Nutrition exam 4

Weight loss diets

-Balance low calorie/portion control diets (WW, Jenny Craig, Nutrisystem) -Low-carb/keto diets (Atkins, South Beach, Zone) •<40 - 100 grams of carbs per day -Low-fat diets (Pritikin, Ornish) •<20 grams of fat per day -Novelty diets (Intermittent Fasting, Princeton diet, Paleo diet) -Quack/fad diets (Grapefruit, Cleansing diets) -Very low-calories diets (Slimfast) •500-700 Calories per day

Phosphorus functions

-Bone and teeth development and maintenance -Main intracellular anion -Part of ATP (energy formation), DNA, RNA, phospholipids -Role in acid-base balance

Major mineral deficiency

-Calcium, potassium and magnesium most common in U.S.

Energy expenditure indirect calorimetry

-Collecting expired air during activity -Factors that effect BMR •Muscle mass, body surface, gender, environmental conditions, thyroid hormones, stress, growth, caffeine, tobacco, exercise, dieting, age •Some weight loss drugs speed up metabolism

Calcium potential benefits

-Colon cancer prevention -Protects against formation of oxalate kidney stones -Lowering of blood pressure -Prevention of stress fractures, shin splints, bone spurs and osteoporosis

Blanket recommendation for prevention of hypertension

-Control weight -Consume a nutritious diet -Exercise regularly -Moderate alcohol intake -Hold salt intake to below recommended levels

Calcium foods

-Dairy (milk, yogurts, cheeses), fortified orange juice and cereals, green leafy vegetables, canned fish, tofu -Bioavailability issues (5-70%)

Nutrition factors for lowering blood pressure

-Decrease salt/sodium intake -If overweight, lose weight -Alcohol in moderation -Increasing intakes of fruit, vegetables, fish, and low-fat dairy products (potassium and calcium) -Reducing intakes of fat, except omega 3 PUFAs

Energy expenditure thermic effect of food

-Digestion, absorption, metabolism of food and nutrients -Protein rich meal > carbohydrate rich meal > fat rich meal -Larger meals -5-10%

Chloride functions

-Electrolyte (main anion in blood) -Nerve transmission, stomach acid, immunity, acid-base balance

Potassium foods

-Fresh or frozen fruits and vegetables, beans, milk, whole grains, coffee, tea, potatoes

Magnesium foods

-Green leafy vegetables (part of chlorophyll), butternut squash, beans, nuts, seeds, whole grains, and cocoa

Energy expenditure adaptive thermogenesis

-Heat production -Triggered by extreme cold, overfeeding, trauma, starvation -Activities include fidgeting, shivering

Sodium functions

-Helps the absorption of glucose and some amino acids -Normal muscle and nerve function -Water balance •Electrolyte (major cation in blood) -Preservative for many foods and flavor enhancer

Potassium toxicity

-Hyperkalemia (also life-threatening) -Poor kidney function

Potassium deficiency

-Hypokalemia (life-threatening); caused by some diuretics (hypertension medications)

Negative consequences of weight cycling (yoyo dieting)

-Increased upper body fat (increase activity of thrifty gene each time) -Diminished self-esteem -Decline in HDL -Decline in immune system function -Reduced BMR •Easier to regain the weight each time

Even mild hypertension can be dangerous

-Individuals who adhere to treatment are less likely to suffer illness or early death -Some people need medications to bring their blood pressure down •Diet and exercise can bring improvements for many and prevent hypertension for others

Trace minerals deficiency

-Iron, zinc, and iodine most common in U.S. and worldwide

Magnesium deficiency

-Irregular heartbeat, weakness, muscle spasms, seizures

Magnesium functions

-Major cofactor (helps enzymes) in many biochemical and physiological processes (energy metabolism and protein, DNA and RNA synthesis); muscle relaxation

Phosphorus foods

-Milk, cheese, meat, bakery products (yeast), cereals, soda (phosphoric acid)

Major minerals

-Need 100 mg or more daily -Found in larger quantities in the body

Trace minerals

-Need in very small amounts daily -Found in much smaller quantities in the body

Calcium needs

-RDA & DV: 1,000 and 1,300 mg/day (higher in teenagers and older adults) -U.S. intake is lower in women -45% of adults use calcium supplements

Phosphorus needs

-RDA & DV: 1,000 mg/day (about equal to calcium)

Magnesium needs

-RDA & DV: 400 mg/day -Fewer than 25% of US adults meet RDA

Phosphorus deficiency

-Rare (bone loss, decreased growth and poor tooth development)

Sodium deficiency

-Rare (hyponatremia): due to water intoxication

Phosphorus toxicity

-Rare (promotes calcium loss from bone and soft bones)

DASH diet (Dietary Approaches to Stop Hypertension)

-Recommends significant increases in fruit and vegetable intakes (7 - 10 servings per day) -Provides no more than 30% of its calories from fat (mostly MUFAs and omega 3s) -Emphasizes legumes (nuts and beans) over red meats for protein -Restricts salt

Calcium absorption and storage

-Stomach acid and vitamin D increase absorption •Can check calcium supplements by adding to 1 cup of vinegar for 15 minutes -Breaking supplement into 2 or 3 times per day increases absorption •More consumed, less absorbed -99% stored in bone and teeth •Along with phosphorus and fluoride -Blood calcium levels tightly regulated by parathyroid hormone (PTH) and calcitriol (1,25-dihydroxyvitamin D) (steroid)

Sodium foods

-Table salt (1 tsp = 2300 mg) (10-15% of intake is added during cooking or at the table), processed foods (breads, cereals, pasta, chips, deli meats, cheeses), canned soups and vegetables, salted nuts, red meat, cafeteria/restaurant foods, soft water, soups, marinates

Sodium toxicity

-UL: 2,500 mg (hypertension, stomach cancer)

Energy expenditure of physical activity

-Varies greatly day to day -Being active or inactive determines much of our daily energy expenditure -25-40%

Water in foods

-Water (bottle and tap; soft and hard), fruits and fruit juices, vegetables, tea, coffee, milk, soda •Caffeinated beverages may not lead to dehydrationbut alcoholic beverages can -Stronger diuretic

Potassium functions

-Water balance, electrolyte (major cation inside cells) -Normal muscle and nerve function -High intake suppresses renin-angiotensin system and promotes excretion of sodium (lower blood pressure)

Chloride foods

table salt

Water toxicity

water intoxication -Caused by: drinking water in excess without electrolytes when exercising; kidney failure -Leads to: Hyponatremia •Headache, blurred vision, muscle cramps, convulsions, and death

HDL's role

•HDL -Produced by the liver and SI -Roams the bloodstream •Picks up cholesterol from cells and transports cholesterol back to liver for excretion (~100%) •Activates lipoprotein lipase to remove triglycerides from blood to cells -Helps to block the oxidation of LDL •Slows development of cardiovascular disease

Muscle Glycogen vs blood glucose

•Muscle glycogen fuels muscle cells -Higher % of energy in anaerobic activities; decrease use overtime in aerobic activities •May increase later in the activity •Liver glycogen maintains blood glucose and provides fuel for muscle cells and other cells in longer duration exercises (>30 min) •Depletion of glycogen stores: -In muscles: fatigue -In liver: hypoglycemia -In both: "Hitting the wall" (exhaustion)

Maintenance of Fluid Balance

controlled by solute concentrations via -transmembrane pumps -osmosis

Body response to physical activity

•Most pronounced effects are seen in the: -Muscular system (increase muscle mass) -Circulatory system (increase heart function) -Respiratory system (increase lung function) -Skeletal system (increase bone mass usually) •As long sex steroid balance is maintained

Transmembrane pumps

•Moves chemicals or ions against concentration gradient •Keeps normal water volume and electrolyte concentrations -Sodium-Potassium pump

Calcium toxicity

-2500 mg -Hypercalcemia can lead to kidney stones (genetics) and tetany (muscle cramps)

Magnesium upper level

-350 mg from supplements and nonfood items only

Ideal blood pressure is 110/70

-A reading of 120/80 to 139/89 can be considered borderline •Especially in the absence of other risk factors •Sometimes this is called prehypertension -Above this level the risks of heart attacks and strokes rises in direct proportion to increasing blood pressure

Sodium needs

-AI: 1,500 mg/day (under age 51) -DV: 2,300 mg/day

Water needs

-AI: 10 - 15 cups per day (3000 mL) •Vary with body size, physical activity, environmental conditions, and diet -Based on 80% fluid intake, 20% food intake -Needs met when intake = output

Chloride needs

-AI: 2,300 mg/day -DV: 3,400 mg/day

Potassium needs

-AI: 4,700 mg/day -DV: 4,700 mg/day -Typical U.S. adult intake falls well below

% body fat

Category Males Females Normal 20-30 Borderline 31-33 Obesity >33 Males Normal 12-20 Borderline 21-25 Obesity >25

Energy expenditure direct calorimetry

Measures body heat released

Growth chart <20 years old

Underweight Less than the 5th percentile Healthy weight 5th percentile to less than the 85th percentile Overweight 85th to less than the 95th percentile Obese Equal to or greater than the 95th percentile

Water deficiency

dehydration -Caused by: diarrhea, vomiting, fever, exercise, burns, frequent urination (diuresis), Type I diabetes -Leads to: dry mouth, thirst, decreased urine output or concentrated dark urine, headaches, dizziness, fainting, eventually coma and death

Chloride deficiency

electrolyte imbalance maybe due ti excessive vomiting

Prevalence and susceptibility of eating disorders

•6 to 10 times more common in females -Up to 5% of women in US will develop some form of anorexia nervosa or bulimia nervosa •A person maybe be more susceptible due to -Family status or genetics (common between siblings) -Have other psychological problems •Depression •Substance abuse or addiction •Anxiety disorders -Playing certain sports •Many eating disorders start with a simple change in diet (weight loss; vegetarianism) -May get out of control because of stress, dysfunctional family relationships, drug abuse •Eating disorders develop 85% of the time during adolescence and early adulthood -High school or college; early during marriage

Diabetes Mellitus

•7th leading cause of death (34% of Americans + 7 million don't know it)) •Three major forms of diabetes -Type I DM -Type II DM -Gestational Diabetes (during pregnancy) •Diagnosis: -Fasting blood glucose level >125 mg/dL or nonfasting >200 mg/dL (hyperglycemia) -Blood hemoglobin A1c level >6.5% -Abnormal oral glucose tolerance test (OGTT)

Protein

•A minor fuel source (used by other cells, not muscles) during most exercises (5%) -More in endurance long duration exercises (up to 15%) •Energy comes from the branched chain amino acids released from muscle mostly -Directly or via gluconeogenesis (liver) to make glucose •Eating more protein than what the body needs alone will not increase muscle mass -Exercise is needed as well

Preventing and Treating CVD

•AHA Step 2 Diet -Low calorie and cholesterol with healthy fats -Total fat 20-35% total calories -SFA < 7 % total calories -Trans fat < 1% -PUFA 7 - 10% total calories (2:1 omega 6 to omega 3 ratio) -MUFA 15 - 20% total calories -Cholesterol < 200 mg daily •2 grams plant stanols/sterols daily •Soluble fiber intake of 3 grams -Whole oats and oat bran health claim •Low sugar intake •Soy protein (25 g) -Health claim •Keep body weight at a healthy level •Increase physical activity

Energy sources for muscle use

•ATP: Immediate usable energy -First 5 seconds or so •Phosphocreatine (creatine phosphate): initial resupply of muscle ATP -Stored in muscle -Re-forms ATP -Concentration in muscle is 5 times greater than ATP •Last roughly 5 minutes or so -Made from amino acids from the diet; some people take creatine supplements

Adaptation of body to Exercise

•Aerobic exercise benefits the circulatory system -More red blood cells are produced -Blood volume is increased -Increased number of capillaries in muscle tissue -Heart muscle strengthens -VO2MAX increases •Bone density may also increases with weight-bearing exercises (better in males) •Lack of exercise leads to muscle atrophy

Raising HDL levels

•Aerobic exercises (increase physical activity) •Hormone/Estrogen Replacement Therapy in postmenopausal women •Alcohol in moderation •Higher MUFA diet with some cholesterol (200 - 400 mg) •Nicotinic Acid

Food sources of minerals

•Animal sources are richest and have the best bioavailability; compounds in plants may diminish bioavailability •Quantity of minerals in plants is influenced by agricultural practices and food processing -The more refined, the less minerals •More foods are being enriched or fortified -Iron is added back to refined wheat products (enriched) -Table salt has iodine added (fortified) -Orange juice may have calcium added (fortified)

Energy expenditure

•Basal metabolism (BMR) (60-70%) -Minimum amount of energy used in a fasting state -Resting metabolism (RMR) •Non fasting measurement; 6% higher than BMR •Calculation: 0.9 kcal/kg BW per hour women 1.0 kcal/kg BW per hour men •Mifflin-St. Jeor -Men: (10 × weight in kg) + (6.25 × height in cm) - (5 × age in years) + 5 -Women: (10 × weight in kg) + (6.25 × height in cm) - (5 × age in years) - 161

Type 1 DM (5% of cases)

•Beta cells are destroyed leads to insulin deficiency (autoimmune disease) -Treatment: insulin therapy multiple times per day (Insulin-Dependent DM) •Children (6-12 years) mostly (Juvenile Diabetes) -Many adults develop it from pancreatic failure •Develops fairly rapidly (over a few weeks) -Symptoms: very sick, ketosis/ketoacidosis, severe weight loss, thirst, frequent urination, hungry •Consumption of dietary carbohydrates must be coordinated with insulin therapy -Total carbohydrates not just sugar (Exchange system, carbohydrate counting)

blood pressure

•Blood pressure -High blood pressure presents no symptoms "silent killer" -Systolic pressure •The first figure in a blood pressure reading •Reflects arterial pressure caused by contraction of the heart's left ventricle -Diastolic pressure •The second figure in a blood pressure reading •Reflects the arterial pressure when the heart is between beats

Calcium functions

•Bone and teeth development and maintenance -Cortical and trabecular/spongy bone (hydroxyapatite; calcification of collagen) •Blood clotting •Nerve impulses •Muscle contraction •Regulate cell metabolism

Cancer

•Cancers are 2nd leading causes of death in U.S. •Many nutrients, phytochemicals, and zoochemicals may help prevent cancers but not treatment -Antioxidants (vitamin C, vitamin E, carotenoids, polyphenols and selenium) -Calcium -Vitamin D -Insoluble Fiber (whole grain wheat, rice, corn) •Excessive fat, sugar, alcohol and calorie intake increase risk

Complications of DM

•Cardiovascular disease -Erosion of the artery walls (atherosclerosis) -Peripheral artery disease very common •Neuropathy •Kidney failure and possible dialysis •Retinopathy -Cataracts and blindness (due to glycated proteins and sugar alcohol toxicity) •Infections and poor wound healing -May lead to amputations

Type 2 DM (90% of cases)

•Characterized by insulin resistance -Insulin production may be normal or even high •Adults mostly (Adult Onset) -Effects more children than Type I •Slow (silent), progressive disease associated with overweight/obesity and genetics (no symptoms) •Develops into pancreatic failure after many years •Treatment: -Diet and possibly weight loss -Physical activity -Oral hypoglycemic medications (Metformin, Rybelsus)

Hypertension

•Chronic high blood pressure (>140/90) remains one of the most prevalent forms of CVD -Affects almost one-third of the entire U.S. adult population •For people age 65 or older, the lifetime risk of developing hypertension approaches 90% -Contributes to half a million strokes and over a million heart attacks each year

Osteoporosis

•Decrease bone mass or density -Low bone mass: osteopenia (common in older adults) -Very low bone mass: osteoporosis (women more than men) •Bone fracture (hip, wrist, vertebrae) •Kyphosis (Dowager's hump) •Diagnosis -DXA Scan (bone density) •Usually lower lumbar region and hip measured -Bone densitometer •Heal or forearm -X-rays (fracture) •Prevention (most important from 15 - 30 years of age) -Bone building nutrients •Vitamins D and K, calcium, phosphorus and soy protein most important -Moderately active lifestyle with weight-bearing activities •Be careful of over doing it -Decrease smoking, alcohol, caffeine or soda consumption -Hormone Replacement Therapy •Postmenopause, early hysterectomies

Prevention of eating disorders

•Discourage restrictive dieting, meal skipping, and fasting •Encourage children to eat only when hungry •Promote good nutrition and regular physical activity •Promote regularly eating meals as a family •Provide information about normal changes during puberty •Correct misconceptions •Carefully phrase weight-related comments •Don't overemphasize numbers on scale •Increase self-acceptance •Encourage coaches to be sensitive to weight and body image •Emphasize thinness is not associated with athletic performance •Enhance tolerance for diversity •Encourage normal expression of emotions •Build respectful environments •Provide some levels of independence, choice, responsibility, and self-accountability

Professional help for weight control

•Doctors are the first professional to see for weight control -May recommend a registered dietician, nutritionist or exercise physiologist •Dietician or Nutritionist -Understand food composition and psychological importance of food •Exercise physiologist -Can provide advice about appropriate physical activity routines •Drug treatments -Appetite suppressors and amphetamine-like medications •Phentermine, Meridia, Methamphetamine -Inhibit digestion or absorption •Xenical/Alli -Increase fat burning (certain supplements and extracts) •Fastin -Side effects of other drugs •Wellbutrin, Diuretics •Surgery: severe restriction on amount of food consumed and nutrient absorption; leads to Dumping Syndrome -Gastroplasty (removal of whole or part of stomach) •Gastric sleeve -Gastric bypass/stomach stapling •Roux-en-Y -Laparoscopic Gastric Banding -AspireAssist device -Vagal Nerve Blockade

weight loss maintenance

•Eat a low-fat, low-calorie diet •Don't skip breakfast •Self-monitor -Regular weighing once per week -Keep a food journal -Reduce behavior risks (watch less than 10 hours of TV per week) •Have a physical activity plan -Exercise at least 1 hour per day

EDNOS

•Eating disorders that do not meet the strict diagnostic criteria of AN or BN -Binge-eating disorder •Obesity -Athlete Triad (gonadal dysfunction, anorexia, and bone disorders); similar to AN but don't have the body image distortion -Athletica Anorexia (both male and female athletes trying to meet a weight guideline (wrestling, boxing) •Occurs for brief amount of time (in season only)

Energy equilibrium

•Energy intake equals energy expenditure •Weight maintenance

Positive energy balance

•Energy intake greater than energy expenditure •Leads to growth, gaining weight

Negative energy balance

•Energy intake less than energy expenditure •Leads to weight loss

Dietary advice for athletes

•Energy: maintain weight •Carbohydrate -3-10 g/kg body weight based on sport •Long duration sports need more carbohydrates -Boosting Glycogen Stores •Carbohydrate (Glycogen) Loading -Reduce carbohydrate intake and exercise normally for a few days followed by reduced exercise and increased carbohydrate intake •Fat: healthy dietary fat -15-25% of kcal (doesn't really change) -Important for weight maintenance •Protein: maintenance of muscle mass -1.2-1.7 g/kg body weight -Higher end for those trying to gain weight or increase muscle mass •Vitamins and Minerals: no need for supplements usually (eating more food to maintain weight) -Iron deficiency or anemia leads to impaired performance -Calcium, vitamin D and the Female Athlete Triad: bone health (low fat mass and amenorrhea) -Potassium, magnesium (prevent muscle cramps)

Estimated energy requirements

•Estimated energy requirements -Men: 662 - (9.53 x age) + pa x ([15.91 x wt] + [539.6 x ht]) -Women: 354 - (6.91 x age) + pa x ([9.36 x wt] + [726 x ht]) •(wt = kg, ht = m, age = years) •PA estimates

Measuring energy intake

•Estimated via nutrient databases or nutrient analysis software -24 hour recalls, 3 or 7 day records, food frequency questionnaires •Calories in foods can be: -Based on bomb calorimeter measurements •Total Calories per serving (food label) -Calculated using known fuel values •Fat 9 kcal/g •Carbohydrates 4 kcal/g •Protein 4 kcal/g •Alcohol 7 kcal/g

Mineral toxicity

•Excess mineral intake can be toxic and fatal -Iron and zinc are a special concern -Increase sodium consumption is associated with hypertension •Carefully consider supplementation -Higher intakes of 1 mineral may hinder absorption of others -Supplements may be contaminated with lead

Excretion of minerals

•Excretion is primarily in urine •Some may be excreted in bile •In kidney failure, mineral intake must be closely monitored to avoid toxicity due to reduced excretion

Fluid needs

•Fluids lost through sweat need to be replaced -Dehydration develops first -Heat exhaustion, heat cramps, heatstroke come quickly after •Fluid Intake -Goal is to lose no more than 2% body weight during activity -Based on urine color (colorless to dark yellow/orange) -Thirst - a late sign of dehydration -Drink plenty of fluid before, during and after exercise •Water Intoxication -Consuming water without replacing electrolytes (sodium; hyponatremia and potassium) and sugar •Sports Drinks -Carbohydrates (various sugars), amino acids and electrolytes

Factors that affect body weight and composition

•Genetics (40-70% of weight differences) -Thrifty gene •Gene that leads to fat storage especially during starvation conditions -Set point theory •Gene that balances body weight before and after weight loss or gain -Many individual genes may cause obesity •Leptin deficiency •Environment (income, education, culture, lifestyle) -These may behave differently in different ethnicities, race, gender •Genetic and environment synergy -Genetics have not changed over the last 50 yrs •Diseases/disorders and medications -Cushing's Disease (excess cortisol) -Steroids, insulin

Guidelines for health

•Healthy People 2030 objectives include: -Reduce the number of adults engaging in no leisure-time physical activity -Increase the proportion of adults who meet current federal physical activity guidelines for aerobic and muscle-strengthening activity •2008 Physical Activity Guidelines for Americans -Engage in 150 min of moderate or 75 min of vigorous aerobic activity, or some combination per wk -Perform muscle-strengthening activities 2+ days per wk

Erogenic aids

•Intended to improve exercise performance or recovery (most are ineffective) •Useful in some circumstances -Protein powders/shakes (caseinate, whey, soy, etc...) -Creatine, sodium bicarbonate and caffeine •Questionable, still under study -Hydroxymethylbutyrate (HMB), glucosamine, branched chain amino acids, glutamine •Dangerous and/or illegal -Anabolic steroids (androstenedione, DHEA), growth hormone (HGH), blood doping, gamma-hydroxybutyric acid (GHB)

Cholesterol Removal from blood

•LDL is the major transporter of cholesterol •Most cells remove cholesterol from blood via LDL receptors, especially liver cells (70%): -Once in cell, LDL is broken down •If cholesterol saturates cell, LDL receptor stops removing cholesterol from blood -Leads to increase LDL cholesterol in blood •Which can be oxidized/damaged •Antioxidants attached to LDL may help prevent •If oxidized LDL builds up in blood stream -Scavenger receptors on macrophages remove oxidized LDL from blood •Leads to atherosclerosis: -Starts with an injury to artery wall (occurs daily) -Macrophages sent to injury site to repair -However, as oxidized cholesterol builds up in macrophages it kills them •Plaque develops Atherosclerosis Occlusion -Eventually may break lose and form blood clot or aneurysm

Definition of obesity

•Life Insurance Tables: ->124% IBW for males = obesity ->120% IBW for females = obesity •Waist circumference: -> 40 inches male or > 35 inches female = Central Obesity •Waist: hip ratio -> 0.9 = Central Obesity

Fat

•Main fuel during rest or longer, low-moderate intensity exercises •Fat catabolism provides more energy than carbohydrates but is less efficient -Only burned as an energy source aerobically •Training affects muscle use of fatty acids -The more trained, the greater efficiency -Training increases: •Size and number of mitochondria •Levels of enzymes for aerobic metabolism •Muscle myoglobin (stores O2)

Water

•Maintaining the right amount of water in the body is essential to life •Adults can survive several weeks without food, but only days without water •There are no stores for water in the body, like for the other macronutrients •About 55% of adult's body weight is water -Lean individuals have greater percentage -Associated with muscle mass and glycogen •Found in 2 compartments -Intracellular Fluid •2/3 of the body's water -Extracellular Fluid •Interstitial (between cells) and blood •Body fluids also contain solutes -Chemicals dissolved in water •E.g., Electrolytes: Cations and Anions (minerals)

Functions of water

•Maintenance of blood volume -Directly influences blood pressure •Transport of nutrients •Involved in metabolic reactions •Temperature regulation •Fluid synthesis (affected most by dehydration) -Saliva (dry mouth) -Urine (darker) •Typical urine output is 4.5 to 8.5 cups/day

Carbohydrate

•Major fuel for most forms of exercise •Glycogenolysis first then glycolysis •Short or high intense activities (more anaerobic) -Glycolysis provides energy for 30 sec to 2 min -Lactate produced •Longer and less intense activities (more aerobic) (also includes CAC and RC) -ATP supply is produced slower but in greater amounts

Bulimia nervosa

•Many are never diagnosed because symptoms and signs are not obvious -Eat alone, isolated •At or slightly above normal weight •Frequently female and successful in work and home -Perfectionist •1/3 of individuals with anorexia nervosa cross over to bulimia nervosa •Turn toward food when faced with problems -Recognize their behavior as abnormal but have difficulty controlling it •50% may have depression as well •Diagnostic Criteria -Recurrent episodes of uncontrolled binge eating -Followed by inappropriate compensatory behavior -Both occur at least twice a week for 3 months -Abnormal perception of body weight or shape

Absorption and Bioavailability

•Many factors influence if a mineral will be absorbed -Need -Bioavailability -Amount consumed in one sitting

Eating disorders

•Medical and psychological condition •More severe distortion of eating process due to distorted body image or weight goal •May develop into life-threatening conditions (can be fatal) •Most common include: -Anorexia Nervosa -Bulimia Nervosa -Eating Disorder Not Otherwise Specified (EDNOS)

Treating CVD

•Mediterranean Diet •Eskimo Diet -Healthy fats and seafood; less meat, dairy and eggs •DASH Diet -Higher in fruits and vegetables •South Beach Diet -Low carb weight loss •Semi Vegetarian and Vegan Diets •Medications -Statins: reduce blood cholesterol levels -Fibrates: reduce blood triglyceride levels -Fish oil supplements: reduce blood triglyceride levels, blood clotting, and inflammation -Aspirin/blood thinners: reduce blood clotting and inflammation

Other blood sugar disorders

•Metabolic Syndrome (Prediabetes; fasting blood glucose = 100 - 125 mg/Dl, HgbA1c = 5.7-6.5%) -88 million Americans -Group of metabolic disorders (central obesity; high blood pressure; dyslipidemia) -Increase risk for developing Type II diabetes •Hypoglycemia (fasting blood glucose < 60 mg/dL) -Biggest effect on mood, behavior, and concentration -Reactive Hypoglycemia •Exaggerated insulin response (insulin shock in Type I DM) -Fasting Hypoglycemia •Low blood sugar during fasting (higher metabolism)

Measuring energy expenditure

•Metabolism (resting/fasting) •Physical Activity •Eating •Adaptation to environment

Disordered eating

•Mild, short-term changes in eating patterns -Occur in response to: •Stressful events •Illness •Desire to modify diet -May lead to changes in body weight and nutritional deficiency problems -Rarely requires medical attention

Anorexia nervosa

•Most common with female performers, models, athletes which require aesthetically pleasing/judging formats are most at risk •Diagnostic Criteria -Refusal to maintain body weight at or above 80% of IBW -Intense or irrational fear of gaining weight or becoming fat -Distorted body image -Females: amenorrhea (3 consecutive missed menstrual cycles)

Diabetes

•Normal blood glucose concentration: -Fasting = 70-100 mg/dL (nonfasting should be <140 mg/dL) -Regulated by various hormones •Insulin (beta cells of pancreas) -Helps move glucose from blood into cells following a meal (lowers blood glucose) •Glucagon (alpha cells of pancreas) and Cortisol (adrenal gland) -Helps maintain or raise blood glucose during fasting and physical activity -Breaks down liver glycogen and skeletal muscle protein for conversion into glucose

Cardiovascular disease

•Number 1 killer of Americans -Heart disease (1) and ischemic stroke (5) •Develops due to atherosclerosis •Risk factors for CVD -Age, gender, race and genetics (cannot change) -High blood LDL cholesterol and triglyceride levels, hypertension, smoking, physical inactivity, obesity, and diabetes (can change or prevent)

Bone development

•Osteoblast activity (forming) exceeds osteoclast activity (destroying) during times of growth and when bone is put under physical stress -Calcium recommendations are higher during these times -Estrogen is very important in teenage and young adult females •Bone remodeling is equal in adulthood •In older adults, osteoclast activity is more dominant, which can result in 25% bone loss and osteoporosis -Women can lose even more when estrogen levels fall during menopause

Benefits of being fit

•Physically active people have: -Improved cardiovascular health -Improved body composition, less fat more muscle mass (lose weight if overweight) -Lower blood glucose and better control -Better sleep -Healthier immune systems -Reduced risk of several cancers -Reduced mental stress -Increased brain activity

Food intake for event

•Pre-exercise meal (about 3 hours) -Don't want to feel hungry before or during event -High carbohydrate/low fiber, easily digested; non-greasy •Fueling during Exercise -Carbohydrate replenishment during events longer than 40 minutes improves performance •Sports drinks, gels, energy bars (not high protein), fruits •Recovery meals (carbs and protein) -Promote protein and glycogen synthesis -Within 30 minutes - 2 hours after exercise -1-1.5 g per kg/body weight

Nonsurgical treatments

•Require long term changes for success •Three key components of a good weight loss program -Reduce energy intake (↓300 kcal/day) •1 pound of adipose tissue contains approximately 3500 kcals (500 kcal/day) •Consume nutrient dense/low glycemic load diets, portion control -Increase regular daily physical activity (↑200 kcal/day) -Control bad eating behaviors •Behavior modification techniques •Weight-loss programs are considered successful when those involved remain at or close to weight loss BW (20%) for 5 yrs -Best results with 2-3 lbs loss per week (slow and steady) -Only about 5% of people following commercial diet programs are successful •Typically 1/3 of weight lost is regained within 3 years •Currently, only surgical approaches to obesity treatment routinely show success

Medications

•Should diet and exercise fail to reduce blood pressure, drugs such as diuretics and other antihypertensive agents may be prescribed -Drug therapy (diuretics [Lasix], Beta-blockers [Lopressor], ACE inhibitors [Fosinopril],calcium channel blockers [Vascor])

Regulation of water balance

•Small changes are compensated quickly by brain (hypothalamus) and kidneys •Body's response to a slight decrease in water or increase in solute levels is: -Hypothalamus activates pituitary gland to produce antidiuretic hormone (ADH) -ADH causes: •Kidneys to retain water •This increases blood volume (dilutes the increase solute level back down to normal) •May cause a slight rise in blood pressure •Larger changes are compensated by adrenal gland, liver, lungs and kidneys •Similar to body's response to reduced blood pressure -Renin-Angiotensin system •Renin (kidneys) converts angiotensinogen (liver) into angiotensin I •Angiotensin converting enzyme (ACE) (lungs) converts Angiotensin I into angiotensin II -Constriction of blood vessels -Releases aldosterone (steroid; adrenal gland) »Causes sodium retention which leads to water retention •End result is larger rise in blood pressure

Ideal body composition

•There is a recent shift from these height/weight tables and BMI to considering components of body weight and their relative proportions -Now recommended to evaluate: •% total body fat •Location of body fat •Diagnosed weight-related medical problems -High blood pressure, type II diabetes

Transport and storage

•Travel in blood in free form or bound to proteins (mostly for trace minerals) -Transferrin, ceruloplasmin •Trace minerals found in free form are highly oxidative and may produce free radicals and tissue damage •Storage varies -Calcium, phosphorus, and fluoride are stored in bones and teeth -Iron is stored in small amounts in liver and bone marrow -Iodine is stored in thyroid gland

Triglyceride removal from blood

•Triglycerides (fat) on chylomicrons (SI) (diet) and VLDL (liver; synthesis from carbohydrates and alcohol) are removed from blood via lipoprotein lipase •Lipoprotein lipase: -Found mostly in adipose tissue and skeletal muscle -Activated by HDL (fat goes from blood into cells for storage or energy) -Blood becomes less viscous

Measuring body fat

•Underwater weighing •Air displacement -BodPod® •Skinfold thickness •Bioelectrical impedance •Dual energy X-ray absorptiometry (DXA)

Body fat distribution

•Upper body (android) and central obesity are associated with (apple shape): -Heart disease and stroke -Hypertension -Type 2 diabetes •Seen in: -Males (androgens) -Diets with high glycemic load -High levels of alcohol intake •Female hormones (estrogen and progesterone) encourage storage of fat in lower body (gynoid; pear shape) -Smaller abdomen, waist -Larger buttocks (hips) and thighs •After menopause, estrogen levels fall -Encourages abdominal fat distribution in women

Characteristics of a good health/fitness program

•Utilizes various types of exercise -Aerobic, Resistance (anaerobic) and Flexibility •Longer duration; >30 minutes •Perform multiple times per week (2-5 times per week depending upon type) •Various intensities: low, moderate, high -Measured by: heart rate, perceived exertion rate, oxygen consumption •Includes progressions -Initiation phase (first 3 - 6 weeks) -Improvement phase •Easily built in to your daily routine •If sedentary for many years, should discuss a fitness program with a health-care provider first •Assess and record baseline fitness scores •Start slowly with shorter intervals •Include warm up and cool down periods (about 5 min each)

Osmosis

•Water moves from the side with a low solute concentration to the side with a higher solute concentration (dilution)

Body mass index

•Weight-for-height standard •Most commonly used -Convenient, easy, cheap Body weight (in kg) or Body weight (in lb) x 703 Height2 (in meters) Height2 (in inches) •Not appropriate for everyone -Does not apply to < 20 years old, > 70 years old, and pregnant and lactating women -May not be fully accurate for athletes, physical fit people •Underweight: BMI <18.5 •Healthy weight: BMI 18.5 to <25 •Overweight: 25 to <30 -Not necessarily a marker of overfat •Obese: > 30

Ideal body weight

•Weight-for-height tables have been used for the last 60 years to determine if weight is healthy -Estimation of body weight associated with health and longevity •Estimated healthy body weight calculation -Males: 106 lbs for 5 ft and 6 lbs for every 1 inch -Females: 100 lbs for 5 ft and 5 lbs for every 1 inch

Percent body fat from BMI

•Women (17 - 68 years) -Percent fat = 1.37 x BMI - 3.47 • •Men (17 - 68 years) -Percent fat = 1.34 x BMI - 12.47

Obesity in US

•~74% of adult Americans are overweight •~42.4% of adult Americans are obese •Highest among Non-Hispanic Blacks •~19.3% of children and adolescents ages 2-19 years are obese •Highest among Hispanics •~37% of children and adolescents ages 2-19 years are overweight