T2 EX2 L2 (WANTUCH) (PATHOPHYS, NUTRITIONAL REQUIREMENTS)

Define DRI

Daily recommended intake; dietary reference standards for the intake of nutrients based upon age, gender, and physiologic states (pregnancy/lactation). Comprise RDA, AI, UL, EAR

Define EAR

Estimated average requirement; the average daily dietary intake level that is sufficient to meet the nutrient requirement of half of (50 percent) healthy individuals in a group

Define RDA

Recommended daily allowance; the average daily dietary intake level that is sufficient to meet the nutrient requirement of nearly all (97-98%) healthy individuals in a group

Define AI

Adequate intake; a value based on observed or experimentally determined approximations of nutrient intake by a group (or groups) of healthy people - used when an RDA cannot be determined

Define UL

Tolerable upper intake limit; maximum daily nutrient intake that is unlikely to pose risk of adverse health effects to almost all individuals in the general population

Define CDRR

Chronic disease risk reduction intake

Role of CDRR

Recommendation for a specific nutrient or food substance to mitigate or reduce the risk of chronic disease based on an appropriate chronic disease endpoint

CDRR for sodium in adults 19+ years?

Reduce intake if above 2300 mg daily

Define AMDR

Acceptable Macronutrient Distribution Range

T/F: AMDR defines the range of usual intakes for macronutrients to provide adequate intake of essential nutrients and is related to reduced risk of chronic disease.

True

T/F: AMDR defines % of total energy intake.

True

Define EER

Estimated energy requirement; estimated daily energy needs based on individual characteristics and activity levels

T/F: DRI, RDA, and AI are different in infants, toddlers, children, adolescents, and geriatric patients; they are generally decreased in pregnant/lactating patients.

False; increased during pregnancy/lactation.

T/F: UL are different in infants, toddlers, children, adolescents, and geriatric patients; in pregnant/lactating patients, UL may or may not be increased.

True

% daily value (DV) is based on what? (two)

Highest RDA for adults aged 18+

2,000 calorie diet

T/F: Macronutrients <500 mg/serving may be listed as 0.0g.

True

Macronutrients? (four)

Carbohydrates

Protein

Fats (lipids)

Water

Micronutrients? (two section, two subtypes)

1. Vitamins

- Water soluble B & C

- Fat soluble D,E,A,K

2. Minerals

- Major elements/electrolytes

- Trace elements

______________ are responsible for providing energy.

A. Macronutrients

B. Micronutrients

A. Macronutrients

Define BMR

Basal metabolic rate; energy necessary for vital functions, in a fasting state

Determined by body size, composition, age, and sex

When is BMR increased? (two)

Tissue synthesis (wound healing, pregnancy)

Illness (chronic or acute)

Factors which affect the thermodynamic effect of digestion? (six)

1. Size of meal

2. Time of day

3. Age

4. Smoking

5. Stress

6. Caffeine

How many kcal/g of fat?

9 kcal/g

How many kcal/g of carbohydrate/glucose?

4 kcal/g

How many kcal/g of protein?

4 kcal/g

Basal metabolic rate is likely acutely increased in all of the following individuals, EXCEPT

A. A 52 yo male admitted to the ICU after a heart attack

B. A 29 yo female in her second trimester of pregnancy

C. A 79 yo male with a 3rd degree burns covering 20% BSA.

D. A 45 yo female who recently started walking 2 miles a day during lunch.

D. A 45 yo female who recently started walking 2 miles a day during lunch.

Monosaccharides examples? (three)

Glucose

Fructose

Galactose

Disaccharides examples? (three)

Maltose

Lactose

Sucrose

Polysaccharides examples? (three)

Starches

Fibers

Glycogen

T/F: Fiber is difficult to digest.

True

Describe difference between soluble and insoluble fibers

Soluble fibers = partial digestion in the large bowel

Insoluble fibers = not able to be digested

Where are carbohydrates stored? As what?

Liver and muscle as glycogen

What is the minimum recommended daily carbohydrate intake to avoid ketone production?

50 g/day

Common sources of complex carbs? (four)

Peas, beans, grains, vegetables

Common sources of simple carbs? (two)

Fruits, veggies

Enzyme responsible for digesting carbs?

Salivary & pancreatic amylase

T/F: Soluble fiber digested into short-chain fatty acids.

True

Carbs are mostly absorbed where?

Small intestine

Via glucose transport proteins and Na+-glucose cotransporters

Liver removes what proportion of glucose & galactose from portal vein blood

2/3

When fed, carbohydrate metabolism is underwent via what process? When fasting, what process occurs?

Fed = glycolysis

Fasting = gluconeogenesis

Energy producing processes associated with carbohydrates? (two)

TCA cycle (aerobic)

Pyruvate-lactate (anaerobic)

T/F: Fructose is a substrate for glycogen and lipogenesis.

True

Consequences of chronic excessive intake of fructose? (two)

1. Upregulation in GLUT5 transporter

2. Correlated with insulin resistance, diabetes, fatty liver, dyslipidemia

Where does carbohydrate digestion start?

A. Saliva

B. Stomach

C. Small intestine

D. Colon

A. Saliva

What effect does fiber have on gastric emptying time?

A. Increases gastric emptying time

B. Decreases gastric emptying time

C. No effect on gastric emptying

B. Increases gastric emptying time

Role of triglycerides (TG), phospholipids, cholesterol? (five)

1. Structural component of cells

2. Cell signaling

3. Precursor to hormones

4. Aid fat-soluble vitamin absorption

5. Energy storage

Essential fatty acids? (two)

1. Linoleic (Omega-6)

2. a-linoleic (Omega-3)

Western diet has what ratio of Omega 6: Omega 3?

20:1

Benefits of reducing Omega 6: Omega 3 ratio?

Ratio reduction may reduce chronic-inflammation and pro-allergic disease states (i.e. asthma)

Fat digestion & absorption process? (three)

1. Bile acids emulsify long-chain triglycerides (LCT) (micelles)

2. Pancreatic lipase breaks down LCT in small intestine

3. MCT can be absorbed without bile & pancreatic lipase (<10 carbons)

Where are fats primarily absorbed?

Small intestin

Where is SCFA produced by digestion of fiber absorbed & metabolized?

In colon

___________ of fatty acids provides 6x the energy from the same weight of carbohydrate

Oxidation

What is EFAD?

Essential fatty acid deficiency; 2-4 weeks with no lipids usually

Presents as dry scaly skin rash, impaired wound healing, immune dysfunction, numbness, paresthesia, blurred vision

Which of the following contains the highest ratio of omega-6 to omega-3 fatty acids?

A. Soybean oil

B. Flaxseed oil

C. Fish oil

D. Canola oil

A. Soybean oil

Essential amino acids? (nine)

Phenylalanine

Isoleucine

Leucine

Lysine

Methionine

Threonine

Tryptophan

Valine

Histidine

T/F: Proteins are the second largest storage of energy.

True

T/F: Digestion of proteins in the stomach occurs via denaturation with HCl acid and hydrolysis with pepsin.

True

T/F: Digestion of proteins in the small intestine occurs via pancreatic enzymes (trypsin) and peptidases.

True

Where are proteins absorbed? How?

Proximal small intestine via passive & active transport

Breakdown and turnover of proteins is ____________ with illness.

A. Increased

B. Decreased

A. INcreased

T/F: Disease, physiological states, and nutrient intake can alter nitrogen output.

True

Increased protein needs exist in what populations? (six)

1. AKI

2. Wounds

3. Trauma

4. Infection

5. Surgery

6. Critical illness

Cases in which protein intake should be monitored carefully? (three)

1. CKD stage III-V (non-HD)

2. Azotemia

3. Refractory hepatic encephalopathy

Protein catabolism is __________ in patients during crucial illness.

A. Increased

B. Decreased

C. Not affected

B. Decreased

Which macronutrient provides the major source of fuel?

Carbohydrates

Which macronutrient is able to provide the largest store of energy?

Lipids

Which macronutrient should be limited in patients with severe infections or inflammation?

Lipids

Which macronutrient should be limited in patients with azotemia?

Proteins

What patients may have a negative nitrogen balance?

Fever, trauma, illness, etc.

T/F: Water provides energy.

False; does not.

Roles of water in the body? (three per slide)

Distributes waste

Removes waste (urine)

Regulates body temperature

Adequate water intake for an adult male? Female?

3.7 L Male

2.7 L Female

Adequate water intake during pregnancy?

3 L

Adequate water intake during lactation?

3.8 L

Describe acute water toxicity?

Rapid consumption of large quantities of fluids that greatly exceeded the kidney's maximal excretion rate of approximately 0.7-1.0 L/hour.

Dehydration may be associated with (four)

1. Kidney stones, gallstones

2. Arrythmias, blood clots

3. Osteoporosis

4. Cancers (bladder, colon)

T/F: Vitamins can be synthesized by the body.

False?

T/F: Vitamins function as coenzymes in metabolism.

True

_________ soluble vitamins are more likely to lead to toxicity.

A. Water

B. Fat

B. Fat

Where are fat soluble vitamins stores?

In adipose tissue

Cystic fibrosis patients are more likely to have deficiencies in _______ soluble vitamins.

A. Water

B. Fat

B. Fat

Minerals make up about what percent of our body weight?

4%

Name all the B vitamins (excluding 8, 10, 11)

B1 - Thiamine

B2 - Riboflavin

B3 - Niacin

B5 - Pantothenic acid

B6 - Pyridoxine

B7 - Biotin

B9 - Folate

B12 - Cobalamin

Role of the small bowel?

Digests and absorbs nutrients

Role of the large bowel?

Absorbs water/electrolytes, excretes excess

Name all of the organs involved in peristalsis (four)

1. Esophagus

2. Stomach

3. Small intestine

4. Large intestine

Which organ is responsible for segmentation (mechanical digestion process)?

Small intestine

Which organ is responsible for absorbing and directing water to blood vessels?

Large intestine

Serotonin _______________ acetylcholine release

A. Promotes

B. Suppresses

A. Promotes

Dopamine ______________ acetylcholine release

A. Promotes

B. Suppresses

B. Suppresses

The parasympathetic nervous system ___________ GI motility

A. Stimulates

B. Inhibits

A. Stimulates

The sympathetic nervous system ____________ GI motility

A. Stimulates

B. Inhibits

B. Inhibits

What effect will metoclopramide have on the digestive tract?

A. as a dopamine agonist, it increases gut motility

B. As a dopamine agonist, it decreases gut motility

C. As a dopamine antagonist, it increases gut motility

D. As a dopamine antagonist, it decreases gut motility

C. As a dopamine antagonist, it increases gut motility

Gastrin ____________ the rate of emptying

A. Increases

B. Decreases

A. Increases

Ghrelin and motilin _________ the rate of emptying

A. Increase

B. Decrease

A. Increase

GLP-1, incretins, and amylin _________ the rate of emptying

A. Increase

B. Decrease

B. Decrease

Where is vitamin B12 primarily absorbed?

Ileum

Where are thiamin, riboflavin, pantothenic acid, biotin, and folate primarily absorbed?

Jejunum

Where are calcium, iron, copper, and zinc primarily absorbed?

Duodenum