RD Exam- Principles of Normal Nutrition

Infancy Kcal Needs EER

(0-6 months) EER: Males 575 kcal/day; 520 for females (7-12 months) EER: M 743/day F 676/day

Infancy protein needs RDA

(0-6 months): 9.1g/day (7-12 months): 11.0 g/day

Metabolic Acidosis

-Kidney Make or Retain too much H+ -Increased Carbonic acid -OR -Kidneys excrete too much base -Compensate by increased respiration to remove CO2

Metabolic Alkalosis

-Loss of H+ -OR -retention of base -retention decrease to retain CO2

Respiratory Alkalosis

-Loss off carbonic acid -hyperventilation -Kidneys compensate by excreting base

Respiratory Acidosis

-Retained CO2 by lungs -Decreased ventilation -Kidneys compensate by increase absorption of base

Childhood Nutrient Needs

1-2 Years EER: 1046 kcal/day for males; 992 kcal/day for females. 1-3 Years Protein needs: 13g/day for both genders 3-8 Years EER: 1742 kcal/day for males; 1642 kcal for females. 4-8 Years Protein needs: 19g/day for both genders

Respiratory quotient

1. CHO: 1 2. protein: 0.8 3. Fat 0.7 4. Mixed: 0.85

BMR Lower with:

1. Females have 5-10% lower BMR 2. BMR declines w/ age 3. Body surface area 4. endocrine glands (thyroid)

Sugars in order of sweetness

1. fructose 2. invert sugar 3. sucrose 4. glucose 5. sorbitol 6. mannitol 7.galactose 8. maltose 9. lactose

BMR Increased During

1. periods of growth 2. Pregnancy 3. lactation 4. fever 5. some diseases (cancer)

Magnesium Range

1.5-2.5 mEq/L

Sodium Range

136-145 mEq/L

Kcal Requirements during pregnancy

1st Trimester: No change in kcal needs 2nd Trimester: additional 340 calories 3rd trimester: additional 452 calories 1st 6 months of lactation: additional 330 calories 2nd 6 months of lactation: additional 400 calories

Disaccharide

2 Monosaccharide's linked- Lactose, Maltose, Sucrose

Sports Nutrition: fluids

2 hours prior to exercise: 14-22 fl. oz. During exercise: 6-12 fl. oz. every 15-20 mins. as tolerated After exercise: 16-24 fl. oz. for each lb. lost during exercise.

Atomic wt; Valence : Na

23;1

Phosphorous needs

3-4.5 mEq/L

Potassium Range

3.5-5 mEq/L

Atomic wt; valence: K

39;1

Calcium Range

4.5-5.5 mEq/L

Sodium Chloride

40% sodium; 1 tsp.= 6g NaCl = 2.4g Na

Atomic wt; Valence: Ca

40;2

Magnesium

50% in Bone; 50% in cells Fx: protein in FA synthesis; stabilize structure of ATP Source: milk, bread M 420 mg F 320 mg

Sports Nutrition: CHO

6-10 g/kg BW/day to replenish glycogen after exercise

Adolescence

9-13 Years EER: 2279 kcal/day for males; 2071 kcal/day for females. RDA for protein is 34g/day for both genders. 14-18 years of age - EER = 3152 kcal/day for males and 2368 kcal/day for females; RDA for protein is 52 g/day for males and 46 g/day for females.

Chloride

96-106 mEq/L

Coenzyme

Activates enzymes: pantothenic acid, thiamin, riboflavin, niacin

AT

Activity Thermogenesis

Albumin in Fluid Balance

Albumin exerts pressure on blood vessel-keeps water within *if albumin drops, pressure drops, fluid leaks out *water moves from extracellular (plasma) to interstitial space (between/around cells)

Protein: simple

Amino Acid

Selenium

Antioxidant Grains, meats, fish, poultry, dairy M 55 micrograms F 45 micrograms

BMR

Basal metabolic rate: 1. measured in the AM when awake, reclining, at normal body temp. at least 12 hours after a meal b. measures O2 consumption

Sodium Reabsorption

By aldosterone

Sodium Retention

By steroids

Manganese

CNS Whole grains, legumes, needs: 1/8-2.3 micrograms

Buffer: Acid/Base Balance

Carbonic Acid: H2CO3 Sodium Bicarbonate: NaHCO3

Hyperkalemia

Cardiac irregularities

Evaluating Acid Base Abnormalities (2b)

Check HCO3 -measures base regulated by the kidneys

Evaluating Acid Base Abnormalities (2a)

Check PCO2 -Blood gas reading: measures Carbonic acid regulated by the lungs

Evaluating Acid Base Abnormalities (1)

Check pH: acidosis or alkalosis

Biotin

Coenzyme in FA synthesis converts pyruvate to oxaloacetate in gluconeogenesis Sources: organ meats, egg yolk, yeast Synthesized by intestinal bacteria inactivated by avidin (protein in raw egg white) AI 30 micrograms Deficiency: muscle pain, dermatitis

Peptide bonds

Connect amino acids- Amino acids contain a unique side chain but have the same general structure

Polyunsaturated Fats

Contains more than one double bond- liquid at room temperature and include fish oils & corn oil.

Saturated Fats

Contains no double bonds (saturated with hydrogen). Solid at room temperature- animal fats, coconut oil, and palm oil

Monounsaturated Fats

Contains one double bond- liquid at room temperature- olive and canola oil

Gluconeogenesis

Conversion of non-CHO sources into glucose. (from glycerol and amino acids)

Calcium needs during pregnancy

DRI = 18 y.o. or younger - 1300 mg., 19-50 y.o. - 1,000 mg.) RDA had indicated increase of calcium to 1200 mg

DIT

Diet-induced thermogenesis

EEPA

Energy expended in physical activity

Sorbitol

EtOH from glucose: absorbed slowly through passive diffusion--converted to fructose; cause diarrhea w/ large consumption

Anasarca

Extreme-generalized edema d/t infusion of effusion of fluid into extracellular space associated w/ heart, liver, and renal failure or Protein/Kcal malnutrition

Trans-fatty acids

Fatty acids with hydrogens on opposite sides of a double bond (trans) instead of on the same side (cis); behave more like saturated fats; increased intake is associated with increased risk for heart disease; sources include hydrogenated margarine (hard or stick margarines tend to be higher in trans-fats than soft or liquid margarines), shortening, baked goods, and chips

Omega 3 Fatty Acids

First double bond at the third carbon starting at the methyl end. ◦Alpha linolenic acid is an omega-3 fatty acid which the body can convert to other omega-3 fatty acids including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). ◦Omega-3 fats aid in normal growth development including brain and eye formation, reduces risk for cardiovascular disease, and reduces risk for inflammatory diseases. ◦The AI for alpha linolenic acid is 1.6 g/day for males and 1.1 g/day for females; sources include fatty fish for EPA and DHA and flaxseed, canola oil, and walnuts for alpha linolenic acid.

Fluid Balance: Osmosis

Fluid moves from less to more concentrated side of membrane

Iron

Food: ferric Stored: ferritin Absorbable: ferrous O2 transport Prevents absorption: milk, tea (tannins) cheese, eggs M 8mg F 18mg

Infant growth

Full-term infants should double their birth weight by 6 months and triple birth weight by age 1.

Phosphorous

Fx: ATP, DNA, RNA, B-vitamin coenzyme formation, transportation or fatty acids, mineralization of bone/teeth. Milk, cheese, meat, whole grain cereals source 700 mg

Calcium

Fx: Blood coagulation, nerve/muscle contraction, mineralization or bone/teeth. Dairy products, sardines, green leafy vegetables, tofu.

Niacin (B3)

Fx: CHO, amino acid and Fatty acid metabolism. Synthesis of fatty acids. Sources: animal proteins, milk, whole grains, legumes Precursor to tryptophan; essential in all cells for energy production/metabolism Needs: M 16 NE; F 14 NE

Zinc

Fx: DNA/RNA synthesis, alcohol, CHO/protein metabolism, growth and reproduction. Liver, eggs, milk, meat, wheat bran. -excess leads to copper or iron deficiency M 11mg F 8mg

Vitamin C ascorbic acid

Fx: Iron absorption, collagen formation, cell function, wound healing. Sources: citrus fruits, green leafy vegetables, peppers, tomatoes, broccoli, strawberries Destroyed by heat, alkaline, oxidation 75-90 mg

Thiamin (B1)

Fx: Nerve function, Muscle tone of GI tract and heart, metabolism of CHO. Sources: organ meats, pork, wheat germ, nuts, whole grains, dried beans, liver. Need: M 1.2 mg; F 1.1 mg

Iron

Fx: Utilization of O2 and elimination of CO2, RBC synthesis, and cellular oxidation. food form = ferric and ferrous (less widely found); transport form = transferrin; storage form = ferritin; sources: heme - animal sources such as liver, meats, non-heme - plant sources such as green leafy vegetables, legumes, enriched grains.

Folate/Folic acid

Fx: amino acid metabolism, synthesis of RNA/DNA, synthesis of RBC/WBC. Prevent neural tube defect Sources: organ meats, green leafy vegetables, dried beans, strawberries, whole grain breads, citrus fruits Needs: 400 micrograms

Calcium

Fx: blood clotting, cardiac fx, nerve transmission, smooth muscle contractility Source: dairy products, leafy vegetables, legumes 1000-1200 mg

Pantothenic Acid

Fx: coenzyme A: energy synthesis of Fatty acids Sources: animal foods, grains, legumes AI 5mg

Vitamin B6/Pyridoxine

Fx: coenzyme in amino acid metabolism, transamination, deamination, metabolism of fatty acid and glycogen. Sources: meats, bananas, nuts, seeds and whole grains, corn Needs: M1.2-1.7 mg; F 1.3-1.5 mg

Cobalamin (B12)

Fx: coenzyme--synthesis of DNA/RNA, Maturation of RBC. Sources: liver, meats, eggs, milk

Potassium

Fx: fluid balance and regulation of neuromuscular activity. Fruits, vegetables, milk, and meat.

Riboflavin (B2)

Fx: formation of B6 and B12 into active forms, metabolic reactions. Sources: liver, green leafy vegetables, cheese, and milk. Lost in UV light Needs: M 1.3mg; F 1.1mg

Chromium

Fx: glucose metabolism. aids in insulin action meat, liver, green leafy vegetables. Source: yeast, oysters, potatoes, liver 25-35 micrograms

Retinol (Vitamin A)

Fx: maintenance of epithelial tissue, night vision, growth. Liver, fish, milk, cheese, yellow/orange fruits and vegetables.

Sodium

Fx: maintenance of fluid balance, nerve transmission, muscle contraction. Table salt, dairy products, meat, processed foods.

Calciferol (vitamin D)

Fx: mineralization of bone via calcium absorption. Fortified milk, fish oils

Tocopherol (vitamin E)

Fx: oxidation of free radicals (protects membranes/RBC) May reduce risk of heart disease by limiting oxidation of LDL cholesterol. vegetable oil, wheat germ, dried beans, nuts.

Magnesium

Fx: synthesis of RNA/DNA; release of energy from CHO, protein and fat. Nuts, seeds, legumes, green leafy vegetables.

Vitamin K

Fx: synthesis of blood clotting factors. Green leafy vegetables, also formed in the intestinal tract.

Fluoride

Fx: teeth, bones Source: soil, water M 4mg F 3gm Dental carries

Polysaccharides

Glycogen (stored in animal muscle and liver) Starch (stored in plant sources - occurs in amylose and amylopectin forms).

HBV

High biological value protein

Phospholipid: location

In cell membrane

Insoluble Fiber

Indigestible fiber (hemicellulose, cellulose) found in bran, wheat, legumes, and nuts- decreases transit time in the intestines and reduces constipation.

Protein as energy source

Inefficient; nitrogen must be removed first; 58% of protein can be converted to glucose

Intracellular Electrolytes

K+, Mg++, P

Disaccharides

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

Essential Fatty Acids

Linoleic, Linolenic-

Extracellular electrolytes

Na+, Ca++, Cl-, HCO3- (bicarbonate)

Weight gain during pregnancy is dependent upon pre-pregnancy weight

Normal: 25-35 lbs. Underweight: 28-40 lbs. Overweight: 15-25 lbs. Pregnant Adolescents: Should gain higher end of each range. Average weight gain during the 1st trimester is 2-4 lbs., thereafter 1 lb./week should be gained

Sports Nutrition: Fat

Not below 15%

PBI

Protein bound Iodine: Measures BMR w/ thyroid gland activity 1. thyroxine (T4) triiodothyronine (T3) 2. when PBI is elevated BMR is elevated 3. measured energy metabolism; level of thyroxine produced 4. not a nutritional assessment parameter `

Breast Feeding

Recommended for the 1st year of life. Colostrum is the nutrient rich first fluid excreted via the breast - contains immunological factors for infant protection Formula - tends to be comparable to breast milk in calories, higher in protein, calcium, sodium, and iron; lower in fat.

Thyroxine

Regulates metabolism/rate of oxidation 1. physical/mental growth 2. stimulates liver glycogenolysis, gluconeogenesis - increase blood glucose

Copper

Rx: Hbg synthesis; Fe absorption Sources: organ meats, shellfish Needs: 900 micrograms

Winterized Oil

Salad dressings wont crystalize when cold -chilled to 45F; fatty acids w/ high MP crystallized and filtered out. - oil not cloudy -olive oil not winterized

Hormones

Secreted from endocrine glands; chemical messengers that trigger enzymes.

Hypernatremia Hyponatremia

Serum Na: BEST assessment for fluid status Hyper: dehydration Hypo: over-hydration

Monosaccharide

Simplest form of sugar: fructose, galactose, glucose

Soluble Fiber

Soluble in water (indigestible by enzyme) found in pectin, gums found in some fruits and oats- lowers cholesterol and delays glucose absorption.

Evaluating Acid Base Abnormalities (2)

Source: respiratory of metabolic?

Essential Amino Acids

THe MTV-PILL Threonine Histidine Methionine Tryptophan Valene Phenylalanine Isoleucine Leucine Lysine

TEF

Thermic effect of Food (greater after consumption of CHO and protein

Transamination

To produce nonessential amino acids-the transfer of one amino group from a compound to another. Vitamin B6 is required

Iodine

Trace mineral; part of thyroxine Source: seafood; iodized salts Goiter

Sports Nutrition: Protein

Varies; Endurance athletes: 1.2-1.4g/kg BW Strength training: 1.6-1.7 g/kg BW

Water

Water aids in nutrient transport to cells and waste removal from cells, acts as lubricant for joints, aids in regulation of body temperature; average intake ~2500 ml, average output ~2500 ml; sources: beverages, foods, oxidation of foods.

Deamination

When protein is needed for energy-amino group is removed so that the non-nitrogen source can be used as an energy source

Complete Protein

all 9 essential amino acids maintain body tissue; promote growth

Protein: conjugated

amino acid + non-protein substance = lipoprotein

Conditionally Essential Amino Acids

arginine; glutamine

Cofactor

assists enzymes; minerals

Third space fluid

both extracellular and extravascular

Insensible water losses

breathing, skin (0.8-1.2 L/day)

K extraction

by aldosterone

Phospholipid: Function

control passage of compounds in/out of cell

Methionine converted to:

cysteine

Electrolytes

dissociate into ions cations (+) and anions (-)

Effects of Protein On Fluid Balance

exerts colloidal osmotic pressure

Cholesterol

found only in animal products; functions in the body include: major part of brain and nerve cells, part of the structural membrane of all cells, aids in production of hormones and vitamin D; produced by the body and therefore not required by the diet.

Protein: derived

fragments from simple and conjugated (peptide)

Protein needs during pregnancy and lactation

increase an extra 25 g (RDA - 71 g protein; based on 1.1 g/kg/day using pre-pregnant weight)

Electrolytes concentration

mEq = mg / atomic wt. X valence example: 1000mg Na/ 23 x1 = 43.5 mEq

Fluid Balance : Diffusion

particles move from more to less concentrated

Tryptophan is a precursor to:

serotonin niacin

Phenylalanine converted to:

tyrosine

Vitamin & Mineral Supplementation for Breast-fed Infants

•Vitamin D - vitamin D supplementation is generally recommended for healthy breast-fed infants during the first 4-6 months to reduce risk of rickets •Iron - at 4-6 months the infant generally requires iron from an additional source (iron fortified cereal, supplementation, etc.). Prior to 4-6 months iron supplementation is generally not recommended and could affect absorption of iron from breast milk. •Fluoride - supplementation is not required up until 6 months and may be needed as a supplement thereafter. •Water soluble vitamins - breast milk reflects mother's intake.