Mosbys Review Biochemistry, Nutrition and Nutritional Counseling Chp 12

What are important post eruptive effects of carbohydrates?

-Carbohydrates are the main energy source for oral cariogenic bacteria. -Streptococcus mutans synthesizes polysaccharides from glucose, which results in increased bacterial plaque formation. -Lactic acid and pyruvate acids are the end products of glycolysis for acidogenic bacteria. Depending on the conditions, acetyl coenzyme A (CoA) might be produced as well. FYI Carbohydrates would contribute to demineralization, not remineralization.

What are some biologic roles and functions of carbohydrates?

-Carbohydrates provide the precursor of structural and functional molecules. -Carbohydrates provide bulk and palatability to the diet. -Carbohydrates spare protein. FYI Fat provides energy at 9 kcal/g. Carbohydrates provide 4 kcal/g

Secondary lactose intolerance can occur as a result of what?

-Certain disease conditions that affect the gastrointestinal mucosa such as Crohn's disease result in temporary or permanent loss of lactase activity. This is considered secondary lactose intolerance. -Intestinal injury may result in secondary lactose intolerance. -Infections that cause injury to the gastrointestinal mucosa cause secondary lactose intolerance. FYI Congenital absence of lactase is considered primary lactose intolerance.

What is associated with dehydration?

-Diarrhea can cause dehydration. -Malfunction of kidneys is a sign of dehydration. -Blood loss can result in dehydration. FYI Sodium retention is associated with water intoxication—or too much water.

What can cause new carious lesions in a Charles teeth? He drinks coffee with sugar, has two meals a day and eats a lot of cheap convenient foods.

-Drinking coffee with sugar throughout the day could be a contributing factor to Charlie's new caries. After consumption of a liquid sugar, it takes healthy saliva approximately 20 minutes to neutralize acids in the mouth and raise the pH to a safe level. If Charlie is constantly drinking sugary coffee throughout the day, he is creating an opportunity for S. mutans to proliferate and produce an acidic oral environment for hours. -The timing of the sugared coffee is a contributing factor as well. Consuming cariogenic foods with a meal rather than between meals reduces cariogenic potential. Sipping on sugary beverages throughout the day puts individuals at increased risk of caries. -In addition to the sugared coffee, Charlie also consumed a diet of convenience foods, which is typically representative of a softer diet. Forms of food can have an impact on the development of new caries. Softer, sticker foods clear slowly from the mouth. It takes about 20 minutes for healthy saliva to neutralize acids in the mouth and raise the pH to a safe level. FYI Consumption of only two meals a day would not contribute to Charlie's increased rate of caries. Although three meals a day would provide a more balanced intake, it would not directly relate to caries risk.

What are some characteristics of fat soluble vitamins?

-Fat-soluble vitamins are not absolutely necessary in the diet every day. -Fat-soluble vitamins can be toxic with chronic excessive intake. -Intake in excess of the daily need is stored in the body. FYI Water-soluble vitamins are excreted in urine. Excess fat-soluble vitamins are stored in the body and are not readily excreted.

Describe water soluble vitamins

-Fat-soluble vitamins can be toxic with excessive intake; water-soluble vitamins are relatively nontoxic with excessive intake. -Water-soluble vitamins are sensitive to heat, light, and oxygen -Water-soluble vitamins are absorbed by both active and passive transport from the upper portion of the gastrointestinal tract. -Fat-soluble vitamins contain only carbon, hydrogen, and oxygen. Water-soluble vitamins may contain the elements carbon, hydrogen, oxygen, and nitrogen. In some instances, they may also contain cobalt or sulfur.

What are limitations of direct approach to nutritional counseling?

-Fostering client dependence is a limitation of the direct approach. -The fact the client is not involved in decision making is a limitation. -There is little chance of success if the client is not committed. FYI With the indirect approach (also known as the behavior modification approach) more time and effort are required to arrive at solutions to dietary problems. Therefore, this would not be a limitation of the indirect approach.

In a healthy individual, if the amount of glucose in the blood exceeds th4 bodys immediate energy needs, what can occur?

-In a healthy individual, glucose will be converted to fat and stored in adipose tissue. -In a healthy individual, glucose will be stored as glycogen in liver and muscle. -Excess glucose can be converted to keto acids to be used in protein synthesis. FYI Excess glucose is not excreted in urine unless an individual is diabetic or has renal disease

What nutrients are lower in edentulous patients?

-Intake of magnesium is commonly lower among edentulous individuals. -Intake of folic acid is commonly lower among edentulous individuals. -Intake of zinc is commonly lower among edentulous individuals. FYI Vitamin B12 is often not properly absorbed in individuals age 70 years. However, this is related to the physiologic inability to properly absorb vitamin B12 in the small intestine, not because of limited mastication.

The DH asks Maria to fill out a dietary intake questionnaire with the assistance of her mother. This type of assessment tool has may advantages. What would be the best rationale to have her fill out this questionnaire?

-It would be beneficial to fill out the questionnaire to allow a more in-depth evaluation of Maria's sugar intake. Although Maria's mother reports that her daughter does not consume any sugar-sweetened beverages, she may not be aware of the natural and hidden sugars in foods, so it would be beneficial to review Maria's diet and circle those sugar-containing items in red. FYI -It is true that the questionnaire can be filled out by the client in the oral health care setting, but this is not the best rationale for use. -Yes, it only takes 15 to 20 minutes to complete the questionnaire, but this is not the best rationale for use.

Soluble fibers regulate the use of sugars and slow down gastric emptying. What are some examples of soluble fibers?

-Pectin is an example of a soluble fiber. -Oat bran is an example of a soluble fiber. -Mucilages are examples of soluble fibers. FYI Lignin is an example of an insoluble fiber.

What are signs of an eating disorder?

-Perimylolysis is the erosion of the lingual surfaces of teeth caused by regurgitation of stomach acids. -Severe weight loss occurs primarily in individuals that are anorexic, refuse to eat food, or limit their calorie intake. -Lanugo is a fine, downy hair that commonly develops on anorexic individuals; it is a protective mechanism to keep the body warm. FYI Although, individuals with periodontitis may not be taking in a proper diet, the occurrence of periodontal disease in an individual is neither a sign nor a symptom of disordered eating.

What are some examples of proteins various roles in oral biology?

-Proteins maintain the integrity of pulpal tissue throughout life. -Proteins are essential for all cells in growth, development and maintenance of the periodontium. -Proteins are essential for the normal function of cellular defenses against subgingival bacteria and toxins. FYI Lipids provide a coating on the tooth's surface and prevent retention of food particles.

What is some facts regarding Basal Metabolic Rate?

-The basal metabolic rate (BMR) is influenced by climate and altitude. The BMR is increased at higher altitudes. -The BMR should be measured while a person is awake, but at rest. -The BMR does not include the energy necessary for normal muscle activity. -The BMR should be measured with a room temperature of 68 to 77 degrees Fahrenheit.

Maria has several areas of incipient decay, what are the potential factors? She has 3 well balanced meals a day, she consumes 3-4 glasses of fruit juice during meal and snack time. Sugar containing foods are not kept at home.

-The form of foods consumed is a consideration of caries risk. Sugar sources are categorized as liquid sugar, solid or sticky sugars, and slow-dissolving sugars. Solid and sticky foods put an individual at greater risk of carious lesions. Although, the other forms of sugars contribute to risk—its more the timing and frequency of those sources that pose a concern. In this scenario, Maria is consuming 100% fruit juice on a daily basis (frequency) and she is consuming the juice with meals and between meals (timing) -Frequency of foods consumed is a consideration of caries risk. -Timing of foods consumed is a consideration of caries risk. FYI Amount of food consumed would NOT be a consideration of caries risk.

A persons body mass index (BMI) of ______ is considered overweight.

A body mass index (BMI) of 25.0 to 25.9 is considered overweight. FYI -A BMI of 18.5 to 24.9 is considered normal weight. -An individual with a BMI of 30.0 to 34.9 is considered obese, class II. -An individual with a BMI >40 is considered extremely obese.

What is a requirement of persons with type 2 diabetes only?

A specialized diet is required only for those with type 2 diabetes. FYI -Routine blood testing is required by individuals with both type 1 and type 2 diabetes. -Daily injections of insulin are only required by individuals with type 1 diabetes. -Routine urine testing to monitor ketone levels is only required by individuals with type 1 diabetes.

What condition can a primary nutrient deficiency occur?

Accessibility to food can result in a primary nutrient deficiency. If nutritious foods are not available to individuals because of transportation or market supplies, this increases risk of primary deficiency of certain vitamins and nutrients. FYI -Drug nutrient interactions exemplify secondary nutrient deficiencies. -Allergies or sensitivity to certain foods could result in a secondary nutrient deficiency. -Metabolic disease that interferes with the digestion and use of certain foods and nutrients could result in secondary nutrient deficiency.

Biochemical disturbances occur as a manifestation of primary and secondary deficiencies. What are some facts about biochemicals?

Biochemical disturbances can occur if the duration of deficiency is long enough to deplete the body's stores and interfere with cellular metabolism. FYI -A gradual decrease in the tissue level of nutrients is the earliest sign of malnutrition. -Anatomic lesions are determined by clinical examination of body tissues. -Anatomic lesions present as signs of chronic and severe malnutrition.

True/False? Anabolic hormones are metabolic regulators that raise the blood glucose level. Catabolic hormones lower the blood glucose level.

Both statements are false. The first statement is false. Anabolic hormones actually lower the blood glucose level. Insulin is an example of an anabolic hormone. The second statement is also false. Catabolic hormones such as glucagon, epinephrine, thyroxine, and adrenocorticotropic hormone (ACTH) raise the blood glucose level.

True/False? Increased caries rate is attributed to a deficiency of vitamin D. Pulp calcification can occur if an excess of vitamin D exists?

Both statements are true. The oral manifestations of vitamin D include increased caries rate, loss of lamina dura around the roots of the tooth, failure of bones to heal, delayed dentition, and loss of alveolar and mandibular bone. Nutrient excess of vitamin D could result in pulp calcification and enamel hypoplasia.

Cholesterol is a precursor of many steroid compounds and a constituent of cell membranes. Cholesterol comes from what sources?

Cholesterol comes from both exogenous and endogenous sources. The foods of animal origin that are consumed daily provide exogenous sources of cholesterol. The body synthesizes cholesterol endogenously at the rate of 1 to 2 g/day. FYI Plant-based foods are not sources of cholesterol.

De novo synthesis is an anabolic process that requires what?

De novo synthesis requires deoxyribonucleic acid (DNA), messenger ribonucleic acid (mRNA), and ribosomal ribonucleic acid (rRNA) FYI α-Keto acid is a catabolic byproduct of protein metabolism that is used as a metabolic fuel for immediate energy needs or for long-term energy storage as fat. It is not involved in de novo synthesis, which is an anabolic process of protein metabolism.

What best describes the dietary reference intake (DRI)?

Dietary reference intake (DRI) values are based on the observed average or experimentally set intake by individuals that appear to sustain a defined nutritional status. FYI -The recommended dietary allowance (RDA) is the intake level sufficient to meet nutrient requirements of nearly all healthy individuals. -The estimated average requirement (EAR) is the nutrient intake value that is estimated to meet the requirements of half of the healthy individuals in a group.

What dietary habit is most likely to contribute to caries risk?

Frequency of simple sugar consumption is the most important risk factor for caries. The more frequent the exposure to sugar, the more cariogenic is the diet. FYI -Liquid sugar clears more readily from the mouth and is less cariogenic than sticky foods. -Combining foods with liquids and other noncarogenic foods during a meal is less cariogenic than a concentrated exposure to sweets between meals as a snack. -Total intake of simple sugars is not as great a concern as the frequency which those sugars are consumed.

______ is the synthesis of blood glucose from noncarbohydrate souces.

Gluconeogenesis is the synthesis of blood glucose from noncarbohydrate sources, including deaminated amino acids and the glycerol portion of lipids. FYI -Glycogenolysis is the breakdown of stored liver glycogen. -Glyconeogenesis is the synthesis of blood glucose from intermediary metabolites. -Glycolysis is a reaction that involves the burning of glucose for energy.

What is the immediate and preferred source of energy for cellular metabolism?

Glucose is the immediate and preferred source of energy for cellular metabolism. FYI -Protein can be used as an energy source when the blood glucose level falls. Amino acids can be converted into glucose after deamination by gluconeogenesis. -Fat can be mobilized from adipose tissue. Triglycerides are broken down into glycerol and fatty acids in the liver. The fatty acids are catabolized by -oxidation to acetyl-CoA. -Ethanol can be oxidized to acetaldehyde, which is then converted to acetyl-CoA.

What condition is characterized by excessive uric acid production?

Gout is characterized by excessive uric acid production leading to production of urate crystals deposited in the joints. FYI -Phenylketonuria, also known as PKU, is an inherited enzyme defect in which individual cannot metabolize phenylalanine found in nearly all proteins. -Homocystinuria and maple syrup urine disease are genetic disorders in which amino acid metabolism is altered; they are treated with low diets and synthetic amino acid formulas.

What monosaccharide is the most important physiologically?

Hexoses, which include glucose, galactose, and fructose, are the most important group physiologically. FYI -Trioses and tetroses are usually formed during intermediary metabolism. -Pentoses are important in nucleic acids and coenzymes, but they are not important physiologically.

What hormones are anabolic?

Insulin, growth hormone, and sex hormones are anabolic hormones. FYI Adrenocortical hormones are catabolic hormones.

Lipoproteins are responsible for carrying lipids throughout the body. What protein primarily carries cholesterol from the liver to peripheral sites?

Low-density lipoproteins (LDL) carry mostly cholesterol from the liver to peripheral body sites. FYI -Very-low-density lipoproteins (VLDL) carry endogenous triglycerides around the body. -Chylomicrons carry exogenous triglycerides around the body. -High-density lipoproteins (HDL) carry cholesterol back to the liver and can be elevated by exercise.

What dietary fibers play a role in lowering blood cholesterol?

Pectin, oat bran, and mucilages are soluble fibers, which play a role in lowering blood cholesterol. FYI Lignin is an insoluble fiber that gives structure to plant cell walls, adds softness to stools, and reduces contact with carcinogens by decreasing transit time through the colon.

What term refers to excessive thirst, a common sign of diabetes?

Polydipsia is a symptom of diabetes and refers to excessive thirst. FYI -Polyuria is a symptom of diabetes and refers to excessive urination. -Polyol is an alcohol that contains multiple hydroxyl groups. Sugar alcohols are an example. -Polyphagia is a symptom of diabetes and refers to extreme hunger.

Individuals with special needs have more periodontal disease compared with the general population. What is the most likely reason for this?

Poor oral hygiene and malocclusion are most likely contributing factors for Melissa's increasing pocket depths. The malocclusion may also be causing secondary occlusal trauma. FYI -Diet could contribute to her increased risk for periodontal disease, but it is not likely the cause in this scenario. -Fruit juice consumption is not likely to increased risk for periodontal disease. -Nutritional deficiencies could contribute to her increased risk for periodontal disease but is not likely the cause in this scenario

What is true regarding the diet of individuals who are edentulous or who have limited mastication b/c loss of teeth?

Reduced intake of fruit, vegetables, and meats is common among edentulous individuals or those with limited mastication because of loss of teeth. FYI -Dairy intake is not affected. Dairy may be limited in the diet of older individuals because of lactose intolerance but not because of limited ability to chew dairy foods. -Although whole grains may be reduced in the diet of older people, grains are soft and easy to chew, so these foods are not commonly eliminated from the diet. -Canned fruits and vegetables may be consumed, but generally, fruit and vegetable consumption declines in edentulous individuals or those with limited mastication because of tooth loss.

What is an example of a simple carbohydrate composed of two monosaccharide units?

Sucrose, fructose and glucose are simple carbohydrates. However, sucrose is composed of two monosaccharide units—glucose plus fructose. FYI -Glucose is a single unit monosaccharide that is the primary energy source for the body. -Fructose is a single unit monosaccharide found in honey and fruits. -Amylose is a straight chain homopolysaccharide. It is a complex carbohydrate.

What method of dietary assessment presents a true measure of intake and is suitable to use with individuals in the clinical setting?

The combination of a 24-hour recall and a food record diary presents a truer measure of dietary intake than either of these alone. Each of these can be used with individuals in the clinical setting. FYI -A food frequency record asks how often food items are consumed. It works best with large groups in a community setting. -Food record diary is a more exact account of everything eaten in a specific period. This can be implemented with individuals in the clinical setting. Food frequency questionnaires are more commonly used with large groups in a community setting. -Multiple 24- hour recalls would not be beneficial. The 24- hour recall is useful for individual counseling in the oral health care setting but does not represent a usual diet.

True/False? Body water, as a percentage of body weight, increases with age. The majority of body water is intracellular.

The first statement is false. Body water actually decreases with age. The second statement is true. The majority of water is distributed intracellularly with the remainder being extracellular.

True/False? Vitamins are inorganic substances that are essential to life. Megadoses of vitamins may result in toxicity of one or many nutrients and inhibition of others.

The first statement is false. Vitamins are organic substances that are essential to life. Minerals are inorganic elements essential to life. The second statement is true. Megadoses of vitamins, as well as minerals could result in toxicity of one or many nutrients and inhibition of others.

True/False? Anorexia bulimia is a condition of binging and purging most commonly seen in adolescent females who appear normal in weight. Anorexia nervosa occurs more commonly in females form lower socioeconomic groups who are typically underachievers.

The first statement is true. Bulimia is a condition of binging and purging most commonly seen in adolescent females who appear normal in weight. The second statement is false. Anorexia nervosa does not occur in females from lower socioeconomic groups who are typically underachievers. Instead, this form of disordered eating is more commonly seen in middle to upper income adolescent females who are overachievers.

True/False? Negative nitrogen balance indicates net protein breakdown. It occurs during childhood, pregnancy, and recovery from undernutrition, surgery or illness.

The first statement is true. Negative nitrogen balance occurs when the intake is less than the output indicating net protein breakdown. The second statement is false. Negative nitrogen balance can occur during prolonged stress, anxiety, insufficient protein or energy intake or from fever and infection.

True/False? The RDA for digestible carbohydrates is 130 g/day. The minimum adult intake is 50-100 g to prevent use of body protein as an energy source.

The first statement is true. The recommended daily allowance (RDA) for carbohydrate intake is 130 g/day. The second statement is also true. To spare the use of body protein for energy, at least 50 to 100 g of digestible carbohydrate must be consumed daily.

True/False? Thermic effect of food (TEF) is the energy needed to digest, absorb, and metabolize food. Age, gender and body size are among a few of the factors that influence TEF.

The first statement is true. Thermic effect of food (TEF) is the energy needed to digest, absorb, and metabolize food. Age, gender, and body size are factors that influence the BMR, so the second statement is false.

What is the recommended fiber intake for adults?

The recommended amount of daily fiber intake for adults is 20-30 grams per day. FYI -50 g/day is recommended for diabetic adults. -35 to 40 g/day is recommended for adult with a family history of diet implicated cancer.

What is considered a non-essential amino acid?

Tyrosine can be synthesized by the body and does not need to be provided by the diet, so it is considered a nonessential amino acid. FYI -Histidine, methionine, and phenylalanine are considered essential amino acids because they cannot be synthesized by the body and must be provided by the diet.

What method of anthropometric analysis is the most accurate measurement for body volume?

Underwater weighing is the most accurate method to determine body volume. Body weight is measured while the individual is partially submersed in water. FYI -Dual energy x-ray absorptiometry (DEXA) can distinguish among fat mass, fat free mass, and bone mineral loss. -Skinfold thickness measurement is obtained by using skinfold calipers to measure subcutaneous fat. Measurements are compared with standards to estimate total body fat composition. -Bioelectrical impedance and ultrasound methods are potential predictors of total body fat. Lean body mass conducts electricity better than fat mass does.

What role does Vitamin C have in tooth formation?

Vitamin C is involved in the hydroxylation of proline and lysine in collagen synthesis. FYI -Protein is involved in the formation of matrix of dentin and enamel. -Vitamin A is important to the normal growth of dentin and enamel. -Vitamin D controls calcification of dentin and enamel.

Osteocytes function in the synthesis of the alveolus. They function in the process of bone apposition and resorption. What vitamins are important in the synthesis of the alveolus?

Vitamins A, C, and D are key vitamins in the ongoing process of bone apposition and resorption in the alveolus. FYI Calcium is a mineral (not a vitamin) that is important in the synthesis of alveoli.

Nutritive sweeteners are used by the body as an energy source. What is an example of a nutritive sweetener?

Xylitol is an example of a noncariogenic nutritive sweetener that is slowly fermented through anaerobic metabolism by oral bacteria. FYI -Aspartame, saccharin, and sucralose are non-nutritive sweeteners.