Macronutrients/Protein energy, Malnutrition

Question 1

Is dietary lipid essential

Answer 1

Some are essential
Major constituent of membrane phospholipids
Precursors of eicosanoids

Question 2

Linoleic acid

Answer 2

C18:2 w6 (from methyl end)

Question 3

Linolenic acid

Answer 3

C18:3 w3 (from methyl end)

Question 4

Requirement of dietary lipid

Answer 4

2-5g/day, UK recommendation
UK diet 8-15g/day, deficiency v rare
Increased intake of w3 may provide protection against CVD and for developing brain

Question 5

CVD risk factors

Answer 5

Genetic susceptibility
Smoking
Sedentary lifestyle
HTN
High serum cholesterol (LDL)
Obesity
Diabetes
Transfat intake

Question 6

Diet and CVD

Answer 6

Increase in sat FA leads to increased LDL and total cholesterol
Blood cholesterol can be lowered by increasing polyunsaturated FA in diet
Increase in trans fat, increased LDL and decreased HDL

Question 7

Types of fat

Answer 7

Cis
Trans
Unsaturated

Trans and unsaturated fats look similar, have similar effects

Question 8

Dietary fats and cancer

Answer 8

Immigrants suffer types of cancer found in the host population rather than type more common in their country of origin (breast, colon, pancreas, prostate)
High fat intake or obesity? Cause unclear

Question 9

Carbohydrates, types

Answer 9

Starch, non starch polysaccharides (fibre), sugar (mainly sucrose)
Mainly plant origin except lactose and v small amount of glycogen
Not needed in theory but has protein sparing effect
Low CHO diets lead to fat utilization and ketosis

Question 10

Monosaccharides and sources

Answer 10

Glucose, small amounts in fruit
Fructose, small amounts in fruit
Sorbitol, commercially prepared mainly in diabetic foods
Inositol, in fibres as hexaphospahte (physic acid), interferes with Fe, Ca absorption

Question 11

Disaccharides

Answer 11

Sucrose, UK consumption 10.5g/day
frequency of consumption more important than total amount

Lactose, no adverse health effects
Many non Europeans can tolerate it

Question 12

Polysaccharides

Answer 12

Starch, v common, crystalline and insoluble

Fibre, insoluble
Cereal, vegetables, fruits
NSP rich foods low in energy, high in bulk
Decreased intake, related to constipation, diverticular disease, appendicitis, colon cancer

Question 13

Why do we need protein

Answer 13

Essential AA needed for
  synthesising new protein
  catecholamines
  thyroid hormones
  NT
  haem
  gluthione

Question 14

Protein quality, plants vs animal

Answer 14

Proteins of animal origin more effective in supporting growth of animals than in plants

High quality proteins, higher utilization, less waste as AA pattern nearer that of body protein

Low quality proteins deficient in some AA

Mixture of low quality proteins complement deficit (imp in countries with a mainly vegetarian diet)

Question 15

Protein requirements per kg of body mass/day

Answer 15

As you grow older, the protein requirement g/kg/day decreases

Question 16

Protein recommendations
Infants
Pregnancy
Lactation

Answer 16

Infants, based on milk intake of breast fed infants showing satisfactory growth

Pregnancy, compatible with protein deposition for 3.3kg infant

Lactation, based on protein content of human milk

Question 17

UK status regarding deficiencies

Answer 17

No group in the UK likely to be deficient
Importance of protein often overestimated
Excessive intake may lead to bone demineralization/deterioration of renal function in renal disease

Question 18

Protein energy malnutrition, consequences

Answer 18

Growth failure
Marasmus
Kwashiorkor
Marasmic kwashiokor

Question 19

Consequences of childhood malnutrition

Answer 19

Stunting of growth, normal weight for height

Growth failure, low heigh for age

Question 20

Classification of PEM by BMI

Answer 20

Acceptable/desirable, 18.5-25
Moderate PEM 17-18.4
Moderately severe PEM 16-17
Severe PEM <16

Question 21

Extreme forms of PEM

Answer 21

Marasmus
Kwashiorkor
Marasmic kwashiorkor

General lack of food as opposed to specific deficiency of vitamins or minerals

Question 22

Causes of childhood PEM

Answer 22

Poverty
Poor sanitation
Infection

Question 23

Marasmus, prevalence in developed and developing countries

Answer 23

Any age of vulnerable groups in a population in both developed and developing countries

Developing countries
chronic food shortage/acute famine (normally in 1st year of life)
Developed countries
socially, economically disadvantaged groups
discord’s of appetite and nutrient absorption, cancer, AIDS

Question 24

Marasmus symptoms

Answer 24

Extreme emaciation
Loss of body fat reserves
Muscle wasting
Protein loss from vital organs
Impaired immune response
Loss of intestinal mucosa=>impaired absorption
Diarrhea and apathy

Question 25

Kwashiorkor symptoms

Answer 25

Additional to marasmus symptoms
Severe pitting, painless edema
Liver enlarged, fat infiltration
Changes in color, texture of hair dermatitis
If v severe, can lead to permanent mental retardation

Question 26

Kwashiorkor causes

Answer 26

Infection often precipitates kwashiorkor
Not specifically a protein deficiency with adequate energy
Most likely a general food deficiency with added deficiency pf antioxidant nutrients not being able to cope with added oxidative infection stress
Infection increases protein req

Question 27

Marasmic kwashiorkor

Answer 27

Not clear what determines which form
Both can be found in 1 family
Child can switch from 1 to another

Question 28

Treatment of PEM

Answer 28

Fluid and electrolyte balance first
ORS, 8tsp sugar, 1tsp salt in 1l boiled water
Dextrose solution
Dilute milk
Normal food when tolerated