety.

Components of a sound weight loss program.

Dietary recommendations

Physical Activity Recommendations

Behavior Modification Recommendations

Any successful weight lost program must include all 3 of these.

Family characteristics for eating disorders

Our family influences what we eat and our patterns with regard to eating.

Families with an anorexic member seem to have a more rigid family structure.

Families in which a member has bulimia show a less stable family organization.

Anorexia Nervosa Personality Traits

Obsessive-compulsive behaviors

Perfectionism

Social inhibition

Compliance

Emotional restraint

Anorexia Nervosa

85-95% are young girls and women.

0.5-3.7% of US females will develop anorexia

~20% of females with anorexia will die from complications

Most common and deadly psychiatric disorder in women

One of the leading causes of death in females between 15-24 years.

Prevalence lower in men.

Anorexia Nervosa Signs and Symptoms

Extremely restrictive eating practices.

Intense fear of gaining weight.

Amenorrhea: No menstrual period for at least 3 months; occurs with insufficient energy to maintain normal body functions.

Signs may be somewhat different in males.

Anorexia Nervosa Health Risks

Electrolyte imbalance (irregular heartbeat, heart failure, death)

Cardiovascular problems (rapid heart rate, low blood pressure, dizziness, fainting due to starvation, low body temperature)

Gastrointestinal problems (weak and loses ability to function, irritable bowel syndrome, constipation, loss of peristalsis, delayed emptying of food)

Bone problems (with amenorrhea due to decreased estrogen production results in poor bone health—causes osteoporosis)

Anorexia Nervosa Treatment

Restore to a healthy weight.

Treat complications.

Encourage healthful behaviors.

Correct dysfunctional feelings toward the eating disorder.

Enlist the help of family and friends.

Bulimia Nervosa

Eating disorder characterized by repeated binge eating followed by purging.

Binge eating: Eating a large amount of food in a short period of time (2 hours) (feels a loss of self-control, a sense of euphoria, "a drug induced high")

Purging occurs after most binge episodes: an attempt to rid the body of unwanted food by vomiting, laxatives, diuretics, fasting for days (following a binge), excessive exercise.

Higher prevalence than AN—affects 1-4% of women

Affects women more than men

A higher prevalence in seen in men who participate in "thin build" sports (wrestling, horse racing, gymnastics)

50% of those diagnosed with anorexia will also be diagnosed with bulimia nervosa at some point, making the statistics on bulimia nervosa difficult to interpret.

1% of patients will die from complications within 10 years of diagnosis.

How to tell if someone (especially a family member) may have bulimia.

Large amounts of food disappear

Frequent trips to the bathroom after a meal or frequent smell of vomit.

Excessive exercise

Withdrawal from usual friends and family

Comments about weight loss or diet is their primary concern.

Bulimia Nervosa Personality Traits

Impulsiveness

Low self-esteem

Extroversion

Erratic personality style that seeks attention and admiration.

Bulimia Nervosa Symptoms

Recurrent episodes of binge-eating (eating a large amount of food in a very short time period (

Bulimia Nervosa Signs

Chronically inflamed and sore throat.

Swollen glands in the neck and below the jaw.

Bulimia Nervosa Health Risks

Electrolyte imbalance (caused by dehydration and loss of sodium and potassium irons from vomiting, imbalance from dehydration can result in irregular heartbeat, failure, and then death.)

Gastrointestinal problems (inflammation, ulceration, and possible rupture of the esophagus or stomach, chronic irregular bowel movements and constipation due to laxative abuse.)

Dental problems (tooth decay and staining, mouth sores from stomach acids released during vomiting.)

Calluses on backs of hands or knuckles from self-induced vomiting.

Swelling of the cheeks or jaw area from frequent vomiting.

Bulimia Nervosa Treatment

Identify and modify the events that trigger bingeing and purging behaviors.

Monitor and alter thought patterns related to food and body image.

Include family and friends to support the patient.

Binge Eating Disorder

Recurrent episodes of eating larger amounts of food than most would eat; occurs during a short period of time.

The person feels a lack of control during this time.

Does NOT include inappropriate compensatory behaviors (i.e. purging, fasting, excessive exercise)

Food triggers: foods high in fat and sugar.

Binge Eating Disorder Symptoms

Often overweight

Chaotic eating behaviors (eating too fast, too much, in private)

Psychological consequences: negative self-esteem/poor body image, avoidance of social contact.

Binge often occurs after stressful events.

Often associated with depression, substance abuse, and anxiety disorders.

Diagnostic Criteria for BED

Binge eating episodes are associated with at least three of the following criteria (DSM-V): eating rapidly, eating when not physically hungry, eating when alone, eating until uncomfortably full, feeling self-disgust about bingeing.

Disordered Eating

Comprised of a variety of unhealthful behaviors including: binge-eating, chronic overeating, chronic dieting

None of these last long enough to cause the person serious illness, but can progress to an eating disorder.

Night-Eating Syndrome

Like binge-eating disorder, it is associated with obesity.

People who are not hungry during the day, but eat in the evening and night.

Consume majority of energy between 8pm and 6am.

Consume significant energy in frequent snacks.

Combination of eating disorder, sleep disorder, and mood disorder.

Muscle Dysmorphia

To have the idea that one is not sufficiently lean and muscular.

Spend long hours lifting weights, and follow an extremely restrictive diet.

Perception is that they are small and frail even though they may actually be quite large and muscular.

Reverse anorexia nervosa.

Chronic Dieting Symptoms

Preoccupation with food, weight, and calories.

Strict dieting.

Excessive exercise.

Loss of concentration; mood swings.

Increased criticism of body shape.

Chronic Dieting Health Risks

Poor nutrient and energy intakes.

Decreased caloric intake causing inadequate vitamin and mineral intake.

Decreased energy expenditure due to a reduced basal metabolic rate.

Decreased ability to exercise.

Increased risk of psychiatric eating disorder.

Female Athlete Triad

Disordered eating: Inadequate food intake and regular strenuous exercise combined, result in a state of severe energy drain that causes a multitude of hormonal changes, including a reduction in estrogen production.

Menstrual irregularities: From a decrease in estrogen production.

Osteopenia/Osteoporosis: Softening of the bone diagnosed pre-menopause.

Risk Factors of Developing an Eating Disorder

Vitamin A Functions.

As an antioxidant->scavenges free radicals and protects LDL from oxidation.

Essential for healthy vision.

Cell differentiation, process by which stem cells mature into specialized cells.

Differentiates immune cells (T cells) to assist in fighting infection. Sperm production and fertilization.

Bone growth.

Vitamin A Food Sources.

Animal (liver, eggs, dairy, fortified foods)

Plants (red, orange, yellow, and deep-green fruits and vegetables that are high in beta carotene can be converted to vitamin A)

Vitamin A Deficiency Disease

Less common in developed countries, is a severe public health concern in developing countries.

Eye problems: Night blindness is most common, others: Corneal drying (xerosis), triangular gray-foamy spots on eye (Bitot's spots), softening of the cornea (keratomalacia), corneal degeneration /hardening and blindness (xerophthalmia)

Impaired immunity (increased susceptibility to infections and increased death rates from infections like measles.)

Hyperkeratosis (plugging of hair follicles with keratin, forming white lumps.

Vitamin A Toxicity Symptoms

Vitamin A can be highly toxic, especially from supplements at 3-4 times RDA.

Animal sources of vitamin A can be toxic. (birth defects and permanent damage to the liver, bones and eyes can result.)

Plant sources are NOT toxic.

Chronic symptoms (increased activity of osteoclasts causing reduced bone density, liver abnormalities (enlarged), birth defects, spontaneous abortion.)

Acute symptoms (blurred vision, nausea, vomiting, vertigo, increase of pressure inside skull, mimicking brain tumor, headaches.)

Selenium Functions.

Antioxidant: Part of the glutathione peroxidase enzyme system (decreases the risk of radicals, sparing vitamin E)

Needed for production of thyroxine, a thyroid hormone.

Poor status associated with cancer.

Selenium Food Sources

High sources are brazil nuts, lobster, and crab.

Other sources are organ meats, pork, seafood, egg, milk, nuts, seeds, wheat, and rice.

Selenium Deficiency Disease.

More common in areas of China where the level of selenium in the soil is very low.

Keshan disease: a heart disease (primary symptom is myocardial necrosis leading to a weakened heart, makes the body more susceptible to illness caused by other nutritional, biochemical, or infectious diseases.)

Kashin-Beck disease: an arthritis (results in atrophy, degeneration, and necrosis of cartilage tissue.)

Impaired mobility.

Infertility, depression, impaired cognitive function, muscle pain and wasting.Sele

Selenium Toxicity Symptoms

Can result from supplements.

Brittle hair and nails, skin rashes, vomiting, nausea, weakness.

Extreme cases can result in cirrhosis of the liver, pulmonary edema and death.

Calcium Functions.

Form and maintain bones and teeth.

Assists with acid-base balance.

Transmission of nerve impulses.

Assist in muscle contraction

Calcium Food Sources

Milk and milk products.

Low-fat cheese, nonfat yogurt.

Fortified foods (orange juice, soy/almond milk)

Green leafy vegetables (broccoli, kale, collard greens, and cabbage)

Small fish with edible bones (sardines, salmon)

Calcium Deficiency Disease.

Osteoporosis: from long-term calcium deficiency.

Hypocalcemia (low blood calcium) can be caused by kidney disease, vitamin D deficiency, or diseases that inhibit PTH production.

Calcium Toxicity Symptoms

Excess excreted in feces.

Calcium supplements can lead to mineral imbalances.

Hypercalcemia (high blood calcium) can be caused by caner or parathyroid hormone (PTH) overproduction.

Calcium bioavailability from spinach is very low: absorption rate is 5%.

Vitamin D Functions

Regulated blood calcium levels.

Stimulates osteoclasts when calcium is needed elsewhere in the body.

Necessary for bone calcification.

May decrease cancer growth.

Vitamin D Food Sources

Ergocalciferol (D2): plants, supplements

Cholecalciferol (D3): animal foods, sun

Fortified foods such as milk

Cod liver oil, fatty fish

Vitamin D Deficiency Disease

Loss of bone masscan occur with diseases that reduce intestinal absorption of fat.

Rickets—in children

Osteomalacia—in adults

Vitamin D Toxicity Symptoms

Can occur from vitamin supplements.

Results in hypercalcemia—high blood calcium.

Vitamin K Function

Blood coagulation (primary)

Bone metabolism function (assists in the production of osteocalcin, a protein that is associated with bone turnover.)

Vitamin K Food Sources

Bacterial synthesis in the digestive tract.

Green leafy vegetables, kale, cabbage-type vegetables.

Vitamin K Deficiency Disease

Reduced blood clotting, excessive bleeding=hemorrhaging.

Can occur with diseases that disturb absorption of fat in the small intestine (celiac disease, Chron's disease, cystic fibrosis)

Long-term use of antibiotics can lead to deficiency

Injection of vitamin K at birth for new borns

Vitamin K Toxicity Symptoms

No side effects from large quantities, however will interfere with anticoagulant medicine. Mainly from supplements (few vitamin/mineral supplements contain vitamin K)

Magnesium Function

A mineral found in bone structure.

Cofactor for over 300 enzyme systems.

Supports vitamin D metabolism, muscle contractions, and blood clotting.

Magnesium Food Sources

Green leafy vegetables.

Whole grains, seeds, nuts.

Seafood.

Beans.

Dark Chocolate.

Some dairy

Magnesium Deficiency Disease

Hypomagnesemia can result in low blood calcium and osteoporosis.

Magnesium Toxicity Symptom

No toxicity from magnesium in food.

Magnesium supplements can cause diarrhea, nausea, cramps, dehydration, acid-base imbalances (often in form of a laxative)

Fluoride Function

Development and maintenance of teeth and bones.

Combines with calcium and phosphorus to protect teeth from bacteria.

Stimulates bone growth.