NSG 200 Exam Review

Module 1: Dietary Patterns, Food Labels, and MyPlate

  • Overview from today’s review: the exam will cover modules 1 and 2 (chapters 1–5 and 9 as reviewed). There are three lectures per module and roughly 25 questions per module, plus some cross-module items. The exam includes standard multiple choice, true/false, calculations, and select-all-that-apply questions (e.g., RDA for protein). Content emphasis includes practical nutrition concepts, critical thinking about labels, and real-world applicability.

  • Accessibility and assignment reminders:

    • Accessibility shortcuts reminder and the accounting macros assignment due on Sunday.
    • For the work on the worksheet (referred to as work you chew), you can either print, type, or handwrite; uploading is not required if you hand in. Any questions should be directed to the instructor.

  • Module 1 key ideas: dietary patterns, food groups, and practical nutrition education.

    • Social determinants of health and what populations in the US struggle with regarding food groups: the US diet tends to be low in seafood and high in grains, high in saturated fat and salt, and fiber from whole grains is typically lacking.

    • Servings by food group (typical daily recommendations):
      extVegetables:2.5extcupsext{Vegetables: } 2.5 ext{ cups}
      extFruits:2extcupsext{Fruits: } 2 ext{ cups}
      extGrains:6extouncesext{Grains: } 6 ext{ ounces}
      extDairy:3extcupsext{Dairy: } 3 ext{ cups}
      extProtein:5.5extouncesext{Protein: } 5.5 ext{ ounces}

    • A reminder: the differences between servings for each group can be nuanced; the slide highlights a pattern of being lower in seafood and fiber, but higher in grains and protein.

    • Moderation concepts for beverages/alcohol:
      extWomen:ext1serving/dayorlessext{Women: } ext{1 serving/day or less}
      extMen:ext2servings/dayorlessext{Men: } ext{2 servings/day or less}

    • You can’t “save” drinks for the weekend; moderation is key.

    • Components of healthy eating patterns (examples of dietary patterns):

    • Mediterranean

    • Plant-based/vegetarian

    • DASH (Dietary Approaches to Stop Hypertension), characterized by fruits and vegetables, low salt, lean meats

    • Foods and patterns linked to poorer health outcomes (and thus target areas for education):

    • Red meat, added sugars, refined grains, processed foods, high saturated fat, high sodium, and low fiber.

    • Food labeling and nutrition education: what the label reflects and why it changes over time.

    • The Nutrition Facts label reflects current nutrition concerns in the US; labels are updated as population health priorities shift (e.g., chronic disease risk factors).

    • Calories are presented prominently; sodium, calcium, and vitamin D (and others) appear due to health concerns.

    • % Daily Value (DV) baseline is based on a 2,000 calorie diet.

    • High and low DV definitions:
      ext{High DV}
      ightarrow ext{DV} ext{ ≥ } 20 ext{ ext{%}}
      ext{Low DV}
      ightarrow ext{DV} ext{ ≤ } 5 ext{ ext{%}}

    • Ingredients list is ordered by descending weight.

    • Expect questions about predominant vs. low ingredients based on order.

    • Nutrient claims and regulations:

    • Nutrient claims are defined legally; you do not need to memorize the exact definitions for this course, but you should recognize the distinction between “low/very low/high” claims and the real nutrient content implications.

    • Structure-function claims exist in the supplement industry and do not require evidence of disease treatment; true disease-related claims would reference disease risk or symptom improvement. If a claim seems to target memory or athletic recovery, verify evidence and be cautious with patients.

    • Supplements and safety:

    • Supplements historically have had limited regulatory oversight; assess potential interactions or contraindications and document any supplement use in the medical record (MedRec).

    • Be prepared to recognize true/false statements about supplements on exam questions.

    • Allergy labeling and gluten issues:

    • The current labeling often includes nine major allergen categories: sesame, milk, eggs, fish, crustacean, sulfur (sulfites), tree nuts, wheat, and soybeans (per the lecture’s list).

    • Gluten-free labeling front-of-package and the implication of 20 parts per million (ppm) of gluten in so-called “gluten-free” products; a product labeled gluten-free may still contain up to 20 ppm gluten. This matters for patients with celiac disease who can be sensitive to trace gluten. The front-of-pack gluten-free claim must be read with caution and checked against the full ingredient list.

    • Celiac disease is a gluten intolerance; gluten is primarily found in wheat, and is also in rye and barley.

    • Gluten-free content claims and nutrition front labels:

    • The FDA allows up to 20 ppm gluten for products labeled gluten-free; for patients with celiac disease, even small amounts may cause symptoms.

    • MyPlate and portion guidance:

    • MyPlate recommendations emphasize servings and food group balance; in particular, half of grains should be whole grains. General distribution guidance should be understood for practical meal planning.

    • Box 2.2 (page 24) — everyday portion size references:

    • The instructor emphasizes studying everyday item comparisons so patients can estimate portions without measuring tools (e.g., a piece of fruit about the size of a tennis ball).

    • If you’re studying for the exam, review these everyday equivalents to help convey portions to patients.

  • Module 1 summary points to remember for exams:

    • Food label basics: 2,000 calorie baseline; high = ≥20% DV; low = ≤5% DV; ingredients by weight; front-of-pack claims have specific meanings.
    • Major patterns to promote: Mediterranean, plant-based/vegetarian, and DASH; prioritize fruits, vegetables, legumes, whole grains, low-fat dairy, lean proteins, seafood, nuts, and unsaturated fats; limit red meat, added sugars, refined grains, processed foods, high saturated fat, high sodium, and low fiber.
    • Know the definitions and practical use of RDA, UL, AI, AMDR, and CDRR; MyPlate guidance on whole grains and protein sources.
    • Understand common exam question formats (e.g., select-all-that-apply about supplements, label reading, and pattern recommendations).

Module 2: Carbohydrates, Proteins, and Fats

  • Carbohydrates: core concepts

    • Major carbohydrate groups: simple sugars and complex carbohydrates.
    • Monosaccharides (examples listed): extglucose,extglucose,extgalactoseext{glucose}, ext{glucose}, ext{galactose}
    • Disaccharides (examples listed): extsucrose,extlactose,extlactoseext{sucrose}, ext{lactose}, ext{lactose}
    • Note: The transcript contains a likely typo (repetition of glucose and lactose). Typical taxonomy is: monosaccharides = glucose, galactose, fructose; disaccharides = sucrose, lactose, maltose. Remember to use standard taxonomy in practice, but be aware the lecture slide as given contains a repeated item.
    • Ketones in urine during low carbohydrate intake indicate fat breakdown; when carbohydrate is scarce, fat oxidation can produce ketone bodies, which may be seen in urine; this is a potential sign of inadequate carbohydrate intake.
    • Preferred brain energy source:
      extBrain/CNSenergy:extglucoseext{Brain/CNS energy: } ext{glucose}
    • Fiber:
    • Definition: an undigestible carbohydrate; benefits include reduced risk of several health issues.
    • Health benefits mentioned: reduces risk of cardiovascular disease, obesity, diabetes, and several cancers; supports digestive health.
    • Sugar alcohols:
    • Endings often with "-itol" (e.g., sorbitol, xylitol, mannitol); considered sugar alcohols and can act as laxatives at higher intake; common GI side effects include gas, bloating, diarrhea, and sometimes nausea.
    • Storage of carbohydrates in the body:
    • The lecture asks, "Where do we store carbohydrate in the body?" (likely glycogen in liver and skeletal muscle) — this is a targeted review point on the slide.
    • Added sugars (pages 49–51 referenced in class):
    • Emphasis on recognizing added sugars and strategies to reduce them in the diet.

  • Protein: core concepts

    • RDA for protein (example given):
    • A weight-based calculation is shown: for a person weighing 100 lb, the video presents a calculation to obtain an RDA protein intake; the instructor’s arithmetic contains a noted inconsistency, but the standard formula is:
      extProteinRDA(g/day)=0.8extgextkgimesm<em>extkgext{Protein RDA (g/day)} = 0.8 \frac{ ext{g}}{ ext{kg}} imes m<em>{ ext{kg}} where m</em>extkg=mextlb2.2046m</em>{ ext{kg}} = \frac{m_{ ext{lb}}}{2.2046}
    • If we apply the standard method to a 100 lb person: m{ ext{kg}} obreak= rac{100}{2.2046} obreak ext{ kg} \ ext{RDA} = 0.8 imes m{ ext{kg}}
      obreak ext{ g} \ ext{RDA}
      obreak
      obreak= 0.8 imes 45.45
      obreak ext{ g}
      obreak
      obreak
      = 36.36 ext{ g/day}
    • The lecture notes also show an alternate sequence yielding 36.4 g, which aligns with the standard formula when starting from kilograms directly. The key takeaway for the exam is the rule: extRDAforprotein=0.8extgextkgimesmextkgext{RDA for protein} = 0.8 \frac{ ext{g}}{ ext{kg}} imes m_{ ext{kg}} with mass in kilograms.
    • Essential vs nonessential amino acids:
    • Essential (indispensable) amino acids must be supplied by the diet; nonessential amino acids can be synthesized by the body.
    • Animal vs plant proteins:
    • Animal proteins are generally complete (contain all essential amino acids) with a noted exception: gelatin is incomplete.
    • Plant proteins are typically incomplete, with exceptions such as soy and quinoa that provide complete protein profiles.
    • Complementary proteins:
    • The combination of different plant proteins throughout the day (not necessarily at the same meal) can provide a complete amino acid profile for the day/week.
    • Functions of protein (broad):
    • Structural (tissues, connective tissue), enzymatic, hormonal, immune functions, transport (hemoglobin, etc.), fluid balance, acid-base regulation, and more; structure defines function.
    • Protein turnover and catabolism:
    • Protein turnover is continuous; red blood cells have about a ~90-day lifespan as an example.
    • Albumin half-life is roughly ~45–90 days (a note on interpreting daily albumin values in hospitals). Changes in albumin in acute measurements often reflect fluid shifts rather than real synthesis changes.
    • Catabolism = breakdown of protein.
    • Protein-energy malnutrition patterns:
    • Marasmus: severe wasting; very low energy intake; often alert but underweight.
    • Kwashiorkor (described as quasi-uracro in lecture): edema, enlarged abdomen with fatty liver, infections risk, decreased appetite; not as wasted visually but with edema.
    • Vegetarian protein considerations: with a variety of plant proteins across the day/week, complete amino acid profiles can be achieved; complementary proteins do not need to be eaten at the same meal.
    • Common exam theme: identify which malnutrition pattern matches patient description; discuss protein energy adequacy and the role of fiber and fat in diet quality.

  • Fat: dietary fat guidelines and properties

    • Dietary guidelines for fat:
    • Total fat AMDR: 20–35% of total calories.
    • Saturated fat: ≤ 10% of calories.
    • Fat types and structure:
    • Saturated fats: no double bonds; often solid at room temperature; common sources include animal fats (cream, butter, lard) and some tropical fats.
    • Unsaturated fats: one or more double bonds; bendable; examples include olive oil, avocados, nuts (monounsaturated fats) and omega-3/omega-6 polyunsaturated fats; generally healthier choices.
    • Trans fats: typically from partial hydrogenation; have a straight chain despite unsaturated bonds; highly harmful; increasingly restricted/removed from foods.
    • Phospholipids: component of cell membranes; act as emulsifiers (hydrophilic and hydrophobic ends) aiding fat digestion.
    • Omega-3 vs omega-6 fatty acids:
    • Chemically differentiated by the position of the first double bond (omega denotes the last carbon in relation to the first double bond): omega-3s vs omega-6s, with distinct roles in inflammation and health outcomes.
    • Healthier fat substitutions and practical tips:
    • Use olive oil or cooking sprays; choose fish/seafood (e.g., salmon) over red meat; include avocado and nuts as fat sources.
    • Foods high in saturated fats and dietary strategies to reduce intake:
    • Common high-saturated-fat foods include dairy fats, fatty meats, butter and lard, cream, and some processed foods.
    • Box 5.2 references and lipid functions:
    • Review Box 5.2 for common lipid functions; note that lipids serve as energy storage and insulation among other roles.
    • Lipids and energy:
    • Lipids provide a high-energy source with 9 kcal per gram (compared to 4 kcal/g for carbohydrates and protein).
    • AMDR recap for fat and its impact on calories:
    • Fat contributes 20–35% of total daily calories; saturated fat should be limited to ≤ 10% of calories.
    • Practical exam emphasis:
    • Recognize saturated vs. unsaturated fats by structure and common food sources; know healthier substitutions; understand trans fat’s health impact and regulatory status.

  • Practical calculations and test-taking tips

    • Calorie and macronutrient calculations are a focus for the homework and exam:
    • Protein: extcaloriesfromprotein=4extkcalextgimesextproteingramsext{calories from protein} = 4 \frac{ ext{kcal}}{ ext{g}} imes ext{protein grams}
    • Carbohydrates: extcaloriesfromcarbohydrates=4extkcalextgimesextcarbgramsext{calories from carbohydrates} = 4 \frac{ ext{kcal}}{ ext{g}} imes ext{carb grams}
    • Fat: extcaloriesfromfat=9extkcalextgimesextfatgramsext{calories from fat} = 9 \frac{ ext{kcal}}{ ext{g}} imes ext{fat grams}
    • Remember: these are used to compute total daily energy expenditure and to analyze dietary patterns in patient education.

  • Exam logistics and study strategy (instructor notes)

    • The instructor emphasizes using the slides as the primary study resource and filling in all answers to consolidate knowledge.
    • Students with learning needs are given extended time for tests; the instructor provides a supportive testing environment with a full class period and encourages asking questions during the exam.
    • For protein calculations, the 0.8 g/kg/day rule is a central formula; use it consistently and verify unit conversions carefully.

  • Ethical/practical implications and clinical relevance

    • Critical appraisal of supplements and marketing claims is essential; patients may encounter structure-function claims that lack robust evidence. Clinicians should verify claims and document patient supplement use.