SI Unit 4 - Review Questions

Describe the height and weight trends of males and females from the 1960's to 2012.

a. Increased height from 1960-2002; followed by decreased height to 2012.
b. Consistent increase in weight throughout.

What percentage of deaths are due to poor diet and physical inactivity?

a. 15%

Define Obesity

a. Excess accumulation of body fat

What are the cut points for obesity in males and females for percent body fat?

a. Males: >22% body fat; >25% in men 40+
b. Females: >32% body fat; >35% in women 40+

List the two possible equations used to measure body mass index (BMI).

a. Weight (kg) / height (m2)
OR
b. Weight (lb) x 703/height (in2)

For what populations is BMI not a good measure of fat?

a. Athletes
b. Adults 65+
c. Pregnant women

Name two limitations of BMI.

a. No direct measure of body composition (ex. muscle vs. fat)
b. Fails to show location of excess fat.

1. What are the BMI cut points (KNOW THESE).

a. Underweight: less than 18.5
b. Normal weight: 18.5 -24.9
c. Overweight: 25 - 29.9
d. Obese: greater than 30

What percentage of the population is overweight OR obese?

a. 71%

What percentage of the population is obese?

a. 42%

What are the cut points in males and females for measuring waist circumference?

a. Men: >102cm (40 inches)
b. Women: >88cm (35 inches)

Describe central obesity.

a. Located in the torso region.
b. Composed of visceral fat
c. Causes a shift in adipokines that results in increased inflammation and insulin resistance.

What are adipokines?

a. Regulate inflammatory process and energy metabolism in tissues.

Name the four comorbid conditions associated with obesity.

a. Pre-diabetes/Type II diabetes
b. Hypertension
c. Heart Disease (dyslipidemia; low HDL; high triglyceride)
d. Certain Cancers

What are the 7 etiological factors that contribute to obesity?

a. Physiology - hormones, appetite control
b. Environmental cues - stress, portion sizes, exposure to foods
c. Genetic Heredity - genetic predisposition
d. Governmental, economic, and societal factors - school nutrition, advertising, fast food
e. Lifestyle choices - sleep, exercise, diet
f. Group or social influences - peer pressure, holidays, social outings
g. Physical environment - walkability, neighborhoods, food deserts

What factors contribute to energy in estimated energy requirements?

a. Sex, age, physical activity, height, and weight

What is the breakdown of energy-out estimated energy expenditure?

a. 50-65% = resting metabolic rate
b. 5-10% = thermic effect of food (energy to digest and absorb food)
c. 25-50% = physical activity

What are some factors that affect Basal Metabolic Rate (BMR)?

a. Age, Height, Growth, Body Composition, Fever, Stress, Environmental Temperature, Fasting/Starvation/Malnutrition, Thyroxine

Describe Energy Deficit

a. Energy out > energy in
b. Key to weight loss
c. Estimated at 3500kcal = 1lbs (per week)

What is the recommended rate of weight loss?

a. 1-2lbs per week

What effect does exercise have on overall health?

a. Improves cardiovascular function.
b. Improves dyslipidemia.
c. Increases HDL cholesterol.
d. Lowers blood pressure.
e. Lowers mortality rate.
Changes occur regardless of weight loss

What is the goal weight in treatment of obesity?

a. 5-10% weight loss that can be maintained for 6 months.

What are the essential components to treatment of obesity?

a. Dietary patterns
b. Physical activity
c. Behavior modification
d. Social and environment support
Multi-level approach is needed

Alexis is 5'7" (67 inches) (1.70m) and weighs 135 pounds (62kg). What is her BMI and what category does she fall into?

a. Weight (kg) / height (m^2)

i. 62/1.7^2 = approximately 21

b. Weight (lb) x 703/height (in^2)

i. 135 x 703/67^2 = approximately 21

c. Normal Weight Category

Todds weight circumference is 39 inches (99cm). Does he have abdominal obesity?

a. No (cut point = greater than 102 cm or 40 inches)

What is the difference between hunger and appetite.

a. Hunger: physiological need for food
b. Appetite: learned behavior that results from seeing or smelling food and deciding you want to eat.

Describe the difference between satiation and satiety.

a. Satiation: during meals - a feeling of fullness that builds while eating and causes you to stop eating (protein).
b. Satiety: between meals - feeling full longer (fat and fiber).

What is energy density and list a high and low energy dense food.

a. Energy density describes kcal per amount of food (grams, ml, cup, tsp, etc.
b. High: peanuts, dried fruit, starchy vegetables
c. Low: popcorn, fresh fruit, broccoli

What is nutrient density?

a. The amount of nutrient per kcal of food (g or mg nutrient/total kcal)

What is LDL cholesterol vs. HDL cholesterol?

a. HDL cholesterol: removes cholesterol from body tissues and brings them to liver to be dismantled.
b. LDL Cholesterol: formed from VLDL and form cholesterol that is deposited into arteries and in body tissues.

Where does saturated fat come from?

a. Animal products & tropical oils

Where does polyunsaturated fat come from?

Omega 3's (fatty fish - DHA, EPA) & 6's (corn, sunflower, safflower oils) Essential

What dietary factors raises LDL cholesterol?

a. Saturated Fats

Where does monounsaturated fat come from?

a. Peanuts and peanut oil
b. Avocados
c. Olive Oil

What dietary factors lowers LDL cholesterol?

a. Soluble Fiber - vegetable and fruit flesh, legumes

How can someone increase their HDL cholesterol?

a. Increase physical activity.

What are the risk factors for heart disease?

a. Family history, age, sex, smoking, alcohol use, physical activity and diet.

What are the blood lipid guidelines for total blood cholesterol?

a. Desirable: less than 200 mg/dL
b. Borderline High: 200 -239 mg/dL
c. High (unhealthy): 240mg/dL and above

What are the blood lipid guidelines for LDL cholesterol?

a. Optimal: less than 100m/dL
i. Important for those with diabetes or Cardiovascular Disease
b. Near optimal: 100-129mg/dL
c. Borderline: 130-159mg/dL
d. High: 160mg/dL and above

What are the blood lipid guidelines for HDL cholesterol?

a. Unhealthy: less than 40mg/dL
b. High (healthy): greater than 60mg/dL

What are the ratios of Cholesterol: HDL recommended by the blood lipid guidelines?

a. Desirable = 3:1
b. Increased risk = 5:1

What are the blood lipid guidelines for triglycerides?

a. Unhealthy: 200-499mg/dL
b. Borderline: 150-199mg/dL
c. Healthy: less than 150 mg/dL

What is the most common form of cardiovascular disease?

a. Atherosclerosis - mounds of lipid that form plaques along the artery walls potentially leading to a thrombus (stationary) or embolus (broken off thrombus).

What types of fat decrease total cholesterol and LDL cholesterol?

a. Unsaturated fats (poly and mono)

What are the specific dietary recommendations for fats in addition to the ones previously outlined in the dietary guidelines?

a. Saturated fats: (less than 10% of total kcal) reduced further to less than 5-6% for those with diabetes or elevated LDL.
b. Cholesterol: less than 200mg if diabetes or elevated LDL present

What are the three factors that can reduce LDL and order it from highest to lowest based on their effect? (do not need to know exact percentages)

a. Replacing Saturated fats (8-10%)
b. Weight reduction (5-8%)
c. Eating soluble fiber (3-5%)

What are the current blood pressure guidelines?

a. Normal BP: Less than 120 and less than 80 mmHg

b. Elevated BP: 120-129 and less than 80 mmHg

c. High BP Stage 1: 130-139 or 80-89 mmHg

d. High BP Stage 2: greater than or equal to 140 or greater than or equal to 90 mmHg

What are the modifiable risk factors for hypertension?

a. Smoking, Obesity, Sedentary Lifestyle, Poor Diet

What are the non-modifiable risk factors for hypertension?

a. Age, Genetics

What are the interventions for hypertension?

a. Regular physical activity
b. Weight loss (5-10%)
c. Limit alcohol intake (men: 2/day; women: 1/day)
d. Stop smoking or do not begin if one does not currently smoke.
e. Adequate intake of calcium, potassium, and magnesium

Describe the DASH (Dietary Approaches to Stop Hypertension) eating pattern?

a. Rich in low fat dairy: 2-3 servings per day (2-3 cups)
b. High in fruits and vegetables: 8-10 servings per day (4-5 cups)
c. Low in saturated fat and cholesterol: use vegetarian protein sources 4-5 times/week (nuts, beans, and seeds)
d. Low in snacks/sweets.

What are the requirements for the DASH Low Sodium Diet?

a. Same as DASH but with 1500mg Sodium limit

What is Metabolic Syndrome?

A cluster of risk factors: any 3 of the following

i. Central obesity (based on waist circumference)

ii. High triglycerides (>150mg/dL)

iii. Low HDL (less than 40mg/dL)

iv. Prediabetes or Diabetes

v. Hypertension

What are the diagnosis criteria for Diabetes?

a. Fasting plasma glucose (12 hours) of greater than or equal to 126 mg/dL OR A1C greater than or equal to 6.5%

What is Hemoglobin A1C

a. Measure of blood glucose over a 3-month period of time (life span of a red blood cell)

What is the difference between Type 1 and Type 2 Diabetes?

a. Type 1: produce little or no insulin (autoimmune disease)
i. Beta Cells of Pancreas Destroyed
b. Type 2: high insulin levels; insulin resistance (glucose is not moving from blood into cells)

Describe Prediabetes.

a. Higher than normal fasting blood glucose of 100-125mg/dL but not high enough to diagnose diabetes.

What are the risk factors for Type 2 Diabetes?

a. Overweight/Obesity
b. Sedentary Lifestyle/Inactivity
c. Family History/Genetics

What are the symptoms of both Type 1 and Type 2 Diabetes?

a. Glucose (sugar) in Urine
i. Frequent Urination
ii. Thirst à Dehydration
b. Excessive Hunger (glucose is not getting into cells)
c. Fatigue (not enough cell energy)

What are some possible complications of Type 2 Diabetes

a. Neuropathy - loss of feeling
b. Amputations - often due to poor wound heeling
c. Kidney Disease
d. Cardiovascular Disease
e. Vision Issues
f. Stroke
These complications can lead to death

How many additional kcal does a women need to consume each day during her second and third trimester?

a. 2nd trimester: 340kcal/day
b. 3rd trimester: 450kcal/day

What populations may need more additional kcal than the average pregnant women?

a. Teenagers, underweight and active individuals

How many additional grams above her RDA does a women need during pregnancy for Protein?

a. 0.8g/kilo + additional 25 grams

(4kcal/g = additional 100 kcal)

REVIEW: What is the function of folate?

a. Blood production, cell growth, prevention of neural tube defects

How does the RDA for folate change during pregnancy?

a. 1.5x higher

Review: what are sources of folate and folic acid?

a. Folate: Dark, leafy, green vegetables
b. Folic Acid: fortified breads and cereals

Review: what is the function of B12?

a. Activities folates
b. Synthesis of RBCs

Review: what are food sources for B12?

a. Animal products

What is the function of Choline?

a. Important for brain and spinal cord development - cell membranes & neurotransmitters

What food sources contain Choline?

a. Eggs, dairy products, legumes, meats & seafood

Review: why are Vitamin D and Calcium important for growth?

a. Contributes to bone development and growth.

What is the recommended intake of Calcium for pregnant women?

a. 1000-1300mg/day
i. Absorption doubles - no RDA increase

How does iron absorption change during pregnancy and why?

a. Absorption triples to support increased blood volume and provide for placental and fetal needs.

How long does an infant draw on material irons to develop their own stores?

4-6 months after birth

Review: what are tips for increasing Iron absorption?

a. Consume vitamin C, Meat, Fish, Poultry
b. Avoid consuming large among of calcium (milk), phytates, & tannic acid with Iron

Review: what is the function of Zinc?

a. DNA and RNA synthesis

What food safety recommendations should be followed for the protein food group during pregnancy?

a. Avoid swordfish and shark due to high levels of mercury.
b. Limit canned albacore tuna to 6oz/week and other fish to 120z/week
Avoid deli/lunch meats &

What food safety recommendations should be followed for the dairy food group during pregnancy?

a. Avoid brie, feta, & blue cheese made from unpasteurized milk due to risk of Listeria.

Why is Listeria dangerous during pregnancy?

a. Listeria can cause meningitis which can cause still-births, miscarriage, infections, etc.

What is the recommended weight gain during pregnancy for each BMI category?

a. Underweight (BMI < 18.5): 28-40lbs - increased risk for low-birth-weight infant
b. Normal (BMI 18.5-24.9): 25-35lbs
c. Overweight (BMI 25-29.9): 15-25lbs
d. Obese (BMI 30+): 11-20lbs

What risks are associated with obesity during pregnancy?

a. Gestational diabetes (GDM)
i. 30-50% of women with GDM will develop Type II Diabetes later in life.
b. Hypertension
c. Macrosomia - large baby

What are the recommended rates of weight gain during pregnancy?

a. 2-4lbs total during the first trimester (weeks 1 to 13/14)
b. ½ to 1lb per week during the second and their trimester (2-4lbs/month)

Describe the components of weight gain during pregnancy in order from greatest to least.

a. Infant at birth ~ 7.5lbs
b. Mothers' necessary fat stores ~ 7lbs
c. Increased blood supply and fluid volume ~ 4lbs each
d. Increased size of uterus & supporting muscles, breast size, and amniotic fluid ~ 2lbs each
e. Placenta ~ 1.5lbs

What are critical periods during pregnancy?

a. Finate period during development in which an adverse event occurring before or during leads to permanently impaired development.
b. All systems have a critical period (heart, brain, lungs)

How many additional calories are needed to produce breast milk and how many of these come from the diet?

a. Additional 500kcal with 330kcal coming from the diet.

Does the RDA for iron increase or decrease during lactation?

a. Decreases

What are some benefits of breast-feeding babies?

a. Immune Support
b. Easily Digested
c. Energy-Nutrient balance
d. Has a proper nutrient balance with high lipid levels - brain development.
e. Protects against other health risk.

What is the name of the early breast milk that is rich in antibodies and is present during the first few days of a baby's life?

a. Colostrum

What three nutrients are key to infant health?

a. Vitamin D: supplementation for breast-fed infants or those drinking less than 1L of formula per day.
b. Iron: adequate stores during months 4-6 but supplementation may be needed after this periord of time.
c. Vitamin K: injection at birth

By ______months an infant will double their birth weight; and by _____ months they will triple their birth weight.

5 months

12 months (1 year)

Describe the feeding recommendations for infants 0-4 months.

a. Feeding skills: coordinated such-swallow-breath, rooting reflex.
b. Satiety Signs: turning of head, stop sucking, closing lips, falls asleep
c. Hunger: wakes and moves, sucks fist, cries, opens mouth
d. Food: breast milk or formula

Describe the feeding recommendations for infants 4-6 months.

a. Feeding skills: reaches mouth with hands, good head control, sitting supported around 5-7 months.
b. Satiety Signs: turns head away, stops sucking.
c. Hunger: cries, opens mouth, or leans forward.
d. Food: breastmilk, formula, + soft pureed foods
i. Introduce iron sources and allergenic foods early.

How should solids be introduced to babies?

a. Around 6 months with focus on important nutrients such as iron and zinc.

When should allergen foods be introduced to infants and what are some examples of these foods?

a. Should be introduced around 6 months at the same time that solids are being started.
b. Dairy, peanuts, tree nuts, fish, wheat, soy, and sesame
i. Dairy: yogurt & cheese
ii. Peanut: thin peanut butter with water
iii. Tree nut: thin nut butter with water

Describe the components of Baby Led Weaning.

a. Infants feed themselves at their own pace and under their own control.
b. Foods are soft enough to mash and can be held by the child (avoid foods that crumble in the mouth)
c. Child should be sitting upright.

Describe the feeding recommendations for infants ages 6-8 months

a. Feeding skills: pincer-grasp present, self-feeding, begins to drink from cup, may be sitting independently.
b. Satiety: slows eating, shuts mouth, pushes food away.
c. Hunger: reaches or points to food
d. Foods: breast milk, formula, + complementary foods

Describe the feeding recommendations for infants 8-10 months.

a. Feeding skills: sits unsupported and beings to hold own bottle.
b. Satiety: pushes food away, shuts mouth, may use taught signs
c. Hunger: reaches or points for food or may use taught signs.
d. Food: breastmilk or formula + small & soft pieces of food.

Describe the feeding recommendations for babies 10-12 months

a. Feeding skills: improving using utensils
b. Satiety: may begin to use word or play with food
c. Hunger: specific words or sounds
d. Foods: breastmilk, formula, + small & soft pieces of food in increasing amounts.

When can water be introduced into an infant diet?

a. After 6 months of life

What does the AAP recommend for juice intake for infants?

a. No juice before age 1