Nutriton Exam 2

Marquette University HEAL 2045

Stability of vitamins in their environment

• Organic compounds made of carbon, hydrogen, oxygen,and sometimes nitrogen or other elements
• Facilitate biochemical reactions within cells
• Essential to life
• Individual molecules
• Do not provide energy (calories), but they are needed for metabolism of energy
• Needed in microgram or milligram quantities
• Vitamins are chemically defined.
• Extremely complex chemical substances.
• Absorption rates of natural and synthetic vitamins sometimes differ because of different chemical forms of the same vitamin.
• Vitamins are susceptible to destruction.
• Vitamins in food are susceptible to destruction and subsequent loss of function.

• Vitamins may exist in more than one form.
• Different forms perform different functions in the body.
• Provitamins.
• Vitamins are essential.
• With few exceptions, the body cannot make vitamins.
• Some vitamins are coenzymes.
• Many enzymes cannot function without a coenzyme, and many coenzymes are vitamins.

• Some vitamins are antioxidants.
• Free radicals are produced continuously in cells as they burn oxygen during normal metabolism.
• Oxidize body cells and deoxyribonucleic acid (DNA) in their quest to gain an electron and become stable.
• Antioxidants protect body cells from being oxidized (destroyed) by free radicals.
• Major antioxidants are vitamin C, vitamin E, and beta-carotene.

• Some vitamins are used as food additives.
• Some foods have vitamins added to them simply to boost their nutritional content.
• Vitamins as medications
• In megadoses, vitamins function like drugs, not nutrients.

• Vitamin: organic molecules required in very tiny amounts for cellular metabolism
• Micronutrient: nutrients that are needed in very small amounts
• Each vitamin performs a specific metabolic function
• Vitamins are essential in the diet b/c the body cannot make them –with a few exceptions. The body can make Vit A, Vit D, & Niacin if appropriate precursors are available

Supplementation of folic acid may mask which vitamin deficiency?

Vitamin B12 deficiency

Are vitamin supplements necessary? Who would benefit from them?

They are not necessary. People who can benefit from them include:

-dieters who consume fewer than 1200 cal/day

-Vegans, who eat no animal products

-People with poor appetite or illness or those who intentionally eliminated one or more food groups from their diet on a regular basis

-older adults with known risk factors

-women of childbearing age who may become pregnant

-alcohol dependent people

-people who are food insecure

-people with chronic illness or chronic use of a medication that impairs nutrient absorption or increases nutrient metabolism or excretion

Differences between fat and water soluble vitamins/how they are stored/excreted etc.

Fat soluble vitamins

• Sources are the fat and oil portion of foods.
• Absorption: fat encased in chylomicrons that enter the lymphatic
system before circulating in the bloodstream.
• Transportation through the blood occurs by attaching to protein
carriers because fat is not soluble in watery blood.
• When consumed in excess, stored primarily in liver and adipose tissue.
• Can be toxic if consuming high intakes through supplements.
• Do not have to be consumed daily because the body can retrieve them from storage as needed.

-They are excreted primarily in feces in through the bile

Fat soluble Vitamins: A, D2, D3, E, K

Water-soluble vitamins

-dissolve in water

-Obtained from body, so they are typically not stored

-excreted in the urine

Examples of water-soluable vitamins: Thiamin (B1), Riboflavin (B2), Niacin (B3), Pyridoxine (B6), Folate, B12, C, phytochemicals

What can affect Vitamin D synthesis in our environment

Season, time of day, air pollution, skin pigmentation, sunscreen use, aging.

How is vitamin D affected in older adults?

It is associated with lower vitamin D synthesis

Interaction between vitamin K and anticoagulants

• Deficiency does not occur from inadequate intake but may occur secondary to malabsorption syndromes or the use of certain medications that interfere with vitamin K metabolism or synthesis, such as anticoagulants and antibiotics.

Anticoagulants thin the blood, while vitamin K makes thrombin and helps make clots. Patients can have vitamin K but it must be consistent.

Food sources of vitamins C, E, B12, and D

Vitamin C

-citrus fruits and juices, vegetables

Vitamin E

-Seeds, nuts, cooking oils, fish, green vegetables, and whole grains

Vitamin B12

-Fortified foods and naturally occurring food such as leafy green vegetables, dried peas and beans, seeds, liver, and orange juice

Vitamin D

-naturally occurs in very few foods, fortified foods are the main source

-Fortified milk, cereal, and juices, salmon, eggs, white mushrooms, canned tuna and sardines, seafood

How do antibiotics affect fat soluble vitamins

They prevent the metabolism and synthesis of them.

Vitamin A intake/supplementation and food source/impact of

• Preformed vitamin A is found only in animal sources.
• Also includes provitamin A carotenoids:
• Natural plant pigments found in deep yellow and orange fruits and
vegetables and most dark green leafy vegetables.
• Beta-carotene, lutein, and lycopene are among the most commonly
known carotenoids.

• Best known for its roles in normal vision, reproduction, growth, and immune system functioning.
• Body can store up to a year’s supply of vitamin A.
• 90% is stored in the liver.
• It may take 1 to 2 years for deficiency symptoms to appear.
• Only preformed vitamin A is toxic in high doses

• Chronic excessive vitamin A intake can cause central nervous system (CNS) changes, bone and skin changes, and liver abnormalities that range from reversible to fatal.
• Toxicity is usually caused by consuming too much vitamin A from supplements.
• At high doses during pregnancy (three to four times the recommended intake), vitamin A is teratogenic.
• Supplementation is not recommended during the first trimester of pregnancy unless there is specific evidence of vitamin A deficiency.

• Beta carotene is nontoxic.
• Stored primarily in adipose tissue:
• may accumulate under the skin to the extent that it causes the
skin color to turn yellowish orange:
• a harmless and reversible condition known as
carotenodermia.
• The Tolerable Upper Intake Level (UL) for vitamin A does not apply
to vitamin A derived from carotenoids.
• Beta-carotene is a major antioxidant in the body.

What is niacin used to treat in large doses?

Large doses of niacin in the form of nicotinic acid (1000-2000 mg/day) are used therapeutically to lower total cholesterol and LDL cholesterol and raise high density lipoprotein (HDL) cholesterol.

Folic acid and pregnancy-timing of supplementation and what it prevents

Adequate intake of folate before conception and during the first trimester of pregnancy reduces the risk of neural tube defects.

Function of Thiamin in the body

• Coenzyme in the metabolism of carbohydrates and branched-chain amino acids.
• Found in lean pork, whole or enriched grains, legumes, seeds and nuts
• Beriberi has been virtually eliminated.
• Deficiency is usually seen only in chronic alcoholics.
• Impairs thiamin intake, absorption, and metabolism.
• Cardiac and renal complications can be fatal

-Helps the cells change carbs into energy

Role of phytonutrients/phytochemicals

• Literally plant chemicals.
• When eaten in the “package” of fruit, vegetables, whole grains,
or nuts, these chemicals work together with nutrients and fiber
to promote health.

serve as a protective shield for cells, defending them against the harm caused by free radicals

They are antioxidants, not all antioxidants are phytochemicals and not all phytochemicals are antioxidants

Vitamin C-which patients would benefit from increasing their intake?

-People who smoke or suffer from second-hand smoke

How often should you ingest water soluble vitamins? Is that the same as fat soluble vitamins?

You should ingest water-soluble vitamins daily due to it being excreted in the urine, whereas fat-soluble vitamins can be ingested every couple of days

Function of Water in the body

• Transports nutrients and oxygen to cells
• Serves as a solvent for vitamins, minerals, glucose, and amino acids
• Participates in metabolic reactions
• Eliminates waste products
• Is a major component of mucus and other lubricating fluids

Fluid calculations for maintenance fluid kcal=mL/day and Holiday segar for infants

•For infants 3.5 to 10 kg the daily fluid requirement is 100 mL/kg.
•For children 11-20 kg the daily fluid requirement is 1000 mL + 50 mL/kg for every kg over 10.
•For children >20 kg the daily fluid requirement is 1500 mL + 20 mL/kg for every kg over 20, up to a maximum of 2400 mL daily.
•Please note that this calculation does not apply to newborn infants (ie, from 0 to 28 days after full term delivery).

When is thirst reliable and when is it not a reliable indicator?

Thirst is reliable for most people. However for unhealthy people, older adults, and children, the sensation of thirst might not occur until they are already dehydrated.

Insensible losses and how it is affected

Insensible water losses are those that cannot be measured. They occur through respirations. Extreme environmental temperatures (very hot or very cold), high altitude, low humidity, and strenuous exercise increases sensible water losses from respirations and the skin.

How do minerals differ from the other substrates we have learned about this semester

Minerals are structurally very simple, inorganic substances.
Major minerals are present in the body in amounts >5g.
•Calcium, phosphorus, magnesium, sulfur, sodium, potassium, and chloride are major minerals.
•Iron, iodine, zinc, selenium, copper, manganese,
fluoride, chromium, and molybdenum are classified as trace minerals or trace elements.
•Both groups are essential for life.

•General functions
•Minerals function to provide structure to body tissues and to regulate body processes.
•Mineral balance
•Maintained by
•releasing minerals from storage for redistribution,
•altering rate of absorption (gastrointestinal (GI)
system), and
•altering rate of excretion (urinary system).

•Mineral toxicities
• Stored minerals can produce toxicity symptoms.
• Toxicity related to excessive use of mineral supplements, environmental or industrial exposure, human errors in commercial food processing, or alterations in metabolism.
•Mineral interactions
• Mineral status must be viewed as a function of the total diet.

Sources of minerals
• Unrefined or unprocessed foods have more minerals than refined
foods.
• Mineral supplements
• Mineral supplements, alone or combined with vitamins, contribute to mineral intake.
• To the greatest extent possible, nutrient needs should be met through food, not supplements.

Calcium not really regulated by urine, it can get it from storage, like from the bones (phosphorus also not really regulated by urine)

AI of sodium in the diet recommended is:

The AI for sodium is 1500 mg for everyone aged 14 and older. The dietary guidelines recommends sodium intake be less than 2300 mg for people ages 14 and older. Average intakes of sodium for people ages 1 and older is 3393 mg/day with a range of approximately 2000-5000 mg a day.

How do minerals react to heat and light

Not really, they cannot be broken down anymore

Selenium and manganese toxicity

Selenium

• A component of a group of enzymes that function as antioxidants to
• disarm free radicals produced during normal oxygen metabolism.
• Selenium deficiency is rare in the United States.

-excess of it can cause oxidative stress and selanosis which has symptoms such as hair loss, gastrointestinal issues, irritability and fatigue, and garlic-odor like breath

Manganese

Dietary deficiencies have not been noted.
•Toxicity is a well-known occupational hazard for miners who inhale manganese dust.
•High manganese intake from drinking water also produces
neuromotor deficits similar to Parkinson disease.

Phosphorus in the food supply

•Phosphorus
•After calcium, the most abundant mineral in the body is phosphorus.
•About 40% to 60% of natural phosphorus from food sources is absorbed.
•Dietary deficiencies of phosphorus seldom occur

Foods: Nuts, eggs, whole grains, beans, organ meats, pork, dairy, chicken, turkey

High potassium containing foods

Whole, unprocessed foods-potatoes, tomatoes, bananas, oranges, legumes, dairy products

What are you concerned about for patients that only drink bottled water?

• Lack of essential nutrients

  • Calcium and Magnesium Deficiency: These minerals are essential for maintaining healthy bones, muscle function, and heart health. Without adequate intake from water or other sources, there could be long-term consequences for bone density and cardiovascular health.

  • Fluoride Deficiency: Some bottled waters do not contain fluoride, which is important for preventing dental cavities. People who rely exclusively on bottled water without fluoride may be at greater risk of tooth decay, especially children.

When does a positive energy balance occur?

When calorie intake exceeds calorie expenditure. (More weight)

Understand the concept of BMR/BEE (same thing), what % of total calories are expended from these processes and what activity factors are. Also understand what can affect one’s BMR (fever, caffeine, sleeping, etc.) BEE is NOT the total number of kals you need in a day.

• Basal metabolism
– Caloric cost of staying alive or the amount of calories required to
fuel the involuntary activities of the body at rest after a 12-hour
fast.
– Basal metabolic rate (BMR) accounts for approximately 60% of
total calories expended.
• The less active a person is, the greater the proportion of
calories used for basal energy expenditure (BEE).
– Involuntary body activities include maintaining body temperature
and muscle tone, producing and releasing secretions, propelling
the gastrointestinal tract, inflating the lungs, and beating the heart.

– BEE accounts for ~60% or more of total calories
expended.
• Can also be manually calculated using any number of formulas

• Physical activity
– Voluntary muscular activity.
– Accounts for approximately 30% of total calories used.
• May be as low as 20% in sedentary people and as high as 50%
in people who are very active.
– A rule-of-thumb method for estimating daily calories expended on
PA is to calculate the percentage increase above BEE based on the
estimated intensity of usual daily activities.
• Sedentary – BEE 1.2
• Lightly active – BEE 1.375
• Moderately active – BEE 1.55
• Very active – BEE 1.725
• Extra active (at job + exercise/sports) – BEE * 1.9
– Tracking devices provide an estimate, not an actual reading.

BEE-the energy you need to exist. (180 lbs person has higher BEE)

• Fever or Illness:

  • When the body is fighting an illness, particularly with fever, BMR increases as the immune system works harder to regulate body temperature and fight infection.

• Caffeine and Stimulants:

  • Caffeine temporarily increases BMR by stimulating the nervous system, leading to more energy expenditure.

    Sleep:

    • During sleep, BMR decreases as the body enters a state of rest. However, it doesn’t fall dramatically—essential bodily functions still continue.

      • Age:

        • BMR decreases with age due to a natural loss of muscle mass and changes in hormone levels.

      • Gender:

        • Men usually have a higher BMR than women, as men tend to have more muscle mass and less body fat.
          

Thermic affect of food and what impacts it

– Calories spent on processing
food
• Estimated to be about 10% of
the total calorie intake
– Can be impacted by:
• Composition of food eaten
• Frequency of eating
• Portion size of meals consumed

(if you have thanksgiving food there is higher metabolism to break the food down.

Central obesity definition for men and women

– Established cutoffs identify overweight as BMI ≥25 and obese as
BMI ≥30.
• Adults with a BMI ≥25 have increased risks of both morbidity
and mortality.

– Storing a disproportionate amount of total body
fat in the abdomen increases risks for type 2
diabetes, dyslipidemia, hypertension, and
cardiovascular disease. (apple shape)

Calculations you will be responsible for on the exam

-BMI (you will be given kg and m)

-the categories of BMI (obesity classes)

-WHC; waist circumference and what disease risks are of concern (slide 21)

Kg/(meters)² = BMI

• Underweight: BMI < 18.5

• Normal weight: BMI 18.5–24.9

• Overweight: BMI 25–29.9

• Obesity:

  • Class 1 (Mild obesity): BMI 30–34.9

  • Class 2 (Moderate obesity): BMI 35–39.9

  • Class 3 (Severe or morbid obesity): BMI ≥ 40

• Waist circumference
– Abdominal fat is clinically defined as a waist
circumference ≥40 in. in men and ≥35 in. in
women.

• Waist to Height Ratio (WHR)
• It may be a better screening tool than both
waist circumference and BMI for
cardiometabolic risk factors.
– Calculated by dividing waist measurement by
height measurement.
– Suggested cutoff value of 0.5 translates to the
practical advice of “keep your waist to less
than half your height.”

healthy food options-you should be able to select healthy alternatives and choose healthy menu options for a patient

• Beyond Calories: Diet Quality
– Eating pattern must
• provide adequate amounts of all essential nutrients, and
• limit foods or nutrients linked to an increased risk of chronic
disease.
– MyPlate depiction of filling ½ the plate with fruits and vegetables,
approximately ¼ with grains, and ¼ with protein with a choice of
dairy on the side.
– “Fat-free” or “sugar-free” versions of ultra-processed foods do not
make them “healthier” nor do they necessarily lower their calorie
content.

Low calorie foods helpful for weight loss

Pick out things low in calories

-fresh fruits and vegetables

-nutrient dense foods

-apple slices

How many minutes of physical activity are recommended per week of moderate-intensity exercise/activity Hint* it is not 60 minutes per day for adults.

– 150-300 per week of moderate-intensity activity above usual activity is recommended.

How does exercise/body mass change energy needs?

Person who has more mass will burn more energy

Negative Energy Balance

When calorie expenditure exceeds calorie intake (lower weight)

Are vitamins susceptible to heat, light, and air?

Yes, (milk in an opaque container), vitamins can change from heat and light.

Beta-carotene

found in yellow, red, and orange fruits and vegetables and helps eyesight.

Antioxidants

A, C, E, Beta-carotene. They help fight free radicals

Holiday Segar calculations

-for infants 3.5-10 kg the daily fluid requirement is 100 mL/kg.

-for children 11-20 kg, the daily fluid requirement is 1000 mL + 50 mL/kg for every kg over 10.

-for children over 20 kg daily fluid requirement is 1500 mL +20 mL/kg for every kg over 20, up to a max of 2400 mL daily

-doesnt apply to newborn infants

riboflavin

• Vitamin B2 is an integral component of the coenzymes flavin adenine
dinucleotide (FAD) and flavin mononucleotide (FMN) that function to
release energy from nutrients in all body cells.
• Milk and dairy products contribute the most riboflavin to the diet.

fluroide

•Fluoride
•Promotes the mineralization of developing tooth
enamel prior to tooth eruption and the
remineralization of surface enamel in erupted teeth
•Fluoridation of municipal water credited with a major decline in the prevalence and severity of dental caries
•Be aware of patients that drink only bottled water

potassium

Intracellular cation
•Nerve / muscle function
•Cardiac function

•AI: 4700mg/day
•Most Americans do not meet this intake
•Lower BP
•Decrease negative effects from too much Na
•Reduce risk of kidney stones
•Reduce bone loss

Potassium deficiency
•Caused by losses of body fluids
•Diuretics / laxative use
•Monitor K+ levels in patients on diuretics that are K+ wasting
•Muscle weakness, confusion, decreased appetite, cardiac dysrhythmias
•Toxicity is rare
•May need to watch content in renal patients

sodium

•Sodium.
•Salt (sodium chloride) is approximately 40% sodium.
•Wide variations in sodium intake exist between cultures and between individuals within a culture.
•Approximately 71% is sodium added to food outside the home.
•Almost 98% of all sodium consumed is absorbed.
•Homeostasis is maintained through urinary excretion.
•A salty meal triggers thirst.
•Drinking fluids dilutes the sodium in the blood.
•Increased blood volume stimulates the kidneys to excrete more sodium and fluid together to restore normal blood volume.
•Low blood volume or low extracellular sodium stimulates the hormone aldosterone to increase sodium reabsorption by the kidneys.

Excretion: Urine via the kidneys

calcium

Most plentiful mineral in the body.
•99% is found in bones and teeth.
•Bone tissue serves as a large, dynamic reservoir that releases calcium to maintain constant concentrations of calcium in blood, muscle, and intercellular fluids when dietary intake of calcium is inadequate.
•Continuous remodeling of bone occurs naturally
throughout life as calcium is deposited and resorbed.

The balance between bone formation and bone breakdown changes with aging.
• After the age of about 30, net bone loss occurs in all people.
• A high calcium intake may help maximize bone density.
• Calcium balance in the blood is achieved through the action of vitamin D and parathormone (PTH).

•Absorption factors
• Lactose
• Sufficient vitamin D
• Acidity of digestive mass
• Binders
• Dietary fat
• High fiber and laxative intake
• Excessive intake of phosphorus or magnesium
• Drug : Nutrient interactions

Calcium deficiency

-inadequate intake

*Reduction in bone mass

*stunting (pediatric)

*Osteoporosis-multifactorial skeletal disorder

*dowager’s hump

*genetic, race, and gender factors

-risk factors

*alchohol

*smoking

*dietary intake

*caffeine

*sedentary lifestyle

Calcium toxicity

-over-supplementation

*constipation

*Urinary stone formation

*reduction in absorbing iron, zinc

*cardiovascular disease

magnesium

•Fourth most abundant mineral in the body.
•50% to 60% is deposited in bone with calcium and phosphorus and most of the rest is stored in various soft tissues and muscles.

• Deficiency is uncommon because the kidneys limit urinary excretion.
• May result from
• type 2 diabetes, celiac disease, and small intestine bypass or resection and alcohol
abuse.
• Aging is associated with lower magnesium intake, decreased absorption, and increased excretion.
• Certain medications can lead to magnesium depletion.

What is wrong with BMI?

Insurance goes up when BMI goes up even if you are healthy

Controlling portion sizes for patients

-Don’t buy huge bags of food

-take half the food home when you go out to eat

Calorie balance

Over time, the calories consumed in excess of expenditure contribute to weight gain.

-because 1 pound of body fat is = 3,500 calories, a surplus of 500 cal/day over a 7 day period theoretically results in a 1 pound weight gain

Negative calorie balance

When calorie expedenture exceeds calorie intake

-decreased calorie input

-increased physical activity