RD Exam Review - Principles of Dietetics (Advanced Nutrition)

Normal saline has ____ mEq sodium/L

154

How many mEq of sodium are in 1 gram of sodium?

43 mEq (1000 mg Na /23 × 1 = 43.5 mEq)

According to regulations, what is the most caffeine that can be in a 12-oz serving of soda pop? 21 mg 55 mg 71 mg 100 mg

71 mg The US Food and Drug Administration (FDA) regulates caffeine in soda. A 12-oz can cannot exceed 71 mg caffeine.

What is the main purpose of water in the body? A. it acts as a medium for cell metabolism B. helps transport Ca through cell membranes C. maintains electrolyte balance D. maintain body temp

A. it acts as a medium for cell metabolism* *B-D are true but not the main purpose

Kreb's Cycle

Acetyl CoA (from fatty acids, pyruvic acids, or degradation of AA) is the intermediate breakdown product of CHO, fat, and protein Oxaloacetate (From CHO and pyruvate) reacts w/ acetyl CoA to form citric acid (Starts the cycle) alpha-ketoglutaric acid (from AA through gluconeogenesis) needs thiamin for decarboxylation W/out enough oxaloacetate from CHO, acetyl CoA from fatty acids are diverted to form ketone bodies

Which amino acid is especially glucogenic?

Alanine Alanine is a glucogenic amino acid that constitutes a high percentage of the amino acids in most proteins. BCAAs, such as valine, leucine, and isoleucine can be converted to alanine. When muscle proteins break down in fasting, for example, alanine is released in relatively large quantity into the bloodstream and is taken up by the liver.

Alcohol digestion and absorption

Alcohol requires no digestion once in the body; it enters the bloodstream immediately through the stomach or small intestine lining. Simple diffusion is a process whereby a substance passes through a membrane without the aid of an intermediary such as an integral membrane protein. Carbon dioxide, oxygen, and ethanol are hydrophobic and pass through the membrane.

Identify the key antioxidant vitamins and antioxidant mineral

Beta-carotene Vitamin E Vitamin C Selenium

Botanicals used that affect blood clotting

Black cohosh - may cause clotting garlic - reduced clotting time (avoid w/ warfarin) Ginger - avoid w/ drugs that affect bleeding Ginkgo Biloba - avoid use w/ warfarin Ginseng - avoid w/ warfarin St. John's Wort - reduces effect of warfarin

vitamin B12

Bound by intrinsic factor in gastric juice coenzyme in protein synthesis forms RBC sources: liver, meal, milk, kidney, eggs, fish, cheese Deficiency: macrocytic, megaloblastic anemia, pernicious anemia (after gastrectomy or removal of ileum d/t lack of intrinsic factor); Schilling test is used to determine deficiency

Which non-essential compound is used to transport non-esterified long-chain fatty acids into the mitochondria for beta oxidation?

Carnitine Carnitine, found in most body tissues, is needed for the transport of fatty acids. This is especially true for long-chain fatty acids, which need carnitine across the inner mitochondrial membrane for oxidation.

Metabolic alkalosis (renal)

Cause: loss of hydrogen d/t loss of acid OR retention of sodium bicarbonate (diuretics) compensatory response: respiration decreased to retain CO2 and to increase carbonic acid (hypoventilation)

Metabolic acidosis (renal)

Cause: retention or production of too much H+, causing an increase in carbonic acid OR kidneys excrete too much base etiology: uncontrolled DM2, starvation, high fat/low CHO diet compensatory response: respiration increased to expel CO2 to decrease carbonic acid (hyperventilation, yawning, sighing)

Vitamin D

Cholesterol is a precursor UV light necessary hydroxylated in liver, then in kidney Needs bile salts, acidity of chyme for absorption Accompanies calcium and phosphorus absorption Sources: sardines, salmon, enriched cereals, tuna, fortified milk Deficiencies: rickets, osteomalacia

Thiamin

Contribute to maintaining mental function and help regulate metabolism Lost as temp or pH rises oxidation of CHO increased CHO, increased need sources: grains, pork, liver (overcooked pork destroys B1) Deficiency: beriberi, Edema and muscle wasting, MEMORY LOSS, muscle weakness, foot drop, tachycardia, confusion, enlarged heart, heart failure, anorexia, weight loss

Copper

Deficiency: Wilson's disease (low serum levels)

Identify the EAR and RDA for carbohydrates during pregnancy and lactation

EAR for pregnancy: 135 g/day RDA for pregnancy: 175 g/day EAR for lactation: 160 g/day RDA for lactation: 210 g/day

Products synthesized from tyrosine

Epinephrine, norepinephrine, and dopamine

Describe the hormones involved in digestions.

Gastrin is a hormone secreted in the stomach that is involved in the production of gastric acid. Secretin is a hormone formed by the epithelial cells of duodenum under stimulus of acid contents from stomach, which incites secretion of pancreatic juice. Cholecystokinin is a polypeptide hormone that stimulates the contraction of the gallbladder to release bile for protein and fat digestion Chymotrypsin is a pancreatic digestive enzyme that catalyzes the hydrolysis of certain proteins in the small intestine into polypeptides and amino acids.

What is the net total of ATPs produced through aerobic pathways?

Glucose enters glycolysis to provide 2 ATPs. Next, the citric acid cycle is responsible for converting 2 pyruvates into 4 ATP molecules. Last, the electron transport system is where 32 ATP are produced. It is expected that 38 ATPs will be produced, though this may vary depending on counting methodology used.

Iron

Heme Sources (animal) vs non heme sources (cereals, vegetables) absorption aided by hydrochloric acid, calcium (binds oxalates) and vitamin C **Eggs, tea, milk, and cheese do not aid in absorption** Sources: fortified breakfast cereal, oysters, beef liver, white beans, lentils, kidney beans, tofu, sardines deficiency: spoon-shaped nails, pale conjunctivae

What is true for the breastmilk produced by a mother with a premature infant compared with the breastmilk of the mother of a full-term infant?

Higher in protein Slightly lower in lactose Higher in energy content

What are the essential amino acids?

Histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine (TV TILL PMH)

Define intracellular water and extracellular water

ICW: Water within the cell ECW: Water in plasma, lymph, spinal fluid, secretion, and ICW around and between the cells; accounts for 20% of body weight

respiratory acidosis (pulmonary)

Increased carbonic acid A drop in blood pH due to hypoventilation (too little breathing, emphysema) and a resulting accumulation of Co2. compensatory response: kidneys increase absorption of sodium bicarbonate

Zinc

Increases taste acuity, essential for growth and sexual maturation in adolescents sources: meat, liver, eggs, fish (animal proteins) Deficiency: reduced immune function, Alopecia, poor wound healing, hypogeusia, Diarrhea, Eye and skin lesions, growth retardation, delayed sexual maturation, impaired appetite, decreased sense of taste and smell

Insensible water loss

Insensible water loss cannot be perceived nor directly measured. For example, sweat through skin or water vapor through breathing Typical daily insensible water loss ranges from 0.8 L to 1.2 L.

Identify good food sources for omega-3 fatty acid

Linolenic acid: Oils, nuts and seeds, soybeans EPA and DHA: Human milk, fish and seafood (sea bass, oyster, salmon)

What are the four types of gastric secretion?

Mucus, acid, proteases, and hormones. Mucus: bicarbonate-rich mucus that coats and lubricates the gastric surface to protect the epithelium from acid and other chemical injuries. Acid: Hydrochloric acid is secreted from parietal cells into the lumen and creates a highly acidic environment that helps to kill microorganisms and bacteria. Proteases: Pepsinogen is secreted into gastric juice from mucous and chief cells. It is then activated by stomach acid into the active protease pepsin, which is critical in the process of the digestion of proteins. Hormones: Gastrin, the principal hormone secreted from the gastric epithelium, a peptide helps to control acid secretion and gastric motility

Normal ranges of cations

Na+ = 136-145 mEq/L K+ = 3.5-5 mEq/L Ca++ = 4.5-5.5 mEq/L

Alpha-linolenic acid (ALA)

Omega-3 Retinal function and brain development Deficiency: neurological changes, numbness, blurred vision If substituted for saturated fats in the diet = decreased hepatic production of triglycerides (inhibits VLDL synthesis), little change in total cholesterol Sources: fish oils, walnuts, flaxseed, canola

Arachidonic acid

Omega-6 polyunsaturated fatty acid found in animal fat that is a major precursor to prostaglandins.

What are the ranges and classifications for laboratory blood cholesterol levels?

Optimal: LDL<100 mg/dL and TC <160 mg/dL Desirable: LDL 100-129 mg/dL; TC 160-199 mg/dL Borderline high risk: LDL 130-159 mg/dL; TC 200-239 mg/dL High risk: LDL: > 160 mg/dL; TC > 240 mg/dL

Sulfur

Part of AA cysteine, cystine, and methionine Sources: meat, fish, eggs, poultry (animal proteins)

Niacin

Precursor: tryptophan Deficiency: Pellagra; Symptoms include the 4 Ds: diarrhea, dermatitis, dementia, and death; beefy bright red tongue, symmetrical pigmented rash in sunlight

Identify factors that affect RBC folate values

Pregnancy (3rd trimester) Smoking Vitamin B12 deficiency Iron deficiency

Daily Values are nutrient standards derived from the Daily Reference Values and ___?

Reference Daily Intakes.

What does thyroxin regulate?

Regulates metabolism and rate of oxidation Influences physical and mental growth Stimulates liver glycogenolysis and gluconeogenesis (Raises blood sugar)

Products of tryptophan

Serotonin, niacin, and melatonin

The end products of bacterial fermentation of malabsorbed carbohydrate are:

Short chain fatty acids, hydrogen and carbon dioxide

Vitamin A

Sources: sweet potatoes, beef liver, spinach, pumpkin pie, mangos, red peppers, cantaloupe, carrots, dried apricots Deficiency: Night blindness, Xerophthalmia and blindness. Bitot spots on conjuctiva; Dry, scaly skin (hyperkeratosis); Impaired growth of teeth and bone; Impaired cell differentiation and gene regulation; Damaged immune function Toxicity: Patient may experience nausea, abdominal cramps, diarrhea, rashes, and interference with medical therapies. -Plasma levels and liver stores of vitamin A increase with age, along with decreased clearance from the blood, making older adults more susceptible to toxicity.

What is the recommended intake for sodium?

The US Dietary Guidelines recommend that Americans should limit their sodium intake to 2,300 mg or less per day. Encourage patients to opt for low-sodium or no-salt-added options.

What are the contraction patterns of the digestive system?

The esophagus transports food using peristaltic contractions to push food forward. In the small intestines, segmentation causes muscles to alternate between phases of relaxation and contractions help to churn the intestinal contents.

Identify the main digestive secretions released in the stomach.

The stomach releases hydrogen chloride (parietal cells), intrinsic factor (parietal cells), gastrin (g cells), and bicarbonate (mucous neck cells). Enzymes released by the stomach are pepsin (chief cells) which is activated by cleaving pepsinogen and gastric lipase (chief cells).

Which of the following is NOT a function of lipids? They act as thermal insulation for certain organs They provide energy during starvation They provide structure to hair, bones, and teeth They act as electrical insulators along myelinated nerves

They provide structure to hair, bones, and teeth Proteins are composed of the molecules that provide structure to hair, bones, and teeth such as keratin and collagen. Lipids act as insulation for internal organs, provide energy during fasting and starvation, and also function as electrical insulators along myelinated nerves.

Name Coenzymes Derived from B Vitamins

Thiamin (B1) = TPP Riboflavin (B2) = FAD Niacin = NAD+ Pantothenic Acid = Coenzyme A Pyridoxine (B6) = PLP

List the micronutrients and macronutrients that affect bone health

Vitamins: Vitamins A, D, K, C Minerals: Calcium, phosphorus, magnesium Macronutrient: Protein

Sensible water loss

Water that is lost through your sweat, urine, and feces.

Selenium

aids cell growth and boosts immune function

Chromium

aids in insulin action glucose metabolism

Pentose Shunt

another fate of glucose-6-phosphate doesn't require ATP Ribose (RNA) is produced NADPH (niacin) produced (essential for the synthesis of fatty acids)

Exercise physiology

at rest and during normal activities, fats are primary energy source (80-90%); CHO 5-18%; protein 2-5% body's reliance on CHO to provide pyruvate for continued lipid oxidation creatine supplements do NOT enhance endurance (not helpful for marathon runners or soccer players)

Which of the following statements about lipids is true? a. Steroid hormones are made from one or more fat-soluble vitamins. b. Digestion of triglycerides requires bile and lipases. c. Triglyceride digestion is completed in the large intestine. d. Insulin stimulates lipolysis and the mobilization of triglycerides.

b. Digestion of triglycerides requires bile and lipases. The digestion of regular fats and oils, which are usually long-chain triglycerides, requires bile acids as well as lipases. In adults, this digestion usually starts in the small intestine and is done with the aid of lipases and bile acids. The bile acids allow the triglycerides to be properly emulsified and the lipases break the triglycerides into individual fatty acids and monoglycerides in the small intestine.

Which of the following statements about controlling blood glucose levels is false? a. Glucocorticoids, such as cortisol, stimulate glycolysis to increase blood glucose levels. b. The adrenals secrete epinephrine and norepinephrine when the patient is fasting, which stimulates muscles to release glycogen to maintain blood glucose levels. c. Beta cells in the islets of Langerhans produce insulin, which is released when blood glucose levels rise in response to a meal. d. Alpha cells in the islets of Langerhans secrete glucagon when the patient is fasting, which stimulates the liver to break down glycogen to maintain blood glucose levels in the normal range of 80 to 120 mg/dL.

b. The adrenals secrete epinephrine and norepinephrine when the patient is fasting, which stimulates muscles to release glycogen to maintain blood glucose levels.

Which of the following statements about glycogen is true? a. Glycogen is stored primarily in the liver but also appears in skeletal and heart muscles. b. The liver stores approximately 100 grams of glycogen. c. The glycogen found in skeletal muscles is catabolized for use anywhere in the body. d. Glycogen is a long-term energy source.

b. The liver stores approximately 100 grams of glycogen. Glycogen is a form of short-term carbohydrate storage for the body. It is not a long-term energy source. Approximately 100 grams of glycogen is stored in the liver, which when catabolized provides approximately 400 kcals. About 300 to 400 g of glycogen is stored in the skeletal muscles, which yields less than 1,600 kcal. Glycogen is not stored in the heart muscle. The glycogen stored in the liver provides energy anywhere in the body, whereas the glycogen stored in the skeletal muscles provides energy only to skeletal muscle cells. The amount of stored glycogen is sufficient to sustain a 70 kg male for approximately 1 day.

In the alanine cycle, alanine is released from muscle, taken up by the liver, and: a. excreted in the urine b. deaminated to release glucose c. converted into adipose d. oxidized to nitric acid

b. deaminated to release glucose

Which of the following combines with CoA in two carbon fragments to make acetyl CoA to then enter the Kreb's cycle to make energy? a. lactic acid b. fatty acids c. glucose d. fructose

b. fatty acids or pyruvic acid

Which step is irreversible? a. pyruvic acid into lactic acid b. pyruvic acid into acetyl CoA c. glu-6-phosphate into glycogen d. glu-6-phosphate into pyruvate

b. pyruvic acid into acetyl CoA

The breakdown of fatty acids to yield acetyl-CoA is called a. glycolysis. b. lipolysis. c. ketogenesis. d. beta-oxidation.

beta-oxidation Fatty acid catabolism involve three stages. 1st stage of fatty acid catabolism is beta-oxidation. 2nd stage is acetyl coA oxidation to carbon dioxide. 3rd stage is electron transfer from electron carriers to the electron transfer chain.

In order to absorb folate consumed from green, leafy vegetables, _________________. a. phosphate groups must be removed by the action of alkaline phosphatase b. glutamate must be transaminated to form alpha-ketoglutarate c. glutamic acid molecules must be removed d. glutamic acid molecules must be added

c. glutamic acid molecules must be removed Food folate contains multiple glutamic acid molecules whereas folic acid, the folate form found in supplements, contains only one glutamic acid. These multiple glutamic acids must be hydrolyzed in order for folate to be absorbed from food sources.

Major buffer in acid-base balance

carbonic acid (h2CO3) controlled by lungs sodium bicarbonate (NaHCO3) controlled by kidneys

Water soluble nutrients are absorbed through

carrier-facilitated passive diffusion

Which minerals are involved in carbohydrate metabolism? a. cobalt, zinc b. chromium, zinc c. copper, chromium d. iron, zinc

chromium, zinc Cr binds to insulin receptor and enhances its activity Zn required for enzymes in CHO metabolism and normal insulin function

Which of the following lipoproteins is not synthesized in the liver? Low-density lipoprotein High-density lipoprotein Chylomicron Very low-density lipoprotein

chylomicron Chylomicrons are synthesized by the intestine and carry dietary lipids

Pyridoxine (B6)

coenzyme in AA metabolism: deamination, transamination increased protein, increased pyridoxine

Cracked lips is a symptom of deficiency for which nutrient? a. Vitamin C b. Magnesium c. Fat soluble vitamins d. B vitamins

d. B vitamins A B vitamin deficiency may result in cracked lips, as well as fatigue, weakness, pale skin, ringing in the ears, loss of appetite, and altered sense of taste.

Osteocalcin depends on which vitamin for synthesis? a. Cobalamin b. Folic acid c. Vitamin D d. Vitamin K

d. Vitamin K

Alcohol metabolism can cause decreased a. uptake of fatty acids from the blood. b. fatty acid syntheses. c. lipogenesis. d. beta-oxidation.

d. beta-oxidation. The shift in the NADH/NAD+ ratio inhibits beta-oxidation of fatty acids and promotes triglyceride synthesis.

respiratory alkalosis (pulmonary)

decreased carbonic acid Arise in blood pH due to hyperventilation (excessive breathing, anxiety, exercise) and a resulting decrease in CO2. compensatory response: kidneys excrete sodium bicarbonate

Anasarca

extreme, generalized edema and widespread swelling of skin due to effusion of fluid into extracellular space Associated with heart, liver, renal failure, and extreme protein/calorie malnutrition

What is the primary fuel used by resting muscle and at low intensity exercise?

fatty acids

Folate

functions: DNA synthesis, forms RBC in bone marrow, prevents neural tube defects zinc-dependent, cleaves polyglutamate to monoglutamate (form in folic acid supplements) 1 mcg DFE = 0.6 mcg folic acid from dietary supplements consumed with food. sources: liver, lentils, beans Deficiency: fatigue, irritability, megaloblastic, macrocytic anemia, spina bifida Populations at risk of deficiency: -Infants and young children -Women of reproductive age -Pregnant women

What is glycolysis?

glucose enters the cell aided by insulin combines with phosphorus in the presence of Mg to for glucose-6-phosphate Aerobic end product: pyruvic acid Anaerobic end product: lactic acid Two ATP and two NADH molecules are also formed.

Which of the following is not characteristic of the catabolic phase of metabolism? Fever Hypercatabolism Increased oxygen demands Glycolysis

glycolysis Ongoing metabolic support is the focus of nutrition during the catabolic phase. Because the risk of overfeeding is significant, it is prudent to feed patients no more than 100% of the resting energy expenditure during the catabolic phase.

Potassium

good sources: meat, fruits, vegetables (banana, orange, tomato, potato, cantaloupe) poor sources: apple, cranberry, blueberry, carrot, corn

The term for the process of normal cell growth by an increase in cell division and number is _____. Hypertrophy Hyperplasia Dysplasia Metaphasia

hyperplasia In dysplasia and metaphasia, the cell number increases as a result of disease or injury. Hypertrophy refers to an increase in cell size. Hyperplasia is an increase in cell number because of growth.

Which of the following denotes an enlargement of an organ or tissues caused by growth in cell size? Hyperplasia Hypertrophy Maturation Cellular replication

hypertrophy Hypertrophy is an enlargement of an organ or tissues caused by cell growth. Hyperplasia is when this enlargement is caused by increase in number of cells.

Which conversion requires glucose-6-phosphatase?

liver glycogen into glucose

Riboflavin

lost in UV light (milk in opaque containers) energy release from protein sources: liver, kidney, meat, milk Deficiency: growth failure, cheilosis, angular stomatitis, magenta tongue

Identify the role of sodium in the body

main positive cation present in extracellular fluid (blood plasma, interstitial fluid, and transcellular fluid) Sodium and chloride together are critical in many life-sustaining processes, such as maintenance of membrane potential, nutrient absorption and transport, and maintenance of blood pressure. Essential for maintenance of the osmotic pressure

Calcium

most abundant mineral calcitonin lowers serum calcium by inhibiting bone resorption Blood calcium homeostasis is tightly regulated by calcitriol (active form of vitamin D), parathyroid hormone (PTH), and calcitonin. (ex. Serum calcium level of 11.5mg/dl will bring on a release of calcitonin from the thyroid glands) deficiency: hypocalcemia leads to tetany

Vitamin C

most easily destroyed aids in iron absorption deficiency: bleeding/lesions on his gums and pinpoint hemorrhages on his skin

Active transport

most nutrients (glucose, AA, Na, K, Mg, Ca, Fe) sodium pump: uphill pumping, against an energy gradient, needs energy from ATP

Fluid balance

osmosis - less to more concentrated diffusion - more to less concentrated **protein (albumin) exerts colloidal osmotic pressure (keeps water inside)**

Coenzyme A is synthesized from which of the following vitamins? Thiamin Pyridoxine Pantothenic acid Biotin

pantothenic acid

Which of the following nutrients uses the highest amount of energy for metabolism and storage? Fat Protein Carbohydrates Alcohol

protein Diet induced thermogenesis (DIT) is commonly determined by calculating the difference between energy expenditure after food consumption and energy expenditure, divided by rate of nutrient energy administration, and presented as a percentage. Energy balance is affected by the higher DIT value of alcohol and protein. In satiety related to DIT, protein has a critical role in food intake regulation. High-protein diets are more effective in weight maintenance and post-weight loss via energy efficiency reduction induced by higher thermogenesis and increased satiety that reduces intake.

Which vitamin acts as a coenzyme in transamination?

pyridoxine

In the Cori cycle, lactate is converted into:

pyruvate lactate is released from tissue, transported to liver, and converted back to pyruvate

The hormone epinephrine ___ blood glucose during ___ stress

raises, catabolic

Linolenic Acid during Pregnancy

recommend 1.4g/day (300 mg DHA) or 1.3g/day if lactating **needed for development of fetal nervous system

Phosphorus

second most abundant mineral sources: meat, milk, poultry, eggs, fish, cheese

Magnesium

signals muscles to relax and contract, may help maintain immune response, and promotes normal blood pressure

What are the folds of Kerckring?

spiral folds formed by the mucosal and submucosal layers of the intestine function to slow the passage of food along the intestines and afford an increased surface for absorption Permanent folds, unaltered when the intestine is distended (unlike stomach)

Vitamin K

synthesized by bacteria; forms prothrombin in liver; aids in blood clotting Sources: spinach, kale, broccoli, green and leafy vegetables Deficiency: hemorrhage, weakness, anemia, gum disease, skin problems consistent with scurvy, fatigue, bleeding gums, bruises, bone fragility, joint pain, frequent infections, slow wound healing Affected by: mineral oil, ABX, and anticoagulants

Biotin

synthesized by intestinal bacteria adds or removes carbon dioxide from compounds during energy metabolism plays an essential role in the Krebs cycle, which is used to generate energy from protein, lipids, and carbohydrates

Wernicke-Korsakoff syndrome is seen in individuals with deficiency of which vitamin?

thiamin Wernicke-Korsakoff syndrome is a manifestation of thiamin deficiency, which is usually seen in individuals suffering from alcoholism

The following are required for the conversion of pyruvic acid into active acetate?

thiamin, niacin, riboflavin, pantothenic acid, magnesium

Vitamin E

tocopherol, tocotrienol one of the least toxic vitamins antioxidant Sources: vegetable oils, whole grains, green vegetables, almonds, cottonseed oil

hypothalamus function

water balance/bp/temp regulation/hunger/thirst/sex. Serotonin (neurotransmitter): low levels increase CHO appetite Leptin: induces satiety, enhances energy expenditure Ghrelin: stimulates appetite and growth hormone secretion (from pituitary)

The colon functions in the absorption of:

water, salts, vitamin K, thiamin, riboflavin