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MBChB221 Digestive > Nutrition > Flashcards

Nutrition Flashcards

1
Q

What three actors influence nutrition

A

Environment (food)
Agent (diet)
Host (Body)

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2
Q

Burden of disease from poor nutrition

A

2 in 5 deaths

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3
Q

NZ obesity

A

~1/3 adults

Child obesity very high

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4
Q

Rationale for Eating Statement 1 “Variety of nutritious foods”

A

Need lots of different nutrients which you can only get from lots of different sources

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5
Q

Why are fruits and vegetables important

A

Vitamins C A K
Minerals
Fibre

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6
Q

Why wholegrains

A

Bran and germ contain FAR more nutrients/vitamins/fibre than the endosperm

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7
Q

Why dairy important

A

Calcium
Vit A K
Protein

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8
Q

Why legumes, nuts, fish, meat important

A

Protein
Iron and Zinc
Vitamin A, E
Fatty Acids

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9
Q

Where do NZers consume too much salt

A

Processed foods

Bread as despite moderate amount of sodium, it is eaten frequently in NZ

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10
Q

Why is eating statement 2 “Minimal sat fat, sugar, salt” important

A

These do bad things

Sat fat - obesity, cardiovascular
Salt - cardiovascular, renal
Sugar - cardiovascular, diabetes

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11
Q

Why is eating statement 3 “Water main drink” important

A

Water doesnt have high sugar etc

Hydration for renal

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12
Q

Why is eating statement 4 “Low alcohol” important

A

Alcohol bad for liver, cardiovascular

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13
Q

Why is eating statement 5 “store food safe way” important

A

Dont want bacterial infections from undercooking etc

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14
Q

Why are population guidelines and individuals different

A

Individual goals need to factor in cost, taste, culture, marketing etc

Specific goals eg Coelaic no wheat even though wholegrain wheat would be recommended for most people

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15
Q

Who is most at risk of malnourishment

A

Low SES

Elderly - can’t swallow all food types, harder to cook well etc

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16
Q

What are the two ways of taking a nutrition assessment

A

Habitual

Time-period

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17
Q

What is a time-period nutrition assessment

A

Intake in a specific time eg last 24 hrs

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18
Q

What is a habitual nutrition assessment

A

Standard intake, not based on any particular day

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19
Q

ABCDE of Nutrition Intake

A

Anthropometry
Biochemical
Clinical
Dietary
Economic / social

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20
Q

Anthropometry Things to check

A

The delta - weight, height, body composition changes including rate of chnage

Weight

Height

Circumferences - waist adults
- mid-upper arm children

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21
Q

Measuring body composition measures

A

Fatfold

Hydro density entry

DEXA

Bio electrical impedance

Air displacement

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22
Q

Drawback to fatfold body composition method

A

Assumes subcutaneous fat is proportional to total fat

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23
Q

Drawback to DEXA

A

Accurate but expensive

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24
Q

Drawback to hydrodensitometry

A

Estimate using volume calculations

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25
Q

BMI calculation

A

Weight / height-squared

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26
Q

Normal BMI

A

18.5-24.99

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27
Q

Obese BMI

A

Over 30

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28
Q

Different ethnic groups have different healthy BMI ranges?

A

Yes
- Asians lower
- Maori higher

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29
Q

When does change in body weight become significant

A

> 5.0% in 3 months

KEY POINT IS TIME INVOLVED

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30
Q

Biochemistry nutrition assessment

A

Blood and urine tests to check nutrients

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31
Q

Clinical Biochemical assessment

A

Signs/symptoms of deficiency/toxicity from physical examination

Oral and dental health

Medications

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32
Q

Where can you check malnourishment using fat

A

Pinching biceps region
- If no fat tissue = severe malnourishment
- If little fat = mild malnourishment

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33
Q

Dietary nutrition assessment

A

Estimation of dietary requirements and whether they’re being met

  • Food and beverage intake
  • Patterns of intake
  • Supplements
  • Food insecurity
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34
Q

Why are nutrition assessments important / used for

A

Malnourishment = high burden of disease

Used for determining if malnourished, making treatment plans, evaluating current interventions etc

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35
Q

What is the main source of energy for all ethnicities

A

Carbohydrates
- But different types eg potatoes Irish, Native American corn

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36
Q

Two principal types of carbohydrates

A

Complex or simple

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37
Q

Complex carbohydrates

A

Starches and fibre

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38
Q

Simple carbohydrates

A

Sugars (Di/monosaccharides)

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39
Q

Fructose

A

Monosaccharide from fruit

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40
Q

Galactose

A

Monosaccharide from dairy

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41
Q

Glucose

A

Monosaccharide that is rarely directly eaten, but made from conversion of other saccharides

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42
Q

Sucrose

A

Disaccharide that is “table sugar” ie main added sugar!

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43
Q

Lactose

A

Disaccharide dairy

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44
Q

Maltose

A

Disaccharide from fermentation (alcohol)

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45
Q

How are carbohydrates stored

A

Polysaccharides

  • Glycogen = main human
  • Starches = main plant, not made by us but consumed
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46
Q

Carbohydrate DIgestion in oral cavity

A

Mechanical - teeth

Chemical - salivary amylase breaks down starch

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47
Q

Carbohydrate digestion in stomach

A

None! As acidity deactivates amylase

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48
Q

Chemical Digestion in Small Intestine (Carbohdrates)

A

Pancreatic Amylase = further breaks down into small polysaccharides

Disaccharides ——> monosaccharide + glucose
X-ase (enzyme always X-ase eg sucrase acts on sucrose -> fructose)

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49
Q

Absorption of glucose

A

Active (Primary/secondary)

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50
Q

Absorption of fructose

A

Facilitated diffusion

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51
Q

Absorption of galactose

A

Secondary active

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52
Q

Fibre benefit

A

Protects against colorectal cancer, and other bowel health

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53
Q

How Microbiome impacted by nutrition

A

Specific nutrients associated with specific microbes = good gut

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54
Q

High glycaemic index carbs

A

Rapid rise in blood glucose / insulin in short-term

  • Worse for diabetes
  • Makes you hungry again soon
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55
Q

Examples of high glycaemic index carbs

A

Added sugar eg coke

Fruit (but fruit still healthy therefore not all high glycaemic bad)

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56
Q

Low glycaemic index carbs

A

Lower glucose and insulin spread over long time

  • Better for diabetes
  • Less hungry soon
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57
Q

Vit B12 Structure

A

Corrinoid ring (4 pyrolle rings)

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58
Q

Change to B12 (Cbl) in stomach

A

Binds to HC

=HC-Cbl

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59
Q

Change to B12 (Cbl) in duodenum

A

HC cleaved by pancreatic enzymes
Now can bind to IF

= Cbl-IF

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60
Q

Change to b12 (Cbl) in ilium

A

Absorbed

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61
Q

Types of B12

A

HC-Cbl = inactive, stored in liver

TC-Cbl = active, used in all cells

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62
Q

Deficiency of B12 results in

A

Macrosytic anaemia (pernicious aneamia)

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63
Q

Main cause of B12 deficiency

A

Lack of IF (required for absorption), rather than direct lack of B12

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64
Q

B12 dietary sources

A

Meat and animal products

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65
Q

People at risk of B12 deficiency

A

Vegans
- Vege fine since eggs, milk as well as meat

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66
Q

Requirements for B12 to bind to IF

A

R-binders

Panc enzymes

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67
Q

Pernicious Anaeamia

A

Autoimmune attack of parietal cells = not enough IF = not enough B12 = macrocytic aneamia

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68
Q

Pernicious Anemia Detetction

A

Autoantibodies of parietal cells

Other autoimmune conditions (as autoimmune conditions rarely isolated to just one)

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69
Q

Treatment of B12 malabsorption

A

Intramuscular injection

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70
Q

Schilling’s Test

A
  1. Radioactive B12 + INJECTION of B12 = saturated B12 = would expect in urine if normal
  2. Radioactive B12 + SWALLOW of B12 = saturated B12 = would expect in urine if problem is making=stomach, not in urine means absorption problem=ilium
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71
Q

What do proteins do

A

Energy
- Only when carbohydrate not sufficient

Enzymes, ion channels, transport, immune, structure etc

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72
Q

Essential Amino Acids number

A

9

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73
Q

Conditionally essential amino acid

A

Cant make in sufficient quantities under certain conditions therefore becomes essential

74
Q

Non-essential amino acid

A

Synthesised by our body = dont need dietary intake

75
Q

Protein percentage of energy intake

A

15-25%

76
Q

Women recommended grams of protein per kilo per dag

A

0.75 g/kg/d

77
Q

Men recommended grams of protein per kilo per day

A

0.84g/kg/d

78
Q

Why do you need to do exercise to make protein intake help build muscle mass

A

If not then excess protein = excreted via urine

79
Q

Are protein supplements useful

A

For most people no, only if malnourished or if intense exercise

80
Q

Supplement important questions to ask

A

Safe
Legal
Batch tested
Work for me specifically

81
Q

What is a complete protein

A

Has all/most of the essential amino acids

Animal proteins are more complete than plant

82
Q

What are complementary proteins

A

Together they form a complete protein and have all/most essential amino acids

83
Q

Protein Digestion pre-stomach

A

1 Cooking denatures protein

2 Mechanical digestion mouth
Moistened saliva

84
Q

Protein digestion stomach

A

Pepsin (pepsinogen -> pepsin by HCl) breaks polypeptide into di/tri peptides

85
Q

Protein digestion small intenstine

A

Broken into individual amino acids by pancreatic enzymes (trypsin, chymotrypsin, carboxypeptidase)

86
Q

Tyypsinogen -> trypsin enzyme

A

Enteropeptidase

87
Q

Chymotypsinogen -> chymotripsin enzyme

A

Trypsin

88
Q

Procarboxypeptidase -> carboxypeptidase enzyme

A

Trypsin

89
Q

What do trypsin, chymotrypsin, and carboxypeptidase do

A

Break di/tripeptides into individual amino acids = can be absorbed

90
Q

Amino acid absorption small intestine method

A

Primary/secondary active into enterocyte

Fac diff into blood

91
Q

What byproduct is produced during protein breakdown

A

Ammonia

92
Q

How do we remove excess ammonia

A

Excretion urine

93
Q

Positive nitrogen balance

A

Intake > exposure
= Growth

94
Q

(Neutral) nitrogen balance

A

Intake = expenditure

Healthy adult that is not growing, pregnant etc

95
Q

Negative nitrogen balance

A

Expenditure > intake

Starvation, cancer, burns etc

96
Q

Nitrogen intake calculation

A

g(N) x 6.25 = g(Protein)

97
Q

Calaculation for nitrogen balance

A

Grams excreted via urine sample

Grams intook via dietary measure of protein, then divide by 6.25

See if equal

98
Q

Kwashiorkor

A

Diet deficient in protein (but sufficient energy)

= Muscle wasting, but preserved subcutaneous fat

99
Q

Marasmus

A

Diet deficient in protein AND energy

= Severe muscle wasting, loss of subcutaneous fat as well

100
Q

Most energy dense macronutrient

A

Fat (37 kJ/g)

101
Q

Where do you get plant fats

A

Nuts and seeds

102
Q

Short chain fatty acid length

A

1 to 6 C

Eg milk

103
Q

How do trans fats occur

A

Not in nature, only byproduct of manufacturing

104
Q

Saturated fats characteristics

A

Solid at room temp
Hard to spoil
Bad for heart

105
Q

Unsaturated fats characteristics

A

Polyunsaturated liquid at room temp
Spoil more readily (unless hydrogenated = trans fat)

106
Q

Essential fatty acids

A

Omega 3 and Omega 6

107
Q

Omega 6 pro/anti inflammatory

A

Pro (which is good as we need ability to do acute inflammation)

108
Q

Omega 3 pro/antiinflammatory

A

Anti (= good)

109
Q

Why is the ratio of omega 3 and 6 important

A

They compete for the same enzymes to be converted into final form = important to ensure we are not saturating the enzymes with just one type

110
Q

Final product of omega 3 and omega 6 conversion

A

Eicosanoids (direct cell action, not hormone)

111
Q

Omega 6 conversion pathway

A

LA (vege oil) -> gammaLA -> AA (animal) -> eicosanoid

112
Q

Omega 3 conversion pathway

A

ALA(veg oil) -> EPA (fish) -> DHA (fish) -> eicosanoid

113
Q

Why do we need omega 3 and 6

A

Brain development
Vision
Inflammatory pathways

114
Q

Do we need more omega 3 or omega 6

A

Absolute - omega 6

In NZ - more omega 3 to improve ratio

115
Q

Ideal omega 3 to 6 ratio

A

1 Omega-3 : 2-4 Omega-6

116
Q

Are sterols endogenous or exogenous

A

Both endogenous from production in our liver, exogenous from fish eggs and plants

117
Q

Fat digestion in mouth

A

Mechanical
Release of lingual lipase (doesn’t do anything until pH activation)

118
Q

Fat digestion stomach

A

Lingual lipase activated by pH
Gastric lipase
Muscle contractions disperse fat into smaller droplets

119
Q

Fat digestion small intestine

A

Bile emulsifies fat into micelles

Pancreatic enzymes break emulsified fats down into monosaccharides, glycerol, fatty acids

120
Q

If removed gall bladder how should you change your diet

A

No gallbladder = cant store bile, but can still produce

Therefore have smaller biles more often, and decrease fat intake

121
Q

Why can micelles be absorbed but larger fat cant

A

Micelles small = sufficiently water soluble

122
Q

What transports exogenous lipid

A

Chylamicrons CM

123
Q

Endogenous lipid transported by

A

VLDL Very low density lipoprotein

124
Q

What happens to CM when travelling around body

A

Shrinks in size and then eventually reabsorbed

125
Q

Desired Energy intake from fat

A

20-35% total

trans/sat should be <10%

126
Q

How is iron stored in the body

A

Ferrotin

127
Q

Iron used in

A

Haemoglobin/myoglobin
Cytochrome P450 - metabolism of fatty acids

128
Q

Iron transported in blood via

A

Transferrin

129
Q

Iron absorbed where

A

Duodenum and proximal Jejunum

130
Q

Can iron be excreted

A

Not easily - only by shedding intestinal cells that have iron stored as ferrotin

131
Q

Iron in plants is

A

Only Nonheme

132
Q

Iron from meat is

A

Heme and nonheme

133
Q

How is heme iron absorbed

A

HCP1 into cell
Hox1 out of heme into Fe2+

134
Q

How is nonheme iron absorbed

A
  1. Reduced to Fe2+ by DRA and Dcytb (in lumen)
  2. Absorbed by Dcytb and DMT1
135
Q

How does iron get from absorptive cell into blood

A

Ferroportin channel (then into transferrin for transport)

136
Q

Hepcidin function

A

Inactivates ferroportin = iron stuck in gut and can’t get to blood

137
Q

Factors that enhance nonheme iron absorption

A

Vitamin C
Acid
MFP (in meat)

138
Q

Factors that inhibit nonheme absorption

A

Phytates - bran
Tannins - tea

139
Q

Dietary sources of iron

A

Meat, spinach etc
Contamination from cookware
Supplements
Fortification - cereal!

140
Q

Who needs high iron

A

Women
Especially pregnant women
Growing children

141
Q

Type of anaemic from iron deficiency

A

Microcytic

142
Q

Stages of iron deficiency

A
  1. Depleted storage
  2. Iron restricted erythropoiesis
  3. Iron deficiency anaemia
143
Q

Most common nutrient deficiency globally

A

Iron

144
Q

What is the RDI

A

Level considered adequate to meet the needs of almost all healthy individuals (ie well above the estimated average requirement)

145
Q

Water voluble vitamins

A

B and C

146
Q

Fat soluble vitamins

A

ADEK

147
Q

Excretion of fat/water soluble vitamins

A

Water - easy excretion via urine
Fats - less ready excretion, stored in fat

148
Q

Absorption of water/fat soluble vitamins

A

Water - direct to blood
Fat - lymph then blood

149
Q

Factors that affect Bioavailability of vitamins

A

Effieicny of digestion
Other foods consumed simultaneously
Food preparation method
Nutritional status
Synthetic/natural source

150
Q

Vitamin B1 other name

A

Thiamine

151
Q

Thiamine absorption site

A

Duodenum

152
Q

Thiamine transport method

A

Active

153
Q

Thiamine transport inhibitor

A

Alcohol

154
Q

Thiamine sources

A

Whole grain - bran and germ which is removed in refined grains

155
Q

Beriberi meaning

A

Thiamine deficiency

156
Q

Wet beriberi impact

A

Heart failure

157
Q

Wet beriberi chronic/acute

A

Acute

158
Q

Dry beriberi acute/chronic

A

Chronic

159
Q

Dry beriberi impact

A

Muscle wasting / neurological

160
Q

Main cause of thiamine deficiency in developed countries

A

Alcoholism as transport inhibited
- Maybe we should supplement alcohol with thiamine

161
Q

Vitamin B9 synonym

A

Folate

162
Q

Folate function

A

Nucleic acid production and heart health

163
Q

Cause of folate deficiency

A

High alcohol
Anti-inflammatory drugs
PREGNANCY

164
Q

Why should we fortify with folate for everyone even though normally just when pregnant that defient

A

So much development happens before you know you’re pregant

165
Q

Impacys of folate deficiency

A

Neural tube defects

Macrocytic anaemia

166
Q

Vitamin D dietary source

A

Oily fish

167
Q

VItamin D our own synthesis

A

Skin needs UV to convert to active form

168
Q

Vitamin D function

A

Maintain plasma concentration of calcium to lead to increased bone density

169
Q

Vitamin D deficiency impact child

A

Rickets

170
Q

Vitamin D defiency impacy adult

A

Osteomalacia

171
Q

Who needs Vit D supplement

A

People who have had bone injury eg surgery, trauma as increased metabolic demand

Drug-nutrient interactions

172
Q

How long should you breastfeed

A

Exclusively 6 months
Continue for 2 years (or longer)

173
Q

If adequate nutrition what changes during a babies first year

A

Massive weight increase
Length, head circumference, brain increase

174
Q

Food security requires

A

Physical, social and economic access to nutritious and safe food

175
Q

Low birth weight, or low growth as a child is associated with

A

Non communicable diseases later in life

176
Q

Baby energy intake per kg compared to adult

A

Greater energy per kg needed

177
Q

Why do people stop breastfeeding too early

A
  1. Back at work
  2. Social norms
178
Q

Baby desired renal solute load

A

Low mOsm/L

Therefore breast milk is good, and better than formula

179
Q

What nutrient do babies need the most

A

Iron

180
Q

Which food groups are children lacking the most in

A

Fruit and veg

181
Q

How should we compact childhood obesity

A

Dietary recommendations, physical activity

EARLY INTERVENTION - before school check

MBChB221 Digestive (9 decks)

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