Exam 3 Flashcards
An estimated 1 in 6 Americans develop foodborne illness each year of varying degrees of severity. Although prevalent, foodborne illness is largely
preventable
What act was signed in to law in 2011 by President Obama to help reduce incidence of foodborne illness and shift focus from responding to contamination to preventing it?
Food Safety and Modernization Act (FSMA)
List 5 of the most common causes (viral/bacterial) of foodborne illness.
Norovirus Salmonella Clostridium perfringens staphylococcus aureus campylobacter
Effects of foodborne illness may be of particular concern and severity in what at-risk groups of people?
Young Children
Older adults
Pregnant women
People with weakened immune systems from disease or some medical treatments (AIDS, cancer, diabetes patients)
Refrigerated foods should be kept below______ degrees Fahrenheit. To avoid temperature “danger zones”, hot foods should be kept above ______degrees Fahrenheit.
41, 135
List the four steps promoted by the Fight BAC! Campaign to reduce the incidence of foodborne illness with examples
- Clean - rinse fruits and vegetables
- Separate - separate raw meat from other groceries
- Cook - cook roasts and steak to 145 F
- Chill - marinate food in the fridge.
What are the core characteristics of a healthy diet?
- Adequate amount of essential nutrients
- Balanced across food groups and macronutrients
- Variety of foods
- Moderation and not overindulging
A healthy diet should…
- Meet nutrient and calorie needs at different life stages
- Help maintain a healthy body weight
3, Help prevent chronic diseases - Foster an enjoyment of eating and appreciation of food
Does the typical American diet does align with recommended limits or goals?
no
What are nutrient dense foods?
Provide healthy nutrients in appreciable amounts relative to calories
What are energy dense foods?
provide calories and low amounts of nutrients
Do healthy diets include foods that are good sources of a number of nutrients relative to the amount of calories?
yes
What is energy density?
the number of calories in a given volume of food
what tend to increase energy density?
Fat, sugar, and alcohol
what tend to decrease energy density?
Fluid (water) and fiber
What is the primary factor that determines energy density
The water, fiber, and fat content of foods
For equal calories, how do nutrient and energy density relate?
portion size decreases as energy density increases
Who issues the dietary guidelines for americans?
Issued by the US Department of Agriculture (USDA) and US Department of Health and Human Services (HHS)
what is the purpose of the dietary guidelines for americans?
Evidence-based guidelines to promote health and reduce risk for major chronic disease
what are the dietary guidelines for americans intended for?
Intended for health professionals to help people age 2 and over consume a healthy diet and prevent chronic diseases
what are the dietary guidelines for americans a basis for?
federal food and nutrition policies, programs, and education
What do the 2015 Dietary Guidelines for Americans focus more on?
focuses more on eating patterns than individual food groups or dietary components
What are the major points in teh 2015 Dietary Guidelines for Americans?
- Follow a healthy eating pattern across the lifespan
- Focus on variety, nutrient density, and amount
- Limit calories from added sugars and saturated fats and reduce sodium intake
- Shift to healthier food and beverage choices
- Support healthy eating patterns for all
What helps communicate the 2015 DGAs?
MyPlate consumer messages
What do the 2015 DGAs recommend for sodium?
reduce daily sodium intake to < 2,300 mg
What do the 2015 DGAs recommend for added sugars?
encouraged to “consume <10% of calories per day from added sugars”
What do thw 2015 DGAs recommend for protein?
the overconsumption of protein by teen boys and adult men in particular prompted the 2015 DGAs to recommend that they specifically reduce consumption of protein foods by decreasing intake of meats, protein and eggs
What do the 2015 DGAs recommend for fatty acids?
consume < 10% of calories from saturated fatty acids was maintained from the 2010 to 2015 DGAs
What do the 2015 DGAs recommend for grains?
consume at least half of grains as whole grains
What’s on a food label?
1 Product name 2 Manufacturer’s name and address 3 Uniform serving size 4 Amount in the package 5 Ingredients in descending order by weight 6 Nutrient components 7 Percent Daily Value
What do healthy diet plans emphasize?
- Eat more plant foods, including fruits, vegetables, and whole grains
- Choose lean protein from a variety of sources
- Limit sweets and salt
- Control portion sizes
- Be physically active
1990 Nutrition Labeling and Education Act (NLEA)
- Amendment to the 1938 Federal Food, Drug and Cosmetic Act
- FDA oversees food and nutrition labeling
- Made nutrition labeling : mandatory for most processed foods and voluntary for fresh meat, poultry, fish, milk, eggs, and produce
- Established standardized “Nutrition Facts” panel
- Established standard portion sizes
- Provides details of nutrient content and ingredients
- Simplifies comparison of similar foods
What are Daily Values?
levels for nutrients developed specifically for nutrition labels
what happens in diabetes?
the use of glucose by the body is disrupted due to lack of or the resistance to insulin
What are the insulin-dependent fates of glucose?
- Immediate energy source to all cells
- Converted into glycogen
- Converted into fat
What are blood glucose levels regulated by?
by the actions of pancreatic hormones
What range are blood glucose levels range maintained in?
narrow range
What are blood glucose levels primarily regulated by?
Primarily through the actions of the pancreatic hormones insulin and glucagon
When is weight loss warranted for obesity?
Weight-loss recommended for anyone with a BMI of 30 or greater and anyone overweight with two or more other risk factors
What are risk factors for overweight individuals that may warrant weight loss?
- Elevated waist circumference
- Cardiovascular disease
- Family history of cardiovascular disease
- Smoking
- Hypertension
- Diabetes
- Physical inactivity
- Age (men 45 years or older; women 55 years or older or postmenopausal)
What are the goals of obesity treatment?
to achieve and maintain clinically meaningful weight loss
What is considered clinical success for obesity patient treatment?
Losing and maintaining of 5-10% of initial body weight
Why do you want to lose 5-10% of initial body weight if obese?
Reduces risk of chronic disease and all-cause mortality
What is considered long term success for obesity patients?
Long-term success dependent on maintenance of 10% weight loss at one year
What percentage of obese individuals are successful after 1 year?
20%
Why use surgical procedures for obese individual?
Yields significant weight loss and reduction of weight-related disorders
Who needs surgical obesity treatments?
Reserved for extreme obesity
What is considered extreme obesity?
- BMI > 40 kg/m²
- BMI > 35 kg/m² with the presence of one or more co-morbidity (risk factors)
What is the problem with the Roux-en-Y obesity treatment?
The Roux-en-Y causes some malabsorption
What do healthy and effective methods of weight loss emphasize?
a variety of nutrient-dense foods with lifestyle changes
Successful “losers” share what common strategies for maintaining weight loss?
- Maintaining a lower-fat, reduced-calorie eating plan
- Eating breakfast
- Weighing self at least once a week
- Watching fewer than 10 hours of television per week
- Exercising on average about one hour per day
What is obesity caused by?
a chronic imbalance in energy intake and expenditure
What percentage of US adults are obese?
Almost 40% of U.S. adults in 2017 (39.8%)
What are some factors that influence obesity?
- Genetics
- Environment
- Behavior
Is obesity considered an epidemic?
yes
What percentage of adults in the US are considered overweight?
Over 70% of U.S. adults in 2016 (71.6%)
What is BMI?
body mass index; body weight (kg)/height2 (m2)
What do hormonal changes associated with obese individuals result in?
result in a low-grade chronic inflammation
What do hormonal changes in obese individuals cause biologically?
- Enlarged fat cells produce excess hormones and hormone-like messengers
- Hormones cause low-grade inflammation
- Adverse health effects and increased risk of chronic disease
What is BMI a measure of?
weight for height to estimate body fat
What is considered underweight for BMI?
18.5 kg/m²
What is considered normal for BMI?
18.5-24.9 kg/m²
What is considered overweight for BMI?
25-29.9 kg/m²
What is considered obese for BMI?
30 kg/m²
What is waist circumference an estimator for?
abdominal obesity
What is a better indicator of health risk than BMI alone?
Considering waist circumference in addition to BMI better indicator of health risk than BMI alone
What does visceral fat put individuals at risk of?
- Cardiovascular disease
- Type 2 diabetes
- Insulin resistance
- Premature all-cause mortality
Is visceral fat an independent or dependent health risk?
independent
What determines the presence of abdominal obesity and increased risk?
waist circumference
What is considered abdominal obesity for women?
> 35 inches (88 cm)
What is considered abdominal obesity for men?
> 40 inches (102 cm)
What does measuring waist circumference assess?
assesses presence of abdominal obesity
Are there a variety of methods to analyze body composition which provide a more direct measure of body fat?
yes
what are low body fat levels associated with?
- delayed physical maturation during adolescence
- Infertility
- amenorrhea (cessation of menstruation)
- accelerated bone loss
- problems that accompany starvation
What is body fat essential for?
manufacture of hormones
What is body fat a required component of?
every cell in the body
What does body fat provide?
a cushion for internal organs
How much body fat do men need for survival?
3 to 5%
How much body fat do women need for survival?
10 to 12%
What is energy required for?
to sustain life
what is energy?
Capacity to do work
How is energy obtained?
Obtained by the breakdown of carbohydrates, protein, fats, and alcohol
What is energy measured in?
measured in units called calories
what is a calorie?
energy required to raise 1 g of water 1°C
what is a kcal?
the energy required to raise 1 kg of water 1°C
What is the energy in food measured in?
kcal
What are two ways that energy balance and food intake are regulated by the body?
short-term and long-term system
what is the short term system for energy balance?
- Mediated by hormones (ghrelin)
- Mediated by stomach pressure
- Regulates hunger and satiety
What is the long-term system for energy balance?
- Mediated by hormones (Leptin)
- Adjusts food intake and energy expenditure
- Maintains adequate fat stores
What is ghrelin?
- Produced in the stomach
- Stimulates hunger
What is leptin?
- Produced by adipose tissue
- Suppresses hunger
How is energy balance regulated?
by hormones
what is food intake regulated by?
fullness during meals and satisfaction between meals
What is satiation?
- Sense of fullness during a meal
- Leads to termination of a meal
What is satiety?
- Feeling the effect of a meal after and between meals
- Lacking interest in food
What is atiation and satiety affected by?
Gastric distention
What is hunger’s origin?
a biological impulse
what is appetite’s origin?
a product of sensory stimuli and perceived pleasure
what is appetite?
Liking or wanting of food
what is appetite affected by?
the “toxic food environment”
What are components of total energy expenditure?
- Basal metabolism
- Thermic effect of food (TEF)
- Activity energy expenditure (AEE)
What is the largest component of total energy expenditure?
basal metabolism
What is energy expenditure required for?
to maintain the ongoing functions that sustain life
What factors affect Basal Metabolic Rate (BMR)?
- Fat-free mass (FFM)
- Largest determinate of BMR is how much muscles and lean tissue someone has
How many more time metaboligcally active is skeletal muscle than adipose tissue?
3x
How do you estimate BMR in normal weight women?
weight (in kg) X 23.2
How do you estimate BMR in normal weight men?
weight (in kg) X 24
What is the Thermic effect of food (TEF)?
Energy needed to digest, absorb, and metabolize nutrients in our food
What is the thermic effect of food generally equivalent to?
10% of the energy content of the food ingested
Does the thermic effect of food vary greatly between people?
no
What is the most variable factor of TEE?
Activity energy expenditure (AEE)
What is Activity Energy Expenditure?
Amount of energy expended in physical activity per day
What does activity energy expenditure include?
Includes contraction of skeletal muscles to move and to maintain posture
What makes up our activity related energy expenditure?
Intentional “exercise” and NEAT
What is NEAT?
Nonexercise activity thermogenesis; activities of daily life
What is cardiovascular disease (CVD)?
Disease of the heart and blood vessels, including the vessels that supply the brain.
Where does the development of atherosclerosis often begins?
with an injury to the arterial lining
What is a major risk factor for heart attack and stroke?
Atherosclerosis
What are nonmodifiable risk factors for CVD?
- Age
- Family history
- Gender
- Post-menopausal
What are modifiable CVD risk factors?
- Hypertension
- Diabetes mellitus
- Dyslipidemia
- Obesity
- Sedentary lifestyle
- Smoking
- Stress
What is dyslipidemia?
elevated cholesterol, LDL, and/or triglycerides; low HDL
What are risk factors that increase the likelihood of developing CVD?
- Family history of heart disease
- Race
- Age
- Gender
- Smoking
- Diet high in saturated and trans fats, cholesterol, sodium, and added sugar
- Sedentary lifestyle
- Obesity
- Diabetes
- Excessive alcohol consumption
- High blood pressure
- High blood lipid levels (cholesterol, LDL, and triglyceride)
What can appropriate diet and lifestyle choices reduce our risk for CVD by?
about 80%
What are some strategies to reduce the risk of CVD?
- Consumption of plant sterols or stanols
- Plant-based diets
- Nut consumption
- Oily, cold-water fish
- Whole grain oats
- Moderate alcohol consumption
- Substituting unsaturated oils for saturated fats
What is atherosclerosis?
- A thickening & hardening of arteries along with plaque development along blood vessel walls, is a major cause of heart attack & stroke
- A form of cardiovascular disease (CVD) that begins with injury to vessel wall that triggers inflammation and low-density lipoprotein (LDL) cholesterol infiltration, which results in plaque accumulation
What are major factors affect risk for CVD?
The concentrations of total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides
What are the 2015 guidelines for americans regarding CVD risk?
- Recommend limiting saturated fat to < 10% of total calories
- Strictly limit intake of trans fatty acids
What are the primary carrier of cholesterol to all cells?
LDL
Where is LDL made?
in the liver
What does LDL transport?
cholesterol from liver to cells of body
Elevated levels of what is associated with an increased risk of heart disease?
LDL
What is often called “bad cholesterol”?
LDL
What is the saying for LDL?
“Less is more”
What is different about HDL?
Contain higher proportion of protein
What does HDL transport?
Transports cholesterol from the cells and tissues to transport back to the liver
What is HDL called?
“Reverse cholesterol transporter”
High levels of what is associated with a decreased risk of heart disease?
HDL
What is HDL’s nickname?
“good cholesterol”
What is the saying for HDL?
“Higher is better”
What does the pancreas secrete insulin in response to?
increased blood glucose
What does insulin do stimulate?
stimulates cells to take up glucose from the blood
What does insulin promote?
- promotes storage of excess glucose as glycogen in liver and skeletal muscle
- promotes conversion of excess glucose to fat in liver and adipose
What does the pancreas secrete in response to increased blood glucose?
insulin
What does the pancreas secrete in response to decreased blood sugar?
glucagon
What does glucagon signal?
signals liver to release glucose into the blood
What does glucagon break down?
glycogen into glucose
What does glucagon synthesize?
new glucose
What is diabetes related to?
abnormal utilization and regulation of glucose by the body
What are the 3 major forms of diabetes?
Type 1 diabetes
Type 2 diabetes
Gestational diabetes
What is type 1 diabetes?
an autoimmune disease
What happens to pancreatic cells in type 1 diabetes?
Pancreatic cells that secrete insulin are destroyed by the body’s immune system
What does the body to with glucose in type 1 diabetes?
Extremely low insulin levels limit body’s ability to use glucose; Muscle and adipose tissues cannot take up glucose
What happens when blood glucose levels increase?
hyperglycemia
What is diabetes the greek word for?
siphon
What is mellitus the latin word for?
sweet
What happens with excess glucose?
spills over into urine
What does type 1 diabetes treatment require?
requires aligning insulin with food intake and activity to maintain desirable blood glucose level
What are 2 ways to help type 1 diabetes?
- monitor blood glucose
2. track food choices and activity
How is insulin administered?
intramuscularly by injection or insulin pump
What is the most common form of diabetes?
type 2
What is type 2 diabetes primarily attributed to?
prevalence of obesity and decreased physical activity
When does type 2 diabetes occur?
when cells are less sensitive to the effects of insulin
Does type 2 diabetes occur even if the pancreas is producing insulin?
yes
What does insulin normally do?
binds to receptors on cell membranes and allows glucose to pass into cells
What happens to glucose levels with insulin resistance?
increase
What happens when insulin resistant cells “resist” the effects of insulin?
impairs the uptake of glucose in to cells
What does the pancreas do in attempt to lower blood glucose?
overworks to make more insulin
What does insulin resistance result in?
elevated levels of serum insulin, glucose and triglycerides and often increased blood pressure
What are common risk factors for insulin resistance?
- Obesity
- Low levels of physical activity
- Genetic predisposition
How many Americans are thought to have prediabetes?
33%
What is prediabetes?
early stages of insulin resistance
What are people with prediabetes’ blood glucose levels like?
lower than people with type 2 diabetes, but higher than normal
What often happens to people with prediabetes without intervention or treatment?
develop type 2 diabetes
What is a prediabetic’s fasting blood glucose level?
100-125 mg/dL
What is a prediabetic’s oral glucose tolerance test?
140-199 mg/dL
what are type 2 diabetes’ fasting blood glucose levels?
> 125 mg/dL
What are type 2 diabetes’ oral glucose tolerance test levels?
> 200 mg/dL
How are prediabetes and diabetes diagnosed?
based on blood glucose concentrations
What are people with prediabetes at an increased risk for?
type 2 diabetes, heart disease, stroke
What are ways to normalize blood glucose and reduce risk?
weight control, physical activity, dietary modifications
What are the short-term consequences of elevated blood glucose?
blurred vision, frequent urination, weight loss
What are the long-term consequences of elevated blood glucose?
Damage to cells and organs, heart disease, hypertension, nerve damage, blindness, kidney failure, stroke, amputation
What is the #1 cause of death in those with diabetes?
heart disease
What organs can diabetes damage?
heart, blood vessels, kidneys, eyes, nerves
What percentage of women develop gestational diabetes?
18%
What increases risk for elevated blood glucose during pregnancy?
obesity
What reduces the risk for elevated blood glucose during pregnancy?
exercise
What can help lower blood glucose levels during pregnancy?
high fiber, low-glycemic index diet
What does elevated blood glucose levels during pregnancy increase the risk of?
complications during pregnancy and at delivery
What can elevated blood glucose levels during pregnancy cause?
baby to grow too large
What does having gestational diabetes put women at risk of developing?
type 2 diabets
Does gestational diabetes usually resolve itself?
yes, after birth
How does gestational diabetes affect the health of the mother and baby?
- Pregnancy hormones and excess body fat may increase insulin resistance
- Glucose crosses placenta to infant
- Infant produces excess insulin
- Extra fuel and insulin causes infant to grow larger
What are gestational diabetes risk factors?
- Obese prior to pregnancy
- Older than 25 years
- Prediabetes
- Family history of type 2 diabetes
- Non-White race
What play major roles in the development of diabets?
decreased physical activity
increased sedentary behaviors
What are dietary factors associated with increased risk of type 2 diabetes?
- excess calories
- low intake of whole grains
- high intake of refined carbohydrates
- sweetened beverage
- trans and saturated fat
Can type 2 diabetes be reversed?
yes
How can type 2 diabetes be modified or reversed?
changing diet, increasing physical activity, achieving and maintaining a healthy body weight
How can type 2 diabetes by managed if lifestyle choices do not work?
oral medications, insulin injections
What is glycemic load?
(Food’s GI x food’s grams of carbohydrates)/100
What affects a food’s glycemic index and glycemic load?
type and amount of carbohydrate
What is glycemic index
A number used to rank carbohydrate foods by their ability to raise blood glucose levels compared with a reference standard
What is glycemic load?
The extent of increase in blood glucose levels, calculated by multiplying glycemic index by the carbohydrate content of a food
What is carb counting?
method used to determine and track carbohydrates consumed for meals and snacks to appropriately balance energy needs, physical activity and medication to manage blood glucose levels
What are two ways to manage blood glucose levels?
meal planning, blood glucose monitoring
What are some ways to monitor blood glucose?
carb counting, monitor fat intake, increase physical activity
What can improve insulin sensitivity?
physical activity
How can a person with diabetes assist with weight control?
increase physical activity
What should people with diabetes do to monitor fat intake?
<7% calories from saturated fat, avoid or limit trans fat
what is hypoglycemia?
abnormally low blood glucose levels
How can someone manage hypoglycemia through diet?
- Moderate carbohydrate intake
- Include protein at meals and snacks
- Emphasize fiber rich foods, particularly soluble fiber
What type of diet is a Mediterranean diet?
plant based diet
What is the Mediterranean diet rich in?
fruit, vegetables, nuts, olive oil, whole grains
What is the Mediterranean diet low in?
processed and red meats, dairy products, sweets
What does the Mediterranean diet lower a person’s risk for?
heart problems and heart-related death
What is the traditional mediterranean diet rich in?
vegetables, fruits, fish, olive oil
What are the health benefits of the Mediterranean diet?
- Different lifestyle and different diets
- High in monounsaturated fats
- Healthy ratio of omega-6 to omega-3 fats
- High in fiber, antioxidants, and polyphenols
- Moderate consumption of wine with food
- Consumption of fish and less other meat
What are characteristics of a plant-based diet?
- Emphasize vegetables and fruits
- Include whole grains, beans, legumes, nuts, and seeds
- Minimal processed foods
- Limit or omit animal foods
- Vegetarian diets are plant-based diets
What does a true vegetarian diet exclude?
all animal foods
What are the common variations of the vegetarian diet?
lacto-vegetarian lacto-ovo vegetarian semi-vegetarian pescatarian flexitarian
What does a lacto-vegetarian eat?
plant foods plus dairy
What does a lacto-ovo vegetarian eat?
plant foods plus dairy products and eggs
What does a semi-vegetarian eat?
only exclude red meats but eat other animal products
What does a pescatarian eat?
plant based with fish and shell fish
What does a flexitarian eat?
mostly plant based but occasionally eat meat
What are the nutritional benefits of a vegetarian diet?
- higher nutrient intake
- fewer overall calories
- lower proportion of calories from fat
- decreased consumption of processed meats
What nutrients do vegetarians get higher intakes of?
- dietary fiber
- vitamins C, E, and folate
- magnesium and potassium
- antioxidants and phytochemicals
What are the health benefits of plant-based diets?
- Lower total blood cholesterol levels
- Lower low-density lipoprotein (LDL levels)
- Lower blood pressure
- Reduced cardiovascular risk
- Lower risk of obesity, heart disease, cancer, type 2 diabetes, and mortality
What is cancer?
Group of conditions that result from uncontrolled growth of abnormal cells that invade the body
What is the second leading cause of death in the US?
cancer
What disease can a plant-based diet reduce the risk of?
cancer
What are the 3 steps of development of cancer?
- initiation
- promotion
- progression
What happens in the initiation stage of cancer?
- Mutated permanently alters DNA sequence
* Mutated cells more likely to divide
What happens in the promotion stage of cancer?
Promoters enhance growth of mutated cells
What happens in the progression stage of cancer?
Cells migrate and invade other tissues (metastasis)
What are some factors that influence the risk of cancer?
- genetic
2. enviornmental
What are some ways a person’s environment can influence their risk of cancer?
- Lifestyle choices like diet can increase or decrease risk
* Diets rich in fruits, vegetables, legumes and whole grains decrease risk; Rich in phytochemicals
What are some recommendations to reduce the risk of cancer?
- Achieve or maintain a healthy body weight
- Limit consumption of energy-dense foods and avoid sugary drinks
- Limit consumption of red meat and avoid processed meat
- Limit salt intake
- Encourage infant breastfeeding
- Be physically active
- Eat mostly foods of plant origin
- Limit alcoholic drinks
- Aim to meet nutritional needs through diet alone
- Avoid consuming moldy grains, legumes and other foods
What are phytochemicals?
provide color aroma and flavor to plant foods
What are the health benefits of phytochemicals?
Chemicals have antioxidant, anti-inflammatory, or hormone-like actions
What nutrients do vegans need to obtain from supplements?
- Iron
- Vitamin D
- Riboflavin
- Vitamin B12
- Omega-3 Fatty Acids: EPA and DHA
- Iodine
What are nutrients of concern for individuals who avoid or restrict animal foods?
- Protein
- Iron
- Vitamin D
- Riboflavin
- Vitamin B12
- Omega-3 Fatty Acids
- Iodine
What is the RDA for iron for vegans?
80% higher
How can vegans get enough protein?
Generally sufficient with adequate and varied energy intake
What is a complete protein?
Provides all nine essential amino acids in amounts to support protein synthesis
What are complete proteins?
Includes meat, dairy, eggs, soy products, and quinoa
What are incomplete protein?
most plant foods
What are some complementary proteins?
beans and rice
beans and nuts
What type of proteins do vegetarians need to consume?
complementary proteins
Where is B12 found?
foods of animal origin
Where must vegans obtain B12 from?
- Fortified foods
- Fortified nutritional yeasts
- B12 supplement
