Human Nutrition Exam 2

Describe how alcohol disrupts metabolism and impairs health

Alcohol disrupts metabolism by converting to toxic acetaldehyde via alcohol dehydrogenase - generates hydrogen ions and electrons, impacting niacin's role in other energy pathways Accumulation of hydrogen ions leads to acidic acid-base balance - lactate production intensifies acid buildup Slowed TCA cycle due to hydrogen accumulation promotes fatty acid synthesis Impaired protein synthesis compromises immunity

Summarize how nutrition interacts with economic and social changes involved in aging

Economic: Living arrangement and income changes; may affect accessibility/availability Social: Malnutrition most likely to affect those living alone - no desire to cook for 1, depression, etc.; especially men with low income/education - never learned necessary skills

Describe the difference in lean body mass and fat mass

Fat mass (FM): Adiposity, calorie reserves, energy stores; metabolically inactive (more fat = lower BMR) Lean body mass (LBM): Water + protein (muscle tissue) + minerals; metabolically active and essential for survival; anything other than fat

Recognize the life-long health significance of the fetal origins hypothesis

The intrauterine environment (particularly nutrition) "programs" the fetus to have particular metabolic characteristics, which can lead to future disease - Nutrition may influence gene expression in the uterus - influences disease in adulthood - Fetus adapts to deficiencies - inability to handle excess nutrients and normal amounts - Chronic diseases: Adverse influences at critical times during fetal development; e.g., malnutrition -> type II diabetes; inadequate growth during placental and gestational development -> hypertension

Describe the trends in childhood obesity and health outcomes when children become overweight/obese

~32% of U.S. children/adolescents aged 2-19 yrs = overweight (and increasing) ~17% = obese Classified by growth charts as 85th (overweight) and 95th (obese) percentiles Physical: Begin puberty earlier; stop growing at a shorter height than peers; greater bone and muscle mass Physical health: Elevated lipid blood profiles (increased triglycerides and cholesterol); type II diabetes and respiratory disorders Psychological development: Emotional and social problems (peers)

Explain why energy needs increase or decrease during aging

DRI: Clusters older adults into 2 groups - 51-70 yrs old and 71 yrs and older Energy needs decline ~5% per decade: Reduced physical activity; basal metabolic rate declines ~1-2% - loss of lean body mass and thyroid hormone production; nutrient needs remain high

Explain how maternal malnutrition can affect critical periods of fetal and maternal growth

Damage during critical periods has permanent consequences for fetus' life and health An adverse influence felt early permanently impairs development; full recovery never occurs An adverse influence felt late temporarily impairs development; full recovery possible

Describe the recommended intakes for water

Dependent on diet, activity, environmental temperature, humidity, etc. 8-12 cups per day - based on kcal expended (2,000)

Summarize nutrient needs of women during pregnancy

1st trimester: Energy needs remain same as for non-pregnant women 2nd trimester: Increase 340 kcals/day 3rd trimester: Increase 454 kcal/day Multiparous: 40-45 kcal/kg pre-pregnancy weight/day General guidelines: Adequate nutritional status prior to conception Healthy weight gain Physical activity Prenatal care and supplements Avoid harmful substances and toxins Energy and nutrient needs high during pregnancy - extra serving in each food group usually meets needs - exceptions with iron, folate (supplements recommended) Tissue development and growth for mother and fetus occur at different times in pregnancy; amounts and specific nutrients to support growth and development vary during pregnancy

Identify who is in most need of supplements

- People with specific nutrient deficiencies - People whose energy intakes are particularly low - Vegetarians who eat all-plant diets, older adults with atrophic gastritis, individuals with lactose intolerance/milk allergies - Following a procedure/taking medications that affect absorption/metabolism

Identify the steps for alcohol metabolism and other damaging factors related to alcohol consumption

1. Alcohol dehydrogenase oxidizes alcohol to acetaldehyde (highly reactive, toxic) - High concentrations responsible for damaging effects of alcohol abuse 2. Acetaldehyde dehydrogenase converts acetaldehyde into acetate; then converted into either carbon dioxide or acetyl CoA - Generates hydrogen ions - affects niacin's role in other metabolism pathways - Accumulated hydrogen ions disrupt acid-base balance; lactate production and slowed TCA cycle contribute to acid buildup and fatty acid synthesis

Describe the Nutrition Care Process model and identify the various steps

1. Nutrition Assessment and Re-Assessment: - Obtain/collect important and relevant data - Analyze/interpret collected data 2. Nutrition Diagnosis: - P - Identify problem - E - Determine etiology/cause - S - State signs and symptoms 3. Nutrition Intervention: - Determine intervention and prescription - Formulate goals and determine action; goals of intervention have measurable outcomes (e.g., laboratory tests) - Implement action 4. Nutrition Monitoring and Evaluation: - Select or identify quality indicators - Monitor and evaluate resolution of diagnosis

Summarize the main steps of the TCA cycle and the importance of the electron transport chain

1. Oxaloacetate starts the TCA cycle 2. Oxaloacetate + acetyl CoA -> 6-carbon compound 3. Undergoes rearrangement, releases carbons as CO2 -> 5- and 4-carbon structure 4. Each reaction changes the structure until original 4-carbon oxaloacetate is formed again - picks up another acetyl CoA, restarts cycle 5. Breakdown of acetyl CoA releases hydrogens (H+) and their electrons (e-) - carried off to ETC by B vitamins (riboflavin and niacin) 6. Glycolysis yields pyruvate from glucose; oxaloacetate must be available from pyruvate to start TCA cycle - why complete oxidation of fate requires carbohydrate ETC: Captures energy in bonds of ATP - series of proteins serving as e- carriers at inner membrane of mitochondria - Carriers continue passing e- from TCA cycle, glycolysis, and fatty acid oxidation on to the next carrier repeatedly until reaching oxygen (O) - O accepts e-, combines with H+, forms water (H2O) - must be available for energy metabolism (essential to life) - As e- are passed down, H+ are pumped across the membrane to outer compartment of mitochondria - rush of H+ back into inner compartment powers synthesis of ATP - ATP leaves the mitochondria, enters the cytoplasm - can be used for energy

Summarize the main steps in the energy metabolism of glucose, glycerol, fatty acids, and amino acids

1. Protein, carbohydrate, and fat can be broken down into acetyl CoA 2. Acetyl CoA can enter the TCA cycle 3. Most of the reactions release hydrogen atoms + their electrons to be carried by coenzymes to the electron transport chain 4. ATP is synthesized 5. Hydrogen atoms react with oxygen to produce water

List the strategies that men and women can implement to prepare for a healthy pregnancy

Achieve and maintain healthy body weight Choose an adequate, balanced diet Become physically active Receive regular medical care Manage chronic conditions Avoid harmful influences (e.g., cigarettes, alcohol, social settings)

Recall the current nutritional recommendations for adolescents and adult women during preconception and pregnancy

Achieve and maintain healthy weight Choose foods containing heme iron (more readily absorbed by the body), additional iron sources - legumes, dark green vegetables, fortified foods (bread, ready-to-eat cereals), and enhancers of iron absorption - vitamin C-rich foods Consume 400 mcg/day of synthetic folate from fortified foods and/or supplements in addition to folate from a varied diet

Describe the importance of acid-base balance in the body

Acidity of body fluids determined by concentration of hydrogen ions (H+); high concentration = acidic Normal energy metabolism generates hydrogen ions plus other acids = must be neutralized 3 systems manage pH fluctuations - Buffers in the blood: Bicarbonate and carbonic acid (plus some proteins) act as buffers; carbon dioxide (frequently formed during energy metabolism) dissolves into carbonic acid in blood - dissociates to form hydrogen ions and bicarbonate ions - Respiration in lungs: Controls concentration of carbonic acid by managing respiration rate - carbonic acid builds up = respiration rate increased to increase the amount of carbon dioxide exhaled and lower carbonic acid concentration; bicarbonate builds up = respiration rate decreased to retain carbon dioxide and form more carbonic acid - Excretion in kidneys: Controls concentration of bicarbonate by increasing or decreasing it; the body's total acid burden remains nearly constant, and the acidity of the urine fluctuates to accommodate the balance

Summarize the physical activity recommendations for adults and older adults

Adults: ~150-300 min/week of moderate intensity, or 75-150 min/week of vigorous-intensity aerobic physical activity, or an equivalent combination; preferably spread throughout the week Older adults: Same as for adults, with additional guidelines - On top of weekly physical activity, multicomponent physical activity - balance training, aerobic and muscle-strengthening activities - Level of effort for physical activity should be determined relative to level of fitness - Those with chronic conditions should understand whether/how their conditions affect their ability to safely do physical activity - If unable to do 150 min/week of moderate-intensity aerobic activity, the should be as physically active as their abilities/conditions allow

Identify the nutrients involved in energy metabolism and the various high energy compounds that captures the energy released during their breakdown

All energy yielding nutrients may be broken down to acetyl CoA Glucose: 1. Glycolysis: 1 glucose yields 2 pyruvate - H+ carried to ETC 2. Pyruvate -> lactate OR acetyl CoA - Anaerobic: Pyruvate -> lactate (for muscles in immediate energy needs) - Aerobic: Pyruvate -> acetyl CoA - Liver may use amino acids + glycerol -> pyruvate (-> glucose) Triglycerides: 1. Glycerol: 3-carbon breakdown; may either -> glucose OR -> pyruvate (-> acetyl CoA) 2. Fatty Acids: 2-carbon breakdown (fatty acid oxidation); each 2-carbon fragment binds with CoA -> acetyl CoA - H+, electrons carried to ETC - Glucose cannot be formed by the 2-carbon fragments; glycerol may form glucose, minimally Amino Acids: 1. Deamination: Lose nitrogen containing group prior to metabolism 2. Several pathways: Amino acids -> pyruvate -> glucose; Amino acids -> acetyl CoA -> body fat; Amino acids -> TCA cycle directly -> energy/glucose - Protein may be a good source of glucose when carbohydrates are unavailable (extreme conditions); not ideal Final Steps of Metabolism: TCA Cycle: Acetyl CoA proceeds through TCA cycle - releases H+, electrons to ETC; final metabolic pathway for carbohydrates, fats, and proteins/amino acids - Circular/cyclical pathway; does not regenerate acetyl CoA - Oxaloacetate: Needed in the 1st step, synthesized in the last step; made from pyruvate, specific amino acids

Define food allergies and determine the difference between an allergic response vs. food intolerance

Allergy: An adverse reaction to food that involves an immune response; immediate/delayed, severe/mild - Skin, GI upset, behavior, etc. - Detection: Test for antibodies - Treatment: Of symptoms only; avoidance of allergen - Prevalence tends to diminish with age Anaphylactic shock: Peanuts, tree nuts, milk, eggs, wheat, soy, fish/shellfish; epinephrine injections in case of emergency as treatment; necessitates food labeling Food intolerance: Specific amount of food/type of food must be consumed for negative results

Describe energy balance and the consequences of not being in balance

Amount of energy in is equal to the amount of energy out Imbalance causes weight changes - Fat - Fluid retention/dehydration - Lean muscle tissue and bone minerals

Describe the difference between anabolic and catabolic reactions

Anabolic: Uses energy to build compounds; includes the making of glycogen, triglycerides, and protein Catabolic: Breaks compounds and release energy; includes breakdown of glycogen, triglycerides, and protein - further catabolism of glucose, glycerol, fatty acids, and amino acids releases differing amounts of energy; much of the energy released is captured in bonds of ATP (adenosine triphosphate)

Describe the physiological processes that influence food intake

Appetite: Not physiological; response to sight, smell, thought, or taste of food Hunger: Physiological response from the hypothalamus (control center for eating; accounts for energy balance status, storage) and gastrointestinal hormones (influences appetite control and energy balance) Satiation: Prompts a person to stop eating in response to stretch receptors within the GI tract as food enters and hunger diminishes Satiety: Prolongs the suppression of hunger following a meal

Describe the physical, emotional, and environmental influences on food intake

Appetite: Not physiological; response to sight, smell, thought, or taste of food Hunger: Physiological response from the hypothalamus (control center for eating; accounts for energy balance status, storage) and gastrointestinal hormones (influences appetite control and energy balance) Satiation: Prompts a person to stop eating in response to stretch receptors within the GI tract as food enters and hunger diminishes Satiety: Prolongs the suppression of hunger following a meal Stress Eating: When appetite overrides hunger and satiety External Cues: Time of day (routine of breakfast at same time daily), availability, sight/taste of food Environmental Influences: Others eating around you, making plans, etc. (social) Nutritional Composition: Protein = most satiating, including high fiber foods = increased satiety, high fat foods = strong satiety signals Neuropeptide Y: Chemical in the brain that stimulates appetite, diminishes energy expenditure, and increases fat storage

Identify inappropriate and appropriate behaviors for children and feeding strategies for parents during mealtimes

Appropriate: Children tend to prefer raw vegetables > cooked vegetables More likely to eat foods they usually reject if they see their peers eating them Encourage children to help with food preparation: Enjoyable experience, fine motor skill building opportunity, opportunity to try new foods Inappropriate: Coercing/rewarding children to try new foods: Less likely to try them again - stressful = aversion Restricting favorite foods: Makes them want more

Identify how nutrition might contribute to, or prevent, the development of age-related problems associated with vision, arthritis, and the brain

Arthritis: - Osteoarthritis: Deterioration of cartilage in the joints; connection with being overweight (lose 10% of body weight = symptom relief); benefits of aerobic activity and strength training; anti-inflammatory diet may be beneficial - no known diet to prevent or cure - Rheumatoid arthritis: Immune system destroys bone and cartilage; no consensus on role of nutrition - Gout: Alcohol and beer - major contributors; deposits of uric acid in joints of extremities; uric acid from purines in foods; medical nutrition therapy - second line of defense to medication Brain: Changes due to genetic and environmental factors; characteristic changes with age - loss of neurons and decreased blood supply - Dementia: Affects 15% of adults over 70 yrs old - Nutrient deficiency: Possible factor in loss of memory/cognition - Alzheimer's: 1 in 8 U.S. adults >65 yrs old and 50% of adults >85 yrs old will have it; nerve cells die and communication between cells degenerates; primary risk factor = age, exact cause = unknown; senile plaques and neurofibrillary tangles form in the brain = oxidative stress a contributing factor; maintain appropriate body weight - no existing medical nutrition therapy for treatment - Cardiovascular risk factors may contribute to development of dementia and Alzheimers: Diets high in omega-3 fatty acids, DHA, and vitamin E may benefit brain health and rid body of free radicals - Alcohol use/binge drinking: Affects older adults Vision: - Cataracts: Oxidative stress a significant contributor; supplements of antioxidant nutrients (vitamin C and E and carotenoids) ineffective in slowing progression of or preventing the condition - Macular degeneration: Deterioration of the macular region of the retina; preventive supplements - omega-3 fatty acids, folate, vitamin B6 and B12, antioxidants, and carotenoids

Describe the challenges of meeting the nutrient needs of adolescents

Autonomy: Adolescents make more decisions for themselves; success will stem from learned behaviors during childhood Growth: Pubertal growth spurts last ~2/5 yrs - Males: 12-13 yrs old; 8 in taller, 45 lbs heavier - Females: 10-11 yrs old (becoming earlier); 6 in taller, 35 lbs heavier Energy/nutrient needs: Greatest during adolescence (exception - pregnancy and lactation); reaches peak at 18 yrs old (decreases 10 kcal/day); varies dependent on current rate of growth, gender, body composition, and physical activity

Identify the USDA food group recommendations for children

Based on kcal/day (ranging from 1,000-1,800) Fruits: 1-1 1/2 cups Vegetables: 1-2 1/2 cups Grains: 3-6 oz Protein foods: 2-5 oz Milk: 2-3 cups

Distinguish between body weight and body composition

Body Weight: Fat mass (FM) + fat free mass/lean body mass (LBM) - Fat mass (FM): Adiposity, calorie reserves, energy stores; metabolically inactive (more fat = lower BMR) - Lean body mass (LBM): Water + protein (muscle tissue) + minerals; metabolically active and essential for survival; anything other than fat Body Composition: The proportions of muscle, bone, fat, and other tissues that make up a person's total body weight - Ideal: FM = ~25%, LBM = ~75% (current obesity rates are skewing the percentages)

Recognize the special concerns when breastfeeding pre-term infants that can promote successful initiation and continuation of breastfeeding

Breast milk composition with preterm infant: Higher in protein, lower in carbohydrates, electrolytes, and minerals - easier to digest/absorb than most formula Concerns: - Infant may not have developed suckle reflex - Infant may be too weak to suckle/feed effectively (latching) - May need to pump milk and feed with bottle/tube initially (gavage feeding) - Necessary to establish adequate milk supply - Best to bring baby to breast as soon as possible to establish suckling/sucking/latching; continuous practice

Identify various types of foods or supplements that should be included or avoided in the diet during pregnancy

Carbohydrates: Fuels fetal brain; protein sparing - ~175 g/day+ Protein: Supports tissue growth and development in mom and fetus - 0.8 g/kg/day in 1st trimester-1/2 of 2nd trimester; 1.1 g/kg/day in 2nd 1/2 of 2nd trimester - 3rd semester; ~25 g/day more than non-pregnant women Essential Fatty Acids: Fetal nerve and vision development - brain growth, structure, and function - omega-3s and omega-6s Fiber: Adequate laxation (progesterone decreases intestinal motility) and provision of phytochemicals (protects against metabolic stress); 25-30 g/day (avg. for females = 7-12 g/day) Folate: 600 mcg/day - decreased risk of neural tube defects, later needed for continued cell growth Vitamin A: 770 mcg/day - cell differentiation; avoid excess retinol/retinoic acid (fetal malformations of heart, brain, ears) Iron: 27 mg/day, UL of 45 mg/day - adequate O2 for fetal growth; too much = GI upset; 30 mg/day supplement at 2nd trimester (unless deficient) B-12: 2.6 mcg/day - increased energy metabolism (activates folate enzyme); fetal nervous system, (formation of red blood cells) Zinc: 12 mg/day 14-18 yrs; 11 mg/day 19-50 yrs - maternal and fetal tissue growth Calcium: 1,000 mg/day - absorption increased; maternal and fetal bone health/growth; inadequate dietary calcium -> taken from maternal bone source Vitamin D: 600 IU - needed for calcium absorption/utilization; DRI not changed in pregnancy

Recognize the physiological regulation of breast milk nutritional content and the significance to the infant's satiety as well as normal growth

Changes in composition of breast milk: Based on length of time after birth of baby Colostrum: Important for baby's first feeding; produced immediately after birth - Increased protein, decreased carbohydrates and fat - Increased maternal white blood cells, immune compounds - Increased vitamin A = cell differentiation Mature breast milk: Composition stabilized ~10 days after birth; continues to change as baby ages to meet needs Changes in composition of breast milk: Dependent upon length of time after birth of baby; important to alternate sides frequently - foremilk consumed first, done 1 breast at a time; if not = cluster feeding - inadequate nutrition - Foremilk: Lower in fat = baby able to consume enough to receive adequate nutrients - Hindmilk: Higher in fat = increases satiety, adequate energy

Explain how dietary modifications are used during patient care (in hospital settings)

Changes in food texture or consistency, modified energy or nutrient content, and inclusion or exclusion of certain foods Mechanically altered diets may be prescribed for people with swallowing/chewing difficulties Clear liquid diets may be used before diagnostic tests or after acute Gl disturbances, intravenous feedings, or fasts Some medical problems may benefit from restriction of specific nutrients A high-calorie, high-protein diet may prevent or reverse malnutrition, improve nutrition status, or promote weight gain In some cases, nutrients need to be delivered via tube feedings or intravenously

Explain how children's appetites and nutrient needs reflect their stage of growth

Children's appetites begin to diminish at 1 yr - consistent with slowing growth Food intake varies spontaneously with growth patterns; increased with rapid growth and vice-versa Growth spurts = higher demand for food Energy intake may vary from meal-to-meal; total daily intake remains constant (absent nutrients from one meal may be compensated in the next) Overweight/obese children - may not adjust intake based on growth and physical activity needs, but rather external cues

Identify the components of energy expenditure and factors that influence each

Constant: Energy expended during both rest and activity Basal Metabolism: Involuntary; energy expended during rest; maintains life - breathing, pumping blood, production of blood, filtering/excreting waste, etc. (basal metabolic rate/BMR) Physical Activity: Voluntary movement of body; most variable component - energy required/used depends on muscle mass, body weight, and activity (frequency, duration, and intensity) Thermic Effect of Food: Energy needed to digest, absorb, transport, store, and metabolize food; accounts for ~10% of energy expenditure; influenced by food composition, meal size, and frequency Adaptive Thermogenesis: Adjustments to energy expenditure based on environment changes; extreme cold/hot, physiological trauma, hormone status (menopause), overfeeding/starvation

List the common lifestyle behaviors and contraindications for mothers and infants that inhibit short-term and long-term breastfeeding

Consuming alcohol: Easily enters breast milk; infants tend to consume less milk when mothers consume alcohol (taste effects) Taking medicinal drugs: Physician consultation required for safety Taking illicit drugs: High risk; enters breast milk Smoking: Passes nicotine to milk; increased risk of SIDS Environmental contaminants: Mercury - mothers must follow similar dietary restrictions/precautions as during pregnancy

Identify various effective approaches to nutrition care (e.g., long-term dietary care, education, etc.) and ineffective approaches

Effective: - Plans should be compatible with preferences and ability to maximize compliance Behavior change - occurs in stages - Emphasis on foods included in the diet instead of excluded - more appealing Only suggest 1-2 changes at a time - increases willingness to change; promotes success and further change - Nutrition education - informs patient of their medical condition; may influence motivation for dietary/lifestyle changes Information should be given 1-on-1 or as a group with common experiences Initial meetings should assess the patient's understanding of material and commitment to change Follow-up meetings reveal if the plan is successfully adopted For best results, dietitians should monitor and evaluate effectiveness - outcome measures Ineffective: Diet books, weight loss programs/products - no maintenance of behavior change; fad-diets - short term; herbal supplements - insufficient data

Explain how the body responds to fluid and electrolyte balance and imbalance

Electrolytes (charged minerals) in the fluids help distribute the fluids inside and outside the cells; ensures the proper water balance and acid-base balance to support all life processes Excessive fluid and electrolyte loss upsets these balances; kidneys are crucial to restoring homeostasis Dissociation of salt: Sodium = cation, chloride = anion; conducts electricity, forms electrolyte solutions - positive and negative charges balanced/neutralized

Summarize the nutrient needs of women during lactation (early lactation vs. lactation)

Energy intake: +330 kcal/day during 1st 6 months; +400 kcal/day during 2nd 6 months; fat reserves provide the rest to achieve ~500 kcal/day needed for average volume of milk Protein: +25 g/day over RDA for nonpregnant/lactating (1 additional large meat/meat substitute serving) Water: ~14 cups of fluid/day; drink before, during, and after breastfeeding sessions; important to monitor urine color and frequency Vitamins/Minerals: Needs met with varied, nutrient dense diet; calcium and vitamin D may need supplementation

Identify the nutritive and non-nutritive characteristics and functions of breast milk

Energy: ~0.65 kcal/mL (varies with fat content) - Contains vitamins and minerals Fat: 3-5% (in mature milk ~17 days postpartum) - Saturated, polyunsaturated, and monounsaturated fats - Essential fatty acids (linoleic and alpha linoleic) - Medium chain fatty acids - easily digested and absorbed; doesn't require pancreatic lipase Protein: ~1% - 2 types - Casein: Clots in stomach; aids in satiation (with fats) - Whey: Stays liquid (easily digestible - Ratio of casein/whey: 70/30-80/20 during early lactation; 50/50 during late lactation Lactose: ~7% - Aids in mineral and calcium absorption Water: ~88% - Isotonic with plasma - Allows suspension of sugars, proteins, electrolytes, and water-soluble vitamins Immune factors: Immunoglobulins and antibodies transferred from mother

Describe the appropriate foods for infants during the first year of life and strategies for their introduction

Exclusive breastfeeding recommended until 6 months - infants developmentally ready to receive solid foods ~4-6 months - Solid foods: Supply needed nutrients otherwise not supplied by breastmilk/formula (e.g., iron); beginning with thick, blended/pureed foods - Identification of allergic reactions: Introduce foods one at a time - wait 3-5 days before introducing another - Offer solids with small spoon/shallow bowl = stimulates mouth muscle development - Do not expose to cow's milk (maintain breast milk/formula), honey (risk of botulism), and fruit juice (high sugar content)

Demonstrate how to estimate energy requirements; identify the "gold standard"

Factors: Genetics, gender (for BMR), growth, age, physical activity (duration, frequency, intensity), body composition and size (height and weight) Gold Standard: Indirect calorimetry - measures gas exchange of O2 consumption vs. CO2 production via metabolic cart or respiratory chamber, converts results to resting energy expenditure via calculations Various Predictive Equations: Most for generally healthy people; other specific equations for chronically ill designed to account for disabilities

Explain how an inadequate intake of each macronutrient will shift metabolism

Fasting: Energy intake < energy needs/expenditure Glucose from glycogen stores in the liver and fatty acids from fat stores in adipose tissue travel to the cells to be broken down into acetyl CoA After several hours, liver glycogen stores depleted - blood glucose levels drop; the body must adjust metabolism for survival Starvation demands cells to degrade their components for fuel Adaptations: 1. Gluconeogenesis: Triggered by the red blood cell's need for glucose; breakdown of lean body mass (proteins) 2. Ketosis: Use of fat in the form of ketone bodies to fuel the brain; slows the rate of lean body mass loss by using fat stores first 3. Energy Conservation: Hormones slow metabolism; reduced energy output as body shifts toward using ketone bodies

Explain how an excess of any of the 3 macronutrients contributes to body fat

Feasting: Energy intake > energy needs/expenditure = fat Proteins: Used to replace normal daily losses, then increase protein oxidation (displaces fat); amino acids deaminated -> carbons used to make fatty acids stored as triglycerides (adipose) Carbohydrates: Excess first used to fill glycogen stores; e.g., sucrose - body splits glucose from fructose -> absorption -> breakdown into pyruvate and acetyl CoA -> assembles several acetyl CoA to fatty acid chains -> fatty acid chains attach to glycerol = triglyceride (stored as fat) Fats: Moves directly into adipose storage

Describe fetal development from conception to birth

Fetal development begins with fertilization of an ovum by sperm, followed by 3 stages: zygote, embryo, and fetus - Zygote: Newly fertilized ovum; begins as single cell, rapidly divides to become blastocyst; in 1st week, it travels down to the uterus and embeds into the uterine wall (implantation); cell division continues - Embryo: Initially, # of cells doubles/24 hrs, rate slows until final 10 weeks; at 8 weeks, has complete central nervous system, beating heart, digestive system, defined fingers and toes, and early facial features - Fetus: Continues to grow 7 months; organs grow to maturity (at varying rates), weight increases from 1 oz to ~ 7 1/2 lbs (full term - 39-40 weeks)

Describe the difference between fit and fat or sedentary and slim

Fit and Fat: Overweight but fit = lower risk of mortality than normal weight and unfit individuals Sedentary and Slim: Lack of cardiorespiratory and muscular fitness; greater metabolism - skinny does not equal healthy in all cases

Integrate behavior change models into an assessment of individuals willingness, compliance, and success with nutrition intervention strategies

Five Stages of Behavior Change - Decisional balance: Weighing the pros and cons - Self-efficacy: Degree of confidence in one's ability to make and maintain a change - Processes of change: Cognitive and affective experiential processes and behavioral processes 5A's Behavior Change Model: - Assess: Determine behavioral risk(s) and factors affecting choice of behavior change goals/methods - Advise: Give clear, specific, personalized behavior-change advice, including harms and benefits - Agree: Collaboratively select appropriate treatment goals and methods based on patient's interest and willingness to change behavior - Assist: Using behavior-change techniques (self-help, counseling), help patient achieve agreed goals by acquiring skills, confidence, and social/environmental support for behavior change, supplemented with adjunct medical treatments when needed or direct to healthcare professional - Arrange: Schedule follow-up, provide ongoing assistance/support, adjust treatment plan as needed, including referral to more intensive/specialized treatment

Explain how the body regulates fluid balance

Fluid Balance: 2/3 of fluids inside the cell, 1/3 outside of the cell Intake from liquids, foods, and metabolism must equal losses from the kidneys, skin, lungs, and GI tract - When the body experiences low blood volume, low blood pressure, or highly concentrated fluids, the acts of ADH, renin, angiotensin, and aldosterone restore homeostasis (fluid balance)

Describe how the body transitions from feasting to fasting

Following a meal, glucose, glycerol, and fatty acids are used as needed and then stored; later used during the fasting state During transition, the body pulls from glycogen and fat stores to keep metabolic processes occurring (constant)

List examples of nutrition interventions and discuss the procedures used when providing nutrition care

Food and/or nutrient delivery: Providing appropriate meals, snacks, and dietary supplements; providing specialized nutrition support (tube feedings/parenteral nutrition); determining the need for feeding assistance or adjustment in feeding environment; managing nutrition-related medication problems Nutrition education: Providing basic nutrition-related instruction; providing in-depth training to increase dietary knowledge or skills; providing information about a modified diet or change in formula Nutrition counseling: Helping the individual set priorities and establish diet-related goals; motivating the individual to change behaviors to achieve goals; solving problems that interfere with the nutrition care plan Coordination of nutrition care: Providing referrals/consulting other health professionals/agencies that can assist with treatment; organizing treatments that involve other health professionals/health care facilities; arranging transfer of nutrition care to another professional/location

Name the environmental and dietary factors of importance to pregnant mothers: foodborne illness due to microorganisms, fish and seafood safety, alcohol, caffeine, non-nutritive sweeteners, sugar-sweetened drinks, energy drinks, water, and hydration, etc.

Foodborne illness: Decreased immune function due to increased progesterone levels - Listeria monocytogenes: Foodborne bacteria in dairy, deli meats, hot dogs, raw seafood - increased risk of preterm delivery, stillbirth, miscarriage, neonatal meningitis, sepsis, pneumonia - Toxoplasma gondii (toxoplasmosis): Parasite that may decrease fetal brain development; found in soiled cat litter, undercooked pork, lamb, and venison Fish/seafood safety: Mercury - can impair fetal growth and harm the developing brain and nervous system; benefits of cooked, safe seafood outweigh risks - limited consumption Alcohol: Can cause irreversible mental and physical retardation - fetal alcohol syndrome (FAS) Caffeine: Normal intakes - not conclusive to be problematic; may be associated with miscarriage if >500 mg/day; current advice = limit to 200 mg/day Non-nutritive sweeteners: High intake associated with increased risk of preterm births Sugar-sweetened drinks: Water is better for maternal hydration/blood volume, blood/nutrient transfer to fetus, amniotic fluid - sugary drinks contribute to gestational diabetes Energy drinks: High levels of sugar, caffeine - minimal consumption Water/hydration: Needed for maternal hydration; increased maternal blood volume; adequate blood/nutrient transfer to fetus; adequate amniotic fluid

Describe how individuals behaviors and attitudes may influence their willingness to make lifestyle changes

For good outcomes: Modification: Positive outcomes on health Awareness: Keep records of diet, activities, etc. Change: Small, specific goals; practice; rewards Cognitive Skills: - Problem solving strategies: Integrate meal plan and physical activity into lifestyle for maintained weight loss - Restructuring (replacing negative thoughts) - Personal attitude: Emotional health, understanding relationships with food; identify and interrupt cues to inappropriate eating behaviors - Support groups

Describe the 'typical' frequency and duration of breastfeeding; describe how the composition of breastmilk changes over each breastfeeding session and over time (from colostrum to mature milk, etc.)

Initially very 2 hrs, 10-12x/day-night; tapers to 6-8x/day as stomach volume increases Intake monitored by growth/growth charts, wet diapers, and stools Breastfeeding usually more frequent than formula feeding: Breast milk = more easily digested/absorbed - more hungry, more often; may get less per feeding compared to bottle feedings Colostrum: Important for baby's first feeding; produced immediately after birth - Increased protein, decreased carbohydrates and fat - Increased maternal white blood cells, immune compounds - Increased vitamin A = cell differentiation Mature breast milk: Composition stabilized ~10 days after birth; continues to change as baby ages to meet needs

Identify the site of metabolic reactions

Inner compartment of mitochondria

Recall the scientific evidence that supports the recommendations for vitamins A, D, E, and K

Functions of Fat-Soluble Vitamins Together: - Vitamins E and A: Oxidation, absorption, and storage - Vitamins A, D, and K: Bone growth and remodeling - Vitamins E and K: Blood clotting

Recognize the United States and Global goals, trends, and policies impacting breastfeeding

Goals: Infants who are breastfed for different periods of time; increase the proportion of employers who have worksite lactation programs; reduce the proportion of breastfeeding newborns who receive formula supplement within 1st 2 days; increase the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies Trends: Significant decrease in breastfeeding once formula became available (1950-1960's); differences in breastfeeding rates for population subgroups - Increased based on education, income, age - Decreased based on race, ethnicity Policies: - Federal legislation: Patient Protection and Affordable Care Act - employers with 50+ employees to provide reasonable breaks to express breast milk <1 yr after birth; employer not required to compensate employee for more break time than already compensated for all employees; employer must provide clean, private place (other than bathroom) - State legislation: All states have laws allowing women to breastfeed in any public/private location; 30 states exempt from public indecency laws; 29 states with laws related to breastfeeding in the workplace; 17 states exempt breastfeeding mothers from jury duty; 6 states implement/encourage development of breastfeeding awareness education campaign

Identify various clinical signs and symptoms of nutrient deficiencies

Hair: Dull, brittle, dry, loose; falls out (protein/energy); corkscrew hair (vitamin C) Eyes: Pale membranes (iron); spots, dryness, night blindness (vitamin A); redness at corners of eyes (B vitamins) Lips: Dry, cracked, or sores in corners of lips (B vitamins) Mouth/gums: Bleeding gums (vitamin C); smooth/magenta tongue (B vitamins); poor taste sensation (zinc) Skin: Poor wound healing (protein/energy, vitamin C, zinc); dry, rough, lack of fat under skin (essential fatty acids, protein/energy, vitamin A, B vitamins); bruising/bleeding under skin (vitamins C, K); pale (iron) Nails: Ridged (protein/energy); spoon shaped, pale (iron) Other: Dementia, peripheral neuropathy (B vitamins); swollen glands at front of neck (protein/energy, iodine); bowed legs (vitamin D)

Describe the role that nutrition plays in longevity

Life expectancy has increased from 1900 (47 yrs) to now (79 yrs) Aging slowed by adopting healthy lifestyle behaviors: Nutritious diet, physical activity, adequate sleep, low stress, avoiding risky behaviors (e.g., smoking, alcohol and drug abuse, etc.) - improves quality of life in later years Physiological and chronological age may be vastly different - Physiological age: Age as an estimate of health and probable life expectancy - Chronological age: Age in years from date of birth Manipulation of diet possibly beneficial - In research models with animals: Energy restriction resulting in longer lifespan and fewer age-related diseases; slowed aging process; food intake set to prevent malnutrition at 70% of normal energy intake resulted in increased antioxidant activity and DNA repair - In humans: Defining energy restriction as either eating less or weighing less; hunger persistent if energy restricted by 30%, but 10-20% decrease resulted in reduced body weight, body fat, inflammatory proteins, growth factors, blood pressure, blood lipids, and improved insulin response

Describe common trends of height, weight, and fat deposition for children through adolescents

Height: 2-3.5 in taller each yr from 1 yr to adolescence Weight: 3.5-7 lbs heavier each yr from 1 yr to adolescence Fat deposition: Reaches a minimum in the amount deposited between 4-6 yrs - Pre-puberty: Adiposity rebound; increased fat in preparation for puberty - occurs sooner and is greater for females

Describe the typical growth rate of infants in their first years of life and their energy requirements

Infant weight: Birth weight doubled by 4-6 months; tripled by 1 yr Infant height: Increase in length by 50% in 1st yr; doubled by 4 yrs Infant body fat: 10-15% body fat when born; increases rapidly during 1st 9 months, decelerates at 6-9 months (due to increased mobility)

Describe why iron deficiency and obesity are often concerns during childhood

Iron-deficiency anemia: Prevalent among toddlers 1-3 yrs - change from breastmilk or iron-fortified formula and cereal to cow's milk (provides insufficient iron) in addition to a fluctuating appetite - 7-10 mg/day needed Obesity: Associated with earlier puberty, stunted growth, and greater bone and muscle mass; elevated blood lipid profiles, type II diabetes, and respiratory disorders; emotional and social problems (particularly amongst peers)

Identify the major roles, deficiency symptoms, and food sources for each of the trace minerals (iron, zinc, copper, selenium, iodine)

Iron: Roles: Hemoglobin (carries oxygen in blood), myoglobin (provides oxygen for muscle contraction); cofactor to enzymes in oxidation-reduction reactions Symptoms: Anemia, fatigue, impaired work performance Sources: Heme - animal products (turkey, beef, liver, etc.); non-heme - plant foods (chickpeas, pumpkin seeds, mushrooms, beans) Zinc: Roles: Cofactor for 100+ enzymes; e.g., collagenase (wound healing), spermatogenesis, growth (children) Symptoms: Delayed wound healing, decrease adult hair (facial, pubic, axillary), hypogonadism, loss of taste/smell, impaired immunity Sources: Red meat and seafood, whole grains, leafy/root vegetables Copper: Roles: Cofactor for several enzymes; e.g., ferroxidase - attaches iron to transferrin, lysyl oxidase - cross-links in collagen and elastic tissue, tyrosinase - converts tyrosine to melanin Symptoms: Microcytic anemia, aortic dissection, poor healing, skeletal/blood vessel abnormalities; Menke's syndrome - sex-linked recessive defect (malabsorption) Sources: Varies widely in whole foods Selenium: Roles: Cofactor for glutathione, peroxidase (antioxidant) - converts peroxide to water Symptoms: Weakness, muscle pain, dilated cardiomyopathy, loss of pigmentation in hair/skin, whitened nail beds Sources: Varies dependent on soil content Iodine: Roles: Structural role in thyroid hormones, regulating basal metabolic rate Symptoms: Cretinism - poor development in children; goiter - overdevelopment of thyroid gland in adults Sources: Based on soil content; iodized salt

Identify the differences between the terms lactation and breastfeeding

Lactation: Physiological, automatic response following pregnancy - Mammary glands secrete milk - Coordinated by hormones prolactin (milk production) and oxytocin (ejection of milk from alveoli -> milk ducts) - Let-down reflex: Contraction of breast in response to suckling - Pumping: May decrease oxytocin = difficulty with let-down - Volume of breast milk: Dependent on prolactin - produces milk based on baby's demands (frequency of feedings); breast size - storage capacity (number of ducts) Breastfeeding: Learned behavior; not all mothers decide to do it; several benefits for infant, mother, and society - Infant: Provides adequate nutrition for changing needs; provides hormones for physiological development; improves cognitive development; immunological protection; protection against chronic diseases; protection against food allergies; reduced risk of SIDS; supports healthy weight - Mother: Contracts uterus/return to pre-pregnancy state; delays ovulation; conserves iron stores; decreases postpartum bleeding; increases energy expenditure; decreases risk of pre- and post-menopausal breast cancer; empowering psychologically, bonding with baby - Society: Cost/time saving medically; increased productivity; cost/time saving (not purchasing formula); environmental savings; convenience

List the macro- and micro- nutrient recommendations for children and how they compare to adults

Macronutrients: Carbohydrates: 130 g/day; same for children and adults (based on brain glucose needs) Fiber: Derived from adult intakes and are based on energy intakes; younger children with low energy intakes less than those for older children with high energy intakes Fat and fatty acids: 30-40% for 1-3 yrs; 25-35% for 4-18 yrs (same as adults) Protein: Increases slightly with age - when body weight is considered, requirements decline; needs based on maintenance of nitrogen balance, quality of protein, and added needs for growth Micronutrients: Needs typically met with adequate, balanced diet - exceptions with iron, vitamin D, and fluoride (supplements not necessary, but often taken) Iron: Iron-deficiency anemia prevalent among toddlers aged 1-3 yrs; supplemented with 7-10 mg/day Vitamin D: Supplemented with fortified milk Fluoride: Dependent on water source

Describe how maternal health may impact the ability for mothers to breastfeed

Mothers should not breastfeed or feed expressed breast milk to their infants if: - Infected with HIV - Infected with human T-cell lymphotropic virus type I or II - Using illicit street drugs or alcoholism - Suspected/confirmed Ebola virus disease - Baby is diagnosed with galactosemia (unable to digest/absorb lactose) Mothers should temporarily not breastfeed and should not feed expressed breast milk to their infants if: - Infected with untreated brucellosis - Taking certain medications (e.g., anti-metabolite drugs for cancer treatment) - Undergoing diagnostic imaging (e.g., radiopharmaceutical therapy for cancer treatment) - Experiencing active herpes simplex virus infection with lesions present on breast

Describe the difference between major minerals and trace minerals

Major minerals are found and needed in larger quantities than trace minerals

Describe the interrelationship between illness and malnutrition

Malnutrition: Frequently reported in patients hospitalized with acute illness; those without nutrition problems on admission often decline in nutrition status - Poor nutrition -> weakened immune function and healing ability; often lengthens hospital stays and increases overall cost of patient care Effects of Illness on Nutrition Status: Reduced food intake, impaired digestion and absorption, and altered nutrient metabolism and excretion

Discuss the different types of dietary modifications available in hospital settings for patients with medical problems

Mechanically altered diets: Food modified in texture Blenderized liquid diet: Contains fluids and food blenderized to liquid form Clear liquid diet: Contains clear fluids or food that are liquid at room temperature and leave minimal residue in the colon Fat-restricted diet: Limits dietary fat to low (<50 g/day) or very low (<25 g/day) intakes Low-fiber diet: Limits dietary fiber; degrees of restriction depends on patient's condition and reason for restriction Low-sodium diet: Limits dietary sodium; degree of restriction depends on symptoms and disease severity High-kcalorie, high-protein diet: Contains foods that are kcalorie and protein dense

Describe how the diet changes in response to a low carbohydrate diet

Metabolism: Similar to fasting; no carbohydrates = no oxaloacetate available for TCA cycle (slowed) Use of glycogen stores to produce glucose for red blood cells; once depleted = gluconeogenesis: Synthesis of glucose from amino acids of protein Urine production increases with gluconeogenesis - ketosis

Explain how minerals are different (or similar) to vitamins and other nutrients

Minerals are inorganic and retain their chemical identities (unlike vitamins/nutrients); usually receives special regulation in the body, may bind with other substances or interact with other minerals - limits absorption Provides the medium essential for normal cellular activity, determines osmotic properties for body fluids, imparts hardness to bones, teeth, and function as cofactors for enzymes

Recognize common nutrition-related concerns of pregnancy, describe interventions to prevent or correct the condition

Nausea/vomiting: Usually resolves by 15-17 wks gestation; "morning sickness" Constipation/hemorrhoids: Progesterone - slows GI motility/peristalsis; fiber and exercise - speeds GI motility Heartburn: Usually during 1st and 3rd trimester; small, frequent meals to alleviate Food cravings/aversions: Usually meats, green vegetables Pica (rare): Ingestion of nonfood substances; potential physiological reaction to nutrient deficiency (calcium and iron) Hyperemesis gravidarum (rare): Excessive vomiting and weight loss; compromised nutritional status, fluid and electrolyte imbalances; may require hospitalization - enteral/parenteral feeding

Explain the difference between normal and successful aging

Normal: Physiologic and biochemical changes that occur over time; increase in rate and severity with poor lifestyle choices Successful: Reduction/delay of physical changes achieved by making healthy lifestyle choices

Provide strategies for adults and older adults to shop/prepare healthy meals for one person or on a restricted budget, or with limited access to grocery stores, etc.

Older people can benefit from both the nutrients and the social interaction provided by congregate meals Government programs deliver meals to those who are home-bound Smart grocery shopping for groceries with a long shelf-life and only buying what will be used helps with the financial struggle

Explain how health professionals identify and treat patients at risk for nutritional problems

Once a patient is admitted to the hospital, the nurse performs a nutrition screening to determine if the patient is malnourished or at risk of being malnourished, and documents the results in the electronic health record (EHR). If not at risk, the nurse continues to monitor and re-screen. If at risk or deemed malnourished, a more specific nutrition assessment is ordered and conducted by a dietitian/qualified professional. During hospitalization, a custom nutrition care plan is created/ordered; the facilitation of the nutrition care plan requires collaboration between the entire healthcare team (dietitian, nurse, physician) Prior to discharge, the patient is monitored and re-evaluated, the patient (and family) are educated/counseled, and the discharge plan is updated, including appropriate follow-up.

Identify relationships between body weight and chronic diseases (underweight, overweight)

Overweight: Obesity (designated disease), cardiovascular disease (CVD), type II diabetes, inflammation, metabolic syndrome, cancer; more likely to be disabled later in life Underweight: Various illnesses due to weakened immune system; wasting diseases, menstrual irregularities and infertility, osteoporosis and bone fractures

List the concerns when nutritional goals are not met during pregnancy for mother and infant

Parental: - Fertility: Male unable to produce viable sperm, loss of sexual interest - Early pregnancy: Prevents full potential of placental development Fetal: - Increased risk of low birth weight (LBW): <5 lbs 8 oz.; greater prevalence of physical and mental birth defects, illnesses, and premature death; related to socioeconomic status, lack of prenatal care, financial stresses (care, nutrition, etc.) - Increased risk of preterm delivery: < 37 wks, viable at 24+ wks; immature lung development, maturity of digestive system, respiratory system, eyes, growth, etc.; decreased nutrient stores; increased risk for lower IQ; increased risk of cerebral palsy/other malformations - Increased risk for 'small for gestational age' (SGA): Suffered growth failure in the uterus All increase risk for infant mortality/morbidity

Describe the chemical reactions taking place in the body that allow for metabolism

Photosynthesis: Plants transform carbon dioxide (CO2) and water (H2O) into simple sugars (glucose) and release oxygen (before metabolism) Humans consume either the plant directly or the animal that consumed the plant (initiates metabolism) During metabolism, the body releases energy (ATP), H2O, and CO2 (byproducts) Cells are the site of metabolic reactions - liver cells are the most metabolically active Anabolic (condensation) and catabolic (hydrolysis) reactions Some energy released during catabolism of glucose, glycerol, fatty acids, and amino acids is captured by ATP - 3 phosphate groups of ATP are hydrolyzed and release energy - provides the energy that powers all the activities of living cells - Coupled reactions: Anabolic reactions that use the energy released by catabolic reactions The body converts chemical energy of food to chemical energy of ATP with ~50% efficiency (the rest radiated as heat)

Summarize how nutrition interacts with physical and psychological changes involved in aging

Physiological changes: Occurs in all organ systems and contributes to overall declining function; affects nutrition status - Body weight: ~35% of older adults in the U.S. are overweight/obese; lowest mortality rates associated with moderate overweight BMI (23.5-27.7) - built nutrient supplies = better prepared for diseases, etc.; low body weight often reflects trauma and malnutrition - may be more detrimental due to less nutrient reserves = weakened defense against disease - Body composition: Lose bone and muscle (not just lean body mass - organs); gain body fat; primarily due to hormonal changes with regulation of appetite and metabolism - GI tract: Loss of strength and elasticity of intestinal wall and musculature - constipation; hormone secretion changes - decreased appetite and energy consumption; atrophic gastritis (1/3 of older adults) - inflamed stomach, bacterial overgrowth, lack of hydrochloric acid and intrinsic factor (important for B12), impaired absorption of protein, vitamin B12, biotin, folate, calcium, iron, and zinc; dysphagia - inability to swallow (often with neurological symptoms), painful, dangerous, hard to swallow water, sit up when eating, requires modification of textures in diet - Tooth loss: Leads to less desire and ability to consume some foods - Sensory losses: Eyesight, taste, and smell - less appetite stimulation Psychological changes: - Depression: Loss of appetite and motivation to cook; support and companionship of family and friends is important and can stimulate positive emotions with eating

Explain how both underweight and overweight can interfere with a healthy pregnancy and how weight gain and PA can support maternal health and infant growth

Pre-pregnancy weight influences infant birthweight Underweight: Higher rates of low-birthweight infant and preterm delivery Overweight/obese: Higher rates of medical complications (e.g., gestational diabetes, hypertension, postpartum infections, preeclampsia/eclampsia); large for gestational age infants = difficult labor and delivery, birth trauma (e.g., shoulder dystocia), cesarean delivery Weight gain: - Maternal needs: Buildup of structures to support fetal growth; uterus, placenta, mammary glands; increased blood volume, metabolism; nutrients going to baby - Fetal needs: Primarily for development/growth of body structures; muscles, nerves, organs, bones, central nervous system; small amount for maintenance metabolism Physical activity: - Exercise recommended: Gradually and regularly; less discomfort during pregnancy, labor, and delivery (faster recovery); improves cardiovascular fitness, limits excessive weight gain, prevents/manages gestational diabetes, hypertension; manages stress

Identify how nutrition might contribute to, or prevent, the development of problems associated with alcohol use

Problems associated with alcohol use: Impaired memory and cognition; increased rate of aging; increased stress; increased likelihood of developing gout Nutrition: Avoiding risky behaviors (alcohol) can help slow the aging process in addition to adopting healthy lifestyle behaviors; medical nutrition therapy a second line of defense in treatment of gout

Describe the pattern of sodium intake in the United States

RDA: 1,500 mg for 19-50 yr old adults; most Americans consume 3x this amount

Identify the main roles, deficiency/toxicity symptoms, and food sources for Vitamin C

Role: Serves as cofactor for enzymes; serves as antioxidant; enhances iron absorption Deficiency: Symptoms include easily bleeding gums, capillaries breaking under skin - Scurvy: Other physical, psychological signs; sudden death from internal bleeding Toxicity: Symptoms include diarrhea, GI distress - UL = 2,000 mg/day - Maximum absorption = 200 mg Food Sources: Fruits and vegetables (potatoes); vulnerable to heat and oxygen

Identify the main roles, deficiency symptoms, and food sources for Vitamin E

Roles: Antioxidant (interferes with free radical production) Deficiency: Erythrocyte hemolysis, neuromuscular dysfunction Food Sources: Widespread, fresh foods - vegetable oils, margarine, salad dressing

Identify the main roles, deficiency symptoms, and food sources for Vitamin K

Roles: Blood clotting (prothrombin), metabolism of osteocalcin, other possible roles Deficiency: Primary - rare; secondary - fat absorption and bile production impacted = vitamin K absorption diminished Food Sources: Leafy green vegetables - spinach, kale, fruits (avocado and kiwi), and some vegetable oils

Identify the main roles, deficiency symptoms, and food sources for Vitamin D

Roles: Maintains bone growth (calcium and phosphorus absorption), protects brain and nerve cells (slows Parkinson Disease), encourages/preserves muscle cell growth, immune cell signaling, adipose tissue regulation, enhances/suppresses gene activity related to cell growth Deficiency: Calcium deficiency (calbindin production), rickets, osteomalacia, osteoporosis; elderly - skin, liver, and kidneys incapable of production/activation of vitamin D Food Sources: Oily fish, egg yolks, fortified milk

Identify the main roles, deficiency symptoms, and food sources for Vitamin A

Roles: Promotes vision (retinal), participates in protein synthesis and cell differentiation (retinoic acid), supports reproduction and regulating growth (retinol) Deficiency: Symptoms would not present until stores depleted (1-2 yrs); increased risk of infectious diseases, night/general blindness, death, keratinization (decreased mucous production) Food Sources: Retinoids commonly found in food derived from animals - carotenoids found in foods derived from plants; animals, plants, golden rice (contains beta-carotene)

List federally and state funded school lunch programs

School meals administered by United States Department of Agriculture (USDA) - School Breakfast Program, National School Lunch Program -Dietary Guidelines for Americans: Nutritional adequacy - 1/3 of recommended intakes provided - Child and Adult Care Food Program (CACFP)

Identify the data that is often collected in the nutrition screening and assessment process

Screening: - Admission data: Age, medical diagnosis, severity of illness/injury - Anthropometric data: Height, weight, body mass index (BMI), unintentional weight changes, loss of muscle/subcutaneous fat - Functional assessment data: Low handgrip strength, general weakness, impaired mobility - Historical information: Family medical history; medication history; dietary restrictions; food allergies/intolerances; requirements for nutrition support; difficulties with meal prep or ingestion; depression, social isolation, or dementia - Signs and symptoms: Reduced appetite or food intake, problems that interfere with food intake (chewing/swallowing difficulties, nausea/vomiting), localized or generalized edema, presence of pressure sores Assessment: - Food intake data: Subject to self-report bias; challenging due to memory, honesty, education - 24-hr dietary recall: Guided interview; timing, prep, amount of meals/snacks - Food/beverage frequency questionnaire: Foods regularly consumed at specific times - Food record: Written account of food/beverages consumed consecutively - Direct observation: Allows estimate of caloric intake; labor intensive, doesn't rely on memory/self-report

Explain the nutritional and metabolism shifts from adolescents to adulthood

Shift in energy needs from growth and development to maintenance when transitioning from adolescence to adulthood Decreased by 10kcal/day for males; 9kcal/day for females above 19 yrs old

Describe how malnutrition of specific nutrients may impact toddlers/child's behavior and development

Short-term hunger: Meal-skipping; impaired ability to pay attention and be productive; irritable, apathetic, uninterested; difficult to make up deficits in other meals Long-term hunger: Impaired growth and immune defenses Iron deficiency: Energy crisis - transport of oxygen in cells needed for energy metabolism; impaired attention span and learning ability; clinical indicators of low hemoglobin/hematocrit - CBC required to rule out B12/folate deficiency Zinc deficiency: Affects growth, taste acuity, and appetite Malnourished children: More vulnerable to lead poisoning - increased absorption if stomach empty - Low intakes of calcium, zinc, vitamins C and D, and iron - increased risk of lead toxicity - Iron deficiency and lead toxicity: Iron deficiency weakens the body's defenses against led absorption, and lead poisoning can cause iron deficiency; overall, both weaken body's defenses against lead absorption

Identify methods to assess both body weight and body composition; pros and cons of each

Skinfold Measures: Estimates body fat by using a caliper to gauge the thickness of a fold of skin in specific areas and comparing them to the standards; must be done before and after by the same person in the same spot Dual Energy X-Ray Absorptiometry (DEXAR): 2 x-rays measure total fat and it's distribution (proportions); can't be used for extremely obese cases Waist Circumference: Measures central obesity by measuring the waist; good indicator of central obesity and it's associated health risks Body Weight: Fails to reveal how much of the weight is fat and where it is located Body Mass Index (BMI): Measure of relative weight for height; does not measure body composition, does not account for muscle mass

Identify the major roles, deficiency symptoms, and food sources for each of the major minerals (sodium, chloride, potassium, calcium, phosphorus, magnesium, and sulfate)

Sodium: Roles: Principal extracellular cation, regulates volume, aids in acid-base balance, nerve impulses, and muscle contraction Symptoms: Hyponatremia - headache, confusion, seizures, coma; often from excessive sweating, vomiting, or diarrhea Sources: Table salt, processed foods, milk, meat, eggs, vegetables Chloride: Roles: Major extracellular anion, balances sodium, crucial electrolyte, hydrochloric acid Symptoms: Hypochloremia - loss of appetite, weakness, lethargy; often from sweating, vomiting, or diarrhea Sources: Table salt, eggs, meats, seafood Potassium: Roles: Primary intracellular cation, maintains fluid balance, nerve function, and muscle contraction Symptoms: High blood pressure, irregular heartbeat, muscle weakness Sources: Abundant in fruits and vegetables Calcium: Roles: Vital for bone structure, supports muscle and nerve function Symptoms: Rickets (in children), tetany, osteoporosis Sources: Milk, cheese, leafy greens, nuts, fish (with bones) Phosphorus: Roles: Essential for bone health, energy metabolism, enzyme function Symptoms: Linked to renal and skeletal issues Sources: Meat, poultry, fish, nuts, legumes Magnesium: Roles: Supports bone health, nerve function, enzyme activity Symptoms: Muscle cramps, insomnia, fatigue Sources: Nuts, legumes, whole grains, leafy greens Sulfate: Roles: Aids protein structure and stability Symptoms: Related to protein deficiency Sources: Protein-rich foods like meats, fish, eggs, and nuts

Describe how vitamins differ from the energy nutrients

Structurally: Individual units instead of several molecules linked together (e.g., amino acids, glucose) Energy: Does not provide energy as nutrients would, but rather assists enzymes with obtaining the energy from nutrients Measurements: Measured in micrograms or milligrams instead of grams

Explain the importance of the WHO child growth charts

The WHO growth charts represent growth standards that describe how healthy children should grow under optimal environmental and health conditions Growth charts aid in the diagnosis of growth abnormalities, nutritional disorders, and disease Lines on a growth chart represent the trajectory of a certain percentile representing height, weight, BMI, head circumference, etc.

Recall the recommendations set for each water-soluble vitamin and determine how their recommendations are set

Thiamin: 1.1-1.2 mg/day; set based on role as coenzyme for TCA cycle, and muscle and nerve activity Riboflavin: 1.1-1.3 mg/day; set based on enzymatic activity Niacin: 14-16 mg/day; set based on protein needs (both synthesized and obtained from diet) Biotin: Insufficient data for RDA; AI = 30 mcg/day Pantothenic Acid: AI established; set based on what is needed to replace daily losses Vitamin B6: 1.3 mg/day; set based on amounts needed to maintain adequate levels of coenzyme Folate: 400 mcg/day; set based on role in DNA synthesis and cell growth Vitamin B12: 2.4 mcg/day; set based on role in DNA synthesis, bone cell activity, and nerve sheaths Choline: No RDA; AI = 425-550 mg/day; set based on methionine availability and roles in lecithin and acetylcholine production Vitamin C: 75-90 mg/day; set based on role as cofactor for a specific enzyme and antioxidant properties

Identify food sources that may impact the absorption of water-soluble vitamins

Thiamin: Alcohol - impairs absorption and enhances excretion Biotin: Egg whites - 2 dozen eggs/day for several days required for impact; protein in egg white binds biotin and prevents absorption Vitamin B6: Alcohol and isoniazid (antibiotic) - B6 antagonists/prevent absorption

Describe instances for the use of dietary supplements for water-soluble vitamins

Thiamin: Deficiency as a result of malnourishment, homelessness, alcoholism, etc. leading to thiamin deficiency disease/Beriberi; not consuming enough variety; meats, poultry, seafood, and grains Riboflavin: Deficiency leading to inflammation of membranes (mouth, skin, eyes, GI tract); not consuming enough dairy products Niacin: Deficiency leading to Pellagra (diarrhea, dermatitis, dementia, and death); not consuming enough meats, poultry, and seafood Biotin: Deficiency leading to skin rash, hair loss, and neurological impairment; potential overconsumption of egg whites (protein in egg bind biotin, prevents absorption) Pantothenic Acid: Deficiency leading to general fatigue, GI distress, and neurological disturbances; not consuming enough variety (beef, poultry, grains, potatoes, tomatoes, broccoli) Vitamin B6: Early deficiency involving depression and confusion, advanced deficiency involving abnormal brain wave patterns and convulsions; overconsumption of alcohol and/or isoniazid (B6 antagonists/impairs absorption of B6); not consuming enough variety (vegetables, fruits, protein foods) Folate: Deficiency leading to neural tube defects, congenital birth defects - impairs cell division, protein synthesis, and replacement of red blood cells (macrocytic/megaloblastic anemia - large immature red blood cells); not consuming enough vegetables, legumes, and fortified grains Vitamin B12: Early deficiency involving impaired cognition, advanced deficiency involving neurological symptoms - reflects poor absorption (not intake) due to lack of HCl or intrinsic factor Choline: Impact of deficiency not understood Vitamin C: Deficiency leading to sensitive bleeding gums and spontaneous internal capillary bleeding; not consuming enough fruits and vegetables

Describe the transport, storage, and absorption for vitamins A, D, E, and K

Transport: Travels via protein carriers (e.g., VLDLs, chylomicrons) Storage: Stored in liver or adipose tissue Absorption: Enters the lymphatic system and then into the circulatory system

Identify the target goals for BMI and weight gain in normal, under- or overweight for healthy pregnancies and fetal development; based on pre-pregnancy heights and weights

Underweight (BMI < 18.5): - Total weight gain range: 28-40 lbs (single); insufficient data (multiple) - Rates of (mean) weight gain in 2nd and 3rd trimesters: 1 (1.0-1.3) Normal weight (BMI 18.5-24.9): - Total weight gain range: 25-35 (single); 37-54 (multiple) - Rates of (mean) weight gain in 2nd and 3rd trimesters: 1 (0.8-1.0) Overweight: (BMI 25.0-29.9): - Total weight gain range: 15-25 (single); 31-50 (multiple) - Rates of (mean) weight gain in 2nd and 3rd trimesters: 0.6 (0.5-0.7) Obese (BMI >30): - Total weight gain range: 11-20 (single); 25-42 (multiple) - Rates of (mean) weight gain in 2nd and 3rd trimesters: 0.5 (0.4-0.6)

Demonstrate how to classify individuals based on their body mass index

Underweight: BMI <18.5 Healthy Weight: 18.5-24.9 Overweight: 25-29.9 Obese: 30-39.9 Extremely Obese: >40

Review the importance of nutrition in the healthcare setting

Various health professionals share the responsibility for providing nutrition care, but only registered dietitians are qualified to provide the medical nutrition therapy (MNT) necessary for diagnosing and treating nutrition problems If a nutrition screening identifies an individual at risk for malnutrition, the registered dietitian may apply the nutrition care process to evaluate potential nutrition problems and implement the appropriate therapy

Recognize emerging topics of concern related to breastfeeding: optimal levels of maternal vitamin D supplementation to support breastfeeding infants, policies influencing breastfeeding in the workplace, in social settings, etc.

Vitamin D supplementation: Inadequate in breastmilk; supplementation recommended via drops on breast/nipple during feeding or in bottle Support for breastfeeding: - During pregnancy: Educate entire family; discuss potential barriers and plans for overcoming; assume ultimate success - provide resources for potential physiological and psychological problems - In hospital: Baby to breast immediately after birth; mom and baby room together; encouragement from hospital staff; no pacifiers or sugar water - delay for better latching Later: In-home support, work environment, family support, and continued support from hospital/medical staff

Identify common nutrient-drug interactions older adults are faced with

Vitamin D: Recommended due to tendency to omit dairy and fortified milk from diet, and limited sun exposure Decreased cholecalciferol (active vitamin D3) formation in skin or impaired kidney function Very susceptible to drug-nutrient interactions - Decrease Lipitor, decreased Ca+ channel blockers; anti-seizure, antacids, laxatives, Orlistat Folate: Absorption may decrease in older people (synthetic form absorbed better) due to lack of intrinsic factor Main cause of decreased folate status in older people other than atrophic gastritis: drug-nutrient interactions - Methotrexate: Treatment of cancer, autoimmune disease, etc. - Anti-folate drugs or anti-tumor drugs are used to treat cancer; tumor growth depends on DNA synthesis and cell division - suppressed with folate deficiency - Chemotherapy agents inhibit metabolism of folic acid Zinc: Medications interfere with absorption

Identify which nutrients are most commonly given as supplements within the first year of life

Vitamin D: Inadequate in breastmilk - supplementation recommended Iron: Low in breastmilk, but readily absorbed; infant stores adequate until ~6 months; supplement iron after 6 months old (e.g., introduce solid foods containing iron)

Describe how water-soluble vitamins differ from the fat-soluble vitamins

Water-soluble Vitamins: - Can/should be consumed regularly - High-solubility in water - Not stored in the body - Absorbed immediately into the circulatory system - Excess excreted in the urine (exception: B12) Fat-soluble Vitamins: - Can't/shouldn't be taken in daily (greater chance of toxicity) - Require bile for digestion and absorption - Excess stored in liver and adipose tissue - Travels through the lymphatic system via carrier protein - Not readily excreted; excreted via feces

Explain why the needs for some nutrients increase or decrease during aging (e.g., water, vitamins, minerals, etc.)

Water: Lack of thirst and decreased total body water make dehydration likely Energy: Need decreases as muscle mass decreases (sarcopenia) Fiber: Likelihood of constipation increases with low intakes and changes in the GI tract Protein: Needs may stay the same or increase slightly Vitamin B12: Atrophic gastritis is a common cause of deficiency Vitamin D: Increased likelihood of inadequate intake; skin synthesis declines Calcium: Intakes may be low; osteoporosis is common Iron: In women, status improves post-menopause; deficiencies linked to chronic blood losses and low stomach acid output Zinc: Intakes are often inadequate and absorption may be poor, but needs may also increase

Recall if and when supplements are needed, how they are regulated, and misleading claims associated with them

When Supplements are Needed: - Individuals with specific nutrient deficiencies, low energy intakes, or certain physiological states (pregnancy) - Vegetarians, older adults with atrophic gastritis, and those with lactose intolerance/milk allergies may require supplements (B12, calcium, vitamin D) - Surgical procedures/medications interfering with nutrient absorption/metabolism may necessitate supplements - Prescribed by a healthcare provider following a dietary assessment Misleading Claims: Overestimating benefits, underestimating risks, and unsubstantiated health claims

Describe the role of blood volume and blood pressure in relation to fluid and mineral balance

When the body experiences low blood volume, low blood pressure, or highly concentrated fluids, the acts of ADH, renin, angiotensin, and aldosterone restore homeostasis (fluid balance) Antidiuretic hormone (ADH): When blood volume drops/extracellular fluid becomes concentrated (dehydration), ADH is released - stimulates kidneys to reabsorb water = less excretion and triggers thirst Renin: Enzyme released from cells in kidneys in response to low blood pressure; causes kidneys to reabsorb sodium = retention of water Angiotensin: Renin hydrolyzes angiotensin from liver, converts angiotensin II through enzymatic activity; angiotensin II is a vasoconstrictor - narrows blood vessels and raises blood pressure Aldosterone: Angiotensin II stimulates aldosterone - signals kidneys to excrete potassium (K) and retain more sodium (Na) and water

Describe the factors that contribute to the development of osteoporosis and strategies to prevent it

When withdrawals of minerals substantially exceed deposits, problems arise (e.g., osteoporosis - long-term calcium deficiency) Disease Prevention: DASH diet - high calcium, magnesium, and potassium, low sodium; reduction of body fat - inverse relationship between calcium intake and body weight; suppression of inflammation - commonly associated with obesity and overweight status