P1. p 115-125

Question 1

In terms of the place of dairy in the US ‘MyPlate’ dietary guidelines:

1) What % of calories is made up by dairy ?
2) What proportion of dairy consumption is milk vs cheese ?

BR 115

Answer 1

1) Dairy makes up 10% of calories
2) About half of dairy is consumed as fluid milk, and half as cheese.

BR 115

Question 2

In terms of dairy, calcium & prostate cancer (PCa):

1) Is dairy product intake associated with a higher risk of prostate cancer ?
2) Is total calcium intake associated with a higher risk of prostate cancer ?
3) What were the findings of the US Male Physicians cohort in this area ?

Y Song J Nutrition 2013:143:189-196

Answer 2

1) Each 400 g/day of dairy products is assocated with a 7% increase in risk of PCa (P<0.05), WCRF Meat Fish Dairy Report
2) On meta-analysis of cohort studies, see a 11% increased risk wrt total Ca intake (P<0.05)(J Cancer Prev 2018:19(6):1449-56)
3) In this 28yr cohort study of 21,600 US male Physcians
a) Skim/low fat milk intake assoc with 19% higher rate of PCa
b) Total dairy intake assoc with 73% higher risk (HR 1.73) of fatal PCa (P=0.05)
c) Pre-diagnostic whole milk intake assoc w HR 2.17 risk of death (P<0.05)

=> overall ~ 2x rate of fatal prostate CA

Y Song J Nutrition 2013:143:189-196

Mnemonic: Pick up calcium/dairy at 7/11 (7% & 11%)

Question 3

Discuss the relationship of dairy to cardiovascular disease, hypertension, risk of diabetes

BR 115

Answer 3

Dairy & diferent outcomes:

CV disease - no or weak INVERSE relationship - however substitution analysis suggests risks are even lower if dairy fat is replaced iwth plant-based or polyunsaturated fat.

Stroke - mild INVERSE relationship,

Hypertension - moderate evidence dairy lower BP

Diabetes - moderate evidence dairy lowers risk of DM in adults

BR 115

Question 4

Discuss evidence of dairy & bone health:

a) In children
b) Milk intake & fracture risk in women

c) Consumption of fortified dairy products & bone mineral density (BMD)
BR 115

Answer 4

1) Moderate evidence that dairy improves bone health in children
2) Drinking about 1 cup (240 cc) of milk/day decreases fracture risk by >= 5% in Caucasian & Chinese women
3) Consuming fortified dairy products can increase BMD by 0.7-1.8% over 2 years.

Question 5

Discuss the effect of dairy intake on inflammation:

1) Yogurt consumption
2) Cheese intake

BR 115

Answer 5

1) Increase yogurt consumption may have a protective effect on lowering inflammation (OR 0.34)
2) Cheese leads to a pro-inflammatory state with higher plasma inflammatory biomarkers.

BR 115.

Question 6

List some foods with a high TRANS fat content

S: Cleveland Clinic

Answer 6

1) Cakes, pies, cookies (esp with frosting)
2) Biscuits -especially frozen
3) Breakfast sandwiches
4) Margarine (stick or tub)
5) Crackers
6) Microwave popcorn
7) Cream-filled candies
8) Doughnuts
9) Fried fast foods
10) Frozen pizza

Question 7

What is a “shortfall nutrient” ?

What do the following terms mean when applied to food groups:

a) “High in nutrient content”
b) Moderately high in nutrient content”

BR 118

Answer 7

Shortfall nutrients means that at least 25% of the US population is not consuming them in adequate amounts.

“High in nutrient content” contains > 20% of the daily value (DV) in a serving

“Moderately high” has 5-20% of daily value per serving.

BR 118

Question 8

List nine shortfall nutrients

BR 118

Answer 8

D - vitamin D

E - vitamin E

F - Fiber

C- vitamin C

C - Calcium

K vitamin K

A - Vitamin A

M - Magnesium

P Potassium

Mnemonic: DEF CCKamp having short falls. Note fat-soluble (ADEK) & vitamin C are shortfall.

Question 9

In terms of calcium absorption:

a) List (5) foods high (>20% DV) in calcium
b) List (5) foods moderately high in calcium
c) List 3 vegetables high in oxalates (and calcium) and thus poor sources of calcium.
d) List 3 vegetables low in oxalates & high in calcium - good sources of calcium

BR 118

Answer 9

High Ca: dairy, Ca fortified non-dairy beverages, tofu, chia & poppy seeds.

Moderate: kale, almonds, beans, okra, bok choy (KABOB)

Poor: Spinach, Beet Greens, Swiss chard. (BSG)

Good: Okra, Kale, bOk chOy - ‘OK’

BR 118

Question 10

In terms of dietary fiber

List 5 foods (food groups) high in this (>20% of daily value)

List 5 foods (groups) moderately high in this (5-20% of daily value)

Fiber is ONLY found in __ foods

BR 118-119

Answer 10

High (> 5 g): Beans, split peas, avocados, bran cereals, raspberries, blackberries, pears, papaya, dried fruits, flaxseeds, some whole grains, whole wheat pasta.

Moderately high (1.25-5 grams): blueberries, strawberries, most other fruit, most vegetables, grains, whole grain bread, popcorn, mushrooms, nuts & seeds.

Only found in PLANT FOODS.

Question 11

In terms of dietary Magnesium

List 5 foods (food groups) high in this (>20% of daily value)

List 5 foods (groups) moderately high in this (5-20% of daily value)

BR 118-119

Answer 11

High (>20% DV): Brazil nuts, almonds, cashews, pine nuts, amaranth, edamame (1/2 cup or 75 grams), dark chocolate (2 Oz or 60 grams)

Moderately high (5-20% of DV): whole grains, peanuts, hazelnuts, pecans, pistachios, walnuts, spinach (12/ cup cooked or 1115 grams) , tofu, potatoes, some beans (black beans, black-eyed peas, lima beans [1 cup or 136 grams]).

Mn - High - ‘ABE CAP’

Question 12

In terms of dietary Potassium

List 5 foods (food groups) high in this (>20% of daily value)

List 5 foods (groups) moderately high in this (5-20% of daily value)

BR 118-119

Answer 12

High: Large baked potato (32%DV), adzuki beans, avocado, soybeans, black turtle beans (14%), lima beans, squash, yams (14%), plantains, bamboo shoots, passion fruit.

Moderately high: legumes, mushrooms, nuts, vegetables & refined grains

Question 13

In terms of dietary Vitamin A

List 5 foods (food groups) high in this (>20% of daily value)

List 5 foods (groups) moderately high in this (5-20% of daily value)

BR 118-119

Answer 13

High: sweet potato, spinach, raw carrots, cantaloupe, red peppers, black-eyed peas.

Moderate: tomato juice, fortified cereals

Question 14

In terms of dietary Vitamin C

List 5 foods (food groups) high in this (>20% of daily value)

List 5 foods (groups) moderately high in this (5-20% of daily value)

BR 118-119

Answer 14

High (>20% of DV; many are > 100%): bok choy, broccoli, Brussels sprouts, cabbage, cantaloupe, cauliflower, currants, citrus fruits, daikon radishes, guava kale, kiwi, mango, mustard greens, papaya, parsley, peas, pineapple, red pepper, strawberries, tomatoes, turnip greens.

Moderately high (5-20% of DV): Most other vegetables and fruits.

Question 15

In terms of dietary Vitamin E

List 5 foods (food groups) high in this (>20% of daily value)

List 5 foods (groups) moderately high in this (5-20% of daily value)

BR 118-119

Answer 15

High (>20% of DV): sunflower seeds, oils (sunflower, safflower), almonds, hazelnuts

Moderate (5-20% of DV): peanut butter, corn oil, spinach, broccoli, avocados

Question 16

In terms of dietary Vitamin K

List 5 foods (food groups) high in this (>20% of daily value)

List 5 foods (groups) moderately high in this (5-20% of daily value)

BR 118-119

Answer 16

High (> 20% of DV): dark leafy greens, kiwi, dried prunes, avocado, broccoli, Brussels sprouts, asparagus

Moderate (5-20% of DV): herb and spices.

Question 17

What is meant by a “food package”

Give an example of a food high in a desired nutrient that you might not eat because of its “food package”

BR 121

Answer 17

Food package is a whole picture view of food and looks at the total profile of the food (ie its nutrients as well as the components it contains)

For example, dairy is the #1 source of calcium, but it is also one of the top sources of saturated fat.

It is important to ask, “Is there a better source or package to get these nutrients ?”

Question 18

In terms of BMI (Body Mass Index):

1) How is it calculated (metric & US units)
2) List 4 limitations

BR 122

Answer 18

BMI = weight (kg) / (height in m)2

or [ (weight in lbs) / (height in inches)2} x 703

Limitations:

1) Doesn’t account for muscle & bone Mass
2) Doesn’t account for differences in body Composition (gender, race, ethnicity)
3) Less valid for those < 20 or > 65 yo - Age
4) Less precise for very Short people

Mnemonic: SCAM

Question 19

In terms of absorbing dietary calcium:

1) What substance in some vegetables limits calcium absorption ?
2) Name 3 vegetables high in this substance which are therefore NOT good dietary sources of calcium.
3) Name 3 vegetables LOW in this substance from which 40-60% of calcium is absorbed. How does this compare to dairy ?

BR 118

Answer 19

1) Oxalates, when present in high amounts, limit the absorption of calcium.
2) Spinach, beet greens & Swiss chard are HIGH in oxalates and thus NOT good dietary sources of calcium (BSG)
3) Kale, Okra & bOk chOy are low in oxalates & thus good sources of calcium (40-60% absorbed)(‘OK’)
- only 32-34% of calcium from dairy is absorbed

BR 118

Question 20

In terms of the Dietary Guidelines for Americans:

1) How often are they updated
2) What types of ‘experts’ sit on the advisory committe which comes up with the guidelines
3) What are possible consequences of the makeup of this comittee ?

BR 115

Answer 20

In terms of the Dietary Guidelines for Americans:

1) They are updated every 5 years
2) The committee includes experts from academia, government and industry.
3) Since industry can influence public policy, the guidelines may be a ‘compromise’ or middle position on dietary practices & there may be a discrepancy between scientific evidence and current recommendations.

Question 21

In terms of the USDA (US Dept of Agriculture)

1) What is its ‘commission’ (ie mandate or purpose)
2) What is the role of dairy in ‘MyPlate’

BR 115

Answer 21

In terms of the USDA

1) Its mandate is to promote US agricultural products
2) Dairy is listed as an ESSENTIAL component of the ‘MyPlate’ dietary guidelines
3) Diary makes up 10% of calories consumed - about half is consumed as milk and half as cheese

Question 22

What are the components of a basic nutrition assessment ?

BR 122, Kelly Nutrition video

Answer 22

A- Anthropometric data

B - Biochemical data

C - Clinical assessment

D - Dietary assessment

Question 23

What are the primary and secondary labs in a nutrition assessment ?

Kelly Nutrition video, BR 122

Answer 23

Primary: Lytes, Hb, Hct, Glu, HbA1c, Alb, Lipids

Secondary: vit D, B12, Fe, ferritin

Question 24

1) Is low Fe anemia freq w WFPB diet ?
2) What aids Fe absorption ?

Kelly nutrition video

Answer 24

1) Low Fe anemia is rare w WFPB diet
2) Vitamin C aids iron absorption

Question 25

1) Name some top sources of plant iron
2) Compare iron content of spinach vs animal sources

Kelly Nutrition video

Answer 25

1) Plant sources of iron:

Beans: lentils, chickpeas, TOFU

Nuts: cashews, chia, ground flax, hemp seeds, pumpkin seeds

Veg: Kale

Fruit: dried apricot, figs, raisins

Grains: Quinoa

2) Weight for weight spinach iron is _ X of:
1. 1 X of red meat
2. 2 X salmon

3 X boiled eggs

3.6 X chicken.