Adult Nutrition

Question 1

Dietary Guidelines for Americans:

Goals

Answer 1

1. Maintain healthy weight
2. Chronic disease prevention
3. Adequate nutrient intake

Question 2

What do Americans need to improve on in their diet?

Answer 2

• Maintain calorie balance
• Increase whole grains and reduce refined sugars
• Increase fruits & vegetables
  
  • Especially dark green, red/orange, beans/peas
• Increase heart healthy fats especially proteins from seafood/fish
• Reduce sodium

Question 3

• What is the gold standard for determining calorie need?
• What is normal nutritional energy (kcal/kg)?
• How many calories are recommended for:
  
  • Women
  • Men
• When should caloric intake be increased?

Answer 3

• Gold standard: indirect calorimetry
• Normal nutrition: 25-35 kcal/kg
• Calories
  
  • 1200-2000 for women
  • 1800-2400 for men
• Increased calorie needs:
  
  • Infection, critical illness, wound healing, chronic illness, cancer

Question 4

Macronutrient Distribution

Carbs, Proteins, Fats

Answer 4

Question 5

What is the role of carbohydrate intake?

Answer 5

• Supports energy metabolism
• Maintains blood glucose
• Immediate source of energy for brain
• Maintains glycogen stores in liver

Question 6

Dietary Fiber:

Soluble vs. Insoluble

Answer 6

• Soluble
  
  • Forms gel-like substance in intestines
  • Food sources:
    
    • Oats, barley, fruits, vegetables, dried peas/beans
• Insoluble
  
  • Increases stool bulk
  • Food source:
    
    • Bran, vegetables with skins, skins on fruits

Question 7

Protein

• Requirements:
  
  • Healthy Adults
  • Non-healthy adults
• Food Sources:
• How are proteins involved in underfeeding the obese?

Answer 7

• Requirements:
  
  • Healthy adults 0.8g/kg
  • Critical illness, cancer, wound healing/pressure ulcers: 1.2-2.0g/kg
• Food sources:
  
  • Meats, dairy, eggs, soy products
• Permissive underfeeding of obese
  
  • Decreased calories, increased protein

Question 8

Fat recommendations:

• Saturated fats:
  
  • Function?
• Unsaturated fats:
  
  • Function?

Answer 8

• Limit saturated fats
  
  • Increases LDL cholesterol, heart disease risk
• Increase monounsaturated fats and omega-3 polyunsaturated fats
  
  • Decreases LDL cholesterol
  • Decrease inflammation
  • Improves HDL cholesterol

Question 9

1. What is malnutrition?
2. What are the consequences of malnutrtion?

Answer 9

1. Decreased intake and increased nutrient needs
   
   • Weight loss, loss of lean body mass
2. Consequences of malnutrition:
   
   • Increased morbidity & mortality
   • Decreased functional capacity
   • Decreased quality of life
   • Increased length of stay
   • Increased hospital costs

Question 10

What are the diagnostic criteria for malnutrition?

Answer 10

• Insufficient energy intake
• Weight loss
• Loss of muscle mass
• Loss of subcutaneous fat
• Localized or generalized fluid accumulation
• Diminished functional status as measured by handgrip strength

Question 11

Vitamin B₁ (thiamine):

• Role
• Food Sources
• RDA
  
  • ​Men
  • Women

Answer 11

• Role: Energy metabolism
• Food sources:
  
  • Pork, enriched & whole grains, legumes
• RDA:
  
  • Men: 1.2 mg/day
  • Women: 1.1 mg/day

Question 12

What two disease processes are caused by a thiamine deficiency?

Answer 12

1. Wernicke-Korsakoff
2. Dry/Wet Beriberi (severe deficiency)

Question 13

Thiamine (Vitamin B₁) deficiency:

• Symptoms
• Wernicke-Korsakoff
• Dry/Wet Beriberi
• Labs?

Answer 13

• Symptoms
  
  • Decreased appetite, fatigue, peripheral neuropathy
• Wernicke-Korsakoff
  
  • Mental confusion (Wernicke’s encephalopathy)
  • Ataxia
  • Uncoordinated eye movements
• Dry/Wet Beriberi—severe deficiency
  
  • Advanced neuromuscular symptoms
  • Edema (wet Beriberi)
  • Heart failure
• Labs: serum thiamine

Question 14

Vitamin B₂ (Riboflavin):

• Role
• Food Sources
• RDA
  
  • ​Men
  • Women

Answer 14

• Role: Energy metabolism
• Food sources
  
  • Milk, dairy products, eggs, enriched cereals, dark leafy greens
• RDA
  
  • Males: 1.3 mg/day
  • Females: 1.1 mg/day

Question 15

Riboflavin (Vitamin B₂)** deficiency:**

• Symptoms:
• Toxicity:

Answer 15

• Symptoms:
  
  • Cheilitis, glossitis, dermatitis, anemia
• Toxicity:
  
  • Rare

Question 16

Vitamin B₃ (Niacin):

• **Role **
• **Food sources **
• RDA
  
  • Men:
  • Women:

Answer 16

• Role: Energy metabolism
• Food sources
  
  • Meats, legumes
  • Synthesize from tryptophan
    
    • 1 mg niacin per 60 mg tryptophan
• RDA
  
  • Men: 16 mg/day
  • Women: 14 mg/day

Question 17

Niacin (Vitamin B₃)** **Deficiency:

• Symptoms:
• Toxicity
• What is the therapeutic use for Nicotinic Acid?

Answer 17

• Symptoms: Glossitis
  
  • Pellagra (Three “D”s)
    
    • Diarrhea, Dermatitis, Dementia…Death
• Toxicity
  
  • Histamine induced flushing, liver damage
• Therapeutic Use for Nicotinic Acid:
  
  • Used to treat elevated cholesterol

Question 18

Vitamin B₅ (Pantothenic Acid):

• **Role: **
• Adequate Intake (AI)
• Food sources
• **Deficiency & toxicity **

Answer 18

• Role: Energy metabolism
• Adequate Intake (AI)
  
  • 5 mg/day
• Food sources
  
  • Widespread
  • Legumes/lentils, whole grains, sweet potatoes, meat
• Deficiency & toxicity rare

Question 19

Vitamin B₆ (Pyridoxine):

• **Role: **
• Food sources:
• RDA

Answer 19

• Role: Energy metabolism
• Food sources:
  
  • Plants & animal sources
  • Potatoes, chicken, salmon, nuts, fortified cereals
• RDA
  
  • 1.3 mg/day

Question 20

**Pyridoxine **(Vitamin B₆) deficiency:

• Symptoms
• Toxicity

Answer 20

• Symptoms
  
  • Irritability, nervousness, depression, peripheral neuropathy (severe)
  • Microcytic anemia
• Toxicity
  
  • Neurotoxicity, photosensitivity

Question 21

Vitamin B₇ (Biotin):

• **Role: **
• Food sources
• Adequate Intake (AI)
• Deficiency

Answer 21

• Role: Energy metabolism
• Food sources
  
  • Widely distributed
  • Egg yolks, liver, yeast, whole grains, vegetables
• Adequate Intake (AI)
  
  • 30 mcg per day
• Deficiency
  
  • Hair loss

Question 22

**Vitamin B₉ (Folate): **

• **Role: **
• Food sources:
• RDA

Answer 22

• Role: Hematopoietic
• Food sources:
  
  • Liver, dark leafy vegetables, broccoli, legumes
  • Fortified grains/cereals
• RDA
  
  • 400 mcg/day

Question 23

Folate (Vitamin B₉) Deficiency:

• Symptoms
• Toxicity
• Labs:

Answer 23

• Symptoms
  
  • Macrocytic or megaloblastic anemia, hyperhomocysteinemia, red tongue, cognitive decline, neural tube defects
• Toxicity
  
  • Rare
  • May mask Vitamin B₁₂ deficiency
• Labs:
  
  • Serum folate, RBC folate, CBC

Question 24

Vitamin B₁₂ (Cobalamin):

• **Role: **
• Food sources:
• RDA:

Answer 24

• Role: Hematopoietic
• Food sources:
  
  • Only animal sources
  • Meat and meat products
• RDA:
  
  • 2.4 mcg/day

Question 25

**Cobalamin** (Vitamin B₁₂) **Deficiency** * **Symptoms:** * Who is **at risk** for this deficiency? * **Labs:**

Answer 25

* **Symptoms:** * **Megaloblastic anemia, pernicious anemia,** homocysteine, neurological deterioration * **At risk:** * **Vegans,** elderly, insufficient intrinsic factor/HCl in stomach * **Labs:** * Serum B₁₂, **Methylmalonyl Co-A,** Complete Blood Count

Question 26

**Vitamin C (Ascorbate): ** * **Food Sources:** * **RDA** * **​**Men * Women * \*increased for ....

Answer 26

* **Food sources:** * Plant sources * Citrus fruits, dark leafy greens, strawberries, bell peppers, cantaloupe * **RDA** * Men: 90 mg/day * Women: 70 mg/day * **\*increased for smokers**

Question 27

**Ascorbate** (Vitamin C) **Deficiency:** 1. **Symptoms:** 2. What can **severe deficiency** cause?

Answer 27

1. **Symptoms** * Easy bruising, petechiae, decreased immunocompetence 2. Severe deficiency ⇒ **Scurvy (4 “H s”) ** * Hemorrhage, Hyperkeratosis, Hypochondriasis, Hematologic abnormalities

Question 28

**Ascorbate** (Vitamin C): * **Toxicity/Excessive intake** * **Upper Limit:**

Answer 28

* **Toxicity/Excessive intake** * Hyperoxaluria * Increased risk for renal oxalate stones * Diarrhea * Iron overdose * **Upper Limit:** 2000 mg/day

Question 29

**Vitamin E (Tocopherol)****:** * **Role:** * **Food Sources** * **Adequate Intake** (AI) * Males: * Females:

Answer 29

* **Role:** Antioxidant * **Food Sources** * Plant oils, nuts, seeds, almonds, hazelnuts * **Adequate Intake** (AI) * Males: 15 mg alpha-tocopherol/day * Females: 15 mg per day

Question 30

**Tocopherol** (Vitamin E): * **Inadequate intake** * **Deficiency** * **Toxicity**

Answer 30

* **Inadequate intake** * Majority of Americans do not meet guidelines * **Decreased antioxidant protection** * Aging, arthritis, cancer, CVD, Alzheimer's disease, infection… * **Deficiency**—rare * Neuromuscular degeneration * **Toxicity** * Low risk

Question 31

**Vitamin A (Carotenes, Retinoids):** * **Functions** * **Food Sources** * Retinol * Carotenoids * **RDA**

Answer 31

* **Functions** * Cell differentiation, vision * **Food Sources** * Retinol * Animals Sources—fish oils * Carotenoids * Plant foods—orange vegetables, dark leafy greens * **RDA** * Men: 3,000 IU * Women: 2,333 IU

Question 32

**Vitamin A:** * **Deficiency Symptoms:** * **Toxicity** * Excessive intake of ....**​** * **Important labs:**

Answer 32

* **Deficiency Symptoms:** * **Night blindness,** poor growth, xerophthalmia, follicular hyperkeratosis * **Toxicity** * Excessive intake of **retinol** * _Very low risk of toxicity from carotenoids_ * _Anorexia, dry itchy skin, hair loss, abnormal liver function_ * _Fetal malformations_ * **Important labs:** Plasma Retinol

Question 33

* What is the key micronutrient of importance in the elderly?

Answer 33

**Sodium**

Question 34

What foods increase sodium?

Answer 34

1. processed foods 2. restaurant/fast food 3. canned foods 4. meats 5. bread 6. condiments 7. cured meats 8. pickled/fermented foods 9. seasonings with salt

Question 35

**RDA for s****odium intake:** * \< 2,300 mg/day = 1 tsp: * 1500 mg/day:

Answer 35

* **\< 2,300 mg/day = 1 tsp:** * Healthy Americans over age 2 * **1,500 mg/day:** * Adults age 51 or older All African Americans Chronic disease * Kidney disease * Hypertension * Congestive heart failure * Liver failure