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Nutrition Flashcards

1
Q

What is DRI?

A

Dietary Reference Intake

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2
Q

How much energy is derived from carbohydrates, lipids/dietary fats, protein, an dalochol?

A

Carbohydrates: 4 kcal/g
Lipids/dietary fats: 9 kcal/g
Protein: 4 kcal/g
Alcohol: 7 kcal/g

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3
Q

What are the current national dietary guidelines for fat, protein, and carbohydrates?

A

Fat: <30% kcal from fat (<10% saturated fats, <1% trans fats)
Protein: 15% kcal
Carbohydrate: 55-60%

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4
Q

What is energy requirement?

A

Amount of food energy needed to balance energy expenditure in order to maintain body size, body composition, and a level of necessary and desirable physical activity consistent with long-term good health.

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5
Q

What are the components of daily energy expenditure for weight-stable adults?

A
  1. Basal metabolic rate (resting metabolic rate) - 60-70%
  2. Dietary-induced thermogenesis - 10%
  3. Physical activity - 20-30%
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6
Q

What are the components of daily energy expenditure for special stages of growth?

A
  1. Growth (tissue development and energy in new tissue)
  2. Pregnancy (maternal and fetal tissue deposition)
  3. Lactation (milk production and energy in milk)
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7
Q

True or False: overweight and obese individuals have relatively low metabolic rates.

A

False; BMR is comprised of organ mass and tissue - fat mass is relatively inert.

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8
Q

True or False: low metabolism contributes significantly to obese individuals’ excess weight gain.

A

False; no association between BMR and weight gain (for most populations)

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9
Q

True or False: there are diets available to increase a person’s metabolic rate thereby inducing weight loss.

A

False (unless that diet contains compounds like caffeine or ephedrine - short term); the only way to increase your BMR is to add muscle mass.

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10
Q

True or False: a person’s metabolic rate decreases during caloric restriction inhibiting the rate of weight loss.

A

True

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11
Q

When does decreased BMR occur?

A

Hypothyroidism
Anorexia nervosa
Individuals with Down syndrome
Very-low-calorie diets and starvation states

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12
Q

When does increased BMR occur?

A

Hyperthyroidism
Parkinson’s disease
Asthma
Any type of hypermetabolic state (burns, injury, sepsis)

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13
Q

BMR is suppressed in situations of severe ___.

A

Caloric restrictions

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14
Q

Energy Intake = ?

A

Energy Expenditure + Change in Energy Stores

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15
Q

What are the BMI ranges for Underweight (Chronic Energy Deficiency III, II, I), Healthy Weight, Overweight, and Obese?

A 
CED III: <16.0
CED II: 16.0-16.9
CED I: 17.0-18.4
Healthy Weight: 18.5-24.9
Overweight: 25.0-29.9
Obese: 30.0+
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16
Q

BMI is highly correlated with ___ in most populations.

A

Adiposity

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17
Q

Describe situations in which BMI does not correlate to adiposity.

A

1.

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18
Q

What are “normal” levels of body fat? Note that there is no consensus

A

Women: 20-35%
Men: 5-20%

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19
Q

What are consequences of low levels of body fat? High levels?

A

Low levels: amenorrhea, cold intolerance, excessive use of protein stores for energy
High levels: Type 2 diabetes, all organ systems affected

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20
Q

When energy expenditure exceeds energy intake, what occurs?

A

Protein energy malnutrition and being underweight

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21
Q

Chronic mild protein energy malnutrition (PEM) leads to ___.

A

Stunting (linear growth failure)

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22
Q

Acute PEM can lead to ___ or ___.

A

Underweight; Wasting (Marasmus)

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23
Q

Is severe marasmus reversible?

A

Yes (calories + appropriate micronutrients)

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24
Q

What are symptoms of kwashiorkor (linked to low protein intake rather than low calorie intake)?

A

Edema, pigment changes

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25
Q

PEM increases risk of death from ___.

A

Concomitant infections

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26
Q

When energy expenditure is excessive (energy expended in metabolic functions), ___ results.

A

Hypermetabolism

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27
Q

Lipids and dietary fats are ___ in organic solvents.

A

Soluble

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28
Q

Dietary lipids include ___, ___, and ___.

A

TAGs, cholesterol, phytosterols

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29
Q

What is the majority of lipids consumed by humans?

A

Triglycerides (>95%)

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30
Q

Saturated fatty acids have ___ double bonds.

A

NO

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31
Q

Saturated fatty acids are ___ at room temperature.

A

Solid

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32
Q

Saturated fatty acids are associated with ___.

A

Hypercholesterolemia

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33
Q

Mono-unsaturated fatty acids are at least 12 C long and have one double bond at ___.

A

n-9

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34
Q

Are mono-unsaturated fatty acids associated with hypercholesterolemia or decreased HDL?

A

NO

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35
Q

Polyunsaturated fatty acids have ___ double bonds.

A

Multiple

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36
Q

What are the two essential fatty acids?

A

Linoleic and alpha-linolenic acid

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37
Q

Oils high in polyunsaturated fatty acids are generally ___ at room temperature.

A

Liquid

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38
Q

Essential fatty acid (EFA) deficiency can result from…

A

…very low fat diets (10-20% of calories coming from fat)

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39
Q

Omega-3 fatty acids are likely critical for neural and retinal tissue development. They have also been shown to reduce CVD risk in people at ____.

A

High risk

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40
Q

Hydrogenation turns liquid oils to solid fats and reduces the rotational mobility of the fatty acyl chain in ___.

A

Trans fats

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41
Q

Trans fats are associated with increased ___ levels, CHD, and atherosclerosis (to the same degree or more than saturated fats).

A

LDL

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42
Q

Soluble fibers are implicated in ___ lowering.

A

Cholesterol

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43
Q

What are the dietary sources of soluble fibers?

A

Legumes, oats, some fruits, some vegetables, nuts

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44
Q

What are the dietary sources of insoluble fibers?

A

Whole grains, wheat bran, some vegetables, potato skins

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45
Q

How do soluble fibers help lower cholesterol?

A
  1. Act as a bile-acid sequestering agent
  2. Reduce rate of insulin rise by slowing CHO absorption and slowing hepatic cholesterol synthesis
  3. Stimulate production of short-chain fatty acids in the gut which inhibit cholesterol synthesis
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46
Q

What are the 4 fat-soluble vitamins?

A
  1. A (retinol)
  2. D (cholecalciferol)
  3. E (tocopherols)
  4. K (phylloquinone)
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47
Q

Which type of vitamin (fat or water soluble) is stored in the body?

A

Fat-soluble (water-soluble tend to be excreted)

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48
Q

What are the 9 water-soluble vitamins?

A
  1. Thiamin (B1)
  2. Riboflavin (B2)
  3. Niacin (B3)
  4. Pantothenic acid (B5)
  5. Pyridoxine (B6)
  6. Biotin (B7)
  7. Folic acid (B9)
  8. B12
  9. Vitamin C (ascorbic acid)
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49
Q

Beta-carotene is a water-soluble pigment that can be cleaved to ___.

A

Retinaldehyde

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50
Q

Retinaldehyde can then be converted to ___ or ___.

A

Retinol and retinoic acid

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51
Q

What is the primary function of retinal?

A

Prostethic group of visual pigments

52
Q

What is the primary function of retinoic acid?

A

Nuclear modulator of gene expression

53
Q

Describe the initiation of nerve impulse by retinol.

A

Retinol –> retinal –> rhodopsin –> conformational change in opsin –> trans-retinal and initiation of nerve impulse

54
Q

___ is required for normal limb and eye development in the embryo.

A

Retinoic acid

55
Q

What are precursors to retinoids?

A

Carotenoids

56
Q

What synthesizes carotenoids?

57
Q

What is an early sign of Vitamin A deficiency?

A

Night blindness

58
Q

Vitamin A deficiency leads to…

A

…dedifferentiation of epithelial cells –> epithelial keratinization, poor appetite, poor growth, and xerophthalmia

59
Q

What is the cardinal sign of Vitamin A deficiency?

A

Xerophthalmia

60
Q

What are the stages of xerophthalmia?

A
  1. Conjunctival xerosis (dryness)
  2. Bitot’s spots
  3. Keratomalacia (softening of cornea, irreversible damage)
61
Q

What is the cardinal sign of Vitamin A toxicity?

A

Bright red margins of gingiva

62
Q

Vitamin D and Parathyroid Hormone Regulate ___ balance.

63
Q

What is the primary function of Vitamin D?

A

Increase intestinal absorption, bone resorption, and renal reabsorption of calcium

64
Q

Vitamin D functions through regulation of ___.

A

Gene expression

65
Q

There is a significant prevalence of ___ vitamin D deficiency in the US.

A

Subclinical

66
Q

What is caused by a failure of appropriate deposition of mineral in the matrix of the epiphyseal cartilage?

A

Rickets (children)

67
Q

Vitamin D can cause ___ by stimulated mobilization of calcium and phosphorus from bone to maintain serum concentrations.

A

Osteomalacia

68
Q

What are the symptoms of rickets?

A
  1. Bowlegs
  2. Frontal bones prominent and bossed
  3. Uncalcified osteoid
69
Q

What is the primary function of vitamin E?

A

Scavenger of free radicals and peroxyl radicals, inhibition of platelet aggregation, and increased vasodilation

70
Q

What is the primary function of vitamin K?

A

Regulation of blood clotting protein synthesis

71
Q

Vitamin K functions as a coenzyme in ___.

A

Carboxylation reactions (carboxylases)

72
Q

What is the primary manifestation of vitamin K deficiency?

73
Q

What is the function of thiamin?

A

Coenzyme for oxidative carboxylation of pyruvate dehydrogenase

74
Q

Thiamin deficiency leads to ___.

75
Q

What are classic signs of a thiamin deficiency (dry beriberi)?

A

Peripheral neuropathy, calf muscle tenderness, wrist and ankle drop, impairment of sensory, motor, and reflex functions affecting limbs

76
Q

What are classic signs of a thiamin deficiency (wet/cardiac beriberi)?

A

Edema, tachycardia, cardiomegaly, congestive heart failure, neuropathy

77
Q

What are classic signs of a thiamin deficiency (cerebral beriberi)?

A

Wernicke’s encephalopathy, mental confusion, coma

78
Q

___ impairs absorption of thiamin across basolateral membrane in gut.

79
Q

Wernicke’s encephalopathy in alcoholism (thiamin deficiency) must do what when someone comes into the ER?

A

Administer IV thiamin prior to glucose, otherwise coma and death can result from rapid hyperglycemia

80
Q

What is the primary function of riboflavin?

A

Redox coenzyme (FAD, FMN) in energy-yielding reactions in citric acid cycle (succinate dehydrogenase) and beta-oxidation (acyl CoA dehydrogenase)

81
Q

What is the key symptom of riboflavin deficiency?

A

Bilateral oral ulcers

82
Q

Niacin can be synthesized from ___.

A

Tryptophan

83
Q

What are the functions of niacin?

A

Coenzyme in redox reactions, ATP synthesis, and ADP-ribose transfer reactions, anti-hyperlipidemic agent in large doses

84
Q

Niacin deficiency disease is known as ___ and is characterized by ___.

A

Pellegra; photosensitive dermatitis around hands, feet, neck (not necklace); 3 D’s: dermatitis, diarrhea, dementia

85
Q

Vitamin C functions…

A

…as a coenzyme in redox reactions.

86
Q

Vitamin C deficiency can lead to ___.

87
Q

What are the cardinal symptoms of Vitamin C deficiency?

A

Things resulting from defects in collagen formation (petechiae, perifollicular hemorrhages, bleeding gums, impaired wound healing, depression, etc)

88
Q

What does folic acid do?

A

Coenzyme for one-carbon transfer reactions (most significantly purine and pyrimidine synthesis and methylation of tRNA - thymidylate synthetase, methionine synthase)

89
Q

What is the only vitamin with a non-organic component and what is this component?

A

Vitamin B12; cobalt atom

90
Q

What is the function of vitamin B12?

A

Coenzyme for one-carbon transfers: methionine synthase and methylmalonyl-CoA mutase - methylmalonyl CoA –> succinyl CoA

91
Q

Vitamin B12 deficiency also looks like ___ deficiency. How are they distinguished?

A

Folate; increased methylmalonic acid in Vitamin B12 deficiency

92
Q

What is the link between Vitamin B12 and folic acid?

A

Methionine synthetase

93
Q

In both folic acid and Vitamin B12 deficiencies, you can get ___ and ___.

A

Megaloblastic anemia

Hyperhomocysteinemia

94
Q

Hyperhomocysteinemia is ___.

A

Atherogenic

95
Q

Folate deficiency leads to…

A

…defective DNA/RNA synthesis, neural tube defects, megaloblastic anemia, and hyperhomocysteinemia

96
Q

Vitamin B12 deficiency leads to…

A

…defective DNA/RNA synthesis, hyperhomocysteinemia, and pernicous (megaloblastic) anemia

97
Q

Calcium is critical for ___.

A

Homeostatic regulation

98
Q

In hypocalcemia, what happens?

A

Plasma calcium concentrations decrease, PTH gene expression increases and secretion activates vitamin D to enhance intestinal calcium absorption, increase renal reabsorption of calcium, and activate bone resorption

99
Q

Vitamin D enhances calcium absorption by upregulating what two things?

A

Ca-ATPase and calbindin

100
Q

True or false - calcium is poorly absorbed.

101
Q

___ is a potent inhibitor of calcium absorption.

102
Q

___, a plant storage form of phosphorus, forms salts with calcium.

103
Q

High dietary sodium increases calcium ___.

104
Q

What is the most abundant intracellular anion?

A

Phosphorus

105
Q

What is a major component of bone, phospholipids in cell membranes, and enzymes, required for energy production, and important for acid-base regulation?

A

Phosphorus

106
Q

What is refeeding syndrome?

A

Occurs when severely malnourished, dehydrated individuals are given glucose and saline; results from rapid expansion of extracellular fluid (increased sodium intake) and increased insulin secretion (increased carb intake); stimulates rapid glycogen synthesis, depletes plasma phosphorus concentration; may result in cardiac arrhythmias and sudden death

107
Q

What are the two oxidation states of iron?

A

Fe2+ (ferrous) and Fe3+ (ferric)

108
Q

Which form of iron is more stable?

A

Fe3+ (ferric), bound to transferrin for plasma transport

109
Q

What is ferrous iron required for?

A

Gut absorption, cellular storage, heme synthesis

110
Q

Where is heme iron found (exclusively)?

A

Animal foods

111
Q

Non-heme iron is found in…

A

…both animal and plant foods.

112
Q

Absorption of ferric iron is increased in the presence of ___, which aids in reduction to ferrous iron.

113
Q

What is the zinc and copper enzyme that assists in cellular iron uptake?

A

Ceruloplasmin

114
Q

What is the plasma transport protein of iron?

A

Transferrin

115
Q

What is the cellular storage protein of iron?

116
Q

What is the hepatocyte storage protein of iron?

A

Hemosiderin

117
Q

What happens to transferrin and ferritin in iron deficiency?

A

Upregulation of transferrin and downregulation of ferritin

118
Q

What happens to transferrin and ferritin in iron excess?

A

Downregulation of transferrin and upregulation of ferritin

119
Q

What are some functions of iron?

A

Iron-sulfur complexes: mitochondrial aconitase in TCA cycle, cellular energy production via oxidative phosphorylation
Heme-containing proteins: carries oxygen, constitutent of peroxidase enzymes, active site of cytochromes

120
Q

What are the nutrients required for heme formation?

A

Iron, copper, zinc, vitamin B6, pantothenic acid

121
Q

What happens in iron deficiency?

A

Microcytic, hypochromic anemia (inhibition of Hb synthesis)

122
Q

Describe the differences in anemia as a result of folic acid or B12 deficiency and iron deficiency.

A

In folic acid/B12 deficiences, cells are large and immature. In iron deficiency, cells are small and pale.

123
Q

True or false - iron is not formally excreted.

124
Q

In adult males, iron deficiency anemia is typically result of ___.

A

GI bleeding

125
Q

How is iron deficiency defined?

A

Abnormally low concentration of plasma hemoglobin

126
Q

What are the primary physical signs of iron deficiency?

A

Fatigue, low energy, pallor, exertional dyspnea

127
Q

Zinc deficiency results in …

A

…anemia, hypogonadism, and dwarfism

FHB (8 decks)

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