Lecture 32 Flashcards
Introduction to Nutrition
diets
- all diets have some evidence base
- all diets can be criticized
- the best healthy diet is the one you will be compliant to
pg 747
Why is there public mistruct in nutritional science (dietary guidelines)?
nutritional quackery -> what the media puts out about nutrition
pg 749
nutrition
- systems biology
- no person consumes each nutrient separately
- nutrients work together
- nutrients are recycled
- nutrients do not target one organ/tissue or metabolic pathway
- nutrients are multifunctional
pg 754
hypothesis: plant based diet can help to mediate inflammation which may reduce the pain response
nutrition and its study is inherently more complicated compared to drugs
- drug trials (aspiring): have a primary variable of pain, secondary variable of quality of life, and an established mechanism exists
- nutritional trial: primary varible of pain, secondary variable of quality of life, mechanism???
pg 755
RCT’s and nutrition
- RCTs designed to be better for drugs, hard to use for nutrition
- can’t really have a placebo/control group because you can’t find people who have never had nutrition
- nutrients are absolutely required daily for all people
- nutrients have no one particular outcome
- better to use dose-response studies
pg 756
food is medicine
- recognizes that nourishment is essential for good health, wellbeing, and resilience
- nourishment is essential to more than physical health -> foster mental, social, and behavioral benefits -> is important across the life course in every setting
pg 759
diet/nutrition and hippocratic oath or osteopathic oath
- original hippocratic oath: “I will use those dietary regimens which will benefit my patients accordig to my greatest ability and judgement”
- modern hippocratic oath does NOT mention anything about nutrition
- osteopathic oath: “I will be ever alert to further the application of basic biologic truths to the healing arts” -> nutrition is a basic biologic truth
pg 761-762
six classes of nutrients
- carbohydrate
- protein -> biological value
- lipids -> SFA, MUFA, PUFA, cholesterol, phospholipids
- water -> hydration is one of the most important nutrients
- vitamins -> water soluble, fat soluble
- minerals -> macrominerals, microminerals, ultra trace minerals, electrolytes
Categories:
- macronutrients: carbs, protein, lipids, water
- micronutrients: vitamins, minerals
- organic (carbon containing): carbs, protein, lipids, vitamins
- inorganic: minerals, water
- energy yielding: carbs, protein, lipids
pg 764-765
calories for nutrient classes
- carbohydrates: 4 kcal/g (some sweeteners and some fibers 2 kcal/g)
- proteins: 4 kcal/g
- fat: 9 kcal/g
- alcohol: 7 kcal/g
pg 765
dietary reference intakes (DRI)
- set of standards in US and Canada
- recommended intakes of energy, nutrients, other dietary components to support health in relatively healthy people
- can be used to plan and evaluate dietary intakes for healthy people
- determined based on sex and age
pg 766
estimate average requirement (EAR)
average daily nutrient intake level estimated to meet the requirement of half the healthy individuals in a particular age, sex, and life-stage group
pg 767
recommended dietary allowance (RDA)
average daily nutrient intake level sufficient to meet the nutrient requirement of nearly all (97-98%) healthy individuals in a particular age, sex, and life-stage group (2 SDs from the EAR)
pg 767
adequate intake (AI)
an intake (not a requirement) that is likely to exceed the actual requirements of almost all individuals in an age, sex, and life-stage group; established when scientific evidence is not sufficient to determine an RDA
pg 767
tolerable upper intake level (UL)
the highest average daily nutrient intake level likely to pose no risk of adverse health effects for nearly all people in a particular age, sex, and life-stage group (toxicity cutoff)
pg 767
chronic disease risk reduction intake (CDRR)
nutrient intake level expected to reduce the risk of developing chronic disease within an apparent healthy population, will be set once evidence level is at least moderate strength of evidence for both a causal and an intake-response relationship between nutrient intake and chronic disease risk
pg 767
first nutrients considered for CDRR
sodium and potassium
in the apparently healthy population, any reduction in sodium intake in the range of intakes greater than the CDRR is expected to reduce risk of cardiovascular disease and HTN
pg 770
acceptable macronutrient distribution ranges
- AMDR
- haven’t been updated since 2005
- percent of total daily energy for children 1-3, 4-18, and adults 19+
- carbohydrates, protein, fat
pg 772
food label daily values
- daily values -> daily reference values (DRVs) and reference daily intakes (RDIs) -> NOT DRIs
- one set of values created by the FDA to represent everyone 4+; standardized to 2000 kcal
- DVs used to calculate % daily values of nutrition and supplement facts labels
- created to help public understand how the amount of a nutrient that is present in a serving of food fits into their total daily diet, and allows them to compare the nutritional value of food products
pg 774
daily recommended values (DRVs)
- macronutrients
- ex: fat = 78 g, cholesterol = 300 g, carbs = 275 g, added sugars = 50 g
pg 775
reference daily intakes (RDIs)
- micronutrients (vitamins and minerals)
- ex: vitamin D = 20 µg, chromium = 35 µg, choline = 550 mg
pg 775
reading a food label
explicited listed vitamins and minerals are called nutrients of public health concern -> listed because they are seen as being too low in the American population
pg 776
carbohydrate on food labels
- total carbohydrate includes ALL types of carbohydrate including those inherent in ingredients (ex: lactose in milk protein)
- FDA has a relatively strict definition of dietary fiber -> limited to the non-digestible soluble and insoluble carbohydrates and ligning that are intrinisic and intact in plants -> isolated or synthetic non-digestible carbs and must have phsyiological benefits for human health
- total sugars is ALL the sugars in the product, including inherent sugars in ingredients; added sugars does not include inherent sugars, and if the total amount of added sugars (including maltodextrin) is less than 0.5 g/serving, it can be labeled as zero added sugars
- sugar alcohols are not digested as sugars and do not significantly impact the postprandial blood glucose response, so they are low glycemic index -> do contribute calories (0-3 kcal/g); best to avoid sugar alcohols as excess can result in GI disturbance
pg 777
net carbohydrate
- label claim for some food companies -> there is no standard definition approved by the FDA
- net carbohydrate = total carbohydrate - (dietary fiber + sugar alcohols)
- essentially the digestible carbohydrate, which would impact blood sugar
pg 778
