NTR 301 Exam One

Calculate a % DRI for a vitamin or mineral (see section of coursepack on calculating percentages):

...

Describe the types of issues to consider when evaluating a reported diet-disease relationship and/or product claim:

● 1. The source- is it someone who has something to SELL? Their product may be motivated more by your business than your well-being. Watch out for CREDENTIALS and TESTIMONIALS (often bogus) ● 2. The supporting evidence- just because it's cited doesn't mean it's relevant. Research may have been done in animals or test tubes but NOT humans; if done on humans, may not have been healthy people. Often only one of the product's INGREDIENTS and not the product itself has been tested. Doesn't ensure the study was well designed or carried out (often single blind or unblended aka "open trials"). Study may not have been published in legitimate, peer-reviewed, scientific journal. Product may not have been tested AT ALL (many products sold based on theories; no initial regulation). Very common for claims associated with the product to be made up. ● 3. The claims themselves- if they SOUND TOO GOOD to be true they probably are. Watch out for products that: profess to cure everything, include words like "MIRACLE" OR "BREAKTHROUGH", describe effects of a deficiency (rare in the US), claim to have been used in other countries, claim the product is patented (patent is based on the novelty of the product, not its effectiveness), describe propriety blends (this just means they are made up and they don't have to tell you what's in it)

Explain what a confounding factor is, why it can affect the interpretation of the results of a study, and give an example:

● A factor associated with both the EXPOSURE AND THE OUTCOME that make the two appear to be more related than they actually are ● Researchers should always CONTROL FOR CONFOUNDERS; sometimes the presence of a new variable leads to NEW RESEARCH ● Confounders are voluntary behaviors that exist together (LIFESTYLE package) ● Ex: sleep

Explain the basic regulations governing food labels, including: the ingredient list, rounding; the use of descriptive terms; serving sizes; health claims:

● All packaged food (expect meat, dairy, eggs and alcohol) is REGULATED BY THE FDA ● Meat, dairy, eggs= USDA; alcohol= ATF ● All packaged food must carry NUTRITION INFORMATION PANEL ● % of daily values based off 2,000 calories ● 5/20 rule- 5% of the DV is low (good if it's a nutrient you desire to limit; bad if you desire to increase), 20% of the DV is high (good if you desire to increase; bad if you desire to decrease) ● Nutrition panels tend to EMPHASIZE THE BAD of a food, making it hard to tell the good (focus on avoiding the bad rather than seeking the good) ● All ingredients must be listed in DESCENDING ORDER BY WEIGHT (first ingredient is the one that present in the largest amount) ● Why would you want to look at the ingredient's list? Allergies, diet (specific consumption) ● Manufacturers allowed to "round down" to 0 when a value is 0.5 grams or less

Explain why researchers might choose to use a test tube/in vitro system or animal study over a human study:

● Allows for INCREASED variables and conditions

Identify the 2 major categories of essential nutrients, explains the basis for their classification, and list their members:

● Approximately 45 NUTRIENTS ● Macronutrients: Present in the body in LARGE AMOUNTS, daily requirements that are relatively large, present in food in relatively large amounts ● Large? Measured in grams; 28 G PER OUNCE ● Members? Protein, carbohydrates, lipids (fats), water ● Water CAN'T PROVIDE ENERGY (exception) ● Micronutrients: Present in the body in SMALL AMOUNTS, daily requirements that are relatively small, present in food in relatively small amounts ● Small? MILLIGRAM (mg)= 1/1000thg MICROGRAM (mcg)= 1/1000000thg ● Members? Vitamins, minerals

Explain why a green bean and a snow pea are NOT legumes and define the term whole grain.

● Beans= legumes (all beans and peas EXCEPT green beans and snow peas) ● Legumes are the MATURE seed inside the pod, green beans and snow peas are the pod which only contains the IMMATURE seed ● Whole grains are grain/seed/grass products in which the outer covering has been PRESERVED; wheat and whole wheat are not interchangeable (whole should be the FIRST word in the list of ingredients)

Describe the ways to assess nutritional status, their uses and limitations and/or advantages and disadvantages:

● Biochemical tests: blood, urine; measures for SPECIFIC NUTRIENTS; most commonly used to access INDIVIDUAL nutrient levels in the body ● Anthropometric tests: 1. TOTAL BODY WEIGHT= weight and height for age (childhood growth), weight for height (adult over/underweight; BMI) 2. BODY COMPOSITION= What are qualities of the weight? (fat v. lean) (ex: underwater weighting; based on principle of DISPLACEMENT, most accurate aka GOLD STANDARD, impractical and uncommon) (ex: skinfold thickness; measures THICKNESS OF BODY FAT at various sites, developed from measures of underwater weighting, EASIER, but evaluator must be WELL TRAINED, may not represent disease-related fat) (ex: bioelectrical impedance; determines BODY WATER CONTENT through the pass of an electrical current, can be done at home with NO TRAINING, can easily be INACCURATE) ● Meaningful changes in body composition happen only SLOWLY OVER TIME ● Appearance (changes in skin and hair) is often used as MARKETING TOOLS for supplements but in actuality is not a useful indicator of nutritional deficiencies ● Signs of nutritional deficiencies often move from the INSIDE TO THE OUTSIDE (first signs will be biochemical); once outward symptoms appear a deficiency is likely already quite severe ● Sense of well-being (depression, tiredness) isn't a useful indicator for reasons stated above EXCEPT tiredness and iron deficiency

Describe how the DRIs for protein, vitamins, minerals, and fiber are determined, including what it means for data to have a "normal distribution" and explain how they are to be used to assess intake:

● Calculated by 1. Determining an AVERAGE OR MEAN requirement within specific age and sex groups (EAR= estimated average requirement; very much estimated*) 2. Adding in an ADDITIONAL AMOUNT to cover individual variation. ● DRIs set up at a level that's designed to COVER 97.5% of the individuals within any given group ● A THEORETICAL DISTRIBUTION is used to set the DRIs; this distribution is called a NORMAL DISTRIBUTION (general assumption) and is used to represent TRUE NEED of any given nutrient across a population (assumes the true requirement for the majority of people will be close to the mean) ● What would be a disadvantage to setting the DRI at the average level of need instead? It would only cover HALF of the population.

Describe the limitations associated with all types of studies regardless of their design.

● Characteristics of the study group- age, sex, ethnicity, etc. (most studies limit characteristics/variability) ● Relationship between the time of onset of the disease/condition and the time the data is collected (epidemiological studies) or the treatment is given (clinical trials) ● The absolute size of the effect- relative v. absolute risk (those who do versus those who don't) (absolute risk- should I worry about it? Will I get the disease?) ● The outcome or end point being measured- the disease itself v. a marker or risk factor for the disease (to better compare studies)

Describe the limitations associated with clinical trials:

● Compliance on the part of the participants: are they doing what they've been asked to do? ● Dosage/dietary level used: may be too low (no effect) or too high (adverse effects) ● Length of the study: too short or require more time (clinical trials are expensive)

Explain why books may make claims that advertisements cannot:

● DIFFERENT RULES apply if claims are being mad strictly in print without the selling of a product ● It's much harder to regulate books because of the 1ST AMENDMENT (freedom of speech)

Describe the purpose of the Dietary Guidelines, especially as compared to the DRIs, and Daily Values:

● DRIs and daily values are NUTRIENT-SPECIFIC recommendations; dietary guidelines are FOOD-BASED recommendations ● DRI doesn't help you know what or how much you should eat of a food to meet the optimal level of intake ● Recommendations designed to help people make HEALTHIER food choices and lead healthier lives ● PERIODICALLY REVISED just like the DRIs ● What should Americans eat? How should we prepare our food to keep it safe? How should we be actively healthy? ● MYPLATE

Explain the purpose of the Daily Values (as compared to the DRIs), calculate the % Daily Value for fat, saturated fat, and carbohydrate for a food if given its Daily Value, explain to someone what a % DV on a food label means, and describe reasons why some people may not find them very helpful:

● Daily values are NOT EQUAL to DRI ● Daily values= a set of recommendations used for FOOD LABELING only (form basis for nutrition facts panel) ● Created as way to COMPARE NUTRIENTS in a food to reference values ● 2,000 for total calorie amount ● Carbohydrates= 60% of total calories (.60 cals from carbs) X (2000 cals)= 1200 cals from carbs; 1200 cals from carbs/ 4cals/g of carbs= 300 g (daily value) ● Fat= 30% of total calories with 10% from saturated fat ● Total fat: (.30 cals from total fat) X (2000 cals)= 600 cals from total fat; 600 cals from fat/ 9 cals/g of fat= 65g (daily value) ● Saturated: (.10 cals from sat fat) X (2000 cals)= 200 cals from sat fat; 200 cals from fat/ 9 cals/g of fat= 20g (daily value; rounded down) ● Percent of daily value calculated by comparing the actual amount of the nutrient in food to the daily value for that nutrient ● Meant to provide a GENERAL IDEA to the healthfulness of a food ● Many people don't find them helpful because they don't know how to INTERPRET the percentages or they aren't able to do the MATH

Identify the 3 categories of DRIs and how they are expressed:

● Defines optimal consumption of macro/micronutrients ● Include? 1. Recommendations for VITAMINS, MINERALS, PROTEIN, FIBER (GRAM, MILLIGRAM, MICROGRAM amounts; ABSOLUTE AMOUNTS by sex, age) 2. TOLERABLE UPPER LEVEL of intake for certain vitamins and mineral (toxicity; GRAM, MILLIGRAM AND MICROGRAM amounts) 3. Recommendations for FAT, CARBOHYDRATES AND PROTEIN (expressed as a PERCENT OF TOTAL CALORIE intake; relative amounts= relative to calorie intake

List the other general characteristics of the DRIs for protein, fiber, vitamins and minerals that were discussed:

● Estimates designed to EXCEED THE NEEDS of almost all healthy people (97.5%) ● Set at levels at are SAFE, even if they exceed individual needs (represent UL for most of the population) ● Designed to be met over a PERIOD OF TIME, not each and every day (average intake reflects recommendations) ● For HEALTHY PEOPLE ONLY, not for people with special requirements that result from disease

Describe the implications associated with the design of the food label relative to how people might view food (and what makes up a "healthful diet") more generally:

● FDA regulates descriptive terms used in labeling (reduced, free, light, etc.) ● What sounds more appealing seen as more healthy (light v. reduced fat mayo) ● Important to read the nutrition label because the name may be misleading ● Defined serving sizes may not (usually isn't) the amount you are eating ● Some health-related claims are allowed on labels based on food's nutrient content ● Labeling regulations don't regulate all aspects of packaging (important to read all parts of a label)

List the DRI recommendations for percent of calories from carbohydrate, fat and protein:

● Fat= 20-35% ● Carbohydrate= 45-65% ● Protein= 10-35%

Explain why the DRIs for fat and carbohydrate were developed, how they are expressed and why they are expressed differently than the DRIs for the micronutrients and protein:

● Fats, carbohydrates and proteins are ENERGY NUTRIENTS ● Why? While deficiency diseases had disappeared, HEART DISEASE was becoming the leading cause of death. ● Researchers believed that REDUCING FAT (saturated*) would reduce heart disease risk, therefore ADDING RECOMMENDATIONS for fat and carbohydrates ● Why they are not expressed in fixed amounts? Fats and carbohydrates represent about 80-90% of total calorie intake. If fixed amounts were set that exceeded an individual's need it would results in UNDESIRABLE CONSEQUENCES (weight gain). ● Expressed as a PERCENTAGE of the individual's total calorie intake ● Percentage is a RELATIVE TERM (it is important to consider the absolute values on which they are based) ● TOTAL CALORIE INTAKE INCREASED between 1970 and 2000. Believed half of the increase came from SOFT DRINKS ● A calorie is a calorie is a calorie

Describe why the DRIs were developed and how they have changed over time and why (especially related to older adults):

● First appeared in 1940s (intended to MAX THE HEALTH OF THE MILITARY/HOME FRONT) ● PREVENT DEFICIENCY DISEASES; provide SPECIFIC RECOMMENDATIONS for proteins, vitamins and minerals for men, women and children ● Influenced by presumed LEVELS OF ACTIVITY; ORIGINAL 8 micronutrients; overall HASN'T CHANGED MUCH ● REVISED PERIODICALLY to reflect latest information ● Shift in focus from REDUCING THE OCCURRENCE of deficiency diseases to DETERMINING LEVELS THAT CAN DECREASE chronic disease risk ● READILY AVAILABLE INFORMATION has increased steadily. Why? INCREASED VARIABLES ● ADDITION OF VALUES for fat, carbohydrates and fiber (previously protein was the only macronutrient) ● ADDITION OF VALUES for more micronutrients (8 to 36) ● ADDITION OF AGE GROUPS (elderly) ● Why would nutrient requirements decrease with increasing age? LESS ACTIVITY (we now know that requirements actually increase with age)

Describe current regulations governing the sale of dietary supplements, particularly with respect to the differences between rules governing a drug v. a dietary supplement:

● Food and Drug Administration (FDA): regales the SALE and LABELING of most foods and all dietary supplements (what can be sold and what's on the label) ● Federal Trade Commission (FTC): regulates the ADVERTISING of food and dietary supplements ● The FDA's ability to regulate what is sold in regard to dietary supplements is LIMITED BY REGULATION (1994) ● Dietary supplements can be sold as long as they are not already regulated as a drug ● For drugs- manufacturer can claim on the label that the product prevents, treats or cures disease BUT it can't be sold until its effectiveness is evident through clinical trials and is approved by the FDA. The product CANNOT be sold until evidence of its safety has been submitted, reviewed and approved. ● For a dietary supplement- manufacturer is NOT allowed to make claims on the label that the product prevent, treats or cures disease. Label claims are restricted to describing the effect of the substance in MAINTAINING the body's normal structure or function, but the FDA does NOT review these claims prior to the product entering the market nor does it require evidence. The manufacturer is supposed to insure the product is safe but the FDA does NOT ask for safety information before product enters market.

Explain the fundamental difference between an indirect and direct test of a diet-disease relationship and give examples of each (including explanations of the terms epidemiology and clinical trial:

● Indirect studies aka epidemiological studies (meaning who gets the disease and who doesn't, and what is different about the two that may explain the PRESENCE OR ABSENCE?) ● Nutritional epidemiology= the incidence and distribution of disease in a population they relate to dietary intake (meaning who gets the disease and who doesn't, and what is different about their DIET?) ● Observational studies look at differences between the prevalence of a disease and the level of dietary component in groups of free living people (meaning no changes in diet are made; data reflects NATURAL HABITS of daily life) ● 1. Differences among groups ACROSS DIFFERENT COUNTRIES (relatively easy since most data has been collected by the government, give researchers a wider range of intake for any one nutrient than typically found in a country, often the FIRST CLUE to diet-disease relationship and can stimulate further research ● 2. Differences among groups WITHIN ONE COUNTRY (regional differences, suggest potential environmental causes and diet is one possibility, more in-depth studies will follow) ● 3. Differences among individuals WITHIN A COUNTRY OR REGION (long term, ex: Harvard nurses' health study; followed since 1976, every other year women answer questionnaire and researchers use date to examine diet-disease relationships) ● Direct studies= epidemiological evidence is strong enough for researchers to use humans in CLINICAL TRAILS ● 1. Human studies or clinical trials: make ALTERATIONS in the level of a dietary component in a group of people rather than simply observing what they eat (can involve changes in general dietary patterns or providing a specific nutrient in supplemental form)

Describe the key messages and limitations associated with MyPlate graphics:

● Intended to be a VISUAL REPRESENTATION of healthy eating ● Goals? SIMPLIFY nutrition messages and provide MORE INFORMATION ● Key messages? Balance, variety, increased fruits and veggies, veggies over fruit, grains over proteins, no sweets/fatty foods ● Limitations? Vague, dairy as only beverage option; no one message, tip or icon appeals to everyone

Explain why it is important to have variety within, as well as across the food groups:

● It is not only important to eat ACROSS the food groups, but to eat a variety of items WITHIN a food group as well ● Some members are BETTER SOURCES of nutrients that others in the group

Define deficient, marginal, over-consumption and excess; identify the type of effect that results from each level of intake; the effect itself; the time for development; the nutrients of greatest concern at each level; and the levels of intake most likely to occur in the US:

● LEVELS OF INTAKE of essential nutrients ● Deficient, marginal, optimal, over-consumption, excess ● Deficient: LITTLE OR NO intake (amount) over WEEKS TO YEARS (timeframe) resulting in a specific set of symptoms (outcome) aka DEFICIENCY DISEASES (ex: vitamin D and rickets), represent DIRECT CAUSE AND EFFECT relationship ● Marginal: LESS THAN OPTIMAL intake over YEARS resulting in increased risk for CHRONIC DISEASES that are MULTI-FACTORIAL (many contributing factors) (ex: cancer) ● Optimal: Defined using DRI (dietary reference intakes) ● Over-consumption: GREATER THAN OPTIMAL intake over YEARS resulting in increased risk for CHRONIC DISEASES (indirect; ex: saturated fat and heart disease) ● Excess: MUCH GREATER THAN OPTIMAL intake over WEEKS TO YEARS that may result in a specific SET OF EFFECTS (side effects= reversible, toxic effects= irreversible; direct)

List the advantages and disadvantages of animal studies:

● Laboratory animals can be used to study diet-disease relationships (typically using methods similar to clinical trials) ● Advantages: increased control (exercise, food intake, sleep, etc.), can be put in harm's way, faster reproduction, dissection (able to look inside the body to examine mechanisms) ● Disadvantages: subjects can't talk (subjective outcomes), not home (may produce responses/results that don't quite work for humans)

Explain why many Americans have marginal levels of intake of certain nutrients:

● Lack of EDUCATION, lack of RESOURCES, consumption of FAST FOOD, dieting, MINDSET

Distinguish between a legal and illegal supplement label claim:

● Legal claim= "Vitalift promotes healthy joints" (indirect claim) ● Illegal claim= "Vitalift reduces the pain from arthritic joints" (direct claim-drug)

Provide the more specific definitions for marginal and excess (UL) levels of intake and what those levels represent (why they were chosen):

● Marginal: LESS THAN OR EQUAL TO 60% of the DRI. Why? As INTAKE MOVES BELOW the level of intake, it becomes LESS LIKELY that any individual's true need for that nutrient is being met. What does the shaded area to the right of 60% represent? People that have a NEED GREATER THAN 60%. What happens to that shaded area as intake gets lower and lower? INCREASES. Remember marginal levels of intake doesn't predict the development of a deficiency disease, instead such consumption has been associated with increased risk for chronic diseases. ● Excess: TOLERABLE UPPER LEVEL intake (UL). The UL represents the HIGHEST LEVEL OF INTAKE for that nutrient that is unlikely to pose risks in most healthy people. This category was developed out of concern regarding the USE OF HIGH DOSE SUPPLEMENTS (guide for supplements; what supplemental levels of a particular nutrient people have been known to CONSUME WITHOUT HARM). NOT a recommended dietary level of intake or a cut-off point for toxicity (MAX).

Distinguish between/among a nutrient, an essential nutrient, a phytonutrient and a nutraceutical and give an example of each:

● Nutrient: Provides NOURISHMENT ● Non-essential Nutrient: A nutrient found in food but it doesn't have to be; our BODIES CAN MAKE IT (ex: cholesterol; made in liver) ● Essential Nutrient: A nutrient of which food is the only or primary source; the BODY CAN'T MAKE IT OR MAKE ENOUGH OF IT (ex: vitamin c; scurvy caused by deficiency) ● Phytonutrient: Compounds found in food that aren't NECESSARY FOR LIFE/GROWTH BUT MAY PROTECT AGAINST CERTAIN DISEASES; found in FRUITS AND VEGETABLES (ex: lutein, lycopene, clorophyl) ●Nutraceutical: Compounds NATURALLY FOUND IN FOOD OR PUT INTO FOOD that may PREVENT OR TREAT diseases; probiotic aka BACTERIA

Explain the general factors that can affect the nutrient content of a fruit or vegetable and whether lowered levels of nutrients associated with processing always matter:

● Of all the food groups Americans are LEAST LIKELY to consume fruits and vegetables ● People often believe you have to eat them FRESH to get the maximum level of nutrients ● What are the barriers to fresh fruit and veggie consumption? Price, prep time, season, shelf life, storage, etc. ● Eating canned or frozen fruits often ELIMINATES such barriers ● Is it really always better to eat produce fresh? This question is not easy to answer, why? 1. Decreases in nutrient levels associated with processing VARY across foods 2. Nutrient levels can differ within an individual food due to GROWING CONDITIONS (organically grown crops have no evidence of higher levels of micronutrients, but they may have higher levels of phytonutrients that are used as pesticides) and the cultivar (different cultivars are used for different purposes) 3. Important to ask whether any effects of processing on nutrient content really matter ● The nutrient values you see on label are really just ESTIMATES

Discuss the difference between a chemical acting as a nutrient and as a drug - what determines which type of function it is having in the body and why that is important:

● Once consumption of a nutrient EXCEEDS the level that can be OBTAINED FROM FOOD NATURALLY any psychological effect that occurs, even if positive, can NOT be viewed as a result of that compound acting as a nutrient, but instead is acting as a DRUG and should be used with appropriate caution (nutrients consumed at unnatural levels become unnatural... aka a drug) ● The dose makes the poison! ● DRI represents level of intake with a LOW RISK FOR INADEQUACY. UL represents a level of intake with a LOW RISK FOR ADVERSE EFFECTS.

Explain why there are two DRIs for protein and identify which one is better used to evaluate individual intake:

● One expressed as a PERCENTAGE OF TOTAL CALORIES and one expressed in GRAMS PER UNIT of body weight ● Protein DOES CONTRIBUTE CALORIES to the diet (percentage), however to be sure its other functions are being met it needs to be COMPARED to the gram-based DRI ● The gram-based DRI is the BEST CHOICE to evaluate individual intake

Explain why the micronutrients on the label were chosen:

● Only vitamins A and C, and minerals calcium and iron are required ● Why? These nutrients are the MOST LIKELY TO BE MARGINAL of deficiency in the US

Explain the terms "patented" and "proprietary":

● Patented- means the product has been awarded a patent based on its novelty, not its effectiveness ● Proprietary- means the formula is made up and they don't have to tell you what's in it

Explain how the food groups are set up and therefore how levels of their intake can be reflected in nutrient levels in the diet:

● Recommendations of MyPlate MAXIMIZE the chances that nutrient needs are being met ● Foods are grouped based on their SIMILAR NUTRIENT CONTENT; no one group or single food provides ALL of the nutrients needed ● Dairy, protein (meats and alternatives), fruits/vegetables, grain products, sources of vitamins/minerals ● Your intake of a food group could be good but the intake of the nutrient is poor

Explain what a calorie represents, list the number of calories provided by a gram of carbohydrate, fat, protein and alcohol, and calculate the total calories of a food knowing its macronutrient content:

● Represents the ENERGY CONTENT of a food ● Calorie/kilocalorie ● Unit of heat equal to amount OF ENERGY NECESSARY TO RAISE 1,000G OF WATER BY 1 DEGREE C ● Calorie content of a food? Measures POTENTIAL ENERGY within its components macronutrients; energy RELEASED FROM MACRONUTRIENTS TO FUEL METABOLIC PROCESSES ● Carbohydrates: 1g= 4 cal ● Protein: 1g= 4 cal ● Fat: 1g= 9 cal ● Ethanol (alcohol): 1g= 7 cal ● Total calorie content? MULTIPLE # of grams by amount of calorie per gram (above values) and ADD for total

Identify factors that can contribute to the inaccuracy of dietary reporting and explain the difference between bias and random error in dietary recording.:

● Shame/guilt (LIES), false representation/ UNNATURAL (changed eating habits on purpose), forgetfulness (MEMORY), inaccurate JUDGMENT ● Bias and random error can SKEW data

Describe the use of disclaimers on labels and in advertising:

● Structure/function claims for dietary supplements must be accompanied by a disclaimer (overall stating product is not a drug) ● The use of disclaimers allows a wide variety of compounds to be sold with NO PRIOR TESTING for safety, purity or potency ● Manufacturers often put a product into the market that is unsafe and simply waits for the FDA to remove it (which is uncommon) ● Manufacturers often put a bogus product into the market with misleading claims on its label and waits for the FDA to force them to change it (slow process) ● This is problematic as the consumer is unaware of the illegitimacy since it already on the market (assumes thoroughness), and once the consumer purchases the product the money is already made (done deal) ● FTC requires disclaimers in ads as well (ex: results may vary, results not typical, etc.)

List reasons why a particular research finding may or may not be reported by the media:

● Study was conducted unethically ● Findings contrast popular beliefs/conventional thinking ● Seriousness of the outcome/results; urgency ● Applies to vulnerable populations; vulnerable populations affected ● Appeals to the public (weight loss, sex, etc.) ● Seemingly effortless (magic tip)

Explain why manufacturers are "encouraged" by the system to sell bogus products:

● The FTC and FDA have LIMITED TIME AND RESOURCES to enforce regulations ● If action is taken the PROCESS IS SLOW and typically only results in change of wording on a label or ad (PRODUCT REMAINS on the market) ● Punishment is limited to fines (no jail time) and is often substantially less than the profit made (COMPANIES DON'T GO BANKRUPT) ● Overall, for manufacturers the risk of regulatory action is NOT HIGH ENOUGH TO DETER the selling of bogus products in comparison to the large amounts of money that can be made ● It's important for consumers to be aware and educated (source, supporting evidence, claims themselves)

Explain what randomization means in a clinical trial and why it is important:

● The process of randomly assignment people to either a control or treatment group ● It ISOLATES the variable of interest (helps to overcome confounders)

Explain why it is more difficult to determine the relationship between chronic diseases and individual nutrients as compared to deficiency diseases and individual nutrients:

● Very complex/MANY RISK FACTORS (diet is just ONE factor for chronic diseases) Why is this important to understand? A lot of people CLAIM to know the answers.

Explain the difference between a nutrient being lost v. destroyed during processing/cooking; the ways by which nutrients can be lost or destroyed during processing/cooking and how that might affect the nutrient content of fresh, frozen, and canned fruits and vegetables:

● When a nutrient is DESTROYED there is a change in its CHEMICAL CHARACTERISTICS causing it to no longer be active; result of EXPOSURE TO AIR (oxygen), HEAT AND LIGHT (natural or artificial) ● The nutrients most likely to be destroyed are VITAMINS (H20- soluble vitamins); mineral can't be destroyed ● When a nutrient is lost it is REMOVED from the food but UNCHANGED chemically; result of exposure to water (dissolved) or physical removal (ex: peeling); nutrients most likely to be lost are H20 soluble vitamins and minerals ● The amount of nutrients that are destroyed or lost depends on: 1. Length of TIME of exposure (more time= greater loss) 2. The TEMPERATURE (higher heat= greater destruction) 3. The amount of WATER (more water= greater loss) 4. Amount of the food's SURFACE AREA that is exposed (smaller pieces= greater surface area= greater loss) ● In order to consider the potential differences among fresh, frozen and canned food you to need to consider how they may be affected by the above factors (air, heat, light, time) ● What factors may be causing decreasing nutrient levels in fresh produce? Light and air (principle issues) ● What factors may be causing decreasing nutrient levels in frozen produce? Minimal air, heat and water (especially when blanched) ● What factors may be causing decreasing nutrient levels in canned produce? Minimal heat, exposure to water ● Cooking at home: the less water used, shorter cooking time, and the lower the heat retains the most nutrients (microwaving> steaming> boiling)

Explain why placebos are used in clinical trials and define the terms placebo effect and double blind:

● When clinical trials examine the effect of SUPPLEMENTAL doses of a specific nutrient it is necessary that a placebo be used in the control group. Why? To CONTROL for the effect of expectation of an outcome (positive or negative) on the perception of the outcome; perception of the outcome= subjective (as compared to the actual outcome) ● Double blind: a study in which neither the researcher nor the participants are aware the experiment is taking place. Why is this important? The researchers may have their own expectations that influence how they interpret the data.

Describe the limitations associated with epidemiological studies:

●Clear-cut conclusions are limited because: 1. Depend on the dietary RECALL/recording of participants 2. May be affected by the presence of CONFOUNDING FACTORS (can be bias, allude to false correlation) 3. These studies are INDIRECT (meaning strictly observational; can only show the existence of an association, can't prove cause and effect)