N- Nutrition! + Dental relevance Flashcards
1
Q
What is nutrition?
A
sum of processes for living organism to receive and use materials from environment to promote its own vital activities.
2
Q
What are nutrients?
A
- substances digested, absorbed, promote body function
* carbohydrate, fat, protein, vitamins, minerals, water
3
Q
What are essential nutrients?
A
substance necessary for life, cannot be synthesised by body, must be in diet.
4
Q
Basic role of carbohydrates
A
Heat and energy
5
Q
Basic role of proteins
A
tissue formation and repair
broken down to produce energy
6
Q
Basic role of fats
A
Heat and energy
incorporated into body tissue
7
Q
Vitamins and Minerals function
A
for regulation of body processes incorporated into tissue (minerals)
8
Q
Water basic role?
A
> fluid medium essential for metabolism
temperature regulation
waste product excretion
9
Q
What does COMA stand for?
A
Committee on Medical Aspects of Food Policy - give reference values for food energy/nutrients
> estimated average requirement (EAR)
reference nutrient intake (RNI)
10
Q
What does SACN stand for?
A
Scientific Advisory Committee on Nutrition
Advises PHE etc., on nutrition and related health issues
11
Q
Name 3 forms of carbohydrates
Foods of plant origin e.g. grain, fruit, vegetables
A
Monosaccharides (simplest form) e.g.
glucose, fructose, galactose
Disaccharides (pairs) e.g.
sucrose, lactose, maltose
Polysaccharides, complex form e.g.
starch (amylose [straight chain] and amylopectin [branched])
12
Q
What are Non-starch polysaccharides (NSPs) ?
A
From- plant cell walls
Found in: cereal, veg, fruit
Dietary fibre! Not digested…
13
Q
Advantages of NSPs?
A
- Bulky
- Full feeling; Stays in stomach for longer
- Prevents constipation
- Prevent colonic cancer?
14
Q
Disadvantages of NSPs?
A
- Binds to minerals (Ca, Fe) -> deficiencies
-Wind from metabolism of NSP in caecum and colon:
methane, CO2, H2
-Depending on type of NSP and bacterial flora
- insufficient energy intake: bulky, takes longer to eat
15
Q
Liver digestion of carbohydrates- 3 fates:
A
1- Metabolism for energy
2- converted to glycogen: stored in muscles and liver
3- converted into fat: when glycogen stores are full
16
Q
What is the Glycaemic index ?
A
(GI 1-100): ranks carbohydrates
- Rate at which the CHO reaches bloodstream as glucose…
17
Q
What is the optimal blood sugar level ?
A
3.5-10mmol/l
18
Q
Low GI foods…
A
Slow and steady release of glucose
19
Q
What % of energy intake should be carbohydrates?
A
40-80%
20
Q
Advantages to carbohydrates
A
Foods cheap, plentiful, palatable, easy to prepare, low fat content
21
Q
What is the free sugars recommendation?
‘Free’ term replaces Non-Milk Extrinsic Sugars (NMES) and
‘added’ terms
A
< 10% strong recommendation
(12 tsps/dy) total energy intake
< 5% conditional recommendation
Reduction throughout life course
22
Q
Examples of Saturated fats
A
- Butter
- Cheese
- Full-fat milk
- Pizza
- Takeaways
- Pies
23
Q
Examples of monounsaturated fats
A
- Olives
- Nuts
- Avocado
24
Q
Examples of polyunsaturated fats
A
Omega 3- oily fish, soya bean
Omega 6- sunflower seeds, wheat germ, corn
25
Trans fatty acids (hydrogenated)
in frying and baking fats, baked goods, long shelf life;
26
Essential fatty acids- role? (2)
for structure and function of cell membranes
to regulate cholesterol metabolism
27
Sources of fat
- Meat
- Dairy
- Eggs
- Vegetable (olive, coconut oil)
28
What is cholesterol?
- from diet and synthesised in the body
| - associated with animal tissues
29
Functions of fat
- energy for tissue activity and body temperature maintenance
- incorporated into body structure
e. g. brain + nervous tissue
- hold position and protection of vital organs
- insulation (subcutaneous heat loss)
- satiety – presence in duodenum delays stomach emptying
- provide fat-soluble vitamins and assist absorption
30
How much % of energy intake is from fats
RNI in g/dy??
35%
70-95g/dy;
20-30g/dy sat fat.
31
Protein found in which foods?
- Meat (myosin)
- Fish
- Eggs (albumin)
- Cheese
- Milk
- Nuts
- Pulses: lentils, beans
- Cereals: wheat (gluten)
32
RNI for protein?
45-55g/dy
33
Protein function?
>replacement during metabolism and wear and tear
e.g. hair, nails, skin, digestive secretions,
bone, dentine, epithelium, antibodies
>new tissue production
e.g. growth, recovery from injury, pregnancy, lactation
>forming enzymes, hormones
>energy source
34
3 fates of protein
1- Structural proteins
2- Converted into other AAs
3- Oxidised for energy
35
What are minerals used for?
3% body wt
Essential constituents of soft tissues, fluids, skeleton, teeth
Incorporated into enzymes, proteins and soluble salts.
36
What % body wt is water
65-70% of body weight
37
Water function
fluid medium for almost all body processes.
body secretions, excretions
sufficient urine flow, prevention of constipation
joint lubrication
temperature control (lung and skin evaporation)
death after a few days
38
How is water lost
urine, faeces, sweat (lose salt), exhaling, vomiting, diarrhoea, haemorrhage, exudate from burns
39
How much water ?
2.5-3 l/day
40
Problems with too much water?
kidneys can't keep up excretion
blood diluted, lower salt concentrations
water moves from blood to cells and organs
brain swells and prevents vital functions
41
How much energy from 1g of...
- Carbo
- Fat
- Protein
- Alcohol
1g carbo = 16kJ (4kCal), most efficient source
1g fat = 37kJ (9kCal)
1g protein = 17kJ (4kCal), takes time to turn into energy, needs
energy
1g alcohol =29kJ (7kCal)
42
What is Basal metabolism ?
amount of energy required for basic life processes e.g. heartbeat, respiration, cellular activity
43
what is a Healthy Balanced Diet?
Lots of fruit and vegetables (40%)
Starchy staple foods (wholemeal bread, wholegrain cereals; 40%,
incl B vits and fibre)
Protein rich foods (lean meat, fish, eggs, lentils)
Some dairy foods (pref. lower fat variety)
44
Food Standards Agency Guidelines
Base meals on starchy foods
5 (7) portions of different fruit and vegetables per day
2 portions of fish per week (incl. 1 portion oily fish)
Cut down on saturated fat and sugar
Eat less salt (no more than 6g day)
Get active and try to be a healthy weight
Drink plenty of water
Limit alcohol intake
45
What should maternal diet consist of?
Need Fat deposits - energy store for feeding
> 400-600kCal extra, 11g protein, plus fluid
> carbohydrate, fat, protein, vitamins, minerals
> anti-infective agents (e.g. immunoglobulins, lysozyme; long-lasting protection)
46
Contraindications to breastfeeding:
> cleft palate (indirect feeding)
> inborn errors of metabolism (e.g. galactosaemia)
> HIV infection
47
4-6mths baby nutrient needs?
> rapid growth and development
> iron stores before birth, depleted
> breast milk or infant formula
48
6-12mths baby nutrient needs?
> iron intake during weaning process
> increased protein uptake required, plus vitamins and minerals
49
What is the weaning process?
Expanding the diet... from 6m+
- GIT is too immature to digest
- Kidneys can't regulate high solute load
- Neuromuscular control of chewing
50
Toddler/pre-school nutrient needs?
milk (1 yr) : 500ml - 1litre
Ca, riboflavin, 1/2 protein, 1/4 energy needs
vit D: proprietary milks and fortified cereals
51
1-4years nutrient needs?
```
Increased energy requirement.
- More active, growth
- Protein requirements slightly increase
- Most vitamins and minerals
- Energy dense diet
- Full fat milk
NSPs
```
52
School Children and Adolescents:
| 5years+
Semi-skimmed milk.
- Regular meals
- Protein!
53
11-14yrs nutrient need?
Increased energy.
Protein 50%
Higher iron rq. for girls.
54
15-18yrs nutrient need?
E and protein increase.
Increase in Ca for boys- due to rapid skeletal development.
Higher Fe requirement for girls.
55
For a BABY=
- Energy rq. in kCal/dy
- % of which should be Sugars
- g/dy RNI of proteins
515-920kCal
40% (lactose)
12-15g
56
for Pre-school=
- Energy rq. in kCal/dy
- % of which should be Sugars
- g/dy RNI of proteins
1200-1700kCal
25-40%
15-19g
57
for Older Children/Adolescents=
- Energy rq. in kCal/dy
- % of which should be Sugars
- g/dy RNI of proteins
1800-2750kCal
17-25%
28-55g
58
Food policies and campaings
- NHS 5 a day campaign
- Change4life
- Healthy start
- FSA: Saturated fat campaign
- Every child matters: (government initiative)
59
Nutritional Organisations
FSA- food standards agency
DH/DfE
British Nutrition foundation
60
Why is a decrease in energy rq after 50yrs+?
Decrease in lean body tissue (muscle)
- grt fall in Basal Metabolic rate
- Less activity...
61
Diet after 50yrs+?
Decreased energy rq but unchanged vit. and min. rq.
| - Must have more nutrient-dense foods...
62
What are GDAs?
Guideline daily amounts
63
WOMEN GDAs:
Calories kCal
- Carbs; of which sugars
2000
Carbs=
230g, 50g
64
WOMEN GDAs:
- Fat; of which saturated
- Protein
- Fibre
- Salt
Fat= 70g, 20g
Protein= 45g
Fibre 25-30g
Salt= 6g
65
MEN GDAs:
Calories kCal
- Carbs; of which sugars
2500
Carbs=
300g; 70g
66
MEN GDAs:
- Fat; of which saturated
- Protein
- Fibre
- Salt
Fat= 95g; 30g
Protein= 55g
Fibre 25-30g
Salt= 6g
67
COMA nutrient recommendations for:
Total intake % of diet energy from:
FAT-
Saturated fat-
Complex carbs-
F- 35%
SF- Less than 11%
Complex carbs= increase by 50%
68
what are RDAs?
Recommended Daily Guidelines (RDAs)
69
Alcohol, number of units per week?
Less than 14 units
Spread out over 3 days
70
Salt RDAs?
6g (2.4g Sodium... Nax2.5= salt)
75% in “bought” food (processed)
71
Cholesterol function?
> structure and function of cell membranes
| > precursor to steroid and adrenocortical hormones; bile acids and neural tissue
72
Cholesterol source?
1/3-1/2 made in liver, rest from diet (smoking, weight, activity)
73
Total Cholesterol suggested range (mmol/l)
<5.2
74
LDL Cholesterol suggested range (mmol/l)
<4
75
HDL Cholesterol suggested range (mmol/l)
>1.15
76
Degenerative changes of old people
```
loss of smell, taste
failing sight
osteoarthritis/osteoporosis
reduction of glucose tolerance
decline in muscle bulk and strength
reduced nutrient-absorption ability
```
77
Older people... Mineral and vitamin rq. ??
Minerals e.g. Ca - NSP increase affects absorption (osteoporosis)
Vitamins e.g. Vit A increase with cod liver oil for arthritis
78
Causes of Older Mal/Undernourishment
Extreme age
Social isolation and loneliness
Loss of appetite
food enjoyment depends on visual appearance, taste, smell
smoking, poor OH, drugs
salivary secretion - taste, chewing and swallowing
(salivary gland dysfunction: Sjögren`s syndrome; xerostomia [drugs]; chemotherapy: mucositis, candidiasis)
Mental disturbances
e.g. dementia – forget, lack of motivation
Physical disabiltiy
79
Causes of Older Mal/Undernourishment...
- Dental problems
- Dysphagia: difficulty swallowing
Hard to chew
Constipation/bowel problems
80
National Diet and Nutrition Survey (NDNS RP)
```
Food consumption
Nutrient intake/status
Physical measurements
Diet diary
Free sugars and fibre
Processed meat?
Un/saturarated fat?
```
81
What are Wellbeing Scores?
```
0-44 = bad diet/lifestyle
45-90= fine tuning needed... long term benefits
90+ = Good job preventing health problems
```
82
Well being scores based on...
Smoking: any is harmful, effects are ‘temporary’
Fresh fruit and veg: multivitamin not a substitute, incorporate small amounts
Colds and flu: unhealthy lifestyle, stress, 50yrs+
weakened immunity
Alcohol: 1 unit/dy re ↓heart disease (slight)
Food prep: salt, sugar and sat. fat in ready meals and sauces; relaxing and social experience
Exercise: regular, small amount better than none
(HIIT, LI Steady State [LISS])
Weight: hard to understand, but obesity can cause and exacerbate life-threatening illnesses in old age
Sun exposure: in top 10 cancers; need for Vit D
Illness prevention: regular checks NB; 25-64yrs cervical cancer screening, 50yrs+ mammograms and rectal exams
Salt: season and preserve; reduce gradually re taste;
processed/packaged food and table salt
83
Diet and nutrition may have an effect with respect to:
- Developmental defects
- Caries
- Erosion
84
Developmental defects can be due to:
Nutritional deficiencies:
- Calcium, phosphates
- Vit.A
- vit.D
- Malnutrition
Nutritional excesses:
- Fluoride
- Tetracycline
85
Nutritional fluoride in caries prevention
Water supplies (1ppm, 10% of UK population)
- Tea
- school milk
86
Excess fluoride implications?
Will cause dental fluorosis
| GIT upset, respiratory arrest and death
87
What is tetracycline?
Broad spectrum antibiotic used for periodontal disease, acne, chest infections (cystic fibrosis patients).
If given during enamel formation stage will cause severe intrinsic staining of enamel.
88
Low Vit.D can result in...
Delayed dental development
| Deficient (hypoplastic) enamel
89
Patients with Vit D resistant rickets
(Hereditary hypophosphatasia)
may present with:
> Large pulp chambers
> Large/promininent pulp horns
> Enamel hypoplasia
> Clefts and tubular defects in dentine
90
clinical significance of vitD resistant rickets
Due to thin enamel, prominent pulp horns and clefts in dentine – patients may present with ‘spontaneous’ dental abscesses
91
Calcium and phosphates – evidence for role in dental development
Role in preventing enamel hypoplasia
Patients with disorders of calcium and phosphate metabolism (x-linked hypophosphatasia, hypoparathyroidism) show significant increases in enamel defects (hypoplasias)
92
Malnutrition may cause what dental defect?
- Enamel hypoplasia (linear grooves) involving primary incisors
- Generalised enamel hypoplasias in 20% of children
- Delayed dental eruption
93
Diet and caries link?
Established role of non-milk extrinsic sugars in aetiology of dental decay – frequency rather than quantity
94
Extrinsic (dietary) causes of erosion=
Acidic drinks (most fruit-flavoured or carbonated drinks)
Acidic food (citrus fruits, yoghurts)
Vit C tablets
Pickled foods + vinegar
95
PEG=percutaneous endoscopic gastrostomy feeding tube
Children who are PEG-fed seem to readily develop excessive calculus deposits on all tooth surfaces
96
Food type and periodontal health
No evidence for fibrous foods reduces plaque-related disease in humans – however…
Eating fibrous foods may help to maintain the supporting tissues of the periodontium, and increased salivary flow from eating fibrous foods may have some beneficial effects on oral health generally
97
Vitamin C and periodontal health?
Vitamin C deficiency is
associated with:
Disturbed collagen formation
Bleeding and swollen gums, loose teeth
98
Folic acid and periodontal health?
the most deficient nutrient in adults
Primarily concerned with DNA synthesis and cell turnover
Probably plays a role in periodontal health by maintaining epithelial integrity and attachment.
Folate mouthwashes and supplements have been shown to reduce pregnancy-related gingivitis
99
Oral manifestations of nutritional deficiencies:
Vitamin B12
glossitis,
fissured tongue,
burning mouth,
erosive or ulcerative lesions
100
Oral manifestations of nutritional deficiencies:
Vitamin C
haemorrhage and swelling
101
Oral manifestations of nutritional deficiencies:
Folic acid
ulcers, burning mouth, depapillation of tongue
102
Oral manifestations of nutritional deficiencies:
| Protein deficiency/kwashiokor
oedema of tongue, atrophy of papillae, circumoral hypopigmentation
103
Depapillation of tongue
burning sensation or altered taste
104
What is Orofacial Granulomatosis?
Orofacial granulomatosis (OFG) is a condition characterized by persistent enlargement of the soft tissues of the mouth, lips and the area around the mouth on the face.
delayed hypersensitivity reaction to benzoates, cocoa, cinnammon, carvone
105
Clinical signs of Orofacial Granulomatosis?
```
Diffuse facial swelling
Lip enlargement + vertical fissuring
Angular cheilitis
Oedema of buccal mucosa
Mucosal tags
Aphthous-like ulceration
```
106
Management of Orafacial granulomatosis?
Exclusion diet
Symptomatic relief (difflam, gengigel)
Immunosupresants
Steroids (mouthwash, systemic)
107
Caries diet advice:
Explain that the frequency of sugar
‘attacks’ needs to be reduced to prevent decay
Offer ‘safe’ alternative snacks/drinks
Advice against drinks for infants in a bottle
Recommend general healthy eating guidelines (5 a day!)
Reinforce the need for toothbrushing with F toothpaste twice a day
108
Erosion diet advice:
Discourage frequency and amount of acid drinks and food
Promote chilling of drinks and limit soft drinks to mealtimes
Use of straw
Promote neutralising foods eg cheese after acid food/drink
Refrain from toothbrushing straight after an acid attack
109
Safe snacks/drinks
Water/milk/tea with no sugar (or sweetners for older patients)
Fresh fruit/veg
Cheese/meat
Bread/breadstick
(Plain crisps)
Nuts (for older patients, with no nut allergy!)
