Midterm 2 Flashcards
1
Q
Essential amino acids
A
Phenylalanine
Valine
Threonine
Tryptophan
Isoleucine
Methionine
Histidine
Leucine
Lysine
2
Q
Non essential amino acids
A
alanine aspartic acid asparagine glutamic acid serine
3
Q
Conditional amino acids (consume during illness or stress)
A
arginine cysteine glutamine glycine proline tyrosine orthinine serine
4
Q
complete proteins
A
all 9 essential amino acids
animal based or soy (tofu, tempeh)
5
Q
incomplete proteins
A
missing one or more essential amino acids
plant based
6
Q
complementary proteins
A
2 or more incomplete
beans and rice
pasta and beans
PB on bread
7
Q
endopeptidase
A
splits at interior peptide bond=get dipeptide or tripeptide
8
Q
exopeptidases
A
cleave from end carboyxl or amine group–so you will get a carboxyl or amine peptidase
cleave one amino acid at a time
9
Q
pepsin, chymotrypsin, trypsin
A
endopeptidase
10
Q
carboxypeptidase
aminopeptidase
A
exopeptidases
11
Q
enterokinase
A
bursh boarder enzyme that converts trypsinogen to trypsin
proteolytic enzyme
12
Q
amino acid and peptide absorption
A
- Na/K ATPase (primary active co transport)
- Na and amino acids (luminal) co transport (secondary)
- amino acid use carrier protein via facilitated diffusion to get to blood
some of our products are di and tri peptides
- into cell with H+ ions
- converted into amino acids via cytoplasmic peptidases
- facilitated diffusion into blood
13
Q
No EAR or RDA for
A
fat
14
Q
Identifying fats
A
chain length and presence of double bonds
sat-no double bonds
monounsat-one double bond
polyunsat-many double bonds
15
Q
omega designation
A
location of double bond from methyl end of structure
ex: omega 3. 1st double bond is at the 3rd Carbon from methyl end
16
Q
Saturated fat
A
not essential because synthesized within the body
associated with CAD and increased LDL
animal and plant based foods
17
Q
MUFAs
A
synthesized by body
n-# indicates where the double bond is
ex: oleic acid is 18 carbon with one double bond at 5th carbon so 18:1 (n-5)
animal: beef, pork, poultry
plant: canola, olive, peanut, sunflower oil
18
Q
PUFAs
A
18-22 carbons long with first double bond at C3 from methyl end
- omega 6-many essential fatty acids not mad e by body including linoleic acid
- omega 3-only essential fa is alpha linolenic acid
19
Q
insufficient intake of linolenic acid
A
scaly skin, dermatitits, poor growth
role: cell membranes, blood clotting, decreased inflamation, enhance brain and joins function, decreased risk of cancer, heart disease, and diabetes
found in: fatty fish, soy, walnutx, flax seed
20
Q
insufficient intake of linoleic acid
A
role: growth, development of bone/skin/hair, increased inflammation, regulates brain function,reproductive role
found in: vegetable oils, nuts, grain fed meet
21
Q
non essential polyunsaturated fat
A
omega 7: decrease inflammation, insulin resistance–macadamiean uts
omega 9: improve djoin health/healing, decrease inflammation–olive and vegetable oils
22
Q
cholesterol
A
important for cellular membrane, precursor for estrogen, testosterone, aldosterone, and bilie acids
No DRI because notessential
<300 mg/day if heart disease family history
23
Q
phytosterols
A
2g/d for heart health
wheat germ, bran, peanuts, vegetable oils, almonds
24
Q
digestion of fat
A
large fat droplet–bile salts emulsify to smaller fat droplets
lipases have more SA to digest lipid into monoglyceride and fatty acids
25
bile salts
amphipathic molecule (polar and non polar)
polar ends--attracted to water
non-polar end binds the fat droplet
26
absorption of fat
fatty acids freely diffuse into epithelium
to smooth ER--reassemble TG
to Golgi--packages
exported as chylomicron via exocytosis
too large for blood--travels via lymph (villus of sm int)
some fatty acids that do not freely diffuse will aggregate with bile salts and cholesterol to form micelles
- as body needs more fat, micelles can release more content
27
insulin release
glucose is taken up by GLUT2 receptor on pancreatic beta cells
glucokinase converts glucose to G6P which signals to release insulin
28
various IG ratios
glucose meal: 40
overnight fast: 4.0
starvation 48 hours: 0.4
29
glucagon release
high blood glucose inhibits glucagon release from alpha cells of pancrease
30
insulin, glucagon effects on cAMP
insulin: inhibitor G protein, inhibits AC, decrease cAMP, decrease PKA. also increase phosphodiesterase (cleaves cAMP to AMP)
glucagon: stimulates AC, increases cAMP, increase PKA
31
glucagon leads to fat catabolism and blood glucose mainenance
Fat catabolism: lipolysis (increased fatty acids in blood, increased glycerol), liver (increased fatty acid utilization, beta oxidation, ketone synthesis), muscle (increase FA beta oxidation, increased KB as fuel)
blood glucose maintenance: increased glycogenolysis, GNG, increased protein catabolism (AAs used in GNG), decreased glucose utilization
32
Maintenance of blood glucose during fasting
exogenous glucose-->4-5 hours, glycogenolysis-->24h, GNG
| all continuous
33
Two electron carriers
Flavin mononucleotide (FMN) and ubiquinone (CoQ)
34
one electron carriers
Fe-S clusters, hemes, copper center
35
complex I
NADH DH
36
Complex II
Succinate DH
37
complex III
Ubiquinol Cyt C Reductase
38
Complex IV
cytochrome oxidase
39
cellular respiration
flow of electrons down eTC
40
oxidative phosphorylation
coupling of electron transfer reactions to phosphorylation of ADP to ATP
41
respiratory control
controlling rate of electron trasnport by ADP availability and the rate of ATP syntehsis
42
adeninine nucleotide total is constant so
ATP + AMP ADP + ADP Keq=1 so that
Keq=1=(ADPxADP)/(ATPxAMP)
AMP=(ADPxADP)/ATP
when ATP low, ADP high, and AMP high high high
43
VLDL is
outer layer of hydrophobic PL and cholesterol and helical proteins
inner: TG and cholesterol ester
44
why are cis unsat and sat liquid vs solid
cis unsat--double bond in same plane: difficult to pack
sat: same plane easy to pack
trans: trans double bond--different plane, FA can still pack but sat enzymes don't work same to break down
45
adipose secretes
leptin and adiponectin
46
leptin
hormone produced from adipocyte saying we are full of fat
released during feeding
suppresses appetite via signaling to hypothal
increase fatty acid oxidation in muscle and liver
decreases lipogenesis in liver
increases lipoportein lipase
47
adiponectin
hormone produced to indicate fasting by fat tissues
produces minor stimulation of appetite
major effects on fat catabolis
increase fatty acid oxidation in muscle and liver
decrease lipogenesis in liver
increase lipoprotein lipase in muscle and heart
48
leptin and brown fat uncoupling
most fat is white
some fat is brown--darkly pigement from high density of mitochondria (cytochromes)
BAT for heat production and lipid oxidation via uncoupling protein 1 (thermogenin)
uncouples ATP synthesis from eTC (like DNP)
49
leptin upregulates
Uncoupling protein 1 in BAT
50
uncoupling protein 1 or thermogenin
enzyme in BAT that leptin upregulates
| causes uncoupling of ATP synthesis from eTC and incresaed heat production from energy release
51
protein to nitrogen conversion
6.25 g protein=1 g N
52
measuring protein status
1. arterial venous mesaurement of amino acid and/or tracer whole organ or tissue bed
2. tracer into a protein to measure synthesis
3. tracer out of a protein to measure degradation
4. Nitrogen balance
53
Nitrogen balance equation
Nintake-Noutput
N intake= oral diet, parenteral or enteral nutrition
N output= UUN (mg/100mL) x urinary volume (L/d) + 20% urinary urea losses + 2g other
UUN is 80% of urinary N losses
urinary urea: ammonia, uric acid, creatinine
other: stool, secretions, sweat, skin
54
Nitrogen balance invalidations
```
significant respiratory secretions
chest/abdominal/draininage tubes
diarrrhea, ostomy, fistula
wound VAC
N retention in edema or ascites q
```
55
Dietitian
credential as RD or RDN
bachelors degree in science field
internship with 1200 more hours
nagional registration exam
75 hours of continuing education every 5 years
professsion overseen by commission of dietetic registration
56
Nutritionist
```
No standard credential
No degree
No internship
No standardized exam
No continuing education
No oversight
```
57
Nutrition education vs MNT (medical nutrition therapy)
Nutrition education: anyone can provide, depends on individual's ability to adapt to recommendations and readiness to change
MNT: provision of individualized education and counseling after thorough assessment, only provided by qualified nutrition professional, effectiveness depends on readiness to change, more cost effective
58
insurance coverage for MNT only for
ESRD and diabetes
59
MNT benefits
cost effective for prevention and disease management
RDN delivered yields clinical outcome improvements in HbgA1C, BP, BMI, LDL-C etc
RDN delivered reduced costs associated with MD time, medication use and hospital admission,
facilitates lifestyle changes
60
Nutriton care process
Nutrition assessment
Nutrition diagnosis
Nutrition Intervention
Nutrition monitoring/evaluation
61
Nutrition assessment
step 1 of NCP
collect, integrate nutrition related data (food history, related symptoms, anthropometric height, weight, BMI, biochemical data, medical tests, procedures, nutrition physical findings, client history)
62
Nutrition diagnosis
step 2 of NCP
identification and labeling of a nutrient related problem that can be treated independently by a nutrition professional
not a medical diagnosis
63
Nutrition Intervention (MNT)
step 3 of NCP
selection, planning, and implementation of specific actions to address the problem or diagnosis.
patient education, grounded in behavior change theory
patient and family centered, requires patient involvemtn
64
Nutrition monitoring and evaluation
```
step 4 of NCP
review and measure patient nutrition status and response to MNT over time with comparisons
monitor progress
measure outcomes
evaluate outcomes
make adjustments
```
65
Collaboration in NCP
physician or nurse: initiates discussion related to therapeutic diet changes
dietitian: provid MNT via NCP
Team: monitor and evaluate
66
failure to thrive
energy, protein, vitamins, trace elements
67
marasmus
protein, energy
68
kwashiorkor
protein
69
pallor
iron, folate, vitamin B12
70
ascites
protein
71
peripheral subcutaneous tissue edema
protein, thiamin
72
myxedema (puffy eyes, non pitting edema)
iodine
73
goiter
iodine, selenium
74
impaired wound healing, pressure ulcer
energy, protein, vitamin C, vitamin A, trace elements
75
craniotabes (soft skull)
vitamin D
76
thorax deformaties (beaded ribs)
vitamin D
77
epiphyseal enlargement of wrists
vitamin D
78
bowed legs
Vitamin D
79
weakness, joint pain
vitamin C
80
subperiosteal bleeding
vitamin C
81
nasolabial seborrhea
riboflavin
82
angular cheilosis
riboflavin, iron
83
purpura (red/purple, no blanching)
vitamin K
84
local hyperpigmentation without UV exposure
niacin
85
icthyosis (dry, scaly, thickened skin)
niacin
86
chronic skin xerosis (dry scaly skin)
vitamin A, vitamin C
87
follicular hyperkeratosis, no bleed
vitamin A
88
follciular hyperkeratosis with petechia
vitamin C
89
corkscrew body hair
Vitamin C
90
splinter hemorrhages in nails
vitamin C
91
spoon nails (koilonychia)
iron, zinc, copper, protein
92
white spots on nails (leukonychia)
zinc
93
banded hair color variation
protein, energy
94
glossitis
energy, protein, riboflavin, iron, vitamin B12, folate, niacin
95
scarlet raw tongue
niacin
96
magenta tongue
riboflavin
97
swollen tongue with submucosal bleeding
vitamin C
98
pale, spongy, receding, bleeding gums
vitamin C
99
angular stomatitis, cheilosis
riboflavin
100
night blindness
vitamin A, zinc
101
corneal keratomalacia
vitamin A
102
corneal scarring
vitamin A
103
Bitot's spots
Vitamin A
104
hypersegmented neutrophils
vitamin B12, folate
105
siderblastic anemia, anisocytosis
copper, vitamin B6
106
neutropenia
copper
107
marasmus
severe starvation in children, <60% normal body weight, loss of adipose and musscle
108
kwashikor
nutritoinally deprived children with low protein intake
| peripheral edema and ascites
109
beriberi
severe thiamin deficiency (alcoholics)
dry: neural pathologies, polyneuropathy, paresis, nystagmus, ataxia, confusion with confabulation and disorientation, dementia
Burning feet syndrome
wet: cardiac edema, HF
110
pellagra
```
niacin deficiency-scarlet tongue, 4Ds
death
diarrhea
dermatitis
depression
```
111
pernicious anemia
B12, folate
112
xeropthalmia
vitamin A deficiency with night blindness, Bitot's spot, corneal ulcers, scarring from keratomalacia, scaly, dry skin
113
scurvy
vitamin C deficiency--weakness, joint pain, puffy bleeding gums, swollen tongue, submucosal bleeding ,corkscrew body hair, and follicular hyperkeratosis with petechiae
114
Rickets
vitamin D deficiency--during childhood, craniotabes, bowed legs, beaded ribs, epiphyseal enlargement of wrists
115
goiter
iodine, selenium: abnormal enlargement of thyroid gland, puffy eyes and non pitting edema
116
corticosteroids
vitamin D, calcium
117
anticonvulsants (phenytoin)
vitamin D, Calcium, folate
118
sulfasalzine
folate
119
trimethoprim/sulfamethoxazole
folate
120
methoxtrexate
folate
121
isoniazid
pyridoxine, niacin
122
PPIs
vitamin B12, Ca, Mg, Fe
123
thiamin deficiency presentation
ill appearance, low body weight
nystagmus, low muscle strength
mild cardiomegaly, severe LV EF
elevated lactic acid
124
primary causes and other causes of thiamin deficieny
primary: alcohol conumption
other: poor intake, reduced absorption (altered GI anatomy) or excessive loss via diuretics or dialysis
125
niacin deficiency presentation
recurrent painful demarcated violaceous reuptions with erythmatous margins, and large areas of blistering on ankles and dorsa of feet
erythmatous desquamating rash on hands, forearms, periorbital skin, and scaly hyperpigmented rash on upper chest (Casal's necklace)
Sun exposure aggravated it.
diarrhea
alcohol use
126
niacin giveaways
hyperpigmentation, 4Ds, sun exposure worsens
127
Tx of niacin deficiency
oral nicotinamide
128
Tx of thiamin deficiency
IV thiamin
129
Ascorbic acid deficiency presentation
refusal to ambulate, unable to stand, hemorrhage in gum line above teeth, weight loss, pale, dark circles under eyes (bruising), pinprick petechiae on legsarms, vertical cracking lips
low vitamin A, vitamin C, vitamin D
anemia workup abnormal (microcytic)
low niacin--causes cracking of lips
low carnitine
130
tissue that is rapidly turning over is from
water soluable vitamins
| tongue/mouth problems are from water soluable vitamin deficiencies
131
Tx of ascorbic acid deficiency
ascorbic acid
cholecalciferol
multivitamin
ferrous sulfate
132
Prognostic nutritional index
158- (16.6 x albumin) - (0.78 tricep skinfold) - (0.20xtransferrin) -(5.8x skin test reactivity)
133
Nutritional risk index
```
(1.519xalbumin) + (41.7xpresent wt/usual wt)
100 not malnourished
97.5-100 mildy maln
83.5 to <97.5 moderaly maln
<83.5 severely maln
```
134
unsteady gait
consider Cu, Vit B12, Vit E
135
paresthesia/numbness/tingling/prickling/burning
Vit B1 or B2
136
not walking
Cu, Vit B12, Vit C
137
dull lackluster hair
protein/energy, alopeci, biotin, zinc
138
dry scaly rash
essential fatty acids
139
alanine to
pyruvate
140
serine to
pyruvate
141
asparginine to
aspartate to OAA
142
aspartate to
OAA
143
threonine to
alpha keto butyrate, propionyl CoA to succinyl CoA
144
methionine to
alpha KB, to propionyl CoA, to succinyl Coa
145
isoleucine to
propionyl CoA to succinyl CoA
146
valine to
propionyl CoA to succinyl CoA
147
Phenylalanine
to succinate/fumarate?
148
glutamate to
alpha KG
149
glutamine to
glutatmate to alpha KG
150
DRI includes
```
EAR estimated average requirements
RDA recommended daily allowance
AI adequate intake
UL upper limit
AMDR acceptable
```
151
Estimated average requirement
average daily nutrient intake which is estimated to meeth the requiement for 50% of healthy individuals in specific age and sex group
152
Recommended daily allowance
average daily nutrient intake that is suffiicent to meet the requirement for almost all 98% of the healthy individuals in a specific age group
153
Adequate intake
recommended average intake that is observed to be adequate when an RDA cannot be determined
154
Upper limit
highest average daily nutrient intake likely to pose no risk of adverse health effects
155
acceptable macronutrient distribution ranges
carbohydrates 45-65%
fat 20-35%
protein 10-35%
156
sources of glucose
fruit
157
sources of fructose
vegetables, honey, agave
158
galactose sources
dairy, sugar beets, avocado
159
sucrose sources
cane sugar
160
lactose sources
milk products
161
malotse sources
malt products
162
oligosaccharides
carbohydrate molecules composed of 2-10 monosaccharide units bounded by glycosidic bonds
163
examples of oligosaccarides
fructo-oligosaccharides
galacto-oligosaccharides
mannan-oligosaccharides (yeast cell walls)
isomalto-oligosaccharides (mixture of short chain CHO, resistant to digestion (prebiotic))
raffinose: storage or trasnport CHO in plants
164
raffinose
found in beans, cruciferous vegetables and whole grains
165
roles of oligosaccharides
cell recognition: lectins, glycolipids
cellular binding: lectins, ligands
immune response: glycoproteins
166
polysaccharides
more than 10 monosaccharide units bound by glycosidic bonds
167
Storage polysaccharides
starch adn glycogen
starch: potato rice wheat and corn
insoluable in water but can be digested via amylase
168
structural polysaccharide
cellulose: wood paper cotton
chitin: exoskeleton of animals
pectin: plant cell walls (most consumed)
169
dietary fiber
cellulose, resistant starch, inulin, lignins, chitins, pectins, beta glucans
FOS, IMO, Raffinose
soluable fiber: dissolves inw ater an d fermented in colon, role in CV health
insoluable: role in bowel health
170
Digestion of carbohydrates
mouth: salivary amylase breaks glycosidic bonds
chyme made no further digestion
HCl destroys bacteria and enature amylase
pancreatic amylase-further break down to mono
mono then absorbed
colon, remaining fibers partially broken down and femreneted by bactria
171
starch breaks down to
limit dextrins--short polysaccharides
| maltose
172
dextrins broken down by
dextrinase into glucose (can be absorbed)
173
glucoamylase
breaks down polysaccarides to glucose
174
lactose intolerance
dx: hydrogen breath test
lactose intolerance test--blood glucose measured 2 h after consuming bevereage high in lactose (inadequate increase in glucose)
stool acidity: use in children--fermenting of undigested lactose results in lactic acid in fecal matter
175
functional food
any modified food or food ingredient that may provide a . health benefit beyond the traditional nutrients it contains
whole, fortified, enriched, enhanced
176
whole oat products
reduce total and LDL C
177
psylium
reduce total and LDL cholesterol
178
cranberry juice
reduce UTI
179
garlic
reduce total and LDL C
180
reen leafy veggies
reduce macular degeeneration
181
tomatos
reduce risk of porostate cancer
182
cruciferous veggies
reduce risk of certain cancers
183
complete proteins sources
animal protein, soy (tofu or tempeh)
184
incomplete protein srouces
plant based proteins
185
complementary proteins
```
two incompleteto create a complete
PB and bread
pasta and beans
beans and rice
incomplete proteins can be consumed within same day
```
186
protein AMDR
10-35% of total energy intake
lean proteins, low in sat fat
0.8g/kg (except child and pregnant)
187
proteins broken to
individual amino acids
dipeptides
tripeptides
188
endopeptidases
splite polypeptide at interior peptide bonds
2 products or 3 products depending how much you cleave
small peptide fragments
189
exopeptidases
cleave off amino acids from one end of polypeptide
carboxyl end-carboxylpeptidases
amino end-aminopeptidases
cleave one amino acid at a time
190
zymogens
inactive storage forms of proteases
trypsinogen, chymotrypsinogen, procarboxypeptidase
stored in zymogen grnaules
secredted via exoctyosis from acinar cells
191
protein digestion
```
stomach:
chief cells secrete pepsinogen
parietal secells secrete H+Cl-
activates pepsinogen to pepsin
pepsin is an endopeptidase (smaller peptide fragments)
```
small intestine: pancreatic proteases (trypsin chymotrypsin, carboxypeptidase)
brushboarder proteases (aminopeptidase, enterokinase)
192
examples of endopeptidases
pepsin
trypsin
chymotrypsin
193
examples of exopeptidases
carboxypeptidase
| aminopeptidase
194
entorkinase
a proteolytic enzyme--responsible for activating other enzymes
195
digestion/absorption proteins
pancreatic zymogens into lumen
enterokinase brush boarder proteolytic converts trypsingoen to trypsin
trypsin helps convert the rest to active forms
get di/tri peptides and individual amino acids
absorb:
amino acids: Na/K ATPase creates gradient (primary)
apical. Na/amino acid co transport. Then basolateral membrane faciliated diffiusion via carrier protein
di and tripeptides: into cell with hydrogen ions. converteed individual amino acids via cytoplasmic peptidases
facilitated diffiusion to blood of amino acids
196
EAR or RDA
does not exist for fat
197
fatty acid nomenclature
carbon chain lenght and presence/number double bonds
| omega (count number of C from first methyl to double bond)
198
Sat FA
not essential because synthesized
CAD, incresae LDL C
animal and plant based foods
199
MUFAs
single double bond
synthesized by body
plant and animal sources (beef, pork, poultry, canola/olive/peanut oil, nuts, avocados, peanut butter
200
PUFAs
first double bond at 3rd carbon from methyl end
omega 6: linoleic acid (essential)
omega 3: linolenic acid (essential)
insufficient: scaly skin, dermatitis, poor growht/heigh
201
omega 3 FA sources
reduce inflammation, reduce heart, diabetes
fatty fish, soy , walnuts, flax seed
202
omega 6 FA sources
reprodutive role, bone, hair, skin, increases inflammation
vegetable oils, muts, grain fed meats
203
non essential PUFAs
omega 7 --macadamia nuts
| omega 9--olive and vegetable oils
204
Trans FA
increase risk of CAD
stick margarine, vegetable shortenings
minimal intake
205
sterols and stanols
reduce total and LDL C
fortified margarine
206
fatty fish
omega 3 fatty acids, risk reduction of heart disease, reduce TG
207
cholesterol
sterol, can be free or esterified
some bound to FA as cholesterol esters
not essential
-emulsification: bile salts amphipathic molecules (polar and non polar side)
lipase: disassembles to monoglyceride and 2 FA, both freely diffuse in intestinal epithelium
some FA are not absorbed right away will aggregate with bile salts, cholesterol to create micelles
monoglyceride and FA enter smooth ER--reassembles TG
enters golgi--packages--exported as chylomicron--travels via lacteal/lymph to blood
208
digestion of lipids
linugal lipase
gastric lipase
pancretic lipase
most in duodenum
emulsify with bile salts to increase surface area for lipases to act and digest lipid
