Advanced Public Health Nutrition Exam 1

coronary artery

artery supplying blood to the heart

rate

frequency/quantity/measure versus another measure

Lipoprotein

group of soluble proteins combined with a transport fat or plasma

proportion

part/portion relative to whole, more like ratio

What type of nutrient is lactose? What are its two subunits?

Carbohydrate; galactose and glucose

Given the magnitude of the cardiovascular disease burden in the United States and globally, and the complexity of dietary risk factor modification, several simultaneous prevention strategies and policies across multiple societal levels are recommended to make a measurable impact on reducing prevalence rates. What are these?

Cardiovascular disease as a global priority -Nutritional and agricultural policies -Nutritional labeling -Regulation of marketing -School and workplace interventions -Standard of care for health care providers -Individual behavior change

In a small pilot study, 12 women with endometrial cancer (cancer of the uterus) and 12 women with no apparent disease were contacted and asked whether they had ever used estrogen. Each woman with cancer was matched by age, race, weight, and parity to a woman without disease. What kind of study design is this?

Case-control study

Clinical symptoms of lactose intolerance include:

Clinical symptoms: Flatulence and diarrhea after the ingestion of a dose of lactose. Other symptoms include: bloating feeling, flatulence, belching, cramps, and a watery explosive diarrhea

What type of study is the Framingham Study?

Cohort Study

Which diet reduced blood pressure most in both subjects with hypertension and without hypertension?

Combination diet lowered SBP by 5.5 and DBP by 3.0. Fruit and veggies was only SBP by 2.8 and DBP by 1.1

Define "confounding" in epidemiologic studies and be able to describe the consequences of confounding.

Confounding is a distortion of a risk estimate that occurs when an extraneous factor is related to the exposure under study AND to the outcome under study. For example, if a study indicates that coffee drinking increases risk of heart disease, and most coffee drinkers in the study were also smokers, the smoking may be the real cause of the heart disease. Consequences are establishing a false "causation" and getting untruthful results

The three diets used in the DASH study included:

Control diet (typical American diet) Fruit and vegetable diet: rich in fruits and vegetables Combination diet: rich in fruits and vegetables, low-fat dairy products, reduced sat and total fat

How many servings each of fruits and vegetables per day were provided in each of the three diets?

Control: 1.6, 2.0 F/V: 5.2, 3.3 Combination: 5.2, 4.4

What five major food groups found in Western diets were generally unavailable to pre-agricultural humans? What total percent of energy intake do these foods now represent in US diets, according to the Cordain et al article?

Dairy: 10.6% Cereal Grains: 23.9% Refined Sugars: 18.6% Refined vegetable oils: 17.6% Alcohol: 1.4% This equates to a total of 72.1% of total energy from sources that did not exist when our genome was adapting to the environment

What were the adaptations that allowed the man to successfully complete the hunt?

-The adaptations of running on two feet, better for long distances. Sweating to keep the human body cool and not needed to rest in shade. Hands to be able to carry water to replenish lost water stores.

Why is damage to the coronary arteries so important in the development of heart disease? Name two kinds of heart tissue that the coronary arteries supply.

Damage to coronary arteries decreases blood flow to heart tissue and starves it of oxygen. This leads to angina, heart attack, atrial fibrillation, or sudden cardiac death. Muscle tissue Cardiac conduction tissue

What is convergent evolution? How does convergent evolution explain the worldwide distribution of skin color and adult lactase levels?

an adaptive evolution The process whereby organisms not closely related independently evolve similar traits as a result of having to adapt to similar environments or ecological niches

Seven Countries Study (Dr. Ancel Keys)

an observational cohort study, started in 1958, to examine relationships among lifestyle, biomarkers, and heart disease....SCS suggested a link between dietary intake, specifically saturated fat, and heart disease

free radical Antioxidant

an uncharged molecule with an unpaired valence electron. a substance that inhibits oxidation, especially one used to counteract the deterioration of food products

What are the dietary recommendations put forth by Konner and Eaton to "rebuild the Food Guide Pyramid"? Provide your critique of these recommendations (why you would support or not support)

-The base of the pyramid would be fruits and vegetables, not grains -the next would be meat, fish, and low-fat dairy products, all very lean -whole grains "might come next" -fats, oils, and refined carbs occupy the small place at the top serving as condiments.

What blood pressure levels are considered normal, elevated, high-blood pressure stage 1, and high blood pressure stage 2 according to American Heart Association guidelines updated in 2017?

normal: <120 and <80 elevated: 120-129 and <80 hypertension stage 1: 130-139 and 80-89 hypertension stage 2: >140 and >90

Infarction

obstruction of the blood supply to an organ or region of tissue

percent

one part in every hundred

Cohort study

regularly obtain info about a lot of people. At the end, try to draw conclusions. You watch before the disease appears. Pros: more reliable because not retrospective. Cons: expensive, time-consuming.

What were the dietary changes brought on by agriculture and how did these affect the bodies and health of the early agriculturalists (living before the Industrial Revolution) compared to earlier hunter-gatherers who lived before the emergence of agriculture?

before agriculture, meat provided 35-65% of calories After agriculture, plant foods > 90% of calories Consequences of dietary shift Decline in stature (6 inches) in Old and New Worlds Skeletal manifestations of malnutrition and infection Height regained after the industrial Revolution, We suffer affluent Malnutrition with high rates of cardiovascular diseases, cancer, and diabetes.

Mean arterial blood pressure is determined by what four general physiologic factors?

blood volume, effectiveness of the heart as a pump, resistance of the system to blood flow, relative distribution of blood between arterial and venous blood vessels

A researcher wants to study the possible relationship of increased serum cholesterol levels to evidence of existing coronary heart disease. A population is surveyed at a single point in time. For each participant the serum cholesterol level is determined and an ECG is performed for evidence of coronary heart disease at the same time. This type of study design is called:

cross-sectional

How has their diet changed and what is their current source and types of food?

diet is now based on corn " Millie meal" and there is little meat from hunting

plaque (in arteries)

fatty, waxy substance that forms deposits on the artery wall

Secondary prevention

intervention to prevent a first heart attack, stroke, angioplasty, etc. in people at risk for cardiovascular disease (high cholesterol, high blood pressure, etc.). Involves making lifestyle changes or taking medication.

Primary prevention

intervention to prevent another heart attack, stroke, angioplasty, etc. in people who have already experienced one of these events. Involves lifestyle changes or taking medication.

What were the methods of dietary assessment and how often were they employed in this study?

Semiquantitative food frequency questionnaire Given every 4 years

What is a nutrition-related theory that explains the functional significance of lightly pigmented skin?

Skin evolved to be lighter as paleolithic ancestors moved further from the tropics to allow Vitamin D synthesis and production and balance of folate levels.

Several of the physicians discussed the issue of using fish oil supplements to prevent heart disease. What were their conclusions?

- Fish oil supplements do not reduce the risk of heart disease

What cultural factors are related to the current distribution of human skin color in various geographic areas?

Environmental factors: clothing, tents, or housing

What are the general conclusions of the Institute of Medicine Report (Nov. 2010) on dietary reference intakes of calcium and vitamin D?

-Raised the RDA for vitamin D -Normal serum level for vitamin D should be above 20 ng/mL, not 30-32 ng/mL

Thrombosis

buildup of platelets/ formation of a blood clot

What are the differences in structure between saturated, monounsaturated, and polyunsaturated fatty acids?

-Sat Fat / Completely saturated with hydrogen bonds -MUFAs / Not completely saturated with hydrogen bonds, one double bond -PUFAs/ Not completely saturated with hydrogen bonds, multiple double bonds

What were the objectives of the study by Li et al?

"Investigate associations of saturated fats compared with unsaturated fats and different sources of carbohydrates in relation to CHD risk."

According to Eaton and Konner, how much has the human genetic constitution changed since the development of agriculture 10,000 years ago? Since the appearance of anatomically modern Homo sapiens sapiens 40,000 years ago?

"Our genomes are fundamentally unchanged since the origins of agriculture ~ 10000 years ago." ?

What is the glycemic index?

"a relative comparison of the blood glucose raising potential of various foods or combination of foods based on equal amounts of carbohydrate in the food"

Figure 1 of the Yu article (p. 2955) displays the relative risk (RR) for cardiovascular disease for dietary components as calculated from meta-analyses of multiple studies. Remember that a relative risk >1.0 indicates an increased risk and a relative risk <1.0 indicates a decreased risk. What beverage is associated with the most decreased risk?

- Coffee 3/cups a day (Avg. RR of 0.88)

In the Yu article in the Central Illustration on p. 2954, what are the foods and nutrients that are recommended for decreased consumption?

-Decrease intake of processed meals, refined grains, added sugars, trans fat, sodium, sugar sweetened beverages (SSBs) and saturated fats. -Limit Alcohol consumption

Compared to now, how were diets of humans or their ancestors different— h. 50,000,000 years ago?

-Early primates coevolved with flowering plants (earliest ~65 MY ago) -Fruit and insect eaters--many diverse, very small species

Compared to now, how were diets of humans or their ancestors different— c. 500 years ago?

-Europe and Americas separate -Mexican food without cheese, beef, pork, or chicken (no Mexico) -No potatoes -No milk -No chilies

Compared to now, how were diets of humans or their ancestors different— b. 50-75 years ago?

-Had refrigerators, no microwaves -Ethnic foods and fast foods were not widespread -Whole milk, butter, lard (sat fats) were common, but not thought to be a problem -Post war liberation-convenience sought

Is simply lowering the percentage of energy from total fat in the diet likely to improve lipid profile or reduce the occurrence of coronary heart disease?

-It's not that simple. Dietary intake of total fat does not represent the full effect of blood lipid profiles or risk associated with coronary heart disease. The types of fats and the types of substitutions consumed are important.

In the video "Human Mammal, Human Hunter" what was the main technique used in the hunt of the Kudu?

-The Persistent Hunt. Following the animal until exhaustion. Human would fatigue slower than the Kudu.

Figure 1 of the Yu article (p. 2955) displays the relative risk (RR) for cardiovascular disease for dietary components as calculated from meta-analyses of multiple studies. Remember that a relative risk >1.0 indicates an increased risk and a relative risk <1.0 indicates a decreased risk. What two foods are associated with the greatest increased risk?

- Processed meats (Avg. RR of 1.42) - Refined grains (Avg. RR of 1.13)

Figure 1 of the Yu article (p. 2955) displays the relative risk (RR) for cardiovascular disease for dietary components as calculated from meta-analyses of multiple studies. Remember that a relative risk >1.0 indicates an increased risk and a relative risk <1.0 indicates a decreased risk. What two dietary patterns are associated with the most decreased risk?

- Prudent (Avg. RR of 0.69) - What is the prudent diet? The concept of "prudent diet" which in realty is a practical modification of the Mediterranean Diet and applicable to people all over the world.

Compared to now, how were diets of humans or their ancestors different— e. 50,000 years ago?

-No agriculture -Modern humans (Homo sapiens sapiens) coexisted with distinctly different sub-species: (Homo sapiens neanderthalensis) -Fire used to roast food and heat stones for cooking -No food cooking containers, grinding equipment, bows, or harpoons -Both aquatic and terrestrial foods used

Compared to now, how were diets of humans or their ancestors different— f. 500,000 years ago?

-No anatomically modern humans )Homo sapiens) -Time of the Homo erectus-a different species -Diet largely meat (>50%): scavenging/hunting large game animals, crude stone tools -Shellfish and fish not used -No tools for grinding plant foods known -Fruits and nuts eaten

Compared to now, how were diets of humans or their ancestors different— g. 5,000,000 years ago?

-No known tools -Primates foraged in the savannah environment in Africa -Plants foods dominant + scavenged meat?

What is the definition of evolution used by evolutionary biologists?

-Present and past species of organisms have their origins in other pre-existing types -Due to changes in gene frequencies in populations over time -Genetic changes that result in greater reproductive success are favored by natural selection -Genetic changes are the basis of the observed differences in the anatomy, physiology and behavior between species -The central unifying theory in all modern biology

In human feeding trials olive oil and carbohydrate were substituted for saturated fat. What were the effects on total cholesterol, HDL, and triglycerides?

- Total Cholesterol: The replacement with olive oil and carbohydrates decrease total cholesterol overall. Olive oil decrease total cholesterol a little more, non-significant difference. -HDL: The replacement with olive oil stayed fairly equal, but did increase HDL a little overall. The replacement with carbohydrates resulted in a significant decrease in HDL levels. -Triglycerides: The replacement with olive oil had an overall decrease in triglyceride levels. The replacement with carbohydrates had an overall increase in triglyceride levels.

What are "trans" fatty acids? How do they affect the risk of coronary heart disease when substituted for carbohydrate, saturated fat, monounsaturated fat, and polyunsaturated fat?

- Trans fats are those fats made artificially by adding hydrogen to liquid oils in order to make them solid. This process is known as hydrogenation, and creates a product known as partially hydrogenated vegetable oil. -Trans fat increase the risk of coronary heart disease when substituted for carbs, sat fat, MUFAs, or PUFAs.

Compared to now, how were diets of humans or their ancestors different— d. 5,000 years ago?

-Agriculture localized, still emerging -Most people still dependent on wild foods -Starchy staple crops present, but not wide spread -Maize (corn) in Mesoamerica and South America -"Wild weeds" domesticated (gourd, sunflower, amaranth)

What are three main critiques of the "Diet Heart Hypothesis"?

-Total serum cholesterol does not represent the complete effect of blood lipids in risk of CHD. - HDL-C strongly protective - LDL-C and oxidation of LDL-C increases risk - Transient postprandial elevations in blood lipids (triglycerides and chylomicrons) are important - Role of carbohydrate intake and fatty acid composition -Dietary cholesterol intake does not represent the full effect of diet on blood lipids. • Types of fat and types of carbohydrate important • Alcohol intake increases HDL but has a minimal effect on total cholesterol • Total energy balance, reflected in degree of adiposity, is inversely related to HDL and positively related to VLDL Genetic determinants of lipid responses -Atherosclerosis and progressive coronary narrowing do not fully represent the pathophysiology of acute myocardial infarction. • Clotting factors and acute thrombosis • Platelet aggregation; fibrinogen • Electrical instability of the heart • Specific polyunsaturated fatty acids may reduce risk

Compared to now, how were diets of humans or their ancestors different— a. 5-10 years ago?

-USDA Food Pyramid (now "My Plate") -5 servings a fruit and vegetables a day -Vitamin, mineral, and herbal supplements -Huge media boom, created a lot of nutrition confusion for people -Many fad diets

Figure 1 of the Yu article (p. 2955) displays the relative risk (RR) for cardiovascular disease for dietary components as calculated from meta-analyses of multiple studies. Remember that a relative risk >1.0 indicates an increased risk and a relative risk <1.0 indicates a decreased risk. What two foods are associated with the most decreased risk?

-Whole Grains (Avg. RR of 0.78) - Nuts (Avg. RR of 0.79)

What are four universal characteristics of pre-agricultural human diets that are useful in understanding how the current Western diet may predispose modern populations to chronic diseases?

-varied -minimally processed -had many wild plants -animal meat was lean with high polyunsaturated:saturated ratio

In the video, Debunking the Paleo diet, Dr. Christina Warinner describes four major beliefs held by adherents to the Paleo Diet fad. What are these?

1. Agricultural diets make us chronically ill—out of sync with our biology 2. We should abandon these agricultural diets and eat like our ancestors did >10,000 years ago 3. Diets were mainly meat-based and Fruit and vegetables with some fats/oils, but with NO GRAINS, LEGUMES, OR DAIRY. 4. If we emulate this "paleolithic" diet, it will improve our health and make us live longer.

The average US adult consumes how many combined servings of fruit and vegetables per day?

1.5

Homo erectus

1.8 M -400,000 years ago Brow ridge Brain 800-1000 cubic cm

The genetic mutation resulting in the capability of adult humans to digest lactose probably occurred at least how many years ago?

10,000 years ago

People that followed diets consistent with the "best diet for preventing heart disease" had (what amount) lower risks for what three conditions?

31% lower risk of heart disease 33% lower risk of diabetes 20% lower risk of stroke

Know the dates of existence and general anatomical features of these species: Australopithicus (both A. afarensis and A. africanus):

4 M-2M years ago Lower limbs evidence of bipedal locomotion Larger brow ridge, protruding face, brain 400-500 cubic cm

Homo sapiens sapiens

40,000 -30,000 years ago No browridge, enlarged fore hood for larger frontal cortex, brain, 1,100-14,00 cubic cm Some browridge (anatomically modern humans-like us)

Homo sapiens neanderthalensis

400,000-30,000 years ago Their DNA is in 3-5% of our genomes

A video clip from CardioSmart is played within the webcast with an interview with a patient named Peter Austin who had an unexpected heart attack at a relatively young age. His physician gives him dietary advice and medication and Mr. Austin describes his previous habit of eating large amounts of "wings" and then displays his improved diet. Later in the webcast, Dr. Frank Sacks is highly critical of Mr. Austin's new diet and points out several concerns. What dietary concerns did Dr. Sacks mention?

A concern that Dr. Sacks mentioned about Mr. Austin's diet was that it had the potential to be high in sodium, saturated fat for animal products, and refined grains. Mr. Austin's stated that he was following a low-fat diet. The American heart association no longer supports low-fat diets. Several research studies have been published about the high-fat Mediterranean diet that has shown correlations with decrease heart disease. The type of fat consumed is essential to consider. A diet high in MUFAs and PUFAs has been shown to be beneficial. Other dietary patterns that have been established to help reduce cardiac disease that was stated by Dr. Sacks was the DASH diet and some vegetarian diets. A single nutrient cannot dramatically reduce a person's risk of cardiac disease. The most proven prevention and risk reduction come from an overall well-balanced diet and physical activity.

What geographic factors are related to human skin color? Are these factors specific to Africa? Why or why not?

A gradual change in an inherited characteristic across the geographic range of species, usually correlated with an environmental transition such as UV exposure, altitude, temperature, or moisture. No, throughout the world, human skin color has evolved to be dark enough to prevent sunlight from destroying the nutrient folate but light enough to foster the production of Vitamin D. Tropics: dark skin (also high elevation) Subtropics and temperate regions: lighter skinned but have the ability to tan Near the poles: very light skinned and burn easily

What are causes of the changes in the Western diet in the following areas (consider agriculture, changes in food processing, economics and marketing, political lobbying) and what are the likely health consequences:

Acid-base balance—many of the common foods consumed by westerners today are acid-producing, while our ancestors consumed foods that induced a net basic pH. This is likely because of agriculture/the ability to refine grains, which do increase acidity and were not available anciently. A Net-base-producing diet may prevent osteoporosis, muscle-wasting, calcium kidney stones, HTN, exercise-induced asthma, and progression of chronic renal insufficiency.

Why is it important to consider both the serum LDL level and serum HDL level when assessing risk of cardiovascular disease?

Abnormal levels of lipids (fats) in the blood are risk factors for cardiovascular disease. ... High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol reduces the risk of cardiovascular disease as it carries cholesterol away from the bloodstream. - HDL-C strongly protective - LDL-C and oxidation of LDL-C increases risk

The article by Roberto, C.A. et al. (2015). Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking. (The Lancet. 385:2400-09) includes discussion of divergent beliefs about what drives and sustains high levels of obesity across the world and examines what is called "false dichotomies". What are these beliefs and what conclusion is reached about them?

Beliefs: personal vs collective responsibilities, supply vs demand explanations for consumption of unhealthy good, government regulation vs industry regulation, top down vers bottom up drivers for change, treatment vs prevention priorities, undernutrition vs overnutrition Conclusions: obesity is driven by both issues related to personal choice and the environment

What are the four primary allegations made by Key's critics that have been refuted by the review paper by Pett and others who reviewed primary source materials for the study and consulted with investigators directly involved in the study?

Countries were selected and excluded based on a desired outcome. France was purposefully excluded. Dietary data taken in Greece during Lent introduced a distortion. Sugar was not considered as a possible contributor to coronary heart disease.

Describe the "response to injury" hypothesis for the development of lesions in coronary arteries (and other arteries). What dietary and non-dietary factors are involved?

Damage to endothelial→ cholesterol, fats, etc. get stuck in the cell wall--> monocytes travel to the site (inflammatory response as cholesterol gets oxidized) → monocytes become macrophages → macrophage eats and digests cholesterol/fat → macrophages turn into foam cells→ foam cells accumulate to form plaque→ plaque hardens and grows (can start to obstruct vessel) → smooth muscle cells migrate to cover the plaque→ cap formed by muscle cells can rupture→ thrombus forms→ thrombus obstructs vessels leading to heart attack, stroke, etc. Dietary: diabetes, hypertension, hypercholesterolemia, diet high in trans fat/refined sugars/refined grains/saturated fat while low in fruits/veggies/whole grains/PUFAs/MUFAs Non-dietary: stress, smoking, genetics (familial hypercholesterolemia, hypertension, etc.), lack of physical activity, age

In the article "Positive sign in America's food fight- interview with Professor Frank Hu" in the Harvard Gazette. (3 December 2015) what factors did Dr. Hu suggest were possible causes of the changes in the U.S. diabetes rates reported in 2014 from U.S. Centers for Disease Control and Prevention?

Decline of consumption of both sugar-sweetened beverages and trans fatty acids

Outline the steps of the classic diet-heart hypothesis for the effects of dietary factors on the development of myocardial infarction.

Diet high in SFAs/cholesterol and low in PUFAs → high serum cholesterol → atheromatous plaque→ coronary artery narrowing→ myocardial infarction

What are key lessons about the diets of Paleolithic peoples and more recent hunter-gatherer populations pointed out by Dr. Christina Warinner in her video Debunking the Paleo diet.

Diversity is key We need to eat whole foods We need to eat fresh and in-season

What are the limitations of taking a "single nutrient" approach to the study of hypertension?

Effect of any single nutrient may be too low Cumulative and interactive effect of several nutrients might be detected Nutrients in foods other than those tested in trials may be present in foods and be effective

Where is lactase located in the body?

Epithelial cells in the small intestine

What is evolutionary discordance? Why is it important for understanding current diet-disease relationships?

Essentially, it is when environmental conditions change, clashing with a species' previously favored genome, which may ultimately is manifested in the form of disease phenotypically, increased illness/death, and reduced reproductive success. With the abrupt change to our diet, activity level, and environmental changes associated with the onset of agriculture, various "diseases of civilization" have surfaced. Understanding how we can try to manipulate our environment to reflect more of what things were like prior to agriculture in various ways may help to mitigate some of the chronic diseases that threaten our society in such a major way today.

Discuss the differences between established, probable, and possible links between nutrition and disease (as outlined in the article "Nutrition research and the mass media: an introduction".)

Established--strongly weighted to one side, 20 rocks to 2 Probable--large amount of rocks on one side but a few rocks on the other side, "just enough to cast some doubt" Possible--scale barely tips to one side, emerging research, needs more research

True or false: most adults in the world have the ability to digest lactose.

False. Most adults in the world do not produce lactase post weaning and thus cannot digest lactose in milk. Where individuals have been consuming dairy for generation adaptations to produce lactase post weaning has developed.

What are causes of the changes in the Western diet in the following areas (consider agriculture, changes in food processing, economics and marketing, political lobbying) and what are the likely health consequences:

Fatty acid composition—consumption of lean meat from our ancestors involved a lack of consistency in SFA consumption—more of the organ meat fat predominated, which included PUFAs and MUFAs. With the onset of agriculture, we are able to fatten animals to get that "desired' marbling, which in turn gives us access to constant SFA intake. Additionally, sources of SFA that were not available at the time are consistently consumed now (baked goods, cheese, milk, margarine, and butter). The invention of margarine and partial hydrogenation lead to the development of unnatural trans fatty acids, which were not in existence at the time. Oil-seed processing increased our ratio of n-6:n-3 consumption, increasing it 9 fold from 2:1 to 10:1.

What aspects of vegetarian diets are believed to reduce blood pressure?

Fiber Mineral content (esp K and Mg) Reduced fat content (esp. Sat fat) Vegetable protein vs animal protein?

What are causes of the changes in the Western diet in the following areas (consider agriculture, changes in food processing, economics and marketing, political lobbying) and what are the likely health consequences:

Fiber content—Virtually the same principles hold true here—refined sugars, vegetable oils, dairy, and alcohol do not have ANY fiber and constitute a large portion of our diets today, displacing high fiber fruits and vegetables. Further, grains are consumed more than in the past, which are not as high in fiber as fruit and vegetables. So agriculture, and the invention of refining various different foods have lead to this issue of too little fiber in our diets today, as compared to what our ancestors consumed in the past.

According to the article by Roberto, C.A. et al. (2015). Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking. (The Lancet. 385:2400-09) The food policy framework for healthy diets and the prevention of obesity described by the World Cancer Research Fund International NOURISHING framework is organized in three broad "domains". What are these domains and what are the policy areas within each domain?

Food Environment: Nutrition labeling standards and regulations Offer healthy foods and set standards in public institutions Use economic tools to address food affordability and purchase incentives Restrict food advertising and other forms of commercial promotion Improve the nutritional quality of the whole food supply Set incentives and rules to create a healthy retail and foodservice environment Food system: Harness the food supply chain and actions across sectors Behavior change: Inform people about food and nutrition through public awareness Nutrition advice and counselling in health-care settings Give nutrition education and skills

What are the recommendations for the best diet to prevent heart disease?

Full of fruits and vegetables, whole grains, nuts, fish, poultry, and vegetable oils Alcohol in moderation if any Easy on red/processed meats, refined carbohydrates, foods/beverages with added sugar, sodium, and trans fat

How are glucose and fructose metabolized differently? Why might this difference result in high fructose consumption causing liver disease and metabolic syndrome?

Glucose: Glucose is mainly metabolized by glycolysis and can be regulated through feedback inhibition by ATP or citrate...which redirects glucose towards storage as glycogen Fructose: Fructose metabolism differs from glucose in that it nearly take place in liver cells and can result in increased fatty acid synthesis, deposition of fat in the liver, increased levels of uric acid, and metabolic syndrome

What is glycemic load (GL)? What foods are high and low in glycemic load?

Glycemic index x the CHO content per serving size High: high-sugar beverages, candy, white pasta, white bread, couscous, french fries/potatoes, low-fiber cereals Low: beans, whole grain products, fiber-rich fruits/veggies

Name two European countries with the highest and two with the lowest rates of death from major cardiovascular diseases. What dietary factors might explain the differences in death rates between countries?

Highest: Lithuania, Latvia (poor diets) Lowest: Netherlands, France (red wine)

In web reading Diet in the News- What to Believe? The authors list 7 key questions to that are helpful in assessing the quality of evidence in a health news article. What are they?

How does the study fit into the current body of evidence? What is the weight of the evidence? Does it report a single study? More>less>one How large is the study? Large>small Was the study done on animals or humans? Is the disease developed or a marker of the disease? The markers don't always turn into the disease What type of study is it?

What were their traditional dietary practices? How diverse was the diet of the !Kung?

Hunting and gathering of fruits and nuts. Hunting by males, gathering by females. Tried a lot of different kinds of foods. Variety. Was dependent on the weather and location of the tribe.

How may dietary supplements (specifically folic acid+B6+B12), and (antioxidant vitamins C and E) affect the risk of cardiovascular disease? What types of studies have provided the strongest evidence?

Improving folate nutrition (and other B-vitamins) appears promising—but doing this with supplements may be risky! • Supplemental intake of antioxidant vitamins does not conclusively lower risk of coronary heart (CHD) and may increase risk of CHD and death. • Randomized Controlled Trial / Placebo Controlled

According to the American Heart Association report in 2018 what percent of U.S. adults have hypertension? How does the percent with high blood pressure vary by age in the US? How has this percent changed since 1997?

In 1997, 24% of American had hypertension In 2019, 50% of Americans have hypertension Gets higher as you get older

How is it possible that a cohort study of a vitamin supplement intervention and a clinical trial (experiment) can result in conflicting findings?

In a cohort study, there is a higher chance of confounding. Those who naturally choose to take vitamin supplement might also have other aspects of a healthier lifestyle (ie physical activity, avoiding tobacco and excess alcohol, not obese, healthy diet) and therefore would likely have reduced risk of some diseases. The randomization of a clinical trial would reduce the change of compounding. When the participants are randomly selected to be in the intervention or treatment group, ideally, those with more healthy and those with less healthy lifestyles would be mixed among both groups.

Where and when where were strains of wild wheat domesticated to give rise to early agriculture?

In the Natufian culture in the Levant (middle east) was where it all began about 13,000 BP. Later, domestication of emmer and einkorn wheat occurred in about 10,000-11,000 BP from wild wheat taken from Turkey. We didn't end up consuming refined grains regularly until the dawn of the industrial revolution, about 150-200 years ago!—prior to that, only arid/temperate climates were able to consume cereal grains as year-round staples.

Distinguish between incidence and prevalence of disease.

Incidence--describes how many new diagnoses there are of a disease Prevalence--describes how many current cases there are of a disease

What are the possible mechanisms by which the DASH diet may have lowered blood pressure levels?

Increase NO bioavailability which helps with vascular basal tone

In the Yu article in the Central Illustration on p. 2954, what are the foods that are recommended for increased consumption?

Increase intake of fruits, vegetables, whole grains, nuts, legumes, and seafood. -Consume water, unsweetened tea and coffee.

In the article How to really eat like a hunter-gatherer: why the Paleo diet is half-baked. by Jabr, Ferris The author describes four hunter-gatherer populations and the percentage of different foods in the diets.What are the groups and where do they live? For each group, what food group provides the first and second largest percent?

Inuit: Meat and fish comprised about 90% of their intake (Greenland, Alaska) Hiwi, meat and fished comprised about 75% of their intake, with fruits and vegetables making up about 5% of intake, and roots about 10% (Colombia and Venezuela) !Kung: Meat and fish represents only about 15% of intake, with fruits and vegetables about 20%, roots about 2-5%, and seeds and nuts a whopping 55% of their intake. Milk and corn meal is about 2 % of intake (South West Africa) Hadza: about 50% of intake from meat and fish, 10-15% from fruits and vegetables, and about 25% from roots (South East Africa)

For each group, what food group provides the first and second largest percent?

Inuit: Meat and fruits and vegetables (fruits and vegetables were minimal) Hiwi: Meat and root (meat is a huge portion of food) !Kung: Seeds and nuts, fruits and vegetables Hadza: Meat and fish, roots

What were the findings of the randomized controlled trial of the Mediterranean Diet that was mentioned in this article?

It reduced the incidence of major cardiovascular events amongst patients with cardiovascular disease over a 4.8 year follow-up period.

What industrialized country outside of Europe has the lowest rates of death from coronary heart disease?

Japan

What have studies of migrant Japanese revealed about serum cholesterol levels? Where were these migrants living at the time of the study? What are characteristics other than serum cholesterol that are different between migrant Japanese and Japanese living in Japan?

Japanese migrants in Hawaii and California had higher levels than residents of Japan. Residents of Japan had lower saturated fat and cholesterol intake (although we now know that dietary cholesterol doesn't matter). They also consumed more alcohol.and weighed much less than the migrants.

Near the end of the webcast the Moderator, Bill Berkrot asked each of the four physicians to briefly state their "take away message" concerning the prevention of heart disease. What were the messages from each of these four panel participants?

JoAnn Manson - Education is essential to address the global crisis with cholesterol levels and heart disease. Along with education good healthy foods need to be made affordable and accessible. Bad unhealthy foods need to be less affordable and less accessible. The healthy choice should be made the easy choice. The amazing technology available to us should be used to improve our health because it has that potential. Frank Sacks -There is subtle knowledge about healthy lifestyle behaviors, a well balanced diet, and medications. There needs to be cooperation between health care professionals, food service industries, and the government to pass policies and laws that support healthy lifestyle behaviors. Making policies will help make the right choice the easy choice to the public. Patrick O'Gara - Prevention is essential and could be, should be started in grade school. Teach the population from a young age about healthy lifestyle behaviors. Educate them about healthy food choices, physical activity, and the benefits of using technology less. Paul Ridker -The population needs to be educated about healthy lifestyle behaviors, about medications, and about physical activity. My fellow physicians and I want to educate and have our patients be well educated.

How do LDL and HDL cholesterol differ in terms of average diameter, density, and content of major lipids and what are their effects on risk of cardiovascular disease?

LDL cholesterol has a very strong association with CVD risk and is the main target of diet interventions and medications

What are concerns about the effects of LDL lowering medications on the behavior and lifestyle of persons using these medications?

LDL lowering medications are successful, but cannot and do not replace the benefits of behavior and lifestyle patterns of a person. Especially in preventive care and recovery care. Prevention ideally would begin in middle school and high school where individuals would learn how to maintain a healthy body weight, eat a balance diet, and incorporate regular physical activity. Also learning how to prepare food, how to shop at a grocery store, the benefits of not participate in smoking, etc. Medications can help many individuals but they cannot replace the foundation of behavior and lifestyle patterns in cardiac health and overall health.

What characterizes a "metabolically unhealthy" ("at-risk") obese person?

Less subcutaneous fat, More visceral fat (around organs), More ectopic fat deposition in the liver and in the skeletal muscle Low HDL, high inflammation, High TG, low insulin sensitivity, high fat mass

What are the likely health consequences of their dietary and cultural changes?

Less variety, less activity, change in nutrients.

What are the current recommendations of the 2015-2020 U.S. Dietary Guidelines for intake of saturated fat and cholesterol?

Limit calories from added sugars and saturated fats and reduce sodium intake. Consume an eating pattern low in added sugars, saturated fats, and sodium. Cut back on foods and beverages higher in these components to amounts that fit within healthy eating patterns. -Consume a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level. -A healthy eating pattern includes: a variety of vegetables from all subgroups, fruits especially whole fruits, fat-free or low-fat dairy, including milk, yogurt, cheese, a variety of protein foods, and oils. -A healthy eating pattern limits: Saturated fats and trans fats, added sugars, and sodium. -Consume less than 10 percent of calories a day from saturated fats. -A person needing 2,000 calories a day should consume less than 16 g of saturated fat.

Why is the glycemic load of diet important to consider?

Long term consumption of high glycemic load CHO can adversely affect metabolism and health by inducing hormonal and physiological changes increasing INSULIN RESISTANCE...Diseases of insulin resistance are often referred to as diseases of civilization...include things like obesity, CHD, type II diabetes, hypertension, and dyslipidemia.

Where does Utah rank among all states in rates of (a) coronary heart disease and (b) stroke?

Lowest rate of coronary heart disease #25 for stroke

What are causes of the changes in the Western diet in the following areas (consider agriculture, changes in food processing, economics and marketing, political lobbying) and what are the likely health consequences:

Macronutrient composition (specifically, protein intake)—protein intake was estimated to be 19-35% with a CHO intake of 22-40%. Could have been due (this is my own speculation) from the lack of agriculture they had at the time. Additionally, with the innovation of agriculture/industrialization, much of our food comes from corn, soy, and wheat—high carbohydrate foods.

What were the dietary interventions tested in the randomized controlled trial of the Mediterranean Diet that were mentioned in this article?

Mediterranean Diet supplemented with either: Extra virgin olive oil or Nuts

What is melanin and how does it protect against the harmful effects of UV radiation?

Melanin is nature's sunscreen: it is a large organic molecule that serves the dual purpose of physically and chemically filtering the harmful effects of UV radiation; it absorbs UV rays causing them to lose energy, and it neutralizes harmful chemicals called free radicals that form in the skin after damage by UV radiation. UVB rays penetrate epidermis, prompting melanocytes to make melanin pigment, which is packaged in structures called melanosomes. Melanosomes are taken up by keratinocytes to shield their DNA by forming a nuclear cap.

What are causes of the changes in the Western diet in the following areas (consider agriculture, changes in food processing, economics and marketing, political lobbying) and what are the likely health consequences:

Micronutrient density—because much of our food includes both sugar and vegetable oils, neither of which were around really at the time of our ancestors, as well as the high caloric and lot nutritive value of either of the two in terms of vitamins/minerals, our micronutrient density/intake has severely declined since the time of hunter-gatherers. Milk and refined grains, neither of which were consumed by hunter-gatherers (apparently) are the least nutrient dense of the food groups we have, yet are essentially the most consumed! With the ability to refine grains worsened the situation, removing the bran and the germ—two of the most nutritious portions of the grain.

Homo sapiens (archaic)

Migration out of Africa 200,000 -150,000 years ago (mitochondrial DNA evidence) 130,000 years ago (African fossil evidence.)

Describe the difference in the nutritional composition of wild game meat compared to modern domesticated beef, pork, and lamb.

Modern carcasses are 20-30% fat, African herbivores are 4% fat Wild game has more mono- and polyunsaturated fat per gram than modern domestic meat. Wild game has more eicosapentanoic acid (EPA, long chain w-3 polyunsaturated fatty acid) Amino acid composition is the same and cholesterol content is similar

What characterizes a "metabolically healthy" obese person?

More subcutaneous (peripheral) fat Less visceral fat mass (less around organs) Lower ectopic fat deposition in the liver and in the skeletal muscle (ectopic=not where it belongs)

What type of research design was the DASH study?

Multi-center clinical trial; randomized feeding study

In the video, Debunking the Paleo diet. Dr. Christina Warinner critiques three major myths related to the current Paleo Diet fad with evidence from archaeological evidence. What are these? Provide some evidence and detail for each.

Myth #2: Paleolithic peoples did not eat whole grains or legumes. We've found tools from 30,000 years ago (this is 20,000 years before the dawn of agriculture), which allude to the fact that ancient peoples used these to grind seeds and grains. There is also an abundance of plant remains in the calculus of paleolithic peoples., including refined barley, legumes, tubers, etc.

In the video, Debunking the Paleo diet. Dr. Christina Warinner critiques three major myths related to the current Paleo Diet fad with evidence from archaeological evidence. What are these? Provide some evidence and detail for each.

Myth #3: the paleodiet foods are similar to those of what our paleolithic ancestors ate. Interestingly, the paleodiet foods are all products of farming....they're all domesticated foods! Example: bananas—they are absolutely a farmer's food...wild bananas are way too full of seeds and cannot be eaten. Other—salads...wild lettuces contain a great deal of indigestible latex. It's bitter, the leaves are tough. We've farmed them to be more edible, tastier, less latex, etc. Olive oil still requires a rudimentary press that the paleolithic people would never have built (how do we know that?), so this is also a farmer's food. We didn't even have many of the fruits and vegetables that we have know back in the day that are being promoted by the paleodiet.

What other sub-species of the Homo sapiens existed at the same time and interbred with Homo sapiens sapiens?

Neanderthals

According to the article by Roberto, C.A. et al. (2015). Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking. (The Lancet. 385:2400-09) what countries have reversed their obesity epidemic?

No countries have achieved this.

If an adult who is lactose intolerant (because they do not produce lactase) is gradually given milk, will they begin to produce lactase in their small intestine?

Nope.

The life expectancy of hunter-gatherer populations is estimated to be 30-35 years, similar to pre-industrial populations. Does this mean that the diets of hunter-gatherers were less healthy than the modern diets of populations with much greater longevity? Why or why not?

Not necessarily - there are a lot of other factors that may affect this age. First, this life expectancy does not account for the high infant and early child mortality rates. Additionally, these populations were more susceptible to infectious diseases that have been largely eradicated or are treatable with modern medicine. Excluding these populations with early mortality, life expectancy was comparable to where it is now.

What were the cohorts (and who were the participants) used in the study by Li et al?

Nurses' Health Study (1980-2010), composed of 84,628 women Health Professionals Follow-Up Study (1986-2010), composed of 42,908 men

The Seven Countries Study was what type of study and when was it started?

Observational cohort study Started in 1958

Who are the !Kung people and where do they live?

Part of the San people who live mostly on the western edge of the Kalahari Desert, Ovamboland and Botswana. (Southern Africa)

Figure 1 of the Yu article (p. 2955) displays the relative risk (RR) for cardiovascular disease for dietary components as calculated from meta-analyses of multiple studies. Remember that a relative risk >1.0 indicates an increased risk and a relative risk <1.0 indicates a decreased risk. What beverage is associated with the greatest increased risk?

Sugar sweetened beverages (SSBs) (Avg. RR of 1.17)

What patients are currently good candidates for the newer cholesterol-lowering medications? What aren't more patients good candidates?

Patients who are currently good candidates for the newer medications are those with extremely elevated cholesterol levels that are not responding to current treatment that may include statins. These individuals may have a genetic predisposition. -More patients that are good candidates are not receiving this medications comes from a variety of reasons. To list a few; high prescription price, insurance coverage, under- diagnosed populations, long term process of government approval, biological markers that are qualifications to receive the drug, and unknown long term side effects.

In what decade did coronary heart disease rates reach a peak in the United States? What factor or factors may have led to a decline since that time?

Peak was 1968 Decrease in smoking (due to surgeon general report on adverse health effects in 1964) Public health campaigns Medications (statins) Lifestyle changes

What health outcomes were studied and how were data obtained on these outcomes?

Primary endpoint was non-fatal myocardial infarction and CHD death Myocardial infarction identified through medical records, used WHO criteria Death identified through next of kin, USPS, or certificates from the National Death Index/state vital statistics departments

What is a general definition of "evolution"?

Process of changing over time.

What types of study design have proven successful in investigating risk factors of chronic disease states such as cardiovascular disease? What are strengths and weaknesses of each?

Randomized trials and cohort studies Randomized trials can prove causation (when double-blinded) but are more expensive and not always ethical Cohort studies cheaper and broader, but are difficult to isolate variables

Describe how the trends in rates of death from heart disease over time differ between men and women in the United States.

Rates were about the same in 1985 and started to decline with the introduction of statins; however, hormone replacement therapy for postmenopausal women began in 1990 and we saw a huge increase in the rate of death for women while men stayed about the same. The cessation of hormone replacement therapy and an awareness campaign for heart disease in women started in 2000, and there was an immediate steep decline in death. In 2013, it had declined to less than men's rate of death.

In the Appel article (1997) it was estimated that a population-wide reduction in systolic or diastolic blood pressure of the magnitude observed with the combination diet would have what effects?

Reduce incident coronary heart disease by approximately 15% and stroke by approximately 27 percent

In the Yu article under the heading of "Pathophysiological effects of dietary components" and in the Central Illustration on p. 2954, what is the most important overall dietary goal for the primordial prevention of cardiovascular disease?

Reduction of excess calories

Compare the nutrient intake of the late Paleolithic diet (based on studies of recent hunter-gatherers as discussed in the Konner and Eaton 2010 article) with the current U.S. Government dietary recommendations with respect to intakes of:

Refer back to table in study guide

Know the Recommended Daily allowances for calcium and vitamin D.

Refer to table in study guide.

Clinical trial or intervention trial

Researchers intervene in these to watch the effects of a specific behavior change. Compares an intervention to a control group. Randomization helps find that an effect is real. Pros: most likely to prove something, Cons: participants have a hard time sticking to a diet etc, expensive.

What are causes of the changes in the Western diet in the following areas (consider agriculture, changes in food processing, economics and marketing, political lobbying) and what are the likely health consequences:

Sodium-potassium ratio—with the manufacturing of salt (a development of civilization), as well as the over consumption of oils/sugar which displace the fruit and vegetables (which are high in potassium), we now get way too much salt and way too little potassium. The ratio has switched.

What are the two types of cholesterol-lowering drugs that are discussed in the webcast? What are pros and cons of each?

Statin Pro: really success to help to lower LDL, helps decrease a person's risk of stroke, heart attack, and other vessel-related diseases. Study have shown anti-inflammatory effects. Statin Cons: Most common side effects are nausea, vomiting, aches, pains, constipation, gas, and diarrhea. Severe side effects include type 2 diabetes, high blood sugar, confusion or memory loss, liver damage, kidney damage, and muscle damage. Statins Increased risk of diabetes PCSK9-Inhibitors Pros: Studies have found that this medication is extremely effective in lowering LDL-c and total cholesterol in a more aggressive way than statins. Studies of this medication have illustrated an improved tolerance by patients that had poor tolerance to traditional statins. PCSK9-Inhibitors seem to be especially effective in treating patients who are genetically predisposed to elevated cholesterol serum levels. PCSK9-Inhibitors Cons: There is a lack of evidence of long-term benefits and effects on cardiovascular health and disease. Evidence illustrates that it is effective is lowering cholesterol levels but what does this mean for the future. More studies are needed to expand the use of PCSK-9 inhibitors. The prescription cost to patients is still unknown.

What is the current thinking on the role of sodium in hypertension, given the results of the DASH-I (Appel 1997) and the DASH-II (from PowerPoint and optional reading) studies?

The DASH II study found additional benefit from sodium reduction, especially among participants with a poor dietary pattern DASH diet participants did not show the age related rise in blood pressure that is typical in the industrialized countries Pressure-natriuriesis curve in the DASH-Sodium trial: evidence of improved kidney function in eliminating sodium, thus reducing blood volume

Framingham Study

The Framingham Heart Study is a long-term, ongoing cardiovascular cohort study on residents of the city of Framingham, Massachusetts. The study began in 1948 with 5,209 adult subjects from Framingham, and is now on its third generation of participants.

According to the PowerPoint slide "Dairy Diaspora" (based on article in Nature "Archaeology: The Milk Revolution") when and where did the domestication of dairy animals begin? When was well-developed dairy economy established in central and western Europe?

The Middle East 10,000-11,000 years ago. 6500 years ago is when well-developed dairy economy was established in central and western Europe

Based on the U.S. maps of obesity shown in the PowerPoint slides, what region of the US has since 1985 been the "wellspring" or "epicenter" of the obesity epidemic? What may be causes of this phenomenon?

The South is the emergence Possible causes: higher levels of poverty, hotter in summer=less physical activity, fried food Great Lakes area: lots of manufacturing jobs, SNAP, processed foods, unemployment

What is the current average level of sodium intake in US? What is recommended? Compare added table salt intake vs. intake from processed foods (see PowerPoint slide of the "Get the Facts: Sodium and the Dietary Guidelines infographic from the U.S. Centers for Disease Control)

The US average is 3,300 mg/day USDA 2015-2020 dietary guidelines: 2,300 mg/day "Salt you use at the dinner table is not the biggest sodium contributor in the American diet. In fact, the majority of the sodium Americans consume -more than 75%-is found in processed food and restaurant meals."

What are the characteristics of metabolic syndrome?

Visceral fat Hyperglycaemia, Dyslipidaemia, Hypertension, Thrombophilia (abnormality of blood coagulation that increases the risk of thrombosis), NAFLD (non-alcoholic liver disease), Adipose tissue dysregulation, inflammation oxidant stress, hyperuricaemia (excess uric acid) gout?

How is BMI calculated?

Weight in kg divided by (height in meters) squared

Figure 1 of the Yu article (p. 2955) displays the relative risk (RR) for cardiovascular disease for dietary components as calculated from meta-analyses of multiple studies. Remember that a relative risk >1.0 indicates an increased risk and a relative risk <1.0 indicates a decreased risk. What dietary pattern is associated with greatest increased risk?

Western (Avg. RR of 1.14)

In the article "Positive sign in America's food fight- interview with Professor Frank Hu" in the Harvard Gazette. (3 December 2015) what was described about the rates of diabetes in the United States, according to a 2014 report from the U.S. Centers for Disease Control and Prevention?

The rate of new cases of diabetes has declined

Dr. Frank Sacks weighed in on the issue of the ratio of omega-3 (n3) and omega-6 (n6) fatty acids in the diet. What is his viewpoint?

The ratio of omega-3/omega-6 fatty acids in the diet does not predict risk of cardiovascular disease and the more polyunsaturated fatty acids in the diet the lower your risk of cardiovascular disease.

What are some major difficulties in studying the role of nutrition as causes of chronic diseases such as cardiovascular disease, osteoporosis, cancer, and Alzheimer's disease?

There are too many confounding factors, it would be difficult to isolate variables, and one of these studies would be too long and expensive

Why have some writers and bloggers criticized Ancel Keys and the Seven Countries Study in the years since Key's death in 2004 (at the age of 100!)

They believe that carbohydrate, not fat, is the cause of heart disease and other illnesses without allowing the possibility that both macronutrients or specific foods that contain them could play a role. SCS didn't say total fat should be restricted, yet these people blame it for low fat diet trends, guidelines, and nutrition policy.

In the article How to really eat like a hunter-gatherer: why the Paleo diet is half-baked. by Jabr, Ferris. How does the author describe the way that present-day followers of the "Paleo Diet" typically define their diets by what they do eat and what they don't eat?

They do not eat: dairy or processed grains at all, peanuts, lentils, beans, peas, and other legumes. They do eat: May eat tree nuts, though. Meat is consumed in large quantities and is often cooked in animal fat of some kind. Eat large amounts of vegetables and the occasional fruit. No refined sugar is allowed, but honey is now and then.

Why has their lifestyle changed?

They have been forced to land reservations and been limited on where they can hunt and have become dependent on the corn introduced to them

What dietary factors may cause or prevent coronary heart disease but are not included in the classic diet-heart hypothesis?

Three dietary strategies are effective in preventing CHD: - Consume unsaturated fats (especially PUFAs) in place of saturated and trans-fatty acids. - Increase consumption of omega-3 fatty acids from plant and fish sources. - Consume a diet high in fruits, vegetables, nuts, whole grains and low in refined grains. • A combination of these three approaches can confer greater benefits than a single approach • Simply lowering the percentage of energy from total fat in the diet is unlikely to improve lipid profile or reduce the occurrence of coronary heart disease In addition to dietary intake, these factors are important: - Physical activity and healthy body weight - Avoid tobacco smoke

What are two different theories that explain the functional significance of darkly pigmented skin color?

To protect people living in tropical areas against skin cancer Dark skin evolved to protect the body's folate stores from destruction and vitamin D levels

According to the National Cholesterol Education Program, what are desirable, borderline high, and high levels of total cholesterol and LDL cholesterol?

Total cholesterol Desirable: <200 Borderline high: 200-239 high: >240 LDL Desirable: <129 Borderline high: 130-159 High: >160

Contrast the target levels of the following nutrients in the three diet groups: total energy, protein, carbohydrate, sodium, calcium, magnesium, total fat, saturated fat, monounsaturated fat, polyunsaturated fat

Total energy: the same Protein: 3% higher in combo Carb: 7% higher in combo Sodium: Same Calcium: More than double in combo Magnesium: More than double in fruits/veg and combo Total fat: 10% lower in combo Saturated fat: 10% lower in combo MUFAs: same PUFAs: same

Using the figure labeled "Central Illustration" on page 1545, describe the results for replacing carbohydrates from refined starches/added sugars in the diet with the five types of nutrients listed.

Trans fat: 2-3% increase in risk SFAs: 1-2% decrease in risk MUFAs: 5% decrease in risk PUFAs: 22% decrease in risk Carbs from whole grains: 12% decrease in risk

Using the figure labeled "Central Illustration" on page 1545, describe the results for replacing saturated fat in the diet with the five types of nutrients listed.

Trans fat: 5% increase in risk MUFAs: 15% decrease in risk PUFAs: 25% decrease in risk Carbs from refined starches/added sugar: 1-2% increase in risk Carbs from whole grains: 8-9% decrease in risk

What factors limit the production of dairy-producing livestock in southern Nigeria? What genetic trait coincides with the absence of dairy animals in southern Nigeria?

Tsetse flies Intermarriage between the Fulani and the Hausa Environment affects the food supply and how people adapted or not to changes. Climate vegetation Lactose intolerance as adults because they have not been able to have dairy products

Primordial prevention

Working to prevent inflammation and atherosclerosis, along with the associated risk factors of high blood pressure, high cholesterol, excess weight, etc. Ideally begins in childhood, now the cornerstone of the AHA. Involves never smoking, maintaining healthy body weight, exercising, and following a healthy diet.

What has been the translation and application (misapplication?) of the ideas put forth by Konner and Eaton in today's popular culture?

cholesterol rec moved from 200 to 180 in 1985. recent fad diets put more emphasis on meat consumption and low carb diets exercise was commonly walking for HG but in 1980s walking as exercise was skeptical -Agriculture makes us sick-out of sync with biology -we need to abandon agricultural diets and eat like our ancestors -we know what paleolithic diets were like: no grains, legumes, or dairy. Mostly meat, some veggies, fruits, and nuts -If we follow this ancient diet our health will improve and we will live longer.

Atherosclerosis

condition in which fatty deposits called plaque build up on the inner walls of the arteries

Ischemia

restriction in blood supply to tissues

Endothelium

single layer of cells lining the inside of organs

What are the health consequences of hypertension?

stroke, heart failure, erectile dysfunction, vision loss, heart attack, kidney disease/failure

Cross-sectional survey

take a group of people on one day, measure predictors. Pros: cheap, quick, multiple variables, view connections. Cons: not behavioral, no proof of causation, may not represent

Case-control study

take people with a condition (experimental group) and compare them to people without the condition. Pros: cheap, quick. Cons: uses data from the past=recall bias

saturated fatty acid monounsaturated fatty acid: polyunsaturated fatty acid: trans fatty acid:

type of fat in which fatty acid chains have all single bonds type of fat with one double bond in the fatty acid chains type of fat with more than one double bond in its fatty acid chains an unsaturated fatty acid occurring in margarine and manufactured cooking oils with a trans arrangement of carbon atoms adjacent to double bond, increases risk of atherosclerosis

What dietary factors were related to the success of Homo erectus?

very good at hunting large game, crude stone tool, fruits and nuts eaten?

In the video, Debunking the Paleo diet. Dr. Christina Warinner critiques three major myths related to the current Paleo Diet fad with evidence from archaeological evidence. What are these? Provide some evidence and detail for each.

yth #1: Humans are evolved to eat meat and paleolithic peoples consumed large quantities of meat We DO NOT have any anatomical, physiological, or genetic adaptations for meat consumption; in fact, the opposite is true—our bodies have adapted to consume plant matter—evidence from our longer digestive tracts so that we can ferment/digest plant matter more fully, we have large molars to shred plant matter, etc. Current measures used to determine whether or not our ancestors consumed lots of meat includes the N-15 test...the theory is that the more Nitrogen-15 there is found in a fossil bone, the higher up on the food chain they air...however, there are plenty of factors that contribute to high N-15 values, which might include airidity, agricultural mechanisms (ex: corn with the ancient maya, who scored VERY high on the N-15 test despite their huge reliance on corn), and due to severe climate changes.

How long ago did agriculture appear?

~10,000 years ago