Nutrition and diet SSA

Question 1

List 3 carries of fluoride and explain their disadvantages:

Answer 1

Salt - gives the consumer choice (politically advantageous) and useful where option to fluoridate water or milk is not possible. You are encouraging and increase in salt consumption

Milk - binding of F to calcium or protein may decrease topical effect. Preventative effects seen especially when teeth are developing. Beneficial but less good evidence than for water fluoridation. Can only be given at certain schools.

Water - does not require behavioural change, cheap and free to the consumer. Also removes socioeconomic factors. Mass medication? Fluoridation is not everywhere.

Question 2

Describe two studies on starch and caries, summarise in one sentence for each the findings/conclusions of the summary and based on these what advice would you give your patient about starch in their diet

Answer 2

Animal studies:
Raw starch is not cariogenic
Cooked starch can cause caries but less so than sucrose
Mixes of cooked starch and sugar can cause levels of caries equal to that seen in sugars alone
All diets provided in powder form and very high frequency of meals
Differences in tooth morphology and salivary composition

Laboratory incubation:
Starch can be hydrolysed to glucose which is metabolised to lactic acid
Does not prove it is cariogenic

Enamel slab experiment
Processed starchy foods cause 1/4 of the demineralisation seen with sugars

Question 3

conclusions of the summary and based on starch and caries

Answer 3

WHO concluded there was no convincing evidence that starch rich staple foods showed a relationship with caries. Would advice to decrease amounts of processed starches. Total carbohydrate should be 50% of energy, with less than 10% of that being free sugars.

Question 4

Evidence link between fruit consumption and caries (animal and human trials)

Answer 4

Harvesting method
No subject went below critical pH
Measures acidogenicty and not cariogenicity
Does not account for protective factors
Does not account for mechanical and gustatory stimulus to saliva flow that fruit consumption causes

Dentine slab study
Dentine was exposed to banana or 10% sucrose 8x day
No difference was found in demineralisation between sucrose or banana
Impact on enamel was not studied
Consumption of fruit was abnormally high

Animal studies
Mashed fruits at high frequencies - 17/day
All fruits caused less caries than sugars but citrus and dried fruits caused less than figs, apples and bananas

Cohort
Northumberland study - negative association between intake of fruit and caries increment

Cross sectional
South Africa - workers on apple and grape farms had higher DMFT compared with grain farm workers however intake of fruit was unusually high

Fresh fruit appears to be of low cariogenicity. Bananas appear to have a greater potential. Fresh unsweetened juices contain free sugars.

Question 5

Give one food example for the following for a vegan man’s diet (B12, iron, calcium, protein, vitamin E)

Answer 5

B12 - fortified soya milk (cannot get B12 from any source other than fortified as they are only found in animal tissues)

Vitamin E - nuts and green vegetables

Iron - lentils and cocoa

Protein - lentils, pulses, quinoa

Calcium - fortified white flour, green vegetables

Question 6

WHO recommendation for sugar intake -

Answer 6

(see table)
<10% of total energy intake
Reduce sugar intake throughout the life course
Do not increase sugar intake in countries that have <5%.
The conditional recommendation is to reduce to <5%

Question 7

How many times is it recommended that you consume free sugars?

Answer 7

Not more than 3 times per day

Question 8

How many times is it recommended that you should have snacks

Answer 8

Not more than 3 times per day and none containing NME sugars

Question 9

List 5 foods associated with periodontitis and note whether they have a positive or negative effect

Answer 9

Deficiencies of calcium and vitamin D cause resorption of cementum and bone

Gingival tissues have high folic acid requirements due to high cellular turnover rate. Low serum folate was independently associated with PD

Vitamin C deficiency causes scurvy (swollen bleeding gums and tooth loss) and is required for collagen synthesis in the PDL, bone matrix and blood vessel walls. Also has a role in immune function as a powerful antioxidant. Weak epidemiological evidence of a negative association between vitamin C status and chronic PD

Inverse relationship between serum beta-carotene and total antioxidant capacity in mild and severe PD

Antioxidants can be found in fruits and vegetables - a higher intake of dietary antioxidants was inversely related to number of teeth with PD

Omega -3 fatty acids - eicosapentoid acid displaces arachedonic acid which dampens down the cyclooxygenase pathway leading to less synthesis of inflammatory markers e.g. prostaglandins. Also produces leukotrine B5 instead of leukotriene B4 which has fewer inflammatory effects. Those with alveolar bone loss had lower serum omega-3 fatty acids

Question 10

Draw a graph demonstrating the relationship between age and tooth exfoliation at 6 years and 12 years

Answer 10

see image

Question 11

Malnourished children in Peru

Answer 11

Delayed exfoliation of deciduous teeth
Delayed eruption of permanent teeth
Caries occurred 15 months later compared with well nourished

Question 12

Ages of milk; when can a child start drinking cow’s milk:

Answer 12

0-12months - breast/formula milk
Under 2 years - full fat
2-5yr - semi skimmed (if overweight)
From 5 years skimmed milk

Question 13

How is cow’s milk beneficial to the teeth?

Answer 13

Should not be drank before 6 months - risk of allergy, mineral content too high

Not the main milk before 12 months - low iron

Contains calcium and phosphate - aids remineralisation of teeth; non cariogenic

Question 14

5 foods that are beneficial to teeth not including those containing fluoride

Answer 14

Cheese - cheese consumption reduces demineralisation of enamel

Milk - lactose (least cariogenic sugar), calcium, phosphate

Tap water

Salivary stimulants - peanuts, sugar free chewing gum, cheese, fibrous foods which require chewing

Polyphenolic compounds in plant foods e.g. phytate in cranberries and is biologically active against S.mutans

Tea - contains fluoride, polyphenols, alkaloids

Honey, chocolate, liquorice - unpractical due to high sugar content

Question 15

When do we develop sense of taste/what is the best age for developing taste

Answer 15

Birth for sweet and bitter; salty at 5 months roughly

Question 16

Number of people over 85 that are adentulous?

Answer 16

65%

Question 17

Percentage of reduced bite strength with denture?

Answer 17

20%

Question 18

Dietary values for:

Answer 18

Saturated fats - <11% overall energy intake

Trans fats <2%

Free sugars - <10%

Question 19

Sources of fibre:

Answer 19

wholegrain cereals, green vegetables, wholegrain pasta, fruit, bran

Question 20

Diagram of total sugars

Answer 20

intrinsic sugars- whole fruit and veg

milk sugars - naturally present in milk

free sugars- added, plus sugars in honey, syrups, fruit juices

Question 21

3 sources of fibre for an adentuous old person

Answer 21

weetabix with milk, porridge, lentil soup, pease pudding, dhal

Question 22

How could you increase intake of foods from meat and alternative groups

Answer 22

fish (easier to chew), minced meats e.g. turkey and beef, stews and cooked tender meat, cooked pulses e.g. mushy peas

Question 23

How could you increase intake of fruits and vegetables

Answer 23

smoothies, mushy peas, grate in salads, soups, stewed fruits, only one 150ml portion of fresh fruit juice per day

Question 24

What is acesulfame potassium? -

Answer 24

calorie free sugar substitute

Question 25

What foods/drinks have high amounts of malic/oxalic/tartaric acid?

Answer 25

vinegar and pickled things (acetic/ethanoic acid), apples (malic), rhubarb leaves (oxalic)

Question 26

What micronutrient causes angular stomitis?

Answer 26

B2

Question 27

Name 2 actions of fluoride

Answer 27

antibacterial and strengthens teeth in development; aids mineralisation; inhibits anaerobic glycolysis and subsequent acid production in oral bacteria

Question 28

Bulk and intense sweeteners, costs and benefits:

Answer 28

Bulk - sorbitol (caloric)

Intese - acesulfame potassium (non-caloric)

Animal studies - caries occur but to a much lesser extent than with sucrose; xylitol is non-cariogenic e.g. Turku - 85% less caries with xylitol substitution

Question 29

Name a vitamin or mineral. Give a function, 2x deficiencies and 2 sources (one which is suitable for vegans)

Answer 29

B1
Whole grain and pork
Beri beri and Wernicke’s encephalopathy
Glucose metabolism

Question 30

Sources of fibre:

Answer 30

wholegrains, pulses, fruits and vegetables

Question 31

Protein in the diet - how much it should make up; how much should be consumed

Answer 31

0.75-1.5g/kg per day or 12-15%

Question 32

give 
- plaque pH studies 
- Cohort studies -
follow through time
(measures change
over time)
- Population studies -
per capita country
level

for starch staple foods

Answer 32

plaque pH- Harvesting - Plaque
pH reduced but not
below critical pH

cohort- Northumberland
study/Iowa study -
difference between
high and low sugar/
starch /unprocessed
starches were not
associated with caries
development

population- WW2/work that looked
at cereal availability
and controlled for
sugars and found
relationship
differences. Starch
went up and sugars
went down. Related
per capita availability
of cereals

Question 33

give 
- plaque pH studies 
- Cohort studies -
follow through time
(measures change
over time)
- Population studies -
per capita country
level

for Highly processed starches

Answer 33

Indwelling electrode - falling to levels similar to sugar. Hypersensitive

Iowa - highly
processed between
meals

No studies published

Question 34

foods containing protective factors

Answer 34

Milk
Calcium and phosphate, casein
Remineralisation

Cheese
calcium, phosphate, caesin
Stimulates salivary
flow. Increases plaque
calcium concentration- enamel slab exp

milk chocolate
cocoa factor, casein, calcium phosphate
protective factors unlikely tp override high sugar content

Plants
Polyphenols- Increase plaque pH, buffer and absord to enamel, inhibit glucan

Question 35

what foods would you give to a vegan for

B12 –
vit E –
Iron –
Protein -

Answer 35

B12 – fortified soya milk.
vit E – nuts and green vegetables.
Iron – lentils, wholemeal bread
Protein - lentils, bulgar, bagel

Question 36

Ages of milk

when can child start cows milk

Answer 36

12months for cows milk

Question 37

how cow’s milk is beneficial to teeth?

Answer 37

contains calcium and Vitamin D.

Question 38

5 foods that are beneficial to teeth not including those containing fluoride?

Answer 38

licorice, oats, cheese, chewing gum, vegetables, saccharin containing foods, chicken, nuts,

Question 39

when do we develop sense of taste/what is the best age for developing taste?

Answer 39

Birth for sweet and bitter, salty at 5months roughly

Question 40

Dietry values for

saturated fats
trans fats
NME (non milk extrinsic

Answer 40

saturated fats <10% overall energy intake
trans fats - <2% overall energy intake
NME (non milk extrinsic) - <10% overall energy intake

Question 41

Sources of fibre?

Answer 41

Wholegrain cereals, green vegetables, wholegrain pasta, fruit, bran

Question 42

Draw diagram of total sugars?

Answer 42

Intrinsic + extrinsic (NME + milk)

Question 43

Work out protein requirement for person given weight

Answer 43

0.7-1.5g/kg

can use range of mid point
1.1

Question 44

3 sources of fibre for an edentate old person?

Answer 44

soft fruits such as bananas and peaches, fruit smoothies and dried fruits, milk soaked bran flakes.

Question 45

3 sources of fibre for an edentate old person?

Answer 45

soft fruits such as bananas and peaches, fruit smoothies and dried fruits, milk soaked bran flakes.

Question 46

Two types of studies which have been carried out on the carcinogenicity of starch and their findings summarised in a sentenc

Answer 46

. Animal studies – raw starch is not cariogenic however cooked starch can cause caries but less than sucrose

b. Clinical experimental studies - Enamel slab experiment – processed starchy foods cause approximately ¼ of the demineralisation seen with sugars
c. Plaque pH studies – highly processed starchy foods containing sugars produced as much acid as high sucrose products.

Question 47

What dietary advice would you give a patient concerning starch?

Answer 47

Consume plenty starchy rich staples as it not linked to caries and good for general health

Avoid higly processed starch foods especially those to which sugars are added

Question 48

Give examples of food sources where a vegan man could find
Iron 
calcium\
protein 
vit b12
vitE

Answer 48

Iron - lentil

Calcium – soy milk, broccoli

Protein – lentil, chickpeas

Vitamin B12 – breakfast cereals, almond milk, fortified soya milk (cannot get B12 from any source other than fortified as they are only found in animal tissues)

Vitamin E – nuts and seeds such as almonds and hazlenut