Comprehensive Nutrition Exam Review

Nutrition Assessment – “ABCD”

• 4 pillars every full assessment must touch; memorize the acronym.
– A = Anthropometrics → height, weight, BMI.
– B = Biochemical tests → lab values (e.g., serum albumin, HbA1c, pre-albumin, lipid panel, iron studies, electrolytes, B-vitamin markers).
– C = Clinical examination → physical signs of deficiency/excess (skin, hair, nails, cognition, edema, wounds, functional status).
– D = Dietary & Social/Drug History → 24-h recall, food frequency, supplements, alcohol, socioeconomic variables.
• Ethical dimension → holistic view prevents stereotyping based on weight alone.

The Six Essential Nutrients

• Carbohydrates – primary fuel.
• Proteins – tissue growth/repair, enzymes, hormones, immunity.
• Lipids – concentrated energy, insulation, fat-soluble‐vitamin carrier.
• Vitamins – organic regulators (water vs. fat-soluble).
• Minerals – inorganic regulators (major vs. trace).
• Water – universal solvent, temperature control, transport.

2020-2025 Dietary Guidelines & MyPlate

• Guideline 1: “Follow a healthy dietary pattern across every life stage.”
• MyPlate visual (quarters): Fruits | Vegetables | Grains | Protein, plus a Dairy cup.
• Encourage whole grains, lean proteins, colorful produce, low-fat dairy; limit added sugars & saturated fat.

Cultural & Vegetarian Patterns

• Kosher (Judaism):
– No meat + dairy together; no pork; seafood must have fins/scales.
• Vegetarian spectrum:
– Vegan: no animal products.
– Lacto-ovo: includes dairy + eggs.
– Lacto: dairy only.
• Practical counseling: pair plant proteins to create complete AA profile.

GI Anatomy & Physiology (Ch 3)

• Major digestive processes: ingestion, propulsion, mechanical & chemical digestion, absorption, elimination.
• Primary site of nutrient absorption = small intestine; large intestine reabsorbs water/electrolytes.
• Bile → secreted by liver, stored in gallbladder, emulsifies fats.
• Intrinsic factor → secreted by stomach parietal cells, required for B_{12} absorption.

Energy Expenditure & BMR

• Basal Metabolic Rate (BMR) = kcal needed at rest to sustain vital functions.
• Raised by: exercise, growth, pregnancy, stress, fever, hyper-thyroid, cold climate.
• Lower with aging, inactivity, energy restriction.
• Thyroid hormones drive rate.
• Equations (Harris-Benedict will be supplied):
BMR{men}=66.5+13.75W+5H-6.78A BMR{women}=655+9.56W+1.85H-4.68A
(W=\text{kg},\;H=\text{cm},\;A=\text{yrs})
• REE (Resting Energy Expenditure) ≈ BMR.

Carbohydrates (Ch 4)

• Primary energy source (4\,kcal/g).
• Types:
– Monosaccharides (glucose, fructose, galactose).
– Disaccharides (sucrose, lactose, maltose) → must be split.
– Polysaccharides (starch, glycogen, fiber) → liver converts to glucose.
• Excess glucose → glycogen then adipose.
• Ketosis: fatty-acid catabolism ↑ when CHO inadequate.
• Fiber goals: women 25\,g, men 38\,g (acceptable exam range 20-35\,g).

Lipids (Ch 5)

• Energy dense (9\,kcal/g); carrier of ADEK.
• Saturated fat → solid @ room T° (butter); raise LDL.
• Unsaturated → oils (olive, plant), omega-3/6 = essential.
• Lipoproteins – transport particles:
– LDL delivers cholesterol to tissues (“bad”).
– HDL removes excess to liver (“good”).
• AHA recommendations: <30\% total kcal from fat, <7\% from saturated fat; dietary cholesterol ≤200\,mg/d.

Proteins (Ch 6)

• RDA for healthy adults: (0.8\,g/kg\,body\,wt).
– Steps: lbs ÷2.2→kg, ×0.8.
• Complete vs. incomplete:
– Complete (all essential AAs): animal, soy.
– Complementation: combine two plant proteins within 24\,h (e.g., rice+beans, PB+bread).
• Nitrogen balance: intake = output.
– Positive in pregnancy, growth, healing.
• PEM disorders: Marasmus (wasting), Kwashiorkor (edema; higher mortality).

Vitamins (Ch 7)

• Water-soluble (B-complex, C): minimal toxicity; deficiency risk ↑ with dehydration/diuresis. Richest natural source of B-vitamins = liver.
• Fat-soluble “ADEK”: require dietary fat & bile for absorption.
– Vit K → coagulation; monitor with warfarin; high in leafy greens.

Minerals (Ch 8)

• Vit C enhances non-heme iron absorption → pair OJ + iron cereal.
• Vit D facilitates Ca absorption → fortified milk, sunlight.
• Fluoride & phosphorus impact tooth integrity (excess or deficit).

Water & Electrolytes (Ch 9)

• Adults 50-60\% water; infants ~75\%.
• Electrolytes (Na⁺, K⁺, Cl⁻) regulate fluid balance, nerve conduction.
• Sodium = extracellular, Potassium = intracellular.
• Thirst = early sign of \ge!1\% body-water loss.

Pregnancy Nutrition (Ch 10)

• Extra kcal: 1st trim +0, 2nd +340, 3rd +450.
• Protein ≈ 60\,g/d total.
• Folate (400-600 µg) prevents neural-tube defects.
• Recommended wt gain (normal BMI): 25-35\,lb.
• Special issues: nausea, hyperemesis, gestational DM, pica (mineral deficiencies).

Infancy & Pediatric Highlights

• Weight: double by 6\,mo, triple by 12\,mo.
• Best food = breast milk; watch malabsorption in cystic fibrosis (supplement ADEK).
• Fiber (4-8 yr): \approx25\,g.
• Most common childhood deficiency → iron-deficiency anemia.
• Food jags, neophobia – address via repeated, pressure-free exposure.
• Allergy: peanuts top trigger.
• Eating disorders: anorexia > mortality than bulimia.

Aging & Older Adults (Ch 13)

• Influences: physiologic decline, psychosocial isolation, economic limits.
• Programs: Meals-on-Wheels (MOW).
• Bone loss begins \approx35-40\,yr; osteopenia needs 1500\,mg Ca, wt-bearing activity, adequate Vit D, avoid excess phosphorus.
• Arthritis relief through weight management; no miracle diet.

Hunger Regulation & Body Composition (Ch 14)

• Hypothalamus hormones:
– Ghrelin ("growl") → hunger signal.
– Leptin → satiety.
• Visceral adiposity (abdominal) ↑ CVD & T2DM risk; more common in men.
• Desirable body-fat %: men 18-24\%, women 25-31\%.
• BMI formula: BMI=\frac{wt\,(kg)}{ht\,(m)^2} (will be provided on exam).

Diabetes Management (Ch 15)

• 1 CHO exchange = 15\,g CHO.
• Example: whole English muffin = 2 exchanges.
• Hypoglycemia signs: tremor, confusion, HA; treat with 4\,oz juice or glucose tabs.

Cardiovascular Disease & DASH

• CVD risks: genetics, smoking, obesity, sedentary, dyslipidemia.
• CHF – weight may be misleading due to edema.
• Diet therapy: Na ≤1500\,mg, cholesterol ≤200\,mg, sat-fat <7\% kcal.
• DASH diet (for HTN & lipids): 8-10 servings fruit/veg daily, whole grains, low-fat dairy, nuts, low Na.

Renal Disease (Ch 17)

• 5 “problem nutrients”: Protein, Phosphorus, Potassium, Sodium, Water.
• HD protein requirement 1.2-1.3\,g/kg.

GI Disorders (Ch 18)

• Celiac: life-long gluten-free.
• Crohn’s & Ulcerative Colitis → low-residue during flare.
• Pancreatitis (acute) → NPO initially, then low-fat enteral.
• Gallstones: “4 F’s” risk – female, forty, fat, fertile.
• GERD: avoid caffeine, alcohol, citrus, spicy; LES = lower esophageal sphincter relaxation.

Cancer Nutrition (Ch 19)

• Promoters: nitrates, processed meats, excess alcohol, charred foods.
• Protectors: vit A, colorful fruits/veg, fiber, phytochemicals.
• Goals: high-kcal, high-protein, small frequent meals, eat when feeling best.

Food Safety & Sanitation (Ch 20)

• Keep hot foods >140^\circ!F, cold foods <40^\circ!F.
• Prevent cross-contamination; wash hands ≥20 s.
• Soft cheeses may harbor Listeria (dangerous to pregnant pts).
• Botulism (Clostridium botulinum) – most lethal; avoid swollen cans.
• Top allergens: peanuts, tree nuts, milk, eggs, wheat, soy, fish, shellfish.

Surgery, Wound Healing & Artificial Nutrition (Ch 21-22)

• Pre-op: enter surgery well nourished if elective.
• Post-op: often NPO + IV fluids <24 h, then advance.
• Wound healing: ↑ protein + fluid.
• Enteral feeds (tube to GI) preferable when gut works; formula classes: polymeric, elemental, disease-specific.
• Parenteral (TPN/PPN) when gut non-functional; sterile compounding, monitor glucose/e-lytes.

Key formulas & numeric targets are presented in \LaTeX for exam readiness. Reinforce each chapter with textbook tables, real-world menus, and cultural considerations to integrate ethical and practical competence.