nutrition

Question 1

function + sources

carbohydrates

Answer 1

• glucose = carbohydrate molecule used for body cell fuel (produces ATP)
• preffered energy source (1g carb = 4 kcal/g)
• promote normal fat metabolism (inadequate carbs affects metabolism)
• main fuel source - glucose for brain + skeletal muscles during exercises, promote RBC + leukocyte production + cell function
• provide fiber - cellulose in vegetables is not digested by humans (increases bulk of stool + defecation)

sources:
* milk
* grains
* fruits
* vegetables

45 - 65% of total calorie intake

Question 2

function + sources

fats

Answer 2

• fat deposits = cushion around organs, insulating layer under skin, concentrated energy source
• phospholipids: important for myelin sheaths + cell membranes
• cholesterol = stabilizing component of plasma membranes, precursor for bile salts + steroid hormones
• prostoglandins: smooth muscle contract, control of BP + inflammation
• triglycerides = majory energy fuel of skeletal muscles + hepatocytes
• enhance fat-soluble vitamin absorption
• 9 kcal/g

sources:
* saturated fatty acids: solid at room temp (animal fat + tropical oils like coconut oil) - increase risk of CAD
* unsaturated fatty acids: soft/liquid at room temperature (seeds, nuts, olive oil, vegetable oils)
- omega-6 from plants/vegetables such as olive, canola, peanuts oils
- omega-3 from fish + shellfish
* monosaturated fatty acids: found in plants + animals, good for reducing cholesterol, glucose, systolic BP
* polyunsaturated fatty acids: from plant + fish oils

20 - 35% of calorie intake

Question 3

function

protein

Answer 3

• made up of amino acids - essential for development of body tissues, required in diet (body cannot manufacture them)
• provide 4 kcal/g
• proteins build + repair body tissues, regulate fluid/acid-base balance, produce antibodies, provide energy, produce enzymes/hormones
• malnutrition = severe wasting of fat + muscle tissue from inadequate protein

sources:
* meat, fish, eggs
* lentils, beans, peas
* nuts, seeds
* soy

Question 4

actions + sources

vitamin A

retinol

Answer 4

actions:
* growth + development (bones, teeth, epitheliial membranes)
* proper wound healing
* steroid biosynthesis
* pigment required for night vision

sources: dairy products, fish, liver, green or orange vegetables, fruits

deficiency = blindness, skin disorders, impaired immunity

excess = irritability, vomiting, hair loss, blurred vision, liver/bone damage

fat-soluble

Question 5

actions + sources

vitamin D

cholecalciferol

fat-soluble

Answer 5

action: increases calcium absorption in GI tract

pathway: cholecalciferol (inactive form) > converted to calcifediol after absorption/formation > metabolized by kidney enzymes to calcitriol (active form)

sources: fortified milk, fish oils, most cereals (vit D2), skin reaction to UV light (vit D3)

deficiency = rickets (bone deformity) in children, bone softening in adults

Question 6

actions + sources

vitamin E

tocopherols

Answer 6

action: antioxidant - prevents formation of free radicals that damage cell membranes + structures

sources: vegetable oils, products made with vegetable oil (margarine, salad dressing), fruits, vegetables, grains, nuts (almonds, hazelnuts), seeds (sunflower seeds), fortified cereals

deficiency = degeneration of nervous system

fat-soluble

Question 7

action + sources

vitamin K

Answer 7

action: cofactor in blood clotting

sources: K1 - green leady and cruciferous vegetables, turnip greens, spinach, cauliflower, cabbage, broccoli, certain vegetable oils (cotton seed oil, canola, olive)
K2 - synthesized by microbial flora in the colon

deficiency = defective blood clotting

fat-soluble

Question 8

actions + sources

vitamin B1

thiamine

Answer 8

action: coenzyme - removes CO2 from organic compounds

sources: pork, nuts, whole grain cereals, legumes

deficiency = berberi (nerve disorder - tingling, poor coodrination, reduced heart function) usually from malnutrition secondary to chronic alcoholism

Question 9

vitamin B2

riboflavin

Answer 9

action: coenzyme in metabolic reactions

sources: milk, lean meats, fish, grains

deficiency: skin lesions (cracks at side of mouth)

Question 10

vitamin B3

niacin

Answer 10

action: coenzyme in metabolic reactions

sources: meats, poultry, fish, beans, peanuts, grains

deficiency: skin and GI lesions, nervous disorders

Question 11

vitamin B6

pyridoxine

Answer 11

action: conenzyme in amino acid metabolism

sources: yeast, corn, meat, poultry, fish

deficiency: irritability, convulsions, muscular twitching, anemia

Question 12

vitamin B9

folic acid

Answer 12

action: coenzyme in nucleic acid and amino acid metabolism

sources: green leafy vegetables, liver, beef, fish, legumes, grapefruit, oranges

deficiency: anemia, birth defects

Question 13

vitamin B12

cobalamin

Answer 13

action: coenzyme in nucleic acid metabolism, maturation of RBCs

sources: meat, liver

deficiency: anemia, nervous system disorders

Question 14

vitamin C

ascorbic acid

Answer 14

action: coenzynme, antioxidant

sources: citrus fruits, tomotoes, broccoli, cabbage

deficiency: scurvy (degenertion of skin, teeth, blood vessels), weakness, delayed wound healing

increases iron absorption

Question 15

lipid-soluble vs water-soluble vitamins

Answer 15

lipid-soluble
* absorbed in small intestine when ingested with dietary lipids
* can be stored in large amounts in liver/fatty tissue (adipose tissue)
* only need intermittent renewel, body can use stored vitamins with insufficient intake
* can accumulate to toxic levels when consumed in high amounts due to being stored + not readily excreted

water-soluble:
* absorbed with water in GI tract + readily dissolve in blood/body fluids
* must be replaced on a daily basis
* excess is excreted in urine, cannot be stored for later use

Question 16

calcium

Answer 16

function: forms bone matrix, regulates nerve conduction + muscle contraction

sources: dairy products, tofu, green leafy veggies (broccoli, collards, kale, turnip greens, bok choy), salmon, sardines, almonds, brazil nuts, sundlower seeds, tahini, dried beans, blackstrap molasses

hypercalcemia = fatigue, weakness, lethargy, anorexia, nausea, constipation, impaired renal function, kidney stones, dysrhythmias, bradycardia, cardiac arrest, bone pane, osteoporosis

hypocalcemia = increased neuromuscular excitability, tingling, muscle spasm, intestinal cramping, hyperactive bowel sounds, convulsion + tetany, prolonged QT interval, cardiac arrest

Question 17

chloride

Answer 17

function: major anion in body fluids, part of gastric acid secretion

sources: salt

Question 18

iron

Answer 18

function: component of hemoglobin + some enzymes of oxidative phosphorylation

sources: dried beans, dried fruits, egg yolks, iron fortified cereals, liver, meat (especially lean red meat, poulty), oysters, salmon, tuna, whole grains

Question 19

magnesium

Answer 19

function: cofactor for many enzymes, normal nerve conduction + muscle contraction

sources: dark green leafy vegetables, fruits, nuts, peas, beans, seeds, soy products, whole grains, milk

hypermagnesia = skeletal smooth muscle contraction, excess nerve function, loss of deep tendon reflexes, nausea + vomiting, muscle weakness, hypotension, brasycardia, respiratory distress

hypomagnesia = behavioural changes, iriitability, muscles cramps, ataxia (no coordination), nystagmusm (rapid eye movements), tetany, convulsions, tachycardia, hypotension

Question 20

phosphorus

Answer 20

function: forms bone matrix, part of ATP + nucleic acids

sources: seeds, whey, cheese, cornmeal, beans, nuts

hyperphosphatemia = prolonged causes calcification of soft tissues in lungs, kidneys, joints

hypophosphatemia = reduced capacity for oxygen transport by RBCs, leukocyte + platelet dysfunction, deranged nerve + muscle function, irritability, confusion, numbness, coma, convulsions, repiratory failure, cardiomyopathies, born resorption

Question 21

potassium

Answer 21

function: normal nerve conduction + muscle contraction, principle cation in intracellular fluid, essetial for acid-base + electrolyte balance

sources: all meats, fish, soy products, veggie burgers, vegetables (broccoli, peas, lima beans, tomatoes, potatoes, sweet potatoes, winter squash), fruits (citrus, cantaloipe, bananas, kiwi, prunes, dried apricot), milk, yogurt, nuts

hyperkalemia: muscle weakness, loss of muscle tone, paralysis, bradydysrhythmias, ventricular vibrillation, cardiac arrest

hypokalemia: skeletal muscles weakness, smooth muscle atony, carddiac dysrhythmias, glucose intolerance, impaired urine concentrating, respiratory arrest, constipation, intestenal distension, nausea, vomiting, paralytic ileus

insulin lowers plasma potassium levels - stimulates Na-K ATPase pump to promote movement of potassium into liver + muscle cells

Question 22

sodium

Answer 22

function: normal nerve conduction + muscle contraction, principle cation in extracellular fluid, essential for acid-base + electrolyte balance

sources: sodium chloride (table salt), milk, beets, celery, processed meats (bacon, sausage, ham), canned soups + veggies, processed baked goods, fast foods

hypernatremia = thirst, headache, weight loss, dry muscous membranes, elevated temp, suken fontanels (infants), prolonged cap refill, tachycardia, weak pulse, low BP, postural hypotension, confusion, coma

hyponatremia = weight gain, edema, ascites, jugular vein destension, lethargy, confusion, seizures, coma, muscle twitching, depressed reflexes, nausea, vomitng

Question 23

zinc

Answer 23

function: enzyme cofactor, needed for proper protein structure, normal growth, wound healing

sources: animal proteins (beef, pork, lam), nuts, whole grains, legumes, yeast)

deficiency = impaired imune response

Question 24

copper

Answer 24

function: cofactor for hemoglobin synthesis

deficiency = impaired wound healing

Question 25

diet types + indications

Answer 25

• clear liquid:
• initial feeding after bowel reset
• fluids + electrolytes to prevent dehydration
• feed a malnourished person/person who has not had orall intake for a while
• bowel prep for surgery or diagnostic tests
• gastroenteritis
• full liquid
• transition diet after clear liquids
• patients with diefficulty chewing, swallowing, tolerating solid foods

mechanical soft diet
- mechanically altered in texture for minimal chewing
- dental problems, head/neck surgery, dysphagia

soft diet
- difficulty chewing/swallowing
- ulcerations of mouth/gums, oral surgery, broken jaw, plastic surgery of head or neck, dysphagia, stroke

low fiber
- least likely to form obstruction in intestinal tract, gastroenteritis, diarrhea, other GI disorders
- white bread, refined cooked cereals, potato no skin, white rice, refined pasta

high fiber
- for constipation, IBS, asymptomatic divericular disease
- 20-35 g dietary fiber daily (fruits, veggies, whole-grain)
- limited gas forming foods (apples, beans, broccoli, nuts, wheat)

cardiac
- Dietery Approaches to Stop Hypertension (DASH) diet: prevent/control hypertension, hypercholesterolemia, obesity
- for atherosclerosis, diabetes mellitus, hyperlipidemia, hypertension, myocardial infarction, nephrotic syndrome, renal failure
- restrict sodium, cholesterol, fat

high-cal high-pro
- for severe, stress, burns, wound healing, cancer, human immunodeficiency virus, acquired immunodeficiency syndrome, COPD, resp failure

carb-consistent
- for diabetes mellitus, hypoglycemia, hyperglycemia, obesity

sodium restricted (1500 mg/day)
- for hypertension, heart failure, renal disease, cardiac disease, liver disease

protein restricted
- for renal disease, end-stage liver disease

renal
- acute kidney injury, chronic kidney diease, hemodialysis, peritoneal dialysis

potassium modified
- for hypoaldosteronism, addison’s disease, angiotensin-converting enzyme inhibitor meds, immunosuppressive meds, potassium-sparing diuretics, chronic hyperkalemia

high calcium
- for bone growth + osteoporosis prevention, vascular contraction, vasodilation, muscle contration, nerve transmission

low-purine
- for gout, kidney stones, elevated uric acid
- restrict achovies, herring, mackerel, sardines, scallops, organ meets, gravies, wild game, goose, sweetbreads

lacto-ovo
- dairy + eggs, no meat

enteral nutrition
- liquefied foods to GI tract via tube
- for swallowing problems, burns, major trauma, liver/organ failure, sever malnutrition