Nutr 344 Exam 2

What are the three types of lipids in the body?

1. Sterols (cholesterol)

2. Phospholipids (emulsifiers)

3. Fats (triglycerides)

What is the most prevalent lipid in  both dietary intake of fat and in body fat storage?

Triglycerides

What are the 3 important functions of cholesterol in the body?

1. Bile

2. Steroid hormones

3. Vitamin D

Do we need to consume cholesterol?

No, body can make cholesterol

What is the role of dietary cholesterol on blood lipids?

The relationship between dietary cholesterol and blood cholesterol has been inconsistent 

Health benefit of monounsaturated fats

Help lower LDL cholesterol and may have help to raise HDL cholesterol

Food sources of monounsaturated fats

olive, peanut, canola oils; and high-oleic safflower and sunflower oils, nuts and avocados

What are the two essential fatty acids (polyunsaturated)?

1. Linoleic acid (omega 6)

2. Alpha-linoleic acid (omega 3)

Why is the intake of essential fatty acids necessary for health?

They are used to build cell membranes and the covering of nerves

Sources of linoleic (omega 6) fatty acids?

walnuts, seeds, safflower, soybean, sunflower, walnut, and corn oils

What are the 3 types of Alpha-linoleic (omega-3) fatty acids?

1. ALA- Alpha-linoleic (plant)

2. EPA- eicosapentaenoic acid (animal)

3. DHA- docosahexaenoic acid (animal)

Sources of ALA

plant oils, nuts and seeds

Sources of EPA

fish/seafood

Sources of DHA

fish/seafood, grass fed meat, dairy, omega-3 enriched eggs

What is the challenge if the only source of omega-3 is plant bases?

Must be converted to EPA and DHA before it is biologically active and can be utilized for something other than energy (1-10% is converted)

What is the potential concern with the current American diet that tends to be a  high ratio of omega-6 to omega-3 fatty acids?

It is believed that omega-6 is pro-inflammatory while omega-3 is anti-inflammatory

What does the research say regarding linoleic acid and its impact on health?

a higher ratio of omega-6:omega-3 may support chronic inflammation

What does some of the current research say related to whole dairy food products as discussed in class?

1. Several foods rich in saturated fatty acids are not associated with increased CVD or diabetes risk

2. There is no evidence that current population wide arbitrary upper limits on saturated fatty acid consumption in the U.S. will prevent CVD or reduce mortality

Differentiate between the nutrient content of egg whites versus egg yolks

Egg white: 3.6 grams of protein and 25 kcal

Egg yolk: 2.4 grams of protein and 50 kcal and ALL OF THE OTHER NUTRIENTS TO INCLUDE OMEGA-3

Are plant-based beef substitutes healthier than unprocessed beef?

No necessarily, calories, fat, saturated fat, and sodium is higher

Hypertension sodium intake

2300mg/1500mg

Elevated lipid profile

may benefit from replacing less healthy fats with more healthy fats, generally be prescribed statins

Narrowed/blocked arteries

all be on statins

Public recommendation of sodium intake

3-4 grams/day

What percentage of salt consists of sodium?

NaCl is 40% sodium

1 teaspoon of salt= how many mg of sodium?

2300 mg

What are the levels of sodium restrictions most recommended for individuals with hypertension?

reducing sodium intake is generally agreed to reduce blood pressure, at least people with hypertension- some observational studies suggest a U-shaped curve

What is the estimated intake of daily sodium in the U.S.?

3600 mg/day

What is the breakdown for the percentage of sodium in the diet that comes from processed and restaurant foods?

75%

What is the breakdown for the percentage of sodium in the diet that comes from cooking or eating?

10%

What is the breakdown for the percentage of sodium in the diet that occurs naturally in foods?

15%

What is the potassium recommendation for adults?

4700 mg/day

Why do we not recommend Potassium supplements without physician supervision?

Supplements not recommended because potassium levels too high or too low can cause a heart attack

Mediterranean diet

Appears to be a healthy option for lowering risk or managing heart disease, T2D and other risk factors- also help in lowing weight (plant focused diet)

DASH diet

designed to lower blood pressure, encourages daily intake, encourages meat more often (less than 6 servings a day)

High in calcium, potassium and magnesium which have all been to show lower BP

What was the origin of the idea for promoting alcohol consumption (red wine) for health?

In the 1980s- observed that the French have relatively low rates of heart disease despite their diet of rich, fatty foods (included red wine)

What is the specific component of red wine that is credited with its potential health benefits?

Resveratrol- acts like an antioxidant

What other foods have resveratrol?

skins and seeds of grapes, blueberries, cranberries, cocoa/dark chocolate and peanuts/pistachios

What would we recommend alcohol consumption to someone who doesn’t consume alcohol?

do not recommend that individuals who do not drink alcohol start drinking

Moderate alcohol intake for men/women

2 for men, 1 for women

What do recommendations say related to sleep?

Sleep is associated with coronary heart disease and many of the other seven components to lower risks

What are the 3 health factors that are an important component of CVD health?

high BP, high cholesterol, smoking

Physical activity

any movement that is carries out by the muscles that require energy

Exercise

planned, structured, repetitive and intentional movement- goal is to improve physical fitness

Aerobic activity

activity in which the body’s large muscles move in a rhythmic manner- have 3 components: intensity, frequency, duration

Muscle strengthening

physical activity, including exercise, that increases skeletal muscle strength, power, endurance, and mass- has 3 components: intensity, frequency, sets and repetition

Bone-strengthening

physical activity that produces an impact or tension on the bones that promotes bone growth and strength (weight-bearing or weight-loading)

Talk test during moderate intensity versus vigorous intensity

moderate-intensity can talk, but not sing

vigorous intensity cannot say more than a few words without pausing

What is the recommended range of minutes for physical activity for adults to attain the most benefits? Children 6-17?

150-300 minutes a week for adults

60 min per day for children

Exercise and weight loss

Diet is more important

98% report they modified their food intake

94% increased physical activity

Exercise and weight maintenance

90% reported they exercise about 60 min/day

What level of sedentary activity would some be at high risk versus low risk?

High: sitting 8-11 hours per day

Low: less than 4 hours per day

Questions to ask patient to assist them in purchasing best body worn devices

How reliable is it?

Is it affordable?

How much information do you want?

What goals do you want to achieve from this device?

How many miles and minutes of physical activity are represented by 10,000 steps?

10,000 steps equals approximately 5 miles and represents 30 minutes of physical activity

Alpha cells

glucagon (hypoglycemia)

Beta cells

insulin (hyperglycemia)

What are the 2 sources for glucose in the human body?

1. The food we eat

2. liver produces glucose as needed

What complication has the greatest risk for pre-diabetes and both T1 and T2?

Dyslipidemia/ heart disease

Normal fasting glucose

<100 mg/dL

Prediabetes fasting glucose

100-125 mg/dL

Diabetes fasting glucose

>126 mg/dL

Why is pre-diabetes taken seriously?

70% of people with prediabetes will eventually progress to T2D

Remission

the individual can stop taking medications required to manage blood glucose levels

What is the goal of the National Diabetes Prevention Program (NDDP)

improve the treatment and outcomes for people at risk of developing T2DM

What criteria must be met to qualify for the NDDP

1. over the age of 18

2. BMI > 24

3. Diagnosis of pre-diabetes OR history of gestational diabetes

What are the weight loss and physical activity goals the NDDP?

7% of body weight lost and at least 150 minutes of physical activity a week

What are the 5 components for the management of T2D?

1. weight loss/controlling weight

2. healthy eating pattern

3. moderate intake of carbohydrates (less than 45% of calories)

4. physical activity

5. monitor blood glucose and medications

What percentage of calories come from carbohydrates in the majority of high-protein, low-carbohydrate diets?

10-30%

Net carbs/ how it is determined

active or impact carbs- subtract the grams of fiber and sugar alcohols from the total carbs

Ketosis

not a dangerous state- achieved by eating a low carb diet and leaves ketones in the blood stream

Ketoacidosis

very high levels of ketones in the blood, can cause death. Occurs in diabetes or people who are starving/sick

How does a state of ketosis assist with weight loss (3)?

more fat burn, reduced hunger, stabilized blood sugar

How do individuals determine if they are in a state of ketosis?

urine strips or breath meter

Difference between Atkins and ketogenic diet

While both are high fat and low carb diets, atkins emphasizes more protein than a ketogenic diet

Paleo diet

whole foods, no processed foods, lean protein, vegetables, nuts and seeds

HCG diet

1. begin to take supplements and consume high fat, high calorie foods for 2 days

2. restrict caloric intake to 500 calories/day for 2-6 weeks (still taking supplements)

3. stop taking supplements and gradually increase caloric intake but avoid sugar and starch for 3 weeks

3 basic types of intermittent fasting

1. alternate day fasting (1-2 days/week of complete fasting)

2. whole day fasting (5-2 method)(5 days with no restrictions and 2 days with 500-600 kcal)

3. Time restricted fasting (16-8 method)(most common- 16 hours of fasting and 8 hours of eating)

Difference between GOLO and other weight loss programs?

GOLO is a supplement that is taken 3 times a day with meals

Noom weight loss program

1. App-based weight loss program rooted in psychology

2. guides behavior changes/personalized

3. dedicated health coach and virtual support group

4. includes pedometer and health log

Weight maintenance

refers to a weight change less than 3%

What is the definition of size acceptance?

Refers to the fact that as human beings we come in all types of shapes and sized and out acceptance of that can reduce weight stigma and ur obsession with weight

What are the 5 basic components of Health At Every Size®?

1. weight inclusivity

2. health enhancement

3. eating for well-being

4. respectful care

5. life-enhancing movement

What is the relationship between Health At Every Size® and healthy weight?

Healthy weight is weight appropriate for body type, something that could also be managed long term

What is the definition of obesity based on the Canadian Adult Obesity Clinical guidelines?

a complex chronic disease in which abnormal or excess body fat (adiposity) impairs health, increases the risk of long term medical complications and reduce lifespan

What is the Hamwi formula for men and women

100# for the first 5 ft + 5 pounds for each additional inch

106 for first 5ft + 6 pounds for each additional inch

Realistic weight goal

health can be improved by just a 5-10% weight loss

Permanent lifestyle changes

develop a new pattern of eating-food choices and eating habits that support new weight- need to build skills to eat and live more healthfully

Positive psychological mindset

keep focusing on the “why” of wanting to lose weight

Ability to handle lapse/relapse

focus on returning to healthful habits and impact on weight will generally be minimal

Development of will power

ability to delay gratification and resist short-term temptations to meet long-term goals

What % of Americans have a diagnosis of Prediabetes? What % have a diagnosis of diabetes?

38%, 11.3%

What % of Americans say they are trying to limit or avoid sugars? Reason?

73%, avoiding weight gain

ADI

the maximum amount of a substance that can be consumed each day over a lifetime without causing
health risks

What does the 2023 American Diabetes Association Standard of Cre say about the impact of LNCS on glycemic management?

Nonnutritive sweeteners do not appear to have a significant effect on glycemic management- they can reduce overall caloric and carbohydrate intake as along as individuals are not compensating with additional calories from other food sources

What does the American Heart Association 2018 Scientific Statement say about LNCS and risk of coronary heart disease or impact on related heart biomarkers?

Consumption of LNCS beverages was not associated with risk of coronary heart disease or related biomarkers

Sugar-sweetened beverages have been associated with increased risk of coronary heart disease

What does Dr. Skolnik present related to research findings of the effect of LNCS on appetite?  The effect of LNCS on the gut microbiome?

The current literature is limited —>  Limited studies have shown changes in microbiome, though most studies short term (5-14 days)

Dr. Skolnik discusses the slide related to “Observation Evidence-The Pitfall of Reverse Causation Bias”.  How does he explain this concept as it relates to LNCS and weight gain in adults?

He first started off by saying logic does not always fit the evidence, the he said observational trials are plagued with the issue of confounding, leading to reverse causation bias

What conclusions does Dr. Skolnik present from prospective randomized control trials related to weight gain in children and adults?

20 studies, prospective, randomized studies- it said that there was very real weight loss as shown in prospective trials

What is the position of the Academy of Nutrition and Dietetics related to the use of LNCS?

a.    NNS works as a strategy for diet/health concerns including the limiting of carbohydrate and energy intake as well as blood glucose and/or weight management

b.    Favorable for use in adults with T1D and T2D