Chapter 1

What is nutrition and why is good nutrition important?

Nutrition is the study of how food nourishes the body and influences health. Involves the study of:

• Food consumption, digestion, absorption
• Food storage
• Factors that influence eating patterns
• Recommended amounts of types of food
• Food safety
• The global food supply

Importance:

1. Supports our ability to perform activities of daily living
2. Enhances our ability to concentrate and perform mental tasks
3. Strengthens our ability to fight infections by maintaining our immune system
4. Provides opportunities for social interactions through shared cooking and eating experiences
5. Plays a role in reducing the risk for disease (deficiency, overnutrition)

What are the 6 groups of nutrients? What is the difference between micro- and macronutrients?

1. Carbohydrates
2. Vitamins
3. Fats and oils
4. Minerals
5. Proteins
6. Water

Macronutrients: nutrients required in relatively large amounts

• Provide energy (calories)
• Carbohydrates, fats and oils, proteins

Micronutrients: nutrients required in smaller amounts

• Vitamins
• Minerals

How many calories per gram do each of the macronutrients provide?

Carbohydrates and proteins: 4 cal/g

Lipids: 9 cal/g

Basically, what do the 3 macronutrients do in the body?

1. Carbohydrates: primary fuel source
2. Fats and Oils: insoluble lipid that provide energy and other essential nutrients
3. Proteins: support tissue growth, repair and maintenance, fluid balance. Can provide energy, but not a primary source of energy

Basic understanding of the DRIs. (Dietary Reference Intakes)

• Amount of nutrient needed to prevent deficiency disease in healthy people
• Amount of a certain nutrient that may reduce the risk of chronic disease
• Upper level of safety for nutrient intake

4 values that make up DRIs

1. EAR
   1. Estimated average requirement
2. RDA
   1. Recommended dietary allowance
3. AI
   1. Adequate intake
4. UL
   1. Tolerable upper intake level

What is the AMDR? (Acceptable Macronutrient Distribution Ranges)

• Range of intakes for a particular energy source
• Associated with reduced risk of chronic disease
• Still provides adequate intake of essential nutrients

Caloric Intakes:

• Carbohydrates: 45-65%
• Fat: 20-35%
• Protein: 10-35%

What is the EER? (Estimated Energy Requirement)

• Average dietary energy intake predicted to maintain energy balance in a healthy adult
• Takes into account:
• Age
• Gender
• Height
• Weight
• Level of Physical Activity

Describe the scientific method.

1. Observation
2. Hypothesis
3. Experiment
4. Data collection and analysis
5. Reject or modify hypothesis

What type of research is often conducted in the field of nutrition?

​​ Epidemiological studies, interventional clinical trials, and randomized clinical trials.

What types of things should you ask yourself when looking at nutrition news?

• Watch for conflict of interest and bias
• Who is reporting the information
• Who conducted the research and who paid for it
• If it's based on reputable research studies
• Is the report based on testimonials

Who can you trust for reliable information about nutrition?

Registered dietitian

• A nutritionist with credentials
• Professional with advanced degree(s) in nutrition or Physician with appropriate expertise in nutrition

What is nutrigenomics?

• The food we eat can influence gene expression
• Studies the interaction with genes, the environment, and nutrition
• Influenced by diet, body weight, substance use, etc.

What are probiotics? What are prebiotics?

Probiotics: foods and supplements that contain live microorganisms that benefit human health. Ex. yogurt, pepper, fermented food

Prebiotics: non-digestive food ingredients that support the growth and activity of probiotics

What are phytochemicals? And what health benefits do they have?

• Chemicals found in plants
• Naturally occurring compounds that protect plants from pests, UV radiation
• Reduce inflammation
• Protect against unhealthful blood cholesterol levels
• Impede the progression of cancer
• Enhance immune function

Chapter 2

What is a healthful diet? (what do each of the terms related to a healthful diet mean)

• A healthful diet provides the proper combination of energy and nutrients

It is:

• Adequate
• Moderate
• Balanced
• Nutrient dense - more nutrient for the amount of calories
• Varied
• Flexible

What is behind our individual food choices?

• Sensory data
• Sociocultural cues
• Learning

What are some things to pay attention to on food labels?

1. Nutrition facts table
2. Ingredient list
3. Allergen declaration and gluten sources
4. Date marking
5. Country of origin claims
6. Composition claims
7. Nutrition claims
8. Methods of production claims
9. Common name

What are some good recommendations from Canada’s Food Guide?

• Be mindful of your eating habits
• Cook more often
• Enjoy your food
• Eat meals with others
• Eat plenty of vegetables and fruit, whole grain and protein foods
• Choose protein foods that come from plants more often
• Limit highly processed foods
• Make water your drink of choice
• Use food labels
• Be aware that food marketing can influence your choices

Chapter 3

What are the basic functions of the: nucleus, ribosomes, endoplasmic reticulum, mitochondria.

1. Nucleus: control center, genetic material, synthesize mRNA
2. Ribosomes: protein synthesis
3. Endoplasmic reticulum: calcium storage
4. Mitochondria: cellular respiration and ATP production

Describe the structure of the cell membrane.

• Contain an amphipathic phospholipid bilayer
• Cholesterol for membrane flexibility
• Proteins for transport

Define hunger and appetite.

Hunger: physiological drive to eat

Appetite: stimulated by sight, smell, thought of food

Where in the brain is hunger regulated?

Hypothalamus: contain a feeding center and a satiety center

Describe the chemicals involved in us feeling an urge to eat.

• Insulin and glucagon (you know this)
• Ghrelin: produced by stomach; hunger hormone produced when stomach is empty
• Nerve cells in the GI tract signal the hypothalamus

How does the amount and type of food play a role in our urge to eat?

• Foods have differing effects on our feeling of hunger and satiety
• Proteins have the highest satiety value
• Bulky foods high in fiber provide a sense of satiety
• Solid foods are more filling than semisolid foods or liquids

What are the main roles of the organs of the GI tract?

Mouth: mechanical digestion (chewing), chemical digestion (salivary amylase)

Esophagus: transports food from the pharynx into the stomach

Stomach: mixes, digests, and stores food

Small Intestine: most digestion and absorption occur in the small intestine

Gallbladder and Pancreas: aide in digestion

Large Intestine: stores food until waste is excreted

Define chemical and mechanical digestion.

Mechanical: physically breaking down food into smaller particles for chemical digestion

Chemical: further degrades the molecular structure of the ingested compounds that can be absorbed by the bloodstream

Describe muscle movement in the GI tract.

Peristalsis: involuntary muscle contractions moving food through the GI tracts

Understand what is happening in the different sections of the GI tract including what the accessory organs/structures do.

Mouth:

• Chewing initiates mechanical digestion
• Some chemical digestion also occurs in the mouth
• Saliva from salivary glands aid in digestion
• Enzymes act to speed up the body processes

Esophagus:

• The epiglottis covers the opening of trachea during swallowing
• Peristalsis is the muscular contractions moving food through the GI tract
• The gastroesophageal sphincter separates the esophagus from the stomach

Stomach:

• Gastrin hormone, secreted by G cells of stomach stimulates gastric juices
• HCl: denatures proteins and activates pepsin
• Intrinsic factor: critical to the absorption of vitamin B12
• Pepsinogen: inactive form of pepsin to digest protein
• Gastric lipase: fat digestion

Gallbladder:

• Stores bile (produced by liver)
• Bile released from common bile duct to duodenum
• Bile emulsifies fat

Pancreas:

• Manufactures, holds and secretes enzymes
• Also secretes bicarbonate to ensure duodenum lining is not eroded and helps enzymes work more effectively

Small Intestine:

• A specialized lining boosts absorption
• Villi contain capillaries and lacteals for nutrient absorption
• Microvilli have enzymes to increase absorption

Large Intestine:

• Undigested food components move through sphincter called the ileocecal valve
• Very little digestion takes place
• Material stored 12-24 hours prior to elimination
• Water and some nutrients are absorbed

How do hormones, enzymes and bile aid digestion?

They break down sugars, fats, and starches into smaller components

Hormones:

Insulin/Glucagon: maintain blood glucose levels

Ghrelin: hunger hormone produced during an empty stomach

CCK: produced by small intestine (satiety)

Leptin: produced by adipose cells (satiety)

Gastrin: stimulate acidic gastric juices

Enzymes:

Salivary amylase: digest CHO

Gastric lipase: digest fat

Bile: emulsifies fat

Describe the 4 methods by which nutrients are absorbed.

1. Simple diffusion

• High concentration to low concentration w/o carrier proteins
• Lipid soluble molecules (some vitamins)

1. Facilitated diffusion (passive transport)

• Movement of nutrients across a cell membrane with the aid of carrier proteins
• Water soluble vitamins (vit. C)

1. Active transport

• Movement of nutrients across a cell membrane using ATP and certain carrier proteins
• Glucose absorbed in small intestine

1. Endocytosis

• Engulfing nutrients into the cell using vesicles, requires ATP
• Proteins and peptides (large molecules)

What nutrients enter the blood after absorption and which enter the lymph?

Blood:

• Monosaccharides
• Carbohydrates
• Amino acids
• Fatty acids
• Water-soluble vitamins

Lymph:

• Long-chain fatty acids
• Fat-soluble vitamins

What functions do the GI flora perform?

GI Flora: largest constituents of the human microbiome (live in large intestine)

• Digest indigestible complex carbohydrates and protein
• Make products that are used by enterocytes or absorbed
• Synthesize vitamins
• Inhibit growth of harmful bacteria
• Stimulate immune system

Basically, how does the enteric nervous system function?

• The muscles of the GI tract mix and move food both voluntary (buccinator) and involuntary (smooth muscle)
• Nerves control the contractions and secretions of GI tract

Describe the common digestive disorders described in the lecture notes.

Heartburn/Acid Reflux:

• Caused by reflux of gastric juice
• HCl in the esophagus

Ulcers:

• Erosion in the GI tract by pepsin and HCl
• H. pylori contributes to the production of both gastric and duodenal ulcers

Cyclic Vomiting Syndrome

• Chronic condition involving severe nausea and vomiting that can last for hours or days

Diarrhea

• Caused by infection, chronic disease, reactions to medication, reaction to food or ingredient
• Food intolerance

Constipation

• No stools passed for 2< days

Irritable Bowel Syndrome

• Disorder characterized by changes in bowel function resulting from brain-gut dysregulation

Cancer

Lactose intolerance

Allergies

Celiac disease

• Damages lining of small intestine and interferes with absorption of nutrients
• Immune reaction to wheat gluten

Chapter 4

What is a healthful body weight?

1. Appropriate for your age
2. Maintained without constant dieting
3. Compatible with normal blood pressure, lipid levels and glucose intolerance
4. Based on a family history of body shape and weight
5. Promotes good eating habits and allows for regular physical activity

What is BMI?

Body Mass Index

• Expresses the ratio of a person’s weight to square of his or her weight
• BMI = weight (kg)/height(m)^2
• BMI values below 18.5 or above 30 have increased risks of health problems

What are the limitations of using BMI and what groups of people shouldn’t use BMI to determine health?

• May not be accurate for everyone
• Should not be used to determine health status
• Groups: age, sex, muscle mass,
• Does not distinguish between subcutaneous and visceral fat, muscle, or bone mass

What are the differences between visceral fat and subcutaneous fat and what are the links to health risks for these 2 types?

Visceral fat is the adipose surrounding internal organs and subcutaneous fat is the adipose CT within the subcutaneous layer

Health risks: heart disease, type 2 diabetes, hypertension

How can percentage of body fat be measured?

• Skinfold calipers
• DXA machine
• Body circumference measurements
• Bod Pod

Advantages/disadvantages of the methods.

• Skinfold calipers don’t really measure subcutaneous fat accurately, and does not measure visceral fat at all
• DXA machines look at both visceral and subcutaneous fat measurements

What is TEE?

Total Energy Expenditure

• The sum of all energy the body expends to maintain basic function and perform all levels of movement and activity
• Basal energy expenditure + thermic effect of food + activity energy expenditure = TEE

What is BMR? What factors affect your BMR?

Basal Metabolic Rate

• Energy expended to maintain basal, or resting functions of the body
• 60-75% of total energy expenditure

Increase BMR:

• Higher lean body mass
• Greater height (more surface area)
• Younger age
• Elevated TH
• Stress, fever, illness
• Males
• Pregnancy and lactation
• Drugs (stimulants, caffeine, tobacco)

Decrease BMR:

• Lower lean body mass
• Lower high
• Older age (minimal)
• Decreased TH
• Starvation, fasting or very-low calorie diets (minimal)
• Females due to less lean tissue

What is TEF? Which macronutrients have the highest TEF?

Thermic Effect of Food (TEF)

• Energy expended to digest, absorb, transport, metabolize, and store nutrients
• Lowest for fat and higher for protein and carbohydrates
• The more processed a food is, the less energy it takes to digest the food

What factors affect body weight? Describe the theories

described in the lecture notes to explain genetics and body weight.

• Genetic inheritance (height, weight, body shape, metabolic rate)
• FTO gene: fat mass and obesity associated gene. Higher levels of hunger, increased intake of foods high in fat and refined starches
• Thrifty gene theory: proposes that a gene(s) causes people to be more energetically thrifty. Less energy expenditure than other people, therefore gain weight. This was believed to be an adaptation to protect people from starving to death during famine

What are some metabolic factors that influence weight loss/gain?

• Relatively low metabolic rate
• Low level of spontaneous physical activity
• Low SNS activity
• Low rate of fat use for energy
• Low level of TH
• Certain medications

What are some things that increase satiety and decrease food intake? What are some things that increase food intake?

Increase Satiety:

• PYY
• Serotonin
• CCK
• Increased blood glucose levels
• Stomach expansion
• Nutrient absorption from S.I.

Increase food intake:

• Beta-endorphins
• neuropeptide-Y
• Decreased blood glucose levels

What are some red flags for diet hype?

• Promotes new, improved diet with no scientific data
• Rapid weight loss (2 pounds/week)
• Certain combination of foods that “burn fat”
• Rigid menu and use of supplements
• Intermittent fasting

What strategies can you follow when designing your own plan to lose weight in a healthful manner?

• Realistic goals: specific, reasonable, measurable
• Eat smaller portions of nutrient-dense foods
• Be aware that portion sizes have increased
• Eat more low energy-dense foods (low cal.)
• Regular physical activity for maintenance, increase lean body mass, improves mood, sleep, and self-esteem

What are some mindful eating tips?

• Focus only on eating
• Savor each bite
• Recruit all your senses
• Pause and rest between bites
• Try 10 minutes of silence

How can you gain weight in a healthy manner?

• Eating nutrient-dense foods
• Must consume more energy than expected
• Eat a diet that includes 500-1000 kcal/day more than is needed to maintain present body weight
• Eat frequently, including meals and snacks
• Avoid the use of tobacco products
• Exercise regularly and incorporate resistance training

Do protein and amino acid supplements increase muscle mass?

No!

What does increase muscle mass:

• Adequate intake of energy
• Protein from high-quality food sources
• resistance training

Define obesity.

• Having excess body fat that adversely affects health
• Large amount of visceral fat (release of fatty acids and adipokines (pro-inflammatory)

Must have 3+ of the following:

• Abdominal obesity (adipose)
• High triglyceride levels
• Low HDL levels
• Hypertension
• High fasting blood glucose

What are some complications of obesity?

• Associated with metabolic syndrome
• Hypertension
• Type 2 diabetes
• Cardiovascular disease

Why does obesity occur?

• Biology
• Physical activity environment
• Individual physical activity
• Individual psychology
• Societal influences
• Food environment
• Food consumption

Chapter 5

What are the 3 most common monosaccharides and list the 3 most common disaccharides found in food?

Monosaccharides

• Glucose
• Fructose
• Galactose

Disaccharides

• Lactose (glucose + galactose)
• Maltose (glucose x2)
• Sucrose (glucose + fructose)

What is starch? What is glycogen?

• Starch: storage molecule in plants that our bodies break down to glucose
• Glycogen: stored by animals and not a dietary source of carbohydrates

Define and give examples of soluble and insoluble fiber.

Soluble fiber

• Dissolves in water
• Easily digested by bacteria in the colon
• Found in citrus fruits, berries, oats and beans
• Reduces risk for cardiovascular disease and type 2 diabetes by lowering blood cholesterol and glucose levels

Insoluble fiber

• Generally do not dissolve in water
• Found in whole grains, the husk of grain and many vegetables
• Promote regular bowel movements

Define ketones. Define ketoacidosis.

Ketones:

• Produced in the body as a byproduct of the breakdown of fatty acids for energy when glucose is not readily available

Ketoacidosis:

• Accumulation of ketones increasing acidity in blood

Why is fiber so important to our health?

• May reduce the risk of colon cancer
• May reduce the risk of heart disease
• Can enhance weight loss
• Helps prevent hemorrhoids constipation and diverticulosis
• May lower the risk of type 2 diabetes

How are carbohydrates digested and absorbed?

• Chemical digestion begins in the mouth with salivary amylase
• Most chemical digestion of carbohydrates occurs in the small intestine
  • Pancreatic amylase
  • Additional enzymes (maltase, sucrase, lactase) break down disaccharides into monosaccharides
• Liver converts non glucose monosaccharides into glucose
  • Fructose and galactose are converted to glucose
  • If glucose is needed, it is released to blood to provide energy through glycolysis
  • If glucose isn’t needed, it is stored in liver and muscle
    • Broken down through gluconeogenesis

Understand how hormones regulate blood glucose.

• Insulin (negative feedback)
• Glucagon (inverse effect of insulin)

Why is fructose different from glucose when it comes to absorption?

• The absorption rate of fructose is slower than glucose in the small intestine. Fructose is absorbed farther down
• Fructose cannot enter brain cells and stimulate satiety signals

Define glycemic index.

• A measure of a food’s ability to raise blood glucose levels

Foods with a low glycemic index:

• Cause mild fluctuations in blood glucose level
• Are better for people with diabetes
• Are generally higher in fiber
• May reduce risk of heart disease, colon and prostate cancer

How much fiber should men and women consume each day?

Women: 25 grams/day

Men: 38 grams/day

*14 grams for every 1000 kcal in the diet

What are the 3 parts of a grain and what do each of the parts contain?

1. Bran
   1. High fiber and Vitamin B
2. Endosperm
3. Germ

Understand the differences between type 1 and type 2 diabetes.

Diabetes: inability to regulate blood glucose levels & high blood glucose becomes chronic

Type 1:

• Autoimmune; immune system attacks beta cells in pancreas
• Body doesn't produce enough insulin
• Has a genetic link
• May lead to ketoacidosis, coma, death

Type 2:

• Develops progressively overtime
• Body cells become insensitive or unresponsive to insulin
• Can be triggered by obesity
• Variations include insulin resistance, impaired fasting glucose, & pre-diabetes
• Eventually the pancreas may become unable to produce any insulin

How can you reduce your risk of developing type 2 diabetes?

• Limit intake of added sugar
• Choose more fiber-rich whole grains and whole grain products
• Moderate exercise may prevent onset of diabetes

Chapter 6

Know the basic structure and function of triglycerides, phospholipids and sterols.

• Triglycerides
  • 3 fatty acid molecules
    • Fatty acids: long chain of carbon atoms surrounded by hydrogen atoms
  • 1 glycerol molecule
    • Glycerol: a 3-carbon alcohol that is a backbone of a triglyceride
• Phospholipids
  • Composed of
    • Glycerol backbone
    • 2 fatty acids
    • Phosphate
    • Manufactured in our bodies
      • Not required in our diet
    • Important components of cell membranes
• Sterols
  • Lipids containing multiple rings of carbon atoms
  • Essential components of cell membranes
    • Help maintain structural integrity
  • Many hormones are sterol based
  • Manufactured in our bodies & not essential components of our diet
  • Cholesterol is the major sterol found in the body

How are triglycerides (specifically the fatty acid part) classified?

• Length of their carbon chain
  • Short (<6), medium (6-12), or long (>14)
• Level of saturation
  • How many hydrogen atoms surround each carbon
• Shape
  • Determined by how fat is chemically processed

What are SFAs, MUFAs and PUFAs?

• Saturated fatty acids (SFA)
  • Plants
  • Hydrogen atoms surrounding every carbon in the chain
    • No double bonds
• Monounsaturated fatty acids (MUFA):
  • Plants
  • Lack hydrogen atoms in one region
    • One double bond
• Polyunsaturated fatty acids (PUFA):
  • Animal
  • Lack hydrogen ions in multiple locations
    • Two or more double bonds

Which fats are solid at room temperature? Which fats are liquid at room temperature?

• Solid
  • Saturated fatty acids
• Liquid
  • Unsaturated fats (PUFA)

What is hydrogenation?

• The addition of hydrogen atoms to unsaturated fatty acids
  • Convert liquid fats (oils) into a semisolid (spreadable) or solid form
  • Used to create margarine from plant oil
  • Often creates trans fatty acids
• Listed on food labels as partially hydrogenated oil

What are the 2 essential fatty acids? Where do we find them in foods? What do they do in the human body?

• 2 fatty acids cannot be synthesized in the body & must be obtained in the diet
• Linoleic (Omega-6) & alpha-linolenic (Omega-3) acid converted into important regulatory compounds in the body
• Precursors to eicosanoids
  • Regulate cell function
    • GI motility, blood clotting, blood pressure, vessel permeability, inflammation
• Linoleic Acid:
  • Omega-6 fatty acid
  • Found in vegetable & nut oils
  • Converted in body to arachidonic acid
  • Involved in blood clotting & blood pressure
• Alpha-linolenic Acid
  • Omega-3 fatty acid
  • Found in dark green leafy vegetables, fish & fish oils, flax & flaxseed oil
  • Converted to EPA & DHA
  • Important regulators of inflammation, blood clotting & blood pressure

What are the functions of fats?

• Energy
  • Fat is energy dense (9 kcal/gram)
  • 30-70% of the energy used at rest comes from fat
  • Fatty acids are used for energy during low to moderate intensity physical activity
  • Fat is also used for energy storage in adipose tissue
• Vitamin Transport
  • Vitamins A, D, E, K, are soluble in fat & fat is required for absorption across intestinal wall
    • A: vision
    • D: bone health
    • E: protect cell membrane from byproducts of metabolism
    • K: blood clotting
• Maintain Cell Function
  • Phospholipids, cholesterol and fatty acids help maintain:
    • Cell membrane permeability
    • Permeability of cell
    • Regulate binding of substances of the cell
  • Fats help maintain:
    • Fluid and flexibility
    • Enable red blood cells to move through small capillaries
  • PUFAs are important for
    • Healthy brain and spinal cord tissue
• Protection
  • Adipose tissue pads our body & protects organs
  • Fat acts as insulation to retain body heat
• Flavour
  • Provides flavor and texture to foods
  • Contributes to satiety responses
    • Take longer to digest
    • Have a higher energy density than proteins and carbohydrates

How are fats digested?

• Insoluble in water
• Very little digestion of lipids occurs in the watery environments of the mouth or stomach
• Digestion of lipids begins in the small intestine
• As fat enters the small intestine:
  • Cells is duodenum secrete CCK and secretin; gallbladder contracts
  • Bile is secretes into the small intestine
  • Bile disperses fat into smaller droplets
  • Pancreatic enzymes break triglycerides into separate fatty acids & a monoglyceride
  • Fat enters the mucosal cell as a micelle (Fas, monoglycerides, phospholipids, and sterols)

How are fats absorbed?

• Absorption of fat occurs primarily in the small intestine
  • SCFA and MCFA absorbed by passive diffusion
  • LCFA absorption occurs in enterocytes with the help of micelles
• Fatty acids & monoglycerides are packages into
  • Lipoproteins
    • Ways that the body has to transport fats through blood
    • Chylomicron is a lipoprotein that is produced by enterocytes to transport fat

How are fats transported?

Chylomicrons

• They are transport vesicles
• They remove absorbed fats from the small intestine
  • They are soluble in water because of phospholipid and protein composition
  • They are transported to lymphatic system through the lacteals to the subclavian vein
• Lipoprotein lipase (LPL) outside
  • Adipose and muscle cells breaks apart triglycerides in chylomicrons
    • Free fatty acids move into the cell
    • Glycerol transported back to kidneys or liver

How are fats used in body cells?

1. Body cells take up fatty acids & use as a source of energy
2. Cells use them to make lipid-containing compounds
3. If body doesn’t need energy, muscle & adipose cells can recreate triglycerides & store them for future use

What is the AMDR for fat?

• 20-35% of calories should be from fat

What are some healthful recommendations regarding fats in our diet?

• Increase intake of omega-3 fatty acids
• Focus on poly- & mono-saturated fats in general
• Switch to healthful fats without increasing your total fat intake
• Limit saturated fat intake
• Avoid industrial trans fats

What is atherosclerosis? What causes it and how does it impact health?

• Definition: accumulation of cholesterol-rich plaque on artery walls that result in hardening of the wall (arteriosclerosis)
• Complex process that begins with
  • Injury to the cells that line insides of vessels
• Injury caused by:
  • Chronic high blood pressure
  • Irritants (nicotine)
  • Chronic high blood glucose
  • Immune response from chronic infection
  • All lead to vessel inflammation
• Chemicals are released that cause blood lipids to accumulate at the site of injury
  • Mainly low-density lipoproteins (LDL)
• LDL
  • Invade the lining of the artery wall and become oxidized
  • Activate other immune cells & forms foam cells & fatty streaks
• Plaques form
  • Narrowing the interior of blood vessel & decreasing blood supply to downstream tissues

What are the modifiable risk factors for CVD?

• Overweight and obesity
• Inactivity
• Smoking
• Type 2 diabetes mellitus
• Inflammation
• Abnormal blood lipids
• High blood pressure

What are the differences between our blood lipids?

• Chylomicron
  • Formed in the gut after a meal
  • Released in the lymph system and then into the blood
  • Largest of the lipoproteins, with the lowest density
  • Taken up by the liver once triglycerides are removed
• VLDL (very low density lipoprotein)
  • 80% are formed in the liver
  • 20% are formed in the intestine
• LDL (low density lipoprotein)
  • “Bad cholesterol”
  • Formed in the blood from VLDL
  • Transformation from VLDL to LDL occurs as the triglycerides are removed from VLDL
• HDL (high density lipoprotein)
  • “Good cholesterol”
  • Synthesized in the liver and released into the blood
  • Transported by the blood throughout the body, picking up free cholesterol

How can we improve our blood lipids?

• Eat lots of vegetables and fruits
• Increase intake of ALA from dark green leafy vegetables, soy, walnut, flax, canola
• Consume oily fish twice per week
• Decrease dietary saturated fat to less than 10% of total energy
• Keep trans fats as low as possible
• Maintain normal blood glucose & consume whole foods with more fiber
• Stop smoking
• Keep fat intake to 20-35% of total energy intake
• Consume no more than 2 alcoholic drinks per day for men and 1 drink per day for women
• Exercise most days of the week for 30-60 minutes
• Maintain a healthy body weight

Chapter 7

What are the building blocks of proteins?

Long chains of amino acids joined together by peptide bonds

What makes amino acids different from each other?

Side chain

What is the difference between essential and nonessential amino acids?

• Indispensable (essential) amino acids
  • Cannot be produced by our bodies (or not in sufficient quantities)
  • Must be obtained from food
  • 9 of 20 are essential
• Dispensable (nonessential) amino acids
  • Can be made by our bodies
  • Made by transferring amino acid groups (transamination)

What is transamination?

The transfer of amino acid groups

How are proteins made?

• Transcription
  • Use of the genetic information in DNA to make mRNA
  • In nucleus
  • MRNA leaves the nucleus and enters the cytoplasm
• Translation
  • Conversion of genetic information in mRNA to a chain of amino acids to form a protein
  • mRNA binds with rRNA
  • tRNA bring appropriate amino acid
  • Amino acids are transferred to ribosomes & assembled into proteins
  • Protein may undergo further modification

What is protein turnover?

• Protein turnover refers to the continuous process of synthesis and degradation of proteins within a cell or organism.
• It involves the balance between protein synthesis, which involves the creation of new proteins from amino acids, and protein degradation, which involves the breakdown of existing proteins into their constituent amino acids.
• Amino Acid Pool:
  • Synthesis of non protein compounds that contain nitrogen, including creatine and serotonin
  • Synthesis of body proteins, such as enzymes, antibodies, and various components of cells
  • Synthesis of fat from amino acid carbon skeletons; this can be stored as adipose tissue
  • Synthesis of glucose from amino acid carbon skeletons; this can be used for energy
  • Energy produced from amino acid carbon skeleton
• Excess nitrogen in the form of ammonia is used to synthesize urea in the liver
• Urea is excreted in urine via the kidneys

What are the 4 levels of protein structure?

• Primary structure
  • Sequential order of amino acids
• Secondary structure
  • Spiral shape
  • Due to chemical bonding within the amino acids
• Tertiary structure
  • Further holding into a unique 3-d shape
  • Most proteins are functional here
• Quaternary structure
  • Some proteins have subunits

What is denaturation? What can cause it?

• Protein loses shape
  • Heat
  • pH level
  • Heavy metals
  • Alcohol
  • Other damaging substances
• Results in irreversible loss in protein function

What is the difference between an incomplete and a complete protein? What types of foods do we find each of them in?

• Incomplete:
  • Do not contain all 9 essential amino acids in sufficient quantities for you to make all your proteins
  • Growth and health are compromised
  • Considered a “low-quality” protein
  • Foods: gelatin, most plant proteins (high-quality food but low quality protein)
• Complete:
  • Contains sufficient amounts of all 9 essential amino acids
  • Considered a “high-quality” protein
  • Foods: animal foods, soy, quinoa

Define mutual supplementation and complementary proteins.

• Mutual
  • Combining of 2 incomplete proteins to make a complete protein
• Complementary
  • 2 protein sources that together supply all 9 essential amino acids
  • Ex. beans and rice

Why do we need proteins? What do they do in the human body?

• Structure, cell growth, repair and maintenance
• Act as enzymes and hormones
• Maintain fluid and electrolyte balance
• acid -base balance
• Immunity
• Energy source
• Transport and storage of nutrients
• Nerve function
• Blood clotting
• Wound healing

How are proteins digested?

• In stomach
  • HCl- denatures protein structure
  • HCl- activates pepsinogen into pepsin
  • Pepsin
    • Breaks down proteins into short polypeptides & amino acids
  • Gastrin
    • Controls HCl- production and pepsin release

How are proteins absorbed?

• Small intestine
  • Proteases digest proteins into peptides & single amino acids
  • Peptidases break apart tripeptides & dipeptides into amino acids
  • Absorption
  • Transported to liver by hepatic portal vein

Which groups need more protein in their diet?

• Children
• Adolescents
• Pregnant or lactating
• Athletes and active people
• Older adults

What happens if you eat too much protein?

• High CHO and heart disease
  • Diets high in protein from animal sources are associated with higher cholesterol
• Kidney disease
  • They may be an increased risk of kidney disease for people who may be susceptible to kidney disease

What happens if you don’t get enough protein in your diet?

• Marasmus
  • Severe wasting of muscle tissue
  • Stunted growth
  • Stunted brain development
  • Anemia
  • Severely weakened immune system
• Kwashiorkor (in early weaning)
  • Some muscle tissue wasting
  • Edema resulting in distended belly
  • Delayed growth and development

Why do some people adopt a vegetarian diet?

• Religious reasons
• Ethical reasons
• Concerns over food safety
• Ecological reasons

What are some challenges of a vegetarian diet?

• Low in:
  • Vitamin B12
  • Vitamin D
  • Riboflavin (B-vitamin)
  • Iron
  • Calcium
  • Zinc

Know the general characteristics of fat-soluble vitamins, water-soluble vitamins, and minerals.

• Fat soluble
  • A, D, E, K
  • Large storage capability
  • Toxicity is possible
  • Deficiency symptoms may take many months to develop
  • May occur in numerous chemical forms
• Water soluble
  • B-complex and C
  • Minimal storage capability
  • Rare toxicity
  • Deficiency symptoms occur quickly
  • Excreted in urine when tissues are saturated
• Minerals
  • Inorganic
  • Cannot be synthesized by plants or animals
  • Not digested or broken down prior to absorption
  • 2 classifications based on need
  • Major minerals
    • Required in amount of at least 100 mg/day
    • Body contains 5 g or higher
    • 7 major minerals:
      • Sodium
      • Potassium
      • Phosphorus
      • Chloride
      • Calcium
      • Magnesium
      • Sulphur
  • Trace and Ultra trace minerals:
    • Required n amounts of less than 100 mg/day
    • Body contains less than 5 g
    • 9 trace minerals:
      • Selenium
      • Fluoride
      • Iodine
      • Chromium
      • Manganese
      • Iron
      • Zinc
      • Copper
      • Molybdenum

Why is supplementation of micronutrients controversial?

• Easier to develop toxicity
• Some may be harmful to certain subgroups of people
• Most minerals are better absorbed from food
• Eating a variety of foods provides many other nutrients
• Supplements may alter the balance between nutrients

Chapter 8

Where are fluids found in the human body?

• 50-70% of body is composed of fluids
• About ⅔ of this fluid is intracellular fluid (ICF)
• The remaining ⅓ is extracellular fluid (ECF)
  • Tissue fluid
  • Intravascular fluid

How do lean tissue and adipose tissue differ with respect to fluid content?

• Lean (skeletal muscle) tissues have higher fluid content than adipose tissue

How does age influence fluid content of the body?

• Lean tissue is lost with age & fluid is lost with it

What is a solvent? What is a solute?

• Solvent
  • Can dissolve many different substances
• Solute
  • Dissolved materials like ions, sugars, amino acids, vitamins & minerals

How does blood volume influence blood pressure?

• Increased blood volume can cause blood pressure to rise
• Decreased blood volume can cause low blood pressure

How does fluid help maintain body temperature?

• High heat capacity of water means that the temperature of our body fluids remains quite stable
• Sweating releases heat as the evaporation of water from the skin cools the skin and blood

What types of fluids are protective in the human body?

• CSF protects the brain and spinal column
• Amniotic fluid protects the fetus
• Synovial fluid is a lubricant around many joints
• Digestive secretions allow for easy passage of material
• Pleural fluid covering lungs allows for expansion & contraction in chest cavity

How does water help maintain acid-base balance?

• Water combines with CO2 to form carbonic acid which dissociates to bicarbonate and hydrogen ions

What is osmosis?

• Osmosis is a biological process where solvent molecules (usually water) move through a selectively permeable membrane from an area of lower solute concentration to an area of higher solute concentration. This movement occurs to equalize the concentration of solute on both sides of the membrane, aiming to achieve equilibrium.

Which electrolytes allow nerve cells to respond to stimuli?

• Movement of sodium and potassium ions across the membranes of nerve cells changes the electrical charge across the membrane

Which electrolyte is the signal for our muscles to contract?

• The movement of calcium into a muscle cell stimulates the muscle to contract
• The calcium is pumped back out of the cell and the muscle relaxes

Where in the brain is the thirst mechanism controlled? What will stimulate the thirst mechanism?

• This mechanism occurs from a cluster of nerve cells (in hypothalamus) that stimulate the desire to drink
• Thirst mechanism is stimulated by:
  • Increase in salt or other dissolved substances in blood
  • Reduction in blood volume & pressure
  • Dryness in tissues of mouth & throat
  • Stimulates the release of ADH so urine output decreases

What does ADH do?

Regulation of Water Balance: ADH acts on the kidneys to increase water reabsorption. It does this by making the kidney tubules more permeable to water, allowing more water to be reabsorbed back into the bloodstream. This helps to conserve water and prevent dehydration when the body's fluid levels are low or when blood osmolarity is high.

Maintenance of Blood Pressure: ADH also has vasoconstrictive effects, meaning it causes blood vessels to constrict. This action helps to increase blood pressure by narrowing the diameter of blood vessels, which leads to increased peripheral vascular resistance.

Urine Concentration: By increasing water reabsorption in the kidneys, ADH helps to concentrate urine, reducing the volume of urine produced. This is particularly important in situations where the body needs to conserve water, such as during dehydration.

Thirst Regulation: ADH can also stimulate thirst by acting on the hypothalamus, which helps to encourage fluid intake and maintain hydration.

How is water lost and gained?

• Gained
  • Beverages, food, and metabolic reactions
• Lost
  • Urine, sweat, exhalation, feces
  • The kidneys control how much water is reabsorbed
  • Excess water is processed by the kidneys and excreted in urine
  • Insensible water is lost through the skin or through the lungs during exhalation
• Significant fluid loss
  • Illness
  • Traumatic injury
  • Exercise
  • High altitudes, extreme temperatures, low humidity
  • Pregnancy
  • Breastfeeding
  • Diuretics

What are the functions of sodium in the body?

• Fluid and electrolyte balance
• Associated with blood pressure and pH balance
• Required for nerve impulse transmission
• Assists in the transport of certain nutrients into body cells

What is hypernatremia, when can it occur, and what does it result in?

• Abnormally high blood sodium concentration
• Can happen to patients with congestive heart failure or kidney disease
• Results in
  • High blood volume, edema, and high blood pressure

What is hyponatremia and when can it occur?

• Abnormally low blood sodium level
• Can result from
  • Prolonged vomiting, diarrhea or sweating
  • Has been seen in marathon athletes who consume too much water

What are the functions of potassium in the body?

• Fluid and electrolyte balance
• Very important in muscle contraction and transmission of nerve impulses
• High potassium diet helps to maintain a lower blood pressure

What is hyperkalemia, when can it occur, and what does it result in?

• High blood potassium level
• Can occur in patients with kidney disease
• Can alter normal heart rhythm
• May result in heart attack

What is hypokalemia, when can it occur, and what does it result in?

• Low blood potassium levels
• Can be seen in patients with kidney disease or diabetic acidosis
• Can occur when taking certain diuretic medications
• Extreme dehydration, vomiting, diarrhea, alcohol abuse & laxative abuse increase the risk
• Symptoms
  • Confusion, loss of appetite, muscle weakness

What are the functions of phosphorous?

• Fluid balance
• Bone formation
• Energy formation
• Found In ATP, DNA, RNA
• Regulates biochemical pathways by activating or deactivating enzymes

When can high blood phosphorus occur? What are the symptoms?

• Kidney disease
• After taking too many vitamin D supplements
• Over consuming phosphorus-containing antacids
• Causes muscle spasms, convulsions

Describe heat cramps, heat exhaustion, and heat stroke.

Heat Cramps

• Painful muscle cramps

• Usually in the abdomen, arms, or legs

• Develop during vigorous activity sessions in the heat

• Spasms can last seconds or minutes

• Important to stop activity immediately, cool down and rest

• Cramps may signal a more serious problem

Heat Exhaustion

• Typically occurs from vigorous activity in heat

• May develop after several days in high heat when fluids are inadequate

• Symptoms include:

◦ cramps, weakness, vomiting, dizziness, & elevated blood pressure & pulse

◦ must be treated promptly & aggressively to prevent heat stroke from developing

Heat Stroke

• Occurs if the body’s temperature regulation mechanisms fail
• Symptoms:
  • Rapid pulse, hot, dry skin, high body temp, weakness
  • Has been fatal in athletes who exercise in extreme heat

How might moderate alcohol consumption be beneficial?

• May reduce risk of heart disease
• Associated with lower risk of blood clots and dementia
• May increase appetite

Where do we absorb alcohol?

• In your stomach and small intestine
• Some is metabolized by alcohol dehydrogenase in the stomach before it is absorbed
• About 80% is absorbed in the small intestine

Which enzyme metabolizes alcohol?

Alcohol dehydrogenase

How quickly do we metabolize one standard drink?

1 and ½ to 2 hours

• Alcohol dehydrogenase converts ethanol to acetaldehyde
• Alcohol circulate in your blood until fully metabolized

What is the effect of alcohol on the brain?

• Depressant of the CNS
• Slows down transmission of nerve impulses & reaction time to stimuli
• Impairs thoughts, actions and behavior
• Extreme
  • Brain stem activity suppressed resulting in death

How can alcohol be harmful?

• Disrupts sleep
• Contain congeners which contribute to hangover symptoms
• Diuretic that cause dehydration and electrolyte imbalances
• Interferes with insulin and glucagon
• Affects PTH and bone-strengthening hormones (osteoporosis)
• Increase risk of breast cancer
• Male and female sexual dysfunction
• Overnutrition and malnutrition
• Displace nutritious foods
• Interfere with absorption and use of protein, zinc, magnesium, thiamin, folate, and vitamins B12, A, D, E, K

Describe the 3 stages of reduced liver function.

• Fatty liver
  • Abnormal buildup of fat in the liver
• Alcohol hepatitis
  • Inflammation of the liver, resulting in loss of appetite, nausea, vomiting, abdominal pain, jaundice
• Cirrhosis of liver
  • Liver cells are scarred
  • Blood flow through liver is impaired
  • Liver function declines

What is FASD?

Fetal alcohol spectrum disorders

• Most severe form is fetal alcohol syndrome (FAS)
• Causes physical, mental & behavioral abnormalities
• Effects are permanent

Chapter 9

What is a coenzyme?

Molecules that combine with an enzyme to activate it

For the following micronutrients please know their functions in the body, what happens if a person is deficient in the micronutrient and what happens if you take too much.

Thiamin -

• CHO and amino acid metabolism
• Beriberi: Wet: circulatory system; Dry: nerves
• No UL

Riboflavin -

• metabolism of CHO and fats
• Ariboflavinosis: fatigue and weakness. Impair metabolism of vitamin B6 and niacin
• No UL

Niacin -

• metabolism, DNA replication & cell differentiation
• Pellagra: dermatitis, diarrhea, dementia, death
• Liver damage, glucose intolerance and blurred vision

Vitamin B6 -

• coenzyme, amino acid and CHO metabolism, transamination, NT and heme synthesis, immune function, metabolism of other nutrients
• Anemia, convulsions, depression, confusion and inflamed patches on skin
• Sensory neuropathy

Vitamin B12 –

• amino acid metabolism, breakdown fatty acids, maintain myelin sheath of nerves, prevent buildup of homocysteine and activates folate
• Atrophic gastritis (acid production), pernicious anemia (issues with intrinsic factor)
• No UL

Pantothenic Acid -

• required for all energy pathways

Biotin -

• required for all energy pathways; metabolism of CHO, protein, fat and gluconeogenesis

Iodine -

• synthesis of thyroid hormones (body temperature, resting metabolic rate, supports reproduction and growth)
• Enlarged thyroid gland (goiter)
• Enlarged thyroid gland (goiter)

Chromium -

• carbohydrate metabolism, enhances ability of insulin to transport glucose into cells, immune system, growth

Manganese -

• assists in energy metabolism and bone health, formation of urea, synthesis of protein found in bone and cartilage

Sulfur -

• stabilizes the 3d shape of proteins, assists in liver detoxification of alcohol and drugs, maintain acid-base balance

What is oxidation?

Results in the formation of free radicals, stable atom loses an e-

What are free radicals? How are they formed and what damage can they do in the body?

• A highly unstable atom with an unpaired electron in the outer shell
• Formed within the phospholipid bilayer and steal electrons from stable lipid heads
• Can destabilize other molecules and damage our cells
  • LDLs, lipoproteins, DNA

How do antioxidants work?

Stabilize free radicals or oppose oxidation

• Vitamins: donate electrons
• Minerals: act as cofactors & help to activate antioxidant enzymes
• Phytochemicals: inhibit oxidation of lipids or donate electrons to stabilize free radicals

For the following micronutrients please know their functions in the body, what happens if a person is deficient in the micronutrient and what happens if you take too much.

Vitamin E -

• antioxidant, protects cells from oxidation, nerve and muscle function, boosts absorption of vit. A if intake is low
• Erythrocyte hemolysis, loss of muscle coordination, poor immune function
• Increases risk of prostate cancer and premature mortality

Vitamin C -

• Synthesis and maintenance of collagen, antioxidant, protects against LDL oxidation, regenerates vit. E after oxidation, bile and NT (serotonin) synthesis, enhances iron absorption
• Scurvy
• Nausea, diarrhea, cramps

Selenium -

• Thyroid hormone and immune function
• Impaired immune function, infertility, muscle wasting
• supplementation

Beta-carotene -

• Antioxidant, enhance immune function, protect skin from UV rays, protect eyes from oxidative damage
• No deficiency symptoms
• May cause skin to turn yellow/orange

Vitamin A -

• Sight, cell differentiation, reproduction, bone growth
• Blindness
• Supplementation: fatigue, loss of appetite, blurred vision, hair loss, liver damage, harmful during pregnancy

Know the basic process of how Vitamin A is involved in vision.

Enables our eyes to react to changes in brightness of light

• Light hits retina
• Retinal combines with opsin to form rhodopsin which helps us interpret B/W images
• Bleaching reaction: rhodopsin is split into retinal & opsin, rods lose color
• Nerve impulse travels to brain

Know the 3 stages of cancer development.

• Initiation: carcinogen causes a mutation in the DNA of a normal cell
• Promotion: cell with mutation in DNA divides repeatedly
• Progression: cancer cells invade surrounding tissues and spread to other sites in the body

What are the nonmodifiable risk factors that influence cancer risk?

• Age
• Genetics

What are the modifiable risk factors that influence cancer risk?

• Tobacco use
• Weight
• Diet
• Physical activity
• Infectious agents
• UV radiation

What can we do to reduce our risk of cancer?

• Live smoke free
• Move more, sit less
• Have a healthy body weight
• Eat well
• Limit alcohol
• Find cancer early

Chapter 10

What are the various components of blood?

• Erythrocytes : transport oxygen
• Leukocytes: immunity
• Platelets: hemostasis and protection
• Plasma: watery mix of blood in which the cells and platelets flow

Which molecules carry oxygen and where are they found?

• Hemoglobin in blood
• Myoglobin in muscle

What are the functions of iron?

Component of the oxygen-carrying proteins in blood and muscle

• Oxygen transport
• Part of enzymes called cytochromes: metabolism of CHO, fats, proteins
• Needed for enzymes involved in DNA synthesis
• Role in cognitive development and immune health
• Part of an antioxidant enzyme

What factors influence the absorption of iron?

• Iron status: when stores are high, absorption is low
• Stomach acid: low acid levels, less absorption
• Ion content in diet: less iron in diet, more absorption

What are the symptoms of iron toxicity? What are the symptoms of iron deficiency?

• Nausea, vomiting, diarrhea, dizziness, confusion, rapid heartbeat, constipation, GI distress
• Hemochromatosis: condition where body absorbs too much iron & iron accumulates in tissues
• Impaired work performance, cognitive function issues, fatigue, pale skin, hair loss, decreased immunity

What are the functions of zinc in the body? What happens if you don’t get enough? What happens if you get too much?

Zinc contributes to hemoglobin

• Enzymatic functions: part of over 300 enzymes
• Structural functions: role in stabilizing proteins for gene expression, vision, antioxidant systems, immunity
• Regulatory functions: helps to regulate gene expression
  • Important for cell division & differentiate during fetal development
  • Activates vit. A
  • Slowed growth, delayed sexual maturation and impotence, impaired appetite, increased incidence of infections
  • Supplements: GI issues, headaches, depressed immunity, interfere with copper absorption

What are the functions of copper in the body? What happens if you don’t get enough?

Critical for iron transport

• Component of ceruloplasmin (iron/copper transport)
• Energy metabolism (cofactor)
• Building connective tissues (collagen, elastin)
• Involved in antioxidant system
• Regulation of NT (serotonin)
• Inhibition of synthesis of hemoglobin
• Microcytic anemia
• Severe: decreased WBC, pediatric osteoporosis

How is vitamin K involved in blood health?

Supports blood clotting

• Synthesis of clotting proteins: prothrombin and other procoagulants
• Inflammation: hormone regulation, defense against cancer

What are the functions of vitamin C in the body?

Required for the synthesis of collagen

• Collagen: fibrous protein in the matrix of connective tissue
• Coenzyme to enzymes that convert procollagen to collagen

What disease is associated with low vitamin C intake?

Bleeding gums & scurvy

What are the functions of bone in the human body?

Structure/Support:

• Provide physical support for organs and body segments
• Protect vital organs
• Work with muscles and tendons to allow movement

Metabolic Processes:

• Acts as a storage reservoir for many minerals, including calcium, phosphorus, and fluoride
• Hematopoesis

What are the 2 types of bone and where are they found?

• Cortical bone (compact bone) - outer surface of all bones, many of the small bones
• Trabecular bone (spongy bone) - inside of bones, within the ends of long bones, vertebrae, sternum, ibs, skull, pelvis

What factors are associated with a lower peak bone density?

• Smoking.
• Drinking excessive amounts of alcohol.
• Low physical activity.
• Poor diet, low in vitamins and calcium.
• Changes in hormones (from smoking or menopause)
• Age.
• Medical conditions like rheumatoid arthritis, chronic kidney disease, overactive parathyroid gland or celiac sprue.

Describe the 3 processes of bone development.

• Bone growth: increase in bone size
• Bone modeling: shaping of bone
• Bone remodeling: reshaping of bone, maintains bone integrity

What do osteoblasts and osteoclasts do?

• Osteoblasts: form new bone by synthesizing bone matrix & hydroxyapatite (crystallizes new bone)
• Osteoclasts: break down bone in a process called resorption

How is bone density assessed?

Bone density is assessed with a DXA/DEXA test

• Generates a bone density score (T-score)

What are the functions of calcium in the body?

99% found in bone

• Forms and maintains bones and teeth
• Assists in acid-base balance
• Critical formal normal transmission of nerve impulses
• Assists in muscle contraction (Ach)
• Maintains blood pressure
• Initiates blood clotting
• Regulation of enzymes

How is blood calcium concentration maintained?

• Low levels
  • PTH is released, activates vit. D
  • Kidneys retain more calcium
  • Osteoclasts to break down bone and release calcium
  • Stimulation of calcium absorption from intestines

What factors influence the bioavailability of calcium?

• Infants, children, adolescents absorb more than 60%
• Pregnant & lactating can absorb 50%
• Healthy adults typically absorb 30%
• Older adults absorption can be as low as 25%
• Bodies cannot absorb over 500 mg at one time

How does phosphorus contribute to bone health?

Combines with calcium in hydroxyapatite crystals

What are the functions of magnesium in the body?

Component of bone & helps regulate bone status

• Influences formation of hydroxyapatite
• Cofactor for over 300 enzyme systems
• Role in ATP, DNA & protein synthesis
• Supports vit. D metabolism
• Important for heart health & blood clotting

What are the functions of fluoride in the body?

Found in teeth and bones

• Development & maintenance of teeth & bones
• Enhances tooth mineralization
• Decreases & reverses tooth demineralization
• Inhibits metabolism of acid-producing bacteria that causes tooth decay

What is fluorosis?

Consuming too much fluoride can increase protein content on teeth enamel

What are the functions of vitamin D in the body?

Vitamin D regulates calcium

• Calcium and phosphorus absorption
• Regulates blood calcium
• Stimulates osteoclasts
• Necessary for calcification of bone

What areas of the body are involved in vitamin D synthesis?

• Skin: UV light to provitamin D
• Liver: provitamin D to calcidiol
• Kidneys: calcidiol to calcitriol (active vit. D)

What factors influence the synthesis of vitamin D?

Latitude and time of year impact ability to synthesize vit. D from sunlight

• Time of day (9am-3pm)
• Skin color (more melanin, less vit. D)
• Age
• Obesity
• Sun protection

What is the vitamin D deficiency disease in children? In adults?

• Rickets
• Osteomalacia

What is osteoporosis?

A condition characterized by low bone mass and deterioration of bone tissue

• Leads to an increased fracture risk

What factors influence the risk of developing osteoporosis?

• Loss of estrogen and testosterone with age
• Decreased ability to metabolize vitamin D

Chapter 11

What are the 4 components of physical fitness?

• Cardiorespiratory: aerobic exercise
• Musculoskeletal fitness: resistance training
• Flexibility: yoga
• Body composition: aerobic exercise and resistance training

What 3 types of exercise help us achieve the 4 components of fitness?

• Aerobic exercise
• Resistance training
• Flexibility

What are the health benefits of regular physical activity?

Reduces risk for chronic diseases

• Heart disease
• Stroke
• High BP
• Obesity
• T2 diabetes
• Some cancers
• Osteoporosis

Define the overload principle.

• To improve fitness you must place an appropriate level of extra physical demand on your body
  • Repeated work that overloads muscle (hypertrophy)

What is the FITT principle? What does each letter stand for?

• Frequency
• Intensity
• Time
• Type

How long will stored ATP fuel muscle activity?

Amount of ATP in muscle is limited & can keep muscle active for 1-3 seconds

What is the ATP-CP energy system and how long will it fuel activity?

Uses creatine phosphate to regenerate ATP

• When more energy is needed, creatine phosphate can be broken down to regenerate ATP
• Supports maximal activity for 3-15 seconds
• Creatine phosphate is used most during intense, short bursts of activity
• Can occur without oxygen (anaerobic)

Define aerobic and anaerobic.

• Aerobic: requires oxygen
• Anaerobic: can occur without oxygen

Define glycolysis.

Breakdown of glucose - yields 2 ATP and 2 pyruvate molecules

• Limited oxygen: pyruvic acid is converted to lactic acid
• Oxygen available: pyruvic acid moves through additional pathways to produce more energy

How long does the breakdown of carbohydrates fuel activity?

Supports activities lasting 30 seconds to 3 minutes

• The breakdown of CHO provides energy for both brief and long-term exercise

What type of activity does the aerobic breakdown of fats support?

Aerobic breakdown of fats supports exercise of low intensity and long duration

• More ATP can be generated from breakdown of fats
• Advantages & disadvantages of using fat as fuel:
  • Abundant energy source
  • Provides 9 kcal/g
  • Breakdown process is slow, therefore used to fuel lower intensity exercise over long duration

Are amino acids a major fuel source during activity?

They are NOT major sources of fuel during exercise

• But are normally used to make glucose to maintain blood concentration during exercise

Know the basics found in your notes about the following ergogenic aids: anabolic steroids, androstenedione (andro), dehydroepiandrosterone (DHEA), creatine, caffeine, ephedrine, carnitine, chromium.

• Anabolic steroids: promise to increase testosterone, increase muscle size, strength, power, speed
• Creatine: does not enhance performance in aerobic activities but may increase work performed during resistance exercise & enhance sprint performance. Relatively safe.
• Caffeine: increases fat use during exercise & spares glycogen
• Ephedrine (Ephedra): marketed as weight loss supplement/energy enhancer. Causes serious side effects
• Carnitine: marketed as a fat burner & performance enhancer, but research does not support these claims
• Chromium: claimed to increase uptake of amino acids & enhance performance, but recent studies don’t support these claims

Define body image.

• The way you perceive, feel about & assess your body

What is the difference between disordered eating and eating disorders?

• General term for describing a variety of atypical/unhealthful eating behaviors
• More severe behaviors of disordered eating (psychological)

What factors contribute to disorders related to body image, eating and exercise?

• Genetics
• Family
• Media
• Social & cultural values
• Comorbidity with other psychological disorders

What is anorexia nervosa? What are the signs and symptoms? What are the health risks associated with anorexia nervosa?

• Low body weight achieved through self-starvation, leading to nutrient deficiency & risk of death
• Restrictive eating patterns, fear of weight gain, amenorrhea
• Integument: damaged hair, skin and nails
• Blood: anemia, compromised immunity
• Renal: dehydration, electrolyte imbalance, renal failure
• Reproductive: amenorrhea, infertility
• Musculoskeletal: loss of muscle tissue, osteopenia, decreased ability to absorb calcium, bone loss, etc.
• Nervous: altered levels of serotonin, altered glucose metabolism, mood changes
• Cardiovascular: low BP, abnormal HR, ECG, sudden death due to ventricular arrhythmias
• GI: abdominal pain and bloating from slow gastric emptying and intestinal motility, acute pancreatitis, constipation
• Other: abnormal thyroid levels

What is bulimia nervosa? What are the signs and symptoms? What are the health risks associated with bulimia nervosa?

• May be a normal weight but have a fear of gaining weight & have poor body image
• Binge eating followed by purging behaviors
• Electrolyte imbalances, GI problems, dental problems, risk of death

What is anorexia athletica?

• Athletes with characteristics of eating disorders (restricted caloric intake) and excessive exercise

What 3 clinical conditions are associated with the female athlete triad?

• Low energy availability with or without eating disorders
• Menstrual dysfunction, such as amenorrhea
• Low bone density
• Energy restriction & high levels of physical activity can disrupt menstrual cycle, which may impact levels of estrogen & progesterone
  • Less estrogen, less retention of calcium in bone

Chapter 14

What is the embryonic stage?

From week 3 to week 8

What are some common teratogens? When is a developing organism most vulnerable to them?

• Drugs, alcohol, some medications & supplements, viruses, smoking, radiation
• During embryonic stage

What structure first implants in the uterus?

blastocyst

What is the placenta?

• Fetus obtains nutrients & gets rid of waste
• Role in hormone production
• No mixing of blood

What risks come with a low birth weight baby?

Less than 5.5 lb

• increased risk of infections, learning disabilities, impaired physical development, & death in year 1
• Too much weight gain also comes with risks

When is folate most important and why?

Critical in the first 28 days (neural tube) of development

Which vitamin in excess can cause fetal abnormalities?

Vitamin A.

What happens to the fetus when the mother smokes?

• Maternal smoking exposes fetus to toxins (lead, cadmium, cyanide, nicotine, carbon monoxide) & reduces fetal blood flow
  • increases risk of miscarriage, still birth, placental abnormalities, preterm delivery & low birth weight

Be familiar with the common nutrition-related concerns of pregnancy covered in the lecture notes.

• Morning sickness: varying degrees of nausea & vomiting, at any time of day - most common in 1st trimester
• Cravings: may be due to hormonal fluctuations, physiologic changes or have familial or cultural roots
• Gastroesophageal reflux (GER): relaxation of smooth muscle of inferior esophageal sphincter
• Constipation: pregnancy hormone that cause smooth muscles to relax & slow the movement of material through the colon
• Gestational diabetes: insufficient insulin production or insulin resistance that increases blood glucose levels
• Preeclampsia: high blood pressure that is pregnancy specific, accompanied by protein in urine, edema & weight gain

When should babies be started on semisolid food? And why?

At 4-6 months

• They should start to consume solid foods rich in iron

Chapter 15

Why may some toddlers benefit from a supplement?

Some have erratic eating behaviors

What can caregivers do to encourage nutritious food choices in children?

• Combat peer pressure by introducing children to role models who have nutritious diets
• Adults should model healthful eating patterns
• Involve children in shopping and preparing meals
• Aim to prepare and eat meals as a family
• Be aware that school attendance influences children’s nutrition

What drives growth during adolescence?

Puberty triggers dramatic growth and maturation

• Begins with onset of puberty
• Rapid change in height, weight, body composition, activity
• Growth is driven by hormonal changes

What stops skeletal growth during adolescence?

• Closure of epiphyseal plates stops skeletal growth

What should caregivers be aware of regarding nutritious food choices during adolescence?

• Influence of peers, personal food choices, developing sense of which foods constitute healthy diet
• Area of concern is lack of fruits, vegetables & whole grains
• Eating is often sporadic & based on convenience
• Appearance and substance use are key concerns of adolescence
• Be aware of eating patterns, excessive exercise, rapid/extreme weight loss, trips to the bathroom after meals, signs of vomiting or laxative use

What is the main reason for acne during the teenage years?

Hormonal changes, stress, genetics, hygiene

What are the physiological changes that accompany aging that are discussed in the lecture notes.

Changes in sensory perception:

• Smell, taste, touch, vision decline with age
• Loss of sense of smell can impact enjoyment of eating
  • may be due to zinc deficiency or medication
• Impaired sense of taste (dysgeusia) mostly affects detecting salty and bitter tastes
• Loss of vision can impact ability to read food labels, best before dates, ability to drive & prepare foods

Changes in GI function:

• Decrease in salivary production influences taste & increases need for moist food
• Reduced HCl-, which limits absorption of vitamins and minerals (B12)

Change in body composition:

• Body fat increases
• Muscle mass decreases
• Bone mineral density decreases

What things can lead to geriatric weight loss?

• Dementia
• Drugs
• Dysphagia
• Dysgeusia
• Dentition
• Diarrhea
• Depression
• Disease
• Dysfunction

What are some recommendations to live a longer, healthier life?

• Never smoke
• Consume no or moderate amounts of alcohol
• Obtain sufficient sleep
• Maintain a healthful body weight
• Regular physical activity